Use Of Cane Research Articles

Effects of Cane Use on Accuracy of Step Length Adjustment during Walking

Effects of Cane Use on Accuracy of Step Length Adjustment during Walking

Cane Use in Patients with Parkinson’s Disease

Cane Use in Patients with Parkinson’s Disease

Haptic Cues for Balance: Use of a Cane Provides Immediate Body Stabilization.

Haptic cues are important for balance. Knowledge of the temporal features of their effect may be crucial for the design of neural prostheses. Touching a stable surface with a fingertip reduces body sway in standing subjects eyes closed (EC), and removal of haptic cue reinstates a large sway pattern. Changes in sway occur rapidly on changing haptic conditions. Here, we describe the effects and time-course of stabilization produced by a haptic cue derived from a walking cane. We intended to confirm that cane use reduces body sway, to evaluate the effect of vision on stabilization by a cane, and to estimate the delay of the changes in body sway after addition and withdrawal of haptic input. Seventeen healthy young subjects stood in tandem position on a force platform, with eyes closed or open (EO). They gently lowered the cane onto and lifted it from a second force platform. Sixty trials per direction of haptic shift (Touch → NoTouch, T-NT; NoTouch → Touch, NT-T) and visual condition (EC-EO) were acquired. Traces of Center of foot Pressure (CoP) and the force exerted by cane were filtered, rectified, and averaged. The position in space of a reflective marker positioned on the cane tip was also acquired by an optoelectronic device. Cross-correlation (CC) analysis was performed between traces of cane tip and CoP displacement. Latencies of changes in CoP oscillation in the frontal plane EC following the T-NT and NT-T haptic shift were statistically estimated. The CoP oscillations were larger in EC than EO under both T and NT (p < 0.001) and larger during NT than T conditions (p < 0.001). Haptic-induced effect under EC (Romberg quotient NT/T ~ 1.2) was less effective than that of vision under NT condition (EC/EO ~ 1.5) (p < 0.001). With EO cane had little effect. Cane displacement lagged CoP displacement under both EC and EO. Latencies to changes in CoP oscillations were longer after addition (NT-T, about 1.6 s) than withdrawal (T-NT, about 0.9 s) of haptic input (p < 0.001). These latencies were similar to those occurring on fingertip touch, as previously shown. Overall, data speak in favor of substantial equivalence of the haptic information derived from both “direct” fingertip contact and “indirect” contact with the floor mediated by the cane. Cane, finger and visual inputs would be similarly integrated in the same neural centers for balance control. Haptic input from a walking aid and its processing time should be considered when designing prostheses for locomotion.

The Effect of Cane Use on Attentional Demands During Walking

ABSTRACTWe investigated the effects of cane use, lateral walking stability, and cane use practice on attentional demands during walking. Attentional demands were assessed using dual-task methodology with a reaction time (RT) task. Sixteen healthy young subjects performed the RT task during walking, before and after cane use practice under four conditions: with/without cane use while wearing normal/unstable shoes. Among normal shoe conditions, cane use resulted in longer RTs. In contrast, RTs were similar regardless of cane use in the unstable shoe conditions. Among conditions without cane use, unstable shoes resulted in longer RTs. In contrast, RTs were similar regardless of shoe type in the cane use conditions. This study suggests that using a cane during walking requires additional attention; however, the resulting attentional demands depend on walking stability.

USO DE BASTÓN Y CAÍDAS EN ADULTOS MAYORES CHILENOS DE LA COMUNIDAD

Aim: To describe the characteristics of cane use and prevalence of falls in community-dwelling older adults who have received technical assistance in a Family Health Center. Method: Quantitative, descriptive and crosssectional study. Sample consisted of 64 older adults between 60 and 94 years of age. A questionnaire addressing socio-demographics, health, cane use and fall-related information was used to collect the data. Statistical analysis was performed with SPSS. An informed consent form was delivered and designed in compliance with Chile’s guidelines on research and confidentiality of information. Results: 95.3% of participants reported knowing the motives for cane use; 7.8% use a cane while walking within home; 45.3% use a cane while walking outdoors; 46.9% use a cane to walk anywhere; and 48.4% said that they do not like to use the cane. The prevalence of falls in the last six months was 73%; 61% of those who have fallen were not using a cane when they fell, and 94% expressed fear of falling. Conclusion: The findings show that a high percentage of older adults is not using a cane, and therefore the ultimate goal of delivering mobility devices is not being achieved. Cane use evaluation and education should be considered as an older adults’ health control measure.

The current potential of low-carbon economy and biomass-based electricity in Cuba. The case of sugarcane, energy cane and marabu (Dichrostachys cinerea) as biomass sources

The emissions of greenhouse gases stand as a major threat of today. Moving towards CO2 neutral or low-carbon economies is a need to achieve sustainable development. This study assesses the potentialities to move Cuba towards a low-carbon economy by replacing the current electricity mix, dominated by fossil fuel based electricity generation, with biomass-based electricity generation. Because of their significant potential, the study focusses on the use of sugarcane, energy cane and marabu (dichrostachys cinerea) based biomass. Results show that biomass can support over 97% of the electricity generation planned by the Cuban government for 2030. Replacing fossil fuel based electricity with biomass-based electricity today potentially reduces up to 81% of the greenhouse gas emissions as compared to the emission levels of 2012. Implementing biomass-based electricity generation in Cuba can also reduce the costs of electricity generation by 1–30% (depending on the market price of fossil fuels).

Risk factors for unintentional injuries among the rural elderly: a county-based cross-sectional survey

This study aimed to provide evidence for the prevention and reduction of unintentional injuries in the rural elderly by analysing epidemiological data of injuries among rural older adults (65+) and identifying the involved risk and protective factors. This study analysed all information, including the social demographic characteristics, chronic disease condition, lifestyle, living environment, mental health, activities of daily living and detailed information about the nature of the injuries. Chi-square tests, rank tests and a multivariate logistic regression were performed. The prevalence of unintentional injuries was 44.4%; according to the multivariate regression analysis, ten variables, including gender, floor tiles, cane use, sleeping duration, roughage intake frequency, mental health status, diabetes, arthritis and cataracts, were involved in the injury patterns. Low roughage intake (OR = 2.34, 95% CI 1.64–3.35), the use of a cane (OR = 1.78, 95% CI 1.31–2.41), a sleeping duration of five hours (OR = 1.75, 95% CI 1.27–2.42) and severe mental disorders (OR = 1.61, 95% CI 1.01–2.57) were the top 4 risk factors. In conclusion, we found that unintentional injuries among the rural elderly were closely related to chronic disease, mental health and residence environment. These findings could be beneficial for the prevention of unintentional injuries and for policy makers and health service managers.

Use of echolocation and long cane for obstacle avoidance during walking: Effects of visual impairment and echolocation expertise

Use of echolocation and long cane for obstacle avoidance during walking: Effects of visual impairment and echolocation expertise

Examination of a Guidance Robot for Visually Impaired People

We are developing the robot in order to guide visually impaired persons in large hospitals. This paper describes the structure of the robot and the results of a demonstration examination in Kanagawa Rehabilitation Hospital, Japan. The robot navigates to the destination while steering, depending on the force with which the user pushes on the robot. The success rate for reaching a destination with the robot was higher than with a white cane in the testing at Kanagawa Rehabilitation Hospital. We evaluated the traveling time and the participant questionnaire as an endpoint by Wilcoxon signed-rank test. Though there is no advantage in traveling time between use of the white cane and the robot, according to the scores of the participants questionnaire, it was shown that traveling with the robot was better than traveling with the white cane for the participants.

P349 Assessment of prevalence and risk factors for carpal tunnel syndrome in polio survivors

Objective Carpal tunnel syndrome (CTS) is a commonly reported nerve entrapment syndrome in patients with chronic physical disabilities. It causes disability independent of underlying disease. In this study, we aimed to identify prevalence and risk factors for CTS in polio survivors. Methods Based on clinical and electrophysiological findings, 46 patients with prior paralytic poliomyelitis were selected from patients referred to clinical neurophysiology laboratory. The CTS was classified according to the severity of nerve conduction (NC) changes. Demographic factors, medical history, crutch or cane use, post-polio syndrome,body mass index (BMI), wrist index and Barthel index were compared between the polio survivors with CTS (CTS group) and without CTS (non-CTS group). A logistic regression analysis was conducted to evaluate odds ratio of different risk factors. Results Prevalence of CTS confirmed by NC studies in polio survivors was 43.4% (20 patient). Eighteen (45%), 12 (30%) and 2 (%5) hands had mild, moderate and severe CTS, respectively. The age, BMI and wrist index were higher in the CTS group than in the non-CTS group (p Discussion Our study confirms a high occurrence of CTS in polio survivors. Conclusions Body mass index may be associated with prevalent CTS in polio survivors. Significance Prevention of weight gain in polio survivors may reduce the risk of CTS.

Identifying the effects of using integrated haptic feedback for gait rehabilitation of stroke patients.

This paper evaluates the prospects of using a novel Integrated Haptic Feedback (IHF) system. IHF can provide over-ground gait training regimens for post-stroke ambulatory subjects. IHF system combines the use of a portable cane for kinesthetic feedback and a wearable vibrotactor array for tactile feedback. Continuous somatosensory input is aiforded to the users at the handle of cane; it serves the purpose of balance assurance at higher gait speeds. Besides, restricted use of upper limb for weight-bearing inspires the users to involve the paretic lower limbs more actively. Furthermore, tactile feedback contributes in enhancing the gait symmetry through afferent signal of vibration. Six post-stroke ambulatory individuals participated in walking trials to identity the effects of IHF system. Results indicate that while walking faster patients' body sway was not disturbed. Statistically significant increase was observed in temporal stance symmetry (p-value=0.02) and in paretic muscle (vastus medialis obliquus and semitendinosus) activation during stance phase (p-value<0.01). The IHF system can be a valuable tool to assist physical therapist in gait rehabilitation of post-stroke individuals.

Techno-economic analysis and climate change impacts of sugarcane biorefineries considering different time horizons

BackgroundEthanol production from lignocellulosic feedstocks (also known as 2nd generation or 2G ethanol process) presents a great potential for reducing both ethanol production costs and climate change impacts since agricultural residues and dedicated energy crops are used as feedstock. This study aimed at the quantification of the economic and environmental impacts considering the current and future scenarios of sugarcane biorefineries taking into account not only the improvements of the industrial process but also of biomass production systems. Technology assumptions and scenarios setup were supported by main companies and stakeholders, involved in the lignocellulosic ethanol production chain from Brazil and abroad. For instance, scenarios considered higher efficiencies and lower residence times for pretreatment, enzymatic hydrolysis, and fermentation (including pentoses fermentation); higher sugarcane yields; and introduction of energy cane (a high fiber variety of cane).ResultsEthanol production costs were estimated for different time horizons. In the short term, 2G ethanol presents higher costs compared to 1st generation (1G) ethanol. However, in the long term, 2G ethanol is more competitive, presenting remarkable lower production cost than 1G ethanol, even considering some uncertainties regarding technology and market aspects. In addition, environmental assessment showed that both 1G (in the medium and long term) and 2G ethanol can reduce climate change impacts by more than 80% when compared to gasoline.ConclusionsThis work showed the great potential of 2G ethanol production in terms of economic and environmental aspects. These results can support new research programs and public policies designed to stimulate both production and consumption of 2G ethanol in Brazil, accelerating the path along the learning curve. Some examples of mechanisms include: incentives to the establishment of local equipment and enzyme suppliers; and specific funding programs for the development and use of energy cane.

Vinasse biogas for energy generation in Brazil: An assessment of economic feasibility, energy potential and avoided CO2 emissions

Energy recovery from waste is one of the strategies that can assist the expansion of renewable energy in Brazil. Among the various types of waste, vinasse, which is a residue that contains a high organic load, originates from the sugarcane industry, which is a very important industry for the Brazilian economy. Due to high levels of sugarcane harvesting in the country and the production of large amounts of ethanol, vinasse is produced at high levels in Brazil. In this context, this paper presents an energy analysis of the avoided carbon dioxide emissions and economic viability associated with the combustion of biogas produced by the anaerobic digestion of the vinasse that results from the use of sugar cane planted in Brazil. Based on the literature review, data related to the process of biogas production from anaerobic digestion of the vinasse were collected and used for the calculation of the energy potential associated. The results show that to achieve economic viability for the use of this waste for energy, the following plantation areas would be required, considering their processed sugarcane equivalents: 14,580 ha (if considering the processing of sugarcane in attached plants), and 6000 ha (if considering the processing of sugarcane in autonomous plants). The total energy potential of this use may reach 3.26 TWhe/y, which represents 0.52% of all domestic energy consumption in 2014. The potential to avoid emissions from the same use could reach 1.9 Mt CO2/y, which is approximately 2.1% of the emissions for the whole industry in Brazil in 2014. These results demonstrate the environmental and energy benefits that can be obtained via power generation from biogas produced by the anaerobic digestion of vinasse and highlight the need to include the use of such residue for energy in expansion plans for the Brazilian energy matrix.

Impact of Cane Use on Bone Marrow Lesion Volume in People With Medial Knee Osteoarthritis (CUBA Trial).

No effective cure exists for knee osteoarthritis (OA). Low-burden self-management strategies that can slow disease progression are needed. Bone marrow lesions (BMLs) are a source of knee pain and accelerate cartilage loss. Importantly, they may be responsive to biomechanical off-loading treatments. The study objective is to investigate whether, in people with medial tibiofemoral OA, daily cane use for 12 weeks reduces the volume of medial tibiofemoral BMLs and improves pain, physical function, and health-related quality of life. This study will be an assessor-masked, 2-arm, parallel-group, multisite randomized controlled trial. The community will serve as the setting for this study. The study participants will be people who are 50 years old or older and have medial tibiofemoral OA and at least 1 medial tibiofemoral BML. The participants will be allocated to either the cane group (using a cane daily whenever walking for 12 weeks) or the control group (not using any gait aid for 12weeks). Outcomes will be measured at baseline and 13 weeks. The primary outcome will be total medial tibiofemoral BML volume measured from magnetic resonance imaging. Secondary outcomes will include BML volume of the medial tibia and/or femur, knee pain overall and on walking, physical function, participant-perceived global change, and health-related quality of life. Additional measures will include physical activity, cointerventions, adverse events, participation, participant demographics, cane training process measures and feasibility, barriers to and facilitators of cane use, and loss to follow-up. People who are morbidly obese will not be included because of difficulties with magnetic resonance imaging. The findings of this study will help to determine whether cane use can alter disease progression in people with medial tibiofemoral OA and/or influence clinical symptoms. This study may directly influence clinical guidelines for the management of knee OA.

Cost-utility of First-line Disease-modifying Treatments for Relapsing–Remitting Multiple Sclerosis

PurposeThis study evaluated the cost-effectiveness of first-line treatments of relapsing–remitting multiple sclerosis (RRMS) (dimethyl fumarate [DMF] 240 mg PO BID, teriflunomide 14 mg once daily, glatiramer acetate 20 mg SC once daily, interferon [IFN]-β1a 44 µg TIW, IFN-β1b 250 µg EOD, and IFN-β1a 30 µg IM QW) and best supportive care (BSC) in the health care payer setting in Finland. MethodsThe primary outcome was the modeled incremental cost-effectiveness ratio (ICER; €/quality-adjusted life-year [QALY] gained, 3%/y discounting). Markov cohort modeling with a 15-year time horizon was employed. During each 1-year modeling cycle, patients either maintained the Expanded Disability Status Scale (EDSS) score or experienced progression, developed secondary progressive MS (SPMS) or showed EDSS progression in SPMS, experienced relapse with/without hospitalization, experienced an adverse event (AE), or died. Patients׳ characteristics, RRMS progression probabilities, and standardized mortality ratios were derived from a registry of patients with MS in Finland. A mixed-treatment comparison (MTC) informed the treatment effects. Finnish EuroQol Five-Dimensional Questionnaire, Three-Level Version quality-of-life and direct-cost estimates associated with EDSS scores, relapses, and AEs were applied. Four approaches were used to assess the outcomes: cost-effectiveness plane and efficiency frontiers (relative value of efficient treatments); cost-effectiveness acceptability frontier, which demonstrated optimal treatment to maximize net benefit; Bayesian treatment ranking (BTR); and an impact investment assessment (IIA; a cost-benefit assessment), which increased the clinical interpretation and appeal of modeled outcomes in terms of absolute benefit gained with fixed drug-related budget. Robustness of results was tested extensively with sensitivity analyses. FindingsBased on the modeled results, teriflunomide was less costly, with greater QALYs, versus glatiramer acetate and the IFNs. Teriflunomide had the lowest ICER (24,081) versus BSC. DMF brought marginally more QALYs (0.089) than did teriflunomide, with greater costs over the 15 years. The ICER for DMF versus teriflunomide was 75,431. Teriflunomide had >50% cost-effectiveness probabilities with a willingness-to-pay threshold of <€77,416/QALY gained. According to BTR, teriflunomide was first-best among the disease-modifying therapies, with potential willingness-to-pay thresholds of up to €68,000/QALY gained. In the IIA, teriflunomide was associated with the longest incremental quality-adjusted survival and time without cane use. Generally, primary outcomes results were robust, based on the sensitivity analyses. The results were sensitive only to large changes in analysis perspective or mixed-treatment comparison. ImplicationsThe results were sensitive only to large changes in analysis perspective or MTC. Based on the analyses, teriflunomide was cost-effective versus BSC or DMF with the common threshold values, was dominant versus other first-line RRMS treatments, and provided the greatest impact on investment. Teriflunomide is potentially the most cost-effective option among first-line treatments of RRMS in Finland.

Identification and validation of clinically meaningful benchmarks in the 12-item Multiple Sclerosis Walking Scale

Background: The 12-item Multiple Sclerosis Walking Scale (12-MSWS) is a validated questionnaire which assessed walking function; it has been widely adopted in multiple sclerosis (MS) clinical research. Objective: Identify and validate clinically meaningful 12-MSWS benchmarks in MS. Methods: Cross-sectional study of 159 MS patients permitted identification of clinically meaningful 12-MSWS benchmarks based on their relationship to real-life anchors. Identified 12-MSWS benchmarks were then validated in a second population of 96 subjects using measures of ambulation, cognition, and patient-reported outcomes. Results: 12-MSWS score of 0–24.99 was associated with working outside the home and assistance-free mobility; 25–49.99 was associated with gait disability and difficulty doing housework; 50–74.99 was associated with unemployment, government healthcare, cane use, and difficulty performing instrumental activities of daily living (IADLs); and 75–100 was associated with change in occupation due to walking, mobility impairment requiring bilateral assistance, and inability to perform IADLs. During the validation step, strong linear associations were identified between 12-MSWS benchmarks and other MS-related disability outcome measures, including ambulatory and non-ambulatory measures. Conclusion: We have identified clinically meaningful 12-MSWS benchmarks which define four groups differentiated by increasing levels of mobility impairment and associated loss of functional independence. These data provide insight into how 12-MSWS translate to meaningful functional limitations in MS.

Effect of different alternative roughages on the profitability of milk production systems with F1 Holstein x Zebu cows

ABSTRACT It was analyzed, by means of simulation, the effect of using four different rougahge alternatives during the dry period on the yield of milk production system using F1 Holstein x Gir cows. The rougahge alternatives were, as follows: 1) use of fresh sugar cane (Saccharum officinarum L.) for three months and corn silage (Zea mays L.) for three months, 2) use of corn silage for six months, 3) use of sorghum silage for six months, and 4) use of fresh sugar cane enriched with urea and ammonium sulfate for six months. The F1 Holstein x Gir herd of the Experimental Farm Felixlândia (FEFX) of the Agricultural Research Corporation of Minas Gerais (EPAMIG), located in the municipality of Felixlândia, state of Minas Gerais, central region of the state was used as reference. The inventory expenses, revenue and other data were registered in CUSTO BOVINO LEITE 1.0 software, aiming to generate the results for the profitability analysis. Fresh sugar cane was the rougahge alternative with the best profitability in milk production system with F1 Holstein x Gir cows, even with a smaller volume of milk produced.

Cartografia digital para estimativa de escoamento superficial visando ao planejamento urbano

RESUMO O trabalho foi desenvolvido na Bacia Hidrográfica do Córrego Caçula, município de Ilha Solteira (SP, Brasil), e teve como finalidade estimar o potencial de escoamento superficial com base em metodologias de cartografia apoiadas em técnicas de tratamento digital de dados objetivando baixo custo e rapidez no processo de análise com vistas a subsidiar o planejamento urbano. O método de curva número (CN), desenvolvido pelo Soil Conservation Service (SCS), foi utilizado para determinação do potencial de escoamento superficial combinando informações de uso e ocupação do solo e tipos de solo presentes na bacia. As cartas de uso e ocupação foram produzidas por meio de imagens de satélite dos anos de 2001 e 2009, possibilitando considerar cenário passado e recente para verificar a influência das mudanças de uso do solo no escoamento superficial. Foi possível averiguar que as modificações no uso e na ocupação ocorridas no período resultaram em mudanças nos índices de escoamento superficial, particularmente em função do crescimento da área urbanizada e de plantio de cana-de-açúcar em substituição a pastagens. Os resultados mostraram forte influência do uso do solo nos valores de escoamento obtidos, e as mudanças de uso, sobretudo de pastagem para cultura de cana-de-açúcar, apontaram fortes variações nos valores obtidos. Em geral, os resultados permitiram avaliar potencialidades e limitações para a expansão urbana, indicando áreas carentes de estudos mais detalhados visando à solução de problemas locais.

Chromium(VI) removal from aqueous medium by maize cane and agave bagasse biomasses

ABSTRACTChromium(VI) is a major water pollutant from industrial effluents whose concentration is to be reduced within the permissible limits. In this paper, the use of maize cane and agave bagasse as inexpensive adsorbent for the removal of Cr(VI) from aqueous solutions is considered. In the first place, they were conditioned and characterized to determine their physicochemical properties with scanning electron microscopy; the elemental composition with energy-dispersive x-ray spectroscopy (EDS); the principal functional groups with Fourier transform infrared spectroscopy; thermal stability with thermogravimetric analysis; and surface properties by specific surface hydration kinetics, point of zero charge determination by mass titration, and active site density are described. In the second place, their adsorption properties for Cr(VI) from aqueous solution were evaluated in a batch system. The kinetics of Cr(VI) sorption with both natural adsorbents were described with a pseudo-second-order model. Equilibrium data were found to be best represented for both adsorbents by the Freundlich isotherm model. Maize cane and agave bagasse can be effectively used as an adsorbents for the removal of Cr(VI) ions from the aqueous solution.

MP04-12 COMORBIDITY STATUS AS A PREDICTOR OF HIGH-GRADE DISEASE IN MEN WITH PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2016MP04-12 COMORBIDITY STATUS AS A PREDICTOR OF HIGH-GRADE DISEASE IN MEN WITH PROSTATE CANCER Timothy Daskivich, Douglas Skarecky, Thomas Ahlering, and Stephen Freedland Timothy DaskivichTimothy Daskivich More articles by this author , Douglas SkareckyDouglas Skarecky More articles by this author , Thomas AhleringThomas Ahlering More articles by this author , and Stephen FreedlandStephen Freedland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1947AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While it has long been known that advanced age is associated with higher tumor grade, it is unknown if comorbid disease burden has a similar, independent association. We sought to evaluate the impact of comorbid disease burden on risk of tumor aggressiveness as indicated by biopsy Gleason score. METHODS We conducted an observational cohort study of 1,482 men with non-metastatic prostate cancer consecutively diagnosed from 1998 to 2004 at two Southern California Veterans Affairs Medical Centers. We determined age, race, Charlson comorbidity index scores, clinical tumor stage, PSA at diagnosis, mobility status (use of walker, wheelchair, or cane), smoking history, and biopsy Gleason score from review of the electronic medical record. We categorized Charlson scores into categories of 0, 1, 2, and 3+ and Gleason scores into categories of ≤6, 7, and 8-10. We used multivariable ordinal and multinomial logistic regression to evaluate the associations between Charlson score and Gleason score after correcting for the covariates mentioned above. RESULTS Our final analytic sample comprised 1,260 men. In a multivariable ordinal logistic regression model predicting higher tumor grade, men with Charlson scores of 2 (OR 1.8, p <0.001) and 3+ (OR 1.8, p <0.001) had significantly greater odds of higher Gleason scores, compared with men with Charlson scores of 0. Other factors associated with higher tumor grade were clinical stage T2b and T2c or higher (vs. T2a or lower), higher PSA, site, and older age at diagnosis. In a multinomial logistic regression model predicting Gleason 7 vs. ≤6, only men with Charlson scores of 2 (OR 1.6, p=0.01) had greater odds of having a Gleason 7 tumor, compared with those with Charlson scores of 0. In a multinomial logistic regression model predicting Gleason 8-10 vs. ≤6, those with Charlson scores of 1 (OR 1.6, p=0.047), 2 (OR 2.8, p=0.01) and 3+ (OR 2.9, p=0.001) had higher odds of having a Gleason 8-10 tumor (Table). CONCLUSIONS Moderate-to-heavy comorbid disease burden at diagnosis is associated with higher biopsy Gleason score, independent of the impact of age. Comorbidity burden appears to be a stronger predictor of Gleason 8-10 than Gleason 7 disease. Abandoning PSA screening in sicker individuals may more often miss potentially lethal tumors. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e32-e33 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Timothy Daskivich More articles by this author Douglas Skarecky More articles by this author Thomas Ahlering More articles by this author Stephen Freedland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...