VIAGRA Info

Very light-skinned children who tan in the sun develop significantly more moles than their peers who stay pale in the sun, new research shows.

The number of moles a person has is among the strongest risk factors for developing melanoma, the most deadly form of skin cancer, so the findings suggest that parents of these children should take extra care to protect them from the sun’s rays, Dr. Lori A. Crane of the University of Colorado in Denver and her colleagues conclude in a report in the Archives of Dermatology.

While sunburns are known to increase melanoma risk, Crane and her team note in the report, the effect of tanning on skin cancer risk isn’t clear; in fact, some studies suggest it’s protective.

To investigate, they looked at 131 very-light-skinned children and 444 darker-skinned white kids born in Colorado in 1998. All underwent full-body mole counts at age 6, 7 and 8 years.

The researchers gauged their skin color using a device called a colorimeter. To determine whether or not the children tanned, they used the device to compare the color of their skin at the inside of their upper arm to the color of the skin on the outside of their lower arm.

At age 6, the average number of moles for the minimally tanned light-skinned children was 14.8, compared to 21.2 for the more darkly tanned children. At age 7, the paler kids had 18.8 moles, on average, while the tanned kids had 27.9 moles. By age 8, the untanned children had 22.3 moles, compared to 31.9 for the tanned kids.

But among the darker-skinned children, whether or not they were tanned made no difference in the number of moles they had on their bodies.

The current study didn’t determine whether the untanned children were simply unable to tan, or had been protected from the sun, Crane told Reuters Health. No matter what, she added, the findings suggest “there should be more careful protection of those children, which is probably not very surprising.”

And parents shouldn’t rely on sunscreen alone for shielding kids from the sun, the researcher added; while it can protect against sunburn, it doesn’t do a good job of preventing tanning.

Also, she added, parents may let their children stay out in the sun longer when they wear sunscreen, which could be harmful. Crane suggests protecting kids with lightweight, loose clothing, including hats, and avoiding the strong mid-day sun.

Binge drinking can weaken the body’s ability to fight infections for at least 24 hours, say U.S. researchers.

Binge drinking is defined as consuming large amounts of alcohol over a short period of time to deliberately get drunk.

In experiments with mice, the researchers found that binge drinking affects toll-like receptor 4 (TLR4), a protein that plays an important role in immune system activation. Specifically, heavy drinking suppresses TLR4’s ability to send signals that activate production of inflammatory cytokines — signaling molecules that begin the inflammatory response to infection.

The researchers also determined that binge drinking inhibits NF-B, a protein complex that controls DNA transcription and expression of some of the cytokines inhibited by alcohol.

“The time frame [after binge drinking] during which the risk of infection is increased might be at least 24 hours,” study author Stephen Pruett, of the College of Veterinary Medicine at Mississippi State University, said in a news release. “A persistent effect of ethanol on cells is indicated, such that inhibition of the response of some cytokines occurs even after the ethanol is cleared” from the body.

Fatigue isn’t the only contributor to medical errors among medical residents. A new study finds that financial woes, family concerns and other elements of distress also play a major role in potentially fatal mistakes.

Fatigue and distress among doctors are known causes of medical errors, but Mayo Clinic researchers say that theirs is the first study to show how each contributes to mistakes. And they recommend that distress be considered independently of fatigue when new training guidelines are considered.

“Changes to the process of physician training should address both resident fatigue and distress to improve resident and patient safety as both factors independently increase the risk of self-reported major medical errors,” said lead researcher Dr. Colin P. West, a internist at the Mayo Clinic in Rochester, Minn.

Fatigue, along with lower quality of life, burnout, depressive symptoms and other signs of distress, independently led to increased rates of self-reported major medical errors among internal medicine residents, West said.

“In fact, common levels of fatigue and distress are associated with double or triple the risk of these errors,” he said.

This is an important distinction, West said, because most current efforts to reform medical training that are intended to promote resident and patient safety have focused on fatigue.

“Our results support this, but suggest that specific attention to promoting resident well-being is needed as well,” he said. “We don’t know enough about effective ways to promote physician well-being, however, and further research is needed to answer this question.”

The report is in the Sept. 23/30 issue of the Journal of the American Medical Association.

Medical mistakes are a serious issue. Nearly 100,000 people in the United States die each year from preventable medical errors, according to a report in 1999 from the Institute of Medicine.

West’s team used data from 430 internal medicine residents, who were surveyed quarterly from 2003 through 2008. The survey asked about their medical errors, if any, as well as quality of life, fatigue, burnout, depression and sleepiness.

Among the 378 doctors who answered questions about medical errors, 39 percent said they had made at least one major error.

West’s group found a connection between these errors and fatigue. For every point increase in the fatigue score, doctors were 14 percent more likely to make a medical error. In addition, for every point increase in the sleepiness score, doctors were 10 percent more likely to err.

Medical errors were also linked to burnout, depression and overall quality of life, the researchers found.

Changes in how doctors are trained are making things better for doctors and safer for patients, said Dr. David J. Birnbach, a professor and vice provost of the University of Miami and associate dean and director of the UM-Jackson Memorial Hospital Center for Patient Safety at the Miller School of Medicine.

“We’ve known for a long time that fatigue in anyone is bad, and medical personnel who are very fatigued tend to make more errors,” he said. “We in the United States have made a dramatic change in the way we train residents to limit the number of hours they work. That’s regulated at a federal level.”

But more needs to be done, Birnbach said. “If you are distressed or fatigued, either of them will impact on your ability to function optimally,” he said. “At the end of the day, you are going to make more mistakes. Medical errors kill people.”

Birnbach said he’s concerned that, although residents are working shorter hours, no system exists to monitor whether they are tired or whether the hospital is complying with current regulations.

Also, he said, no mechanism is in place to deal with distress and fatigue among older practicing doctors, who make up the bulk of physicians. “We have not regulated the group that is most sensitive to sleep deprivation,” he said. “We have no rules for the 65- or 70-year-old practitioner.”

Regulating the hours residents can work in training is “a good start,” he said, “but eventually, we are going need to regulate everybody’s hours in medicine to increase the safety.”

In another report in the same issue of JAMA, doctors who participated in a program that included meditation, self-awareness exercises and stories of “meaningful clinical experiences” improved their well-being, had more empathy toward patients and were less “emotionally exhausted” or burned out, the researchers found.

The study demonstrated that primary care physicians participating in a continuing medical education program that focused on self-awareness experienced improved personal well-being, including burnout and improved mood, the researchers wrote.

“They also experienced positive changes in empathy and psychosocial beliefs, both indicators of a patient-centered orientation to medical care,” they said. Such changes are associated with positive patient associations, such as taking a patient’s experience of illness into account and promoting patients’ participation in care, the study concluded.

A bout of diarrheal disease caused by the stomach bugs Salmonella or Campylobacter increases the odds that a person will develop inflammatory bowel disease, with the risk persisting 15 years or more after infection.

The risk is particularly high for hospitalized patients, Dr. Henrik Nielsen from Aarhaus University Hospital in Aalborg, Denmark, and colleagues report in the latest issue of the journal Gastroenterology.

Inflammatory bowel disease, or IBD, refers to a group of conditions, including Crohn’s disease and ulcerative colitis, marked by chronic inflammation in the intestines, leading to symptoms like abdominal pain and diarrhea.

Nielsen and colleagues compared the risks of IBD between 13,148 patients with documented gastroenteritis caused by Salmonella or Campylobacter and 26,216 uninfected controls.

Over the course of 7.5 years, IBD was diagnosed for the first time in far more gastroenteritis patients (107 or 1.2%) than healthy control subjects (73 or 0.5%), according to the researchers.

The increased risk of IBD with exposure to these stomach bugs was highest during the first year.

After accounting for a variety of factors that might influence the risk, stomach bug patients had nearly a threefold increased risk of developing IBD over the entire study period, and nearly a twofold increased risk in the first year after infection.

The risk of IBD was more than fivefold higher for patients hospitalized within days before or after the episode of gastroenteritis.

The increased risk of IBD after the gastroenteritis episode persisted throughout the 15-year observation period and was similar for Salmonella and Campylobacter and for a first-time diagnosis of Crohn’s disease and ulcerative colitis, the investigators report.

The composition of a woman’s contraceptive pill influences her risk of developing blood clots of the leg and lung, European researchers say.

Scientists have long known that oral contraceptives, which contain the female hormones estrogen and progestogen, increase the likelihood of deep vein thrombosis of the leg and pulmonary embolism, but new studies in Denmark and the Netherlands determined that some pills are safer than others. Neither study received funding from any companies that make oral contraceptives.

Pills containing a second-generation progestogen — levonorgestrel or norgestrel — and a low dose of estrogen are safest, they concluded.

The overall risk of venous thromboembolism is low, perhaps three for 10,000 woman-years for women in general, said Dr. Ojvind Lidegaard, a professor of obstetrics and gynecology at the Rigshospitalet in Copenhagen, and lead author of one of two reports in the Aug. 14 online issue of BMJ. But older contraceptive pills double or triple that risk, and the newest generation of oral contraceptives increase the risk fourfold or fivefold, he said.

A first message from the studies is that “the risk when you are taking an oral contraceptive depends on both the estrogen dose and the progestogen dose, and the lower the dose, the less risk,” Lidegaard said.

Both studies found that the risk decreases with the length of time a woman takes a combination pill, and that progestogen-only pills and the use of hormone-releasing intrauterine devices are not associated with an increased risk.

The Dutch study, which compared 1,524 women under the age of 50 who had deep venous thromboembolisms with 1,760 women with no such history, found a fivefold increased risk in oral contraceptive users. The risk of an event was highest in the first three months of use and lowest with pills containing levonorgestrel.

Pills with equal doses of estrogen that contained the progestogen desogestrel had double the risk of the pills using levonorgestrel, the researchers found.

The Danish study of all women aged 15 to 49 from 1995 to 2005 found roughly the same association.

In general, the newer oral contraceptives have a higher risk than the older ones, Lidegaard said. “The fourth-generation pills are not safer than the first-generation pills, which we had not expected,” he said.

For women who want to use an oral contraceptive and are at higher risk because of obesity or a family history of venous thromboembolism, “it would be wise to take a second-generation product,” Lidegaard said.

While the study looked at oral contraceptives marketed in Europe, the results apply to “all women in industrial countries,” said Dr. Astrid van Hylckama Vlieg, a research fellow in the department of clinical epidemiology at Leiden University and a member of the Dutch research team.

“In the United States, you have several products we describe,” she said.

It won’t be easy for a woman to act on the information in the studies, she said. “By just looking at the package, you can’t tell which generation of progestogen is used,” she said. A consultation with the physician writing the prescription is advisable, she said.

“The message of these studies is that all the pills are effective as contraceptives if taken as directed, and that side effects have to do with the choice of pill,” said Dr. Nick Dunn, a senior lecturer in medical education at the University of Southampton Medical School in England, who wrote an accompanying editorial.

While the risk of venous blood clots is very small, it cannot be disregarded, Dunn said. “Women with any sort of family history should think very carefully before taking any contraceptive pill,” he said. “These papers strongly suggest that there are safer pills among the choices that are available.”

A glass of wine a day cut the risk of treatment-linked skin toxicity by two-thirds in women undergoing radiation therapy for breast cancer, Italian researchers report.

Skin reactions are a common side effect of cancer radiation therapy, and, while medications can help prevent these problems, they can be expensive and often have their own side effects. In some cases, drugs used to reduce radiation-linked side effects can actually protect breast cancer tumor cells, according to a news release from the American Society for Radiation Oncology.

So, researchers at Catholic University and the National Research Council in Italy wondered if the natural antioxidants found in wine might work to ward off radiation-linked damage.

In the study, 348 women with breast cancer were divided into three groups depending on the dose of radiation received. The researchers found that patients who drank wine on the days they had their treatment had lower rates of Grade 2, or higher acute toxicity, than those who did not. In fact, women who drank one glass of wine a day had a 13.6 percent rate of skin toxicity compared to a 38.4 percent incidence among patients who did not consume wine, according to the study.

“If wine can prevent radiotherapy-induced toxicity without affecting antitumor efficacy, as we observed, it also has the potential to enhance the therapeutic benefit in cancer patients without increasing their risk of serious adverse effects,” study author Dr. Vincenzo Valentini, a radiation oncologist at Catholic University in Rome, said in the news release. “The possibility that particular dietary practices or interventions can reduce radiation-induced toxicity is very intriguing.”

Sex hormone levels affect the risk of broken bones in older men, says a new study.

The finding comes from a study that included 1,436 men age 65 and older who had their sex hormone levels measured periodically for about five years. The researchers found that men with low levels of estradiol or high levels of sex hormone binding globulin (SHBG) were more likely to suffer osteoporotic fractures.

In addition, men with low levels of testosterone and estradiol combined with high levels of SHBG were more than three times as likely to break a bone as men with average levels of the hormones, the study found.

Testosterone is the main male sex hormone. Estradiol provides most estrogen effects in men and women. SHBG is a protein that binds to testosterone and estradiol in the blood. It’s known to reduce circulating sex steroid concentrations and has previously been linked with fracture risk.

“In clinical practice today, estradiol and SHBG levels are not commonly measured when assessing skeletal health or fracture risk in men,” study co-author Dr. Eric Orwoll, of Oregon Health and Science University, said in a news release from the Endocrine Society. “This practice should be revised. The results from our study strongly suggest that the measurement of both sex hormones, estradiol and testosterone, as well as SHBG levels in older men may help identify men at higher risk.”

Many of the men in the study were age 80 and older, a growing segment of the population, Orwoll noted.

Dear Pharmacist: Sometimes after I take Viagra, my vision turns blueish-grey and it gets blurry. Is this this an expected side effect? I can’t ask my doctor because he may stop prescribing it for me. C.G., Long Island, New York

A: Viagra and the two other FDA approved medications for erectile dysfunction, Cialis and Levitra, are blockbuster drugs that are known to affect vision and many men fear they will go blind by using these drugs. But this doesn’t stop men from using these drugs, or buying fake versions over the Internet. Counterfeit impotence pills are big business for drug dealers. For example, consider Viagra, affectionately dubbed the “blue diamond” pill. According to Jim Thomson, founder of the European Alliance for Access to Safe Medicines, “The margin (for Viagra) is about 2,000 times more profitable than cocaine.”

Prescribed sex pills work by suppressing a chemical pathway (called PDE-5) that enhances the effects of a naturally-occurring chemical in your body called “nitric oxide.” During arousal, this chemical relaxes smooth muscles surrounding the penis which facilitates blood flow down South. That’s when the magic happens and an erection is obtained.

What does an erection have to do with blue vision and blindness? Absolutely nothing, but I thought it was interesting. Anyway, sex enhancement pills happen to affect a second pathway (called PDE-6) and this increases a chemical called “cyclic GMP” which affects cells in your retina. Through this mechanism, sex drugs can cause that infamous blue vision, vision loss, double vision or blurriness. Men who take higher dosages of medication are affected more often.

There are many confirmed cases of visual disturbances such as double vision or blue vision. In a small clinical trial, researchers found an unusually high percentage of visual disturbances. More specifically, 6 of the 7 patients in the study experienced vision loss in one or both eyes within 24 hours after using Viagra (sildenafil). Interestingly, these patients were also dealing with hypertension, diabetes, elevated cholesterol, or high cholesterol. Regardless, the scientists concluded that “Sildenafil may provoke ‘non-arteritic ischemic optic neuropathy’ (NAION) in individuals with an arteriosclerotic risk profile.” So yes, vision problems can occur.

But it’s not all bad news for the super sex pill. Recently, a study published in the September 2009 issue of The Journal of Stroke and Cerebrovascular Disease basically cleared the besmirched reputation of these drugs by testing them in a group of ill patients who had already suffered a stroke. The scientists looked for worsening symptoms of stroke, heart attack, vision or hearing loss, and death from any cause for two weeks. They concluded that intake of Viagra 25 mg per day “appeared to be safe.” What happens after two weeks? Who knows, but if you rely on sex pills, you may have underlying diabetes or heart disease.

Having sex every day improves the quality of men’s sperm and is recommended for couples trying to conceive, according to new research.

Until now doctors have debated whether or not men should refrain from sex for a few days before attempting to conceive with their partner to improve the chance of pregnancy.

But a new study by Dr David Greening of Sydney IVF, an Australian center for infertility and in vitro fertilisation (IVF) treatment, suggests abstinence is not the right approach.

He studied 118 men with above-average sperm DNA damage and found the quality of their sperm increased significantly after they were told to ejaculate daily for seven days.

On average, their DNA fragmentation index — a measure of sperm damage — fell to 26 percent from 34 percent, Greening told the European Society of Human Reproduction and Embryology in Amsterdam on Tuesday.

Frequent sex does decrease semen volume but for most men this is not a problem.

“It seems safe to conclude that couples with relatively normal semen parameters should have sex daily for up to a week before the ovulation date,” he said in a statement.

“In the context of assisted reproduction, this simple treatment may assist in improving sperm quality and ultimately achieving a pregnancy.”

Greening said it was likely frequent ejaculation improved the quality of sperm by reducing the length of time they were exposed to potentially damaging molecules called reactive oxygen species in the testicular ducts.

Men are much more likely to seek and have casual sex than women, and are far less choosy about the looks of their sex partners.

That’s the conclusion of a new study by British researchers who analyzed questionnaire responses from 860 American, German and Italian students.

The students were asked to imagine being approached by a member of the opposite sex, described as either “slightly unattractive,” “moderately attractive” or “exceptionally attractive.” The participants were then asked what their response would be if such members of the opposite sex offered to go out, go to their apartment, and to go to bed with them.

The 427 men were more likely than the 433 women to agree to casual sex, and the men expressed a greater desire for it than women. The study also found that the men were more likely to go out, go to the apartment, and go to bed with members of the opposite sex in all three categories of attractiveness.

Men needed to be exceptionally attractive to tempt women to consider casual sex, said Dr. Achim Schutzwohl, of the department of psychology at the University of Brunel in the U.K., and colleagues.

German men were less likely to accept date, apartment and sex offers than Italian and American men. Italian men were more likely than Americans to accept an offer of sex.

“While men are not entirely insensitive to their requestor’s attractiveness, women have higher standards and are more likely to engage in casual sex with an exceptionally attractive man than with a less attractive man,” the researchers concluded.