Society for Ambulatory Assessment

Second quarter 2007 (April to June)

Boseck J.J., Engel S.G. & Allison K.C. (Apr 2007). The application of Ecological Momentary Assessment to the study of the night eating. International Journal of Eating Disorders, 40(3):271-276.

Objective: Night eating syndrome (NES) was first described in 1955 by Albert Stunkard and colleagues. NES consists of either overeating at night or waking up during the night and eating. Method: In the current study we used ecological momentary assessment (EMA) to describe 14 self-defined night-eaters. The participants in the current study completed an EMA protocol of approximately two weeks. Results: We found that ratings of hunger appeared to be higher during night awakenings than in the evening. Also, both affect and arousal generally decreased throughout the day and were lowest during awakening episodes. Conclusion: The current study adds interesting data in describing the experience of night-eating behavior with ecological momentary assessments from self-described night-eaters.

Brage S., Ekelund U., Brage N., Hennings M.A., Froberg K., Franks P.W. & Wareham N.J. (2007 Apr 26). Hierarchy of individual calibration levels for heart rate and accelerometry to measure physical activity. J Appl Physiol. [Epub ahead of print]

Combining accelerometry with heart rate (HR) monitoring may improve precision of physical activity measurement. Considerable variation exists in the relationships between physical activity intensity (PAI) and HR and accelerometry, which may be reduced by individual calibration. However, individual calibration limits feasibility of these techniques in population studies and less burdensome, yet valid, methods of calibration are required. We aimed to evaluate the precision of different individual calibration procedures against a reference calibration procedure; a ramped treadmill walking-running test with continuous measurement of PAI by indirect calorimetry, in 26 women and 25 men [mean(SD): 35(9)yrs; 1.69(0.10)m; 70(14)kg]. Acceleration (along the longitudinal axis of the trunk) and HR were measured simultaneously. Alternative calibration procedures included treadmill testing without calorimetry, sub-maximal step and walk tests with and without calorimetry, and non-exercise calibration using sleeping HR and gender. Reference accelerometry and HR models explained >95% of the between-individual variance in PAI (p<0.001). This fraction dropped to 73 and 81%, respectively, for accelerometry and HR models calibrated with treadmill test without calorimetry. Step test calibration captured 62-64% (accelerometry) and 68% (HR) of the variance between individuals. Corresponding values were 63-76% and 59-61% for walk test calibration. There was only little benefit of including calorimetry during step and walk calibration for HR models. Non-exercise calibration procedures explained 54% (accelerometry) and 30% (HR) of the between-individual variance. In conclusion, a substantial proportion of the between-individual variance in relationships between PAI, accelerometry and HR is captured with simple calibration procedures, feasible for use in epidemiological studies. Key words: Energy expenditure, movement sensor, accelerometry, heart rate monitoring, individual calibration.

Burton C., Weller D. & Sharpe M. (May 2007). Are electronic diaries useful for symptoms research? A systematic review. J Psychosom Res., 62(5):553-61.

OBJECTIVE: The objective of this study was to evaluate electronic diaries as a tool for investigating associations between physical symptoms and psychological variables. METHODS: A qualitative systematic review of electronic diary studies in pain and symptoms research was performed. RESULTS: Studies of electronic diary use report good acceptability and accuracy of data recording. A descriptive classification of the findings of electronic diary studies yielded five categories: experience, recording data when symptoms were present; interaction, testing the relationship between variables at different levels; sequential, observing associations at different time lags; process, recording possible mediating constructs such as catastrophization and self-efficacy; and intervention, recording during treatment to identify trends. Most data from diary studies suggest relatively weak associations between variables. CONCLUSION: Electronic diaries are a potentially valuable tool for psychosomatic research. We suggest further possibilities for their use.

Carmona G.A., Lacraz A. & Assal M. (Apr 2007). Walking activity in prosthesis-bearing lower-limb amputees. Rev Chir Orthop Reparatrice Appar Mot., 93(2):109-15. [French]

PURPOSE OF THE STUDY: A large body of literature has been devoted to gait analysis in amputees. Most studies have been conducted in the laboratory setting where numerous variables are analyzed: gait efficiency, energy cost, walking velocity. At the present time however, data are lacking on the real-life use of walking prostheses. Little is known about how long patients wear their prosthesis or how difficult it is for them to walk during different periods of the day. Currently, such information depends on the quality of the interview and the patient-physician relationship. A precise assessment of walking activity in amputees and use of prostheses would be a valuable source of information for therapists and would provide complimentary information to that collected from laboratory gait analysis. The purpose of this study was to study walking activity in home-dwelling prosthesis-bearing lower-limb amputees and to determine variables affecting walking performance. To our knowledge, this is the first published study on this topic. MATERIAL AND METHODS: The series included home-dwelling prosthesis-wearing lower-limb amputees (Syme amputation or more proximal) who were able to get up and go without assistance. A StepWatch3 recorder was implanted on the prosthesis for 15 consecutive days. Variables recorded were number of steps, total walking time, and walking velocity. Variables which might affect walking in prosthesis-wearing amputees were also recorded: body mass index, use of a walking aid, level and reason for amputation, age at amputation and at recording, time between amputation and recording. RESULTS: From June 2004 to May 2005, 43 patients wore the StepWatch3 for the scheduled 15 days during their daily activities. Mean age at amputation was 42 years (range 13-78 years) and at recording 52 years (range 25-85 years). Considered separately, gait parameters showed that all of the patients wore their prosthesis daily and that the best walking performance was significantly observed among below-knee amputees who did not use a walking aid and who underwent amputation for a non-vascular cause. Multivariate analysis revealed that above-knee amputees lost 93 minutes of walking time per day (21% loss), and that amputees who used a walking aid lost 58 minutes per day (13% loss). Daily walking time declined 2.5 minutes per year of age. Body mass index was not correlated with total daily walking time but had a direct significant effect on walking velocity.

Clays E., Leynen F., De Bacquer D., Kornitzer M., Kittel F., Karasek R. & De Backer G. (Apr 2007). High job strain and ambulatory blood pressure in middle-aged men and women from the Belgian job stress study. J Occup Environ Med., 49(4):360-7.

OBJECTIVE: The aim of this study was to assess whether job strain is associated with 24-hour ambulatory blood pressure measurements within a subsample of the Belgian Job Stress Project (BELSTRESS) population. METHODS: A group of 89 middle-aged male and female workers perceiving high job strain and an equally large group of workers perceiving no high job strain wore an ambulatory blood pressure monitor for 24 hours on a regular working day. RESULTS: Mean ambulatory blood pressure at work, at home, and while asleep was significantly higher in workers with job strain as compared with others. The associations between job strain and ambulatory blood pressure were independent from the covariates. CONCLUSIONS: Within this study, high job strain was an important independent risk factor for higher ambulatory blood pressure at work, at home, and during sleep in a group of men and women.

Dimsdale J.E., Ancoli-Israel S., Ayalon L., Elsmore T.F. & Gruen W. (May-Jun 2007). Taking fatigue seriously, II: variability in fatigue levels in cancer patients. Psychosomatics., 48(3):247-52.

Fatigue is a common and distressing complaint of cancer patients. It is typically measured with symptom inventories that reflect the patient’s experience over the previous days or weeks. This study examined short-term variation in fatigue levels in a heterogeneous group of cancer patients over a 3-day period to examine the feasibility of such repeated assessments and to characterize the extent and pattern of fatigue symptoms in cancer patients. Thirty-four cancer outpatients with diverse malignancies wore a prototype fatigue watch monitor for three consecutive 24-hour periods and provided fatigue ratings every hour while awake for the 3 days. Patients completed an average of 40 self-reports over 72 hours. These reports revealed a diurnal variation in fatigue, with increasing levels in the evening. The reports also revealed considerable differences across individuals and within individuals in terms of fatigue ratings. Multiple ratings of fatigue within short periods of time can be obtained and reveal that fatigue levels are quite variable, even within an individual. Cancer patients experience their fatigue as “moderate to extreme” 33% of the time.

Gard D.E, Kring A.M., Gard M.G., Horan W.P. & Green M.F. (Jul 2007). Anhedonia in schizophrenia: Distinctions between anticipatory and consummatory pleasure. Schizophr Res., 93(1-3):253-60. [Epub 2007 May 9]

Research on anhedonia in schizophrenia has revealed mixed results, with patients reporting greater anhedonia than healthy controls on self-report measures and semi-structured interviews, but also reporting comparable experiences of positive emotions in response to pleasurable stimuli. Basic science points to the importance of distinguishing between anticipatory and consummatory (or in-the-moment) pleasure experiences, and this distinction may help to reconcile the mixed findings on anhedonia in schizophrenia. In two studies, we tested the hypothesis that anhedonia in schizophrenia reflects a deficit in anticipatory pleasure but not consummatory pleasure. In Study 1, we used experience sampling methodology to assess reported experiences of consummatory and anticipated pleasure among schizophrenia patients and controls. In Study 2, schizophrenia patients and controls completed a self-report trait measure of anticipatory and consummatory pleasure and interviews that assessed negative symptoms, including anhedonia, and community functioning. In both studies, we found evidence for an anticipatory but not a consummatory pleasure deficit in schizophrenia. In addition, anticipatory pleasure was related to clinical ratings of anhedonia and functional outcome. Clinical and research implications of these findings are discussed.

Goulet G., Mongrain V., Desrosiers C., Paquet J. & Dumont M. (Apr 2007). Daily light exposure in morning-type and evening-type individuals. J Biol Rhythms., 22(2):151-8.

Morning-type individuals (M-types) have earlier sleep schedules than do evening types (E-types) and therefore differ in their exposure to the external light-dark cycle. M-types and E-types usually differ in their endogenous circadian phase as well, but whether this is the cause or the consequence of the difference in light exposure remains controversial. In this study, ambulatory monitoring was used to measure 24-h light exposure in M-type and E-type subjects for 7 consecutive days. The circadian phase of each subject was then estimated in the laboratory using the dim-light melatonin onset in saliva (DLMO) and the core body temperature minimum (Tmin). On average, M-types had earlier sleep schedules and earlier circadian phases than E-types. They also showed more minutes of daily bright light exposure (> 1000 lux) than E-types. As expected, the 24-h patterns of light exposure analyzed in relation to clock time indicated that M-types were exposed to more light in the morning than E-types and that the reverse was true in the late evening. However, there was no significant difference when the light profiles were analyzed in relation to circadian phase, suggesting that, on average, the circadian pacemaker of both M-types and E-types was similarly entrained to the light-dark cycle they usually experience. Some M-types and E-types had different sleep schedules but similar circadian phases. These subjects also had identical light profiles in relation to their circadian phase. By contrast, M-types and E-types with very early or very late circadian phases showed large differences in their profiles of light exposure in relation to their circadian phase. This observation suggests that in these individuals, early or late circadian phases are related to relatively short and long circadian periods and that a phase-delaying profile of light exposure in M-types and a phase-advancing profile in E-types are necessary to ensure a stable entrainment to the 24-h day.

Hamilton N.A., Catley D. & Karlson C. (May 2007). Sleep and the affective response to stress and pain. Health Psychol., 26(3):288-95.

OBJECTIVE: The current study examined sleep disturbance (i.e., sleep duration, sleep quality) as a correlate of stress reactivity and pain reactivity. DESIGN AND OUTCOME MEASURES: An ecological momentary assessment design was used to evaluate the psychosocial functioning of men and women with fibromyalgia or rheumatoid arthritis (N=49). Participants recorded numeric ratings of pain, the occurrence of a stressful event, as well as positive and negative affect 7 times throughout the day for 2 consecutive days. In addition, participants reported on their sleep duration and sleep quality each morning. RESULTS: Sleep disruption was not found to be an independent predictor of affect. However, sleep was found to buffer the relationship between stress and negative affect and the relationship between pain and both positive and negative affect. CONCLUSION: These results are consistent with a model in which good-quality sleep acts as a biobehavioral resource that minimizes allostatic load.

Heilman K.J. & Porges S.W. (Jul 2007). Accuracy of the LifeShirt((R)) (Vivometrics) in the detection of cardiac rhythms. Biol Psychol., 75(3):300-5. [Epub 2007 Apr 29]

The use of heart rate measures in research requires accurate detection and timing of beat-to-beat values. Numerous technologies are available to researchers; however, benchmarking of a specific apparatus is seldom conducted. Since heart rate variability provides a portal to the neural regulation of the heart, accurate detection and timing of beat-to-beat values is essential to both basic physiological research and the clinical application of heart rate variability measures. The current study evaluated the accuracy of an ambulatory system, the LifeShirt((R)) (Vivometrics), relative to a standard laboratory-based heart rate monitoring equipment (Biopac), during baseline and exercise conditions. LifeShirt((R)) performed equivalently to the Biopac during both conditions, experienced few errors of detection, generated similar times between sequential heart periods, and produced similar summary indices of heart rate and heart rate variability.

Hermida R.C., Ayala D.E., Smolensky M.H. & Portaluppi F. (May 2007). Chronotherapy in hypertensive patients: administration-time dependent effects of treatment on blood pressure regulation. Expert Rev Cardiovasc Ther., 5(3):463-75. [Review]

Ambulatory blood pressure measurements (ABPM) correlate more closely with target organ damage and cardiovascular events than clinical cuff measurements. ABPM reveals the significant circadian variation in BP, which in most individuals presents a morning increase, small post-prandial decline, and more extensive lowering during nocturnal rest. However, under certain pathophysiological conditions, the nocturnal BP decline may be reduced (nondipper pattern) or even reversed (riser pattern). This is clinically relevant since the nondipper and riser circadian BP patterns constitute a risk factor for left ventricular hypertrophy, microalbuminuria, cerebrovascular disease, congestive heart failure, vascular dementia and myocardial infarction. Hence, there is growing interest in how to best tailor and individualize the treatment of hypertension according to the circadian BP pattern of each patient. Significant administration-time differences in the kinetics and in the beneficial and adverse effects of antihypertensive medications are well known. Thus, bedtime dosing with nifedipine gastrointestinal therapeutic system (GITS) is more effective than morning dosing, while also significantly reducing adverse effects. The therapeutic coverage and efficacy of doxazosin GITS are dependent on the circadian time of drug administration. Moreover, valsartan administration at bedtime, as opposed to upon wakening, results in an improved diurnal/nocturnal BP ratio, increased percentage of controlled patients, and significant reduction in urinary albumin excretion in hypertensive patients. Chronotherapy provides a means of individualizing the treatment of hypertension according to the circadian BP profile of each patient, and constitutes a new option to optimize BP control and reduce the risk of cardiovascular disease.

Hilbert A. & Tuschen-Caffier B. (2007 Jun 15). Maintenance of binge eating through negative mood: A naturalistic comparison of binge eating disorder and bulimia nervosa. Int J Eat Disord. [Epub ahead of print]

OBJECTIVE: To examine negative mood as a proximal antecedent and reinforcing condition of binge eating in binge eating disorder (BED) and bulimia nervosa (BN). METHOD: Using an ecological momentary assessment design, 20 women with BED, 20 women with BN, and 20 nonclinical control women were recruited from the community, provided with a portable minicomputer, and asked to rate their mood and list their thoughts at randomly-generated beep sounds and before, during, and after episodes of eating. RESULTS: In both eating disorder groups mood before binge eating was more negative than before regular eating and at random assessment. Binge eating was followed by a deterioration of mood. The BED group revealed less antecedent negative mood than the BN group and less concomitant negative cognitions about food/eating and stress. CONCLUSION: Affect regulation difficulties likely lead to binge eating in both disorders, but binge eating may not be effective for regulating overall mood. (c) 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007.

Hoppmann, C. A., Gerstorf, D., Smith, J., & Klumb, P. L. (2007). Linking goals and behavior: Do domain-specific possible selves translate into daily activities in very old age? Journals of Gerontology: Psychological Sciences, 62, P104-P111.

We used time-sampling information from a subsample of the Berlin Aging Study (N = 83; M = 81.1 years) to investigate the link between possible selves in three domains (health, everyday cognition, and social relations) and performance of daily activities. In the domains of health and social relations, hoped-for selves were associated with higher probabilities of performing daily activities in those domains. There were no associations in the cognitive domain or between feared selves and activities. Individuals who engaged in hope-related activities reported concurrent higher positive affect and subsequently had a higher probability of survival over a 10-year period. These findings speak to important associations between beliefs about possible selves and activities in advanced old age and the value of considering associations between microlevel and macrolevel indicators of successful aging.

Horvath S., Taylor D.G., Marsh J.P. & Kriellaars D.J. (Jun 2007). The effect of pedometer position and normal gait asymmetry on step count accuracy. Appl Physiol Nutr Metab., 32(3):409-415.

Manufacturers of pedometers recommend wearing a pedometer on the midline of the right thigh and this recommendation is used in research. However, there is conflicting evidence regarding the effect of pedometer position on accuracy. The purpose of this study was to systematically evaluate the effect of pedometer position on accuracy for 3 modes of gait. The Yamax SW200 pedometer was evaluated in 20 subjects in 5 different positions simultaneously: left mid-axillary, left mid-thigh, umbilical, right mid-thigh, and right mid-axillary. Each subject was asked to walk on a treadmill (54, 80, and 107 m.min–1), to walk overground (slow, preferred, and fast speeds), and to ascend and descend stairs. Pedometer steps were recorded and compared with actual steps observed. Using the same protocol, instantaneous triaxial accelerometry was used to explain position-dependent differences in accuracy. At slow speeds, the left mid-axillary position demonstrated the lowest net mean (+/-SD) error across all modes of gait (7.7% (+/-11.6%%) overground; –0.6% (+/-2.2%) stairs). The right mid-thigh position had significantly (p < 0.01) higher error for treadmill (18.1% (+/-17.3%)), overground (12.9% (+/-15.2%)), and stairs (2.9% (+/-3.9%)). Pedometer position dependent error was demonstrated, with the left mid-axillary position superior to the recommended position of right mid-thigh. The greater accuracy on the left side was wholly explained by gait asymmetry evident in step-induced accelerations recorded at right and left pedometer positions. A model of absolute error based on the ratio of steps at different gait speeds was generated to demonstrate the importance of this finding in pedometer-based lifestyle intervention studies.

Hussong A.M. (May 2007). Predictors of drinking immediacy following daily sadness: An application of survival analysis to experience sampling data. Addictive Behaviors, 32(5)1054-1065.

Previous studies of daily assessments show modest mood-drinking covariation as a function of gender and coping motives; however previous analyses also assume a fixed interval across all individuals in the onset of drinking following negative mood. The current study used survival analysis and experience sampling methods to test whether gender and coping motives predicted shorter sadness-to-drinking intervals among those with greater alcohol-related drinking consequences. A sample of 85 college students (46% male; 78% Caucasian) completed daily assessments over 28 days. Survival analyses showed that women drank more on days following elevated sadness when they reported being motivated to drink to cope and having experienced alcohol-related consequences. For men, the two groups showing greater drinking risk following days of elevated sadness did not report alcohol-related consequences, with those reporting the presence of coping motives showing the greatest risk. Implications of these findings for self-medication mechanisms are discussed.

Isomursu M, Tähti M. & Väinämö S. (Apr 2007). Experimental evaluation of five methods for collecting emotions in field settings with mobile applications. International Journal of Human-Computer Studies, 65(4):404-418.

This paper presents experiences on using five different self-report methods, two adopted from literature and three self-created, for collecting information about emotional responses to mobile applications. These methods were used in nine separate field experiments done in naturalistic settings. Based on our experiments, we can argue that all of these methods can be successfully used for collecting emotional responses to evaluate mobile applications in mobile settings. However, differences can be identified in the suitability of the methods for different research setups. Even though the self-report instruments provide a feasible alternative for evaluating emotions evoked by mobile applications, several challenges were identified, for example, in capturing the dynamic nature of mobile interaction usage situations and contexts. To summarise our results, we propose a framework for selecting and comparing these methods for different usage purposes.

Jacobi D., Perrin A.E., Grosman N., Dore M.F., Normand S., Oppert J.M. & Simon C. (Apr 2007). Physical activity-related energy expenditure with the RT3 and TriTrac accelerometers in overweight adults. Obesity (Silver Spring)., 15(4):950-6.

OBJECTIVE: The objective was to evaluate two accelerometers, the RT3 and the TriTrac-R3D for their ability to produce estimates of physical activity-related energy expenditure (PAEE) in overweight/obese adults. RESEARCH METHODS AND PROCEDURES: PAEE estimates from both accelerometers were obtained in two experiments. In Experiment 1, 13 overweight/obese subjects (BMI 34.2+/-6.4 kg/m2) were monitored over 2 weeks in everyday life, PAEE being simultaneously measured by the doubly labeled water method (DLW). In Experiment 2, 8 overweight/obese subjects (BMI 34.3+/-5.0 kg/m2) and 10 normal-weight subjects (BMI 20.8+/-2.1 kg/m2) were monitored during a treadmill walking protocol, PAEE being simultaneously measured by indirect calorimetry. RESULTS: In Experiment 1, there was no significant difference between methods in mean PAEE (DLW: 704+/-223 kcal/d, RT3: 656+/-140 kcal/d, TriTrac-R3D 624+/-419 kcal/d). The relative difference between methods (accelerometer vs. DLW) was -17.1%+/-16.7% for the RT3 and -20.0+/-44.6% for the TriTrac-R3D. Correlation for PAEE between RT3 and DLW was higher than between TriTrac-R3D and DLW (r=0.67, p<0.05 and r=0.36, p=0.25, respectively). The 95% confidence interval (CI) (kcal/d) of the mean difference between methods was large, amounting to -385 to 145 for the RT3 and -887 to 590 for the TriTrac-R3D. In Experiment 2, both accelerometers were sensitive to the changes in treadmill speed, with no significant difference in mean PAEE between methods in overweight/obese subjects. CONCLUSIONS: Although both accelerometers did not provide accurate estimates of PAEE at individual levels, the data suggest that RT3 has the potential to assess PAEE at group levels in overweight/obese subjects.

Kamarck T.W., Muldoon M.F., Shiffman S.S. & Sutton-Tyrrell K. (May 2007). Experiences of demand and control during daily life are predictors of carotid atherosclerotic progression among healthy men. Health Psychol., 26(3):324-32.

OBJECTIVES: The authors previously reported that individuals who rate their daily life as more demanding or less controllable by momentary electronic diary (ED) reports showed greater intima-medial thickness (IMT) by carotid ultrasonography. They now present prospective findings on this relation. DESIGN: Three hundred thirty-five healthy individuals (ages 50-70 at study onset) completed ongoing ratings of activity and mood over a 6-day period, using ED assessments. MAIN OUTCOME MEASURES: Mean bilateral carotid artery IMT was measured at baseline and 36 months later. RESULTS AND CONCLUSION: Mean ratings of high demand and low control were significantly associated with IMT progression among men but not among women. These associations were not explained by traditional risk factors or by measures of occupational stress. Effects were partially accounted for by elevated ambulatory heart rates among those with low ratings of control. These data support the utility of ED-based measures for examining psychosocial risks in the prediction of cardiovascular disease progression. Copyright (c) 2007 APA, all rights reserved.

Kavey R.E., Kveselis D.A., Atallah N. & Smith F.C. (May 2007). White coat hypertension in childhood: evidence for end-organ effect. J Pediatr., 150(5):491-7.

OBJECTIVE: To evaluate the hypothesis that white coat hypertension (WCH) represents a prehypertensive state by correlating ambulatory blood pressure monitoring (ABPM) results with BP response to treadmill exercise (TE) and echocardiographic measurement of left ventricular mass index (LVMI) in children with high blood pressure (HBP). STUDY DESIGN: We evaluated 119 consecutive children age 6 to 18 years (mean = 13.3 years; 65% male) referred for HBP. Office systolic BP (SBP) exceeded the 95th percentile for age/sex/height in all of the children; 10% also had elevated diastolic BP (DBP). WCH was defined as elevated office SBP +/- elevated DBP with normal mean awake ABPM-SBP. ABPM classified 62 subjects as having WCH and 57 as having HBP. RESULTS: Office BP did not differ between the 2 groups. As defined, awake ABPM-SBP was lower in the WCH group (males: HBP, 142 +/- 12 vs WCH, 124 +/- 5; females: HBP, 137 +/- 8 vs WCH, 121 +/- 5). Awake and asleep DBP and asleep SBP were significantly lower in the WCH group. On TE, maximal SBP exceeded norms for age/sex/body surface area in 63% of the HBP group and 38% of the WCH group. LVMI exceeded the 95th percentile for age/sex in 59% of the males and 90% of the females in the HBP group and in 33% of the males and 36% of the females in the WCH group. CONCLUSIONS: Exaggerated exercise BP and/or increased LVMI in 62% of those subjects with WCH suggest that this diagnosis in children may represent a prehypertensive state.

Knouse L.E., Mitchell J.T., Brown L.H., Silvia P.J., Kane M.J., Myin-Germeys I. & Kwapil T.R. (2007 May 10). The Expression of Adult ADHD Symptoms in Daily Life: An Application of Experience Sampling Methodology. J Atten Disord. [Epub ahead of print]

Objective: To use experience sampling method (ESM) to examine the impact of inattentive and hyperactive-impulsive ADHD symptoms on emotional well-being, activities and distress, cognitive impairment, and social functioning assessed in the daily lives of young adults. The impact of subjective appraisals on their experiences is also examined. Method: Participants (n =206) complete up to 56 in-the-moment assessments of mood and current activities using Personal Digital Assistants for 1 week. Results: Multilevel modeling techniques reveal that ADHD inattentive and hyperactive-impulsive symptoms differentially relate to daily experiences. Higher inattentive symptoms are associated with indices of general distress, including less positive and more negative mood as well as more concentration problems. Higher hyperactive-impulsive symptoms are associated with reduced sensitivity to contextual factors in perceptions of situations. Conclusion: These findings demonstrate predictive validity for adult self-report of ADHD symptoms in a general population sample and suggest future research directions using ESM.

Kos D., Nagels G. & D’Hooghe M.B. (Apr 2007). Measuring activity patterns using actigraphy in multiple sclerosis. Chronobiology International, 24(2)345-356.

Multiple sclerosis (MS) is a demyelinating disease resulting in impairments in motor and mental performance and restrictions in activities. Self-report instruments are commonly used to measure activity patterns; alternatively, actigraphs can be placed on several parts of the body. The aims of this study were to evaluate the superiority and specificity of actigraph placement (wrist vs. ankle) in subjects with MS and healthy controls and explore the relationship between self-report and objective activity patterns. A total of 19 subjects with definite MS and 10 healthy volunteers wore actigraphs on the non-dominant wrist and ankle for three days while they kept a log to register performed activities every .5 h. Wrist and ankle actigraphs produced similar activity patterns during the most active hours (09:00-20:30 h) (ANOVA, time × location interaction: F = .901, df = 23, p = .597) in individuals with MS and healthy controls (between subjects factor F = 3.275, p = .083). Wrist placement of the actigraphs was better tolerated than ankle placement. Wrist actigraph data corresponded to a higher degree with self-reported activities of the upper limbs in the early afternoon, whereas ankle data seem to reflect better whole body movements in the later afternoon/early evening. Overall, actigraph data correlated moderately with self-reported activity (r = .57 for ankle and r = .59 for wrist). The regression model revealed that self-reported activities explained 44% of the variance in ankle and 50% of wrist data. Wrist and ankle actigraphs produce similar activity patterns in subjects with MS and in healthy controls; however, the placement of actigraphs on the wrist is better tolerated. Ankle actigraphs reflect general movement but underestimate upper body activity. Subjective registration of activity level partly matches with objective actigraph measurement. A combination of both objective and subjective activity registration is recommended to evaluate the physical activity pattern of subjects with MS.

Kristensen P.L., Moller N.C., Korsholm L., Wedderkopp N., Andersen L.B. & Froberg K. (2007 Jun 6). Tracking of objectively measured physical activity from childhood to adolescence: The European youth heart study. Scand J Med Sci Sports. [Epub ahead of print]

A number of studies have investigated tracking of physical activity from childhood to adolescence and, in general, these studies have been based on methods with some degree of subjectivity (e.g., questionnaires). The aim of the present study was to evaluate tracking of physical activity from childhood to adolescence using accelerometry, taking into account major sources of variation in physical activity. Both a crude and an adjusted model was fitted, and, in the adjusted model, analyses were corrected for seasonal variation, within-week variation, activity registration during night time sleep, within instrumental measurement error, and day-to-day variation in physical activity. In all, 208 subjects were included in the crude analyses. Stability coefficients estimated from the crude model were low (i.e., 0.18 and 0.19 for boys and girls, respectively) and only borderline significant. However, in the adjusted model highly significant stability coefficients of 0.53 and 0.48 for boys and girls, respectively, were observed. It was concluded that physical activity behavior tends to track moderately from childhood to adolescence.

Kuppens P., Van Mechelen I., Nezlek J.B., Dossche D. & Timmermans T. (May 2007). Individual Differences in Core Affect Variability and Their Relationship to Personality and Psychological Adjustment. Emotion, 7(2):262-274.

How people’s feelings change across time can be represented as trajectories in a core affect space defined by the dimensions of valence and activation. In this article, the authors analyzed individual differences in within-person affective variability defined as characteristics of core affect trajectories, introducing new ways to conceptualize affective variability. In 2 studies, participants provided multiple reports across time describing how they were feeling in terms of core affect. From these data, characteristics of participants’ core affect trajectories were derived. Across both studies, core affect variability was negatively related to average valence, self-esteem, and agreeableness, and it was positively related to neuroticism and depression. Moreover, spin, a measure of how much people experienced qualitatively different feelings within the core affect space, was related more consistently to trait measures of adjustment and personality than other measures of within-person variability, including widely used measures of within-person single-dimension standard deviations.

Litcher-Kelly L., Kellerman Q., Hanauer S.B., Stone A.A. (Apr 2007). Feasibility and utility of an electronic diary to assess self-report symptoms in patients with inflammatory bowel disease. Ann Behav Med., 33(2):207-12.

Background: Self-report items from the Crohn’s Disease Activity Index (CDAI) are completed using a 7-day paper diary; however, there are reports of protocol deviations by both patients and researchers/clinicians. The self-report literature has demonstrated these deviations can distort the information collected by introducing recall bias, especially for subjective measures like pain and well-being. Purpose: The purpose of this pilot study is to evaluate the feasibility of using an electronic diary to collect symptom self-reports. Methods: Sixteen patients with Inflammatory Bowel Disease completed entries on the diary 12 times per day for 3 weeks. The diary included “user-friendly” features that made it easier to incorporate into their daily lives. Results: Despite 2 compliance outliers, the overall compliance was 88%; when these outliers were removed compliance increased to 92%. Participants used the diary features appropriately and completed a substantial number of assessments per day. Although overall compliance declined significantly over the 3-week study period, the number of prompts completed did not change significantly over time. Conclusions: Limitations include the small sample size, but despite this limitation this report supports the feasibility of collecting symptom information using an electronic diary. Future studies are needed to evaluate the possibility of using an electronic diary to collect the CDAI self-report information in both clinical and research settings.

Lopes V.P., Vasques C.M., Maia J.A. & Ferreira JC. (Jun 2007). Habitual physical activity levels in childhood and adolescence assessed with accelerometry. J Sports Med Phys Fitness., 47(2):217-22.

AIM: The purposes of this study were: 1) to evaluate age and gender differences in physical activity (PA) of children and adolescents; 2) to find out if children and adolescents fulfill the PA recommendations of 60 min x day(-1) of moderate (MPA) to vigorous PA (VPA). METHODS: PA was assessed in 265 female and 238 male subjects, ranging from 6 to 18 years of age, grouped in 4 age groups, with MTI ActiGraph model 7164, during 7 consecutive days. The MTI actigraph data was reduced to bouts (30-, 20-, 10-, and 5-min) and minutes spent in MPA, VPA, and very VPA (VVPA). RESULTS: The oldest boys and girls revealed a lower number of PA bouts than the younger ones. Significant gender differences were found in daily VPA, F(1, 492)=37.67, P<0.001; and VVPA F(1, 494)=24.11, P<0.001. Boys were more active than girls. Significant age group differences were also found in MPA, F(3, 494)=87.4, P<0.001; VPA, F(3, 492)=78.15, P<0.001; and VVPA, F(3, 454)=54.89, P<0.001. In both genders MPA, VPA and VVPA decreased with age. Till the age of 14, children had means between 79.6+/-30.6 and 144.1+/-76.9 min*day(-1) of PA. After this age, there was a decrease to 44.1+/-19.9 min*day(-1) in girls and to 56.3+/-31.9 min*day(-1) in boys. CONCLUSION: Boys had more minutes a day of VPA and VVPA than girls. PA decreased with age. The subjects of this study, aged 6 to 15, fulfilled the recommendations of 60 min x day(-1) of MPA to VPA.

Mahlberg R. & Walther S. (Jun 2007). Actigraphy in agitated patients with dementia : Monitoring treatment outcomes. Z Gerontol Geriatr., 40(3):178-184.

Especially in pharmacotherapeutic research, a variety of methods to monitor behavioural and psychological symptoms of dementia (BPSD) are currently being discussed. To date, the most frequently used of these are clinical scales, which, however, are subjective and highly dependent on personnel resources. In our study, we tested the usefulness of actigraphy as a more direct and objective way to measure day-night rhythm disturbances and agitated behaviour.After a baseline assessment, 24 patients with probable dementia of the Alzheimer type (NINCDS-ADRDA) and agitated behaviour received either 3 mg melatonin (n=7), 2.5 mg dronabinol (n=7), or placebo (n=10) for two weeks. In addition, 10 young and 10 elderly healthy subjects were examined as a control group. Motor activity levels were assessed using an actigraph worn continuously on the wrist of the non-dominant hand. At the beginning and the end of the study, patients’ Neuropsychiatric Inventory (NPI) scores were also assessed.In the verum group, actigraphic nocturnal activity (P=0.001), NPI total score (P=0.043), and NPI agitation subscale score (P=0.032) showed significant reductions compared to baseline. The treatment-baseline ratio of nocturnal activity (P=0.021) and treatment-baseline difference of the nocturnal portion of 24 h activity (P=0.012) were reduced. Patients’ baseline activity levels were similar to those seen in healthy elderly subjects. Younger healthy subjects exhibited higher motor activity even at night. There was no correlation between actigraphy and NPI.Both actigraphic measures and the gold standard clinical scale were able to distinguish between the verum and placebo groups. However, because they did not correlate with each other, they clearly represent different aspects of BPSD, each of which reacts differently to therapy. As a result, actigraphy may well come to play an important role in monitoring treatment success in BPSD.

Mancia G., Bombelli M., Facchetti R., Madotto F., Corrao G., Trevano F.Q., Grassi G. & Sega R. (Jun 2007). Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study. Hypertension., 49(6):1265-70. [Epub 2007 Apr 23 ]

The hypothesis has been advanced that cardiovascular prognosis is related not only to 24-hour mean blood pressure but also to blood pressure variability. Data, however, are inconsistent, and no long-term prognostic study is available. In 2012 individuals randomly selected from the population of Monza (Milan), 24-hour ambulatory blood pressure (Spacelabs 90207) was measured via readings spaced by 20 minutes. Systolic and diastolic blood pressure variability was obtained by calculating the following: (1) the SD of 24-hour, day, and night mean values; (2) the day-night blood pressure difference; and (3) the residual or erratic blood pressure variability (Fourier spectral analysis). Fatal cardiovascular and noncardiovascular events were registered for 148 months. When adjusted for age, sex, 24-hour mean blood pressure, and other risk factors, there was no relationship between the risk of death and 24-hour, day, and night blood pressure SDs. In contrast, the adjusted risk of cardiovascular death was inversely related to day-night diastolic BP difference (beta coefficient=-0.040; P<0.02) and showed a significant positive relationship with residual diastolic blood pressure variability (beta coefficient=0.175; P<0.002). Twenty-four-hour mean blood pressure attenuation of nocturnal hypotension and erratic diastolic blood pressure variability all independently predicted the mortality risk, with the erratic variability being the most important factor. Our data show that the relationship of blood pressure to prognosis is complex and that phenomena other than 24-hour mean values are involved. They also provide the first evidence that short-term erratic components of blood pressure variability play a prognostic role, with their increase being accompanied by an increased cardiovascular risk.

Mattocks C., Leary S., Ness A., Deere K., Saunders J., Kirkby J., Blair S.N., Tilling K. & Riddoch C. (Apr 2007). Intraindividual variation of objectively measured physical activity in children. Med Sci Sports Exerc., 39(4):622-9.

PURPOSE: This study examined the seasonal and intraindividual variation in objectively measured physical activity in 11- to 12-yr-olds. METHODS: Children were asked to wear a uniaxial accelerometer for 7 d four times throughout the course of about a year. A random-intercepts model was used to separate the inter- and intraindividual components of physical activity. Gender, age, body mass index (BMI), height, and month of measurement were fitted to the model as potential confounders. RESULTS: A total of 315 children had valid data for at least two measurement occasions, and 244 had data for all four measurement occasions. The unadjusted intraclass correlation coefficient (ICC) for total activity (counts per minute) was 0.54; 0.49 after adjusting for gender, age, and BMI; and 0.53 after adjusting for gender, age, BMI, and month. Further adjustment for pubertal status at baseline had no effect on the ICC. Restricting the analysis to only those with data for all four measurement occasions (N=244), or to measurements taken on school days only, had no effect on the ICC. The fully adjusted ICC was 0.51 for weekdays only and 0.39 for weekend days only. For minutes of moderate to vigorous physical activity, minutes of vigorous activity, minutes of sedentary behavior, and number of 30-min blocks of sedentary behavior, the fully adjusted ICC were 0.45, 0.37, 0.59, and 0.39, respectively. The analysis was repeated for boys and girls separately, but the differences in ICC were small. CONCLUSION: There was substantial intraindividual variation in the objectively measured physical activity of these children. Studies using single a measurement occasion where physical activity is the exposure should take this into account to adjust for regression dilution.

McClain J.J., Sisson S.B., Washington T.L., Craig C.L. & Tudor-Locke C. (Apr 2007). Comparison of Kenz Lifecorder EX and ActiGraph accelerometers in 10-yr-old children. Med Sci Sports Exerc., 39(4):630-8.

A new accelerometer, the Kenz Lifecorder EX (LC; Suzuken Co. Ltd, Nagoya, Japan), offers promise as a feasible monitor alternative to the commonly used Actigraph (AG: Actigraph LLC, Fort Walton Beach, FL). PURPOSE: This study compared the LC and AG accelerometers and the Yamax SW-200 pedometer (DW) under free-living conditions with regard to children’s steps taken and time in light-intensity physical activity (PA) and moderate to vigorous PA (MVPA). METHODS: Participants (N=31, age=10.2 +/- 0.4 yr) wore LC, AG, and DW monitors from arrival at school (7:45 a.m.) until they went to bed. Time in light and MVPA intensities were calculated using two separate intensity classifications for the LC (LC_4 and LC_5) and four classifications for the AG (AG_Treuth, AG_Puyau, AG_Trost, and AG_Freedson). Both accelerometers provided steps as outputs. DW steps were self-recorded. Repeated-measures ANOVA was used to assess overlapping monitor outputs. RESULTS: There was no difference between DW and LC steps (Delta=200 steps), but a nonsignificant trend was observed in the pairwise comparison between DW and AG steps (Delta=1001 steps, P=0.058). AG detected significantly greater steps than the LC (Delta=801 steps, P=0.001). Estimates of light-intensity activity minutes ranged from a low of 75.6 +/- 18.4 min (LC_4) to a high of 309 +/- 69.2 min (AG_Treuth). Estimates of MVPA minutes ranged from a low of 25.9 +/- 9.4 min (LC_5) to a high of 112.2 +/- 34.5 min (AG_Freedson). No significant differences in MVPA were seen between LC_5 and AG_Treuth (Delta=4.9 min) or AG_Puyau (Delta=1.7 min). CONCLUSION: The LC detected a comparable number of steps as the DW but significantly fewer steps than the AG in children. Current results indicate that the LC_5 and either AG_Treuth or AG_Puyau intensity derivations provide similar mean estimates of time in MVPA during-free living activity in 10-yr-old children.

Minutolo R., Borrelli S., Scigliano R., Bellizzi V., Chiodini P., Cianciaruso B., Nappi F., Zamboli P., Conte G. & Nicola L.D. (2007 Apr 9). Prevalence and clinical correlates of white coat hypertension in chronic kidney disease. Nephrol Dial Transplant. [Epub ahead of print]

BACKGROUND: The role of white coat hypertension (WCH) in the poor control of blood pressure (BP) in chronic kidney disease (CKD) is ill defined. METHODS: We measured systolic clinical (CBP) and ambulatory blood pressure (ABP) in 290 consecutive patients with non-dialysis CKD [glomerular filtration rate (GFR) <60 ml/min/1.73 m(2)]. We defined normotension (NOR) if CBP and daytime ABP <130 mmHg, sustained hypertension (SH) when both BP >/=130 mmHg, WCH if only daytime ABP <130 mmHg, and masked hypertension (MH) when only CBP <130 mmHg. RESULTS: NOR patients were 15.5%, WCH 31.7%, SH 46.9% and MH 5.9%. Due to the high prevalence of WCH, achievement of BP target (<130 mmHg) was more than doubled by daytime ABP than CBP (47.2 vs 21.4%). WCH was characterized by prevalence of diabetes (31.5%), left ventricular hypertrophy (LVH; 50.0%) and CBP values (146 +/- 12 mmHg) lower than in SH (41.9%, 71.3% and 158 +/- 18 mmHg) but greater than in NOR (17.8%, 37.8% and 118 +/- 7 mmHg). Among patients with CBP >/=130 mmHg, the independent risk of having SH rather than WCH increased in the presence of higher CBP [Odds ration (OR) 1.61, 95% confidence intervals (CI) 1.29-2.02], LVH (OR 1.94, 95% CI 1.03-3.63) and proteinuria (OR 3.12, 95% CI 1.31-7.43). In the WCH group, 24 h, daytime and nighttime ABP were 118 +/- 7/68 +/- 8, 120 +/- 7/71 +/- 8 and 112 +/- 12/63 +/- 9 mmHg, respectively. CONCLUSIONS: In CKD, WCH is highly prevalent and can be predicted in the absence of higher CBP, LVH and proteinuria. In these patients, pursuing a low BP target may not be safe because of the risk of cardio-renal hypoperfusion especially at nighttime.

Moghaddam N.G. & Ferguson E. (Jun 2007). Smoking, mood regulation, and personality: An event-sampling exploration of potential models and moderation. Journal of Personality, 75(3):451-478.

The aim of the present study was to test potential models of smoking-related changes in mood and how these are moderated by personality (behavioral activation and inhibition systems). Three models yielding distinct predictions regarding mood changes associated with cues to smoking and effects of ingestion were identified: the negative reinforcement model, the appetitive-incentive model, and the incentive-sensitization model. Seventy participants provided baseline data on personality and mood, and subsequently monitored their smoking behavior over 48 hours using an event-contingent diary–eliciting reports of mood state immediately prior to, and after, each cigarette smoked. MANOVA and multilevel modeling indicated that mood (hedonic tone and energetic arousal) improved significantly (po.001) from baseline to pre-smoking, but did not change from pre- to post-smoking, thereby supporting the incentive-sensitization model. Further multilevel analyses indicated that significant variability in hedonic tone was moderated by the behavioral activation system.

Mule G., Nardi E., Cottone S., Cusimano P., Incalcaterra F., Palermo A., Giandalia M., Geraci C., Buscemi S. & Cerasola G. (2007 May 31). Metabolic syndrome in subjects with white-coat hypertension: impact on left ventricular structure and function. J Hum Hypertens. [Epub ahead of print]

Some reports have suggested that white-coat hypertension (WCH) is associated with some features of the metabolic syndrome (MetS). These metabolic disturbances, instead of WCH per se, may potentially explain the greater extent of end-organ damage sometimes observed in WCH subjects (WCHs) when compared to normotensive individuals (NTs). The aim of the present cross-sectional study was to compare left ventricular (LV) structure and function in three groups of subjects: WCHs with MetS, WCHs without MetS and NTs. A total of 145 WCHs, 35% of whom had MetS, were enrolled. As controls, 35 NTs were also studied. In all subjects, routine blood chemistry, echocardiographic examination and 24-h ambulatory blood pressure monitoring were performed. When compared with WCHs without MetS, those with MetS showed higher LV mass indexed by height elevated by a power of 2.7 (LVMH(2.7)) (49.6+/-14.8 vs 38.9+/-9.8 g/m(2.7); P<0.0001). The same parameter was greater in WCHs without MetS than in NTs (32+/-8 g/m(2.7); P=0.004). Moreover, the E-wave deceleration time was longer in WCHs with MetS than in those without it (236.2+/-66.4 vs 200.5+/-30.8 ms; P<0.0001). The relationship of MetS with LVMH(2.7) was confirmed in multivariate regression models. Our results seem to suggest that MetS may have a deleterious influence on LV structure and function in WCH. However, WCH, being associated with an increased LV mass, also in subjects without MetS, may not be considered as an innocuous phenomenon.Journal of Human Hypertension advance online publication, 31 May 2007; doi:10.1038/sj.jhh.1002238.

Myin-Germeys I. & van Os J. (May 2007). Stress-reactivity in psychosis: Evidence for an affective pathway to psychosis. Clinical Psychology Review, 27(4)409-424.

This paper will review a series of studies using the Experience Sampling Method that suggest that altered sensitivity to stress is an endophenotype for psychosis. The Experience Sampling Method is a structured diary technique allowing the assessment of emotional reactivity to stressors occurring in normal daily life. Elevated emotional reactivity to stress was found in subjects vulnerable to psychosis, suggesting that affective responses to stressors in the flow of daily life are an indicator of genetic and/or environmental liability to psychosis. Indeed, the small stressors in daily life associated with affective responses also predict more intense moment-to-moment variation of subtle positive psychotic experiences. Increased emotional reactivity was found to be independent from cognitive impairments, and argued to constitute evidence of an affective pathway to psychosis that may underlie a more episodic, reactive, good-outcome type of psychosis. Evidence for this hypothesis was found in data suggesting that the experience of stressful life events and early trauma were associated with increased stress-sensitivity, and that women were more likely to display elevated stress-reactivity. These findings are discussed in the light of recent biological and psychological mechanisms.

Neal D.J. & Fromme K. (Apr 2007). Event-Level Covariation of Alcohol Intoxication and Behavioral Risks During the First Year of College. Journal of Consulting and Clinical Psychology, 75(2):294-306.

The authors examined the global- and event-level associations between alcohol intoxication and 10 behavioral risks during the 1st year of college. Participants (n = 1113; 62% female; 54% Caucasian) completed 30 days of Web-based self-monitoring that assessed alcohol consumption and involvement in 10 behavioral risks. Generalized estimating equations analyses were used to determine which behaviors covaried with event-level versus global indices of intoxication as well as the moderating effects of gender on the intoxication-behavior associations. Alcohol use was globally related to 8 of the 10 behavioral risks; more important, 5 of the 10 behaviors specifically covaried with daily alcohol intoxication. The differential pattern of associations observed can inform clinical work by identifying groups of students who may most benefit from various intervention approaches and content.

Nezlek, J. B. (Jun 2007). A multilevel framework for understanding relationships among traits, states, situations, and behaviors. European Journal of Personality, 21, 789-810.

A conceptual and analytic framework for understanding relationships among traits, states, situations, and behaviours is presented. The framework assumes that such relationships can be understood in terms of four questions. (1) What are the relationships between trait and state level constructs, which include psychological states, the situations people experience and behaviour? (2) What are the relationships between psychological states, between states and situations and between states and behaviours? (3) How do such state level relationships vary as a function of trait level individual differences? (4) How do the relationships that are the focus of questions 1, 2, and 3 change across time? This article describes how to use multilevel random coefficient modelling (MRCM) to examine such relationships. The framework can accommodate different definitions of traits and dispositions (Allportian, processing styles, profiles, etc.) and different ways of conceptualising relationships between states and traits (aggregationist, interactionist, etc.).

Nezlek, J. B. (Jun 2007). Reactions to daily events as a function of familiarity with an environment. European Journal of Personality, 21, 811-812.

Undergraduate participants provided measures of their psychological well-being and described the positive and negative events that occurred each day, once during the first and second semesters of an academic year. For four of the five measures of daily well-being, reactivity to negative events decreased from the first to second semester, whereas for four of the five measures of well-being, reactivity to positive events did not change over the year. These results suggest that familiarity with an environment moderates reactivity to negative daily events. As people become more familiar with an environment, negative events may elicit smaller decreases in well-being. In contrast, increases in well-being elicited by positive events appear to be unrelated to familiarity with the environment. More broadly, these differences suggest that the reactivity to positive and negative events reflect the operation of different processes.

Ng-Mak D.S., Cady R., Chen Y.T., Ma L., Bell C.F. & Hu X.H. (May 2007). Can migraineurs accurately identify their headaches as “migraine” at attack onset? Headache., 47(5):645-53.

BACKGROUND: While treating migraine early when the headache is mild is believed to link to improved treatment outcomes, it is not clear whether patients can correctly self-identify a headache as a migraine at onset in real-world settings. OBJECTIVE: This study aims to assess the likelihood that patients can correctly self-identify a headache as a migraine at onset, and to evaluate cues that patients use to correctly identify migraine attacks. METHODS: Adult migraineurs were recruited from 14 headache clinics across the United States. Patients recorded their headache experiences via an electronic diary daily over a period of 30 days. On days when they experienced headaches, patients were asked to recall the types of headache they experienced at both onset and peak. Patients also identified cues for deciding whether the headache was a migraine or not. Using identification of migraine at headache peak as the criterion, we examined the sensitivity and specificity of migraine identification at onset. We employed generalized estimating equation (GEE) to evaluate factors identified at headache onset that predicted migraine identified at headache peak. RESULTS: Of the 192 enrolled patients, 182 patients recorded a total of 1197 headache episodes over 30 days. At headache onset, 888 episodes were deemed by patients as migraine and 309 episodes not migraine; a majority (92%) of these early migraine identifications were confirmed at headache peak. Sensitivity and specificity of self-identification of migraine at onset were 91% and 97%, respectively. A number of factors at headache onset were predictive of a migraine identified at peak: sensitivity to light (OR = 3.1, 95% CI: 1.9-5.0), headache severity (OR = 2.0, 95% CI: 1.4-2.8), nausea symptoms (OR = 2.6, 95% CI: 1.5-4.5), and visual disturbance (OR = 2.3, 95% CI: 1.1-4.9). Patients who ruled out tension-type headache at onset were twice (OR = 2.0, 95% CI: 1.5-2.8) as likely to conclude a migraine at peak. CONCLUSIONS: Most migraineurs in tertiary care settings can correctly self-identify a headache as a migraine at onset. Factors such as headache severity, presence of nausea, visual disturbance, sensitivity to light, and no tension-type headache, appeared to augment the correct identification.

Orrell A., Doherty P., Coulton S., Miles J., Stamatakis E. & Lewin R. (2007 May 9). Failure to validate the Health Survey for England physical activity module in a cardiac population. Health Policy. [Epub ahead of print]

OBJECTIVES: The Health Survey for England physical activity module interview, although not validated, is used as a performance indicator to see if people are achieving current physical activity targets and is the primary source of information for physical activity related policy making. The aim of this study was to assess the validity of the Health Survey for England physical activity module as a measure of physical activity in older adults with coronary heart disease. METHODS: Seventy-two older adults who had experienced a cardiac event completed the Health Survey for England physical activity interview and wore an accelerometer for seven consecutive days. Physical activity classification levels were derived from accelerometry and from the Health Survey for England physical activity interview, together with the number of episodes in which participants were moderately active for 30min or more. RESULTS: The Health Survey for England physical activity interview exhibited high sensitivity (1.0) and specificity (0.76) for people engaged in high levels of physical activity, moderate sensitivity (0.40) and specificity (0.56) for people engaged in medium levels of physical activity and low sensitivity (0.35) and high specificity (0.92) for people engaged in low levels of physical activity. Compared with the accelerometer, the survey misclassified 63% of participants. CONCLUSIONS: The Health Survey for England physical activity interview misclassified true activity levels in older adults with heart disease by overestimating actual activity in the less active participants. Similar biases on self-report physical activity measures have been demonstrated in the general population, suggesting that the Health Survey for England physical activity module interview may be providing inaccurate information on national activity levels.

Page E., Cazeau S., Ritter P., Galley D. & Casset C. (2007 May 3). Physiological approach to monitor patients in congestive heart failure: application of a new implantable device-based system to monitor daily life activity and ventilation. Europace. [Epub ahead of print]

AIMS: We examine an expert system designed to permanently monitor patients with congestive heart failure (CHF) using data of a dual-sensor pacemaker and to allow warning of significant changes in physiological indices. METHODS AND RESULTS: This study included 67 implanted patients divided into two groups: a control group without history of CHF (n = 19) who had received DDDR pacemakers (DDD group) and a test group (n = 48) who had received cardiac resynchronization therapy systems (CRT group) for severe CHF (NYHA III or IV, LVEF <40%). The embedded monitoring system measures minute ventilation (MV) and activity (ACT) at rest and at exercise. All devices collect data, and all adverse medical events were recorded. Data are stored daily for up to 3 months. The mean ACT was similar for both groups. Mean rest and exercise MV were significantly higher in CRT group. On 195 periods of 1-month follow-up in the CRT group, 31 events were suspected, 22 were true positive, 9 were false-positive, and 3 clinical adverse events were not predicted (sensitivity: 88%, specificity: 94.7%, positive predictive value: 71%, negative predictive value: 98.2%) CONCLUSION: A new diagnostic expert system that holds promise for the long-term ambulatory monitoring of CHF was developed.

Palmas W., Pickering T., Eimicke J.P., Moran A., Teresi J., Schwartz J.E., Field L., Weinstock R.S. & Shea S. (May 2007). Value of ambulatory arterial stiffness index and 24-h pulse pressure to predict progression of albuminuria in elderly people with diabetes mellitus. Am J Hypertens., 20(5):493-500.

BACKGROUND: Ambulatory 24-h pulse pressure predicts progression of albuminuria in people with diabetes mellitus. It is not known whether the ambulatory arterial stiffness index (AASI) may add to that prediction. METHODS: We compared the multivariate-adjusted association of AASI and 24-h pulse pressure with progression of urine albumin excretion during follow-up in a multiethnic cohort of older people with type-2 diabetes mellitus. The baseline evaluation included office and 24-h ambulatory blood pressure (BP) measurements, and a spot urine measurement of albumin-to-creatinine ratio (ACR). The ACR measurements were repeated annually during 3 years. RESULTS: The AASI was >or=0.55 units in 47% of those exhibiting progression of albuminuria, and in 37% of those without progression (P = .004), whereas 24-h pulse pressure was >or=65 mm Hg in 50% and 38% of those with and without progression, respectively (P = .001). In repeated measures mixed linear model (n = 1043), after adjustment for several covariates including office pulse pressure, AASI in the fourth quartile was independently associated with higher follow-up ACR (P = .024). However, that association did not persist after adjusting for 24-h pulse pressure, which was an independent predictor (P < .001). Cox proportional hazards models examined progression of albuminuria in 957 participants without macroalbuminuria at baseline. The hazard ratio (95% CI) for AASI >or=0.55 units was 1.37 (1.02-1.83) after multivariable adjustment, including office pulse pressure. But AASI was not an independent predictor after adjustment for ambulatory pulse pressure, which was again an independent predictor (P = .033). CONCLUSIONS: Ambulatory 24-h pulse pressure outperformed AASI in predicting progression of albuminuria in elderly people with type 2 diabetes.

Perez-Lloret S., Toblli J.E., Cardinali D.P., Malateste J.C. & Milei J. (2007 Jun 14). Nocturnal hypertension defined by fixed cut-off limits is a better predictor of left ventricular hypertrophy than non-dipping. Int J Cardiol. [Epub ahead of print]

The classification of subjects as nocturnal hypertensives in accordance with non-dipping (i.e. systolic blood pressure – BP – fall <10%) is less reproducible as compared to the fixed cut-off limits method (nocturnal BP means >120/70 mm Hg). The present study was carried out to assess if nocturnal hypertension defined by fixed cut-off limits may be a better predictor of left ventricular hypertrophy (LVH) than to non-dipping. Echocardiography and 24-h ambulatory blood pressure monitoring were performed in 223 subjects. Logistic regression showed that nocturnal hypertension defined by fixed cut-off limits was a significant predictor of LVH (OR=11.1, 95%CI=3.0-40.1) whereas non-dipping was not (OR=1.4, 95%CI=0.4-5.5). No interaction was detected (p<.3). These results suggest that the definition of nocturnal hypertension based on fixed cut-off values is a better predictor of left ventricular hypertrophy than non-dipping.

Polzien K.M., Jakicic J.M., Tate D.F. & Otto A.D. (Apr 2007). The efficacy of a technology-based system in a short-term behavioral weight loss intervention. Obesity (Silver Spring)., 15(4):825-30.

OBJECTIVE: The objective was to examine the efficacy of adding a technology-based program to an in-person, behavioral weight loss intervention. RESEARCH METHODS AND PROCEDURES: Fifty-seven subjects (BMI=33.1+/-2.8 kg/m2; age=41.3+/-8.7 years) participated in a 12-week intervention with random assignment to Standard In-Person Behavioral Weight Control Program (SBWP) or Intermittent or Continuous Technology-Based Program (INT-TECH, CON-TECH). SBWP subjects received seven individualized weight loss sessions encouraging dietary and exercise modifications. INT-TECH and CON-TECH subjects received all SBWP components; additionally, these groups used a SenseWear Pro Armband (BodyMedia, Inc.) to monitor energy expenditure and an Internet-based program to monitor eating behaviors. These features were used by INT-TECH subjects during weeks 1, 5, and 9 and CON-TECH subjects weekly throughout the intervention. RESULTS: Intent-to-treat analysis revealed weight loss of 4.1+/-2.8 kg, 3.4+/-3.4 kg, and 6.2+/-4.0 kg, for SBWP, INT-TECH, and CON-TECH groups, respectively (CON-TECH>INT-TECH, p<or=0.05). DISCUSSION: These results indicate that the technology-based program needs to be used continuously throughout the intervention period to significantly impact weight loss. Future studies should examine the long-term and independent effect of this technology on weight loss, and for whom this intervention format is most effective.

Roetenberg D., Slycke P.J. & Veltink P.H. (May 2007). Ambulatory position and orientation tracking fusing magnetic and inertial sensing. IEEE Trans Biomed Eng., 54(5):883-90.

This paper presents the design and testing of a portable magnetic system combined with miniature inertial sensors for ambulatory 6 degrees of freedom (DOF) human motion tracking. The magnetic system consists of three orthogonal coils, the source, fixed to the body and 3-D magnetic sensors, fixed to remote body segments, which measure the fields generated by the source. Based on the measured signals, a processor calculates the relative positions and orientations between source and sensor. Magnetic actuation requires a substantial amount of energy which limits the update rate with a set of batteries. Moreover, the magnetic field can easily be disturbed by ferromagnetic materials or other sources. Inertial sensors can be sampled at high rates, require only little energy and do not suffer from magnetic interferences. However, accelerometers and gyroscopes can only measure changes in position and orientation and suffer from integration drift. By combing measurements from both systems in a complementary Kalman filter structure, an optimal solution for position and orientation estimates is obtained. The magnetic system provides 6 DOF measurements at a relatively low update rate while the inertial sensors track the changes position and orientation in between the magnetic updates. The implemented system is tested against a lab-bound camera tracking system for several functional body movements. The accuracy was about 5 mm for position and 3 degrees for orientation measurements. Errors were higher during movements with high velocities due to relative movement between source and sensor within one cycle of magnetic actuation.

Rowlands A.V., Stone M.R. & Eston R.G. (Apr 2007). Influence of speed and step frequency during walking and running on motion sensor output. Med Sci Sports Exerc., 39(4):716-27.

PURPOSE: Studies have reported strong linear relationships between accelerometer output and walking/running speeds up to 10 km x h(-1). However, ActiGraph uniaxial accelerometer counts plateau at higher speeds. The aim of this study was to determine the relationships of triaxial accelerometry, uniaxial accelerometry, and pedometry with speed and step frequency (SF) across a range of walking and running speeds. METHODS: Nine male runners wore two ActiGraph uniaxial accelerometers, two RT3 triaxial accelerometers (all set at a 1-s epoch), and two Yamax pedometers. Each participant walked for 60 s at 4 and 6 km x h(-1), ran for 60 s at 10, 12, 14, 16, and 18 km x h(-1), and ran for 30 s at 20, 22, 24, and 26 km x h(-1). Step frequency was recorded by a visual count. RESULTS: ActiGraph counts peaked at 10 km x h(-10 (2.5-3.0 Hz SF) and declined thereafter (r=0.02, P>0.05). After correction for frequency-dependent filtering, output plateaued at 10 km x h(-1) but did not decline (r=0.77, P<0.05). Similarly, RT3 vertical counts plateaued at speeds > 10 km x h(-1) (r=0.86, P<0.01). RT3 vector magnitude and anteroposterior and mediolateral counts maintained a linear relationship with speed (r>0.96, P<0.001). Step frequency assessed by pedometry compared well with actual step frequency up to 20 km x h(-1) (approximately 3.5 Hz) but then underestimated actual steps (Yamax r=0.97; ActiGraph pedometer r=0.88, both P<0.001). CONCLUSION: Increasing underestimation of activity by the ActiGraph as speed increases is related to frequency-dependent filtering and assessment of acceleration in the vertical plane only. RT3 vector magnitude was strongly related to speed, reflecting the predominance of horizontal acceleration at higher speeds. These results indicate that high-intensity activity is underestimated by the ActiGraph, even after correction for frequency-dependent filtering, but not by the RT3. Pedometer output is highly correlated with step frequency.

Schepers H.M., Koopman H.F. & Veltink P.H. (May 2007). Ambulatory assessment of ankle and foot dynamics. IEEE Trans Biomed Eng., 54(5):895-902.

Ground reaction force (GRF) measurement is important in the analysis of human body movements. The main drawback of the existing measurement systems is the restriction to a laboratory environment. This paper proposes an ambulatory system for assessing the dynamics of ankle and foot, which integrates the measurement of the GRF with the measurement of human body movement. The GRF and the center of pressure (CoP) are measured using two six-degrees-of-freedom force sensors mounted beneath the shoe. The movement of foot and lower leg is measured using three miniature inertial sensors, two rigidly attached to the shoe and one on the lower leg. The proposed system is validated using a force plate and an optical position measurement system as a reference. The results show good correspondence between both measurement systems, except for the ankle power estimation. The root mean square (RMS) difference of the magnitude of the GRF over 10 evaluated trials was (0.012 +/- 0.001) N/N (mean +/- standard deviation), being (1.1 +/- 0.1)% of the maximal GRF magnitude. It should be noted that the forces, moments, and powers are normalized with respect to body weight. The CoP estimation using both methods shows good correspondence, as indicated by the RMS difference of (5.1 +/- 0.7) mm, corresponding to (1.7 +/- 0.3)% of the length of the shoe. The RMS difference between the magnitudes of the heel position estimates was calculated as (18 +/- 6) mm, being (1.4 +/- 0.5)% of the maximal magnitude. The ankle moment RMS difference was (0.004 +/- 0.001) Nm/N, being (2.3 +/- 0.5)% of the maximal magnitude. Finally, the RMS difference of the estimated power at the ankle was (0.02 +/- 0.005) W/N, being (14 +/- 5)% of the maximal power. This power difference is caused by an inaccurate estimation of the angular velocities using the optical reference measurement system, which is due to considering the foot as a single segment. The ambulatory system considers separate heel and forefoot segments, thus allowing an additional foot moment and power to be estimated. Based on the results of this research, it is concluded that the combination of the instrumented shoe and inertial sensing is a promising tool for the assessment of the dynamics of foot and ankle in an ambulatory setting.

Shiffman S. (May 2007). Use of more nicotine lozenges leads to better success in quitting smoking. Addiction, 102(5):809-814.

Aims and design: The finding that smokers who used more pieces of nicotine gum achieved better treatment outcomes has been interpreted to indicate that the use of more pieces of gum leads to better treatment outcomes. However, these correlational findings are subject to at least three alternate explanations: (1) reverse causation; (2) a confounding third variable; or (3) behavioral processes. We tested these alternative explanations in secondary analyses of data from a clinical trial of nicotine lozenges. Participants and methods: Subjects (n = 1030) who quit smoking for at least 2 weeks in a placebo-controlled trial of nicotine lozenges were studied. Lozenge use was recorded daily; outcome was assessed as carbon monoxide (CO)-verified 28-day continuous abstinence at 6 weeks. Findings: To refute the reverse causation hypothesis we analyzed data on compliance during a period when subjects were abstinent: high use of active lozenge was associated with greater success; for each additional lozenge used, the odds of success increased by 10%. The third variable and behavioral processes hypotheses both predict that high lozenge use will be associated with improved outcomes even in the placebo condition. However, our analyses showed that this was not the case. Further, greater use of lozenges increased the active-placebo difference, as would be expected under a pharmacological explanation of compliance effects. Conclusion: The analyses rebut the alternative explanations, and suggest that use of more nicotine lozenges is causally associated with better quit rates.

Shimbo D., Pickering T.G., Spruill T.M., Abraham D., Schwartz J.E. & Gerin W. (May 2007). Relative utility of home, ambulatory, and office blood pressures in the prediction of end-organ damage. Am J Hypertens., 20(5):476-82.

BACKGROUND: Home blood pressure (HBP) monitoring plays an increasingly important role in the diagnosis and treatment of hypertension. We evaluated the independent value of HBP compared with ambulatory blood pressure (ABP) and office blood pressure (OBP) in the prediction of cardiovascular end-organ damage in normotensive subjects and untreated patients with mild hypertension. METHODS: One hundred sixty-three subjects underwent measurements of OBP, HBP, ABP, and echocardiography. A physician using a mercury-column sphygmomanometer performed three OBP measurements. The ABP was recorded using a noninvasive ambulatory monitor (mean, 35.4 awake readings per subject). Participants took HBP readings with an automatic, oscillometric device over a 10-week period (mean, 277.9 readings per subject). The left-ventricular mass index (LVMI) was calculated from measurements obtained from two-dimensionally guided M-mode or linear tracings on echocardiography. RESULTS: For systolic and diastolic blood pressures (SBP/DBP), the correlation coefficients of the LVMI with OBP, awake ABP, and HBP were 0.29/0.27, 0.41/0.26, and 0.47/0.35, respectively (all P < .01). In a multivariate regression analysis in which age, sex, body mass index, OBP, awake ABP, and HBP were included, only age, sex, and HBP were significant predictors of LVMI. When only the first 12 home readings were used, the superiority of HBP was no longer evident. CONCLUSIONS: In contrast to OBP and ABP, HBP measurements, when averaged over a 10-week period, are independently related to LVMI. The HBP adds prognostic information over and above OBP and ABP in the prediction of cardiovascular end-organ damage, but this relationship appears to depend on the number of readings taken.

Shrier L.A., Shih M. & Hacker L. (Apr 2007). A momentary sampling study of the affective experience following coital events in adolescents. Journal of Adolescent Health, 40(4):e1-e8.

Purpose: To describe the affective experience following sexual intercourse among sexually active adolescents. We hypothesized that these youth would experience more positive and less negative affects following sexual intercourse than at other times in their daily lives. Methods: Approximately every 3 waking hours, sexually active adolescents aged 15-21 years used a handheld computer to report current affect and recent sexual intercourse in response to random signals. Participants also completed a report after sexual intercourse. Affect was determined by eight states, as well as composite variables for positive and negative affect. Generalized estimating equations compared affect on reports that did and did not include sexual intercourse. Each model included average affect, affect variability (standard deviation), and significant interactions with the occurrence of sexual intercourse. Based on their distribution, outcome variables were modeled as presence/absence of affect. Results: Sixty-seven youth completed 1385 random and 392 event reports. There were 266 unique coital reports (median 2.6/participant/week); 94% were with a main partner and 49% involved condom use. Youth were more likely to report positive affect and less likely to report negative affect when they were also reporting recent sexual intercourse, as compared to noncoital reports. In multivariate analyses, participants had greater odds of reporting well being and alertness and lower odds of reporting stress and anger following sexual intercourse compared to other times. Conclusions: Adolescents report improvement in specific positive and negative affective states following sexual intercourse. Determining how feeling more positive and less negative after sexual intercourse may motivate or reinforce sexual intercourse will be important in understanding adolescent sexual behavior.

Sparacino G., Zanderigo F., Corazza S., Maran A., Facchinetti A. & Cobelli C. (May 2007). Glucose concentration can be predicted ahead in time from continuous glucose monitoring sensor time-series. IEEE Trans Biomed Eng., 54(5):931-7.

A clinically important task in diabetes management is the prevention of hypo/hyperglycemic events. In this proof-of-concept paper, we assess the feasibility of approaching the problem with continuous glucose monitoring (CGM) devices. In particular, we study the possibility to predict ahead in time glucose levels by exploiting their recent history monitored every 3 min by a minimally invasive CGM system, the Glucoday, in 28 type 1 diabetic volunteers for 48 h. Simple prediction strategies, based on the description of past glucose data by either a first-order polynomial or a first-order autoregressive (AR) model, both with time-varying parameters determined by weighted least squares, are considered. Results demonstrate that, even by using these simple methods, glucose can be predicted ahead in time, e.g., with a prediction horizon of 30 min crossing of the hypoglycemic threshold can be predicted 20-25 min ahead in time, a sufficient margin to mitigate the event by sugar ingestion.

Sonnenschein M., Sorbi M.J. & van Doornen L.J.P. (Apr 2007). Evidence that impaired sleep recovery may complicate burnout improvement independently of depressive mood. Journal of Psychosomatic Research, 62(4):487-494.

Objective: This article examines recovery through sleep in relation to sleep quality, exhaustion, and depression in clinical burnout. The authors focus on actual recovery per night, given its relevance to burnout improvement. Methods: Sixty clinically burned-out participants and 40 healthy controls recorded symptoms with an electronic diary for 2 weeks at random times per day. Recovery through sleep was defined as the difference in fatigue between late evening and the next morning. Results: In clinical burnout, sleep quality and recovery are impaired, and depression is elevated. Poor recovery through sleep is associated with poor same-night sleep quality, clarifying the mechanisms underlying poor recovery. Individual differences in recovery though sleep were related to differences in refreshed awakening, but not to other sleep problems. Impaired recovery was also related to severity of exhaustion, but not to severity of depressive mood, indicating that, in burnout, nonprofit from sleep is a symptom of energy depletion, not a sign of depression. Conclusion: Impaired recovery through sleep may hamper recovery from burnout independently of the influence of depression.

Sonnenschein M., Mommersteeg P.M.C. & Houtveen, J.H. (May 2007). Exhaustion and endocrine functioning in clinical burnout: An in-depth study using the experience sampling method. Biological Psychology, 75(2)176-184.

The current study investigates the relationship between HPA-axis functioning and burnout symptoms by employing an electronic symptom diary. This diary method circumvents the retrospection bias induced by symptom questionnaires and allows to study relationships within-in addition to between-subjects. Forty two clinically burned-out participants completed the exhaustion subscale of the Maslach burnout inventory and kept an electronic diary for 2 weeks to assess momentary exhaustion and daily recovery through sleep. On 3 consecutive weekdays within the diary period, saliva was sampled to determine the cortisol awakening response (CAR), levels of dehydroepiandrosterone-sulphate (DHEAS) on the first 2 weekdays, and to conduct the dexamethasone suppression test (DST) on the third weekday. We found significant relationships between endocrine values and general momentary symptom severity as assessed with the diary, but not with the retrospective questionnaire-assessed burnout symptoms. Simultaneous assessments of endocrine values and burnout symptoms assessed with the diary after awakening rendered significant associations between persons, and a trend within persons. More severe burnout symptoms were consistently associated with a lower level and smaller increase of CAR, higher DHEAS levels, smaller cortisol/DHEAS ratios and a stronger suppression after DST. Burnout symptoms were significantly related to endocrine functioning in clinical burnout under the best possible conditions of symptom measurement. This adds support to the view that severity of burnout symptoms is associated with HPA-axis functioning.

Stein R.I., Kenardy, J. & Wiseman C.V. (Apr 2007). What’s driving the binge in binge eating disorder?: A prospective examination of precursors and consequences. International Journal of Eating Disorders, 40(3):195-203.

Objective: Previous research, mostly using retrospective reports, indicated a relation of negative affect and dietary restraint with the occurrence of binge episodes in binge eating disorder (BED). We employed Ecological Momentary Assessment (EMA) to better understand precursors and consequences of binge eating. Method: Thirty-three females with BED carried a handheld computer for 7 days, and were periodically prompted to indicate their current emotions, hunger, and binge status. Results: Negative mood and hunger were significantly higher at prebinge than at nonbinge times, but negative mood was even higher at postbinge. Participants attributed binge episodes to mood more frequently than to hunger or abstinence violation. Conclusion: The finding that negative mood is actually heightened subsequent to a binge suggests the need to further investigate what is reinforcing about a binge, including possible escape from self-awareness. Strengths of EMA technology are discussed, as well as its broad utility in BED assessment and treatment.

Stergiou G.S., Argyraki K.K., Moyssakis I., Mastorantonakis S.E., Achimastos A.D., Karamanos V.G. & Roussias L.G. (Jun 2007). Home blood pressure is as reliable as ambulatory blood pressure in predicting target-organ damage in hypertension. Am J Hypertens., 20(6):616-21.

BACKGROUND: Our objective was to assess the value of home blood pressure (BP) monitoring in comparison to office BP measurements and ambulatory monitoring in predicting hypertension-induced target-organ damage. METHODS: Sixty-eight untreated patients with hypertension with at least two routine prestudy office visits were included (mean age, 48.6 +/- 9.1 [SD] years; 50 men). Office BP was measured in two study visits, home BP was measured for 6 workdays, and ambulatory BP was monitored for 24 h. All BP measurements were obtained using validated electronic devices. Target-organ damage was assessed by measuring the echocardiographic left-ventricular mass index (LVMI), urinary albumin excretion rate (AER) in two overnight urine collections, and carotid-femoral pulse-wave velocity (PWV) (Complior device; Colson, Garges-les-Gonesse, Paris, France). RESULTS: The correlation coefficients of LVMI with office BP were 0.24/0.15 (systolic/diastolic), with home BP 0.35/0.21 (systolic, P < .01), and with 24-h ambulatory BP 0.23/0.19, awake 0.21/0.16, and asleep 0.28/0.26 (asleep, both P < .05). The correlation coefficients of AER with office BP were 0.24/0.31 (diastolic, P < .05), with home BP 0.28/0.26 (both P < .05), and with 24-h ambulatory BP 0.25/0.24, awake 0.24/0.25 (diastolic, P < .05), and asleep 0.26/0.18 (systolic, P < .05). There was a trend for negative correlations between PWV and diastolic BP measurements (not significant). In multiple-regression models assessing independent predictors of each of the three indices of target-organ damage, systolic home BP and age were the only independent predictors of increased LVMI that reached borderline statistical significance. CONCLUSIONS: These data suggest that home BP is as reliable as ambulatory monitoring in predicting hypertension-induced target-organ damage, and is superior to carefully taken office measurements.

Tanaka C., Tanaka S., Kawahara J. & Midorikawa T. (May 2007). Triaxial accelerometry for assessment of physical activity in young children. Obesity (Silver Spring)., 15(5):1233-41.

OBJECTIVE: The purpose of the present study was to derive linear and non-linear regression equations that estimate energy expenditure (EE) from triaxial accelerometer counts that can be used to quantitate activity in young children. We are unaware of any data regarding the validity of triaxial accelerometry for assessment of physical activity intensity in this age group. RESEARCH METHODS AND PROCEDURES: EE for 27 girls and boys (6.0 +/- 0.3 years) was assessed for nine activities (lying down, watching a video while sitting and standing, line drawing for coloring-in, playing blocks, walking, stair climbing, ball toss, and running) using indirect calorimetry and was then estimated using a triaxial accelerometer (ActivTracer, GMS). RESULTS: Significant correlations were observed between synthetic (synthesized tri-axes as the vector), vertical, and horizontal accelerometer counts and EE for all activities (0.878 to 0.932 for EE). However, linear and non-linear regression equations underestimated EE by >30% for stair climbing (up and down) and performing a ball toss. Therefore, linear and non-linear regression equations were calculated for all activities except these two activities, and then evaluated for all activities. Linear and non-linear regression equations using combined vertical and horizontal acceleration counts, synthetic counts, and horizontal counts demonstrated a better relationship between accelerometer counts and EE than did regression equations using vertical acceleration counts. Adjustment of the predicted value by the regression equations using the vertical/horizontal counts ratio improved the overestimation of EE for performing a ball toss. DISCUSSION: The results suggest that triaxial accelerometry is a good tool for assessing daily EE in young children.

Toschke J.A., von Kries R., Rosenfeld E. & Toschke A.M. (2007 May 17). Reliability of physical activity measures from accelerometry among preschoolers in free-living conditions. Clin Nutr. [Epub ahead of print]

BACKGROUND AND AIMS: Physical activity (PA) is a major determinant of obesity. Accelerometers have been reported to provide valid measures among adults. However, studies among preschoolers rarely report positive findings. To assess the day-to-day variability of accelerometers in preschoolers. METHODS: Uni-axial accelerometer (Actigraph monitor AM 7164-2.2) counts including one weekend from the time of getting up in the morning until bedtime. RESULTS: On average, boys showed 899 counts per minute (cpm) compared to 764 for girls (p<0.01; overall mean 828cpm). Intra-individual correlation for accelerometry data between single days of examination was low with Pearson correlation coefficients between r=0.31 and 0.51. Furthermore, child’s body mass index (BMI) and accelerometer measures were not related to each other (Pearson’s correlation coefficient r=-0.06). Subsequent analyses showed higher measures (+50%cpm; p<0.01) for instruments placed in front of the umbilicus compared to instruments placed at the right hip. CONCLUSIONS: Measurements of uni-axial accelerometers showed a low reliability among preschoolers. Uni-axial accelerometers placed on elastic belts might measure PA with low precision among preschoolers under free-living conditions possibly due to slipping instruments. This might explain lacking findings of an association between PA and obesity in studies among preschoolers.

VanWinkel R., Henquet C., Rosa A., Papiol S., Fananas L., De Hert M., Peuskens J., van Os J. & Myin-Germeys I. (2007 May 24). Evidence that the COMT(Val158Met) polymorphism moderates sensitivity to stress in psychosis: An experience-sampling study. Am J Med Genet B Neuropsychiatr Genet. [Epub ahead of print]

Gene-environment interactions involving the catechol-O-methyltransferase Val(158)Met polymorphism (COMT(Val158Met)) have been implicated in the causation of psychosis. Evidence from general population studies suggests that Met/Met subjects are sensitive to stress, a trait associated with psychosis. We hypothesized that the Met allele would moderate the effects of stress on negative affect (NA) in controls, and on NA and psychosis in patients with a psychotic disorder. Thirty-one patients with a psychotic disorder and comorbid cannabis misuse and 25 healthy cannabis users were studied with the experience sampling method (ESM), a structured diary technique assessing current context and emotional and psychotic experiences in daily life. A significant interaction between COMT(Val158Met) genotype and ESM stress in the model of NA was found for patients (interaction chi(2) = 7.4, P = 0.02), but not for controls (interaction chi(2) = 3.8, P = 0.15). In the model of ESM psychosis, a significant interaction between COMT(Val158Met) genotype and ESM stress was also apparent (interaction chi(2) = 11.6, P < 0.01), with Met/Met patients showing the largest increase in psychotic experiences as well as NA in reaction to ESM stress. The findings suggest that the COMT(Val158Met) polymorphism moderates affective and psychotic responses to stress in patients with psychosis, providing evidence for gene-environment interaction mechanisms in the formation of psychotic symptoms. (c) 2007 Wiley-Liss, Inc.

Warms C.A., Belza B.L. & Whitney J.D. (Apr-Jun 2007). Correlates of physical activity in adults with mobility limitations. Fam Community Health., 30(2 Suppl):S5-16.

This study identified the correlates of objectively and subjectively measured physical activity in adult wheelchair users. Fifty participants wore an activity monitor for a week and completed a questionnaire about factors associated with physical activity. Objectively measured activity correlated significantly with body mass index. Subjectively measured activity correlated significantly with age, stage of change, health, healthcare providers discussing exercise, and social support for exercise. Research on the effect of body mass index on activity in this population is needed. Intervention planners should plan programs that place emphasis on modifying the social environment (including healthcare providers) and removing attitudinal barriers.

Wichers M.C., Myin-Germeys I., Jacobs N., Peeters F., Kenis G., Derom C., Vlietinck R., Delespaul P. & van Os J. (Jun 2007). Evidence that moment-to-moment variation in positive emotions buffer genetic risk for depression: a momentary assessment twin study. Acta Psychiatr Scand., 115(6):451-7.

OBJECTIVE: The negative affective response to daily life stressors, which previous work suggest is a fundamental depression endophenotype, may be moderated by positive emotions. It was investigated whether positive affect (PA) buffers negative affect (NA) reactivity in response to stress and whether PA moderates the genetic predisposition to negative affect reactivity. METHOD: A total of 279 twin pairs participated in a momentary assessment study with the experience sampling method, collecting appraisals of stress and affect in the flow of daily life. Lifetime diagnoses of depression were obtained. RESULTS: There was a significant interaction between stress appraisal of event (STRESS) and PA in the association with NA. The interaction between proband PA, proband STRESS and co-twin lifetime depression showed that higher PA reduced the interaction between proband STRESS and co-twin lifetime depression. CONCLUSION: Positive emotions not only buffer against NA reactivity, but in addition attenuate genetic effects on negative mood bias in daily life.

Wittmeier K.D., Mollard R.C. & Kriellaars D.J. (Apr 2007). Objective assessment of childhood adherence to Canadian physical activity guidelines in relation to body composition. Appl Physiol Nutr Metab., 32(2):217-24.

Low levels of childhood physical activity (PA) are a contributing factor to obesity. The objective of this study was to determine the adherence of children to PA guidelines in relation to body composition. Body fat (Slaughter equation) and body mass index (BMI) were determined during the school year (n = 251, ages 8-11 y). Daily energy expenditure (EE, kcal.kg-1.d-1) and activity time (AT, min.d-1) above moderate and vigorous intensity thresholds were assessed (accelerometry). Using EE criteria, 35.9% expended < 3.0 kcal.kg-1.d-1, 27.9% expended between 3.0 and 5.9 kcal.kg-1.d-1, 13.5% expended between 6.0 and 7.9 kcal.kg-1.d-1, and 22.9% expended >or= 8.0 kcal.kg-1.d-1. Using AT criteria, 52.2% accumulated < 30.0 min, 31.1% accumulated 30.0-59.9 min, 12.7% accumulated 60.0-89.9 min, and 4.0% accumulated >or=90.0 min of AT. The EE corresponding to accumulation of AT > 90 min was 14.8 kcal.kg-1.d-1. The AT corresponding to >or= 8 kcal.kg-1.d-1 was 73.0 min. Inverse relationships were observed between EE and body fat (p = 0.0004), BMI (p = 0.002), mass (p = 0.008), and fat mass index (FMI) (p = 0.001), as well as between AT and body fat (p = 0.001), BMI (p = 0.008), mass (p = 0.017), and FMI (p = 0.002). Controlling for BMI, FMI was inversely related to EE (p = 0.049) and AT (p = 0.039). Fat-free mass index and AT were positively related (p = 0.038). Physical activity had beneficial effects on body composition for children independent of BMI. The relationship between AT and daily EE guidelines was rationalized (60 min.d-1 with 8 kcal.kg-1.d-1) and demonstrated association with acceptable body composition. The 60 min.d-1 of moderate activity may be a more suitable initial target than 90 min.d-1, as so few children met the upper tiers of PA guidelines.

Wonderlich S.A., Crosby R.D., Engel S.G., Mitchell J.E., Smyth J. & Miltenberger R. (Jun 2007). Personality-based clusters in bulimia nervosa: differences in clinical variables and ecological momentary assessment. J Personal Disord., 21(3):340-57.

The present study examined whether personality-based subgroups of bulimic individuals differed in eating disorder behavior, comorbid psychopathology, treatment history, and momentary assessments of mood and behavior. Participants completed an Ecological Momentary Assessment (EMA) protocol for a period of 2 weeks. Latent profile analysis on the Dimensional Assessment of Personality Pathology revealed 3 groupings of bulimic participants: Interpersonal-emotional, Stimulus seeking-hostile, and Low personality pathology. The personality-based groups differed in histories of mood, anxiety, substance use disorders, features of borderline personality disorder, treatment history, and several momentary measures. These findings suggest that personality variation within the bulimia nervosa diagnostic construct may be associated with meaningful conceptual and clinical differences, including daily experiences in the natural environment.

Woodward S.H., Arsenault N.J., Voelker K., Nguyen T., Lynch J., Leskin G. & Sheikh J. (Jul 2007). Estimating heart rate and RSA from the mattress-recorded kinetocardiogram. Psychophysiology., 44(4):635-8. [Epub 2007 Apr 16]

This article describes a method for extracting heart rate (HR) and respiratory sinus arrhythmia (RSA) from the kinetocardiogram (KCG) recorded from accelerometers embedded in a mattress topper. Validation has been performed via comparison with simultaneously recorded ECG. All-night estimates of HR and RSA magnitude derived from both methods were highly correlated. KCG-derived estimates of HR were slightly lower, and those of RSA magnitude higher, than those derived from ECG. These biases are consistent with the need to constrain KCG estimation to periods free of body movement. Mattress actigraphy represents a zero-burden method of obtaining intensive longitudinal indices of cardiac status.Klumb, P. L., Hoppmann, C. A. & Staats, M. (2006). Work hours affect spouse’s cortisol secretion-For better and for worse. Psychosomatic Medicine, 68, 742-746.

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