Society for Ambulatory Assessment

Third quarter 2007 (July to September)

Anveden I. & Meding B. (Oct 2007). Skin exposure in geriatric care – a comparison between observation and self-assessment of exposure. Contact Dermatitis, 57(4):253-258.

The aim of this study was to compare observation and self-assessment of skin exposure to irritants during a working day in nursing in geriatric care. The study group consisted of 40 volunteers, 13 nurses, and 27 assistant nurses. Before the start of a working day, the participants completed a questionnaire regarding skin exposure to water, gloves, hand disinfection, and moisturizers. Observers subsequently used a hand-held computer to register the time and frequency of each exposure. The total mean skin exposure time was 96 min per working day, including glove use. The mean exposure time to water was 9 min per working day. A tendency to overestimate was found for all exposures. A strong correlation between self-reports and observations was found for hand disinfection and moisturizers, while a moderate correlation was found for gloves and number of water exposures and a weak correlation for total time of water exposure. Despite the differences between self-assessment and observation of the exposure, we consider the questionnaire to be useful for surveying skin exposure in nursing. Furthermore, the observations in this study suggest that nursing work in geriatric care may comprise limited exposure to water.^

Becker J., Schwartz C., Saris-Baglama R.N., Kosinski M. & Bue Bjorner J. (Oct 2007). Using Item Response Theory (IRT) for Developing and Evaluating the Pain Impact Questionnaire (PIQ-6™). Pain Medicine, 8(s3):129–144.

Objectives. To describe the development and evaluation of the Pain Impact Questionnaire (PIQ-6TM), a six-item measure of pain severity and impact on health-related quality of life (HRQOL) domains. Participants. Two general US population samples (N = 829 and N = 7,025) and one chronic pain patient sample (N = 350) were included.
Methods. The PIQ-6TM was developed using conventional and item response theory (IRT) methods in four steps: 1) initial selection and development of items based on results from a previously developed Bodily Pain item bank; 2) final item selection based on new data and investigations of unidimensionality, differential item functioning (DIF), and IRT modeling; 3) development of scoring algorithms, population norms, and cross-calibrations; and 4) psychometric evaluation. Results. Six items on pain intensity and impact satisfied requirements of unidimensionality and lack of DIF and could be scored using IRT methods. The PIQ-6 showed good internal consistency reliability (coefficient alpha = 0.94) and good construct validity. Convergent validity was supported by strong correlations with pain severity scales (visual analog and numerical rating scales; r = 0.81–0.84); discriminant validity was suggested by correlations with the SF-8™ Health Survey Physical and Mental Component Summary measures (r = −0.77; r = −0.32, respectively), significant mean score differences between chronic pain patients and the general population, and between patients differing in self-reported medical conditions (P < 0.001). Conclusion. The PIQ-6 is a brief, precise questionnaire available in a paper-and-pencil version and a computerized version that includes scoring and feedback software. It may facilitate large-scale, inexpensive, precise, and norm-based pain assessment and monitoring in a wide variety of settings (e.g., homes, clinics, offices).

Berlin S., Shalit L., Yarom Y. & Moran D.S. (Aug 2007). Metabolic rate prediction by massless actigraphy for outdoor activities. Mil Med, 172(8):882-887.

PURPOSE: In military scenarios, there is a need for a system that can enable identification of possible future injury during different activities that are considered to be physically strenuous. The purpose of the present study was to determine whether the use of an octagonal actigraph in conjunction with heart rate (fc) measurements could serve as an accurate method for metabolic rate estimation for different free-living activities in field settings. METHODS: Twenty young healthy volunteers (10 men, 22 +/- 3 years of age, and 10 women, 23 +/- 3 years of age) participated in this study. All participants were exposed to six different activities (walking, running, sweeping, climbing and descending stairs, and shopping). Continuous actigraphic measurements were collected from the hip and wrist, fc was monitored with a Polar chest belt, and oxygen consumption (VO2) was measured with a K4b2 system. RESULTS: A prediction model for VO2 was constructed from actigraphic and fc measurements. Comparisons between predicted and measured VO2 values revealed high correlations (hip, R2 = 0.842; wrist, R2 = 0.822). CONCLUSIONS: This new prediction model highly correlated with VO2 measurements. The hip was found to be more favorable than the wrist for assessment of VO2 for different free-living activities.

Boggia J., Li Y., Thijs L., Hansen T.W., Kikuya M., Bjorklund-Bodegard K., Richart T., Ohkubo T., Kuznetsova T., Torp-Pedersen C., Lind L., Ibsen H., Imai Y., Wang J., Sandoya E., O’brien E. & Staessen J.A. (Oct 2007). Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet, 6;370(9594):1219-1229.

BACKGROUND: Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated the prognostic significance of the ambulatory blood pressure during night and day and of the night-to-day blood pressure ratio. METHODS: We did 24-h blood pressure monitoring in 7458 people (mean age 56.8 years [SD 13.9]) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay, and China. We calculated multivariate-adjusted hazard ratios for daytime and night-time blood pressure and the systolic night-to-day ratio, while adjusting for cohort and cardiovascular risk factors. FINDINGS: Median follow-up was 9.6 years (5th to 95th percentile 2.5-13.7). Adjusted for daytime blood pressure, night-time blood pressure predicted total (n=983; p<0.0001), cardiovascular (n=387; p<0.01), and non-cardiovascular (n=560; p<0.001) mortality. Conversely, adjusted for night-time blood pressure, daytime blood pressure predicted only non-cardiovascular mortality (p<0.05), with lower blood pressure levels being associated with increased risk. Both daytime and night-time blood pressure consistently predicted all cardiovascular events (n=943; p<0.05) and stroke (n=420; p<0.01). Adjusted for night-time blood pressure, daytime blood pressure lost prognostic significance only for cardiac events (n=525; p> or =0.07). Adjusted for the 24-h blood pressure, night-to-day ratio predicted mortality, but not fatal combined with non-fatal events. Antihypertensive drug treatment removed the significant association between cardiovascular events and the daytime blood pressure. Participants with systolic night-to-day ratio value of 1 or more were older, at higher risk of death, and died at an older age than those whose night-to-day ratio was normal (> or =0.80 to <0.90). INTERPRETATION: In contrast to commonly held views, daytime blood pressure adjusted for night-time blood pressure predicts fatal combined with non-fatal cardiovascular events, except in treated patients, in whom antihypertensive drugs might reduce blood pressure during the day, but not at night. The increased mortality in patients with higher night-time than daytime blood pressure probably indicates reverse causality. Our findings support recording the ambulatory blood pressure during the whole day.

Brown L.H., Silvia P.J., Myin-Germeys I. & Kwapil T.R. (Sep 2007). When the need to belong goes wrong: the expression of social anhedonia and social anxiety in daily life. Psychol Sci, 18(9):778-782.

People possess an innate need to belong that drives social interactions. Aberrations in the need to belong, such as social anhedonia and social anxiety, provide a point of entry for examining this need. The current study used experience-sampling methodology to explore deviations in the need to belong in the daily lives of 245 undergraduates. Eight times daily for a week, personal digital assistants signaled subjects to complete questionnaires regarding affect, thoughts, and behaviors. As predicted, higher levels of social anhedonia were associated with increased time alone, greater preference for solitude, and lower positive affect. Higher social anxiety, in contrast, was associated with higher negative affect and was not associated with increased time alone. Furthermore, greater social anxiety was associated with greater self-consciousness and preference to be alone while interacting with unfamiliar people. Thus, deviations in the need to belong affect social functioning differently depending on whether this need is absent or thwarted.

Butte N.F., Puyau M.R., Adolph A.L., Vohra F.A. & Zakeri I. (Aug 2007). Physical activity in nonoverweight and overweight Hispanic children and adolescents. Med Sci Sports Exerc, 39(8):1257-1266.

BACKGROUND: Despite the high prevalence of childhood obesity among U.S. Hispanic children and adolescents, quantitative, objective data on their patterns and levels of physical activity are scarce. OBJECTIVES: 1) To describe qualitatively the types of physical activities in which nonoverweight and overweight Hispanic children and adolescents participate; 2) to use accelerometry to quantitatively describe the duration, intensity, and frequency of physical activity; 3) to examine the influence of age, gender, and BMI status on physical activity levels; and 4) to determine the relationships between physical activity and adiposity, fitness, and risk for the metabolic syndrome. METHODS: Cross-sectional assessment of physical activity using accelerometers was made for three continuous days in 897 nonoverweight and overweight Hispanic children, ages 4-19 yr. Ancillary measurements included blood pressure, anthropometry, body composition by dual-energy x-ray absorptiometry, fitness by VO2peak test, and metabolic risk factors, using standard clinical and biochemical methods. RESULTS: Types and levels of physical activity were influenced by age, gender, and body mass index (BMI) status. Total physical activity counts declined markedly with increasing age (P = 0.001) and were consistently higher in boys than in girls (P = 0.001). Total activity counts were lower (P = 0.002) and sedentary activity counts were higher in overweight than in nonoverweight children (P = 0.001). Sleep duration (min.d(-1)) was slightly lower in overweight compared with nonoverweight children, ages 4-8 yr (P = 0.03). Physical activity levels were significantly associated with percent FM, VO2peak, fasting serum insulin, and waist circumference, although the strength of the associations were generally low. CONCLUSION: Efforts should be made to shift the time in sedentary activity to light activity, and to increase the time spent in moderate to vigorous activity in U.S. Hispanic children and adolescents, with special attention given to the overweight, girls, and adolescents.

Chen E., Matthews K.A. & Zhou F. (Aug 2007). Interpretations of ambiguous social situations and cardiovascular responses in adolescents. Ann Behav Med, 34(1):26-36.

Background: Previous research has documented effects of ambiguous outcome social situations on individual differences in cardiovascular reactivity in laboratory contexts. Purpose: This study tested whether interpretations of ambiguous social situations are associated with daily life cardiovascular responses using ambulatory approaches. Methods: There were 206 high school adolescents assessed on interpretations of ambiguous social situations in the laboratory who then completed ambulatory monitoring of blood pressure (BP) and heart rate (HR) for 2 days. Results: Adolescents who perceived threat during ambiguous situations exhibited higher systolic BP when talking to others compared to occasions of not talking with anyone, whereas the opposite was true for those with low threat perception. For high-threat adolescents, higher systolic BP was found when interacting with friends, whereas for low threat adolescents, lower systolic BP was found when interacting with parents. Greater threat interpretations were also associated with elevated HR at night. Conclusions: Understanding how adolescents perceive social interactions may help in gauging their daily cardiovascular responses.

Conrad A., Wilhelm F.H., Roth W.T., Spiegel D. & Taylor C.B. (2007 Sep 18). Circadian affective, cardiopulmonary, and cortisol variability in depressed and nondepressed individuals at risk for cardiovascular disease. J Psychiatr Res. [Epub ahead of print]

Depression is a risk factor for cardiovascular disease (CVD) perhaps mediated by hypothalamic-pituitary-adrenal (HPA) axis or vagal dysregulation. We investigated circadian mood variation and HPA-axis and autonomic function in older (55 years) depressed and nondepressed volunteers at risk for CVD by assessing diurnal positive and negative affect (PA, NA), cortisol, and cardiopulmonary variables in 46 moderately depressed and 19 nondepressed volunteers with elevated CVD risk. Participants sat quietly for 5-min periods (10:00, 12:00, 14:00, 17:00, 19:00, and 21:00), and then completed an electronic diary assessing PA and NA. Traditional and respiration-controlled heart rate variability (HRV) variables were computed for these periods as an index of vagal activity. Salivary cortisols were collected at waking, waking+30min, 12:00, 17:00, and 21:00h. Cortisol peaked in the early morning after waking, and gradually declined over the day, but did not differ between groups. PA was lower and NA was higher in the depressed group throughout the day. HRV did not differ between groups. Negative emotions were inversely related to respiratory sinus arrhythmia in nondepressed participants. We conclude that moderately depressed patients do not show abnormal HPA-axis function. Diurnal PA and NA distinguish depressed from nondepressed individuals at risk for CVD, while measures of vagal regulation, even when controlled for physical activity and respiratory confounds, do not. Diurnal mood variations of older individuals at risk for CVD differ from those reported for other groups and daily fluctuations in NA are not related to cardiac autonomic control in depressed individuals.

Cooney N.L., Litt M.D. & Cooney, J.L. (Sep 2007). Alcohol and tobacco cessation in alcohol-dependent smokers: Analysis of real-time reports. Psychology of Addictive Behaviors, 21(3):277-286.

Alcohol-tobacco interactions and relapse precipitants were examined among alcohol-dependent smokers in a trial of concurrent alcohol and tobacco treatment. After discharge from treatment, participants completed 14 days of electronic diary (ED) assessments of mood, self-efficacy, urges to drink or smoke, and drinking and smoking behavior. ED data revealed an increase in frequency of alcohol urges after smoking episodes. Drinking relapse episodes were predicted by prior ED ratings of low self-efficacy to resist drinking and high urge to smoke. Smoking relapse episodes were predicted by high urge to smoke and high negative, high arousal mood. Results support a cross-substance cue reactivity model of multiple substance use and a limited-strength model, but not a cross-substance coping model.

Corder K., Brage S. & Ekelund U. (Sep 2007). Accelerometers and pedometers: methodology and clinical application. Curr Opin Clin Nutr Metab Care, 10(5):597-603.

PURPOSE OF REVIEW: The relationship between physical activity and health varies considerably, partly due to the difficulty of assessing physical activity accurately. This review examines recent literature on the validation of movement sensors to assess habitual physical activity. Recommendations are given for the use of movement sensors during free-living conditions and methods of data analysis and interpretation are discussed. RECENT FINDINGS: Recent progress in physical-activity research includes detailed comparative studies of different monitor brands. The move away from using linear-regression equations and the use of novel data-analysis strategies is increasing the accuracy with which energy expenditure can be estimated from accelerometry. New technologies, including the combination of accelerometry with the measurement of physiological parameters, have great potential for the increased accuracy of physical-activity assessment. SUMMARY: Accelerometry is able to adequately assess physical activity and its association with health outcomes but currently methods have limited accuracy for the estimation of free-living energy expenditure. Pedometers provide an inexpensive overall measure of physical activity but are unable to assess intensity, frequency and duration of activity or to estimate energy expenditure. Interpretation of monitor output is best kept as close to the measurement domain as possible.

Dearnley C., Haigh J. & Fairhall J. (2007 Aug 29). Using mobile technologies for assessment and learning in practice settings: A case study. Nurse Educ Pract. [Epub ahead of print]

The aim of this project was to explore the feasibility and identify the issues of using mobile technologies in the assessment of health and social care students in practice settings. We report here on a case study, which took place between a University department and varied clinical settings where students were on placement. Twenty-nine student midwives and five members of lecturing staff took part in the study and were issued with PocketPCs on which to record assessment documentation including action plans and evidence of achieving performance criteria. Qualitative data were obtained from three focus groups with student midwives and individual interviews with their link lecturers and quantitative data were gathered through short questionnaires to provide simple descriptive statistics. Findings indicated that students preferred the neatness and durability of the PocketPC to the paper based format, which became worn overtime. The ability to add to notes and references as and when appropriate was welcomed. However, anxiety about losing the device or material stored within it proved to be a major constraint. Lecturing staff found that synchronising the device with the University electronic diary system was extremely useful whilst clinical staff approached the change with varying levels of acceptance or dismissal. Introducing mobile technology into the clinical setting will require a significant shift in culture and a significant level of training and support.

Denchev S.V., Simova I.I. & Matveev M.G. (Oct 2007). Evaluation of the SCHILLER BR-102 plus noninvasive ambulatory blood pressure monitor according to the International Protocol introduced by the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. Blood Press Monit, 12(5):329-333.

OBJECTIVE: To evaluate the SCHILLER BR-102 plus (Schiller AG, Baar, Switzerland) noninvasive ambulatory blood pressure recorder according to the International Protocol for validation of blood pressure measuring devices in adults introduced by the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. METHOD: One SCHILLER BR-102 plus blood pressure recorder was tested by a validation team, consisting of three persons: two observers (nurses) and a doctor, acting as supervisor and ‘expert’. The European Society of Hypertension International Protocol comprises two phases. Fifteen participants were recruited for the first phase and, following a successful test, a further 18 persons (giving a total of 33) were recruited additionally. For phase 1, five of the 15 participants had systolic blood pressure and diastolic blood pressure in each of the ranges: low, medium and high. For phase 2, 11 of the 33 participants (including the first 15 participants) had systolic blood pressure and diastolic blood pressure in each of the ranges. The mercury standard for validation was preferred over the optional Sphygmocorder. Because the SCHILLER BR-102 plus has the oscillometric method as backup to the basic auscultatory measurement, both systems of measurement were subjected to individual validations. RESULTS: Results obtained show that the SCHILLER BR-102 plus noninvasive ambulatory blood pressure recorder meets all the requirements specified in the International Protocol for both oscillometric and auscultatory methods. CONCLUSION: On the basis of these results, the SCHILLER BR-102 plus can be recommended for ambulatory blood pressure measurement in clinical practice using both auscultatory and oscillometric modes.

DeNiet M., Bussmann J.B., Ribbers G.M. & Stam H.J. (Sep 2007). The stroke upper-limb activity monitor: its sensitivity to measure hemiplegic upper-limb activity during daily life. Arch Phys Med Rehabil, 88(9):1121-1126.

OBJECTIVE: To test the Stroke Upper-Limb Activity Monitor (Stroke-ULAM), which uses electrogoniometry and accelerometry to measure the amount of upper-limb usage in stroke patients in daily life conditions, for its sensitivity to discriminate between moderately recovered and well-recovered stroke patients and control subjects. DESIGN: Cross-sectional study. SETTING: At home or a rehabilitation center. PARTICIPANTS: Seventeen patients with stroke and 5 control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Level of usage of upper limb and the percentage of affected upper-limb activity compared with unaffected upper-limb activity (proportion). RESULTS: The level of usage of the affected upper limb of stroke patients was lower than that of the nondominant upper limb of control subjects (electrogoniometry, 97.8 degrees+/-92.3 degrees/min vs 286.2 degrees+/-46.5 degrees/min, P<.01; accelerometry 1.0+/-0.5 g/min vs 2.4+/-0.8 g/min, P<.01). Stroke patients had lower proportions than control subjects in both electrogoniometry (22.6%+/-18.0% vs 84.6%+/-9.8%, P<.01) and accelerometry (39.2%+/-21.4% vs 93.3%+/-5.0%, P<.01). Well-recovered stroke patients had significantly higher proportions compared with moderately recovered patients on both electrogoniometry and accelerometry. CONCLUSIONS: The Stroke-ULAM sensitively measures actual performance, and therefore can be a valuable addition to the mostly capacity-oriented tools currently used to evaluate upper-limb function. Proportion is preferred to the level of usage.

DeSantis A.S., Adam E.K. & Doane L.D. (Jul 2007). Racial/ethnic differences in cortisol diurnal rhythms in a community sample of adolescents. Journal of Adolescent Health, 41(1):3-13.

Purpose: To identify potential physiological pathways to racial disparities in health outcomes, this study uses cortisol data collected from a community sample of 255 adolescents to examine whether there are racial/ethnic differences in cortisol slopes and levels across the waking day in naturalistic settings. Methods: This study uses salivary cortisol data (sampled five times per day over 3 days) to examine racial/ethnic differences in diurnal cortisol rhythms, while covarying the presence of major depressive disorder and chronic and episodic life stress (assessed by structured interviews), momentary negative emotion (reported in diaries completed with cortisol samples), and socioeconomic status, sleep, and health variables (assessed by questionnaire) previously found to be associated with cortisol levels. Results: African-American and Hispanic youth were found to have flatter cortisol slopes across the waking day than their Caucasian counterparts. Differences are due to higher bedtime cortisol levels among Hispanics and to both lower wakeup and higher bedtime levels among African-Americans. Although higher levels of negative emotion were associated with flatter diurnal rhythms, the socioenvironmental factors examined failed to explain the observed racial/ethnic differences in diurnal cortisol rhythms. Conclusions: Significantly flatter diurnal cortisol slopes were found among African American and Hispanic adolescents, a pattern which has been related to negative health consequences. Further research is needed to examine how early these differences emerge and to identify their developmental origins. Although genetic contributions are possible, greater prenatal stress exposure, low birth weight, adverse early childhood experiences, experiences with racism or discrimination, and lifetime history of chronic stress are all reasonable psychosocial hypotheses to pursue.

Donadio V., Liguori R., Vetrugno R., Contin M., Elam M., Wallin B.G., Karlsson T., Bugiardini E., Baruzzi A. & Montagna P. (Sep 2007). Daytime sympathetic hyperactivity in OSAS is related to excessive daytime sleepiness. J Sleep Res, 16(3):327-332.

The aim of this study was to investigate the relationships among sympathetic hyperactivity, excessive daytime sleepiness (EDS) and hypertension in obstructive sleep apnoea syndrome (OSAS). Ten newly diagnosed OSAS patients with untreated EDS and daytime hypertension underwent polysomnography (PSG) and daytime measurements of plasma noradrenaline (NA), ambulatory blood pressure (BP), muscle sympathetic nerve activity (MSNA) by microneurography and objective assessment of EDS before and during 6 months of compliance-monitored continuous positive airway pressure (CPAP) treatment. One month after the start of CPAP, BP, MSNA and NA were significantly lowered, remaining lower than baseline also after 3 and 6 months of treatment. CPAP use caused a significant improvement of sleep structures, and reduced EDS. A statistical correlation analysis demonstrated that EDS was not correlated with sleep measures obtained from baseline PSG (% sleep stages, apnoea and arousal index, mean oxygen saturation value), whereas daytime sleepiness was significantly correlated with MSNA. Furthermore, MSNA and BP showed no correlation. Our data obtained from selected patients suggest that the mechanisms inducing EDS in OSAS are related to the degree of daytime sympathetic hyperactivity. Additionally, resting MSNA was unrelated to BP suggesting that factors other than adrenergic neural tone make a major contribution to OSAS-related hypertension. The results obtained in this pilot study need, however, to be confirmed in a larger study involving more patients.

Ebner-Priemer U.W., Kuo J. & Kleindienst N. (Jul 2007). State affective instability in borderline personality disorder assessed by ambulatory monitoring. Psychological Medicine, 37(7):961-970.

Background: Although affective instability is an essential criterion for borderline personality disorder (BPD), it has rarely been reported as an outcome criterion. To date, most of the studies assessing state affective instability in BPD using paper-pencil diaries did not find indications of this characteristic, whereas in others studies, the findings were conflicting. Furthermore, the pattern of instability that characterizes BPD has not yet been identified. Method: We assessed the affective states of 50 female patients with BPD and 50 female healthy controls (HC) during 24 hours of their everyday life using electronic diaries. Results: In contrast to previous paper-and-pencil diary studies, heightened affective instability for both emotional valence and distress was clearly exhibited in the BPD group but not in the HC group. Inconsistencies in previous papers can be explained by the methods used to calculate instability (see Appendix). In additional, we were able to identify a group-specific pattern of instability in the BPD group characterized by sudden large decreases from positive mood states. Furthermore, 48% of the declines from a very positive mood state in BPD were so large that they reached a negative mood state. This was the case in only 9% of the HC group, suggesting that BPD patients, on average, take less time to fluctuate from a very positive mood state to a negative mood state. Conclusion: Future ambulatory monitoring studies will be useful in clarifying which events lead to the reported, sudden decrease in positive mood in BPD patients.

Evans S.R., Simpson D.M., Kitch D.W., King A., Clifford D.B., Cohen B.A. & McArthur J.C. (2007 Jul). A randomized trial evaluating Prosaptide for HIV-associated sensory neuropathies: use of an electronic diary to record neuropathic pain. PLoS ONE, 2(6):e551.

OBJECTIVES: To examine the efficacy and safety of Prosaptide (PRO) for the treatment of painful HIV-associated sensory neuropathies (HIV-SN). DESIGN: A randomized, double-blind, placebo-controlled, multicenter study in participants with sensory neuropathy. Pain modulating therapy was discontinued prior to baseline. Participants were stratified by sural sensory nerve action potential (SNAP) amplitude. Participants were trained to use an electronic diary (ED) to record pain. SETTING: Peripheral neuropathies are common complications of HIV infection. The pathogenesis is unknown and currently treatments are restricted to symptomatic measures. We examined PRO against placebo (PBO) for treatment of painful HIV-SN and performed a post-hoc evaluation of an electronic diary (ED) to record HIV-associated neuropathic pain. PARTICIPANTS: Eligible participants included adults with neurologist-confirmed painful HIV-SN. INTERVENTIONS: 2, 4, 8, or 16 mg/d PRO or PBO administered via subcutaneous (SC) injection for six weeks. Neurotoxic antiretroviral drug usage was held constant. OUTCOME MEASURES: Changes from baseline in the weekly average of evaluable daily random prompts measuring pain using the Gracely pain scale and adverse events. RESULTS: 237 participants were randomized. The study was stopped after a planned futility analysis. There were no between-group differences in the frequency of adverse events or laboratory toxicities. The 6-week mean (sd) Gracely pain scale changes were -0.12 (0.23), -0.24 (0.35), -0.15 (0.32), -0.18 (0.34), and -0.18 (0.32) for the 2, 4, 8, 16 mg, and PBO arms respectively. A similar variability of pain changes recorded using the ED were noted compared to previous trials that used paper collection methods. CONCLUSIONS: 6-week treatment with PRO was safe but not effective at reducing HIV-associated neuropathic pain. Use of an ED to record neuropathic pain is novel in HIV-SN, resulted in reasonable compliance in recording pain data, but did not decrease the variability of pain scores compared to historical paper collection methods.

Fanciullo G.J., Cravero J.P., Mudge B.O., McHugo G.J. & Baird J.C. (Oct 2007). Development of a New Computer Method to Assess Children’s Pain. Pain Medicine, 8(s3):121–128.

Objective. The primary objective of this study was to determine initial psychometric properties and feasibility of a new Computer Face Scale for measuring pediatric pain. Drawbacks to current measurement tools include a lack of continuous variables, suboptimal mode of implementation, and difficulty interpreting results. A computer method of pediatric pain measurement is presented that addresses these problems. Basic psychometric properties, feasibility, and children’s preference when compared with Wong-Baker Faces Scale were determined. Methods. Fifty-four hospitalized, pediatric inpatients were tested using both the Computer Face Scale and the Wong-Baker Faces Scale. An additional 30 children (not hospitalized) were tested using only the Computer Face Scale. Results. Both hospitalized and nonhospitalized children between the ages of 3 and 17 years of age are able to use the Computer Face Scale to express relative amounts of pain/hurt and happiness. The Computer Face Scale shows acceptable psychometric properties and is preferred by most children. Conclusions. The Computer Face Scale offers advantages over traditional pediatric pain measurement tools. The opportunity for real time review, electronic and time-stamped recording, electronic display, and temporal comparisons of reports affords the potential for improvement in pediatric pain assessment and treatment.

Finkenauer C., Gallucci M. & van Dijk W.W. (Aug 2007). Investigating the role of time in affective forecasting: Temporal influences on forecasting accuracy. Personality and Social Psychology Bulletin, 33(8):1152-1166.

Using extensive diary data from people taking their driver’s license exam, the authors investigated the role of time in affective forecasting accuracy. Replicating existing findings, participants grossly overestimated the intensity and duration of their negative affect after failure and only slightly overestimated the intensity and duration of their positive affect after success. Extending existing findings, participants accurately predicted a decrease of their affective reactions over time but underestimated the speed with which this decrease would occur. In addition, they showed greater forecasting accuracy for positive affect than negative affect when the exam was distant and greater forecasting accuracy for negative affect than positive affect when the exam was close. The motivational processes underlying these findings are being discussed.

Gard D.E., Kring A.M. & Gard M. (Jul 2007). Anhedonia in schizophrenia: Distinctions between anticipatory and consummatory pleasure. Schizophrenia Research, 93(1-3):253-260.

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.

Goldstein D.H., Wilson R. & VanDenKerkhof E.G. (Oct 2007). Electronic Monitoring in an Acute Pain Management Service. Pain Medicine, 8(s3):94–100.

Objectives. This article will address the process involved in the development and implementation of a clinician-driven portable electronic chart on an Acute Pain Management Service (APMS). We describe the latest version of the program and provide 1 year of clinical data.
Setting. Tertiary care center in Kingston, Ontario, Canada. Patients. All patients admitted to the APMS between August 1, 2005, and July 31, 2006. Results. A total of 8,726 APMS visits were made to 2,528 patients. Mean length of stay on the Service was 2.3 days. Sixty-one percent of patients reported an active pain score >3/10. Pain scores were highest with hip or knee surgery. Thirty-five percent of patients reported nausea. Conclusions. Executive sponsorship, alignment with institutional priorities, and user input are essential to the development, implementation, adoption, and sustainability of an electronic patient record. Ready access to data at the bedside can improve quality of care, while ongoing, comprehensive data can contribute to Phase IV drug trials. Incorporating both clinical and research outcomes in the database improves data quality and usability, but must be balanced with the impact of clinical time constraints on documentation. Wireless technology and Tablet computers provide portability and adequate screen size for documentation and reviewing of patient data on an acute pain service. It is necessary to provide solutions to process issues, such as printing electronic records during the transition from paper to electronic records.

Gorely T., Marshall S.J., Biddle S.J. & Cameron N. (2007 Aug 20). The prevalence of leisure time sedentary behaviour and physical activity in adolescent girls: An ecological momentary assessment approach. Int J Pediatr Obes. [Epub ahead of print]

Study objective. To use ecological momentary assessment to describe how adolescent girls in the United Kingdom spend their leisure time. Design. Cross-sectional, stratified, random sample from secondary schools in 15 regions within the United Kingdom. The data are from a larger study of adolescent lifestyles (Project STIL). Participants. A total of 923 girls with a mean age of 14.7 years (range 12.5-17.6 years). The majority were white-European (88.7%). Main results. Across all behaviours, television viewing occupied the most leisure time on both weekdays and weekend days. The five most time consuming sedentary weekday activities occupied on average 262.9 minutes per weekday and 400 minutes per weekend day. In contrast, only 44.2 minutes was occupied by active transport or sports and exercise per weekday, and 53 minutes per weekend day. Only a minority watched more than 4 hours of TV per day (3.3% on weekdays and 20.7% on weekend days). Computer use is low in this group. Some differences were noted in the means and prevalences between weekend and weekdays, most likely reflecting the greater discretionary time available at the weekend. Few age differences were noted. Conclusions. Adolescent girls engage in a variety of behaviours that contribute to an overall lifestyle that may be active or sedentary. Effective physical activity promotion strategies must focus on facilitating shifts towards healthy overall patterns of behaviour rather than shifts in any one single behaviour.

Gorely T., Marshall S.J., Biddle S.J. & Cameron N. (2007 Aug 22). Patterns of Sedentary Behaviour and Physical Activity Among Adolescents in the United Kingdom: Project STIL. J Behav Med. [Epub ahead of print]

The purpose of this study was to use ecological momentary assessment to investigate the patterning of physical activity and sedentary behaviours in UK adolescents and to examine if different lifestyle groups differ on key explanatory variables. A total of 1,371 (38% boys, mean age 14.7 years) adolescents completed diaries every 15 min for 3 weekdays outside of school hours and 1 weekend day. Cluster analysis yielded five-cluster solutions for both boys and girls to explain the grouping of sedentary behaviours and physical activity. The clusters demonstrated that adolescents engage in many leisure time behaviours but have one activity that predominates. Active adolescents spend more time outside and more time with their friends. Few demographic and environmental variables distinguished between clusters. The findings suggest a potential need for different behavioural targets in interventions to reduce sedentary behaviour in sub groups of the adolescent population. Further research is required to examine the modifiable determinants of different sedentary lifestyles among young people.

Gosse P., Papaioanou G., Coulon P., Reuter S., Lemetayer P. & Safar M. (Aug 2007). Can ambulatory blood-pressure monitoring provide reliable indices of arterial stiffness? Am J Hypertens, 20(8):831-838.

BACKGROUND: The use of ambulatory recordings of blood pressure (BP) was proposed to estimate arterial stiffness (AS). We compared the relative value of the ambulatory AS index (AASI), and of the slope of pulse pressure (PP) according to mean BP (MBP) obtained from 24-h ambulatory BP monitoring, to the monitoring of the arrival time of Korotkoff sounds (QKD interval) in the prediction of cardiovascular (CV) events. METHODS: Twenty-four-hour ambulatory BP and QKD monitoring were recorded at baseline, before antihypertensive treatment of hypertensive patients in our Bordeaux cohort. From these recordings, the AASI, the PP/MBP slope, and the theoretical value of the QKD for a systolic pressure of 100 mm Hg and a heart rate of 60 beats/min (QKD100-60) were calculated. The patients were then given antihypertensive treatment and followed by their family physicians, who were unaware of the QKD, AASI, and PP/MBP slope results. Regular updates on patients were obtained. The reproducibility of measurements was studied in 38 normal subjects evaluated on two occasions. RESULTS: The reproducibility of the AASI and the PP/MBP slope was less than that of BP over 24 h and of QKD100-60. The cohort comprised 469 patients. With an average follow-up of 70+/-39 months, 62 CV complications, including 13 deaths, were recorded. In the monovariate analysis, age, PP over 24 h, QKD100-60, AASI, and the PP/MBP slope were significantly related to the occurrence of complications. In the multivariate analysis, when age and PP over 24 were included in the model, only QKD100-60 remained significantly linked to CV events. CONCLUSIONS: Our data support the value of the AASI as an indirect estimate of AS and as an element in the evaluation of CV risk in hypertensive patients. However, the reproducibility of this index is less, and its predictive value for complications is poorer, than that of QKD100-60, a parameter that we believe is more closely linked to AS.

Hagstromer M., Oja P. & Sjostrom M. (Sep 2007). Physical activity and inactivity in an adult population assessed by accelerometry. Med Sci Sports Exerc, 39(9):1502-1508.

INTRODUCTION: Strong evidence suggests a link between physical inactivity and chronic disease prevalence in the adult population. To target the right groups for interventions in a population, accurate assessment of physical activity is important. The objective of this study was to assess the levels and pattern of physical activity and inactivity in an adult population sample using an objective method. METHODS: In total, 1114 adults (56% women, 45+/-15 yr), randomly recruited from the Swedish population across a year, used an accelerometer (Actigraph MTI) for seven consecutive days. Inactivity was defined as <100 counts per minute, and cutoff values for moderate and vigorous activity were 1952-5724 and >5724 counts per minute, respectively. Average intensity was measured as counts per minute. RESULTS: The adults were active in at least moderate-intensity activity for a median (intraquartile range) of 31 (18-47) min.d(-1). Fifty-two percent accumulated 30 min.d(-1) of at least moderate-intensity physical activity. Only 1% achieved those 30 min from three or more bouts of at least 10 min. Average intensity, moderate and vigorous physical activity was lower with higher age or body mass index (BMI). Men spent more time than women in moderate and vigorous physical activity, but there was no gender difference in average intensity. The variation in inactivity could not be explained by gender, age, or BMI. CONCLUSION: Objectively obtained estimates of physical activity yielded lower values and a different activity pattern compared with those obtained by commonly used self-reports. This highlights the need to better understand the nature and measurement issues of health-enhancing physical activity of adults.

Hardwick M.E., Pulido P.A. & Adelson W.S. (Jul/Aug 2007). The Use of Handheld Technology in Nursing Research and Practice. Orthopaedic Nursing, 26(4):251-255.

Use of handheld devices with electronic patient diaries (EPDs) can improve the quality of patient-reported information collected in clinical and research settings. EPDs have advantages compared with traditional paper-based instruments that include decreased data entry error and decreased time spent on data management. Orthopaedic pain management, which is often dependent on patient-reported pain levels, can benefit from the use of EPDs. A pilot survey was conducted to compare two self-report pain diary methods in shoulder surgery patients: (a) EPD or (b) paper entry. Compliance was lower in the EPD group, which was attributed to insufficient ease of use. Handheld technology can be used by nurses to improve and streamline patient care by capturing clinical data, by organizing and reporting home health services, and by providing references for evidence-based practice. Handheld technology can facilitate the transformation of clinical documentation of assessments, interventions, and outcomes into evidence-based decision making in orthopaedic nursing.

Havermans R., Nicolson N.A. & deVries M.W. (Sep 2007). Daily Hassles, Uplifts, and Time Use in Individuals With Bipolar Disorder in Remission. Journal of Nervous & Mental Disease, 195(9):745-751.

Although life stress has been shown to trigger relapse in bipolar disorder, little is known about how bipolar patients perceive daily hassles or their positive counterparts, uplifts. We used the experience sampling method to investigate the daily experience of hassles and uplifts in 38 patients with remitted bipolar disorder and 38 healthy controls. Largely because of current unemployment, patients were more often alone and at home and spent less time working and more time in passive leisure activities. Contrary to expectations, the groups did not differ in total frequencies or appraisals of events. Within the patient group, however, those patients with current depressive symptoms and more previous depressive episodes experienced negative events as more stressful. These findings are consistent with hypothesized processes linking depressive symptoms to the generation of stressful conditions or to the reactivation of negative cognitive schemas.

Heapy A., Sellinger J., Higgins D., Chatkoff D., Bennett T.C. & Kerns R.D. (Oct 2007). Using Interactive Voice Response to Measure Pain and Quality of Life. Pain Medicine, 8(s3):145–154.

Objectives. To describe the feasibility of using Interactive Voice Response (IVR) technology to collect daily, prospective data about pain and quality of life in a randomized clinical trial of transdermal fentanyl (TDF). Design. This article focuses on the use of IVR technology within a larger study that compared the relative efficacy of TDF to short-acting opioids for treating chronic noncancer pain. IVR allows individuals to call into a telephone system to answer questions using the telephone keypad.
Participants. Forty-six participants consented to be in the study and made at least one IVR phone call. Thirty-one participants completed the study. All participants were veterans from the VA Connecticut Healthcare System, and all reported chronic pain that had previously been treated with short-acting oral opioids. Outcome Measures. Participant adherence with calling into the IVR system was assessed via frequency counts of the number of calls placed vs the number of expected calls. Participants provided data about average pain, pain interference, medication adherence and side effects, satisfaction with pain control, and sleep quality. Results. Participants who completed the study made 84.6% of the 1302 expected calls into the IVR system, and an additional 4% of missed calls were obtained through follow-up. Proportion of completed calls declined slightly across the three call-in intervals, but remained high (from 87.5% to 81.3%). Conclusions. These data suggest that IVR is an effective way to collect prospective treatment data. Detailed discussion of additional benefits and potential drawbacks to the use of IVR technology is provided.

Hodt-Billington C., Helbostad J.L. & Moe-Nilssen R. (2007 Sep 24). Should trunk movement or footfall parameters quantify gait asymmetry in chronic stroke patients? Gait Posture. [Epub ahead of print]

The purpose of this study was to investigate gait asymmetry in chronic stroke patients in comparison with subjects with no known asymmetries. Further, we wanted to decide which gait symmetry parameter has the best ability to discriminate between the two groups. Twenty subjects with hemiplegia (mean age 58 years, S.D.=8 years) and 57 subjects with no known gait asymmetry (mean age 77 years, S.D.=5 years) walked six times along a 7-m walkway at slow, preferred and fast speed. Measures of vertical, anteroposterior, and mediolateral trunk asymmetry were assessed from triaxial accelerometry data. The footfall parameters of single support (% of stride time) and step length (m) asymmetry were assessed from data obtained using an electronic walkway. Vertical (p<0.001), anteroposterior (p=0.01), mediolateral (p=0.01) trunk movement and single support (p=0.03) showed significant differences in asymmetry between the two groups. No difference in step length asymmetry was found between the two groups. Neither single support asymmetry nor step length asymmetry showed the ability to discriminate subjects with hemiplegic gait from subjects in the comparison group. Measures of trunk movement asymmetry, however, were able to discriminate between the two groups (p</=0.001). The results indicate that trunk movement should be included in the assessment of gait asymmetry in chronic stroke patients.

Hoeksma J.B., Oosterlaan J. & Schipper E. (Aug 2007). Finding the attractor of anger: Bridging the gap between dynamic concepts and empirical data. Emotion, 7(3):638-648.

Although it accounts for the prototypical course of emotions, the attractor concept has hardly ever been used empirically. Authors applied Empirical Differential Equations (EDE) to frequent (hourly) anger ratings to find the attractor of anger. The attractor concept, its neurological basis, and EDE are explained. The attractor of anger follows an underdamped oscillator, and is affected by the capacity to inhibit prepotent responses. Anger accelerates less fast when inhibitory control increases. Results stress the internal dynamics of emotions, and help to bridge the gap between concepts from dynamic systems theory and empirical data.

Houtveen J.H. & van Doornen L.J. (2007 Aug 30). Medically unexplained symptoms and between-group differences in 24-h ambulatory recording of stress physiology. Biol Psychol. [Epub ahead of print]

People with medically unexplained symptoms (MUS) often have a comorbid history of stress and negative affect. Although the verbal-cognitive and (peripheral) physiological stress systems have shown a great degree of independence, at the same time it is claimed that chronic stress and negative affect can result in a disregulated physiological stress system, which may lead to MUS. Previous studies could not demonstrate a straightforward between subject relationship between MUS and stress physiology, supporting the view of independence. The aim of the current study was to further explore this relationship using an improved methodology based on ecologically valid 24-h real-life ambulatory recordings. Seventy-four participants (19 male; 55 female) with heterogeneous MUS were compared with 71 healthy controls (26 male; 45 females). Momentary experienced somatic complaints and mood, heart rate, cardiac autonomic activity, respiration and saliva cortisol were monitored using electronic diary and ambulatory registration devices. Participants with MUS reported much more momentary complaints and negative affect as compared to controls. Although MUS seemed to be associated with elevated heart rate and reduced low and very-low frequency heart period variability, these effects disappeared after controlling for differences in sports behaviour. No group differences were found for cardiac autonomic activity, respiration, end-tidal CO(2) and saliva cortisol. Our 24-h real-life ambulatory study did not support the existence of a connection between MUS and disregulated peripheral stress physiology. Future studies may instead focus on central measures to reveal potential abnormalities such as deviant central processing of visceral signals in MUS patients.

Hurtig-Wennlof A., Ruiz J.R., Harro M. & Sjostrom M. (Aug 2007). Cardiorespiratory fitness relates more strongly than physical activity to cardiovascular disease risk factors in healthy children and adolescents: the European Youth Heart Study. Eur J Cardiovasc Prev Rehabil, 14(4):575-581.

BACKGROUND: Physical activity and cardiorespiratory fitness are closely related to health variables in adults, especially those considered to be among risk factors for cardiovascular diseases. The possible tracking of cardiovascular disease risk factors from childhood to adulthood makes it important to increase our understanding of the complex relationships between physical activity, cardiorespiratory fitness and cardiovascular risk factors early in life. DESIGN: A cross-sectional, school-based study on healthy children and adolescents, aged 9-10 years (295 girls, 295 boys) and 15-16 years (302 girls, 233 boys) was performed during a school year in Sweden and Estonia, as part of the European Youth Heart Study. METHODS: Total physical activity, and minutes spent in inactivity and activity of moderate or higher intensity were measured by accelerometry. A maximal ergometer bike test was used for estimation of cardiorespiratory fitness. The risk factors included blood pressure and fasting blood levels of insulin, glucose, triglycerides, total cholesterol and high-density lipoprotein cholesterol. RESULTS: Canonical correlations between physical activity and cardiorespiratory fitness versus cardiovascular disease risk factors showed significant associations in both age and sex groups (rc=0.46-0.61, P<0.0001). The cardiorespiratory fitness was found to be the strongest contributor to these relationships. In girls high values of the physical activity variables were also associated with a favourable cardiovascular profile. CONCLUSIONS: Cardiorespiratory fitness relates more strongly to cardiovascular risk factors than components of objectively measured physical activity in children and adolescents. Physical activity becomes more important in the 15-year-old adolescents, indicating that these modifiable lifestyle factors increase in importance with age.

Jasser S.A., Garvin J.H., Wiedemer N., Roche D. & Gallagher R.M. (Oct 2007). Information Technology in Mental Health Research: Impediments and Implications in One Chronic Pain Study Population. Pain Medicine, 8(s3):176–181.

Objective. The Department of Veterans Affairs and Veterans’ Administration hospitals began using the electronic medical record in 1994, streamlining provider-to-provider communication of vital clinical information, and simultaneously providing investigators access to vast amounts of clinical data for research purposes. Administrative and coded data, including symptoms and diagnoses as derived from chart content, are one of the most ready substrates for analysis of these massive databases to answer various research-related inquiries. We evaluated the capability of this type of coded data to accurately identify patients with schizophrenia from a group of 819 patients taking opioids for chronic pain in the primary care clinic of the Philadelphia Veterans’ Administration Medical Center. Methods. Patients were identified for inclusion in this analysis by their sequential enrollment in an Opioid Renewal Clinic as referred by their primary care providers, as well as a nonreferred cohort of chronic pain patients maintained on opioids by their primary care providers (N = 819). The prevalence of schizophrenia obtained by coded diagnostic labeling by computerized chart review was compared with the prevalence of schizophrenia obtained by systematic independent manual chart review of all cases by a research psychiatrist. Results. Based purely on coded diagnostic labeling, the prevalence of schizophrenia in this population was 14%, nearly 14 times the estimated general population prevalence. However, manual independent chart review of the identified cases by a research psychiatrist (N = 119) resulted in the actual prevalence in this group to be estimated at 1.8%. None of the patients with three or less incidents of diagnostic labeling by code had schizophrenia. Of those with four or more incidents, 74% had schizophrenia. Conclusions. Better accuracy is obtained when cases of schizophrenia are identified by multiple coding incidents derived from longitudinal clinical encounters. These findings suggest that the extraction of up to three coding incidents for schizophrenia alone is not an accurate means of identifying this clinical population for research and epidemiological purposes. Further, when designing automated, information technology-based approaches to the identification of subjects for clinical research and extracting their data from electronic medical records using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes, mental health diagnoses must be uniquely considered on a disease-by-disease basis.

Kikuchi H., Yoshiuchi K., Ohashi K., Yamamoto Y. & Akabayashi A. (2007 Sep 10). Tension-type headache and physical activity: an actigraphic study. Cephalalgia. [Epub ahead of print]

There have been some studies on the relationship between tension-type headache (TTH) and physical activity. However, most previous studies were not prospective and assessed physical activity by questionnaire. Therefore, this study was aimed to investigate the relationship between TTH intensity and physical activity prospectively utilizing computerized ecological momentary assessment and actigraphy. Thirty-one TTH patients wore watch-type computers equipped with actigraphy inside for 1 week to record momentary headache intensity and physical activity. Multilevel modelling was used to investigate the effect of headache intensity on the simultaneous and subsequent activity level. There were significant negative associations between headache intensity and the simultaneous and subsequent activity level, and activity level was significantly reduced at headache exacerbations. These results provide objective and quantitative evidence suggesting that TTH negatively affects physical activity.

Kneipp S.M., Welch D.P., Wood C.E., Yucha C.B. & Yarandi H. (2007 Jul 13). Psychosocial and Physiological Stress Among Women Leaving Welfare. West J Nurs Res. [Epub ahead of print]

Women receiving Temporary Assistance for Needy Families (TANF) report more stress and have poorer health than women in the general population. Studies suggest chronic stress may contribute to poor health via physiological mechanisms, yet little is known about these mechanisms in this population. This study examined psychosocial stress, salivary cortisol, 24-hr ambulatory blood pressure and heart rate, and health among 40 single mothers before and after exiting TANF. As a group, perceived stress decreased after leaving TANF (p = .02), with other measures of psychosocial and physiological stress remaining unchanged. Within participants, changes in psychosocial stress predicted depression and general health over time (adjusted R(2) = .30 and .22; p = .006 and .004, respectively). These findings indicate psychosocial stress is positively associated with depression and negatively associated with general health as women exit welfare. Psychosocial stress was not associated with changes in physiologic indicators of stress.

Laurenceau J., Hayes A.M. & Feldman G.C. (Jul 2007). Some methodological and statistical issues in the study of change processes in psychotherapy. Clinical Psychology Review, 27(6):682-695.

As the number of psychotherapies with demonstrated efficacy accumulates, an important task is to identify principles and processes of change. This information can guide treatment refinement, integration, and future development. However, the standard randomized control trial (RCT) design can limit the questions that can be asked and the statistical analyses that can be conducted. We discuss the importance of examining the shape of change, in addition to the importance of identifying mediators and moderators of change. We suggest methodological considerations for longitudinal data collection that can improve the kinds of therapy process questions that can be examined. We also review some data analytic approaches that are being used in other areas of psychology that have the potential to capture the complexity and dynamics of change in psychotherapy.

Louro M.J., Pieters R. & Zeelenberg M. (Aug 2007). Dynamics of multiple-goal pursuit. Journal of Personality and Social Psychology, 93(2):174-193.

The authors propose and test a model of multiple-goal pursuit that specifies how individuals allocate effort among multiple goals over time. The model predicts that whether individuals decide to step up effort, coast, abandon the current goal, or switch to pursue another goal is determined jointly by the emotions that flow from prior goal progress and the proximity to future goal attainment, and proximally determined by changes in expectancies about goal attainment. Results from a longitudinal diary study and 2 experiments show that positive and negative goal-related emotions can have diametrically opposing effects on goal-directed behavior, depending on the individual’s proximity to goal attainment. The findings resolve contrasting predictions about the influence of positive and negative emotions in volitional behavior, critically amend the goal gradient hypothesis, and provide new insights into the dynamics and determinants of multiple-goal pursuit.

Lukasiewicz M., Fareng M., Benyamina A., Blecha L., Reynaud M. & Falissard B. (Aug 2007). Ecological momentary assessment in addiction. Expert Rev Neurother, 7(8):939-950. Review.

Numerous symptoms in psychiatry are subjective (e.g., sadness, anxiety, craving or fatigue), fluctuate and are environment dependent. Accurate measurement of these phenomena requires repeated measures, and ideally needs to be performed in the patient’s natural environment rather than in an artificial laboratory environment or a protected hospital environment. The usual paper and pencil questionnaires do not meet these two conditions for reasons of logistics. A recently developed method, ecological momentary assessment (EMA), made it possible to implement these field assessments via ingenious use of various devices (most frequently an electronic diary) coupling an auditory signal with computerized data capture. The subject carries the device with him/her at all times, and data is recorded in vivo in real time. The programming of repeated measures in the form of a Likert scale or pull-down menu is easily achieved. A recall alarm system can help increase compliance. Compared with classical self-report, EMA improves the validity of the assessment of certain symptoms, which are the main evaluation criteria in clinical trials concerning certain pathologies (e.g., craving and treatment of addiction), where measurement was previously liable to bias. This article sets out to present this method, its advantages and disadvantages, and the interest it presents in psychiatry, in particular via three original applications developed by the authors including: measurement of reaction time without the knowledge of the subject in order to test certain cognitive models; use of a graphic solution for the data recorded for functional analysis of disorders; and the use of data collection via mobile phone and text messages, which also enables therapeutic interventions in real time by text messages, personalized on the basis of the situational data collected (e.g., in the case of craving, the associated mood, solitary or group consumption or concomitant occupations).

Lurbe E. & Redon J. (2007 Aug 11). Discrepancies in office and ambulatory blood pressure in adolescents: help or hindrance? Pediatr Nephrol. [Epub ahead of print]

The goal of this commentary is to review the most relevant topics concerning the clinical utility of ambulatory blood pressure (BP) monitoring, such as the state of the art “reference BP values”, the importance of the discrepant situations between office and ambulatory BP (white-coat and masked hypertension) and those of the recommended clinical indications to now. From a small number of studies, operational thresholds to define hypertension have been established. They are useful tools even though more studies are necessary to create strong reference values. Ambulatory BP measurement is increasingly recognized as being indispensable to the diagnosis and management of hypertension, and it has contributed significantly to our understanding of hypertension by revealing or “unmasking” BP phenomena that were not readily apparent using traditional techniques of measurement in clinical practice. Ambulatory BP monitoring should be performed in adolescents with either office mild essential hypertension before starting antihypertensive drug treatment or a strong family history of hypertension or an early cardiovascular event. Obese children with normal office BP values will also benefit from ambulatory BP monitoring. Other indications are the assessment of refractory hypertension or drug-induced hypotension. Finally, additional BP information in chronic renal failure, diabetes, and autonomic neuropathy can be obtained by using ambulatory BP monitoring.

Lyons K.E. & Pahwa R. (Jul 2007). Electronic motor function diary for patients with Parkinson’s disease: A feasibility study. Parkinsonism & Related Disorders, 13(5):304-307.

Parkinson’s disease (PD) studies often measure daily motor function with paper diaries resulting in issues of compliance and reliability. The feasibility and compliance of PD patients using electronic diaries were examined. Twelve patients completed diaries for 7 consecutive days. Diaries recorded motor function, time and date of each half-hour entry and had an alarm as notification of missed entries. Entry compliance was 99.98% within 24 h and average response time during awake hours was 63 min. Electronic diaries could be operated by PD patients, provided valuable information about response patterns and resulted in average response compliance of approximately 1 h.

Marceau L.D., Link C., Jamison R.N. & Carolan S. (Oct 2007). Electronic Diaries as a Tool to Improve Pain Management: Is There Any Evidence? Pain Medicine, 8(s3):101–109.

Objective. Chronic pain is a common and costly syndrome which affects approximately one in three US adults. Factors such as shortened length of the medical visit, increased availability of technological approaches to care, and a more informed patient all suggest that a new paradigm is required for chronic pain management. Although much has been written about the use of electronic diaries in clinical trials, little has been presented about the use of these diaries in clinic practice and their potential for changing pain behavior. The intent of this preliminary study is to measure accessibility and usability of a software program designed for use on a personal digital assistant and to discuss how the software program may impact clinic practice and patient behavior. Methods. We present the results of a preliminary, randomized, comparison, crossover trial of 36 chronic pain patients who were asked to monitor their pain, mood, activity interference, medication use, and pain location on either a paper or electronic diary for 2 weeks. Patients in the electronic diary condition were able to observe changes in their ratings over time and view them on a secure web site. Results. No differences were found between paper and electronic tracking on pain descriptors, pain interference, mood, or helpfulness of medication. Similar to past findings, patients found the electronic diary easier to use (P < 0.0001) and would continue using it (P < 0.05) over paper if given the choice. Importantly, patients using the electronic diary reported more frequently that a provider suggested medication change (P < 0.05) based on feedback from the electronic diary. One trend requiring further investigation is that electronic diary users reported that the diary enabled them and their doctor to make care adjustments according to changes in pain status. Conclusion. This study goes beyond previous research on preference and data quality to investigate how the information provided may affect patient and physician perspectives toward pain management. Although not the initial intent of this study, findings indicate that electronic tracking may provide information which can affect management decisions. A follow-up study is ongoing to investigate these initial results. If found to be true, electronic monitoring may have broad implications for health care, policy, and improvement in quality of care for chronic pain sufferers in the future.

Matos S., Birring S.S., Pavord I.D. & Evans D.H. (Aug 2007). An automated system for 24-h monitoring of cough frequency: the leicester cough monitor. IEEE Trans Biomed Eng, 54(8):1472-1479.

The objective monitoring of cough for extended periods of time has long been recognized as an important step towards a better understanding of this symptom, and a better management of chronic cough patients. In this paper, we present a system for the automatic analysis of 24-h, continuous, ambulatory recordings of cough. The system uses audio recordings from a miniature microphone and the detection algorithm is based on statistical models of the time-spectral characteristics of cough sounds. We validated the system against manual counts obtained by a trained observer on 40 ambulatory recordings and our results show a median sensitivity value of 85.7%, median positive predictive value of 94.7% and median false positive rate of 0.8 events/h. An analysis application was developed, with a graphical user interface, allowing the use of the system in clinical settings by technical or medical staff. The result of the analysis of a recording session is presented as a concise, graphical-based report. The modular nature of the system interface facilitates its enhancement with the integration of further modules.

Mullins M.E. & Devendorf S.A. (2007). Assessing Goal-directed Attention as an Indicator of Self-regulation: A Comparison of Two Approaches. North American Journal of Psychology, 9(2):229-250.

Research on self-regulation has continually expanded our understanding of psychological processes in a variety of contexts. A number of theories of self-regulation exist, many of which include goals and goal-directed attention as critical components. One under-researched aspect of the topic, however, is its measurement (Zeidner, Boekaerts, & Pintrich, 2000). We suggest that Likert-type scales may be inadequate to assess the goal-focused aspect of self-regulation, and that a diary assessment may be superior. A model centered around self-regulation in a laboratory training context is presented and tested using both a Likert-type scale and a diary measure of the construct. Regression analyses indicate that the diary performed more consistently with research-based expectations for self-regulation. Implications and future research directions are discussed.

Murray G. (Sep 2007). Diurnal mood variation in depression: A signal of disturbed circadian function? Journal of Affective Disorders, 102(1-3):47-53.

Background: Diurnal variation in mood is a prominent symptom of depression, and is typically experienced as positive mood variation (PMV-mood being worse upon waking and better in the evening). The present study sought to advance understanding of PMV by measuring daily mood variation in non-clinical individuals with varying levels of depressed mood. Based on research into normative variation in mood and evidence that circadian amplitudes may be decreased in depression, it was hypothesised that compared to those with low levels of depression, individuals meeting Centre for Epidemiological Studies-Depression Scale (CES-D) cut-off for probable depression would exhibit an attenuated circadian component in diurnal variation of Positive Affect (PA). Method: Ninety-nine young healthy women (mean age=21.5, SD=3.0) living on a normal sleep-wake schedule provided mood reports every two hours between 0800 h and 2200 h for 7 days. Results: The high depression group (CES-D≥23, n=22) exhibited a pattern of diurnal variation consistent with PMV (increased PA in the evening relative to the morning). As predicted, evidence was also found that the high depression group was characterized by a decreased circadian component to diurnal variation in PA relative to the low depression group (CES-D<23,n=77). Conclusions: It is provisionally concluded that diurnal mood variation in depression can usefully be understood from the perspective of weakened circadian function. Findings are discussed in terms of limitations of the study’s naturalistic design and future research avenues identified.

Oishi S., Diener E., Choi D., Kim-Prieto C. & Choi I. (Oct 2007). The Dynamics of Daily Events and Well-Being Across Cultures: When Less Is More. Journal of Personality & Social Psychology, 93(4):685-698.

The authors examined cultural and individual differences in the relation between daily events and daily satisfaction. In a preliminary study, they established cross-cultural equivalence of 50 daily events. In the main study, participants in the United States, Korea, and Japan completed daily surveys on the 50 events and daily satisfaction for 21 days. The multilevel random coefficient model analyses showed that (a) the within-person association between positive events and daily satisfaction was significantly stronger among Asian American, Korean, and Japanese participants than among European American participants and (b) the within-person association between positive events and daily satisfaction was significantly weaker among individuals high in global life satisfaction than among those low in global life satisfaction. The findings demonstrate a weaker effect of positive events on daily well-being among individuals and cultures high in global well-being.

Peters M.L. & Crombez G. (Oct 2007). Assessment of Attention to Pain Using Handheld Computer Diaries. Pain Medicine, 8(s3):110–120.

Objective. We review how handheld computer diaries may be used to measure attention to pain in daily life, and how this method helps in clarifying the relationship between attentional focusing and chronic pain. Results. Signal-contingent sampling of attention to pain and pain intensity with computer diaries has demonstrated that at times when patients report increased attention to pain, they also report higher pain intensity. Time-lagged analyses assessing the temporal precedence of changes in pain and attention using computer diaries demonstrated that this association is bidirectional. One diary study manipulated attention toward or away from pain, but this manipulation proved not successful in changing pain intensity. Conclusion. Signal-contingent sampling of pain and attention within patients has furthered our understanding of how these two constructs are related. Handheld computer diaries offer a flexible tool and have several advantages over traditional self-report questionnaires and paper diaries. Complex sampling schemes, in which the timing of signals, or the content of the questions may depend on previous events or responses, are possible. Future research may focus upon the application of handheld computers to measure pain and attention in therapy outcome studies, and upon the combination of event contingent sampling with time contingent sampling.

Phelan S., Roberts M., Lang W. & Wing R.R. (Oct 2007). Empirical evaluation of physical activity recommendations for weight control in women. Med Sci Sports Exerc, 39(10):1832-1836.

PURPOSE: Recent recommendations advise 30-60 min of physical activity per day to prevent weight gain and 60-90 min to prevent weight regain. No studies have used objective measures of physical activity to verify these public health recommendations. The purpose of this study was to use objective measures to quantify the amount and intensity of physical activity in a weight-loss-maintainer group and an always-normal-weight group, and, thus,empirically evaluate the recommendations for prevention of weight gain versus regain. METHODS: The weight-loss-maintainer group (N = 135) lost >/= 30.6 kg, maintained >/= 10% weight loss for 14.2 yr, and had a BMI of 22.0 kg.m. The always-normal-weight group (N = 102) had a BMI of 21.1 kg.m and no history of overweight. Accelerometry was used to assess the amount and intensity of physical activity. RESULTS: The weight-loss-maintainer group spent significantly more minutes per day than the always-normal-weight group in physical activity (58.6 vs 52.1; P = 0.0001), largely because of more time spent in higher-intensity activities (24.4 vs 16.9; P = 0.02). The majority of individuals in the always-normal-weight group engaged in 30-60 min.d of physical activity, whereas a greater proportion of individuals in the weight-loss-maintainer group engaged in > 60 min (P = 0.002). CONCLUSIONS: Findings support current recommendations that more activity may be needed to prevent weight regain than to prevent weight gain. Including some higher-intensity activity may also be advisable for weight-loss maintenance.

Piasecki T.M., Richardson A.E. & Smith S.M. (Sep 2007). Self-Monitored Motives for Smoking Among College Students. Psychology of Addictive Behaviors, 21(3):328-337.

College student smokers (N = 50) were asked to carry electronic diaries for 14 days and record smoking events (n = 1,139). They indicated why they were smoking each cigarette on a checklist of potential motives. Results suggest that a desire to reduce craving (62.8% of occasions) and habit/automatic processes (42.8%) were the most frequent motives. More dependent and daily smokers were especially likely to endorse smoking to reduce craving and for habit/automatic reasons and were less likely to cite coping with negative emotion as a reason for smoking. Dependent and daily smokers were more likely to endorse at least 1 dependence-like motive and were less likely to exclusively attribute smoking to nondependence motives. Self-monitored motives appeared valid, according with conceptually related states, activities, and events in the diary records. Diary-recorded motives were compared with smokers’ responses to a retrospective motives questionnaire administered at baseline. The 2 assessment modes produced discrepant estimates of the most influential motivational processes. Questionnaire responses incompletely forecast conceptually similar diary-reported motives. Dependence and daily smoking showed a different pattern of associations with diary-based versus retrospective motives measures.

Provenzano D.A., Fanciullo G.J., Jamison R.N., McHugo G.J. & Baird J.C. (Oct 2007). Computer Assessment and Diagnostic Classification of Chronic Pain Patients. Pain Medicine, 8(s3):167–175.

Objective. In order to establish a diagnosis of chronic pain, emphasis is placed on a patient’s report of the pain’s intensity, location, and character. The aim of this study was to evaluate the feasibility of a computer assessment method to collect self-reports of pain that were then used in discriminant analyses to distinguish among chronic pain diagnoses. Methods. A convenience sample of 511 patients from two university-based pain clinics completed a computer pain assessment battery that elicited demographic information, pain drawings, pain and emotion intensity ratings, and intensity ratings of verbal descriptors. Patients classified themselves into one of six chronic pain diagnoses. Discriminant analyses were performed in an attempt to identify the unique features of patients’ pain experience associated with each of the diagnostic categories.
Results. Pain drawings successfully classified patients into three of the diagnostic categories (back, head, and neck pain). In a second analysis, two pain descriptors (cramping and stabbing) separated rheumatoid arthritis patients from those with either fibromyalgia or neural pain. One descriptor of pain (cramping) and one descriptor of emotion (frustration) together distinguished between fibromyalgia and neural pain. Conclusions. 1) Computer assessment of a range of patient symptoms is feasible in the pain clinic. 2) Discriminant analysis based on pain drawings can distinguish among patient-reported diagnoses of back pain, headache, and neck pain. 3) Discriminant analysis based on three verbal descriptors can help to distinguish among diagnoses of fibromyalgia, neuralgia, and rheumatoid arthritis. 4) However, in general, most computerized descriptive information is not useful in distinguishing differences among pain patient diagnostic groups.

Roetenberg D., Baten C.T. & Veltink P.H. (Sep 2007). Estimating body segment orientation by applying inertial and magnetic sensing near ferromagnetic materials. IEEE Trans Neural Syst Rehabil Eng, 15(3):469-471.

Inertial and magnetic sensors are very suitable for ambulatory monitoring of human posture and movements. However, ferromagnetic materials near the sensor disturb the local magnetic field and, therefore, the orientation estimation. A Kalman-based fusion algorithm was used to obtain dynamic orientations and to minimize the effect of magnetic disturbances. This paper compares the orientation output of the sensor fusion using three-dimensional inertial and magnetic sensors against a laboratory bound opto-kinetic system (Vicon) in a simulated work environment. With the tested methods, the difference between the optical reference system and the output of the algorithm was 2.6 degrees root mean square (rms) when no metal was near the sensor module. Near a large metal object instant errors up to 50 degrees were measured when no compensation was applied. Using a magnetic disturbance model, the error reduced significantly to 3.6 degrees rms.

Rowan P.J., Cofta-Woerpel L., Mazas C.A., Vidrine J.I., Reitzel L.R., Cinciripini P.M. & Wetter D.W. (Aug 2007). Evaluating Reactivity to Ecological Momentary Assessment During Smoking Cessation. Experimental & Clinical Psychopharmacology, 15(4):382-389.

Ecological momentary assessment (EMA) consists of assessing phenomena in real time in the natural environment. EMA allows for more fine-grained analyses of addictive behavior and minimizes threats to internal validity, such as recall biases and errors. However, because of the intensive monitoring involved in EMA, measurement reactivity is a concern. To test whether EMA with palmtop personal computers induces reactivity, the authors compared smoking-related outcomes between smokers using EMA and those not using EMA during a quit attempt. The use of no-EMA control groups has been rare in reactivity investigations to date. The EMA protocol included event-contingent assessments (smoking episodes, urge episodes) and random assessments. Outcomes included biologically confirmed abstinence and self-report measures of withdrawal, self-efficacy, motivation, affect, and temptations. Participants were smokers motivated to quit (N = 96). They were randomized to 1 of 3 groups: EMA for the week preceding a planned quit date, EMA for the week following the quit date, and no EMA. Abstinence rates did not differ between the groups at Day 7 or at Day 28 postcessation. For the 20 subscales assessed at each of 3 assessment times, there were significant differences between participants with and without EMA experience for 3 subscales at the 1st of 3 assessment times, and significant differences for 3 different subscales at the 3rd assessment time. These differences suggest some reactivity to EMA, although the inconsistent pattern across time indicates that further research is needed to definitively conclude that EMA induces reactivity.

Seekins T., Ipsen C. & Arnold N.L. (Aug 2007). Using ecological momentary assessment to measure participation: A preliminary study. Rehabilitation Psychology, 52(3):319-330.

Purpose/Objective: Participation is emerging as the gold standard of outcome measurement in disability and rehabilitation, but there are few methods for measuring it. This article describes the development of a dynamic measure of participation that uses the International Classification of Functioning, Disability and Health as the framework for measure development and ecological momentary assessment (EMA) as the data collection methodology. Research Method/Design: Researchers programmed personal data assistants to prompt 5 residents of a rural community to report their location, activity, social contact, environmental barriers and facilitators, secondary conditions, and ratings of community connectedness and fulfillment. Results: Overall, 5 participants reported data on 1,352 engagements over 7 weeks. Participants reported greater community connectedness and fulfillment when they spent time with others, were not home, and were not experiencing barriers or secondary conditions. Conclusions/Implications: EMA measures and methodology are 1 step in answering questions about participation within the ecological framework of disability.

Smith M.Y., DePue J.D. & Rini C. (Oct 2007). Computerized Decision-Support Systems for Chronic Pain Management in Primary Care. Pain Medicine, 8(s3):155–166.

Objective. Computerized decision-support systems (CDSSs) can offer clinical guidance, as well as promote doctor–patient collaboration and patient self-care. As such, they have great potential for improving chronic pain management, particularly in the primary care setting, where physicians often lack sufficient pain-specific clinical expertise and communication skills. The objective of this study was to examine the use of CDSSs in chronic pain management, and to review the evidence for their feasibility and effectiveness. Design. A review of the available literature using search terms associated with computerized decision-support and chronic pain management. Major databases searched included: MEDLINE, CINAHL, PsychINFO, HealthSTAR, EMBASE, Cochrane Library, Computer and Information Systems Abstracts, and Electronics and Communications Abstracts. Descriptive and evaluative studies were included. Results. Nine studies describing eight CDSSs met study inclusion criteria. With but two exceptions, CDSSs were specific to a pain-related condition(s). All were designed to assist clinicians to manage pain medically. Aside from pain status, input specifications differed markedly. Evaluative studies were exclusively feasibility studies and varied widely in design and level of description. All were nonexperimental; most were methodologically weak. Two primary care studies were reported. Patient and clinician acceptability ratings of CDSSs ranged from moderate to high. Due to insufficient data, definitive conclusions concerning the impact of CDSSs on provider performance and patient outcomes were not possible. Conclusion. Research on CDSSs in chronic pain management is limited. The effects of CDSSs on provider and patient outcomes remain understudied, and their potential to improve doctor–patient collaboration and self-care largely untested.

Smith C. V., Nezlek, J. B., Webster, G. D., & Paddock, E. L. (Aug 2007). Relationships between daily sexual interactions and domain-specific and general models of personality traits. Journal of Social and Personal Relationships, 24, 497-515.

Although sexuality is an important component of personal relationships, there has been relatively little research on relationships between personality and everyday sexual behavior. Moreover, existing research on sexual behavior and   personality (defined in terms of the Five-Factor Model, FFM) has found weak and inconsistent relationships. We hypothesized that sexual behavior can be better   understood in terms of a model of personality that focuses on sexuality rather than in terms of a general model of personality. The present study examined  relationships between two models of personality and daily sexual behavior. For 3 weeks, two different samples described their sexual interactions and they completed a measure of the FFM (N = 104) and the Sexy Seven (N = 48). A series   of multilevel modeling analyses found that personality as measured by both models was related to both positive (e.g., feeling desired) and negative (e.g.,   feeling guilty) reactions to sexual experiences. As predicted, comparisons of the strength of the relationships between reactions to daily sexual experience  and the two models found reactions to sexual experience were related more strongly to the Sexy Seven than to the FFM. The importance of considering both domainspecific and general measures of personality is discussed in terms of  understanding sexual behavior.

Smyth J.M., Wonderlich S.A. & Heron K.E. (Aug 2007). Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. Journal of Consulting and Clinical Psychology, 75(4):629-638.

The relation of mood and stress to binge eating and vomiting in the natural environments of patients with bulimia nervosa (BN) was examined using real-time data collection. Women (n = 131; mean age = 25.3 years) with BN carried a palmtop computer for 2 weeks and completed ratings of positive affect (PA), negative affect (NA), anger/hostility (AH), and stress (STRS); they also indicated binge or vomit episodes (BN-events) 6 times each day. Mixed models were used to compare mood and STRS between and within days when BN-events occurred. Between-days analyses indicated that binge and vomit days both showed less PA, higher NA, higher AH, and greater STRS than days with no BN-events. Within-day, decreasing PA, and increasing NA and AH, reliably preceded BN-events. Conversely, PA increased, and NA and AH decreased following BN-events. Demonstration of the temporal sequencing of affect, STRS, and BN-events with a large BN sample may help advance theory and clinical practice, and supports the view that binge and purge events hold negatively reinforcing properties for women with BN.

Spruill T.M., Pickering T.G., Schwartz J.E., Mostofsky E., Ogedegbe G., Clemow L. & Gerin W. (Aug 2007). The impact of perceived hypertension status on anxiety and the white coat effect. Ann Behav Med, 34(1):1-9.

Background:The white coat effect can lead to overdiagnosis of hypertension and unnecessary pharmacologic treatment. Mechanisms underlying the white coat effect remain poorly understood but are critical to improving the accuracy of clinic blood pressure measurement. Purpose: This study investigated whether perceived hypertension status was associated with state anxiety levels during a clinic visit and the magnitude of the white coat effect, independent of true blood pressure status. Methods: This observational study included 214 normotensive and mildly hypertensive participants who were 18 to 80 years old, had no cardiac history, and were willing to discontinue antihypertensive medications for 8 weeks. Participants underwent 36 hr ambulatory blood pressure monitoring and physician blood pressure measurement. Outcome measures were state anxiety reported during the clinic visit and the white coat effect. Results: An analysis of covariance indicated that participants who perceived themselves as hypertensive reported greater state anxiety (p < .001) and showed larger white coat effects (ps < .01) compared with those who perceived themselves as normotensive. True hypertension status based on ambulatory blood pressure was not related to either outcome. Anxiety accounted for approximately 19% of the association between perceived hypertension status and the white coat effect. Conclusions:These findings suggest that the perception of being hypertensive is associated with greater anxiety during clinic blood pressure measurement and a larger white coat effect, independent of the true blood pressure level. Anxiety appears to be a mechanism by which perceived hypertension status contributes to the white coat effect.

Stergiou G.S. & Parati G. (Oct 2007). The optimal schedule for self-monitoring of blood pressure by patients at home. J Hypertens, 25(10):1992-1997.

The optimal schedule for home blood pressure monitoring should represent the usual level of home blood pressure, give a reproducible value, and have prognostic ability. Therefore, outcome studies, as well as short-term trials assessing the reproducibility of home blood pressure, its stability over time and its relationship with ambulatory blood pressure should be taken into account. A review of this evidence suggests that the optimal schedule should be based on 12-14 measurements, and even more measurements up to 25 are desirable. Morning and evening measurements should be obtained, with at least duplicate measurements per occasion. Measurements on the initial day should preferably be discarded.

Stevens J., Murray D.M., Baggett C.D., Elder J.P., Lohman T.G., Lytle L.A., Pate R.R., Pratt C.A., Treuth M.S., Webber L.S. & Young D.R. (2007 Sep 12). Objectively Assessed Associations between Physical Activity and Body Composition in Middle-School Girls: The Trial of Activity for Adolescent Girls. Am J Epidemiol. [Epub ahead of print]

Declining levels of physical activity probably contribute to the increasing prevalence of overweight in US youth. In this study, the authors examined cross-sectional and longitudinal associations between physical activity and body composition in sixth- and eighth-grade girls. In 2003, girls were recruited from six US states as part of the Trial of Activity for Adolescent Girls. Physical activity was measured using 6 days of accelerometry, and percentage of body fat was calculated using an age- and ethnicity-specific prediction equation. Sixth-grade girls with an average of 12.8 minutes of moderate-to-vigorous physical activity (MVPA) per day (15th percentile) were 2.3 times (95% confidence interval: 1.52, 3.44) more likely to be overweight than girls with 34.7 minutes of MVPA per day (85th percentile), and their percent body fat was 2.64 percentage points greater (95% confidence interval: 1.79, 3.50). Longitudinal analyses showed that percent body fat increased 0.28 percentage points less in girls with a 6.2-minute increase in MVPA than in girls with a 4.5-minute decrease (85th and 15th percentiles of change). Associations between MVPA in sixth grade and incidence of overweight in eighth grade were not detected. More population-based research using objective physical activity and body composition measurements is needed to make evidence-based physical activity recommendations for US youth.

Stinson J.N., Stevens B.J., Feldman B.M., Streiner D., McGrath P.J., Dupuis A., Gill N. & Petroz G.C. (2007 Aug 25). Construct validity of a multidimensional electronic pain diary for adolescents with arthritis. Pain. [Epub ahead of print]

The aim of this study was to evaluate the construct validity and feasibility of a multidimensional electronic pain diary (e-Ouch(c)) in adolescents with juvenile idiopathic arthritis (JIA). Two descriptive studies with repeated measures were conducted between January and December 2005. Participants were drawn from a large metropolitan rheumatology clinic in a university affiliated pediatric tertiary care centre. In Study 1, 76 adolescents with active arthritis recorded their pain three times a day for 2weeks using the e-Ouch(c). In Study 2, 36 adolescents recorded their pain three times a day for 1week before and 2weeks after joint injections. Adolescents in both studies completed multiple measures to determine the construct validity and feasibility of the e-Ouch(c). Adolescents reported mild levels of pain intensity, unpleasantness, and interference as well as stiffness, and mild to moderate levels of fatigue. e-Ouch(c) average weekly pain unpleasantness and interference scores were higher in adolescents with higher pain intensity scores. Correlations between average weekly pain ratings on the e-Ouch(c) and scores from: (a) recalled least, average and worst weekly pain, (b) health-related quality of life and pain coping, and (c) disease activity were as predicted. Pain ratings were significantly lower following joint injections with effect sizes in the low to moderate and moderate to high ranges at the first and second week post-injection, respectively. These findings provide evidence of the construct validity and feasibility of the e-Ouch(c) electronic diary in adolescents with JIA. Use of real-time data capture approaches should be considered in future studies of chronic arthritis.

Stone A.A. & Broderick J.E. (Oct 2007). Real-Time Data Collection for Pain: Appraisal and Current Status. Pain Medicine, 8(s3):85–93.

Objective. Real-time data capture (RTDC) techniques have rapidly developed with the advent of computer and information technology. We plan to discuss the use of RTDC in the assessment of pain, including issues pertaining to its rationale, sampling protocols, and our opinion on the current status of the methodology. Design. This is “thought” piece involving no systematic data collection methods. Results. We described the rationale for using RTDC, including issues in recall bias, the desire for detailed information about pain, and the ability to examine within–person associations between pain and other variables. The mechanics of RTDC implementations were discussed with a focus on sampling protocols and data collection methods. The final section concerned the status of RTDC. Current acceptance of RTDC is evaluated and three issues in the science of RTDC were discussed: the interpretation of differences between recall and the average of momentary assessments for the same period; if RTDC is advancing our understanding of pain; and, the issue of what consumers of pain assessments actually desire. RTDC extensions to feedback based on momentary assessments are also discussed. Conclusion. Real-time data collection can be a useful methodology for improving our understanding of pain and especially of its dynamic nature in real-world settings.

Syed F.I., Oza A.L., Vanderby R., Heiderscheit B. & Anderson P.A. (Sep 2007). A method to measure cervical spine motion over extended periods of time. Spine, 1;32(19):2092-2098.

STUDY DESIGN: System validation study. OBJECTIVE: To develop and validate a motion sensor system for measuring cervical spine motion over extended time periods. SUMMARY OF BACKGROUND DATA: Many studies using different methodologies have tried to estimate cervical spine motion. These have mostly been carried out in a laboratory setting performing active/passive range of motion or activities of daily living. However, cervical spine performance over extended periods of time in natural environments remains unknown. METHODS: A novel motion sensor system, Wisconsin Analysis of Spine Motion Performance (WASP), was validated using 2 benchmarks: a materials testing machine (MTS) and optical motion tracking laboratory. Parameters tested included drift, frequency response, accuracy, effect of sensor orientation, and coupled motions. Applied motions from the MTS and measured motions in subject volunteers under various conditions were compared with WASP using correlation coefficients. Intersubject and intrasubject variability analyses for WASP were also performed. RESULTS: The average WASP slopes for accuracy (compared with MTS) in flexion-extension, lateral bending, and axial rotation were 0.89, 0.93, and 0.38, respectively. The correlation coefficient was 0.99 in all cases. Compared with optical motion tracking, the WASP regression slopes were 1.1, 1.02, and 0.4 and the correlation coefficients were 0.98, 0.92, and 0.93 in the 3 axes of motion. Coupled motion was noted during all subject motions. WASP peak detection algorithm had a 0% error discounting boundary conditions. CONCLUSION: WASP was accurate in flexion-extension and lateral bending. In axial rotation, WASP was less accurate. However, the system was highly reliable with low intersubject and intrasubject variability. WASP can be used in estimating cervical spine motion with high reliability while keeping in mind the decreased accuracy in measuring axial rotation.

Treuth M.S., Catellier D.J. & Schmitz K.H. (Jul 2007). Weekend and weekday patterns of physical activity in overweight and normal-weight adolescent girls. Obesity, 15(7):1782-1788.

Objective: To describe the patterns (specifically comparing weekdays and weekends classified by intensities) of physical activity (PA) measured by accelerometry in adolescent girls. Research Methods and Procedures: Healthy sixth grade girls (n = 1603), 11 to 12 years old, were randomly recruited from 36 schools participating in the Trial of Activity in Adolescent Girls. Age, ethnicity, socioeconomic status, weight, and height were taken. PA patterns were measured for 6 days using accelerometry. Results: Adolescent girls spend most of their time in sedentary (52% to 57% of the day) and light activity (40% to 45% of the day) on weekdays and weekends. In all girls, total PA comprised 44.5% of the day (41.7% light, 2.2% moderate, and 0.7% vigorous) with sedentary activity comprising 55.4%. Moderate-to-vigorous PA (MVPA) was higher (p < 0.001) on weekdays than weekends in all girls, but MVPA was lower in at-risk of overweight + overweight girls (p < 0.001) on both weekdays and weekends compared with normal-weight girls. Discussion: Adolescent girls are more active at moderate and vigorous intensities on weekdays than on weekends, and at-risk of overweight and those overweight spend less time engaging in MVPA than normal-weight girls.

Van den Berg-Emons R.J., Schasfoort F.C. & de Vos, L.A. (Jul 2007). Impact of chronic pain on everyday physical activity. European Journal of Pain, 11(5):587-593.

Although patients with chronic pain are often considered to have reduced levels of everyday physical activity, data on their activity levels are scarce and inconclusive. Therefore, this study explored whether patients with chronic pain have reduced activity levels, as objectively measured with an activity monitor. The activity monitor is based on long-term ambulatory monitoring of signals from body-fixed accelerometers during everyday life, aimed at assessment of mobility-related activities. Measurements with the monitor were performed during a weekday (24 h) in 18 patients with chronic pain and compared with measurements obtained from 18 gender and age matched healthy comparison subjects. The mean (SD) age of the patients was 44 (11) years, and the mean (SD) duration of their complaints was 8 (7) years. Compared with the healthy subjects, the duration of dynamic activities was not significantly reduced (p = 0.10) in the patient group. Mean (SD) intensity of everyday physical activity was lower (p = 0.03) in the patients than in the healthy comparison subjects (0.021 [0.006] g versus 0.026 [0.004] g), and patients spent more time lying down (47.0 [10.2]% versus 34.3 [5.6]%; p = 0.000) and less time sitting (29.2 [8.9]% versus 36.4 [9.3]%; p = 0.03) than the healthy comparison subjects. In spite of significant differences between patients and healthy comparison subjects for some aspects of the activity pattern (which may reflect pain behaviour), the impact of chronic pain on everyday physical activity was relatively small.

Vansteelandt K., Rijmen F. & Pieters G. (Aug 2007). Drive for thinness, affect regulation and physical activity in eating disorders: A daily life study. Behaviour Research and Therapy, 45(8):1717-1734.

Using Ecological Momentary Assessment, the within patient associations between drive for thinness, emotional states, momentary urge to be physically active and physical activity were studied in 32 inpatients with an eating disorder. Participants received an electronic device and had to indicate at nine random times a day during 1 week their momentary drive for thinness, positive and negative emotional states and their urge to be physically active and physical activity. Multilevel analyses indicated that patients with higher mean levels for urge to be physically active were characterized by lower body mass index (BMI) and chronically negative affect whereas patients with higher mean levels for physical activity were characterized by lower BMI and higher dispositions for drive for thinness. In addition, within patient relations between drive for thinness and urge to be physically active were moderated by BMI and chronically negative affect whereas within patient relations between drive for thinness and physical activity were moderated by BMI. Finally, also positive emotional states were significantly associated with physical activity within patients. By using a daily process design, characteristics of physical activity were revealed that have not been identified with assessment methods that have a lower time resolution.

Vouyioukas D., Maglogiannis I. & Pasias V. (Aug 2007). Pervasive E-health services using the DVB-RCS communication technology. J Med Syst, 31(4):237-246.

Two-way satellite broadband communication technologies, such as the Digital Video Broadcasting with Return Channel via Satellite (DVB-RCS) technology, endeavour to offer attractive wide-area broadband connectivity for telemedicine applications, taking into consideration the available data rates, Quality of Service (QoS) provision, survivability, flexibility and operational costs, even in remote areas and isolated regions where the terrestrial technologies suffer. This paper describes a wide-area tele-medicine platform, specially suited for homecare services, based on the DVB-RCS and Wi-Fi communication technologies. The presented platform combines medical data acquisition and transfer, patient remote monitoring and teleconference services. Possible operational scenarios concerning this platform and experimental results regarding tele-monitoring, videoconference and medical data transfer are also provided and discussed in the paper.

Waeber B., Genoud M., Feihl F., Hayoz D. & Waeber G. (Aug 2007). Ambulatory blood pressure monitoring: a mean to stratify cardiovascular risk. Blood Press Monit, 12(4):263-265.

OBJECTIVE: Current hypertension guidelines stress the importance to assess total cardiovascular risk but do not describe precisely how to use ambulatory blood pressures in the cardiovascular risk stratification. METHOD: We calculated here global cardiovascular risk according to 2003 European Society of Hypertension/European Society of Cardiology guidelines in 127 patients in whom daytime ambulatory blood pressures were recorded and carotid/femoral ultrasonography performed. RESULTS: The presence of ambulatory blood pressures >or =135/85 mmHg shifted cardiovascular risk to higher categories, as did the presence of hypercholesterolemia and, even more so, the presence of atherosclerotic plaques. CONCLUSION: Further studies are, however, needed to define the position of ambulatory blood pressures in the assessment of cardiovascular risk.

Wichers M., Aguilera M., Kenis G., Krabbendam L., Myin-Germeys I., Jacobs N., Peeters F., Derom C., Vlietinck R., Mengelers R., Delespaul P. & van Os J. (2007 Aug 8). The Catechol-O-Methyl Transferase Val(158)Met Polymorphism and Experience of Reward in the Flow of Daily Life. Neuropsychopharmacology. [Epub ahead of print]

Genetic moderation of experience of reward in response to environmental stimuli is relevant for the study of many psychiatric disorders. Experience of reward, however, is difficult to capture, as it involves small fluctuations in affect in response to small events in the flow of daily life. This study examined a momentary assessment reward phenotype in relation to the catechol-O-methyl transferase (COMT) Val(158)Met polymorphism. A total of 351 participants from a twin study participated in an Experience Sampling Method procedure to collect daily life experiences concerning events, event appraisals, and affect. Reward experience was operationalized, as the effect of event appraisal on positive affect (PA). Associations between COMT Val(158)Met genotype and event appraisal on the one hand and PA on the other were examined using multilevel random regression analysis. Ability to experience reward increased with the number of ‘Met’ alleles of the subject, and this differential effect of genotype was greater for events that were experienced as more pleasant. The effect size of genotypic moderation was quite large: subjects with the Val/Val genotype generated almost similar amounts of PA from a ‘very pleasant event’ as Met/Met subjects did from a ‘bit pleasant event’. Genetic variation with functional impact on cortical dopamine tone has a strong influence on reward experience in the flow of daily life. Genetic moderation of ecological measures of reward experience is hypothesized to be of major relevance to the development of various behavioral disorders, including depression and addiction.

Wichers M., Myin-Germeys I., Jacobs N., Peeters F., Kenis G., Derom C., Vlietinck R., Delespaul P. & Van Os J. (Sep 2007). Genetic risk of depression and stress-induced negative affect in daily life. Br J Psychiatry, 191:218-223.

BACKGROUND: A bias to develop negative affect in response to daily life stressors may be an important depression endophenotype, but remains difficult to assess. AIMS: To assess this mood bias endophenotype, uncontaminated by current mood, in the course of daily life. METHOD: The experience sampling method was used to collect multiple appraisals of daily life event-related stress and negative affect in 279 female twin pairs. Cross-twin, cross-trait associations between dailylife mood bias and DSM-IV depression were conducted. RESULTS: Probands whose co-twins were diagnosed with lifetime depression showed a stronger mood bias to stress than those with co-twins without such a diagnosis, independent of probands’ current depressive symptoms and to a greater extent in monozygotic twins than in dizygotic twins. CONCLUSIONS: Genetic liability to depression is in part expressed as the tendency to display negative affect in response to minor stressors in daily life. This trait may represent a true depression endophenotype.

Wilson D.K., Kitzman-Ulrich H., Williams J.E., Saunders R., Griffin S., Pate R., Van Horn L., Evans A., Hutto B., Addy C.L., Mixon G. & Sisson S.B. (2007 Jul 17). An overview of “The Active by Choice Today” (ACT) trial for increasing physical activity. Contemp Clin Trials. [Epub ahead of print]

BACKGROUND: Although school-based behavioral interventions for increasing physical activity (PA) in children and adolescents have been conducted, little evidence suggests that these curriculum-based approaches lead to increases in overall activity outside of program days. The overall goal of the “Active by Choice Today” (ACT) trial is to expand the body of knowledge concerning the factors that influence long-term increases in PA in underserved adolescents (low socioeconmic status, minorities) during their middle school years. DESIGN AND SETTING: An overview of the ACT study design, theoretical framework, process evaluation, and primary hypotheses is presented. The trial involves twenty-four middle schools (1560 6th graders) in South Carolina that are randomly assigned to one of two after-school programs (motivational and life skills intervention, or general health education). INTERVENTION: The intervention integrates constructs from Self-Determination and Social Cognitive Theories to enhance intrinsic motivation and behavioral skills for PA. The intervention targets skill development for PA outside of program days and the after-school program social environment (autonomy, choice, participation, belongingness, fun, enjoyment, support) is designed to positively impact cognitive mediators (self-efficacy, perceived competence), and motivational orientation (intrinsic motivation, commitment, positive self-concept). MAIN HYPOTHESES/OUTCOMES: It is hypothesized that the 17-week motivational and life skills intervention will lead to greater increases in moderate-to-vigorous PA (based on 7-day accelerometry estimates) at post-intervention as compared to the general health education program. CONCLUSIONS: Implications of this innovative school-based trial are discussed.

Witkow M.R. & Fuligni A.J. (Aug 2007). Achievement goals and daily school experiences among adolescents with Asian, Latino, and European American backgrounds. Journal of Educational Psychology, 99(3):584-596.

The current study examined the fit of a 2 × 2 achievement goal model among a diverse sample of nearly 700 10th-grade students, distinguishing between both mastery and performance goals and approach and avoidance orientations. Additionally, relationships between achievement goals and GPA and intrinsic value of school were examined, and adolescents’ interpretations of daily school experiences and feelings were found to mediate these relationships. Together, these findings suggest that experiences in adolescents’ daily lives help explain the relationship between goals and achievement outcomes.

Yoshiuchi K., Cook D.B., Ohashi K., Kumano H., Kuboki T., Yamamoto Y. & Natelson B.H. (2007 Jul 24). A real-time assessment of the effect of exercise in chronic fatigue syndrome. Physiol Behav. [Epub ahead of print]

Patients with chronic fatigue syndrome (CFS) report substantial symptom worsening after exercise. However, the time course over which this develops has not been explored. Therefore, the objective of this study was to investigate the influence of exercise on subjective symptoms and on cognitive function in CFS patients in natural settings using a computerized ecological momentary assessment method, which allowed us to track the effects of exercise within and across days. Subjects were 9 female patients with CFS and 9 healthy women. A watch-type computer was used to collect real-time data on physical and psychological symptoms and cognitive function for 1week before and 2weeks after a maximal exercise test. For each variable, we investigated temporal changes after exercise using multilevel modeling. Following exercise, physical symptoms did get worse but not until a five-day delay in CFS patients. Despite this, there was no difference in the temporal pattern of changes in psychological symptoms or in cognitive function after exercise between CFS patients and controls. In conclusion, physical symptoms worsened after several days delay in patients with CFS following exercise while psychological symptoms or cognitive function did not change after exercise.

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