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As Pfizer where is better to buy viagra how much is viagra at walgreens and Moderna wait for the U.S. Federal and Drug Administration to issue an emergency use authorization for their respective treatments, the importance of a seamless – or at least well-connected – supply chain has become increasingly clear.According to the U.S. Department of Health and Human Services, the first rollout of the where is better to buy viagra treatment is likely to be very limited, with state governors and public health departments directing allocation of the first available doses. But if plans to produce tens of millions of doses by the end of 2020 see fruition, professionals say logistics will play an increasingly vital role in getting those doses to people who need them.

"This is a phenomenally critical issue that every health system is going to have to manage and figure out the way forward," said Anne Snowdon, executive director of clinical research at HIMSS (parent company where is better to buy viagra of Healthcare IT News). Snowdon – who created HIMSS Analytics' Clinically Integrated Supply Outcomes Model, which signifies digital health maturity in a system's supply chain processes – called the question of treatment rollout the "classic supply chain strategy" in a recent HIMSS TV interview. "If you are tracking every patient who receives every dose of treatment, and with the where is better to buy viagra simple scan of a barcode or QR code or RFID tag – or however it's labeled – can identify what lot number, what site was it manufactured, when was that manufactured, and now you track that to every individual citizen who receives that dose, you now have an ability to know who had side effects, who had a great response to that treatment, who didn't, and now you've got a data set to work from," said Snowdon. Such data, said Snowdon, can be used to ensure every global citizen has access to the treatment in the order of priority needed.

HIMSS CEO Hal Wolf agreed, saying that such tracking can be used specifically to highlight how different social determinants of health may affect treatment access and efficacy."We could have adverse or different effects based upon the environment in which it's put into," he said, pointing out that some of the treatments require storage in ultracold conditions (prompting a recent uptick in dry ice demand, for example)."To be honest, there are going to be times when you're relying on where is better to buy viagra the distribution capabilities of someone who wouldn't normally be in the supply chain. It may be leveraging the delivery capabilities of a local business."Chris Hale, KountableBefore treatments are given to individuals, however, doses have to physically make their way from manufacturers to healthcare providers. "What we're really talking about is a where is better to buy viagra governance risk and compliance functionality that relies on relative real-time data, coordination and transparency," said Chris Hale, CEO and co-founder of the global procurement company Kountable. "When you put those things together, there's not a lot of solutions that will work that don't involve technology." Logistically speaking, "what you really have to do is start at the end consumer, in this case the patient, and work backwards," said Hale.

"If you start at the supplier, it's a fairly easy journey and a fairly developed journey where is better to buy viagra – until it breaks. You have to finish the job. It's the person in the last position who matters most." Given the size of the demand and the relatively unconnected nature of some parts of the world – including the rural United States – Hale said unconventional thinking could prove where is better to buy viagra necessary. "To be honest, there are going to be times when you're relying on the distribution capabilities of someone who wouldn't normally be in the supply chain," he said.

"It may be leveraging where is better to buy viagra the delivery capabilities of a local business." Hale also said that the processes should be nimble, with the potential to shift if circumstances prove necessary. "There's sort of different degrees of success that need to be tracked independently. Did the treatments get the right place at the where is better to buy viagra right time in the right condition?. That's a supply chain problem.

Were they distributed to patients and where is better to buy viagra administered effectively?. Did they work?. What where is better to buy viagra happens after?. " he said.

"There's going to be a very real need where is better to buy viagra for continuous improvement business processes applied to the full chain," he added. "It's a question of vectors. 'Is it working and where is better to buy viagra improving?. ' rather than 'did it work?.

'" where is better to buy viagra It's important to work the kinks out sooner rather than later, he said, especially as demand grows. "It's not tomorrow's problem, but it's not next year's either," he said. "The entire thing is going to be driven by availability of where is better to buy viagra supply … We're still going to be making allocation decisions for years to come." Hale said he feared that treatment access in the longer term would follow the trajectory of personal protective equipment, with huge shortages in some jurisdictions. "I hope it doesn't look and feel like PPE," he said.

"Each state where is better to buy viagra has different communities, different geography, different challenges to address."Dr. Rhonda Medows, Providence"I will tell you that I'm disappointed in the federal response" to erectile dysfunction treatment as a whole, said Dr. Rhonda Medows, president of population health at Providence, one of the largest nonprofit health where is better to buy viagra systems in the United States. When it came to assessment, surveillance and testing, she said, "we were delayed, we were slow … and now the plan is to distribute treatments based on state population size.

Not population risk for erectile dysfunction treatment, where is better to buy viagra but state population size. That's not what we were expecting or anticipating."Given the plan in place, she said she hopes state governors make allocation decisions with public health in mind. "The volume of treatments they're getting is really small," where is better to buy viagra she said. "I don't know how else to emphasize it.

You need to prioritize within the priority groups where is better to buy viagra. Vaccinate and protect your front line and first responders. One, for their benefit where is better to buy viagra and well-being and two, because we need them. Second is to vaccinate and protect the people who will suffer the highest degree of morbidity and mortality from the agent.

Nursing homes, elderly, those with chronic conditions." With that prioritization in mind, she said the organization has been planning the best ways to distribute doses efficiently."Providence has already done the where is better to buy viagra work of registering with each state health entity" as a distributor, she said. "We've registered each of our hospitals, ERs, individual physicians and clinicians … We've ordered the special freezers for the Pfizer one, then we have the regular freezers for the other treatments. We've already stocked the facilities for the ancillary things where is better to buy viagra we need to go along with the treatment. The supply chain has been accumulating supplies just in case.

Our facilities, with that part of the logistics, are fine." Providence has been relying on advanced analytics as part of where is better to buy viagra its treatment preparations, she said, including patient population assessments across all care settings, and logistics and personnel planning. She noted that the initial volume of treatment to be distributed "will not even be adequate" for the group of clinicians and providers who are most exposed to the viagra."Even within those groups, we're going to be forced to sub-prioritize," she said. "We've done the where is better to buy viagra logistics of figuring out healthcare professionals at the highest risk from day-to-day work, including doctors, maintenance sanitation employees, those doing food delivery to other sites. It's a full health professional suite." Once more treatments are available, she said, a challenge will be reaching patients in more rural areas, who might struggle with the freezer requirements or facility access.

"Each state has where is better to buy viagra different communities, different geography, different challenges to address," she said. "In those communities where there's already not great physical access space could we retrofit mobile vans with the deep freeze requirements?. " "We know that we have some facilities or clinics that could be a [distribution] site, but then there's a whole world of people, so to speak, in where is better to buy viagra the communities" who will be lower on the treatment priority list. Medows noted the importance of centering the needs of groups especially affected by erectile dysfunction treatment, such as Black, Latino, and Native people.

A recent Commonwealth Fund study showed that systemic and medical racism is likely to affect vaccination rates, with distrust among many people of color stemming in large part "from institutional experiences with racism and unethical medical where is better to buy viagra experimentation." treatments are also linked to coverage and financial barriers that reflect a legacy of racial inequity, wrote Commonwealth researchers. Hale, too, said that he feared that uncontrolled or unregulated supply chains would lead to a replication of inequity. "Unfortunately this kind of complexity also … creates economic distortions," where is better to buy viagra he said. And given the nature of the disease – which spreads regardless of political borders and disproportionately impacts already underserved people – it's imperative to address these potential gaps from the get-go, said experts.

"When one individual is vulnerable, we are literally all vulnerable," where is better to buy viagra said Wolf. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.Cleveland Clinic, DigitalC, TransDigm Group and The Lubrizol Foundation have come together to help provide affordable high-speed internet to residents of the Fairfax neighborhood in Cleveland.

Installation should be complete for Fairfax residents by the second quarter of 2021.WHY IT MATTERSThe effort aims to help impact disparities in internet coverage in the local community, which can affect access to education, healthcare and economic opportunities. According to 2019 Census Bureau data, Cleveland is the worst-connected large city, with nearly 50,000 households not having reliable broadband. HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>.

Especially during a global viagra, access to the internet affects a person’s ability to search and apply for jobs, use healthcare and telehealth services, fully participate in their education and virtually connect with friends, family and colleagues.Broadband for the households covered in this program will be provided by EmpowerCLE, a wireless internet service provider founded by and operating within DigitalC. DigitalC is a nonprofit organization focused on improving Cleveland’s digital equity and providing residents with an affordable, high-speed internet connection.EmpowerCLE has installed equipment on the rooftops of two Cleveland Clinic main campus buildings in order to expand its coverage in the Fairfax community. EmpowerCLE brand ambassadors and technicians will visit local households to offer the connection and install the necessary equipment to begin service.While DigitalC and EmpowerCLE provide affordable internet services, in order to further lower the cost for Fairfax residents, Cleveland Clinic has brought together additional partners with an interest in connecting underserved areas. TransDigm and The Lubrizol Foundation have agreed to contribute significant funds to further reduce the monthly subscription fee and help subsidize the cost of equipment.THE LARGER TRENDIn addition to working with DigitalC, earlier this year, Cleveland Clinic signed on to the American Connection Project Broadband Coalition, which advocates to bring high-speed internet to rural and under-connected areas.Connecting underserved areas with reliable high-speed internet is one way Cleveland Clinic aims to positively impact social determinants of health in communities.

Social determinants of health are factors such as food security, housing, infant mortality, chronic diseases, education quality and access, and economic opportunity that affect a person’s health and wellbeing.According to the National Academy of Medicine, medical care is estimated to account for only 20% of a person’s health – social determinants of health can make up the other 80%.ON THE RECORD“The erectile dysfunction treatment viagra has further illuminated the crucial role internet access plays in the overall health and well-being of a population, and it is critical that we work to overcome digital inequities,” said Dr. Tom Mihaljevic, president and CEO of Cleveland Clinic.“Social determinants of health lay the foundation of a person’s overall health and have a lifelong impact on their health outcomes,” said Dr. Adam Myers, director of Cleveland Clinic Community Care. €œBy identifying areas we can help, such as providing broadband connection, and engaging with like-minded partners, we can make a difference in creating a better, healthier community for everyone.”Twitter.

@SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.SUNY Upstate Medical University in Syracuse, New York, has 35 operating rooms across multiple locations including academic and community facilities. As with most traditional perioperative departments, it was facing three major issues.THE PROBLEMFirst, low OR utilization despite demand for time. SUNY Upstate was not hitting its desired utilization targets and did not have actionable data for department chairs and administration to take the right actions for improvement.

At the same time, it had surgeons and departments wanting more access to OR time. HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. Second, standardizing systemwide decision making based on objective data.

The provider organization needed to unify decision making in key areas – block policy to allocate time, block release times, areas for operational improvement – across the academic and community settings to ensure shared best practices and goals while maintaining a high level of visibility into decision making.Decisions were questioned often because of the lack of objective data, clearly defined and understood across the various stakeholders.And third, visibility into the performance metrics that matter. SUNY Upstate had various reporting sources that were in conflict with each other, creating a distrust in data presented during operational and committee meetings.PROPOSALTo solve its problems, SUNY Upstate Medical University turned to LeanTaaS, which markets software that combines lean principles, predictive analytics and machine learning to transform hospital and infusion center operations.LeanTaaS’ technology, iQueue for Operating Rooms, promised several attractive outcomes, said Dr. William Marx, medical director of perioperative services at SUNY Upstate Medical University.“LeanTaaS’ technology predicts when blocks will be underutilized and enables surgeon offices to release them sooner than auto release deadlines so a large pool of shared open time can be created,” said Marx. €œLike OpenTable makes it easy to book restaurant tables, their tools would make it really simple to see open OR time anytime, anywhere and ask for it.”This aspect of the tool would help SUNY do more cases, thereby improving three key metrics.

Prime time utilization, staffed room utilization and case volume, he added."The data availability and transparency to everyone involved in meeting our goals has been critical in our collaboration efforts in policy writing and adoption."Dr. William Marx, SUNY Upstate Medical UniversityTransparency was another attractive promised outcome for Marx.“It would provide cloud-based mobile and web tools that showed the right metrics to the right user on demand,” he explained. €œThis would alleviate the lack of transparency into data between surgeons and operations and also create a single source of truth to eliminate discrepancies in reports arising from competing sources of information. The transparency has been the best feature as we have introduced the product to our leadership and surgical staff.”Yet another aspect he liked was what the vendor called “actionability.”“The tools promised ready access to actionable data to department chairs across SUNY Upstate Medical University so we could hold ourselves accountable, measure what’s important and make decisions, not just debate the numbers,” he said.

€œOne specific such metric is what they call ‘collectable time,’ which is far more actionable than ‘block utilization,’ the traditional metric all ORs have used to right-size blocks, which is far less actionable and defensible.”Marx was also interested in data hygiene.“Over the years we knew we had made decisions and used logic in our EHR that had errors, for example, assigned overlapping block times given to different surgeons. We just weren’t sure how to identify them systematically, and LeanTaaS’ implementation process promised to ferret those out,” he noted.MEETING THE CHALLENGELaunched in July 2020, iQueue is being used across SUNY Upstate facilities by OR scheduling, clinic scheduling, surgery chairs and surgeons themselves. It integrates easily with the organization’s Epic EHR and provides a cloud-based add-on the provider can access on any browser whether mobile or web.“We send iQueue a nightly feed from our data warehouse and a real time feed in HL7, so the integration is relatively light,” Marx said. €œiQueue provides a few powerful tools by using this data in real time.”One of these tools is OpenTable for Open OR Time.

This is actually a set of tools that streamline how the OR can advertise open time, enable and encourage clinics to release time ahead of auto releases, and request it 24/7 when needed. This has led to what Marx called a “mentality of plenty” instead of one of “scarcity” where everyone felt they were competing for the same limited OR time.Another tool is deep on-demand analytics.“There is a comprehensive set of daily refreshed metrics that help us look at over a dozen powerful metrics – utilization rated, volume, trends, opportunities for improvement in delay, and turnover times,” Marx explained. €œThe tool allows very easy sharing across campuses improving data transparency and credibility across all stakeholders.”Surgeons get personalized weekly texts and messages pushed to them to keep them abreast of their performance. SUNY Upstate has been able to shift cases from one campus to another and improve utilization of others.

It also has seen how some surgeons have actually had duplicate blocks on the same day. The on-demand analytics has helped to redesign block scheduling patterns so they coincide with surgeon and OR availability.Then there is data-driven accountability, Marx said.“We have been able to adopt a new way of looking at how to measure usage of block time and hold ourselves accountable – ‘collectable time’ – this has made the conversations in our decision making bodies like the OR committee a lot lore data-driven and actionable,” he said. €œThere has been strong adoption and engagement from leadership, which continued to expand to all levels. Business office, surgeons and MSG schedulers.”By cultivating a strong partnership between SUNY Leadership and the LeanTasS team, SUNY Upstate has seen continued active user growth and engagement, he added.“We now have a Tiger Team at SUNY Upstate Medical University, assembled from key stakeholder groups, relying on iQueue to provide real-time data to the team to assess progress and drive improvements in efficiency,” Marx noted.

€œThe data availability and transparency to everyone involved in meeting our goals has been critical in our collaboration efforts in policy writing and adoption.”RESULTSIn just a few months (the tools went live in early July), SUNY Upstate has been able to see significant success. The key results achieved with iQueue include:Absorbed significantly higher case volume during business hours. €œWe have seen a 3.4% increase in weekly volume of cases done within existing capacity and in business hours,” Marx explained. €œThis is hugely important for any system since OR volume is a key driver of hospital performance.”Increases usage of OR minutes during business hours.

Correspondingly, SUNY Upstate has experienced a 5.5% increase in the number of OR minutes used during business hours. Since business hours are when ORs are staffed, that also means the organization is using its fixed and variable costs better instead of doing cases into the night. Since costs are fixed, improving OR utilization has helped reduce non-productive time.Increase utilization across the board. SUNY Upstate has seen a positive impact on key utilization metrics including prime time and staffed room utilization with a 2% and 1% improvement, respectively, in under 3 months.Increase “release proactivity.” Before iQueue, offices were releasing time on an average of two days ahead of EHR auto release.

With iQueue, the organization increased its block release time to five days and block release has actually increased to 12 days ahead of auto release across the health system. This is very important, Marx said, because now offices that need time have a lot more runway to plan for cases and get patients access into the OR sooner to get cases done.Data/EHR hygiene. Increased visibility of the data stored in the EHR has led to improved EHR hygiene, which was an unexpected benefit, Marx noted.“As a result of all this, we have been able to collaborate across the system to adopt a systemwide block policy with stretch goals. Our goal is to improve block utilization from around 50% to 70% by January 1, 2021, and we are well on our way to getting there,” he said.

€œThis will be a big forward step for us.”ADVICE FOR OTHERSMarx has three pieces of advice for his peers who may be exploring this kind of technology.“Math works,” he stated. €œPredictive analytics- and machine learning-based systems are going to be instrumental in taking healthcare from making decisions based on ‘tribal rules set by committees’ or gut feel supported by ad-hoc analytics to a data-driven approach that makes useful predictions and prescribes the right actions.”Surgery has to move to adopting more objective data and 21st century tools to make critical operational and clinical decisions, he added.“Fear of change is natural but the status quo is worse,” he continued. €œWe have all seen what has happened to industries like retail, banking, airlines, transportation – those players that use data win and others that don’t fall behind.”Healthcare has to embrace innovation and change, and there are excellent options out there to work with organizations that truly get healthcare problems and will work with executives to solve them, he said. Data transparency has assuaged some of the anxiety that surgeons have about access, he added.“And erectile dysfunction treatment can accelerate your thinking and decision making,” he concluded.

€œTelemedicine is a great example of how such shocks to the system can accelerate the pace of adopting new tools. Use that to your advantage and take action.“Because no matter what happens in Washington, reimbursement levels aren’t about to go up and surgical volumes aren’t going to come down,” he added. €œSo we all need tools that help us do more with less – increase patient access, improve the patient experience and lower unit delivery costs.”Without such tools, he said, healthcare executives and clinicians are shooting in the dark and making sub-optimal decisions every day.Twitter. @SiwickiHealthITEmail the writer.

Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.New research published this week in the Journal of the American Medical Informatics Association found that chatbots and other conversational agents can be used to provide up-to-date facts about erectile dysfunction treatment.Researchers from IBM Watson Health and Vanderbilt University Medical Center explored the ways governmental agencies, employers, provider organizations and health plans used the Watson Assistant platform to deliver erectile dysfunction treatment-related information to users."Given the enormous demand for information about erectile dysfunction treatment, many stakeholders have leveraged emerging conversational technologies to automate responses to common erectile dysfunction treatment related questions and information needs specific to their organizations," wrote the team.WHY IT MATTERSAs the researchers noted, chatbots have been used in healthcare to aid in performing specific tasks, determining social needs, and prompting behavior change.But in response to the rapidly evolving information – and disinformation – landscape around the novel erectile dysfunction throughout 2020, many organizations turned to natural language processing tools as part of public-awareness strategies.As of August 10, 101 organizations had used Watson Assistant to develop a conversational agent related to erectile dysfunction treatment, with usage data available for 37. Those organizations used their chatbots to provide a wide range of information, including:erectile dysfunction treatment symptoms.Testing information.Information on preventative behaviors.Local and national information about the disease.Response initiatives.Availability of services and how to access them.Guidelines, restrictions, closures and reopening information.Course and exam information.Unemployment benefits and information.Stimulus payments. Business assistance.Volunteering opportunities.A total of 6,872,021 messages were sent in conversations about erectile dysfunction treatment using the platform between March 30 and August 10, with conversational turns (meaning pairs of interactions between users and agents) highest among provider organizations and lowest for health plans."Yet, across organizations, the number of conversational turns is not reflective of highly complex conversations," researchers wrote. "Due to the novel and rapidly evolving context in the early stages of a viagra, most users probably asked simple, transactional types of questions such as 'Is the hospital open?.

' and 'What is erectile dysfunction treatment?. '"This trend is likely to change as the viagra evolves," they continued. "For example, in the later weeks of this study, conversational length among employers spiked. We hypothesize that as workers returned to work, more complex conversations around workplace safety and reopening policies occurred."THE LARGER TRENDAs with many other tools, chatbots are an inherently neutral technology, with the potential to either help or hurt patients in a healthcare setting.For example, as a viewpoint piece in the Journal of the American Medical Association outlined this summer, a chatbot's response to a user's declaration of wanting to harm themselves can cause confusion or even danger.

It is important, said the authors of that piece, for the operators of chatbots to be nimble and ready to intervene personally if necessary.At the same time, chatbots can be used to ease user anxiety about seeking medical care, particularly at hours when humans aren't available. "Chatbots are scalable, so they can meet an unexpected surge in demand when there is a shortage of qualified human agents," wrote the authors of a different JAMIA piece published in July. "Chatbots can provide around-the-clock service at a low operational cost."ON THE RECORD"We have demonstrated the ability of a wide variety of organizations including governments, employers, providers, and payers to use conversational technologies to provide current information related to erectile dysfunction treatment to their citizens, employees, patients, and beneficiaries," read the December JAMIA study. "The WA platform enabled rapid implementation of a set of conversational agents for a wide variety of use cases, and usage data show demand for and adoption of these technologies during a rapidly evolving public health crisis," the researchers added.

Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.The Office of the National Coordinator for Health IT announced this week that it would soon launch a project to develop unified specifications for addresses in healthcare. ONC's Project US@ initiative – launched in conjunction with standards development organizations including HL7, the National Council for Prescription Drug Programs and X12 – aims to issue a unified, industry-wide specification for representing addresses by the end of 2021.

"As mundane as address may seem it is often one of the key elements used for the purposes of patient matching and linking records," wrote Deputy National Coordinator for Health IT Steven Posnack in a Tuesday blog post explaining the initiative. HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. WHY IT MATTERSHealth IT professionals praised the move, calling it an important step for accuracy in patient matching.

Ben Moscovitch, director of the Pew Charitable Trusts’ health IT initiative, pointed to previous Pew research showing that the use of a consistent mailing address format can lead to marked improvement in record linkage rates. "Although such progress would not completely solve the problem, address standardization can help improve record matches in the near-term with data that is collected and used," wrote Moscovitch in a blog post heralding the forthcoming project launch.Moscovitch noted, as did Posnack, that even existing U.S. Postal Service guidelines for address formatting have limits. The same location, for instance, might be written "42 East Wallaby Way" or "42 E.

Wallaby Wy," which would be adequate for mail to reach its destination but could create mismatching problems with medical records."Such mismatches can lead to unnecessary testing and care provided based on outdated or incomplete information. In addition, if a provider ends up referring to the record of the wrong person, patients might even receive care that isn’t right for them," wrote Moscovitch. By contrast, setting a single standard could help avoid matching errors and also improve data sharing among pharmacies and insurance companies, he noted. THE LARGER TREND Although effective patient matching is essential for interoperability and safety – especially in the time of erectile dysfunction treatment – strategies for implementing it vary.

In August, Sens. Maggie Hassan, D-New Hampshire, and Bill Cassidy, R-Louisiana, introduced the Patient Matching Improvement Act, which would make the USPS' address-matching tool available to hospitals and erectile dysfunction treatment testing labs. (Although, again, this would not wholly solve the issue.) "Giving health care providers access to the Postal Service’s existing address tools would help save lives by making it easier to conduct erectile dysfunction treatment contact tracing," said Sen. Hassan in a statement.

"This common-sense bipartisan legislation should be included in the next erectile dysfunction treatment relief package." Other efforts include expanding an existing person-matching framework to payers and turning to emerging biometrics technologies. ON THE RECORD"Project US@ is reflective of how subtle improvements in health IT can have a big impact when implemented at a national scale," said Posnack. "By doing this together, we will be able to establish a lasting, industry-wide approach to representing patient addresses that is consistent across a spectrum of clinical and administrative transactions." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication..

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10, 2021 (HealthDay News) Shortness of breath in people wellbutrin viagra with "long erectile dysfunction treatment" might not just be about the lungs — it may indicate heart damage from the disease, new research suggests. "The findings could help to explain why some patients with long erectile dysfunction treatment still experience breathlessness one year later, and indicate that it might be linked to a decrease in heart performance," explained study author Dr. Maria-Luiza Luchian, of the University Hospital Brussels in Belgium.

Her team presented the findings Thursday at a virtual meeting of the European Society of Cardiology (ESC) wellbutrin viagra. The new study included 66 patients, average age 50, who had no history of heart or lung disease before being hospitalized with erectile dysfunction treatment between March and April 2020 at Luchian's hospital in Brussels. One year after leaving the hospital, 35% of the patients still experienced shortness of breath during physical activity.

All of the patients underwent imaging of their lungs and heart, including a new imaging technique called "myocardial work," which provides more precise information wellbutrin viagra on heart function than previous methods, the researchers said. The results revealed poorer heart performance in people with shortness of breath compared to those without shortness of breath. There was also a significant and independent association between abnormal heart function and persistent shortness of breath ("dyspnea"), the study authors noted.

"Our study shows that more than a third of erectile dysfunction treatment patients with no history of heart or lung disease had persistent dyspnea on effort a year after wellbutrin viagra discharge from hospital," Luchian said in an ESC news release. "When looking in detail at heart function by cardiac uasound, we observed subtle abnormalities that might explain the continued breathlessness," she noted. "Future studies, including different erectile dysfunction treatment variants and the impact of vaccination, are needed to confirm our results on the long-term evolution and possible cardiac consequences of this disease," Luchian suggested.

Two experts based in the United States said the new wellbutrin viagra findings were interesting, but more study is needed. Dr. Michael Goyfman is chief of cardiology at Long Island Jewish Forest Hills, in New York City.

He said myocardial work is still largely unavailable in routine clinical practice, and "it remains unclear what treatments would be helpful for patients with shortness of breath a year after erectile dysfunction treatment who display wellbutrin viagra these specific echocardiographic abnormalities. Additional studies would be helpful to apply these findings to patients." Dr. Roshini Malaney is a cardiologist at Staten Island University Hospital, also in New York City.

She explained that "shortness of breath is one of the most common symptoms of wellbutrin viagra many heart conditions, such as a heart attack, heart failure and inflammation of the heart muscle, also known as myocarditis or pericarditis." Malaney added that "erectile dysfunction treatment is known to cause high amounts of inflammation in the body, which can accelerate or induce a heart condition that was not present before." Certain risk factors — smoking, high cholesterol, high blood pressure and diabetes — can raise a person's risk even further, she said. "Persisting symptoms after an with erectile dysfunction treatment, especially shortness of breath, should warrant prompt evaluation by a cardiologist due to the possibility of underlying heart muscle damage from the ," Malaney believes. Echocardiograms can help confirm a diagnosis.

"This is an easy, accessible and noninvasive test that can be done in the office, which gives us a lot of information about the heart and its function and can wellbutrin viagra detect damage due to erectile dysfunction treatment," Malaney said. Because the Belgian findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal. More information For more on long erectile dysfunction treatment, go to the U.S.

Centers for Disease Control and Prevention wellbutrin viagra. SOURCES. Roshini Malaney, MD, cardiologist, Staten Island University Hospital, New York City.

Michael Goyfman MD, chief wellbutrin viagra of cardiology, Long Island Jewish Forest Hills, New York City. European Society of Cardiology, news release, Dec. 9, 2021 Ernie Mundell and Robert Preidt Copyright © 2021 HealthDay.

All rights reserved.Latest Neurology wellbutrin viagra News By Steven Reinberg HealthDay ReporterTHURSDAY, Dec. 9, 2021 (HealthDay News) Children at risk for multiple sclerosis (MS) might find some protection from the disease by spending more time in the sun, a small study suggests. Although MS is rare in children and young adults, those with relatives who have the condition have increased odds of developing the disease early.

Exposure to sunlight may cut their risk in wellbutrin viagra half, researchers say. "In families where there's several cases of MS, then we know that typically there's a higher risk for individuals in that family," said lead author Dr. Emmanuelle Waubant, a neurologist and director of the Regional Pediatric Multiple Sclerosis Center at the University of California, San Francisco.

She emphasized that this study doesn't prove sunshine reduces MS risk, only that there may be wellbutrin viagra a connection. "If you have siblings with MS or parents with MS, then maybe making sure you spend more time in the sun regularly could help decrease the risk of having the disease," Waubant said. MS is an autoimmune disease that affects the central nervous system, causing unpredictable symptoms such as numbness, tingling, mood changes, blindness and/or paralysis, according to the National Multiple Sclerosis Society.

The majority of patients are diagnosed between ages wellbutrin viagra 20 and 50. There seems to be something "very peculiar about MS and kids, because why would a child develop a disease that typically would start 20 or 30 years later?. " Waubant said.

Researchers theorize it's probably because they may have greater exposure to risk factors and/or maybe a higher wellbutrin viagra number of genes that may trigger the disease. Increasing vitamin D has been tied to a lower risk for MS and may explain the sunshine effect that researchers found. Waubant suspects that a combination of sunshine increasing vitamin D and revving up immune cells in the skin is protective.

"We think it could be not only vitamin D, but also the wellbutrin viagra fact that there are immune cells in the skin, and these immune cells are stimulated by exposure to the sun, and that is unrelated to vitamin D," she said. "Those immune cells are actually good immune cells -- they help dampen inflammation." For the study, Waubant's team studied more than 300 children and young adults with MS and more than 500 without the disease. Participants ranged from ages 3 to 22.

Their parents wellbutrin viagra answered questions about how much time their child spent in the sun in the summer before the study. In all, 19% of those with MS had spent fewer than 30 minutes a day outdoors, compared with 6% of those without MS. Also, 18% of those with MS spent one to two hours a day outdoors, compared with 25% of those without MS.

Waubant's team calculated that those who spent 30 to 60 minutes a day outdoors had a 52% lower risk of wellbutrin viagra developing MS, compared with those who spent less than a half-hour a day outdoors. More time in the sun reduced the risk even more. Compared with participants who were outdoors less than a half-hour a day, those who spent one to two hours a day had an 81% lower risk of MS, researchers found.

More hours outdoors than that didn't reduce wellbutrin viagra the risk further, Waubant noted. Sun exposure in the first year of life also lowered MS odds. One expert who reviewed the finding wasn't convinced that the lower MS risk that researchers identified was only due to sun exposure.

"The study did control for a variety of variables, such as physical activity, and wellbutrin viagra exercise is beneficial, so is it really sun exposure or physical activity that is protective?. " said Dr. Asaff Harel, director of the Multiple Sclerosis Center at Lenox Hill Hospital in New York City.

Harel said individuals often have wellbutrin viagra MS symptoms prior to diagnosis. QUESTION What kind of disease is multiple sclerosis?. See Answer "It is possible that those symptoms could keep someone from going outside, skewing the results," he said.

"Such a chicken-or-the-egg scenario is always a possibility with such studies." Sara Bernstein, manager of research information at the National Multiple Sclerosis Society, said that sunlight wellbutrin viagra and vitamin D have previously been linked to MS risk. "Evidence suggests that higher lifetime exposure to sunlight and higher blood levels of vitamin D are associated with a lower risk of developing MS," she said. "MS is more common at latitudes that are farther from the equator and less common in areas closer to the equator -- a factor that also suggests the influence of sunlight exposure on MS." More research is needed to understand the relationship between vitamin D and the development of childhood MS, Bernstein said.

Nearly 1 wellbutrin viagra million Americans were living with MS in 2019, according to U.S. Census data. The findings were published online Dec.

8 in wellbutrin viagra Neurology. More information There's more about MS from Johns Hopkins Medicine. SOURCES.

Emmanuelle Waubant, MD, PhD, neurologist, director, Regional Pediatric Multiple wellbutrin viagra Sclerosis Center, University of California, San Francisco. Sara Bernstein, manager, research information, National Multiple Sclerosis Society. Asaff Harel, MD, MSc, neurologist, director, Multiple Sclerosis Center, Lenox Hill Hospital, New York City.

Neurology, Dec wellbutrin viagra. 8, 2021, online Copyright © 2021 HealthDay. All rights reserved.

From Healthy Resources Featured Centers Health Solutions From Our SponsorsLatest Diabetes News By Denise wellbutrin viagra Mann HealthDay ReporterTHURSDAY, Dec. 9, 2021 (HealthDay News) A condition called "diabetic retinopathy" often threatens the vision of adults with diabetes, but new research suggests that kids with type 2 diabetes may be particularly vulnerable to the vision-robbing complication. In fact, these kids were nearly twice as likely to develop the condition as children with type 1 diabetes were, the researchers found.

"The new findings emphasize the need to differentiate between the two types of diabetes when discussing screening for eye disease with patients and families," said study author wellbutrin viagra Patricia Bai. She is a medical student at Mayo Clinic Alix School of Medicine in Arizona. "Closer monitoring for retinopathy development in youth-onset type 2 diabetes to prevent vision-threatening complications may be warranted," Bai said.

Type 2 is the form of diabetes most closely wellbutrin viagra tied to obesity. It occurs when your body doesn't use the hormone insulin properly. When insulin can't do its job, blood sugar (glucose) builds up in your body, where it can cause complications including diabetic retinopathy.

The condition, which damages wellbutrin viagra blood vessels in the retina, is the leading cause of vision loss in people aged 18 to 64, according to the American Diabetes Association. The only way to catch diabetic retinopathy early is through annual eye exams. For the study, the researchers examined the risk of developing diabetes-associated eye disease in 525 people aged 22 or younger who were diagnosed with either form of diabetes during a 50-year time period.

Within the first 15 years of diagnosis, risk of developing diabetic retinopathy was 88% greater in kids with type 2 diabetes, compared with those who had type wellbutrin viagra 1 disease. Kids with type 2 diabetes were also more likely to have advanced forms of diabetic eye disease and need surgery to treat the condition. The new study did have its share of limitations.

Type 1 diabetes often comes on quickly, but wellbutrin viagra type 2 is more insidious, which is why it often takes longer to diagnose. Type 2 symptoms such as frequent urination, excessive thirst and fatigue may go unnoticed, which would shorten the timeline of complications. With type 1, you don't make insulin or make very little of it, and symptoms can be dramatic, usually resulting in a quicker diagnosis.

"Increasing dedicated public health efforts to screen for type 2 diabetes and capture those who remain undiagnosed may help ensure management strategies are in place to reduce wellbutrin viagra the risk for developing eye complications," Bai said. "We do hope our findings will provide background for future studies that focus on prevention of ocular disease in youth-onset type 2 diabetes." The findings were published online Dec. 2 in the journal JAMA Ophthalmology.

Commenting on the report, experts who were not involved with the new wellbutrin viagra study noted that they are concerned that rising rates of type 2 diabetes in kids may cause a tsunami of vision complications in the future. "As the obesity epidemic spreads to children, the rates of type 2 diabetes are showing up in younger patients," said Dr. Joshua Miller, medical director of diabetes care at Stony Brook Medicine in New York.

QUESTION ______________ is another term for type 2 wellbutrin viagra diabetes. See Answer Making matters worse, type 2 diabetes isn't always diagnosed right away. "It can take upward of five to 10 years to diagnose type 2, which means there is a greater potential for complications to develop.

We are against the clock," wellbutrin viagra Miller added. The most important timeframe in preventing complications is right after someone develops diabetes and in the ensuing two decades, Miller said. "Diagnosing type 2 in a child and intervening can absolutely reverse or delay diabetes onset and lower risk of long-term complications," he said.

The best wellbutrin viagra way to stave off diabetes complications is to keep your blood sugar under tight control from the get-go. Dr. Kammi Gunton, an ophthalmologist at Wills Eye Hospital in Philadelphia, agreed.

"We know that the incidence of diabetic retinopathy increases with years since diagnosis, and the more years you have it, the greater the chance of complications," Gunton said. Largely because type 2 diabetes wasn't historically seen in kids, there's not enough data out there wellbutrin viagra to say exactly when and how often these kids should have screening eye exams. "With type 2, we ask them to come in at the time of diagnosis, and they should be examined every year," Gunton said.

"With type 1, it varies from three to five years following diagnosis and then yearly." More information Learn more about how diabetes affects your vision and what to do about it at the American Diabetes Association. SOURCES. Patricia Bai, medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Ariz..

Joshua Miller, MD, medical director, diabetes care, Stony Brook Medicine, Stony Brook, New York. Kammi Gunton, MD, ophthalmologist, Wills Eye Hospital, Philadelphia. JAMA Ophthalmology, Dec.

2, 2021, online Copyright © 2021 HealthDay. All rights reserved.Latest Heart News THURSDAY, Dec. 9, 2021 (American Heart Association News) Bob Parker was waiting for a parking spot at his neighborhood coffee shop when he suddenly saw a flash.

His foot slipped off the break and he crashed into a pole. The café window shattered. Inside his crumpled car, Parker couldn't speak or move.

A bystander called 911 and Parker, then 72, was taken to a local hospital. Testing showed he'd had a stroke caused by a clot in his carotid artery. Because he got help soon after symptoms started, he was eligible for a clot-busting medicine.

His symptoms eased. "He seemed mostly stunned, but could still talk," said Jennifer Parker-Stanton, Bob's daughter. That night, Parker had a second stroke.

This time, it left him unable to move or swallow and his speech was garbled. Parker spent 48 days in the hospital, undergoing speech, occupational and physical therapy. By the time he returned home, he was able to walk short distances using a cane but continued to struggle with aphasia – a disorder that impairs the ability to speak and understand language caused by damage in the brain from a stroke.

It was a drastic change for Parker, a longtime college professor, mainly teaching English education and early education/reading. "I had lectured all over the world and after my stroke I could start a sentence, but I couldn't finish it," said Parker, who lives in Pasadena, California. As her dad recovered, Parker-Stanton said he would sometimes use strange words.

He may retrieve the word he wanted to use hours later. "Once for my birthday, he called to wish me a happy advancement day," she said. Parker's strokes occurred in December 2009.

More than 30 years before, he'd been diagnosed with high blood pressure, a major risk factor for stroke and heart disease. He also had a family history of both. However, he didn't manage that risk.

He was inconsistent with taking medicine that could've helped control his blood pressure. A few weeks before his stroke, Parker nearly fainted during his regular 2-mile run. For a couple of hours after that, the right side of his face drooped – a symptom of stroke.

Parker said that scared him, but he put it out of his mind when it went away and didn't mention it to his doctor. After his stroke, he learned the episode was one of four transient ischemic attacks – temporary blockages of blood flow that are considered warning signs of a stroke – that he'd endured. Following his stroke, Parker began regularly taking his medications and maintained a log of his blood pressure readings to share with his doctor.

As a longtime lecturer, he became determined to regain the ability to speak smoothly. His voice was garbled. Yet he discovered writing gave him the fluidity of voice that he'd "lost" initially with aphasia as well as a new sense of purpose.

"I recovered word by word," he said. In 2013, he reconnected with a former pupil, Jesse Silva. At that point, speech was still a challenge.

Parker sometimes typed his thoughts as his voice faltered. "He knew what he wanted to say, but there was a disconnect," Silva said. Parker had advised Silva as a doctoral candidate.

Now the tables were turned. Silva has helped Parker with his writing. Over the years, Silva has noticed an improvement in Parker's speech.

"There's a better flow in conversation and there are very few moments where he can't remember a word," he said. Parker, now 84, writes for three or four hours every day. He's chronicled his stroke recovery and life in his writing, along with poetry and novels.

He's published four books since his stroke and is finishing three others. He keeps active, walking a mile each day, and practicing the martial art Qigong to help with his balance. Parker also continues to visit the coffee shop where he had his stroke.

He spends hours there writing and socializing. "I don't know what I would do if I didn't stay busy," he said. A year ago, he joined a virtual writing group.

He shares his work and reads a poem each week as another way to recover his speech and nurture his love of writing. It was hard at first, he said, to overcome the fear of slurring or speaking slowly. "When I joined, I was scared of my reading," he said.

"Now I am part of the group." QUESTION What is a stroke?. See AnswerLatest HIV News By Alan Mozes HealthDay ReporterTHURSDAY, Dec. 9, 2021 (HealthDay News) What do all the microbes living rent-free in your gut have to do with disease risk?.

Perhaps a lot. A groundbreaking analysis of decades-old stool and blood samples from the early AIDS epidemic suggests that men who had high levels of inflammation-causing bacteria in their intestinal tract may have had a greater risk for contracting HIV. At issue is the specific makeup of the bacteria, fungi, algae and other single-celled organisms that colonize everyone's digestive tract.

Collectively, they're known as the gut microbiome. "A healthy gut microbiome is essential for many bodily functions, such as turning food into energy, fighting bad pathogens and maintaining the lining of our intestines," said study lead author Yue Chen, an associate professor of infectious diseases and microbiology at the University of Pittsburgh. "Scientists are increasingly learning that it has other wide-ranging impacts, including fighting cancer, influencing our behavior and activating our immune response." This new study found that men infected in the early stages of the HIV/AIDS viagra had more pro-inflammatory gut microbes before they became HIV-positive than did men who remained HIV-negative.

And certain types of gut microbes seemed to be associated with a quicker progression from HIV to full-blown AIDS, the study found. Study co-author Charles Rinaldo said he'd been looking into a potential link between the microbiome and HIV/AIDS for the better part of four decades. That effort kicked into high gear once he and his colleagues at Pitt uncovered "a treasure trove of specimens" available for analysis — namely, 35-year-old stool and blood samples collected from a group of gay men starting in 1984.

All had been part of a U.S. National Institutes of Health (NIH) study, and all the samples were frozen. That allowed researchers fresh access to samples from 265 men.

None had HIV when they joined the NIH's study. Within a year of providing blood and stool samples, however, 109 had contracted the viagra that causes AIDS. To the 21st century researchers, their samples were telling.

"Participants who went on to contract HIV had a greater relative abundance of 'Prevotella stercorea' — a bacterium that promotes inflammation — and lower levels of four 'Bacteroides' species that are known to be involved in immune response," Chen noted. Analyses of blood samples also indicated that participants who eventually contracted HIV had higher levels of inflammation before they were infected, Chen said. "My colleagues and I believe that the unfavorable gut microbiome was aggravating the immune response and promoting inflammation, making the men more susceptible to contracting HIV, and less able to prevent the disease from progressing to AIDS in a time before antiretroviral therapy existed," Chen said.

And though a scientific blast from the past, the new findings could offer insight into tackling a host of current and emerging viral challenges, the researchers said. "It is important for us to understand that humans are complex organisms that host other complex organisms," said Rinaldo, a professor of infectious diseases and microbiology. "What we eat, our activities and environmental exposures, and a variety of other factors can all influence how we respond to a pathogen and whether we become seriously ill or have a benign ," he explained.

"If the gut microbiome influences a person's susceptibility to HIV in this way, it could be doing the same for other pathogens, such as erectile dysfunction treatment." SLIDESHOW A Timeline of the HIV/AIDS viagra See Slideshow Two experts, who were not involved in the study but reviewed the findings, agreed. "The microbiome is one component of how your body responds immunologically," said Dr. Christina Price, chief of clinical allergy and clinical immunology at Yale University in New Haven, Conn.

She described the findings as "interesting" and "remarkable," but in no way surprising. Along with our skin, tears, mucus and saliva, the gut is one of the primary natural immunity defense systems, added Lona Sandon of the University of Texas Southwestern Medical Center at Dallas. Sandon referred to her own research into an apparent link between microbiome status and rheumatoid arthritis risk.

That work, she said, showed that while "a healthy gut microbiome keeps the gut wall healthy," microbial disruptions can undermine the gut's protection from disease. "If the microbiome creates an environment in which these tissues cannot respond effectively, then immunity will be negatively impacted," she said. The new findings were published online Dec.

9 in the journal Microbiome. More information Harvard University's T.H. Chan School of Public Health has more about the microbiome.

SOURCES. Yue Chen, PhD, associate professor, infectious diseases and microbiology, University of Pittsburgh. Charles Rinaldo, PhD, professor, infectious diseases and microbiology, University of Pittsburgh.

Christina Price, MD, chief, clinical allergy and immunology, Yale University, and chief, allergy and clinical immunology, West Haven VA, New Haven, Conn.. Lona Sandon, PhD, MEd, RDN, LD, program director and assistant professor, department of clinical nutrition, University of Texas Southwestern Medical Center at Dallas. Microbiome, Dec.

9, 2021, online Copyright © 2021 HealthDay. All rights reserved.

Latest erectile dysfunction News where is better to buy viagra FRIDAY, Dec. 10, 2021 (HealthDay News) Shortness of breath in people with "long erectile dysfunction treatment" might not just be about the lungs — it may indicate heart damage from the disease, new research suggests. "The findings could help to explain why some patients with long erectile dysfunction treatment still experience breathlessness one year later, and indicate that it might be linked to a decrease in heart performance," explained study author Dr. Maria-Luiza Luchian, of the University where is better to buy viagra Hospital Brussels in Belgium.

Her team presented the findings Thursday at a virtual meeting of the European Society of Cardiology (ESC). The new study included 66 patients, average age 50, who had no history of heart or lung disease before being hospitalized with erectile dysfunction treatment between March and April 2020 at Luchian's hospital in Brussels. One year after leaving the hospital, where is better to buy viagra 35% of the patients still experienced shortness of breath during physical activity. All of the patients underwent imaging of their lungs and heart, including a new imaging technique called "myocardial work," which provides more precise information on heart function than previous methods, the researchers said.

The results revealed poorer heart performance in people with shortness of breath compared to those without shortness of breath. There was also a significant and where is better to buy viagra independent association between abnormal heart function and persistent shortness of breath ("dyspnea"), the study authors noted. "Our study shows that more than a third of erectile dysfunction treatment patients with no history of heart or lung disease had persistent dyspnea on effort a year after discharge from hospital," Luchian said in an ESC news release. "When looking in detail at heart function by cardiac uasound, we observed subtle abnormalities that might explain the continued breathlessness," she noted.

"Future studies, including different erectile dysfunction treatment variants and the impact of vaccination, are needed to confirm our results on the long-term evolution and possible cardiac consequences of this disease," where is better to buy viagra Luchian suggested. Two experts based in the United States said the new findings were interesting, but more study is needed. Dr. Michael Goyfman is chief where is better to buy viagra of cardiology at Long Island Jewish Forest Hills, in New York City.

He said myocardial work is still largely unavailable in routine clinical practice, and "it remains unclear what treatments would be helpful for patients with shortness of breath a year after erectile dysfunction treatment who display these specific echocardiographic abnormalities. Additional studies would be helpful to apply these findings to patients." Dr. Roshini Malaney is a cardiologist at Staten Island University Hospital, also where is better to buy viagra in New York City. She explained that "shortness of breath is one of the most common symptoms of many heart conditions, such as a heart attack, heart failure and inflammation of the heart muscle, also known as myocarditis or pericarditis." Malaney added that "erectile dysfunction treatment is known to cause high amounts of inflammation in the body, which can accelerate or induce a heart condition that was not present before." Certain risk factors — smoking, high cholesterol, high blood pressure and diabetes — can raise a person's risk even further, she said.

"Persisting symptoms after an with erectile dysfunction treatment, especially shortness of breath, should warrant prompt evaluation by a cardiologist due to the possibility of underlying heart muscle damage from the ," Malaney believes. Echocardiograms can help confirm a diagnosis where is better to buy viagra. "This is an easy, accessible and noninvasive test that can be done in the office, which gives us a lot of information about the heart and its function and can detect damage due to erectile dysfunction treatment," Malaney said. Because the Belgian findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal.

More information For more on long erectile dysfunction treatment, where is better to buy viagra go to the U.S. Centers for Disease Control and Prevention. SOURCES. Roshini Malaney, MD, cardiologist, Staten Island University Hospital, New where is better to buy viagra York City.

Michael Goyfman MD, chief of cardiology, Long Island Jewish Forest Hills, New York City. European Society of Cardiology, news release, Dec. 9, 2021 where is better to buy viagra Ernie Mundell and Robert Preidt Copyright © 2021 HealthDay. All rights reserved.Latest Neurology News By Steven Reinberg HealthDay ReporterTHURSDAY, Dec.

9, 2021 (HealthDay News) Children at risk for multiple sclerosis (MS) might find some protection from the disease by spending more time in the sun, a small study suggests. Although MS is rare in children and young adults, those with relatives who have the condition where is better to buy viagra have increased odds of developing the disease early. Exposure to sunlight may cut their risk in half, researchers say. "In families where there's several cases of MS, then we know that typically there's a higher risk for individuals in that family," said lead author Dr.

Emmanuelle Waubant, a neurologist and where is better to buy viagra director of the Regional Pediatric Multiple Sclerosis Center at the University of California, San Francisco. She emphasized that this study doesn't prove sunshine reduces MS risk, only that there may be a connection. "If you have siblings with MS or parents with MS, then maybe making sure you spend more time in the sun regularly could help decrease the risk of having the disease," Waubant said. MS is an autoimmune disease that affects the central nervous system, causing unpredictable symptoms such as numbness, tingling, mood changes, blindness and/or paralysis, according to the National Multiple where is better to buy viagra Sclerosis Society.

The majority of patients are diagnosed between ages 20 and 50. There seems to be something "very peculiar about MS and kids, because why would a child develop a disease that typically would start 20 or 30 years later?. " Waubant where is better to buy viagra said. Researchers theorize it's probably because they may have greater exposure to risk factors and/or maybe a higher number of genes that may trigger the disease.

Increasing vitamin D has been tied to a lower risk for MS and may explain the sunshine effect that researchers found. Waubant suspects that a combination of sunshine where is better to buy viagra increasing vitamin D and revving up immune cells in the skin is protective. "We think it could be not only vitamin D, but also the fact that there are immune cells in the skin, and these immune cells are stimulated by exposure to the sun, and that is unrelated to vitamin D," she said. "Those immune cells are actually good immune cells -- they help dampen inflammation." For the study, Waubant's team studied more than 300 children and young adults with MS and more than 500 without the disease.

Participants ranged from ages 3 to where is better to buy viagra 22. Their parents answered questions about how much time their child spent in the sun in the summer before the study. In all, 19% of those with MS had spent fewer than 30 minutes a day outdoors, compared with 6% of those without MS. Also, 18% of those with MS spent one where is better to buy viagra to two hours a day outdoors, compared with 25% of those without MS.

Waubant's team calculated that those who spent 30 to 60 minutes a day outdoors had a 52% lower risk of developing MS, compared with those who spent less than a half-hour a day outdoors. More time in the sun reduced the risk even more. Compared with participants who were outdoors less than a half-hour a day, those who spent where is better to buy viagra one to two hours a day had an 81% lower risk of MS, researchers found. More hours outdoors than that didn't reduce the risk further, Waubant noted.

Sun exposure in the first year of life also lowered MS odds. One expert where is better to buy viagra who reviewed the finding wasn't convinced that the lower MS risk that researchers identified was only due to sun exposure. "The study did control for a variety of variables, such as physical activity, and exercise is beneficial, so is it really sun exposure or physical activity that is protective?. " said Dr.

Asaff Harel, director of the Multiple Sclerosis Center at Lenox Hill Hospital in New York where is better to buy viagra City. Harel said individuals often have MS symptoms prior to diagnosis. QUESTION What kind of disease is multiple sclerosis?. See Answer "It is possible that those where is better to buy viagra symptoms could keep someone from going outside, skewing the results," he said.

"Such a chicken-or-the-egg scenario is always a possibility with such studies." Sara Bernstein, manager of research information at the National Multiple Sclerosis Society, said that sunlight and vitamin D have previously been linked to MS risk. "Evidence suggests that higher lifetime exposure to sunlight and higher blood levels of vitamin D are associated with a lower risk of developing MS," she said. "MS is more common at latitudes that are farther from the equator and less common in areas closer to the equator -- a factor that also suggests the influence of sunlight exposure on MS." More research is needed to understand the relationship between vitamin D and the development of where is better to buy viagra childhood MS, Bernstein said. Nearly 1 million Americans were living with MS in 2019, according to U.S.

Census data. The findings where is better to buy viagra were published online Dec. 8 in Neurology. More information There's more about MS from Johns Hopkins Medicine.

SOURCES. Emmanuelle Waubant, MD, PhD, neurologist, director, Regional Pediatric Multiple Sclerosis Center, University of California, San Francisco. Sara Bernstein, manager, research information, National Multiple Sclerosis Society. Asaff Harel, MD, MSc, neurologist, director, Multiple Sclerosis Center, Lenox Hill Hospital, New York City.

Neurology, Dec. 8, 2021, online Copyright © 2021 HealthDay. All rights reserved. From Healthy Resources Featured Centers Health Solutions From Our SponsorsLatest Diabetes News By Denise Mann HealthDay ReporterTHURSDAY, Dec.

9, 2021 (HealthDay News) A condition called "diabetic retinopathy" often threatens the vision of adults with diabetes, but new research suggests that kids with type 2 diabetes may be particularly vulnerable to the vision-robbing complication. In fact, these kids were nearly twice as likely to develop the condition as children with type 1 diabetes were, the researchers found. "The new findings emphasize the need to differentiate between the two types of diabetes when discussing screening for eye disease with patients and families," said study author Patricia Bai. She is a medical student at Mayo Clinic Alix School of Medicine in Arizona.

"Closer monitoring for retinopathy development in youth-onset type 2 diabetes to prevent vision-threatening complications may be warranted," Bai said. Type 2 is the form of diabetes most closely tied to obesity. It occurs when your body doesn't use the hormone insulin properly. When insulin can't do its job, blood sugar (glucose) builds up in your body, where it can cause complications including diabetic retinopathy.

The condition, which damages blood vessels in the retina, is the leading cause of vision loss in people aged 18 to 64, according to the American Diabetes Association. The only way to catch diabetic retinopathy early is through annual eye exams. For the study, the researchers examined the risk of developing diabetes-associated eye disease in 525 people aged 22 or younger who were diagnosed with either form of diabetes during a 50-year time period. Within the first 15 years of diagnosis, risk of developing diabetic retinopathy was 88% greater in kids with type 2 diabetes, compared with those who had type 1 disease.

Kids with type 2 diabetes were also more likely to have advanced forms of diabetic eye disease and need surgery to treat the condition. The new study did have its share of limitations. Type 1 diabetes often comes on quickly, but type 2 is more insidious, which is why it often takes longer to diagnose. Type 2 symptoms such as frequent urination, excessive thirst and fatigue may go unnoticed, which would shorten the timeline of complications.

With type 1, you don't make insulin or make very little of it, and symptoms can be dramatic, usually resulting in a quicker diagnosis. "Increasing dedicated public health efforts to screen for type 2 diabetes and capture those who remain undiagnosed may help ensure management strategies are in place to reduce the risk for developing eye complications," Bai said. "We do hope our findings will provide background for future studies that focus on prevention of ocular disease in youth-onset type 2 diabetes." The findings were published online Dec. 2 in the journal JAMA Ophthalmology.

Commenting on the report, experts who were not involved with the new study noted that they are concerned that rising rates of type 2 diabetes in kids may cause a tsunami of vision complications in the future. "As the obesity epidemic spreads to children, the rates of type 2 diabetes are showing up in younger patients," said Dr. Joshua Miller, medical director of diabetes care at Stony Brook Medicine in New York. QUESTION ______________ is another term for type 2 diabetes.

See Answer Making matters worse, type 2 diabetes isn't always diagnosed right away. "It can take upward of five to 10 years to diagnose type 2, which means there is a greater potential for complications to develop. We are against the clock," Miller added. The most important timeframe in preventing complications is right after someone develops diabetes and in the ensuing two decades, Miller said.

"Diagnosing type 2 in a child and intervening can absolutely reverse or delay diabetes onset and lower risk of long-term complications," he said. The best way to stave off diabetes complications is to keep your blood sugar under tight control from the get-go. Dr. Kammi Gunton, an ophthalmologist at Wills Eye Hospital in Philadelphia, agreed.

"We know that the incidence of diabetic retinopathy increases with years since diagnosis, and the more years you have it, the greater the chance of complications," Gunton said. Largely because type 2 diabetes wasn't historically seen in kids, there's not enough data out there to say exactly when and how often these kids should have screening eye exams. "With type 2, we ask them to come in at the time of diagnosis, and they should be examined every year," Gunton said. "With type 1, it varies from three to five years following diagnosis and then yearly." More information Learn more about how diabetes affects your vision and what to do about it at the American Diabetes Association.

SOURCES. Patricia Bai, medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Ariz.. Joshua Miller, MD, medical director, diabetes care, Stony Brook Medicine, Stony Brook, New York. Kammi Gunton, MD, ophthalmologist, Wills Eye Hospital, Philadelphia.

JAMA Ophthalmology, Dec. 2, 2021, online Copyright © 2021 HealthDay. All rights reserved.Latest Heart News THURSDAY, Dec. 9, 2021 (American Heart Association News) Bob Parker was waiting for a parking spot at his neighborhood coffee shop when he suddenly saw a flash.

His foot slipped off the break and he crashed into a pole. The café window shattered. Inside his crumpled car, Parker couldn't speak or move. A bystander called 911 and Parker, then 72, was taken to a local hospital.

Testing showed he'd had a stroke caused by a clot in his carotid artery. Because he got help soon after symptoms started, he was eligible for a clot-busting medicine. His symptoms eased. "He seemed mostly stunned, but could still talk," said Jennifer Parker-Stanton, Bob's daughter.

That night, Parker had a second stroke. This time, it left him unable to move or swallow and his speech was garbled. Parker spent 48 days in the hospital, undergoing speech, occupational and physical therapy. By the time he returned home, he was able to walk short distances using a cane but continued to struggle with aphasia – a disorder that impairs the ability to speak and understand language caused by damage in the brain from a stroke.

It was a drastic change for Parker, a longtime college professor, mainly teaching English education and early education/reading. "I had lectured all over the world and after my stroke I could start a sentence, but I couldn't finish it," said Parker, who lives in Pasadena, California. As her dad recovered, Parker-Stanton said he would sometimes use strange words. He may retrieve the word he wanted to use hours later.

"Once for my birthday, he called to wish me a happy advancement day," she said. Parker's strokes occurred in December 2009. More than 30 years before, he'd been diagnosed with high blood pressure, a major risk factor for stroke and heart disease. He also had a family history of both.

However, he didn't manage that risk. He was inconsistent with taking medicine that could've helped control his blood pressure. A few weeks before his stroke, Parker nearly fainted during his regular 2-mile run. For a couple of hours after that, the right side of his face drooped – a symptom of stroke.

Parker said that scared him, but he put it out of his mind when it went away and didn't mention it to his doctor. After his stroke, he learned the episode was one of four transient ischemic attacks – temporary blockages of blood flow that are considered warning signs of a stroke – that he'd endured. Following his stroke, Parker began regularly taking his medications and maintained a log of his blood pressure readings to share with his doctor. As a longtime lecturer, he became determined to regain the ability to speak smoothly.

His voice was garbled. Yet he discovered writing gave him the fluidity of voice that he'd "lost" initially with aphasia as well as a new sense of purpose. "I recovered word by word," he said. In 2013, he reconnected with a former pupil, Jesse Silva.

At that point, speech was still a challenge. Parker sometimes typed his thoughts as his voice faltered. "He knew what he wanted to say, but there was a disconnect," Silva said. Parker had advised Silva as a doctoral candidate.

Now the tables were turned. Silva has helped Parker with his writing. Over the years, Silva has noticed an improvement in Parker's speech. "There's a better flow in conversation and there are very few moments where he can't remember a word," he said.

Parker, now 84, writes for three or four hours every day. He's chronicled his stroke recovery and life in his writing, along with poetry and novels. He's published four books since his stroke and is finishing three others. He keeps active, walking a mile each day, and practicing the martial art Qigong to help with his balance.

Parker also continues to visit the coffee shop where he had his stroke. He spends hours there writing and socializing. "I don't know what I would do if I didn't stay busy," he said. A year ago, he joined a virtual writing group.

He shares his work and reads a poem each week as another way to recover his speech and nurture his love of writing. It was hard at first, he said, to overcome the fear of slurring or speaking slowly. "When I joined, I was scared of my reading," he said. "Now I am part of the group." QUESTION What is a stroke?.

See AnswerLatest HIV News By Alan Mozes HealthDay ReporterTHURSDAY, Dec. 9, 2021 (HealthDay News) What do all the microbes living rent-free in your gut have to do with disease risk?. Perhaps a lot. A groundbreaking analysis of decades-old stool and blood samples from the early AIDS epidemic suggests that men who had high levels of inflammation-causing bacteria in their intestinal tract may have had a greater risk for contracting HIV.

At issue is the specific makeup of the bacteria, fungi, algae and other single-celled organisms that colonize everyone's digestive tract. Collectively, they're known as the gut microbiome. "A healthy gut microbiome is essential for many bodily functions, such as turning food into energy, fighting bad pathogens and maintaining the lining of our intestines," said study lead author Yue Chen, an associate professor of infectious diseases and microbiology at the University of Pittsburgh. "Scientists are increasingly learning that it has other wide-ranging impacts, including fighting cancer, influencing our behavior and activating our immune response." This new study found that men infected in the early stages of the HIV/AIDS viagra had more pro-inflammatory gut microbes before they became HIV-positive than did men who remained HIV-negative.

And certain types of gut microbes seemed to be associated with a quicker progression from HIV to full-blown AIDS, the study found. Study co-author Charles Rinaldo said he'd been looking into a potential link between the microbiome and HIV/AIDS for the better part of four decades. That effort kicked into high gear once he and his colleagues at Pitt uncovered "a treasure trove of specimens" available for analysis — namely, 35-year-old stool and blood samples collected from a group of gay men starting in 1984. All had been part of a U.S.

National Institutes of Health (NIH) study, and all the samples were frozen. That allowed researchers fresh access to samples from 265 men. None had HIV when they joined the NIH's study. Within a year of providing blood and stool samples, however, 109 had contracted the viagra that causes AIDS.

To the 21st century researchers, their samples were telling. "Participants who went on to contract HIV had a greater relative abundance of 'Prevotella stercorea' — a bacterium that promotes inflammation — and lower levels of four 'Bacteroides' species that are known to be involved in immune response," Chen noted. Analyses of blood samples also indicated that participants who eventually contracted HIV had higher levels of inflammation before they were infected, Chen said. "My colleagues and I believe that the unfavorable gut microbiome was aggravating the immune response and promoting inflammation, making the men more susceptible to contracting HIV, and less able to prevent the disease from progressing to AIDS in a time before antiretroviral therapy existed," Chen said.

And though a scientific blast from the past, the new findings could offer insight into tackling a host of current and emerging viral challenges, the researchers said. "It is important for us to understand that humans are complex organisms that host other complex organisms," said Rinaldo, a professor of infectious diseases and microbiology. "What we eat, our activities and environmental exposures, and a variety of other factors can all influence how we respond to a pathogen and whether we become seriously ill or have a benign ," he explained. "If the gut microbiome influences a person's susceptibility to HIV in this way, it could be doing the same for other pathogens, such as erectile dysfunction treatment." SLIDESHOW A Timeline of the HIV/AIDS viagra See Slideshow Two experts, who were not involved in the study but reviewed the findings, agreed.

"The microbiome is one component of how your body responds immunologically," said Dr. Christina Price, chief of clinical allergy and clinical immunology at Yale University in New Haven, Conn. She described the findings as "interesting" and "remarkable," but in no way surprising. Along with our skin, tears, mucus and saliva, the gut is one of the primary natural immunity defense systems, added Lona Sandon of the University of Texas Southwestern Medical Center at Dallas.

Sandon referred to her own research into an apparent link between microbiome status and rheumatoid arthritis risk. That work, she said, showed that while "a healthy gut microbiome keeps the gut wall healthy," microbial disruptions can undermine the gut's protection from disease. "If the microbiome creates an environment in which these tissues cannot respond effectively, then immunity will be negatively impacted," she said. The new findings were published online Dec.

9 in the journal Microbiome. More information Harvard University's T.H. Chan School of Public Health has more about the microbiome. SOURCES.

Yue Chen, PhD, associate professor, infectious diseases and microbiology, University of Pittsburgh. Charles Rinaldo, PhD, professor, infectious diseases and microbiology, University of Pittsburgh. Christina Price, MD, chief, clinical allergy and immunology, Yale University, and chief, allergy and clinical immunology, West Haven VA, New Haven, Conn.. Lona Sandon, PhD, MEd, RDN, LD, program director and assistant professor, department of clinical nutrition, University of Texas Southwestern Medical Center at Dallas.

Microbiome, Dec. 9, 2021, online Copyright © 2021 HealthDay.

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Dr viagra online in canada viagra pill price. Scott Gottlieb, former Commissioner of the Food and Drug Administration, speaks during the Skybridge viagra pill price Capital SALT New York 2021 conference in New York City, U.S., September 15, 2021.Brendan McDermid | ReutersFormer Food and Drug Administration Commissioner Dr. Scott Gottlieb said Monday viagra pill price that U.S. Intelligence agencies should be tasked with investigating emerging public health threats overseas to combat future disease outbreaks.Gottlieb, who also sits on Pfizer's board, told CNBC's "Squawk Box" that the public has lost trust in U.S.

Health agencies and called for more funding for the Centers for Disease Control and Prevention.He said identifying problematic viagraes viagra pill price abroad and equipping the CDC with better crisis mitigation resources would improve the nation's ability to counter any new contagions that arise."I think going forward we're not going to just be able to depend on countries voluntarily sharing information," Gottlieb said in an appearance promoting his book, "Uncontrolled Spread." "We're going to have to go in and have the capacity to collect it and to monitor for these things, and that means getting our foreign intelligence services much more engaged in the public health mission globally."World Health Organization officials have said they weren't sure China disclosed all its data on erectile dysfunction treatment's origins. Gottlieb suggested that countries today are less forthcoming with disease details because they fear viagra pill price being isolated. He noted that the U.S. Has avoided bringing intelligence agencies into international public health issues because the CDC worried that "anyone wearing a white coat overseas would be perceived to be a spy."CNBC Health &.

Science Besides treating outbreaks as national security matters, Gottlieb said the CDC was ill-prepared at the beginning of the viagra for the subsequent widespread rollout of erectile dysfunction treatment tests and treatments.The CDC's changing messaging around erectile dysfunction treatment prevention tactics also undermined the public's faith in the agency, Gottlieb said.But the proper resources, competencies and logistical management could help the CDC better handle public health emergencies, Gottlieb said. "I think coming out of this viagra, a lot of people have lost confidence in the public health officials," Gottlieb said. "They felt that guidance wasn't well informed, it wasn't well articulated, it wasn't distributed in a way that we could assimilate it into our lives."The viagra has highlighted the systemic bias in health-care facing people of color as well, Gottlieb said, including unequal access to erectile dysfunction treatment testing and technology. Improving the country's outbreak preparedness doesn't just entail bolstering the CDC and disease surveillance – it involves finding solutions for disparities in health-care and structural disadvantages permeating American society, Gottlieb said."If we're going to make ourselves more resilient going forward to these kinds of public health crises, we're going to have to address those inequities and do more to make sure that we're getting adequate health care to people who have historically been locked out of those opportunities," Gottlieb said.Disclosure.

Scott Gottlieb is a CNBC contributor and is a member of the boards of Pfizer, genetic testing start-up Tempus, health-care tech company Aetion and biotech company Illumina. He also serves as co-chair of Norwegian Cruise Line Holdings′ and Royal Caribbean's "Healthy Sail Panel.".

Dr where is better to buy viagra where is better to buy viagra. Scott Gottlieb, former Commissioner of the Food and Drug Administration, speaks during the Skybridge Capital SALT New York 2021 conference in New York City, U.S., September 15, 2021.Brendan McDermid where is better to buy viagra | ReutersFormer Food and Drug Administration Commissioner Dr. Scott Gottlieb said Monday that where is better to buy viagra U.S. Intelligence agencies should be tasked with investigating emerging public health threats overseas to combat future disease outbreaks.Gottlieb, who also sits on Pfizer's board, told CNBC's "Squawk Box" that the public has lost trust in U.S. Health agencies and called for more funding for the Centers for Disease Control and where is better to buy viagra Prevention.He said identifying problematic viagraes abroad and equipping the CDC with better crisis mitigation resources would improve the nation's ability to counter any new contagions that arise."I think going forward we're not going to just be able to depend on countries voluntarily sharing information," Gottlieb said in an appearance promoting his book, "Uncontrolled Spread." "We're going to have to go in and have the capacity to collect it and to monitor for these things, and that means getting our foreign intelligence services much more engaged in the public health mission globally."World Health Organization officials have said they weren't sure China disclosed all its data on erectile dysfunction treatment's origins.

Gottlieb suggested where is better to buy viagra that countries today are less forthcoming with disease details because they fear being isolated. He noted that the U.S. Has avoided bringing intelligence agencies into international public health issues because the CDC worried that "anyone wearing a white coat overseas would be perceived to where is better to buy viagra be a spy."CNBC Health &. Science Besides treating outbreaks as national security matters, Gottlieb where is better to buy viagra said the CDC was ill-prepared at the beginning of the viagra for the subsequent widespread rollout of erectile dysfunction treatment tests and treatments.The CDC's changing messaging around erectile dysfunction treatment prevention tactics also undermined the public's faith in the agency, Gottlieb said.But the proper resources, competencies and logistical management could help the CDC better handle public health emergencies, Gottlieb said. "I think coming out of this viagra, a lot of people have lost confidence in the public health officials," Gottlieb said.

"They felt that guidance wasn't well informed, it wasn't well articulated, it wasn't distributed in a way that we could assimilate it into our lives."The viagra has highlighted the systemic bias in health-care facing people of color as well, Gottlieb said, including unequal access to erectile dysfunction treatment testing and technology. Improving the country's outbreak preparedness doesn't just entail bolstering the CDC and disease surveillance – it involves finding solutions for disparities in health-care and structural disadvantages permeating American society, Gottlieb said."If we're going to make ourselves more resilient going forward to these kinds of public health crises, we're going to have to address those inequities and do more to make sure that we're getting adequate health care to people who have historically been locked out of those opportunities," Gottlieb said.Disclosure. Scott Gottlieb is a CNBC contributor and is a member of the boards of Pfizer, genetic testing start-up Tempus, health-care tech company Aetion and biotech company Illumina. He also serves as co-chair of Norwegian Cruise Line Holdings′ and Royal Caribbean's "Healthy Sail Panel.".

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Ted Billinger viagra mg Jr. Liked to joke that he would work until he died. That turned out to be prophetic viagra mg. When Billinger died of a heart attack in 2019 at age 71, he was still running Teddy B’s, the pharmacy his father had started more than 65 years earlier in Cheyenne Wells, Colorado.

With no other pharmacist to work at the store, prescriptions already counted out and sealed in bottles were suddenly locked away in a pharmacy that no one could enter. And Cheyenne Wells’ fewer than 800 residents were abruptly viagra mg left without a drugstore. Pharmacies were once routinely bequeathed from one generation to the next, but, in interviews with more than a dozen pharmacists, many said the pressure of running an independent drugstore have them pushing their offspring toward other careers. And when they search for a buyer, they often find that attracting new pharmacists, especially to rural settings, is difficult.

With a viagra mg large group of pharmacists nearing retirement age, more communities may lose their only drugstore. €œIt’s going to be harder to attract people and to pay them,” said David Kreling, a professor emeritus at the University of Wisconsin-Madison School of Pharmacy. €œIf there’s not a generational thing where someone can sit down with their son or daughter and say that they could take the store over, there’s a good chance that pharmacy will evaporate.” Tom Davis, Billinger’s friend and co-owner of Kiowa Drug in Eads, Colorado, stepped in to sort out the mess in Cheyenne Wells. With permission from the State Board of Pharmacy, viagra mg the county sheriff let Davis into Teddy B’s in the eastern Colorado town to take an inventory of the remaining drugs.

Customers who had dropped off their prescriptions before Billinger died were able to pick up their medications. Davis then bought the pharmacy from Billinger’s viagra mg estate. He runs it as a convenience store and six days a week delivers prescriptions to it from Eads, 44 miles away. €œBy the time you paid a pharmacist, the location there was borderline unprofitable,” Davis said.

Davis and viagra mg his brother co-own seven pharmacies and have started to plan for retirement by hiring five young pharmacists and allowing them to buy ownership stakes in those pharmacies over time.(Rachel Woolf for KHN) He has received numerous requests to open pharmacies in other eastern Colorado towns, but making that work financially would be difficult. Reimbursements from insurance plans have dwindled, and customer bases have eroded as health insurers push patients toward mail-order deliveries. €œI fill prescriptions every day where my reimbursement is less than the cost of the drug,” Davis said. €œIn other settings, you might tell a patient, ‘We don’t have that viagra mg in stock,’ or ‘Why don’t you go down the street to the chain?.

€™ But down here, we just take care of our patients, and we just eat it.” He can survive, he said, because, after 48 years, he no longer has any business debt. €œI look at my bottom line,” Davis said. €œWith the amount of profit that I had at the end of the year, viagra mg that would not have been enough if I was having to pay a mortgage.” A woman enters Teddy B’s in Cheyenne Wells, Colorado. (Rachel Woolf for KHN) Dia Giron, manager at Teddy B’s convenience store transfers prescriptions to a locked case after Kiowa Drug delivers them.

(Rachel Woolf for KHN) Studies have found the number of pharmacists nationally to be sufficient, even more than enough, to meet current needs, although viagra mg supply and demand don’t always line up. Finding pharmacists is more difficult in rural areas. €œOnce they get a taste of the big city,” Kreling said, “it’s hard to get them back to the farm.” Workforce data also shows worrisome trends. Concerns about a shortage of pharmacists viagra mg led the federal government to pour money into pharmacy schools in the 1970s, creating a temporary bump in the number of graduates.

The people in that bulge in the pharmacist pipeline have hit retirement age. €œMany of them owned independent pharmacies, and they were working in rural communities,” said University of Minnesota pharmacy professor Jon Schommer, who studies workforce issues. Now, as the demand for pharmacists to provide viagra mg testing and vaccinations during the erectile dysfunction treatment viagra increases, drugstore chains are offering incentives — such as large salaries, signing bonuses and help paying off school loans — that are often more enticing than anything a rural pharmacy could muster. Pharmacy technician Jess Sierra prepares prescriptions at Kiowa Drug in Eads, Colorado.

How pharmacy graduates envision their careers has also shifted. Many no longer want to own a pharmacy and are viagra mg content to work at pharmacy chains or other health care organizations, according to several pharmacy school professors. As of 2018, only about half of pharmacists worked in traditional retail drugstores. That makes rural viagra mg recruitment more difficult.

Denise Robins had worked at R&R Family Pharmacy in Springfield, Colorado, for 18 years when the owner retired. She and three family members bought the drugstore in a last-ditch effort to keep it open. €œNone of us viagra mg are pharmacists, so that made it a little tougher,” Robins said. €œWe just knew it was really going to make it hard for people here if they had to travel an hour to get to a pharmacy.” But finding a pharmacist to work in the southeastern Colorado town of fewer than 1,400 people was a challenge.

The first pharmacist Robins found commuted 48 miles one way from Lamar. But after a year and a half, viagra mg the trip became too much. She then hired someone who wanted to work for only a year, to make enough money to travel. Then Robins interviewed two University of Colorado pharmacy school graduates.

She hired one, but that didn’t viagra mg work out. So she called back the second candidate, who still had not found a permanent job. He had viagra mg two young kids, and he and his wife were working opposite schedules. He took the job two years ago and has remained there since.

I fill prescriptions every day where my reimbursement is less than the cost of the drug.Tom Davis In Berryville, Virginia, pharmacist Patricia White opened Battletown Pharmacy in 2011 because she wanted to carry on the family business. Her father had owned a local pharmacy and had recently died viagra mg. But when turning a profit with Battletown proved a struggle, White decided to retire. She lined up two potential buyers, but neither went through with the sale.

She then hoped to transfer the pharmacy to a recent graduate viagra mg but didn’t want to saddle him with a failing business. €œI told him he couldn’t make any money, and he said, ‘Thanks for being honest,’” White recalled. Closing seemed like the only palatable option. Battletown shut down at the end viagra mg of August.

€œI did not want to sell out to a chain,” she said. €œThat’s always been my mentality.” When a viagra mg chain buys a pharmacy, it doesn’t always decide to run it. Instead, it might close the pharmacy and transfer the pharmacy’s prescription files to one of its outlets. Retiring pharmacists who spent decades serving a community generally don’t want to see that happen, said David Zgarrick, a Northeastern University pharmacy professor.

€œThey’d like to sell their pharmacy to another pharmacist who would continue to run it very much in the same manner,” viagra mg he said. Some plan ahead, hiring another pharmacist and offering that person an equity stake in the business. Over time, the new pharmacist can buy out the owner. Many independent pharmacist-owners plan to live off the profits from selling their pharmacy, its inventory and its prescription viagra mg records.

€œTheir pharmacy is their retirement savings,” Zgarrick said. But, Zgarrick said, the added pressure from the viagra may be pushing more pharmacists into retirement. And a long-running viagra mg bull stock market may mean some pharmacists have enough in their retirement portfolios to call it quits without a sale. Davis talks with a pharmacy technician Jess Sierra at Kiowa Drug.

(Rachel Woolf for KHN) In Eads, Davis, 70, still loves being viagra mg a pharmacist. He and his brother co-own seven pharmacies and have started to plan for retirement by hiring five young pharmacists and allowing them to buy ownership stakes in those pharmacies over time. He had wondered how long he could keep the Kiowa pharmacy running, though. With fewer than 700 residents, Eads may be viagra mg the smallest town in Colorado with a pharmacy.

Combining Davis’ customer base with Cheyenne Wells’ may have saved pharmacy access for both communities. €œSo maybe where we could have lost two pharmacies in the area, we’ve been able to exist. We’re stronger now viagra mg than we had ever been,” Davis said. €œThat wasn’t the original plan.

We cared about those people and just wanted to take care of them.” Markian Hawryluk. MarkianH@kff.org, @MarkianHawryluk Related Topics viagra mg Contact Us Submit a Story TipGUNNISON, Colo. €” The night after Thanksgiving, a small ambulance service that covers a huge swath of southwestern Colorado got a call that a patient needed an emergency transfer from the hospital in Gunnison to a larger one with an intensive care unit 65 miles away in Montrose. The patient — a 78-year-old man — was experiencing atrial fibrillation, an irregular heartbeat that viagra mg usually isn’t life-threatening.

But for patients like this one with chronic health conditions, a history of cardiac issues and high blood pressure, the condition can cause a stroke or heart failure. Workers from Gunnison Valley Health Paramedics rolled the patient, who was on a gurney, out of the hospital and into the frigid night air. AnnieGrace Haddorff, the emergency medical technician on call, helped load the patient into the viagra mg ambulance and jumped into the driver’s seat. Paramedic Alec Newby got into the back and hooked the patient up to a blood pressure cuff.

A pulse oximeter, which measures heart rate and blood oxygen saturation. And an electrocardiogram, which records the heart’s electrical viagra mg activity. €œYour heart is obviously pissed off,” Newby told the man as the ECG confirmed the atrial fibrillation. The ambulance pulled onto U.S.

Highway 50 for the one-hour-and-15-minute drive past clusters of viagra mg homes among rolling hills of sagebrush, the expansive Blue Mesa Reservoir and the gaping Black Canyon of the Gunnison, with its craggy spires. The patient was stable enough for the long drive, which covered only a sliver of GVH Paramedics’ 4,400-square-mile service area. It is more than twice the size of Delaware and is the largest response zone for an ambulance service viagra mg in all of Colorado. A typical fire or emergency medical service response area ranges from 100 to 400 square miles.

Each time a patient must be transported to another medical facility, Gunnison Valley Health Paramedics is left with few vehicles to respond to emergencies in a coverage area more than twice the size of Delaware.(Helen Santoro for KHN) In recent years, interfacility transports or transfers, also known as IFTs, like this one have become increasingly common for GVH Paramedics, forcing the team to drive far outside its already vast zone. Before the viagra, the number of transfers rose because the population of Gunnison County was steadily increasing, more tourists were viagra mg being drawn to places like the popular Crested Butte ski resort, and GVH Paramedics had expanded its services to larger metropolitan hospitals outside Gunnison County. But now the team is being called to move patients more frequently, and greater distances, because the hospital beds in the relatively close cities of Montrose and Grand Junction are filled with erectile dysfunction treatment patients. The team is regularly required to drive patients to Denver, which is around three hours and 40 minutes from Gunnison.

Officials from the ambulance service worry that they might find themselves unable to respond to an emergency because their resources, which include six ambulances but only enough staff viagra mg to operate three of those vehicles, are tied up on a long-haul transfer. What were once 2½- or three-hour trips to Montrose are now far longer excursions, “and that takes resources from this community,” said CJ Malcolm, chief of emergency services. €œWe were doing that pre-erectile dysfunction treatment, but now the state is so impacted, it’s like a daily part of our lives.” Before the viagra, all the ambulances would be simultaneously out on 911 calls or IFTs less than 10 times a year. Now, Malcolm viagra mg said, it is happening with greater frequency.

In those cases, GVH Paramedics leans on the emergency response team in Crested Butte, about 28 miles from Gunnison, or the response to the patient is delayed. In 2018, GVH Paramedics made viagra mg 166 IFTs, requiring nearly 40,000 miles of travel and a total of 987 hours of ambulance operation, according to data collected by the team. Last year concluded with 260 IFTs, over 70,000 miles of travel and a total of 1,486 hours of ambulance operation. That’s a 50% increase in time on the road.

€œAnytime we have one or two ambulances out on an IFT, this leaves a massive tract of land viagra mg with only one ambulance to respond,” Malcolm said. €œThis is a moderately terrifying position to be put into when we can easily have two or three 911 calls in a row.” In August, for example, Gunnison Valley Health hospital transferred more than 60 patients, 37 of whom were transported by GVH Paramedics. That means that at least once a day that month, a GVH Paramedics crew was taking a patient out of town, Malcolm said. And if crew members aren’t scheduled to be back viagra mg in Gunnison by 1 a.m., they must spend the night in a hotel to avoid driving along treacherous mountain roads while overly tired.

GVH Paramedics’ service area covers almost all of Gunnison County, a large portion of Saguache County and sections of Montrose and Hinsdale counties. It contains mountain ranges, canyons and wide expanses of high desert. With around 6,600 full-time residents viagra mg and a university, Gunnison is the largest town the team serves. The surrounding towns — including Tin Cup, Pitkin and Ohio City — are villages with a couple of hundred people or former mining towns where the artifacts from the boom times outnumber the residents.

The Nov viagra mg. 26 drive to Montrose took the Gunnison Valley Health Paramedics team an hour and 15 minutes. (Helen Santoro for KHN) GVH Paramedics’ 21 full-time staff members and 10 to 20 individuals who work as needed have certifications in wildland firefighting and backcountry medicine skills, including swift-water, ice and avalanche rescue. To deal with the increased demands from IFTs, they have added an extra staff member to each shift, and off-duty staffers viagra mg are being called in to assist.

As the viagra drags on, the number of IFTs will probably continue to increase. By mid-November, the number of people in the hospital with erectile dysfunction treatment in Colorado was staggeringly high, approaching the December 2020 peak of 1,847. Hospitalizations remained above viagra mg 1,500 through the end of the month. As a result, 93% of the state’s acute care hospital beds and 94% of ICU beds were being used as of Nov.

30, according to data from the Colorado Department of Public Health and Environment. €œI don’t viagra mg think we see the capacity concerns easing anytime soon,” said Cara Welch, senior director of communications at the Colorado Hospital Association. Adding to the strain are people seeking care they delayed because of the viagra and other respiratory viagraes, such as respiratory syncytial viagra, circulating in the state, Welch said. Kelly Thompson, chief of operations of CareFlight of the Rockies, an air ambulance service viagra mg that operates in Colorado and other parts of the West, agreed with this assessment.

€œWe’ve already been transporting large numbers of kids with RSV that are sick, and you have erectile dysfunction treatment on top of all of this,” Thompson said. €œIt’s a big concern. This is the time when we have a lot of sick people.” viagra mg In early November, to manage escalating concerns about hospital capacity, Colorado hospitals and health systems activated tier 3 of the state's patient transfer system — the highest level. That means erectile dysfunction treatment and non-erectile dysfunction treatment patients can be moved without their consent from a hospital that doesn’t have enough capacity to one with more space.

Hospitals can also send sicker patients to medical centers with more specialized care. As the GVH Paramedics crew members approached Montrose with their patient over the recent holiday weekend, Newby viagra mg called the hospital to let the staff know they were arriving. They pulled up to the emergency room entrance, and Newby and Haddorff rolled the patient into a hospital room. The Montrose hospital staff took over, moving the patient from the gurney to a hospital bed as Newby updated them on the patient’s medical records.

Soon they were back in the ambulance, headed for viagra mg home. €œIFTs can be stressful,” said Haddorff as she maneuvered the twisty mountain road bathed in moonlight. Related Topics Contact Us Submit a Story Tip.

Ted Billinger where is better to buy viagra Jr. Liked to joke that he would work until he died. That turned where is better to buy viagra out to be prophetic. When Billinger died of a heart attack in 2019 at age 71, he was still running Teddy B’s, the pharmacy his father had started more than 65 years earlier in Cheyenne Wells, Colorado.

With no other pharmacist to work at the store, prescriptions already counted out and sealed in bottles were suddenly locked away in a pharmacy that no one could enter. And Cheyenne Wells’ fewer than 800 residents were abruptly where is better to buy viagra left without a drugstore. Pharmacies were once routinely bequeathed from one generation to the next, but, in interviews with more than a dozen pharmacists, many said the pressure of running an independent drugstore have them pushing their offspring toward other careers. And when they search for a buyer, they often find that attracting new pharmacists, especially to rural settings, is difficult.

With a large group of pharmacists nearing retirement age, more communities where is better to buy viagra may lose their only drugstore. €œIt’s going to be harder to attract people and to pay them,” said David Kreling, a professor emeritus at the University of Wisconsin-Madison School of Pharmacy. €œIf there’s not a generational thing where someone can sit down with their son or daughter and say that they could take the store over, there’s a good chance that pharmacy will evaporate.” Tom Davis, Billinger’s friend and co-owner of Kiowa Drug in Eads, Colorado, stepped in to sort out the mess in Cheyenne Wells. With permission from the State Board of Pharmacy, the county sheriff let Davis into Teddy where is better to buy viagra B’s in the eastern Colorado town to take an inventory of the remaining drugs.

Customers who had dropped off their prescriptions before Billinger died were able to pick up their medications. Davis then bought the pharmacy from Billinger’s where is better to buy viagra estate. He runs it as a convenience store and six days a week delivers prescriptions to it from Eads, 44 miles away. €œBy the time you paid a pharmacist, the location there was borderline unprofitable,” Davis said.

Davis and his brother co-own seven pharmacies and have started to plan for retirement by hiring five young pharmacists and allowing them to buy ownership stakes in those pharmacies over time.(Rachel where is better to buy viagra Woolf for KHN) He has received numerous requests to open pharmacies in other eastern Colorado towns, but making that work financially would be difficult. Reimbursements from insurance plans have dwindled, and customer bases have eroded as health insurers push patients toward mail-order deliveries. €œI fill prescriptions every day where my reimbursement is less than the cost of the drug,” Davis said. €œIn other settings, you might tell where is better to buy viagra a patient, ‘We don’t have that in stock,’ or ‘Why don’t you go down the street to the chain?.

€™ But down here, we just take care of our patients, and we just eat it.” He can survive, he said, because, after 48 years, he no longer has any business debt. €œI look at my bottom line,” Davis said. €œWith the amount of profit that I had at the end of the year, that would not have been enough if I was having to where is better to buy viagra pay a mortgage.” A woman enters Teddy B’s in Cheyenne Wells, Colorado. (Rachel Woolf for KHN) Dia Giron, manager at Teddy B’s convenience store transfers prescriptions to a locked case after Kiowa Drug delivers them.

(Rachel Woolf for KHN) Studies have found the number of pharmacists nationally to be sufficient, even more where is better to buy viagra than enough, to meet current needs, although supply and demand don’t always line up. Finding pharmacists is more difficult in rural areas. €œOnce they get a taste of the big city,” Kreling said, “it’s hard to get them back to the farm.” Workforce data also shows worrisome trends. Concerns about a shortage of pharmacists where is better to buy viagra led the federal government to pour money into pharmacy schools in the 1970s, creating a temporary bump in the number of graduates.

The people in that bulge in the pharmacist pipeline have hit retirement age. €œMany of them owned independent pharmacies, and they were working in rural communities,” said University of Minnesota pharmacy professor Jon Schommer, who studies workforce issues. Now, as the demand for pharmacists to provide testing and vaccinations during the erectile dysfunction treatment viagra increases, drugstore chains are offering incentives — such as large salaries, signing bonuses and help paying off school where is better to buy viagra loans — that are often more enticing than anything a rural pharmacy could muster. Pharmacy technician Jess Sierra prepares prescriptions at Kiowa Drug in Eads, Colorado.

How pharmacy graduates envision their careers has also shifted. Many no longer want to own a pharmacy and are content to work at pharmacy chains or other health where is better to buy viagra care organizations, according to several pharmacy school professors. As of 2018, only about half of pharmacists worked in traditional retail drugstores. That makes rural recruitment more where is better to buy viagra difficult.

Denise Robins had worked at R&R Family Pharmacy in Springfield, Colorado, for 18 years when the owner retired. She and three family members bought the drugstore in a last-ditch effort to keep it open. €œNone of us where is better to buy viagra are pharmacists, so that made it a little tougher,” Robins said. €œWe just knew it was really going to make it hard for people here if they had to travel an hour to get to a pharmacy.” But finding a pharmacist to work in the southeastern Colorado town of fewer than 1,400 people was a challenge.

The first pharmacist Robins found commuted 48 miles one way from Lamar. But after a year and a half, the where is better to buy viagra trip became too much. She then hired someone who wanted to work for only a year, to make enough money to travel. Then Robins interviewed two University of Colorado pharmacy school graduates.

She hired one, where is better to buy viagra but that didn’t work out. So she called back the second candidate, who still had not found a permanent job. He had two young kids, and he and his wife where is better to buy viagra were working opposite schedules. He took the job two years ago and has remained there since.

I fill prescriptions every day where my reimbursement is less than the cost of the drug.Tom Davis In Berryville, Virginia, pharmacist Patricia White opened Battletown Pharmacy in 2011 because she wanted to carry on the family business. Her father where is better to buy viagra had owned a local pharmacy and had recently died. But when turning a profit with Battletown proved a struggle, White decided to retire. She lined up two potential buyers, but neither went through with the sale.

She then hoped to transfer the pharmacy to a recent graduate but didn’t want to saddle him with where is better to buy viagra a failing business. €œI told him he couldn’t make any money, and he said, ‘Thanks for being honest,’” White recalled. Closing seemed like the only palatable option. Battletown shut down at the end of where is better to buy viagra August.

€œI did not want to sell out to a chain,” she said. €œThat’s always been my mentality.” When a chain buys a pharmacy, it doesn’t always decide to run where is better to buy viagra it. Instead, it might close the pharmacy and transfer the pharmacy’s prescription files to one of its outlets. Retiring pharmacists who spent decades serving a community generally don’t want to see that happen, said David Zgarrick, a Northeastern University pharmacy professor.

€œThey’d like to sell their pharmacy to another pharmacist who would continue to run it very where is better to buy viagra much in the same manner,” he said. Some plan ahead, hiring another pharmacist and offering that person an equity stake in the business. Over time, the new pharmacist can buy out the owner. Many independent pharmacist-owners plan to live off the profits where is better to buy viagra from selling their pharmacy, its inventory and its prescription records.

€œTheir pharmacy is their retirement savings,” Zgarrick said. But, Zgarrick said, the added pressure from the viagra may be pushing more pharmacists into retirement. And a long-running bull stock market may mean some pharmacists have where is better to buy viagra enough in their retirement portfolios to call it quits without a sale. Davis talks with a pharmacy technician Jess Sierra at Kiowa Drug.

(Rachel Woolf for KHN) In Eads, Davis, 70, still loves where is better to buy viagra being a pharmacist. He and his brother co-own seven pharmacies and have started to plan for retirement by hiring five young pharmacists and allowing them to buy ownership stakes in those pharmacies over time. He had wondered how long he could keep the Kiowa pharmacy running, though. With fewer than 700 residents, Eads may be the smallest town where is better to buy viagra in Colorado with a pharmacy.

Combining Davis’ customer base with Cheyenne Wells’ may have saved pharmacy access for both communities. €œSo maybe where we could have lost two pharmacies in the area, we’ve been able to exist. We’re stronger now than we where is better to buy viagra had ever been,” Davis said. €œThat wasn’t the original plan.

We cared about those people and just wanted to take care of them.” Markian Hawryluk. MarkianH@kff.org, @MarkianHawryluk Related Topics Contact Us Submit a Story where is better to buy viagra TipGUNNISON, Colo. €” The night after Thanksgiving, a small ambulance service that covers a huge swath of southwestern Colorado got a call that a patient needed an emergency transfer from the hospital in Gunnison to a larger one with an intensive care unit 65 miles away in Montrose. The patient — a 78-year-old man — was experiencing atrial fibrillation, an irregular heartbeat that usually isn’t where is better to buy viagra life-threatening.

But for patients like this one with chronic health conditions, a history of cardiac issues and high blood pressure, the condition can cause a stroke or heart failure. Workers from Gunnison Valley Health Paramedics rolled the patient, who was on a gurney, out of the hospital and into the frigid night air. AnnieGrace Haddorff, the emergency medical technician on call, helped load the patient into the ambulance and jumped where is better to buy viagra into the driver’s seat. Paramedic Alec Newby got into the back and hooked the patient up to a blood pressure cuff.

A pulse oximeter, which measures heart rate and blood oxygen saturation. And an where is better to buy viagra electrocardiogram, which records the heart’s electrical activity. €œYour heart is obviously pissed off,” Newby told the man as the ECG confirmed the atrial fibrillation. The ambulance pulled onto U.S.

Highway 50 for the one-hour-and-15-minute drive past clusters of homes among rolling hills of sagebrush, the expansive Blue where is better to buy viagra Mesa Reservoir and the gaping Black Canyon of the Gunnison, with its craggy spires. The patient was stable enough for the long drive, which covered only a sliver of GVH Paramedics’ 4,400-square-mile service area. It is more than twice the size of Delaware and is the largest response zone for an ambulance service in all of where is better to buy viagra Colorado. A typical fire or emergency medical service response area ranges from 100 to 400 square miles.

Each time a patient must be transported to another medical facility, Gunnison Valley Health Paramedics is left with few vehicles to respond to emergencies in a coverage area more than twice the size of Delaware.(Helen Santoro for KHN) In recent years, interfacility transports or transfers, also known as IFTs, like this one have become increasingly common for GVH Paramedics, forcing the team to drive far outside its already vast zone. Before the viagra, the number of transfers rose because the population of Gunnison County was steadily increasing, more tourists were being drawn to places like the popular Crested Butte ski resort, and GVH Paramedics had expanded where is better to buy viagra its services to larger metropolitan hospitals outside Gunnison County. But now the team is being called to move patients more frequently, and greater distances, because the hospital beds in the relatively close cities of Montrose and Grand Junction are filled with erectile dysfunction treatment patients. The team is regularly required to drive patients to Denver, which is around three hours and 40 minutes from Gunnison.

Officials from the ambulance service worry that they might find themselves unable to respond to an emergency because their resources, which include six ambulances where is better to buy viagra but only enough staff to operate three of those vehicles, are tied up on a long-haul transfer. What were once 2½- or three-hour trips to Montrose are now far longer excursions, “and that takes resources from this community,” said CJ Malcolm, chief of emergency services. €œWe were doing that pre-erectile dysfunction treatment, but now the state is so impacted, it’s like a daily part of our lives.” Before the viagra, all the ambulances would be simultaneously out on 911 calls or IFTs less than 10 times a year. Now, Malcolm said, it is happening with where is better to buy viagra greater frequency.

In those cases, GVH Paramedics leans on the emergency response team in Crested Butte, about 28 miles from Gunnison, or the response to the patient is delayed. In 2018, GVH Paramedics made 166 IFTs, requiring nearly 40,000 miles of travel and where is better to buy viagra a total of 987 hours of ambulance operation, according to data collected by the team. Last year concluded with 260 IFTs, over 70,000 miles of travel and a total of 1,486 hours of ambulance operation. That’s a 50% increase in time on the road.

€œAnytime we have one or two ambulances out where is better to buy viagra on an IFT, this leaves a massive tract of land with only one ambulance to respond,” Malcolm said. €œThis is a moderately terrifying position to be put into when we can easily have two or three 911 calls in a row.” In August, for example, Gunnison Valley Health hospital transferred more than 60 patients, 37 of whom were transported by GVH Paramedics. That means that at least once a day that month, a GVH Paramedics crew was taking a patient out of town, Malcolm said. And if crew members aren’t scheduled to be back in Gunnison by 1 a.m., they must spend the night in a hotel to avoid driving where is better to buy viagra along treacherous mountain roads while overly tired.

GVH Paramedics’ service area covers almost all of Gunnison County, a large portion of Saguache County and sections of Montrose and Hinsdale counties. It contains mountain ranges, canyons and wide expanses of high desert. With around 6,600 full-time residents and a university, Gunnison is the largest town the team serves where is better to buy viagra. The surrounding towns — including Tin Cup, Pitkin and Ohio City — are villages with a couple of hundred people or former mining towns where the artifacts from the boom times outnumber the residents.

The Nov where is better to buy viagra. 26 drive to Montrose took the Gunnison Valley Health Paramedics team an hour and 15 minutes. (Helen Santoro for KHN) GVH Paramedics’ 21 full-time staff members and 10 to 20 individuals who work as needed have certifications in wildland firefighting and backcountry medicine skills, including swift-water, ice and avalanche rescue. To deal with the increased demands from IFTs, they have added an where is better to buy viagra extra staff member to each shift, and off-duty staffers are being called in to assist.

As the viagra drags on, the number of IFTs will probably continue to increase. By mid-November, the number of people in the hospital with erectile dysfunction treatment in Colorado was staggeringly high, approaching the December 2020 peak of 1,847. Hospitalizations remained where is better to buy viagra above 1,500 through the end of the month. As a result, 93% of the state’s acute care hospital beds and 94% of ICU beds were being used as of Nov.

30, according to data from the Colorado Department of Public Health and Environment. €œI don’t think we see the capacity concerns easing anytime soon,” said Cara Welch, senior director where is better to buy viagra of communications at the Colorado Hospital Association. Adding to the strain are people seeking care they delayed because of the viagra and other respiratory viagraes, such as respiratory syncytial viagra, circulating in the state, Welch said. Kelly Thompson, chief of operations of CareFlight of the Rockies, an air ambulance service that operates in Colorado and other parts where is better to buy viagra of the West, agreed with this assessment.

€œWe’ve already been transporting large numbers of kids with RSV that are sick, and you have erectile dysfunction treatment on top of all of this,” Thompson said. €œIt’s a big concern. This is the time when we have a lot of sick people.” In early November, to manage escalating concerns about hospital capacity, Colorado hospitals and health systems activated tier 3 where is better to buy viagra of the state's patient transfer system — the highest level. That means erectile dysfunction treatment and non-erectile dysfunction treatment patients can be moved without their consent from a hospital that doesn’t have enough capacity to one with more space.

Hospitals can also send sicker patients to medical centers with more specialized care. As the GVH Paramedics crew members approached Montrose with their patient over the recent holiday weekend, Newby called the hospital to let the staff know they were arriving. They pulled up to the emergency room entrance, and Newby and Haddorff rolled the patient into a hospital room. The Montrose hospital staff took over, moving the patient from the gurney to a hospital bed as Newby updated them on the patient’s medical records.

Soon they were back in the ambulance, headed for home. €œIFTs can be stressful,” said Haddorff as she maneuvered the twisty mountain road bathed in moonlight. Related Topics Contact Us Submit a Story Tip.

What is the normal dose of viagra

NCHS Data what is the normal dose of viagra Brief No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep what is the normal dose of viagra is associated with an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2).

Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the loss of ovarian what is the normal dose of viagra activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status.

The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and what is the normal dose of viagra 22.1% are postmenopausal. Keywords.

Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, what is the normal dose of viagra in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 what is the normal dose of viagra. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend what is the normal dose of viagra by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle what is the normal dose of viagra and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for what is the normal dose of viagra Figure 1pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 what is the normal dose of viagra had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 what is the normal dose of viagra. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant what is the normal dose of viagra linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 what is the normal dose of viagra year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for what is the normal dose of viagra Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of what is the normal dose of viagra women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 what is the normal dose of viagra. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image what is the normal dose of viagra icon1Significant linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if what is the normal dose of viagra they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data what is the normal dose of viagra table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did what is the normal dose of viagra not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 what is the normal dose of viagra. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories.

Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status.

A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €.

2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?.

€Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?. €Trouble falling asleep.

Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone.

Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option.

Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454.

2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB. Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50.

2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N.

Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9.

2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.

J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International.

SUDAAN (Release 11.0.0) [computer software]. 2012. Suggested citationVahratian A.

Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD.

National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

NCHS Data where is better to buy viagra http://knutson-law-firm.com/levitra-price-australia/ Brief No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an where is better to buy viagra increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2).

Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the where is better to buy viagra loss of ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status.

The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and where is better to buy viagra 22.1% are postmenopausal. Keywords.

Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than where is better to buy viagra one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 where is better to buy viagra. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by where is better to buy viagra menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less where is better to buy viagra.

Women were premenopausal if they still had a menstrual cycle. Access data where is better to buy viagra table for Figure 1pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling where is better to buy viagra asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 where is better to buy viagra. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear where is better to buy viagra trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or where is better to buy viagra less.

Women were premenopausal if they still had a menstrual cycle. Access data where is better to buy viagra table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage where is better to buy viagra of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 where is better to buy viagra. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status where is better to buy viagra (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a where is better to buy viagra menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for where is better to buy viagra Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women where is better to buy viagra in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 where is better to buy viagra. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories.

Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status.

A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €.

2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?.

€Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?. €Trouble falling asleep.

Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone.

Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option.

Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454.

2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB. Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50.

2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N.

Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9.

2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.

J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International.

SUDAAN (Release 11.0.0) [computer software]. 2012. Suggested citationVahratian A.

Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD.

National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

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