Blog – Medical Research News and Interviews
17 Dec Alzheimer’s: Distinct Cognitive Deficits Associated with Regional Brain Atrophy
MedicalResearch.com Interview with: Lieke Smits drs. L.L. Smits VU University Medical Center Department of Neurology - Alzheimer Center 1081 HV Amsterdam, The Netherlands MedicalResearch.com: What are the main findings of the study? Answer: In this study we used two visual ratings scales to estimate atrophy of the medial temporal lobe (MTA) and posterior atrophy (PA) on MRI in patients with Alzheimer’s disease. We assessed associations between MTA and PA with cognitive impairment. We found that MTA was associated with worse performance in memory, language and attention, while PA was associated with worse performance in viuso-spatial functioning and executive functioning. Further stratification for age at diagnosis revealed that in late onset (>65 years old) MTA was associated with impairment in memory, language, visuo-spatial functioning and attention. In early onset patients (<65 years old), worse performance on visuo-spatial functioning almost reached significance.17 Dec Hospice Care: Discussed Earlier by Physicians Who Would Enroll Themselves if Terminally Ill
MedicalResearch.com Interview with: Garrett M. Chinn, MD, MS Division of General Medicine, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston MedicalResearch.com: What are the main findings of this study: Dr. Chinn: Despite the desire of most Americans facing terminal illness to spend their remaining time at home, only 24% of those aged 65 and older do so. Many spend their final days in an institutional setting such as an acute care hospital, often receiving aggressive care. In the case of patients facing stage 4 lung cancer, many who would prefer to emphasize pain relief over extending life report not having discussed hospice with a physician. More than 25% indicate that they had not addressed advanced care directives such as do-not-resuscitate orders with their doctors but wanted to do so. This tells us that patients wish to better understand their illness and prognosis and might be interested in learning about hospice. And although the general trend for hospice utilization has increased over the past decade, a high percentage of hospice enrollment occurs quite late in the course of illness, often during an acute hospitalization.16 Dec Cannabis: Heavy Use Associated with Working Memory Deficits
MedicalResearch.com Interview with: Dr. Matthew J. Smith PhD Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, 13th Floor, Abbott Hall, Chicago, IL 60611 MedicalResearch.com: What are the main findings of the study? Dr. Smith: We observed that the shapes of brain structures involved in a working memory brain circuit seemed to collapse inward in a similar fashion among both of the groups that had a history of daily cannabis use. These cannabis-related changes in shape were directly related to the participants’ poor performance on working memory tasks. Some of the shape abnormalities were more severe in the group with schizophrenia and the history of daily cannabis use. We also found that participants with an earlier age of daily cannabis use had more abnormal brain shapes.16 Dec Blood Pressure: Effect of CPAP in Patients with Obstructive Sleep Apnea
MedicalResearch.com Interview with: Dr. Miguel-Ángel Martínez-García Respiratory Department, Hospital Universitario y Politécnico La Fe Valencia, Spain MedicalResearch.com: What are the main findings of this study: Answer: The main findings of the study are: 1. The treatment with CPAP (continuous positive airway pressure) achieves a clinically and statistically significant reduction of blood pressure in patients with resistant hypertension (blood pressure that remains above goal in spite of the use of at least three antihypertensive drugs) and obstructive sleep apnea.16 Dec Chemotherapy: Adherence Increased with Generic, Lower Cost Medications
MedicalResearch.com Interview with:
Dawn L. Hershman, MD MS
Associate Professor of Medicine and Epidemiology
Leader, Breast Cancer Program
Herbert Irving Comprehensive Cancer Center
Columbia University Medical Center
MedicalResearch.com: What are the main findings of the study?
Dr. Hershman: We have found in the past that compliance to 5 years of hormone therapy for the adjuvant treatment of breast cancer is low. While toxicity is a main reason, other factors are also important. Recent studies suggest out of pocket costs are high among cancer patients. We evaluated the change in adherence to hormone therapy after the introduction of generic Aromatase inhibitors. We found that discontinuation decreased and adherence increased with generic aromatase inhibitors compared to brand name. we found that higher co-payments were associated with decreased adherence and increased discontinuation. We also found that patients in the highest income group were more likely to be adherent to hormone therapy.
15 Dec Traumatic Brain Injury: Dietary Therapy
MedicalResearch.com Interview with:
Miranda M. Lim, MD, PhD
Assistant Professor, Sleep Medicine
Division of Pulmonary and Critical Care
Portland VA Medical Center and Oregon Health & Science University
MedicalResearch.com: What are the main findings of the study?
Dr. Lim: People with traumatic brain injury (TBI) often have persistent sleep-wake disturbances including excessive daytime sleepiness and nighttime insomnia, yet the link between a hard blow to the head and drowsiness remains a mystery. We report that a dietary supplement containing branched chain amino acids helps keep mice with TBI awake and alert. The findings suggest that branched chain amino acids, something all humans produce from foods in their normal diets, could potentially alleviate sleep problems associated with TBI. In experiments with brain-injured mice that had trouble staying awake, we found that feeding the animals a dietary supplement enriched with branched chain amino acids improved wakefulness. Treated mice not only stayed continuously awake for longer periods of time, they also showed more orexin neuron activation, neurons known to be involved in maintaining wakefulness. (Previous studies have shown that people with narcolepsy lose significant amounts of orexins.) Branched chain amino acids are the building blocks of neurotransmitters, the chemicals released by neurons in the brain, including glutamate and GABA. We believe that branched chain amino acids act to restore the excitability of orexin neurons after brain injury, which could potentially promote wakefulness. Further studies are needed to pinpoint the exact mechanism of branched chain amino acids effect on sleep pathways in the brain, and to determine any side effects.
15 Dec Flu: Vaccine For Prevention in Children
MedicalResearch.com Interview with:
Ghassan Dbaibo, M.D., FAAP
Professor and Vice-Chair for Research and Faculty Development
Department of Pediatrics and Adolescent Medicine
Head, Division of Pediatric Infectious Diseases
Director, Center for Infectious Diseases Research
Professor, Department of Biochemistry and Molecular Genetics
American University of Beirut Beirut, Lebanon
MedicalResearch.com: What are the main findings of the study?
Dr. Dbaibo:
- 55% efficacy (95% CI 39–67%) for prevention of all influenza
- These results are comparable with other estimates of efficacy and effectiveness for trivalent inactivated flu vaccines in this age group
- 73% efficacy (97.5% CI 47–86%) for prevention of moderate-to-severe influenza
- By preventing moderate-to-severe influenza, vaccination prevented the most clinically consequential outcomes of infection, reducing hospitalisations by 75% and medical visits by 69%.
- Seroprotection rates of more than 95% for each of the four influenza strains in the vaccine
- An acceptable safety and reactogenicity profile
15 Dec Elite Athletes Have Lower Risk of Later Life Diabetes
MedicalResearch.com Interview with:
Dr. Merja K. Laine
Department of General Practice and Primary Health Care
University of Helsinki
MedicalResearch.com: What is the background of your study?
Answer: We were interesting to know does a top-level sport during young adulthood protect against disturbances in glucose regulation in later life. In Finland, a unique study program including former male elite athletes and their age- and area-matched controls already initiated in 1985. In 2008, we invited those subjects who participated in the study earlier and were still alive.
15 Dec ADHD: Using MRI to Measure Brain Iron
MedicalResearch.com Interview with:
Dr. Vitria Adisetiyo, Ph.D.
Postdoctoral Research Fellow
Medical University of South Carolina
Center for Biomedical Imaging Charleston, SC 29425
MedicalResearch.com: What are the main findings of the study?
Dr. Adisetiyo: Using a non-invasive MRI method called magnetic field correlation imaging, we detected significantly reduced striatal and thalamic brain iron in medication-naive children and adolescents with ADHD compared to age-, gender- and IQ-matched typically developing controls. ADHD patients who had a history of psychostimulant medication treatment (e.g. Ritalin, Aderrall) had brain iron levels comparable to controls, suggesting brain iron may normalize with psychostimulants. Blood iron measures did not differ between patients and controls.
15 Dec Diabetes: Hyperglycemia Suppresses TGF, Contributing to Delayed Wound, Corneal Healing
MedicalResearch.com Interview with:
Fu-Shin X. Yu, Ph.D.
Professor and Director of Research
Kresge Eye Institute/Department of Ophthalmology
Wayne State University School of Medicine
Detroit, MI 48201
15 Dec ADHD: Environmental Risk Factors
MedicalResearch.com Interview with:
Professor Desiree Silva MB BS, FRACP, MPH
Consultant Paediatrician
Suite 210 Specialist Centre, Joondalup Health Campus
60 Shenton Avenue, Joondalup WA 6027
MedicalResearch.com: What are the main findings of the study?
Prof. Silva: Our study is one of the largest population based studies of 12,991 children with ADHD. We found that smoking in pregnancy, maternal urinary infections, preeclampsia, being induced and threatened pre-term labour increases the risk of ADHD with little gender differences. Prematurity also increased the risk of ADHD including babies born late preterm and early term marginally increased the risk of ADHD.
14 Dec Adolescent Girls: Early Puberty, Negative Peer Influence, and Problem Behaviors
MedicalResearch.com Interview with:
Sylvie Mrug, PhD
Departments of Psychology and Health Behavior
University of Alabama at Birmingham, Birmingham, Alabama;
MedicalResearch.com: What are the main findings of the study?
Dr. Mrug: Experiencing early puberty and having a best friend who misbehaves at age 11 both contribute to more aggressive and delinquent behavior in adolescent girls. Although most of these effects are transient and disappear by age 16, early maturing girls are at risk for continually higher delinquent behavior. Early puberty also seems to make girls more vulnerable to negative peer influences.
14 Dec Medical Research: Men Received More Funding Than Women
MedicalResearch.com Interview with:
Mike Head
Network Manager
Infectious Disease Research Network
MedicalResearch.com: What are the main findings of the study?
Answer: The differences in total funding received between male and female principal investigators (PIs) is considerable. This can be partially explained by there being far more male senior scientists than female. But this in itself is not ideal, and there are two further causes for concern:
1. The median award size - male PIs receive larger awards than female PIs, across virtually every topic area and type of science.
2. The differences in median award size and total funding awarded by gender remain virtually unchanged across the fourteen years of this dataset. The gap is not closing.
13 Dec Yoga Effects on Blood Pressure and Quality of Life
MedicalResearch.com Interview with Dr. Moa Wolff Center for Primary Health Care Research Department of Clinical Sciences in Malmö, Lund University Jan Waldenströms gata 35, Skåne University Hospital, Malmö 205 02, Sweden MedicalResearch.com: What are the main findings of the study? Dr. Wolff: We investigated the effects of two yoga interventions on blood pressure and quality of life in patients in primary health care diagnosed with hypertension. Our study showed that a short yoga program practiced daily at home had an antihypertensive effect, as well as a positive effect on self-rated quality of life compared to controls.13 Dec Hepatitis C: Factors Associated with Spontaneous Clearance
MedicalResearch.com Interview with:
Dr. Jason Grebely PhD
The Kirby Institute
University of South Wales, Australia
MedicalResearch.com: What are the main findings of the study?
Dr. Grebely: Although 20%-40% of persons with acute hepatitis C virus (HCV) infection demonstrate spontaneous clearance, the time course and factors associated with clearance remain poorly understood. This study investigated the time to spontaneous clearance and predictors among participants with acute HCV. Female sex, favorable IL28B genotype, and HCV genotype 1 were identified to be independent predictors of spontaneous clearance. This study provides important insights into factors affecting HCV viral control and offers guidance in clinical decision-making for the treatment of acute HCV infection.
13 Dec Probiotics and Effect on Allergic Rhinitis?
MedicalResearch.com Interview with: Dr Kamal Ivory Institute of Food Research Norwich Research Park Norwich, UK Gut Health & Food Safety ISP The Institute of Food Research receives strategic funding from BBSRC MedicalResearch.com: What are the main findings of the study? Dr. Ivory: In the present study we show that administration of probiotics in the gut can induce changes at the nasal mucosa where the immune system meets pollen allergen. This implies a potential to alter the course of allergic rhinitis. However, in our single high dose pollen challenge in the clinic (out of pollen season), we did not measure any significant changes in the clinical parameters we had set. It is not clear if this was because a single challenge fails to replicate occurrence during natural seasonal exposure to pollen in terms of dosage and timing. That aside, the mode of action may vary from one probiotic organism to another and it is possible that a cocktail of probiotic organisms may be needed for clinical effectiveness. If funding becomes available, we would like to repeat the study during the pollen season.11 Dec Prostate Cancer: Potential Biological Factor Contributing to Racial Disparities
MedicalResearch.com Interview with:
Dr David P. Turner PhD
Assistant Professor, Director of shRNA Technology
Medical University of South Carolina
Dept of Pathology & Lab Medicine
Charleston SC 29425
MedicalResearch.com: What are the main findings of the study?
Dr. Turner: Our research has identified a potential mechanistic link between sugar derived metabolites and cancer associated pathways which may be a biological consequence of the socioeconomic and biological factors that are known to drive cancer health disparity. African Americans develop and die more frequently of cancer than any other population in the US. We examined the levels of reactive metabolites known as advanced glycation end-products, or AGEs for short, in serum and tumor samples from African American and Non-Hispanic White prostate cancer patients. In both the serum and tumor tissue, the levels of AGE metabolites were consistently higher in the African American prostate cancer patients than their White counterparts. AGE functions as a ligand for the receptor for AGEs, or RAGE for short. We also identified that RAGE protein levels were higher in African Americans with prostate cancer.
10 Dec Hepatitis C: Does Chemotherapy Cause Viral Relapse?
Posted at 13:18h
in Author Interviews, Chemotherapy, Gastrointestinal Disease, Hepatitis - Liver Disease, MD Anderson
MedicalResearch.com Interview with:
Harrys A. Torres, MD, FACP
Assistant Professor, Director of Hepatitis C Clinic
Department of Infectious Diseases, Infection Control and Employee Health
The University of Texas MD Anderson Cancer Center
MedicalResearch.com: What are the main findings of the study?
Dr. Torres: The main findings of the study were that patients with hepatitis C virus (HCV) infection who were successfully treated with antivirals and attained sustained virologic response (SVR) did not have a relapse of HCV infection after receiving immunosuppressive chemotherapy for cancer. Patients in the study received different chemotherapeutic agents, including rituximab and systemic corticosteroids. Durability of SVR was maintained up to 14 years after chemotherapy in cancer patients.
10 Dec Pediatric Liver Transplant Outcomes: Racial, Socioeconomic Disparities
Posted at 13:01h
in Author Interviews, Gastrointestinal Disease, Pediatrics, Race/Ethnic Diversity, Transplantation
MedicalResearch.com Interview with:
Rachel Patzer, PhD, MPH
Assistant Professor
Emory University School of Medicine
Department of Surgery, Division of Transplantation
MedicalResearch.com: What are the main findings of the study?
Dr. Patzer: We found significant racial/ethnic differences in important health outcomes among pediatric and adolescent patients who received a liver transplantation at a large transplant center in the Southeastern U.S., where rates of mortality and graft failure were higher among minorities compared to white patients.
10 Dec Sexual Lifestyles Through Life Course: Attitudes Have Changed
MedicalResearch.com Interview with:
Catherine H. Mercer Ph.D.
Senior Lecturer
UCL Centre for Sexual Health & HIV Research
Research Department of Infection & Population Health
University College London London U.K.
MedicalResearch.com: What are the main findings of the study?
Dr. Mercer: Firstly, the National Surveys of Sexual Attitudes and Lifestyles, Britain’s nationally-representative surveys of sexual behaviour (or Natsal for short), have captured substantial changes in sexual attitudes and lifestyles over the past 60 years, having collected data from over 45,000 people born between the 1930s and the 1990s – a period spanning much of the 20th Century.
Secondly, the recent changes in behaviour that we have observed - so over the past decade - have however been considerably more marked for women than men, with the gender gap in reported behaviour narrowing, and in some cases, disappearing altogether.
Thirdly, we’ve seen a greater acceptance of more diverse sexual lifestyles, such as same-sex sexual partnerships, but greater intolerance of what many people might consider as ‘disrespectful’ sexual partnerships, including non-exclusivity in marriage.
10 Dec Resistant Hypertension: Better Control With Therapeutic Drug Monitoring
Posted at 12:35h
in Author Interviews, Blood Pressure - Hypertension, Compliance, JACC, Outcomes & Safety, UT Southwestern
MedicalResearch.com Interview with;
Dr. Wanpen Vongpatanasin, MD
Professor of Medicine
Director, Hypertension Section, Cardiology Division
UT Southwestern Medical Center
MedicalResearch.com: What are the main findings of the study?
Dr. Vongpatanasin: We found that more than 50% of patients with resistant hypertension were non-adherent to at least one drug prescribed by their primary care physicians for blood pressure control.
When we provided this information back to the patients, as part of care in our hypertension specialty clinic, we found that many patients report difficulty taking prescribed medications due to either associated side effects or cost of the medication. When we adjusted patient's medications to fit their needs, BP levels were substantially improved during subsequent visits without increasing the number of medications.
06 Dec Sugar-Sweetened Beverages and Endometrial Cancer
MedicalResearch.com Interview with:
Maki Inoue-Choi, PhD, MS, RD
Division of Cancer Epidemiology and Genetics, National Cancer Institute
National Institute on Minority Health and Health Disparities, NIH
Rockville, MD 20850
MedicalResearch.com: What are the main findings of the study?
Answer: In our study, postmenopausal women who reported higher consumption of sugar-sweetened beverages were more likely to develop estrogen-dependent type I endometrial cancer, the most common type of this cancer.
06 Dec Breast Density Associated with Increased Breast Cancer Risk
MedicalResearch.com Interview with:
Nicholas M Perry MD
London Breast Institute
MedicalResearch.com: What are the main findings of your study?
Dr. Perry: The main findings from the study were that automated density readings outperformed radiologists, and that women under the age of 50 had a more significant risk of breast cancer from higher breast density.
Also, and quite surprising was the appearance of a completely different age- density pattern in women with breast cancer. Whereas the women in the study without cancer showed a normal and steady decline in breast density with age, those with cancer showed a completely different curvi-linear pattern, which was evident in women as young as 30.
The message is that breast density remains an important factor for both the current breast screening methodologies, and for future research into investigation and management.
06 Dec Obesity: Sleep Quality, Anxiety-Depression, and Quality of Life
MedicalResearch.com Interview with:
Dr G. Neil Thomas,
Regional Director,
NIHR Research Design Service West Midlands
Deputy Director, Master of Public Heath Programme
Reader in Epidemiology
Department of Public Health, Epidemiology and Biostatistics
School of Health and Population Sciences
College of Medical and Dental Sciences The University of Birmingham
Edgbaston, Birmingham, B15 2TT
MedicalResearch.com: What are the main findings of the study?
Dr. Thomas: This population of severely obese individuals (mean BMI 47kg/m2) from a regional specialist weight management service poor sleep quality (Pittsburgh Sleep Quality Index, PSQI) and daytime sleepiness (Epworth Sleepiness Scale) were strongly associated with poorer quality of life (Impact of Quality of Life-Lite (IWQOL-Lite)
06 Dec Sleep disordered breathing as predictor of readmission and mortality
MedicalResearch.com Interview with:
Dr. Takatoshi Kasai, MD, PhD
Department of Cardiology and Cardio-Respiratory Sleep Medicine,
Juntendo University School of Medicine, Tokyo, Japan
MedicalResearch.com: What are the main findings of the study?
Dr. Kasai: Sleep disordered breathing, determined using predischarge nocturnal pulse oximetry, is prevalent and is an independent predictor of the combined end point of readmission and mortality in hospitalized patients with left ventricular systolic dysfunction after acute decompensated heart failure.
06 Dec Probiotics Ineffective in Preventing Childhood Asthma
MedicalResearch.com Interview with:
Dr. Meghan Azad, PhD
Banting Postdoctoral Fellow
Department of Pediatrics
University of Alberta
MedicalResearch.com: What are the main findings of the study?
Dr. Azad: In this study, our goal was to evaluate the clinical evidence for using probiotics (live "healthy bacteria") to prevent childhood asthma. We reviewed the results of 20 clinical trials involving over 4000 infants, where probiotics were administered during pregnancy or the first year of life, and found no evidence to support the use of probiotics for asthma prevention. Children receiving probiotics were just as likely to develop asthma as children receiving placebo. Similarly, there was no effect of probiotic supplementation on the development of wheezing.
06 Dec Diabetes Increases Risk of Stillbirth and Infant Death
MedicalResearch.com Interview with:
Mr Peter Tennant
Research Associate (Epidemiology)
Institute of Health & Society,
Newcastle University,
Baddiley-Clark Building, Richardson Road,
Newcastle upon Tyne, NE2 4AX.
MedicalResearch.com: What are the main findings of the study?
Answer: For women with type 1 or type 2 diabetes, the prevalence of stillbirth or late miscarriage (3%) was around four times greater than in women without the condition, while the risk of their infant dying during the first year of life (0.7%) was nearly twice as high. There was no difference in risk between women with type 1 or type 2 diabetes.
A woman's blood glucose concentration around the start of pregnancy, estimated from her glycated haemoglobin concentration (HbA1c), was the most important predictor of risk. The risk increased by 2% for each 1mmol/mol (0.1% in traditional DCCT units) increase in HbA1c above the target of 53mmol/mol (7%) recommended by the American Diabetes Association (ADA). If all the women in our study had achieved that ADA target before pregnancy, we estimate that around 40% of the stillbirths, late miscarriages, and infant deaths could have been avoided.
06 Dec Multiple Births and Fertility Treatments
MedicalResearch.com Interview with: Aniket D. Kulkarni, M.B., B.S., M.P.H Women's Health and Fertility Branch Centers for Disease Control and Prevention Atlanta, Georgia MedicalResearch.com: What are the main findings of the study? Dr. Kulkarni: Our study estimates the contribution of fertility treatments and natural conception to multiple births. Fertility treatments include IVF and non-IVF treatments. Non-IVF treatments primarily include ovulation induction and ovarian stimulation coupled with timed intercourse or intrauterine insemination (IUI). All estimated proportions were adjusted for maternal age which makes this study unique. The incidence of twin births nearly doubled and the incidence of triplet and higher-order births quadrupled over the last 4 decades. Our study estimates that by 2011, a total of 36% of twin births and 77% of triplet and higher-order births resulted from conception assisted by fertility treatments, after adjusting for maternal age. After initial increase, the incidence of triplet and higher order births decreased by 29% from 1998 to 2011. The decrease in triplet and higher order births has coincided with a 70% reduction in the transfer of 3 or more embryos during IVF and a 33% decrease in the proportion of triplet and higher order births attributable to IVF. The decline in the number of embryos transferred during IVF became possible due to monitoring of ART treatments and outcomes and the work of professional societies, which have repeatedly revised practice guidelines to include recommendations for lowering the number of embryos transferred. In contrast, non-IVF fertility treatments of ovulation induction and ovarian stimulation are estimated to contribute the increasing number of multiple births. Hence there is a need for surveillance of births from non-IVF fertility treatments.06 Dec Sexual function problems are common but distress about them much less so
MedicalResearch.com Interview with:
Dr Kirstin R Mitchell PhD
Lecturer in Sexual and Reproductive Health
Dept of Social and Environmental Health Research
Faculty of Public Health & Policy
London School of Hygiene and Tropical Medicine
MedicalResearch.com: What are the main findings of the study?
Dr. Mitchell: We explored the distribution of sexual function in the British population using a probability sample survey (the third National Survey of Sexual Attitudes and Lifestyles [Natsal-3]) of 15 162 individuals aged 16–74 years. We measured sexual function using the Natsal-SF, a novel validated measure, which assessed problems with individual sexual response, sexual function in a relationship context, and self-appraisal of sex life.
Men and women in the oldest age groups surveyed (55 – 74) were more likely to have low overall sexual function than those in the youngest age group (16 – 24). After taking account of age differences, low sexual function was associated in both men and women with being unemployed, with current depression, and with poor general health. It was also associated with higher numbers of lifetime partners (women only), paying for sex (men only), and reporting same-sex partners, as well as with other aspects of sexual health, such as being diagnosed with an STI and experiencing sex against their will.
Low sexual function was associated with relationship breakdown, and with people not being happy with their relationship. Within relationships, the most common problem was an imbalance in level of interest in sex between partners, which affected around a quarter of both men and women. Just under one in five men and women said their partner had experienced sexual difficulties in the last year, and this proportion increased with age, particularly among women.
Lack of interest in sex was one of the most commonly reported problems for both men and women, affecting three in every twenty (15%) men, and with women twice as likely as men to say that this had been an issue in the last year. Difficulty reaching climax (16%) and vaginal dryness (13%) were among common problems for women; and reaching a climax more quickly than desired (15%), and difficulty getting or keeping an erection (13%) among men.