Erectile Dysfunction

We studied subjects enrolled at twelve U.S. Neurology centers specializing in Movement and/or Autonomic disorders in an observational and risk factor study of MSA.^{16 (link)} Subjects were followed biannually. All centers obtained Institutional Review Board approval. All subjects provided written informed consent and met Consensus Criteria for probable MSA.^{5 (link), 6 (link)} Each investigator reviewed an UMSARS training video prior to enrolling subjects to ensure scoring consistency across sites. One hundred and seventy five subjects completed a baseline evaluation and were followed every 6 months thereafter for 5 years for available subjects. To minimize problems associated with delayed recall, we provided inclusion/exclusion criteria for both diagnosis and symptoms. Baseline assessments were completed at the study facility and annually onsite thereafter. Questionnaires were sent via mail to subjects at the 6, 18, 30, 42, and 54 month time points; telephone interviews were completed by the enrolling physician to gather UMSARS data if the questionnaire data were not returned.
We followed Consensus criteria^{5 (link), 6 (link)} for inclusion and exclusion of MSA and for designation of MSA-P and MSA-C. The full inclusion/exclusion criteria are provided in appendix A. Subjects were classified by MSA subtype based on study examinations, medical records and, as needed, information from the treating physician. Subjects were categorized as MSA-P if they exhibited parkinsonism but no cerebellar features and in whom parkinsonism preceded cerebellar signs by at least one year. For subjects with both cerebellar and parkinsonism, we designated them by onset of first symptom (ataxia or symptoms of parkinsonism). Onset of first symptom was determined from the EMSA-SG minimal data set which details patient symptoms and date of onset to the nearest month when these symptoms first developed. If the dates were not reported by patients, or they had difficulty with recalling onset, we resorted to other sources including relatives, spouses, and medical history to determine the date of onset. MSA-C subjects were defined as those with predominant cerebellar signs but minimal or no parkinsonism in whom cerebellar signs preceded parkinsonism by at least one year. Subjects with severe symptomatic autonomic failure were defined as orthostatic fall in blood pressure (by 30 mm Hg systolic or 15 mm Hg diastolic) or urinary incontinence (accompanied by erectile dysfunction in men) or both. Levodopa responsiveness was defined as a significant and sustained improvement in motor function observed by the patient after drug administration.

The study will be carried out in 16 primary care health centres in the Region of Madrid.
It will include participants aged 18 or older, with a diagnosis of venous ulcer recorded in the electronic medical record (ABI greater than 0.8 and less than 1.3; diameter of the lesion greater than or equal to 1 cm) and under treatment in primary care nursing consultations. The individuals must be able to walk with or without the aid of devices, understand and answer the questionnaires autonomously, be accessible throughout the duration of the study and have expressed their agreement to participate and signed the consent form.
Those who are unable to commute to the health centre, or who reside outside the area where the research is carried out for more than 6 months per year, will be excluded. People with mixed ulcers, deep vein thrombosis (DVT) in acute phase, decompensated heart failure, dermatitis in acute phase, rheumatoid arthritis, undergoing treatment with antineoplastic drugs or with some absolute contraindication for physical exercise will also be excluded.
Withdrawal criteria are set for patients who, during the course of the trial, present a change in their clinical condition that prevents them from further participation, such as inflammation of the locomotor system (with heat, flushing, pain and functional impotence) or trauma due to a fall during the course of program with or without fracture and/or haematoma at both joint and soft tissue level (muscle and tendons) [24 ], must drop out of the study.

Knowledge of smoking-related diseases was measured by four “yes/no” questions regarding the following: Whether smoking causes heart disease, emphysema, gastric carcinoma and impotence (26 ). Choosing “yes” gets 1 point in each option while choosing “no” gets 0 point. The sum of the scores of all questions ranged from zero to four.