Society for Ambulatory Assessment

Second quarter 2006 (April to June)

Aboy M, Fernandez JR, McNames J, Hermida RC. (2006 Apr). The individual RDH index: a novel vector index for statistical assessment of antihypertensive treatment reduction, duration, and homogeneity. Blood Press Monit.;11(2):69-78.

We propose a new vector index for the statistical assessment of antihypertensive treatment duration and homogeneity from ambulatory blood pressure monitoring. We termed this approach for evaluating and comparing blood pressure coverage offered by antihypertensive drugs over 24 h as the reduction-duration-homogeneity index. The reduction-duration-homogeneity index is a three-component vector index that incorporates information about the reduction, duration, and homogeneity of antihypertensive treatment, as well as their statistical significance. The advantages of the reduction-duration-homogeneity index are demonstrated by several comparative examples.

Allen, Kelli D. PhD, Golightly, Yvonne M. PT, MS; Olsen, Maren K. PhD (June 2006). Pilot Study of Pain and Coping Among Patients With Osteoarthritis: A Daily Diary Analysis. JCR: Journal of Clinical Rheumatology. 12(3):118-123.

Background and Objectives: Few studies have examined patterns of pain and coping among patients with osteoarthritis (OA). This pilot study used a daily diary approach to examine pain and coping strategy use among white and nonwhite veterans with OA. Methods: Participants (23 white, 13 nonwhite; 89% male; mean age = 63 years) completed diaries of pain (10-cm visual analog scale) and coping (total, problem-focused, and emotion-focused) for 30 days. Analyses examined relationships of mean self-reported pain severity and variability with coping strategy use as well as racial differences in these associations. Results: The mean pain level (4.46 [scale of 0-10], standard deviation [SD] = 2.12) and mean within-subject pain variance (1.94, SD = 1.79) were similar between white and nonwhite participants. With respect to pain variability, 2 distinct subgroups were observed, with approximately half of participants reporting high variability and half reporting low variability. The mean total coping score (on a scale of 0-7) was 2.62 (SD = 1.77), with problem-focused strategies being used more often than emotion-focused. There were no significant associations between coping (total, problem-focused, and emotion-focused) and mean pain severity, but the direction of these relationships differed according to race. Conclusion: Results of this pilot study showed considerable between-subject variability in pain and coping strategy use as well as some racial differences. Medical treatment and self-management approaches may be improved if they can be tailored according to patients’ pain patterns and preferred coping strategies.

Almeida EA, Oliveira EI, Lopes JA, Almeida AG, Prata MM. (2006 Apr). Tissue Doppler imaging in the evaluation of left ventricular function in young adults with autosomal dominant polycystic kidney disease. Am J Kidney Dis.;47(4):587-92.

Hypertension and increased left ventricular mass index (LVMI) have been reported in patients with early stages of autosomal dominant polycystic kidney disease (ADPKD). Whether these abnormalities are associated with diastolic dysfunction in this stage remains to be established. The aim of the study is to evaluate diastolic function in young normotensive patients with ADPKD by using tissue Doppler imaging (TDI), the most sensitive method available to date. Thirty-two young clinically normotensive patients aged 21 to 30 years were compared with 23 controls with similar ages. Ambulatory blood pressure measurement (ABPM) was performed to confirm normal blood pressure. Subsequently, patients and controls underwent echocardiography using transmitral Doppler and TDI. LVMI was greater in patients with ADPKD than controls (89.3 +/- 17.7 versus 77.6 +/- 15.9 g/m2; P < 0.02). No significant differences were found in transmitral Doppler and TDI results. When ABPMs were taken into account, 11 patients had mild hypertension and showed increased LVMI and decreased early diastolic peak velocity (E wave: 67.0 +/- 12.0 cm/s in hypertensive patients with ADPKD versus 81.4 +/- 3.3 cm/s in normotensive patients with ADPKD versus 79.3 +/- 2.9 cm/s in controls; P < 0.04) and decreased TDI peak early diastolic annular velocity (11.6 +/- 2.8 cm/s in hypertensive patients with ADPKD versus 13.2 +/- 1.6 cm/s in normotensive patients with ADPKD versus 13.4 +/- 1.6 in controls; P < 0.05). Diastolic dysfunction is not a prominent sign in young normotensive patients with ADPKD.

Anan F, Takahashi N, Shimomura T, Imagawa M, Yufu K, Nawata T, Nakagawa M, Yonemochi H, Eshima N, Saikawa T, Yoshimatsu H. (2006 May ). Hyperhomocysteinemia is a significant risk factor for silent cerebral infarction in patients with chronic renal failure undergoing hemodialysis. Metabolism.;55(5):656-61.

In patients with chronic renal failure undergoing hemodialysis (HD), the presence of silent cerebral infarction (SCI) is associated with high mortality. Plasma total homocysteine (tHcy), which increases with renal dysfunction, has been flagged as a novel predictor for cerebrovascular events. We tested the hypothesis that the presence of SCI correlates with tHcy in HD patients. Based on brain magnetic resonance imaging findings, 44 patients undergoing HD were divided into a with-SCI group (61+/-9 years [mean+/-SD]; n=24) and a without-SCI group (60+/-8 years, n=20), in whom 24-hour ambulatory blood pressure monitoring was performed. The number of patients with diabetes or hypertension was not different between the 2 groups. We made the following observations: (1) the percentage of smokers was higher in the with-SCI group than in the without-SCI group (P<.05); (2) plasma levels of high-density lipoprotein cholesterol were lower and tHcy was higher in the with-SCI group than in the without-SCI group (P<.05 and P<.0001, respectively); (3) and systolic ambulatory blood pressure and mean heart rate during nighttime were higher in the with-SCI group than in the without-SCI group (P<.05). Multivariate logistic analysis identified hyperhomocysteinemia as an independent and significant risk factor for SCI (odds ratio, 1.22; 95% CI, 1.10-1.36; P<.01). Our findings indicate that plasma tHcy may be a novel useful predictor for SCI in patients with chronic renal failure undergoing HD.

Armeli, Stephen; Feinn, Richard; Tennen, Howard (May 2006). The Effects of Naltrexone on Alcohol Consumption and Affect Reactivity to Daily Interpersonal Events Among Heavy Drinkers. Experimental and Clinical Psychopharmacology, Vol 14(2),. pp. 199-208.

The authors examined whether the associations among daily positive and negative interpersonal events, alcohol consumption, and affect varied as a function of naltrexone or placebo administered in a targeted (in anticipation of or in response to high-risk drinking situations) or daily fashion. Heavy drinkers (N = 149) received 4 sessions of brief coping skills counseling in addition to 8 weeks of naltrexone treatment. They recorded for 8 weeks in structured nightly diaries their interpersonal interactions, affect, and alcohol consumption. The authors predicted that participants receiving naltrexone, compared with those taking placebo, would drink less in response to interpersonal encounters and that naltrexone administration would attenuate the link between positive interpersonal events and positive affective states. Results indicated that both positive and negative interpersonal interactions were associated with an increased probability of engaging in any drinking and that positive daily social celebratory events were associated with an increased probability of engaging in heavy drinking. Participants taking naltrexone in a targeted fashion showed the strongest positive association between the number of positive social celebratory events and drinking. Although this finding was inconsistent with the overall reduction in drinking that has been generally reported for those treated with naltrexone, positive social celebratory events occurred on only a minority of days. Participants taking naltrexone, compared with those taking placebo, showed weaker associations between positive social celebratory events and positive and negative affective states. Findings are discussed in terms of naltrexone’s dampening effects on the rewarding properties of alcohol use and certain positively valenced stimuli.

Arora, Vineet MD, MA; Dunphy, Carrie BS; Chang, Vivian Y. BA; Ahmad, Fawaz MS; Humphrey, Holly J. MD; Meltzer, David MD, PhD (June 6, 2006). The Effects of On-Duty Napping on Intern Sleep Time and Fatigue. Annals of Internal Medicine. 144(11):792-798.

Background: Naps during extended work shifts are effective in reducing fatigue in other industries, but the use of a nap as a countermeasure to prevent fatigue in residents is uncertain. Objective: To assess the effects of a call-night nap on resident sleep and fatigue. Design: 1-year, within-participant, paired trial with crossover at midmonth. Setting: Academic teaching hospital. Participants: 38 of 40 internal medicine interns. Measurements: Sleep was measured by using wristwatch actigraphy. By using the experience sampling method on a personal digital assistant, random alerts prompted interns to rate fatigue on the 7-point Stanford Sleepiness Scale (7 is most tired). Hospital paging logs and structured interviews provided information on use of coverage. Intervention: For 2 weeks of every month, interns were assigned to the nap schedule, which provided coverage to on-duty interns from midnight to 7:00 a.m. so that they could finish their work and take a nap. The other 2 weeks of the month constituted a standard schedule. Results: Interns received 41 more minutes of sleep while on call with the nap schedule (185 minutes vs. 144 minutes; P < 0.001). When interns with the nap schedule used coverage, they received 68 more minutes of sleep (210 minutes vs. 142 minutes; P < 0.001). Despite these small increases in sleep, interns reported less overall fatigue while on the nap schedule than while on the standard schedule (1.74 vs. 2.26; P = 0.017). Postcall fatigue with the nap schedule was lower by nearly 1 point (2.23 vs 3.16; P = 0.036), which is almost equivalent to the difference between on-call and postcall fatigue with the standard schedule (2.06 vs. 3.16). However, use of coverage by interns on the nap schedule was impaired by their desire to care for their patients and concerns about discontinuity of care. Limitations: This was a single-institution study that did not have the power to examine outcomes related to intern or patient well-being.

Barker, Erin T.; Williams, Rebecca L.; Galambos, Nancy L. (May-Jun 2006). Daily Spillover to and from Binge Eating in First-Year University Females. Eating Disorders, Vol 14(3),. pp. 229-242.

Coping models of binge eating propose that stress and/or negative affect trigger binge eating, which serves to shift attention to the binge and its consequences. The current study tested these general assumptions using 14-day daily diary data collected from 66 first-year university females. Hierarchical Generalized Linear Modeling results showed that increased stress, negative affect, and weight concerns were associated with an increased likelihood of reporting symptoms of binge eating within days. Elevated weight concerns predicted next-day binge eating and binge eating predicted greater next-day negative affect. Discussion focuses on implications for coping models of binge eating.

Bayo J, Cos FX, Roca C, Dalfo A, Martin-Baranera MM, Albert B. (2006 Apr). Home blood pressure self-monitoring: diagnostic performance in white-coat hypertension. Blood Press Monit; 11(2):47-52.

To determine the diagnostic performance of home blood pressure self-monitoring in white-coat hypertension using a 3-day reading program. One hundred and ninety nontreated patients recently diagnosed with mild-moderate hypertension, selected consecutively at four primary healthcare centers in the city of Barcelona, were included. Each patient underwent morning and night home blood pressure self-monitoring with readings in triplicate for three consecutive days, followed by 24-h ambulatory blood pressure monitoring. The normality cut-off point value for home blood pressure self-monitoring and daytime ambulatory blood pressure monitoring was 135/85 mmHg. Sixty-three patients were diagnosed with white-coat hypertension with home blood pressure self-monitoring (34.8%; 95% confidence interval: 27.9-42.2) and 74 with ambulatory blood pressure monitoring (41.6%; 95% confidence interval: 33.7-48.4). No statistically significant differences were observed between home blood pressure self-monitoring values and those of diurnal ambulatory blood pressure monitoring [137.4 (14.3)/82.1 (8.3) mmHg vs. 134.8 (11.3)/81.3 (9.5) mmHg]. Home blood pressure self-monitoring diagnostic performance parameters were sensitivity 50.0% (95% confidence interval: 38.3-61.7), specificity 75.7% (95% confidence interval: 66.3-83.2), positive and negative predictive values 58.7% (95% confidence interval: 45.6-70.8) and 68.6% (95% confidence interval: 59.4-76.7), respectively, and positive and negative probability coefficients 2.05 and 0.66, respectively. Analysis of different normality cut-off points using a receiver operating characteristic curve failed to produce significant improvement in the diagnostic performance of home blood pressure self-monitoring. The diagnostic accuracy of a 3-day home blood pressure self-monitoring reading program in white-coat hypertension was poor. Ambulatory blood pressure monitoring continues to be the test of choice for this indication.

Bennett GG, Wolin KY, Puleo E, Emmons KM. (2006 Apr). Pedometer-determined physical activity among multiethnic low-income housing residents. Med Sci Sports Exerc.;38(4):768-73.

We sought to characterize pedometer-determined physical activity among a predominantly racial and ethnic minority sample of adults residing in low-income housing. Data were collected from 433 participants at baseline in a randomized colon cancer prevention intervention trial conducted within low-income housing communities. Using random effects models to control for clustering within housing sites, we examined variation in daily steps by several sociodemographic characteristics. Participants recorded a mean of 5326 (+/- 3871 SD) daily steps over a 5-d sampling period. Significantly lower levels of pedometer-determined physical activity were found among older-aged participants (P < 0.0001), women (P = 0.02), those who were overweight and obese (P = 0.03), those reporting no weekly exercise (P = 0.04), as well as among nonworking individuals (P < 0.0001). No significant differences were found by education or income. In multivariable analyses, age, gender, body mass index, and employment status remained significantly associated with steps. These findings suggest a high prevalence of physical inactivity among low-income housing residents. These data, derived from a well-characterized sample, provide useful estimates for the investigation of pedometers as measures of total accumulated physical activity among lower-income, racial and ethnic minority populations.

Bishop, George D.; Pek, Jolynn; Ngau, Francis (Jun 2006). Blunted Cardiovascular Responses to Daytime Activities as Related to Reduced Nocturnal Blood Pressure Decline. Annals of Behavioral Medicine, Vol 31(3),. pp. 248-253.

Background: Individuals showing less than a 10% decline in blood pressure at night (“nondippers”) are known to be at increased risk for hypertension and other cardiovascular conditions. Purpose: This research tested the assertion by Räikkönen et al. (1) that nondippers show blunted cardiovascular responses to activities during daytime hours. Methods: Ambulatory blood pressure and impedance monitoring was performed with 149 young adults in Singapore. At each daytime blood pressure reading, participants completed a computerized questionnaire indicating location, posture, physical activities, feelings, and social interactions. Results: Significant interactions between dipper status and feeling tired, location, posture, and physical activity provided qualified support for the blunting hypothesis. However, blunting of BP responses was not attributable to blunting of either cardiac output or total peripheral resistance responses. Conclusion: Nondippers appear to show blunted daytime responses to certain types of daytime activities. However, these effects are limited and appear to be the result of different mechanisms than those responsible for reduced nighttime blood pressure decline.

Buck, Rhiannon; Morley, Stephen (Oct 2006). A daily process design study of attentional pain control strategies in the self-management of cancer pain. European Journal of Pain, Vol 10(5),. pp. 385-398.

This study investigated the use of attentional control strategies in the self-management of pain using daily process design methodology. Twenty six cancer patients with pain completed diaries 3 times daily for 10 days. Diaries incorporated measures of pain intensity, affect, coping, coping efficacy, and the novelty and predictability of pain, and participants completed a cross-sectional measure of catastrophizing. At the across-person level, focusing on pain was associated with increased negative affect, and the use of pain focusing strategies was positively correlated with experiencing pain that was novel in its location or quality. Distractions that were interesting, important and pleasant were positively correlated with positive affect, perceptions of control over pain and ability to decrease pain. Over-prediction of pain was positively correlated with catastrophizing, and negatively correlated with perceptions of control over and ability to decrease pain. The within-person analysis (ARIMA modelling) showed that catastrophizing moderated the effects of pain focusing strategies, novel pain and over-predictions of pain. Meta-analysis of the ARIMA models revealed that the within-person effects of using attentional strategies did not generalize across the sample. These findings indicated that the effects of distraction strategies are influenced by their motivational-affective significance rather than the frequency with which they are used, and provided further evidence that the threat value of pain influences the way in which people cope with their pain. Theoretical and clinical implications are discussed.

Cerin, Ester; Barnett, Anthony (May 2006). A processual analysis of basic emotions and sources of concerns as they are lived before and after a competition. Psychology of Sport and Exercise, Vol 7(3),. pp. 287-307.

Objectives: To examine the natural flow of (a) pre- and post-competition temporal patterns of intensity, frequency and daily mean level (a composite measure of frequency and intensity) of basic emotions and (b) frequency of reports of competition-related and competition-extraneous concerns across time. Method: The Experience Sampling Method (ESM) was used, which permits the monitoring of the spontaneous flow of daily affective and cognitive experiences in the athletes’ habitual environment. Thirty-nine male elite martial artists were assessed on 12 basic emotions and concerns at five random times a day across 1 week before and 3 days after a competition. On the competition day, the participants were assessed 1 h before and immediately after the contest. Results: Different patterns of change were observed for intensity and frequency of emotions and frequency of competition-related and competition-extraneous concerns. Frequency of fear was the most reactive affective component to competition vicinity. Increased frequency of some outcome-contingent negative emotions persisted for three days post-competition. The presence of negative emotions was the lowest in the post-competition days. Conclusions: This study confirms that, for a better understanding of the process of competitive stress, monitoring of both intensity and frequency of a wide range of emotions is needed. This research area may also benefit from analysing possible psychological spill-over between sport, competition and other life domains.

Cuspidi C, Meani S, Lonati L, Fusi V, Valerio C, Sala C, Magnaghi G, Maisaidi M, Zanchetti A. (2006 Apr). Short-term reproducibility of a non-dipping pattern in type 2 diabetic hypertensive patients. J Hypertens.;24(4):647-53.

Little information is available on the reproducibility of nocturnal variations in blood pressure in type 2 diabetic hypertensive patients. We aimed to compare the intrasubject short-term reproducibility of a nocturnal non-dipping pattern and the prevalence of cardiac and extracardiac signs of target organ damage, in a group of type 2 diabetic hypertensive patients and in an age/gender-matched group of non-diabetic hypertensive subjects. Thirty-six treated hypertensive patients with long-lasting type 2 diabetes (> 10 years duration) consecutively attending our hospital out-patient hypertension clinic (group I; mean age, 65 +/- 9 years), and 61 untreated non-diabetic subjects with grade 1 and grade 2 uncomplicated essential hypertension, matched for age and gender, and chosen from patients attending an outpatient clinic (group II; mean age, 65 +/- 5 years), were considered for this analysis. All patients underwent blood sampling for routine blood chemistry, 24-h urine collection for microalbuminuria, two 24-h periods of ambulatory blood pressure monitoring (ABPM) within a 4-week period, echocardiography, and carotid ultrasonography. A dipping pattern was defined as a greater than 10% reduction in the average systolic and diastolic blood pressure at night compared with average daytime values. A reproducible nocturnal dipping and non-dipping profile was found in 11 (30.6%) and 21 (58.3%) diabetic patients, respectively; while only in four (11.1%) patients was a variable dipping profile observed. Of the 23 patients with a non-dipping pattern during the first ABPM period, 21 (91.3%) also had this type of pattern during the second ABPM recording. In group II (non-diabetic hypertensive patients), 30 patients (49.2%, P < 0.05) had a dipping pattern, 13 patients (21.3%, P < 0.01) had a non-dipping profile pattern and 18 patients (29.5%, P < 0.01) had a variable dipping pattern. Of the 20 patients with a non-dipping pattern during the first ABPM period, 13 (65.0%) confirmed this type of pattern during the second ABPM recording. Finally, the prevalence of left ventricular hypertrophy (77.7 versus 41.4%, P < 0.01), carotid plaques (80.5 versus 38.3%, P < 0.01), carotid intima-media thickening (54.3 versus 44.0%, P < 0.05) and microalbuminuria (11.1 versus 2.0%, P < 0.01) was significantly higher in group I than in group II. According to a logistic regression analysis, diabetes, left ventricular hypertrophy and carotid plaques were the main independent predictors of the non-dipping (pattern in the overall population. These findings indicate that intrasubject variability of non-dipper pattern is lower in diabetic than in non-diabetic hypertensive patients, that classification of diabetic hypertensive patients as dipper or non-dipper on the basis of a single ABP recording is more reliable than in non-diabetic patients, and that the more frequent and reproducible non-dipping (pattern in diabetic patients is associated with a more prominent cardiac and extracardiac target organ damage.

Darcan S, Goksen D, Mir S, Serdaroglu E, Buyukinan M, Coker M, Berdeli A, Kose T, Cura A. (2006 May). Alterations of blood pressure in type 1 diabetic children and adolescents.Pediatr Nephrol.;21(5):672-6.

The aim of this study was to assess the association between metabolic control, microalbuminuria, and diabetic nephropathy with ambulatory blood pressure monitoring (ABPM) in normotensive individuals with type 1 diabetes mellitus (DM). ABPM was undertaken in 68 normotensive type 1 diabetic patients with a mean age of 14.4+/-4.2 years. Microalbuminuria was diagnosed on the basis of a urinary albumin excretion rate grater than 20 microg/min in two of the three 24-h urine collections. Hypertension (HT) frequency was greater in the microalbuminuric patients than normoalbuminuric patients (54 vs 17.54%, p=0.05) with ABPM. Microalbuminuric patients had a higher diastolic pressure burden than normoalbuminuric patients. There were no differences in systolic and diastolic dips between the two groups. Diastolic pressure loads in all periods showed a significant correlation with duration of diabetes, mean HbA1c from the onset of diabetes, and level of microalbuminuria. Nocturnal dipping was reduced in 41.2% of the patients. In the normoalbuminuric group 41.1% and in the microalbuminuric group 63.6% were nondippers. Our data demonstrate higher 24-h and daytime diastolic blood pressure load and loss of nocturnal dip in type 1 diabetic adolescents and children. High diastolic blood pressure burden in diabetic patients could represent a risk for nephropathy.

Dinger MK, Behrens TK. (2006 Apr). Accelerometer-determined physical activity of free-living college students. Med Sci Sports Exerc.;38(4):774-9.

This study was conducted to provide descriptive data of accelerometer-determined ambulatory physical activity in a sample of free-living college students and to examine college students’ ambulatory physical activity patterns. All participants (245 females, age = 19.9 +/- 1.6 yr, body mass index (BMI) = 22.9 +/- 3.3 kg x m(-2); 209 males, age = 20.2 +/- 2.0 yr, BMI = 25.2 +/- 4.0 kg x m(-2)) wore an accelerometer for seven consecutive days. Accumulated physical activity (ct.d, ct x min(-1) x d(-1), and min x d(-1) spent at different intensities) and minutes per day spent in moderate or vigorous physical activity in sessions of at least 10 min were analyzed to describe the physical activity of the sample and examine physical activity patterns. The entire sample accumulated 362,750.1 +/- 112,824.1 ct x d(-1) (males = 383,787.2 +/- 112,001.3 vs females = 344,804.1 +/- 110,619.5 ct x d(-1), P < 0.01) and 46.7 +/- 18.9 min x d(-1) in moderate physical activity (males = 51.7 +/- 19.8 vs females = 42.5 +/- 17.0 min x d(-1), P < 0.01). They were more active on weekdays than weekend days (P < 0.05), and they spent 13.6 +/- 12.7 min x d(-1) (males = 13.2 +/- 12.0 vs females = 13.8 +/- 13.3, P > 0.05) in moderate or vigorous physical activity sessions of at least 10 min. Participants in this study accumulated a moderate amount of physical activity on most weekdays. Most participants, however, were not meeting the current moderate physical activity recommendation when moderate or vigorous physical activity sessions of at least 10 min were examined.

Dolan E, Li Y, Thijs L, McCormack P, Staessen JA, O’Brien E, Stanton A. (2006 Apr). Ambulatory arterial stiffness index: rationale and methodology. Blood Press Monit.;11(2):103-5.

Increased arterial stiffness is associated with the development of cardiovascular disease and may even predict its development at an early stage. Increased pulse pressure is seen as a marker of increased arterial stiffness and can be readily measured by ambulatory blood pressure monitoring. We propose another surrogate measure of arterial stiffness derived from ambulatory blood pressure monitoring that may predict cardiovascular mortality over and above pulse pressure, namely, the dynamic relationship between diastolic and systolic blood pressure over 24 h–the ambulatory arterial stiffness index. Using all blood pressure readings over the 24-h period from 11 291 (5965 women; mean age 54.6 years) patients referred for ambulatory blood pressure monitoring to a blood pressure clinic, diastolic blood pressure was plotted against systolic blood pressure, and the regression slope was calculated; ambulatory arterial stiffness index was defined as one minus this regression slope. Both ambulatory arterial stiffness index and pulse pressure were higher in women (0.42 vs. 0.40 and 57.0 vs. 55.3 mmHg, respectively). For the entire group, the correlation between ambulatory arterial stiffness index and pulse pressure was 0.5. Ambulatory arterial stiffness index is a new measure that is readily available from ambulatory blood pressure monitoring and may provide added prognostic information for cardiovascular outcome.

Graves JW, Grossardt BR, Gullerud RE, Bailey KR, Feldstein J. (2006 Apr). The trained observer better predicts daytime ABPM diastolic blood pressure in hypertensive patients than does an automated (Omron) device. Blood Press Monit.;11(2):53-8.

Accurate blood pressure measurement is critical to successful clinical trials. Concerns about observer errors have led to the use of automated oscillometric devices without evidence that their performance is similar to that of trained observers. This study compares blood pressures obtained by trained observers and with an oscillometric device (Omron 705CP) to 24-h ambulatory blood pressure monitoring. We performed a post-hoc analysis of 313 untreated hypertensive patients at the end of the washout phase of a Novartis hypertension trial. Patients had three seated trained observer mercury auscultatory blood pressure measurements followed by 24-h ambulatory blood pressure monitoring. The next day, the ambulatory blood pressure monitoring was removed and three seated readings were obtained with an Omron 705CP. Correlations for systolic blood pressure and diastolic blood pressure were obtained between daytime ambulatory blood pressure monitoring (0900 and 2100) and the two office methods. In addition, we investigated the degree of difference of trained observer and Omron measurements from ambulatory blood pressure monitoring. For systolic blood pressure, the correlation with ambulatory blood pressure monitoring of the trained observer was significantly better than with that of the Omron 705CP (0.641 vs. 0.555, P=0.01). For diastolic blood pressure values, even greater disparity between the two office method correlations with ambulatory blood pressure monitoring was observed (trained observer=0.593 vs. Omron=0.319, P<0.0001). Both trained observer and Omron readings were consistently higher than ambulatory blood pressure monitoring for systolic blood pressure (P<0.0001) and diastolic blood pressure (P<0.0001). Omron measurements, however, deviated from ambulatory blood pressure monitoring more than those of the trained observer (P<0.0001 for systolic blood pressure and diastolic blood pressure). For clinical trials using diastolic blood pressure targets, the Omron 705CP cannot replace the auscultatory blood pressure measurements of a trained observer. For systolic blood pressure, the Omron device and the trained observer had similar correlations with ambulatory blood pressure monitoring; however, both methods gave consistently higher systolic blood pressure values. Further study of oscillometric devices should be conducted before universally replacing auscultatory blood pressure determinations by trained observers in clinical trials.

Houtveen, Jan H.; Groot, Paul F. C.; de Geus, Eco J. C. (Feb 2006). Validation of the thoracic impedance derived respiratory signal using multilevel analysis. International Journal of Psychophysiology, Vol 59(2),. pp. 97-106.

The purpose of the current study was to validate the change in thoracic impedance (dZ) derived respiratory signal obtained from four spot electrodes against incidental spirometry. Additionally, a similar validation was performed for a dual respiratory belts signal to compare the relative merit of both methods. Participants were 38 healthy adult subjects (half male, half female). Cross-method comparisons were performed at three (paced) respiration frequencies in sitting, supine and standing postures. Multilevel regression was used to examine the within- and between-subjects structure of the relationship between spirometric volume and the respiratory amplitude signals obtained from either dZ or respiratory belts. Both dZ derived respiratory rate and dual belts derived respiratory rate accurately reflected the pacing frequencies. For both methods, fixed factors indicated acceptable but posture-specific regression on spirometric volume. However, random factors indicated large individual differences, which was supported by variability of gain analyses. It was concluded that both the dZ and dual belts methods can be used for measurement of respiratory rate and within-subjects, posture-specific, changes in respiratory volume. The need for frequent subject-specific and posture-specific calibration combined with relatively large measurement errors may strongly limit the usefulness of both methods to assess absolute tidal volume and minute ventilation in ambulatory designs.

Jones H, Atkinson G, Leary A, George K, Murphy M, Waterhouse J. (2006 Apr). Reactivity of ambulatory blood pressure to physical activity varies with time of day. Hypertension.;47(4):778-84.

Blood pressure (BP) fluctuates over a 24-hour period, but it is unclear to what extent this variation is governed completely by changes in physical activity. Our aim was to use a BP “reactivity index” to investigate whether the BP response to a given level of physical activity changes during a normal sleep-wake cycle. Hypertensive patients (n=440) underwent simultaneous 24-hour ambulatory BP, heart rate (HR), and activity monitoring. BP and HR were measured every 20 minutes. Actigraphy data were averaged over the 15 minutes that preceded a BP measurement. Individual BP and HR reactivity indices were calculated using least-squares regression for twelve 2-hour periods. These indices were then analyzed for time-of-day differences using a general linear model. Systolic BP and HR were generally more reactive to physical activity than diastolic BP. The highest reactivity of systolic BP (mean+/-SE=4+/-1 mm Hg per logged unit change in activity) was observed between 8:00 AM and 10:00 AM (P=0.014). Between 10:00 AM and 12:00 PM, BP reactivity then decreased (P=0.048) and showed a secondary rise in the early afternoon. These 24-hour changes in BP reactivity did not differ significantly between groups formed on the basis of early and late wake times (P=0.485), medication use, age, and sex (P>0.350). In conclusion, under conditions of normal living, the reactivity of BP and HR to a given unit change in activity is highest in the morning and shows a secondary rise in the afternoon.

Kamel N, Gursoy A, Koseoglulari O, Dincer I, Gullu S. (2006 Apr). Isolated office hypertension: association with target organ damage and cardiovascular risk indices. J Natl Med Assoc.;98(4):601-6.

Isolated office hypertension (IOH) has been accepted as a benign condition by some researchers, whereas others believe that it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this present study was to evaluate the effects of IOH on target organ damage and cardiovascular risk indices. Arterial blood pressure (BP) measured in the office and by 24-hour ambulatory blood pressure measurement (ABMP), carotid intima-media thickness (CIMT), left ventricular mass index (LVMI), cardiothoracic index (CTI), duration of QTc, 24-hour microalbuminuria, fibrinogen, C-reactive protein (CRP), total cholesterol, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein (HDL) cholesterol and triglyceride levels were evaluated. Thirty-three subjects with IOH (office BP > or = 140/90 mmHg and daytime ambulatory BP <135/85 mmHg), 17 patients with sustained hypertension (office BP > or = 140/90 mmHg and daytime ambulatory BP > or = 135/85 mmHg), and 17 normotensive control subjects were recruited in the study. The three groups were matched for age, sex and body mass index. CIMT was greater in patients with IOH than in normotensive subjects, and it was significantly lower than that of sustained hypertension patients. Significantly higher LVMI was determined in subjects with IOH compared to normotensive subjects. CTI, QTc, microalbuminuria, fibrinogen, CRP, total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels did not differ significantly among the three groups. IOH causes significant target organ damage and should not be regarded as a benign condition.

Kimhy, David; Delespaul, Philippe; Corcoran, Cheryl (Apr 2006). Computerized experience sampling method (ESMc): Assessing feasibility and validity among individuals with schizophrenia. Journal of Psychiatric Research, Vol 40(3),. pp. 221-230.

The Experience Sampling Method (ESM) is an ecologically valid, time-sampling of self-reports developed to study the dynamic process of person-environment interactions. ESM with digital wristwatch and booklets (paper-based ESM; ESMp) has been used extensively to study schizophrenia. The present study is designed to test the feasibility and validity of using Computerized ESM (ESMc) among individuals with schizophrenia. ESMc is advantageous in allowing for recording of precise time-stamps of responses. We used PDAs (“Personal Digital Assistant”; Palm handheld computers) to collect data on momentary psychotic symptoms, mood, and thoughts over a one day period among 10 hospitalized schizophrenia patients and 10 healthy controls. ESMc was equally acceptable to both groups, with similar ratings of comfort carrying the PDAs and operating them, interference with daily activities, as well as response rates. The schizophrenia patients reported significantly higher ratings of auditory and visual hallucinations, suspiciousness, sense of unreality, lack of thought control, fear of losing control, difficulty expressing thoughts, as well as depression/ sadness, loneliness and less cheerfulness. Significant inverse relationships were found among both groups between ratings of feeling cheerful and being stressed, irritated, and sad/depressed. Among the schizophrenia subjects, the correlation between ratings of suspiciousness on ESMc and Scale for Assessment of Positive Symptoms (SAPS) approached significance, as well as the link between suspiciousness and stress. Our results support the feasibility and validity of using ESMc for assessment of momentary psychotic symptoms, mood, and experiences among individuals with schizophrenia. The authors discuss the potential applications of combining ESMc with ambulatory physiological measures.

Leclerc, Jocelyne; Rahn, Michelle; Linden, Wolfgang (Apr 2006). Does personality predict blood pressure over a 10-year period? Personality and Individual Differences, Vol 40(6),. pp. 1313-1321.

We posited that if personality traits were to influence disease development, then there would have to exist a stable link between personality and certain indicators of health status. This hypothesis was evaluated by measuring the stability of blood pressure (BP)-personality associations over a 10-year interval. One hundred and twelve participants completed ambulatory blood pressure monitoring (ABPM) and personality questionnaires twice, over a 10-year time interval. Stability coefficients (r) for measures of depression, hostility, self-deception and impression management were 0.35, 0.55, 0.26 and 0.41, respectively. BP was also fairly stable (r = .44 and r = .59 for systolic/diastolic BP). Associations between personality indicators and BP were noted for depression, hostility, and impression management at baseline. Hostility additionally correlated with diastolic BP 10 years later. Further analyses revealed differential results for men and women, as well as a more pronounced linkage in individuals with a positive family history of hypertension. Multiple regression analyses were utilized to assess gender differences. High self-deception was found to predict significant variance in 10-year BP. Higher age and low hostility were both independent predictors of 10-year BP in women. These results support the hypothesis that personality traits can play a role in disease development.

Lee, Matthew R.; Ohazaki, Sumie; Yoo, Hyung Chol (May 2006). Frequency and intensity of social anxiety in Asian Americans and European Americans.   , Cultural Diversity and Ethnic Minority, Vol 12(2),. pp. 291-305.

Asian American students have typically reported greater levels of social anxiety than European American students on self-report measures (e.g., Okazaki, 1997; Norasakkunkit & Kalick, 2002). This study employed an event-contingent experience sampling methodology to examine whether Asian American university students experienced social anxiety more often and more intensely than European Americans in their daily lives. Forty-five Asian American and 38 European American students participated in a two-week diary study. The results showed that on average, Asian Americans and European Americans reported a similar number of events that evoked anxiety in social situations, but Asian Americans reported more negative emotions on average in social situations than did European Americans.

Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. (2006 May). Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension.;47(5):846-53.

In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, office, home, and ambulatory blood pressure (BP) values were measured contemporaneously between 1990 and 1993 in a large population sample (n=2051). Cardiovascular (CV) and non-CV death certificates were collected over the next 148 months, which allowed us to assess the prognostic value of selective and combined elevation in these 3 BPs over a long follow-up. There were 69 CV and 233 all-cause deaths. Compared with subjects with normal office and 24-hour BP, the hazard ratio for CV death showed a progressive increase in those with a selective office BP elevation (white-coat hypertension), a selective 24-hour BP elevation (masked hypertension), and elevation in both office and 24-hour BP. This was the case also when the above conditions were identified by office versus home BP values. Selective elevation in home versus ambulatory BP or vice versa also carried an increased risk. There was indeed a progressive increase in both CV and all-cause mortality risk from subjects in whom office, home, and ambulatory BP were all normal to those in whom 1, 2, or all 3 BPs were elevated, regardless of which BP was considered. The trends remained significant after adjustment for age and gender, as well as, in most instances, after further adjustment for other cardiovascular risk factors. Thus, white-coat hypertension and masked hypertension, both when identified by office and ambulatory or by office and home BPs, are not prognostically innocent. Indeed, each BP elevation (office, home, or ambulatory) carries an increase in risk mortality that adds to that of the other BP elevations.

Meegan, Sean P.; Goedereis, Eric A. (Jun 2006). Life Task Appraisals, Spouse Involvement in Strategies, and Daily Affect Among Short- and Long-Term Married Couples. Journal of Family Psychology, Vol 20(2),. pp. 319-327.

The purpose of this study was to examine predictors and consequences  of spouses’ involvement in each others’ strategies for pursuing important personal goals called life tasks. Husbands and wives within 39 short- and long-term marriages described five life tasks and provided appraisals of whether each was shared with their spouse. Participants later completed 14 consecutive diary entries recording daily life task pursuit strategies, the extent of spouse involvement in each, and measures of positive and negative affect. Results indicated that interdependence in life task appraisals prospectively predicted greater spouse involvement, and greater spouse involvement was associated with more positive affect for that day. Life task appraisals may provide avenues for understanding couples’ strategies for dealing with goals or stressors and how those strategies affect mood.

Mehl, Matthias R.; Gosling, Samuel D.; Pennebaker, James W. (May 2006). Personality in Its Natural Habitat: Manifestations and Implicit Folk Theories of Personality in Daily Life. Journal of Personality and Social Psychology, Vol 90(5),. pp. 862-877.

To examine the expression of personality in its natural habitat, the authors tracked 96 participants over 2 days using the Electronically Activated Recorder (EAR), which samples snippets of ambient sounds in participants’ immediate environments. Participants’ Big Five scores were correlated with EAR-derived information on their daily social interactions, locations, activities, moods, and language use; these quotidian manifestations were generally consistent with the trait definitions and (except for Openness) often gender specific. To identify implicit folk theories about daily manifestations of personality, the authors correlated the EAR-derived information with impressions of participants based on their EAR sounds; judges’ implicit folk theories were generally accurate (especially for Extraversion) and also partially gender specific. The findings point to the importance of naturalistic observation studies on how personality is expressed and perceived in the natural stream of everyday behavior.

Michel, Gisela (May 2006). A multi-level decomposition of variance in somatic symptom reporting in families with adolescent children. British Journal of Health Psychology. 11(2):345-355.

Objectives. This paper examines four different levels of possible variation in symptom reporting: occasion, day, person and family. Design. In order to rule out effects of retrospection, concurrent symptom reporting was assessed prospectively using a computer-assisted self-report method. Methods. A decomposition of variance in symptom reporting was conducted using diary data from families with adolescent children. We used palmtop computers to assess concurrent somatic complaints from parents and children six times a day for seven consecutive days. In two separate studies, 314 and 254 participants from 96 and 77 families, respectively, participated. A generalized multilevel linear models approach was used to analyze the data. Symptom reports were modelled using a logistic response function, and random effects were allowed at the family, person and day level, with extra-binomial variation allowed for on the occasion level. Results. Substantial variability was observed at the person, day and occasion level but not at the family level. Conclusions. To explain symptom reporting in normally healthy individuals, situational as well as person characteristics should be taken into account. Family characteristics, however, would not help to clarify symptom reporting in all family members.

Moran A, Palmas W, Pickering TG, Schwartz JE, Field L, Weinstock RS, Shea S. (2006 May). Office and ambulatory blood pressure are independently associated with albuminuria in older subjects with type 2 diabetes. Hypertension.;47(5):955-61.

Blood pressure strongly predicts microalbuminuria and later progression to renal failure in people with diabetes. Ambulatory blood pressure monitoring seems to be superior to office blood pressure in predicting progression to microalbuminuria in type 1 diabetes. The associations of ambulatory blood pressure with office blood pressure and microalbuminuria in type 2 diabetes remain unclear. We studied the association of office blood pressure taken with an automated device and ambulatory blood pressure with spot urine albumin:creatinine ratio in 1180 older people with type 2 diabetes participating in the Informatics for Diabetes Education and Telemedicine Study. Office and awake systolic blood pressure were independently associated with albuminuria (P<0.001 for both) in a multivariate linear regression analysis that adjusted for age, gender, duration of diabetes, hemoglobin A1c, number of antihypertensive medications, and use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Twelve percent of participants had well-controlled office blood pressure but not ambulatory blood pressure, whereas 14% had well-controlled ambulatory but not office blood pressure. The prevalence of microalbuminuria and macroalbuminuria in these subgroups was intermediate between those with well-controlled or uncontrolled blood pressure by both methods. We found, in a multiethnic group of older subjects with type 2 diabetes, that office systolic blood pressure and awake systolic ambulatory blood pressure exhibited independent associations with degree of albuminuria.

Peter P, Martin U, Sharma A, Dunne F. (2006 Apr). Effect of treatment with nebivolol on parameters of oxidative stress in type 2 diabetics with mild to moderate hypertension. J Clin Pharm Ther.;31(2):153-9.

The aim of this study was to examine the effect of the cadioselective B(1)-adrenoceptor blocker nebivolol on glycaemic control, lipid profile and markers of oxidative stress in patients with type 2 diabetes over a 6-month period. Twenty-six patients with mild to moderate hypertension (140-160 mmHg systolic, 90-105 mmHg diastolic) confirmed on 24-h blood pressure monitoring, were treated with nebivolol 5 mg daily for 6 months. Total serum cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) subfractions, lipid hydroperoxides (LHPs) and total antioxidant capacity (TAC) were measured before and after 6 months of treatment. Nebivolol, as expected, reduced mean daytime systolic and diastolic pressures on ambulatory monitoring (149 +/- 9 to 140 +/- 13 mmHg, P = 0.02 and 84 +/- 7 to 77 +/- 9 mmHg, P < 0.001). There were no significant changes in serum cholesterol or triglycerides following treatment but a significant increase in HDL cholesterol was noted (1.12 +/- 0.19 to 1.25 +/- 0.36 mmol/L, P = 0.008). Patients showed a highly significant reduction in TAC from 501 +/- 57 to 422 +/- 29 trolox equivalent (P < 0.001). Baseline LHPs were very high and showed no significant change over the 6-month period (18.7 +/- 7.4 and 18.7 +/- 10.9 micromol/L). The LDL score increased significantly from 1.7 +/- 0.7 to 2.3 +/- 0.7 (P = 0.0002) at 6 months suggesting a change to a more atherogenic lipid profile. Neither weight nor glycaemic control changed during treatment. Nebivolol appears to be lipid neutral and may even have a positive effect on HDL cholesterol. Despite this it may promote the formation of potentially atherogenic LDL subfractions possibly as a result of reduced antioxidant defences. Further studies are needed to clarify the changes observed in parameters of oxidative stress.

Sbarra, David A.; Ferrer, Emilio (May 2006). The Structure and Process of Emotional Experience Following Nonmarital Relationship Dissolution: Dynamic Factor Analyses of Love, Anger, and Sadness. Emotion, Vol 6(2),. pp. 224-238.

Dynamic factor analysis was used to examine the structure and process of daily emotions in a sample of young adults following a romantic breakup. Participants completed a daily diary for 4 weeks reporting on their love/longing for their ex-partner, anger, and sadness. Using a lag-1 process factor analysis model, results revealed that love/longing, sadness, and anger could be reliably distinguished as separate but correlated mood states in a trivariate model. Four emotional dynamics (amplification, reversing, persistence, and cooccurrence) were operationalized and investigated. Differences in these dynamics were observed on the basis of overall adjustment to the separation and attachment styles. Findings are discussed in terms of attachment and contemporary emotion theories, as well as the need to operationalize time-based affective processes.

Scanaill CN, Ahearne B, Lyons GM. (2006 Apr). Long-term telemonitoring of mobility trends of elderly people using SMS messaging. IEEE Trans Inf Technol Biomed.;10(2):412-3.

A telemonitoring system, based on short message service (SMS), has been developed to remotely monitor the long-term mobility levels of elderly people in their natural environment. Mobility is measured by an accelerometer-based portable unit, worn by each monitored subject. Mobility level summaries are transmitted hourly, as an SMS message, directly from the portable unit to a remote server for long-term analysis. Each subject’s mobility levels are monitored using custom-designed mobility alert software, and the appropriate medical personnel are alerted by SMS if the subject’s mobility levels decrease.

Schlotz, Wolff; Schulz, Peter; Hellhammer, Juliane (May 2006). Trait anxiety moderates the impact of performance pressure on salivary cortisol in everyday life. Psychoneuroendocrinology, Vol 31(4),. pp. 459-472.

Stress and negative affective states are associated with cortisol in everyday life. However, it remains unclear what types of stressors and which affective states yield these associations, and the effect of trait anxiety is unknown. This study investigates the associations of specific task-related stressors and negative affective states in everyday life with salivary cortisol, and explores the mediating and moderating role of state negative affect and trait anxiety, respectively. Salivary cortisol, subjective stress, and state negative affect were measured three times a day on 2 days in 71 participants in everyday life, using a handheld computer to collect self-reports and time stamps and an electronic device to monitor saliva sampling compliance. Stress measures comprised the experience of performance pressure and failure during daily tasks; measures of negative affect comprised worn-out, tense, unhappy, and angry. Effects were tested using multilevel fixed-occasion models. Momentary performance under pressure was related to higher momentary cortisol measures, while mean task failure was related to lower daily cortisol concentrations. The association of performance pressure with cortisol varied between subjects, and this variation was explained by trait anxiety, yielding stronger associations in participants scoring high on trait anxiety. No evidence was found for a mediating role of state negative affect. These results describe the well-documented associations of everyday stressors and affect with salivary cortisol more precisely, suggesting that performance pressure is a significant condition related to short-term changes in cortisol. Subjects scoring high on trait anxiety seem to process stress-relevant information in a way that amplifies the association of performance pressure with reactions of the hypothalamus-pituitary-adrenal axis.

Schneiders, Josien; Nicolson, Nancy A.; Berkhof, Johannes (May 2006). Mood Reactivity to Daily Negative Events in Early Adolescence: Relationship to Risk for Psychopathology. Developmental Psychology, Vol 42(3),. pp. 543-554.

Emotional responses to negative daily experiences in young adolescents may provide important clues to the development of psychopathology, but research is lacking. This study assessed momentary mood reactivity to daily events as a function of risk profile in a school sample, ages 11-14. High-risk (HR, n = 25) and low-risk (LR, n = 106) subgroups completed frequent self-reports of mood and events for 5 days. HR adolescents reported more negative events involving family and peers. Multilevel modeling results showed that negative events, especially if stressful, were associated with increased negative and decreased positive affects, with heightened responses in HR adolescents. HR adolescents with greater stress over the last 3 months showed additional increases in depressed mood following negative events. Altered reactivity to and dysfunctional appraisals of daily events may link adolescent risk profiles to later mental health problems.

Shiffman, Saul; Scharf, Deborah M.; Shadel, William G.(Apr 2006). Analyzing Milestones in Smoking Cessation: Illustration in a Nicotine Patch Trial in Adult Smokers. Journal of Consulting and Clinical Psychology, Vol 74(2),. pp. 276-285.

Tests of addiction treatments seldom reveal where treatment exercises its effect (i.e., promoting initial abstinence, preventing lapses, and/or impeding progression from lapse to relapse). The authors illustrate analyses distinguishing effects on these milestones in a randomized trial of high-dose nicotine patch (35 mg; n = 188) versus placebo (n = 136) in adult smokers, who used electronic diaries to monitor smoking in real time during 5 weeks of treatment. High-dose patch promoted initial abstinence (hazard ratio [HR] = 1.3) and decreased the risk of lapsing among those who achieved abstinence (HR = 1.6). The biggest effect of treatment was to prevent progression to relapse among those who had lapsed (HR = 7.1). Analysis of effects by milestones may enhance understanding of cessation treatments and their mechanisms of action.

Slaven JE, Andrew ME, Violanti JM, Burchfiel CM, Vila BJ. (2006 Apr). A statistical test to determine the quality of accelerometer data. Physiol Meas.;27(4):413-23.

Accelerometer data quality can be inadequate due to data corruption or to non-compliance of the subject with regard to study protocols. We propose a simple statistical test to determine if accelerometer data are of good quality and can be used for analysis or if the data are of poor quality and should be discarded. We tested several data evaluation methods using a group of 105 subjects who wore Motionlogger actigraphs (Ambulatory Monitoring, Inc.) over a 15 day period to assess sleep quality in a study of health outcomes associated with stress among police officers. Using leave-one-out cross-validation and calibration-testing methods of discrimination statistics, error rates for the methods ranged from 0.0167 to 0.4046. We found that the best method was to use the overall average distance between consecutive time points and the overall average mean amplitude of consecutive time points. These values gave us a classification error rate of 0.0167. The average distance between points is a measure of smoothness in the data, and the average mean amplitude between points gave an average reading. Both of these values were then normed to determine a final statistic, K, which was then compared to a cut-off value, K(C), to determine data quality.

Stavro PM, Woo M, Leiter LA, Heim TF, Sievenpiper JL, Vuksan V. (2006 Apr). Long-term intake of North American ginseng has no effect on 24-hour blood pressure and renal function. Hypertension.;47(4):791-6. Epub 2006 Mar 6.

Ginseng is consumed by 10% to 20% of adults in Asia and by up to 5% in Western countries. Despite observational evidence suggesting a link between its intake and the development of hypertension, there remains no long-term scrutiny for its effect on blood pressure (BP). We therefore undertook a randomized, placebo-controlled, double-blinded, crossover trial in 52 hypertensive individuals to determine the effect of 12-week North American ginseng intake on 24-hour BP; we also measured serum cystatin C as a marker of renal function. After a 4-week placebo run-in, we randomly assigned 52 participants to 3 g/day of ginseng or placebo for 12 weeks. This was followed by an 8-week washout and a subsequent 12-week period in which the opposite treatment was administered. At run-in and at weeks 0 and 12 of each treatment period, participants were fitted with an ambulatory BP monitor to assess 24-hour BP. The primary outcome was the treatment difference at week 12 in mean 24-hour systolic BP. Secondary outcomes were treatment differences at week 12 in other ambulatory BP parameters and serum cystatin C. Forty participants (77%) completed the trial, with 3 removed from main analysis (n=2, antihypertensive drug changes; n=1, incomplete ambulatory monitoring). In the remaining 37, 12-week ginseng treatment was associated with a neutral effect on all ambulatory BP parameters compared with placebo; an intention-to-treat analysis supported this. Ginseng did not affect serum cystatin C level. Overall, long-term ginseng use had no effect on 24-hour BP and renal function in hypertensive individuals.

Tennen, Howard; Affleck, Glenn; Zautra, Alex (Apr 2006). Depression History and Coping With Chronic Pain: A Daily Process Analysis., Health Psychology, Vol 25(3),. pp. 370-379.

This study examined how a previous episode of depression is related to daily pain and reactions to pain among individuals with fibromyalgia, a chronic pain syndrome. Seventy-one women with fibromyalgia (including 30 who were previously depressed) rated their pain and mood 3 times daily for 30 days. Each night, participants rated the extent to which they responded to pain by catastrophizing, how much control they had over that day’s pain, their ways of coping with pain that day, and the effectiveness of their coping efforts. Multivariate multilevel regression models revealed that after controlling for neuroticism and current depressive symptoms, formerly depressed and never-depressed individuals differed in how they coped with increased pain and in how they appraised the efficacy of their coping efforts. Formerly depressed participants who also reported more current depressive symptoms showed a greater decline in pleasant mood on more painful days than did formerly depressed participants who were experiencing fewer current depressive symptoms. These findings illustrate how a history of depression can be captured in the dynamics of daily life.

Thompson D, Batterham AM, Bock S, Robson C, Stokes K. (2006 Apr). Assessment of low-to-moderate intensity physical activity thermogenesis in young adults using synchronized heart rate and accelerometry with branched-equation modeling. J Nutr.;136(4):1037-42.

Low-to-moderate intensity physical activity thermogenesis is a highly variable and quantitatively important component of total energy expenditure that is difficult to assess outside the laboratory. Greater precision and accuracy in the measurement of this key contributor to energy balance is a research priority. We developed a laboratory-based protocol that simulated a range of low-to-moderate intensity physical activities. We characterized the bias and random (individual) error in estimating energy expenditure using combined accelerometry and heart rate (AHR) with branched-equation modeling and a simple motion sensor (pedometer) against an indirect calorimetry criterion. Twenty young adult subjects performed a 2-h laboratory-based protocol, simulating 6 low-to-moderate intensity physical activities interspersed with periods of rest. The physical activity level during the laboratory-based protocol reflected an energy expenditure toward the lower end of the active category. We found that AHR-derived energy expenditure showed no evidence of substantial fixed or proportional bias (mean bias 6%), whereas pedometer-derived energy expenditure showed both fixed and proportional bias (bias at minimum, mean, and maximum energy expenditure +11, -20, and -36%, respectively). It appears that AHR provides an accurate estimate of criterion energy expenditure whereas a simple motion sensor (pedometer) does not. It is noteworthy that AHR provides quantitative information about the nature and patterns of physical activity, such as the amount of time and/or energy spent engaged in physical activity above critical health-related thresholds.

Tuomisto, M. T.; Terho, T.; Korhonen, I. (Apr 2006). Diurnal and weekly rhythms of health-related variables in home recordings for two months. Physiology & Behavior, Vol 87(4),. pp. 650-658.

Several telecare systems for long-term monitoring of the well-being of patients at home have been developed as an aid in healthcare and to reduce hospitalization costs. Most of the systems have been designed to measure only one or two variables. Because well-being is a combination of both psychological and physiological wellness, there is a need to monitor several psychophysiological variables simultaneously in out-of-hospital conditions for a long period. To understand better the variability of patients’ wellness-related variables in long-term recordings, the knowledge of the normal variation in health-related variables in healthy people is necessary. In our study, 14 healthy working middle-aged men were studied daily for 24 h and periods of 50 to 79 days. The variables measured were beat-to-beat heart rate, motor activity, blood pressure, body weight, and temperature. At night respiratory frequency, time of movements, amount of quiet sleep, and ballistocardiographic respiratory variation were also measured. Heart rate variability in the waking period was calculated later (standard deviation of the 5 min average of the successive normal to normal beat to beat intervals). Daily self-reported well-being, activities, and consumption of alcohol were monitored by keeping a behavioral diary. After normalizing the physiological data, the diurnal and weekly variability was calculated for each variable. In several variables the most notable diurnal and weekly variability was found between working time and free time. In conclusion, diurnal and weekly rhythms in several wellness-related physiological and psychological variables were identified, depending on working and free-time in healthy middle-aged men.

van Sluijs EM, van Poppel MN, Twisk JW, van Mechelen W. (2006 Apr). Physical activity measurements affected participants’ behavior in a randomized controlled trial. J Clin Epidemiol.;59(4):404-11.

Assessing levels and determinants of physical activity as outcome measurements might have an independent effect on participant’s physical activity behavior. The objective is to study this effect in a randomized controlled trial (RCT) promoting regular physical activity in Dutch general practice. METHODS: Using a Solomon four-group design, participants were randomized twice. After randomization to a control or intervention-condition at general practice level (N = 29), participants were randomized to a group participating in measurements at baseline, 2 and 6 months (3M-group, N = 361), or a group only participating in measurements at 6 months (1M-group, N = 356). Outcome measures assessed at 6 months included: level of physical activity (self-reported and objectively measured with accelerometry), meeting ACSM/CDC guideline for regular physical activity, stage of change, and determinants of physical activity. Follow-up data on 635 participants (89%) was collected. Statistically significant measurement effects were found for meeting the ACSM/CDC guideline (self-reported), self-efficacy for resisting relapse, knowledge, and on awareness. Other outcome measures showed positive trends, except stages of change. Measurements of physical activity affect participant’s physical activity behavior, possibly triggered by a raised awareness about their own physical activity level. Implications for future research are discussed, as well as methodologic limitations of the study design.

Uchino, Bert N.; Berg, Cynthia A.; Smith, Timothy W. (Jun 2006). Age- Related Differences in Ambulatory Blood Pressure During Daily Stress: Evidence for Greater Blood Pressure Reactivity With Age., Psychology and Aging, Vol 21(2),. pp. 231-239.

Prior research on age and emotions has found that older adults may show better physiological regulation to stressful stimuli than do younger adults. However, the stress reactivity literature has shown that age is associated with higher cardiovascular reactivity to laboratory stress (J. R. Jennings et al., 1997). The authors investigated these conflicting findings further by examining daily ambulatory blood pressure in 428 middle-aged to older adults. Consistent with the age and reactivity literature, relatively old individuals showed significantly greater increases in ambulatory diastolic blood pressure compared with younger individuals when dealing with daily stressors. However, results also revealed that relatively old individuals reported less of an increase in negative affect during daily stress compared with their younger counterparts. The results of this study are consistent with the age-related increase in cardiovascular risk but highlight the complex links between stress and different facets of the aging process.

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