Biomedical subjects

Antonio Ciampi

Publications and source records attributed to Antonio Ciampi.

14 recordsLinked to original sources

PubMed2007

Twelve-month course of depressive symptoms in older medical inpatients.

BACKGROUND: The study aimed: (1) to describe the 12-month course of depressive symptoms among medical inpatients aged 65+, and (2) to investigate predictors of a more severe course that could be identified easily by non-psychiatric staff. METHODS: Patients were recruited at two Montreal hospitals. Inclusion criteria were: aged 65+, admitted to medical service, at most mild cognitive impairment. Patients were screened for major and minor depression (DSM-IV criteria). All depressed patients and a random sample of non-depressed patients were invited to participate in the prospective study. The Hamilton Depression Scale (HAMD) was administered at admission, 3, 6, and 12 months. Individual patient trajectories of depressive symptoms over time were grouped using hierarchical clustering into three patient groups with a minimal, mild, and moderate/severe course of symptoms, respectively. The baseline predictors of a more severe clinical course were identified using ordinal logistic regression. RESULTS: Two hundred and thirty-two patients completed baseline and one or more follow-up interviews. Baseline patient characteristics that independently predicted a more severe symptom course included higher initial HAMD score, depressive core symptoms lasting 6 months or more, and female sex. CONCLUSION: The 12-month course of depression symptoms in this medically ill older sample was generally stable. Patients who will experience a more severe course can be identified by non-psychiatric staff at admission to hospital.

Aged↗

PubMed2006

Helping family doctors detect vulnerable caregivers after an emergency department visit for an elderly relative: results of a longitudinal study.

BACKGROUND: Family doctors have been ascribed a role in monitoring patients and their informal caregivers. Little is known about the factors that might alert physicians to changing circumstances or needs of the caregivers. The study objective was to examine changes in family caregivers' quality of life following an emergency department (ED) visit by an older community-dwelling relative that might cue doctors to subsequent caregiver distress. METHODS: A longitudinal study with follow-up at 1- and 4-months was conducted in the EDs of 4 hospitals in Montreal, Canada. Caregivers reported on demographics and quality of life (SF-36). Patients reported on demographics and functional disability. Multiple linear regression for repeated measures was used to evaluate changes in caregiver quality of life and factors related to these changes. RESULTS: 159 caregivers (60.5 yrs +/- 15.8%; 73.0% female), including 68 (42.8%) spouses, 60 (37.7%) adult children, and 31 (19.5%) other relatives participated. Following an initial ED visit by older relatives, caregiver general health and physical functioning declined over time, while mental health status improved. Compared to the other relative caregiver group, spouses were at increased risk for decline in general health, mental health, and physical functioning at 1 month, while adult children were at increased risk for decline in physical health at 1 month. CONCLUSION: Spouses were most at risk for decline in quality of life. Primary care physicians who become aware of an ED visit by an elderly person may be alerted to possible subsequent deterioration in family caregivers, especially spouses.

Adult↗

PubMed2006

Prediction of risk for shoulder dystocia with neonatal injury.

OBJECTIVE: The purpose of this study was to develop a predictive model of risk for shoulder dystocia (ShD) with injury. STUDY DESIGN: Medical records in 3 urban university teaching hospitals were reviewed to identify and characterize 498 cases of ShD, including 90 with neonatal injury and a comparison group with of 622 with vaginal delivery (VgD) without ShD. The data were subjected to logistic regression modeling to find the best combination of variables to discriminate between the injury and VgD groups. RESULTS: The best model included birth weight in combination with maternal height and weight as well as gestational age and parity. A score over 0.5 detected 50.7% of the shoulder dystocia cases with brachial plexus injury along with a false positive rate of 2.7%. CONCLUSION: Using a statistical model it is possible to identify adverse combinations of factors that are associated with ShD and neonatal injury along with a relatively low false positive rate.

Birth Injuries↗

PubMed2006

Predictors of self-reported noncompliance with antihypertensive drug treatment: a prospective cohort study.

BACKGROUND: Persistence and compliance are different aspects of the broader concept of adherence to drug treatment. In a prior study, determinants of nonpersistence in a group of patients newly prescribed antihypertensive medications were examined. OBJECTIVE: To determine noncompliance among those who were persistent with therapy. METHODS: A prospective cohort study was conducted, in which individuals prescribed a new antihypertensive monotherapy were identified through a network of 173 pharmacies. Participants were interviewed by telephone twice during a three-month period. At the end of this period, individuals who reported still taking the medication initially prescribed were included in the analysis. Self-reported noncompliance was measured at three months. Data were analyzed using a multivariate logistic regression model. RESULTS: Of 509 eligible participants, 118 (23.2%) reported noncompliance with their drug treatment. Noncompliance was significantly associated with the use of angiotensin-converting enzyme inhibitors (adjusted OR [AOR] 3.0; 95% CI 1.17 to 7.92) compared with the angiotensin II receptor blocker losartan, and with the belief that hypertension is not a risk factor for cardiovascular diseases (AOR 2.0; 95% CI 1.21 to 3.33). On the other hand, noncompliance was inversely associated with the use of more than four pills of medication per day (AOR 0.3; 95% CI 0.15 to 0.64). CONCLUSIONS: Compliance with drug treatment could be improved by proper selection of medication, and by attempts to correct the false perceptions patients may have about hypertension. Further research is needed to better understand the clinical significance of a higher number of pills as a predictor of good compliance. Further research is also needed using different means of measuring noncompliance.

Antihypertensive Agents↗

PubMed2006

Does depression in older medical inpatients predict mortality?

BACKGROUND: Previous studies of the effect of depression on mortality among older medical inpatients have yielded inconsistent results. We examined the effects on mortality of both a diagnosis of depression at hospital admission and a history of previous depression, taking into account potential sources of bias (sample selection and confounding). METHODS: Medical inpatients aged 65+ with at most mild cognitive impairment were recruited at two Montreal hospitals and were screened for depression. All those with a diagnosis of major or minor depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] criteria) and a random sample of nondepressed patients were invited to participate. Baseline data included: history of previous depression, severity of physical illness, comorbidity, and health services utilization. Cox proportional hazards methods were used to analyze survival during the 16- to 52-month follow-up period. RESULTS: Five hundred patients were enrolled; 116 (23.2%) had a history of previous depression. After adjustment for demographic factors, physical illness, cognitive impairment, and prior service utilization, the only depression group with significantly different mortality was patients with both current major depression and a history of depression, who had lower mortality than all other patient groups (hazard ratio 0.42; 95% confidence interval: 0.25, 0.70). CONCLUSIONS: Among patients with no history of depression, a diagnosis of depression was not associated with mortality after adjustment for confounding by physical illness and other factors. Coincident major depression and history of depression was associated with decreased mortality.

Age Distribution↗

PubMed2006

The prognosis of major and minor depression in older medical inpatients.

BACKGROUND: Major and minor depression is frequent in older medical inpatients, but the prognosis of these two disorders is not clear. The current study proposed to determine the prognosis of major and minor depression in this population. METHOD: This prospective, observational cohort study, conducted in Montreal, Quebec, Canada, involved assessment of 380 elderly medical inpatients with major, minor, or no depression at three, six, and 12 months after enrollment using the Diagnostic Interview Schedule and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Information on suicide attempts, completed suicides, and potential prognostic factors was also collected. Analysis of outcomes and potential prognostic factors involved descriptive statistics and multiple logistic regression. RESULTS: Among patients with major depression at enrollment, 13% were recovered, 14% were partially recovered, and 73% remained depressed with a protracted stable or protracted fluctuating course. Among patients with minor depression, 28% were recovered and 72% had a protracted course. Patients diagnosed with major depression at enrollment often had minor depression at follow up and vice versa. CONCLUSION: The prognosis of both major and minor depression in older medical inpatients is poor and worse than previously thought.

Activities of Daily Living↗

PubMed2005

Patients' anxiety and expectations: how they influence family physicians' decisions to order cancer screening tests.

OBJECTIVE: To compare the influence of physicians' recommendations and patients' anxiety or expectations on the decision to order four cancer screening tests in clinical situations where guidelines were equivocal: screening for prostate cancer with prostate-specific antigen for men older than 50; breast cancer screening with mammography for women 40 to 49; colorectal cancer screening with fecal occult blood testing; and colorectal cancer screening with colonoscopy for patients older than 40. DESIGN: Cross-sectional mailed survey with clinical vignettes. SETTING: British Columbia, Alberta, Ontario, Quebec, and Prince Edward Island. PARTICIPANTS: Of 600 randomly selected family physicians in active practice approached, 351 responded, but 35 respondents were ineligible (response rate 62%). MAIN OUTCOME MEASURES: Decisions to order cancer screening tests, physicians' perceptions of recommendations, patients' anxiety about cancer, and patients' expectation to be tested. RESULTS: For all screening situations, physicians most likely to order the tests believed that routine screening with the test was recommended; physicians least likely to order tests believed routine screening was not. Patients' expectations or anxiety, however, markedly increased screening by physicians who did not believe that routine screening was recommended. In regression models, the interaction between physicians' recommendations and patients' anxiety or expectation was significant for all four screening tests. When patients had no anxiety or expectations, physicians' beliefs about screening strongly predicted test ordering. Physicians who believed routine screening was recommended ordered the test in most cases regardless of patient characteristics. But patients' anxiety or expectations markedly increased the probability that the test would be ordered. The probability of test ordering went from 0.28 to 0.54 for prostate-specific antigen (odds ratio [OR] = 1.9), from 0.15 to 0.44 for mammography (OR = 2.8), from 0.33 to 0.79 for fecal occult blood testing (OR = 2.4), and from 0.29 to 0.65 for colonoscopy (OR = 2.2). CONCLUSION: Differences in clinical judgment about recommended practice lead to practice variation, but physicians are also influenced by nonmedical factors, such as patients' anxiety and expectations of receiving tests. In terms of magnitude of influence, clinical judgment is more powerful than nonmedical patient factors, but patient factors are also powerful drivers of family physicians' decisions about cancer screening when practice guidelines are equivocal.

Adult↗

PubMed2003

Effects of exposure measurement error when an exposure variable is constrained by a lower limit.

Epidemiologic studies routinely suffer from bias due to exposure measurement error. In this paper, the authors examine the effect of measurement error when the exposure variable of interest is constrained by a lower limit. This is an important consideration, since often in epidemiologic studies an exposure variable is constrained by a lower limit such as zero or a nonzero detection limit. In this paper, attenuation of exposure-disease associations is defined within the framework of a classical model of uncorrelated additive error. Then, the special case of nonlinearity due to the effect of a lower threshold is examined. A general model is developed to characterize the effect of random measurement error when there is a lower threshold for recorded values. Findings are illustrated under the assumption that the true exposure follows the lognormal and gamma distributions. The authors show that the direction and magnitude of bias in estimated exposure-response associations depends on the population distribution of the exposure, the magnitude of the recording threshold, the value assigned to below-threshold measurement results, and the variance in the measured exposure due to random measurement error.

Bias↗

PubMed2002

A new approach to training back-propagation artificial neural networks: empirical evaluation on ten data sets from clinical studies.

We present a new approach to training back-propagation artificial neural nets (BP-ANN) based on regularization and cross-validation and on initialization by a logistic regression (LR) model. The new approach is expected to produce a BP-ANN predictor at least as good as the LR-based one. We have applied the approach to ten data sets of biomedical interest and systematically compared BP-ANN and LR. In all data sets, taking deviance as criterion, the BP-ANN predictor outperforms the LR predictor used in the initialization, and in six cases the improvement is statistically significant. The other evaluation criteria used (C-index, MSE and error rate) yield variable results, but, on the whole, confirm that, in practical situations of clinical interest, proper training may significantly improve the predictive performance of a BP-ANN.

Biometry↗

PubMed2002

Prediction trees with soft nodes for binary outcomes.

Consider the problem of predicting the occurrence of an event, the onset of diabetes mellitus, say, from a vector of continuous and discrete predictors. We propose a new algorithm for the construction of a tree-structured predictor for the event of interest, which uses a new approach for dealing with continuous predictors. The novelty is that the tree uses splits for continuous variables. This means that at each node an individual goes to the right branch with a certain probability, function of a predictor. The predictor as well as the particular shape of the function is chosen from the data by the proposed algorithm. We evaluate its performance on several real data sets, in particular comparing it with a standard tree-growing algorithm. We also present an analysis of a well-known data set, the Pima Indian diabetes data set, to illustrate the application of the method in biostatistics.

Aged↗

PubMed2002

Determinants of discontinuation of new courses of antihypertensive medications.

Discontinuation of medication use constitutes a major barrier to adequate control of high blood pressure. We examined the effect of an array of potential predisposing, enabling and reinforcing factors on the discontinuation of newly prescribed antihypertensive medications. We conducted a prospective cohort study through a network of 173 pharmacies across Canada where were identified individuals newly prescribed an antihypertensive monotherapy. We interviewed participants by telephone four times to obtain information for a minimum duration of 18 months after entry into the cohort. We analyzed data using a multivariate proportional hazard model. Of 682 eligible participants, 43.3% had discontinued their initial medication at the end of the observation period. Individuals more likely to discontinue their initial medication were those who perceived side effects from this medication [Hazard Ratio (HR) = 1.91; 95% Confidence Interval (CI) 1.47-2.47). Individuals with medication insurance coverage were less likely to discontinue (HR = 0.74; 95% CI 0.55-0.99). Persistence with newly prescribed medications could be improved by selecting antihypertensive medications containing fewer side effects and by lifting economic barriers to drug treatment.

Adolescent↗

PubMed2002

Uses and limitations of statistical accounting for random error correlations, in the validation of dietary questionnaire assessments.

OBJECTIVE: To examine statistical models that account for correlation between random errors of different dietary assessment methods, in dietary validation studies. SETTING: In nutritional epidemiology, sub-studies on the accuracy of the dietary questionnaire measurements are used to correct for biases in relative risk estimates induced by dietary assessment errors. Generally, such validation studies are based on the comparison of questionnaire measurements (Q) with food consumption records or 24-hour diet recalls (R). In recent years, the statistical analysis of such studies has been formalized more in terms of statistical models. This made the need of crucial model assumptions more explicit. One key assumption is that random errors must be uncorrelated between measurements Q and R, as well as between replicate measurements R1 and R2 within the same individual. These assumptions may not hold in practice, however. Therefore, more complex statistical models have been proposed to validate measurements Q by simultaneous comparisons with measurements R plus a biomarker M, accounting for correlations between the random errors of Q and R. CONCLUSIONS: The more complex models accounting for random error correlations may work only for validation studies that include markers of diet based on physiological knowledge about the quantitative recovery, e.g. in urine, of specific elements such as nitrogen or potassium, or stable isotopes administered to the study subjects (e.g. the doubly labelled water method for assessment of energy expenditure). This type of marker, however, eliminates the problem of correlation of random errors between Q and R by simply taking the place of R, thus rendering complex statistical models unnecessary.

Diet↗

PubMed2002

What influences family physicians' cancer screening decisions when practice guidelines are unclear or conflicting?

OBJECTIVES: To determine (a) the respondents' perceptions of 4 unclear or conflicting cancer screening guidelines: prostate-specific antigen (PSA) for men over 50, mammography for women 40-49, colorectal screening by fecal occult blood testing (FOBT), and colonoscopy for patients over 40; and (b) the influence of various factors on the decision to order these tests. STUDY DESIGN: National Canadian mail survey of randomly selected family physicians. POPULATION: Family physicians in active practice (n=565) selected from rural and urban family medicine sites in 5 provinces representing the main regions in Canada. OUTCOME MEASURED: Agreement with guideline statements, and decision to order screening test in 6 clinical vignettes. RESULTS: Of 565 surveys mailed, 351 (62.1%) were returned. Most respondents agreed with the Canadian Task Force recommendations, and most believed that various guidelines for 3 of the 4 screens were conflicting (PSA 86.6%; mammography 67.5%; FOBT 62.4%). Patient anxiety about cancer, patient expectations of being tested, and a positive family history of cancer increased the odds that the 4 tests would be ordered. A good quality patient-MD relationship decreased the odds of ordering a mammogram. Screening decisions were also significantly influenced by the respondents' beliefs about whether screening was recommended and whether screening could cause more harm than good. A physician's sensitivity to his or her colleagues' practice influenced screening decisions regarding PSA and mammography. CONCLUSIONS: These results suggest a conceptual framework for understanding the determinants of screening behavior when guidelines are unclear or conflicting.

Adult↗

PubMedDate not supplied

Short-term stability of diagnoses of major and minor depression in older medical inpatients.

The authors sought to determine the short-term stability of diagnoses of major and minor depression in older medical inpatients. The investigation was a test-retest design involving comparisons between different pairs of interviewers who assessed patients independently on medical wards of two acute-care, university-affiliated hospitals by use of the Diagnostic Interview Schedule (DIS) at intervals between 1 and 51 days. Patients were 380 cognitively-intact patients age > or =65, assessed twice with the DIS. Core depressive symptoms (depressed mood, loss of interest or pleasure) were more stable than the other depressive symptoms. The presence of moderate-to-severe depressive symptoms, moderate-to-severe disability, and depression symptoms of > or =6 months' duration were associated with a higher short-term stability of diagnosis. Age, gender, language, education, rater, interval between assessments, baseline number of medications, medical comorbidity, severity of medical illness, acute physiology score, and cognitive functioning were not associated with short-term depression stability. Stability of diagnosis may be improved by emphasis on core depressive symptoms or the presence of more severe depressive symptoms, moderate-to-severe disability, and duration of symptoms > or =6 months.

APACHE↗