Society for Ambulatory Assessment

First quarter 2008 (January to March)

Ben-Dov, I.Z., Kark, J.D., Mekler, J., Shaked, E. & Bursztyn, M. (Apr 2008).The white coat phenomenon is benign in referred treated patients: a 14-year ambulatory blood pressure mortality study. J Hypertens. 26:699-705.

OBJECTIVE: Previous reports on the prognosis of white coat hypertension are ambiguous. We aimed to determine the prognostic implications of the white coat phenomenon in treated patients. METHODS: Our 14-year hospital-based ambulatory blood pressure (BP) monitoring prospective database was analyzed for all-cause mortality. The relationships of the white coat and masking effects with mortality were assessed both categorically (controlled awake versus clinic BP) and in a continuous mode (clinic-awake BP difference). RESULTS: During the follow-up period, 2285 treated patients (aged 61 +/- 13 years, 57% women) were monitored (17 621 patient-years, 286 deaths). Mean BMI was 27.8 +/- 4.5 kg/m and 13% were treated for diabetes. Controlled hypertension (normal clinic and awake BP) was found in 15.8%, high clinic BP (with controlled awake BP; namely, white coat uncontrolled hypertension) in 12.1%, awake hypertension (with controlled clinic BP; namely, masked uncontrolled hypertension) in 11.8%, and sustained hypertension (both clinic and awake) in 60.3%. Compared with white coat uncontrolled hypertension, age-adjusted Cox-proportional all-cause mortality hazard ratios were 1.42 (0.81-2.51) for controlled hypertension, 1.88 (1.08-3.27) for masked uncontrolled hypertension, and 2.02 (1.30-3.13) for sustained hypertension. Hazards ratios per 1% increase in the clinic-awake BP difference were 0.992 (0.983-1.002) for systolic BP and 0.981 (0.971-0.991) for diastolic BP, adjusted for age, sex, diabetes, and either systolic or diastolic awake BP, respectively. CONCLUSION: In treated hypertensive patients referred for ambulatory BP monitoring, the white coat effect is benign compared with the reverse (masking) phenomenon, which has a poorer prognosis.

Boettger, S., Hoyer, D., Falkenhahn, K., Kaatz, M., Yeragani, V.K. & Bär, K.J. (Mar 2008). Nonlinear broad band dynamics are less complex in major depression. Bipolar Disord. 10:276-84.

OBJECTIVES: Cardiac mortality is known to be increased in depressive patients. However, the underlying mechanisms remain elusive to date. Decreased heart rate variability (HRV) has been discussed as contributing to increased cardiac mortality, but studies examining patients suffering from major depressive disorder (MDD) have revealed inconsistent results. This study aimed to investigate long-term and broad band parameters of heart rate regulation in MDD, which have been shown to be more sensitive for the assessment of autonomic dysfunction. METHODS: A total of 18 non-medicated patients suffering from MDD and 18 matched control subjects without cardiac disease were recruited and 24-h ambulatory electrocardiograms were recorded. Data were recorded during three distinct time intervals linear and nonlinear parameters as well as autonomic information flow (AIF) were calculated. RESULTS: The power law slope was significantly reduced in the patient group for all intervals investigated and correlated with symptom severity, whereas standard deviation of the 5-min NN intervals (SDANN) and area under the AIF curve (INT(NN)) showed significant differences between groups in the morning hours only. Analysis of standard HRV parameters in the time and frequency domain revealed no significant differences between groups. CONCLUSIONS: The evidence for decreased complexity of cardiac regulation in depressed patients presented here might be useful as an indicator of the increased cardiac mortality known in depression, especially since these parameters are capable of predicting cardiac mortality in other diseases. The importance of these parameters for patients at risk should be evaluated in future prospective studies.

Breines, J.G., Crocker, J. & Garcia, J.A. (Feb 2008). Self-Objectification and Well-Being in Women’s Daily Lives. Pers Soc Psychol Bull. – Epub ahead of print

Laboratory experiments and surveys show that self-objectification increases body shame, disrupts attention, and negatively predicts well-being. Using experience sampling methodology, the authors investigated self-objectification in the daily lives of 49 female college students. Building on the predictions of objectification theory, they examined associations between internalizing an observer’s perspective on the self and psychological well-being, and examined the moderating roles of trait self-esteem and appearance-contingent self-worth. Within-person increases in self-objectification predicted decreased well-being, but this association was moderated by trait self-esteem and trait appearance-contingent self-worth; high self-esteem, highly appearance-contingent participants reported increased well-being when they self-objectified. Furthermore, perceived unattractiveness partially mediated the main effect and the three-way interaction: high self-esteem, highly contingent participants experienced smaller drops in well-being when they self-objectified, in part because they felt less unattractive. These results suggest that in daily life, some women receive a boost from self-objectification, although most women experience decreases in well-being when self-objectifying.

Brondolo, E., Libby, D.J. & Denton, E. (Jan 2008). Racism and ambulatory blood pressure in a community sample. Psychosomatic Medicine. 70:49-56.

Objective: Racism has been identified as a psychosocial stressor that may contribute to disparities in the prevalence of cardiovascular disease. The goal of the present article was to investigate the relationship of perceived racism to ambulatory blood pressure (ABP) in a sample of American-born Blacks and Latinos, Methods: Participants included English-speaking Black or Latino(a) adults between the ages of 24 and 65. They completed daily mood diaries and measures of perceived racism, socioeconomic status, and hostility. Participants were outfitted with ABP monitors; 357 provided data on waking hours only, and 245 provided data on both waking and nocturnal ABP. Results: Perceived racism was positively associated with nocturnal ABP even when controlling for personality factors and socioeconomic status. Conclusions: The results suggest that racism may influence cardiovascular disease risk through its effects on nocturnal BP recovery.

Burke, L.E., Sereika, S.M., Music, E., Warziski, M., Styn, M.A. & Stone, A. (Mar 2008). Using instrumented paper diaries to document self-monitoring patterns in weight loss. Contemp Clin Trials. 29:182-93.

Self-monitoring of eating is associated with successful weight loss, but adherence is imperfect and deteriorates over time. Moreover, intentionally or not, many individuals have difficulty keeping faithful records. We used instrumented paper diaries (IPDs) to study self-monitoring in randomly chosen participants in the PREFER trial, a behavioral treatment for weight-loss study. The diaries they used to self-report eating were periodically replaced with IPDs at various times during an 18-month weight-loss program, consisting of three successive phases: intense treatment (n=35), less-intense treatment (n=13), and maintenance (n=16). We compared electronically documented self-monitoring data, showing when and how often IPDs were used, with self-reported data, then compared the electronically validated adherence and weight loss. Self-reported diary usage exceeded IPD-documented usage while the electronic data demonstrated a significant decline in self-monitoring over time. Diary recording often was not timely. Percentage weight lost correlated significantly with frequency of IPD use (p=.001) and the number of diary entries made within 15 min of opening the IPD (p=.002). This is the first study to document patterns of self-monitoring among participants in a weight-loss program, which demonstrated that individuals may falsify the times and frequency of self-monitoring. Furthermore, our results showed that adherence to self-monitoring and the timeliness of recording significantly correlate with improved weight loss.

Coley, B., Jolles, B.M., Farron, A., Pichonnaz, C., Bassin, J.P. & Aminian, K. (Apr 2008). Estimating dominant upper-limb segments during daily activity. Gait Posture. 27:368-75.

A new method of evaluation for functional assessment of the shoulder during daily activity is presented. An ambulatory system using inertial sensors attached on the humerus was used to differentiate a dominant from a non-dominant shoulder. The method was tested on 31 healthy volunteers with no shoulder pathology while carrying the system during 8h of their daily life. Shoulder mobility based on the angular velocities and the accelerations of the humerus were calculated and compared every 5s for both sides. Our data showed that the dominant arm of the able bodied participants was more active than the non-dominant arm for standing (+20% for the right handed, +15% for the left handed) and sitting (+24% for the right handed, +32% for the left handed) posture, while for the walking periods the use of the right and left side was almost identical. The proposed method could be used to objectively quantify upper-limb usage during activities of daily living in various shoulder disorders.

Dassau, E., Bequette, B.W., Buckingham, B.A. & Doyle, F.J. 3rd. (Feb 2008). Detection of a meal using continuous glucose monitoring: implications for an artificial beta-cell. Diabetes Care. 31:295-300.

OBJECTIVE: The purpose of this study was to introduce a novel meal detection algorithm (MDA) to be used as part of an artificial beta-cell that uses a continuous glucose monitor (CGM). RESEARCH DESIGN AND METHODS: We developed our MDA on a dataset of 26 meal events using records from 19 children aged 1-6 years who used the MiniMed CGMS Gold. We then applied this algorithm to CGM records from a DirecNet pilot study of the FreeStyle Navigator continuous glucose sensor. During a research center admission, breakfast insulin was withheld for 1 h, and discrete glucose levels were obtained every 10 min after the meal. RESULTS: Based on the Navigator readings, the MDA detected a meal at a mean time of 30 min from the onset of eating, at which time the mean serum glucose was 21 mg/dl above baseline (range 2-36 mg/dl), and >90% of meals were detected before the glucose had risen 40 mg/dl from baseline. CONCLUSIONS: The MDA will enable automated insulin dosing in response to meals, facilitating the development of an artificial pancreas.

Eguchi, K., Pickering, T.G., Hoshide, S., Ishikawa, J., Ishikawa, S., Schwartz, J.E., Shimada. K. & Kario, K. (Apr 2008). Ambulatory blood pressure is a better marker than clinic blood pressure in predicting cardiovascular events in patients with/without type 2 diabetes. Am J Hypertens. 21:443-50.

BACKGROUND: The prognostic significance of ambulatory blood pressure (ABP) has not been established in patients with type 2 diabetes (T2DM). METHODS: In order to clarify the impact of ABP on cardiovascular prognosis in patients with or without T2DM, we performed ABP monitoring (ABPM) in 1,268 subjects recruited from nine sites in Japan, who were being evaluated for hypertension. The mean age of the patients was 70.4 +/- 9.9 years, and 301 of them had diabetes. The patients were followed up for 50 +/- 23 months. We investigated the relation between incidence of cardiovascular diseases (CVDs) and different measures of ABP, including three categories of awake systolic blood pressure (SBP <135, 135-150, and >150 mm Hg), sleep SBP (<120, 120-135, and >135 mm Hg), and dipping trends in nocturnal blood pressure (BP) (dippers, nondippers, and risers). Cox regression models were used in order to control for classic risk factors. RESULTS: Higher awake and sleep SBPs predicted higher incidence of CVD in patients with and without diabetes. In multivariable analyses, elevated SBPs while awake and asleep predicted increased risk of CVD more accurately than clinic BP did, in both groups of patients. The relationships between ABP level and CVD were similar in both groups. In Kaplan-Meier analyses, the incidence of CVD in nondippers was similar to that in dippers, but risers experienced the highest risk of CVD in both groups (P < 0.01). The riser pattern was associated with a approximately 150% increase in risk of CVD, in both groups. CONCLUSIONS: These findings suggest that ABPM is a better predictor of cardiovascular risk than clinic BP, and that this holds true for patients with or without T2DM.

Favre, J., Jolles, B.M., Aissaoui, R. & Aminian, K. (2008). Ambulatory measurement of 3D knee joint angle. J Biomech. 41:1029-35.

Three-dimensional measurement of joint motion is a promising tool for clinical evaluation and therapeutic treatment comparisons. Although many devices exist for joints kinematics assessment, there is a need for a system that could be used in routine practice. Such a system should be accurate, ambulatory, and easy to use. The combination of gyroscopes and accelerometers (i.e., inertial measurement unit) has proven to be suitable for unrestrained measurement of orientation during a short period of time (i.e., few minutes). However, due to their inability to detect horizontal reference, inertial-based systems generally fail to measure differential orientation, a prerequisite for computing the three-dimentional knee joint angle recommended by the Internal Society of Biomechanics (ISB). A simple method based on a leg movement is proposed here to align two inertial measurement units fixed on the thigh and shank segments. Based on the combination of the former alignment and a fusion algorithm, the three-dimensional knee joint angle is measured and compared with a magnetic motion capture system during walking. The proposed system is suitable to measure the absolute knee flexion/extension and abduction/adduction angles with mean (SD) offset errors of -1 degrees (1 degrees ) and 0 degrees (0.6 degrees ) and mean (SD) root mean square (RMS) errors of 1.5 degrees (0.4 degrees ) and 1.7 degrees (0.5 degrees ). The system is also suitable for the relative measurement of knee internal/external rotation (mean (SD) offset error of 3.4 degrees (2.7 degrees )) with a mean (SD) RMS error of 1.6 degrees (0.5 degrees ). The method described in this paper can be easily adapted in order to measure other joint angular displacements such as elbow or ankle.

Galliher, J.M., Stewart, T.V., Pathak, P.K., Werner, J.J., Dickinson, L.M. & Hickner, J.M. (Mar-Apr 2008). Data collection outcomes comparing paper forms with PDA forms in an office-based patient survey. Ann Fam Med. 6:154-60.

PURPOSE: We compared the completeness of data collection using paper forms and using electronic forms loaded on handheld computers in an office-based patient interview survey conducted within the American Academy of Family Physicians National Research Network. METHODS: We asked 19 medical assistants and nurses in family practices to administer a survey about pneumococcal immunizations to 60 older adults each, 30 using paper forms and 30 using electronic forms on handheld computers. By random assignment, the interviewers used either the paper or electronic form first. Using multilevel analyses adjusted for patient characteristics and clustering of forms by practice, we analyzed the completeness of the data. RESULTS: A total of 1,003 of the expected 1,140 forms were returned to the data center. The overall return rate was better for paper forms (537 of 570, 94%) than for electronic forms (466 of 570, 82%) because of technical difficulties experienced with electronic data collection and stolen or lost handheld computers. Errors of omission on the returned forms, however, were more common using paper forms. Of the returned forms, only 3% of those gathered electronically had errors of omission, compared with 35% of those gathered on paper. Similarly, only 0.04% of total survey items were missing on the electronic forms, compared with 3.5% of the survey items using paper forms. CONCLUSIONS: Although handheld computers produced more complete data than the paper method for the returned forms, they were not superior because of the large amount of missing data due to technical difficulties with the hand-held computers or loss or theft. Other hardware solutions, such as tablet computers or cell phones linked via a wireless network directly to a Web site, may be better electronic solutions for the future.

Hannon, J.C. & Brown, B.B. (Jan 2008). Increasing preschoolers’ physical activity intensities: An activity-friendly preschool playground intervention. Prev Med. – Epub ahead of print

OBJECTIVE: The purpose of this study was to see if portable play equipment added to a preschool playground resulted in higher intensities of physical activity among 3-5-year-old children. METHODS: Activity-friendly equipment was added to an outdoor preschool playground. Accelerometry-measured intensities of 15-s epochs of physical activity were tracked for 5 pre-intervention and 5 post-intervention days during outdoor play. Data were collected during fall 2005 in Salt Lake City for 64 preschoolers aged 3, 4, and 5 years. RESULTS: After the intervention, both male and female 3- to 5-year-olds significantly decreased sedentary behavior and significantly increased light, moderate, and vigorous physical activity as measured by accelerometry. CONCLUSIONS: Results suggest simple interventions, requiring little teacher training, can yield increases in healthy physical activity.

Haralabidis, A.S., Dimakopoulou, K., Vigna-Taglianti, F., Giampaolo, M., Borgini, A., Dudley, M.L., Pershagen, G., Bluhm, G., Houthuijs, D., Babisch, W., Velonakis, M., Katsouyanni, K., Jarup, L., HYENA Consortium. (Feb 2008).Acute effects of night-time noise exposure on blood pressure in populations living near airports. Eur Heart J. 29(5):658-64.

AIMS: Within the framework of the HYENA (hypertension and exposure to noise near airports) project we investigated the effect of short-term changes of transportation or indoor noise levels on blood pressure (BP) and heart rate (HR) during night-time sleep in 140 subjects living near four major European airports. METHODS AND RESULTS: Non-invasive ambulatory BP measurements at 15 min intervals were performed. Noise was measured during the night sleeping period and recorded digitally for the identification of the source of a noise event. Exposure variables included equivalent noise level over 1 and 15 min and presence/absence of event (with LAmax > 35 dB) before each BP measurement. Random effects models for repeated measurements were applied. An increase in BP (6.2 mmHg (0.63-12) for systolic and 7.4 mmHg (3.1, 12) for diastolic) was observed over 15 min intervals in which an aircraft event occurred. A non-significant increase in HR was also observed (by 5.4 b.p.m.). Less consistent effects were observed on HR. When the actual maximum noise level of an event was assessed there were no systematic differences in the effects according to the noise source. CONCLUSION: Effects of noise exposure on elevated subsequent BP measurements were clearly shown. The effect size of the noise level appears to be independent of the noise source.

Head, G.A. & Lukoshkova, E.V. (Apr 2008). Understanding the morning rise in blood pressure. Clin Exp Pharmacol Physiol. 35:516-21.

1. The morning period has been recognized as the highest risk period of the day for cardiovascular events, particularly stroke and is also associated with a rapid surge in blood pressure. 2. Evidence now exists to show that the morning surge in blood pressure is an independent risk factor in some elderly hypertensive subjects. 3. However, methods to assess the contribution of the morning blood pressure surge from ambulatory recordings or home recordings, using clock times or times of waking, do not take into consideration the individual patterns of blood pressure change which can range from a rapid rise prior to or following waking to a slow increase over several hours. 4. In the present review we describe a novel method for determining the individual changes using a double logistic equation fitted to the individual pattern of blood pressure change. 5. Methods are presented to determine the rate of rise function over the morning period as well as predicting the change over a fixed time window which may be useful in refining the contribution of the blood pressure surge to cardiovascular risk. 6. Hypertensive people have an exaggerated rise in morning blood pressure as well as a greater rate of rise. 7. Antihypertensive drugs and dosing regimes are being developed which may be useful adjuncts to standard therapy for preventing morning hypertension and hopefully also reducing cardiovascular damage or events.

Henskens, L.H., Kroon, A.A., van Oostenbrugge, R.J., Haest, R.J., Lodder, J., de Leeuw, P.W. (Apr 2008). Different classifications of nocturnal blood pressure dipping affect the prevalence of dippers and nondippers and the relation with target-organ damage. J Hypertens. 26:691-698.

OBJECTIVE: We assessed how different definitions of the awake and asleep periods and use of various blood pressure (BP) indices affect the extent of the nocturnal BP dip, the prevalence of dippers and nondippers, their respective reproducibilities and the relation of nondipping with target-organ damage. METHODS: We performed 24-h ambulatory BP monitoring twice and determined the left ventricular mass index and urinary albumin excretion as indices of target-organ damage in 150 hypertensive patients (off-medication). Awake and asleep periods were assessed using fixed and diary time methods, covering all readings available (wide) or excluding morning and evening transition hours (narrow). Nondipping (BP dip < 10%) was established for systolic BP and diastolic BP, their combinations (and/or), and mean arterial pressure. RESULTS: The different awake-asleep definitions caused significant variation in both the extent of the BP dip and the number of dippers and nondippers in comparison with the wide diary definition (i.e. use of actual awake and sleep periods). The prevalences of dippers and nondippers also varied significantly with the BP index. Reproducibility analyses of the BP dip and the dipping status yielded repeatability coefficients (expressed as percentages of nearly maximal variation) between 42.39 and 48.71%, and kappa values between 0.323 and 0.459, respectively. Some classifications, but not all, discriminated significantly between consistent dippers and nondippers in terms of left ventricular mass index or urinary albumin excretion. CONCLUSIONS: Use of different definitions of awake-asleep and BP indices affects significantly the classification of nocturnal BP dipping and its relation with hypertensive target-organ damage.

Holt-Lunstad, J., Birmingham, W. & Jones, B.Q. (Mar 2008). Is There Something Unique about Marriage? The Relative Impact of Marital Status, Relationship Quality, and Network Social Support on Ambulatory Blood Pressure and Mental Health. Ann Behav Med. 18 – Epub ahead of print

BACKGROUND: Having close social relationships and being married specifically have been reliably associated with health benefits including lower morbidity and mortality. PURPOSE: The purpose of this study was to examine the influence of marital status, relationship quality, and network support on measures of psychological and cardiovascular health. METHOD: We examined ambulatory blood pressure (ABP) among 204 married and 99 single males and females (N = 303). RESULTS: We found that both marital status and marital quality were important. Married individuals had greater satisfaction with life (SWL) and blood pressure dipping than single individuals. High marital quality was associated with lower ABP, lower stress, less depression, and higher SWL. Importantly, contrasting those who are unmarried with those in low-quality marriages, we find that single individuals had lower ABP-suggesting that single individuals fare better than their unhappily married counterparts. Likewise, having a supportive network did not moderate (i.e., buffer) the effects of being single or unhappily married. CONCLUSIONS: Findings indicate being married per se is not universally beneficial, rather, the satisfaction and support associated with such a relationship is important. However, marriage may be distinctive, as evidence further suggests that support from one’s network does not compensate for the effect of being single. These results highlight the complexities in understanding the influence of social relationships on long-term health, and they may help clarify the physiological pathways by which such associations exist.

Hussong, A.M., Gould, L.F. & Hersh, M.A. (Mar 2008). Conduct problems moderate self-medication and mood-related drinking consequences in adolescents. J Stud Alcohol Drugs. 69:296-307.

OBJECTIVE: We tested whether conduct problems moderate the relation between negative mood and drinking in adolescents as consistent with either a self-medication or a drinking consequences model. METHOD: The sample included 75 rising ninth graders (i.e., in the summer before starting ninth grade) who completed a two-stage, multimethod, multireporter study. We used experience sampling to assess negative mood and drinking across 21 days and hierarchical linear modeling to test our hypotheses. RESULTS: Counter to predictions, both self-medication and drinking consequence mechanisms were evident only in youth with fewer conduct problems. CONCLUSIONS: Findings provide support for the importance of considering multiple mechanisms as underlying the relation between negative mood and drinking as pertaining to subpopulations of vulnerable youth. Implications for prevention and understanding negative mood-drinking relations in adolescents are discussed.

Iida, M., Seidman, G. , Shrout, P.E. (Mar 2008). Modeling support provision in intimate relationships. Journal of Personality and Social Psychology, Vol 94: 460-478.

Whereas supportive interactions are usually studied from the perspective of recipients alone, the authors used a dyadic design to incorporate the perspectives of both provider and recipient. In 2 daily diary studies, the authors modeled provider reports of support provision in intimate dyads over several weeks. The 1st involved couples experiencing daily stressors (n = 79); the 2nd involved couples experiencing a major professional stressor (n = 196). The authors hypothesized that factors relating to (a) recipients (their requests for support, moods, and stressful events), (b) providers (their moods and stressful events), (c) the relationship (relationship emotions and history of support exchanges), and (d) the stressor (daily vs. major stressors) would each predict daily support provision. Across both studies, characteristics of providers, recipients, and their relationship emerged as key predictors. Implications for theoretical models of dyadic support processes are discussed.

King, A.C., Ahn, D.K., Oliveira, B.M., Atienza, A.A., Castro, C.M., Gardner, C.D. (Feb 2008). Promoting physical activity through hand-held computer technology. Am J Prev Med. 34:138-42.

BACKGROUND: Efforts to achieve population-wide increases in walking and similar moderate-intensity physical activities potentially can be enhanced through relevant applications of state-of-the-art interactive communication technologies. Yet few systematic efforts to evaluate the efficacy of hand-held computers and similar devices for enhancing physical activity levels have occurred. The purpose of this first-generation study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing moderate intensity or more vigorous (MOD+) physical activity levels over 8 weeks in mid-life and older adults relative to a standard information control arm. DESIGN: Randomized, controlled 8-week experiment. Data were collected in 2005 and analyzed in 2006-2007. SETTING/PARTICIPANTS: Community-based study of 37 healthy, initially underactive adults aged 50 years and older who were randomized and completed the 8-week study (intervention=19, control=18). INTERVENTION: Participants received an instructional session and a PDA programmed to monitor their physical activity levels twice per day and provide daily and weekly individualized feedback, goal setting, and support. Controls received standard, age-appropriate written physical activity educational materials. MAIN OUTCOME MEASURE: Physical activity was assessed via the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire at baseline and 8 weeks. RESULTS: Relative to controls, intervention participants reported significantly greater 8-week mean estimated caloric expenditure levels and minutes per week in MOD+ activity (p<0.04). Satisfaction with the PDA was reasonably high in this largely PDA-naive sample. CONCLUSIONS: Results from this first-generation study indicate that hand-held computers may be effective tools for increasing initial physical activity levels among underactive adults.

Knafl, U., Lehmann, H. & Riederer, M. (Feb 2008). Electromagnetic field measurements using personal exposimeters. Bioelectromagnetics. 29:160-2.

The goal of this brief communication is to call the attention of researchers to possible pit falls when using personal exposimeters (PEM) in epidemiological field studies. One example of problematic handling of PEMs is presented in detail, whereas other possible error sources and other aspects to be considered using such devices are outlined only briefly.

Kristensen, P.L., Møller, N.C., Korsholm, L., Wedderkopp, N., Andersen, L.B. & Froberg, K. (Apr 2008). Tracking of objectively measured physical activity from childhood to adolescence: The European youth heart study. Scand J Med Sci Sports. 18:171-8.

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

Lau, H. & Tong, K. (Feb 2008). The reliability of using accelerometer and gyroscope for gait event identification on persons with dropped foot. Gait Posture. 27:248-57.

Identification of gait events using an optimal sensor set and a reliable algorithm would be useful in the clinical evaluation of patients with dropped foot. This article describes a threshold detection method for identifying gait events and evaluating the reliability of a system on ten subjects with dropped foot and three non-impaired controls. The system comprised three sensor units of accelerometers and gyroscopes attached at the thigh, shank and foot of the impaired leg in subjects with dropped foot, and the dominant leg in the controls. A performance index was devised to compare the values of different measuring directions of the sensor units and evaluate the system’s reliability. The performance index, with the ideal value equal to 1, depended on the classification accuracy and timing variation of the turning points. These were obtained from the threshold detection method that distinguished the absolute maximum and minimum turning points from local maximum and minimum turning points. It was found that some specific turning points could effectively identify gait events with a high median value in the performance index. These turning points included: the minimum turning point in superior-inferior acceleration on the thigh at loading response (0.972); the minimum turning point in anterior-posterior angular velocity on the shank at pre-swing (0.955) and the maximum turning point in superior-inferior acceleration on the foot at initial swing (0.954). Combining the results of sensor measurements in different orientations and attachment locations could be used for gait event identification. It was shown that the threshold detection method is reliable. Portable gait-monitoring devices can be used for monitoring of daily activities and functional control.

Lind, L., Karlsson, D. & Fridlund, B. (Feb 2008). Patients’ use of digital pens for pain assessment in advanced palliative home healthcare. Int J Med Inform. 77:129-36.

BACKGROUND: Appropriate pain assessment is a necessary prerequisite for adequate pain control. A way to follow-up on the pain is to let patients use paper-based or electronic pain diaries. PURPOSE: The aim was to explore and describe palliative home care patients’ experiences of assessing their pain by using a pain diary together with digital pen and mobile Internet technology. METHODS: A system for the follow-up of pain treatment was developed and evaluated by means of a qualitative cross-case content analysis. From December 2002 until September 2003 12 palliative patients, who initially assessed VAS pain>or=35 mm (VAS 0-100 mm), used the system. Patients reported their momentary pain intensity and the number of consumed extra doses of analgesics three times per day. Analysis data were collected from interviews with patients and spouses, questionnaires, medical records, and the system log. RESULTS: In spite of severe illness and difficulties in comprehending the technology and system intervention, patients found the pain diary and digital pen easy to use for pain assessment. Patients took a greater part in their own care and experienced an improved contact with their caregivers, which led to a sense of increased security. The medical records showed a quick response to variations in the patients’ health status by means of changes in medical treatment. CONCLUSIONS: The pain assessment system for palliative patients using pain diaries together with digital pen and wireless Internet technology constitutes an effortless method and has positive influences on the care.

Lord, S., Rochester, L., Baker, K. & Nieuwboer, A. (Feb 2008). Concurrent validity of accelerometry to measure gait in Parkinsons Disease. Gait Posture. 27:357-9.

The Vitaport Activity Monitor (VAM) is an ambulatory monitoring device that uses accelerometer signals to assess the quality and quantity of walking and mobility related activities in home and community. The objective of this study was to investigate the concurrent validity of the VAM and GAITRite((R)) to measure gait speed, step length and step frequency during a test of functional gait that included single, dual and multiple task components for 12 people with Parkinsons Disease (PD) and 11 comparisons participating. For PD participants, ICCs were excellent for all gait variables (ICC (2, 2)=0.92-0.99, p< or =0.0001). For control participants, ICCs were good to excellent for all gait variables (ICC (2, 2)=0.74-0.94, p< or =0.05). Mean score differences between the two instruments were greatest for step frequency for both PD and comparisons. The VAM is useful for objective gait measurement in the home and community.

Manikonda, J.P., Störk, S., Tögel, S., Lobmüller, A., Grünberg, I., Bedel, S., Schardt, F., Angermann, C.E., Jahns, R. & Voelker, W. (Feb 2008). Contemplative meditation reduces ambulatory blood pressure and stress-induced hypertension: a randomized pilot trial. J Hum Hypertens. 22:138-40.

A total of 52 pharmacologically untreated subjects with essential hypertension were randomly allocated to either 8 weeks of contemplative meditation combined with breathing techniques (CMBT) or no intervention in this observer-blind controlled pilot trial. CMBT induced clinically relevant and consistent decreases in heart rate, systolic and diastolic blood pressure if measured during office readings, 24-h ambulatory monitoring and mental stress test. Longer-term studies should evaluate CMBT as an antihypertensive strategy.

Manios, E.D., Koroboki, E.A., Tsivgoulis, G.K., Spengos, K.M., Spiliopoulou, I.K., Brodie, F.G., Vemmos, K.N. & Zakopoulos, N.A. (Jan 2008). Factors influencing white-coat effect. Am J Hypertens. 21:153-8.

BACKGROUND: The transient blood pressure (BP) rise during clinical visits is usually referred to as white-coat effect (WCE). The aim of the present study was to investigate factors that may influence the WCE. METHODS: A total of 2004 subjects underwent office BP measurements and 24-h ambulatory BP monitoring (ABPM) on the same day. The WCE was estimated as the difference between office and average daytime ambulatory BP (ABP). According to the office and daytime BP values, the study population was divided into normotensives (NTs), white-coat hypertensives (WCHs), masked hypertensives (MHTs), and sustained hypertensives (SHTs). Statistical analyses were performed using one-way analysis of variance and multiple linear regression models. RESULTS: The mean systolic and diastolic WCE was 9 +/- 16 and 7 +/- 12 mm Hg, respectively. In the entire group of patients, multiple linear regression models revealed independent determinants of systolic WCE in the following rank order: office systolic BP (SBP) (beta = 0.727; P < 0.001), female gender (beta = 0.166; P < 0.001), daytime SBP variability (beta = 0.128; P < 0.001), age (beta = 0.039, P = 0.020), and smoking (beta = 0.031, P = 0.048). A 1.0 mm Hg increase in daytime SBP variability correlated with an increment of 0.589 mm Hg (95% confidence intervals, 0.437-0.741) in the systolic WCE. The regression analyses for diastolic WCE revealed the same factors as independent determinants. A 1.0 mm Hg increase in daytime diastolic BP (DBP) variability was independently associated with an increment of 0.418 mm Hg (95% confidence intervals, 0.121-0.715) in the diastolic WCE. CONCLUSIONS: Factors such as gender, age, smoking, office BPV and daytime BPV may exert an important influence on the magnitude of the WCE.

Merrilees, C.E.; Goeke-Morey, M., Cummings, E.M. (Feb 2008). Do event-contingent diaries about marital conflict change marital interactions? Behaviour Research and Therapy, Vol 46: 253-262.

Recent increase in the use of diary measures has prompted questions about the effect completing diaries has on participants. After extensive training, married couples completed event-contingent diaries about their couple disagreements for 15 days, focusing on emotional and behavioral aspects of marital conflict. Serving as a control for placebo effects of participation, the diary group (n = 110) and a non-randomized control group (n = 57) also completed brief daily checklists, with minimal training, over the reporting period. Before and after the reporting period, couples engaged in videotaped conflict-resolution tasks that were coded for conflict behaviors and emotions expressed. ANOVAs comparing groups indicated that completing event-contingent diaries for 15 days had no apparent effects on observed husbands’ and wives’ expressed emotions and behaviors during marital interactions. Parental reports on the brief daily diaries indicated minimal differences between the groups in global measures of marital functioning. At the same time, husbands’ self-reports in the home indicated decreasing perceptions of marital quality over the recording period. Thus, although no differences in conflict tactics emerged based on observed marital interactions in the laboratory, certain self-reports of responding suggested potential reactivity effects

Moore, S.T., MacDougall, H.G. & Ondo, W.G. (Jan 2008). Ambulatory monitoring of freezing of gait in Parkinson’s disease. J Neurosci Methods. 167:340-8.

Freezing of gait (FOG) is common in advanced Parkinson’s disease (PD), is resistant to treatment and negatively impacts quality of life. In this study an ambulatory FOG monitor was validated in 11 PD patients. The vertical linear acceleration of the left shank was acquired using an ankle-mounted sensor array that transmitted data wirelessly to a pocket PC at a rate of 100 Hz. Power analysis showed high-frequency components of leg movement during FOG in the 3-8 Hz band that were not apparent during volitional standing, and power in this ‘freeze’ band was higher (p=0.00003) during FOG preceded by walking (turning or obstacles) than FOG preceded by rest (gait initiation). A freeze index (FI) was defined as the power in the ‘freeze’ band divided by the power in the ‘locomotor’ band (0.5-3 Hz) and a threshold chosen such that FI values above this limit were designated as FOG. A global threshold detected 78% of FOG events and 20% of stand events were incorrectly labeled as FOG. Individual calibration of the freeze threshold improved accuracy and sensitivity of the device to 89% for detection of FOG with 10% false positives. Ambulatory monitoring may significantly improve clinical management of FOG.

Nagata, K., Osada, N., Shimazaki, M., Kida, K., Yoneyama, K., Tsuchiya, A., Yasuda, T. & Kimura, K. (Feb 2008). Diurnal blood pressure variation in patients with sleep apnea syndrome. Hypertens Res. 31:185-91.

Sleep apnea syndrome (SAS) is an important risk factor for hypertension and cardiovascular diseases. Diurnal blood pressure (BP) changes are evaluated by 24 h ambulatory blood pressure monitoring (ABPM). The purpose of this study was to clarify the relationship between diurnal BP variation and SAS severity, as well as the impact of antihypertensive therapy on diurnal BP variation. Patients seen at our clinic between April and September 2006 with excessive daytime sleepiness or apnea were enrolled. All patients had polysomnography and ABPM. Mean 24 h BP and nighttime BPs were significantly higher in the SAS group than in the non-SAS group. No significant differences were observed in daytime BPs between the two groups. SAS patients had a high mean 24-h BP and an elevated nighttime BP, both of which increased as SAS severity increased. Nighttime BPs were significantly higher in the moderate SAS group than in the non-SAS group. Nighttime BP and morning BP were significantly higher in the severe SAS group than in the non-SAS group. With respect to antihypertensive agents’ effects on diurnal BP changes, there were no significant differences between the SAS and non-SAS groups. In conclusion, compared with non-SAS patients, patients with SAS had a higher 24-h BP, especially nighttime BP. Patients with moderate SAS tended to have elevated nighttime BP. In patients with severe SAS, elevated BP was sustained during the night despite the use of antihypertensive agents.

Nakonezny, P.A., Byerly, M.J. & Rush, A.J. (Jan 2008). Electronic monitoring of antipsychotic medication adherence in outpatients with schizophrenia or schizoaffective disorder: an empirical evaluation of its reliability and predictive validity. Psychiatry Res. 157:259-63.

This study examined the reliability and predictive validity of electronic monitoring (EM) in assessing the oral antipsychotic medication adherence of outpatients with schizophrenia or schizoaffective disorder. Sixty-one adult outpatients with schizophrenia or schizoaffective disorder who took a single oral antipsychotic medication were assessed monthly over a 6-month study period with EM of medication bottle opening. Symptom severity, as measured by the Positive and Negative Syndrome Scale (PANSS) total score, was assessed monthly over the 6-month study period. Cronbach’s coefficient alpha revealed very high internal reliability (alpha=0.94). A high degree of test-retest reliability was found (beta ranged from 0.75 to 1.19 and r ranged from 0.63 to 0.90). As for predictive validity, greater mean EM adherence was significantly related to lower mean symptom severity.

Nezlek, J.B., Vansteelandt, K., Van Mechelen, I. (Feb 2008). Appraisal-emotion relationships in daily life. Emotion. 8: 145-150.

Using a daily process design, the present study examined relationships between momentary appraisals and emotional experience based on Smith and Lazarus’ (1993) theory of emotions (1993). Nine times a day for 2 weeks, participants (N = 33, 23 women) recorded their momentary experience of 2 positive emotions (joy, love) and 4 negative emotions (anger, guilt, fear, sadness) and the core relational theme appraisal contents Smith and Lazarus hypothesized as corresponding to these emotions. A series of multilevel modeling analyses found that the hypothesized relationships between appraisal contents and these emotions were stronger than relationships between contents and other emotions, although appraisals were related to other emotions in many cases. Moreover, there were some individual differences in the strength of these relationships. These results suggest that there are no one-to-one relationships between appraisal contents and specific emotional experiences, and that specific emotions are associated with different appraisal contents, and that specific appraisals are associated with different emotions.

Nilsson, A., Brage, S., Riddoch, C., Anderssen, S.A., Sardinha, L.B., Wedderkopp, N., Andersen, L.B., Ekelund, U. (Jan 2008). Comparison of equations for predicting energy expenditure from accelerometer counts in children. Scand J Med Sci Sports. – Epub ahead of print

Several prediction equations developed to convert body movement measured by accelerometry into energy expenditure have been published. The aim of this study was to examine the degree of agreement between three different prediction equations, when applied to data on physical activity in a large sample of children. We examined 1321 children (663 boys, 658 girls; mean age 9.6+/-0.4 years) from four different countries. Physical activity was measured by the MTI accelerometer. One equation, derived from doubly labeled water (DLW) measurements, was compared with one treadmill-based (TM) and one room calorimeter-based (CAL) equation (mixture of activities). Predicted physical activity energy expenditure (PAEE) was the main outcome variable. In comparison with DLW-predicted PAEE, both laboratory-derived equations significantly (P<0.001) overestimated PAEE by 17% and 83%, respectively, when based on a 24-h prediction, while the TM equation significantly (P<0.001) underestimated PAEE by 46%, when based on awake time only. In contrast, the CAL equation agreed better with the DLW equation under the awake time assumption. Predicted PAEE differ substantially between equations, depending on time-frame assumptions, and interpretations of average levels of PAEE in children from available equations should be made with caution. Further development of equations applicable to free-living scenarios is needed.

Nyberg, G., Ekelund, U. & Marcus, C. (Feb 2008). Physical activity in children measured by accelerometry: stability over time. Scand J Med Sci Sports. – Epub ahead of print

The aim of this study was to examine the stability of objectively measured physical activity in Swedish children and to study variables that predicted physical activity and body mass index standard deviation score (BMI SDS) at follow-up. A total of 97 children provided valid repeated measurements of physical activity between 2002 and 2005. The children were on average 7.5 years at baseline (SD+/-0.92) and 9 years at follow-up (SD+/-0.92). The mean follow-up time was approximately 1.5 years (mean 558 days, SD+/-224). An accelerometer (Actiwatch((R)), Cambridge Neurotechnology Ltd., Cambridge, UK) was used to measure physical activity during 7 consecutive days. Yearly weight and height were examined and BMI SDS was calculated. Baseline physical activity was significantly correlated with physical activity at follow-up (r=0.59) with a stronger correlation for boys (r=0.72) than for girls (r=0.51). High physical activity levels were more stable (r=0.74) than low physical activity levels (r=0.55). Physical activity at follow-up was explained by physical activity at baseline and season (R(2)=0.46) whereas BMI SDS at follow-up was explained by BMI SDS at baseline and age (R(2)=0.90). The results of this study suggest that physical activity levels are fairly stable in 6-10-year-old children.

Pierin, A.M., Ignez, E.C., Jacob Filho, W., Barbato, A.J. & Mion, D. Jr. (Feb 2008).Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements. Clinics. 63:43-50.

OBJECTIVE: To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to “office measurement.” CONCLUSION: This study showed that the measurement most similar to home blood pressure measurement and ambulatory blood pressure monitoring was blood pressure measured by the patient, and that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic value relative to “office measurements”.

Putnam, K.M. & McSweeney, L.B. (Feb 2008). Depressive symptoms and baseline prefrontal EEG alpha activity: a study utilizing Ecological Momentary Assessment. Biol Psychol. 77:237-40.

Prefrontal cortex (PFC) electroencephalography (EEG) alpha asymmetry has been found in individuals with major depression. However, EEG activity has never been examined in regard to specific depressive symptoms. We examine the relationship between resting baseline PFC alpha activity and both rumination and self-esteem in a depressed outpatient group (N=6) and a healthy control group (N=7) using high-density EEG sampling and multiple longitudinal self report measures, i.e. Ecological Momentary Assessment (EMA). Symptom measures were collected five times daily for 7 days, i.e. 35 assessments. Using a mixed-level analysis, significant Group x Hemisphere interactions for PFC sites and both rumination and self-esteem were found. Within the depressed group, lower bilateral PFC activity predicted higher levels of rumination, and lower right PFC activity predicted higher levels of self-esteem. There were no significant effects for the control group. Results indicate that specific symptoms of depression are uniquely associated with patterns of PFC EEG alpha activity.

Räikkönen, K. & Matthews, K.A. (Apr 2008). Do Dispositional Pessimism and Optimism Predict Ambulatory Blood Pressure During Schooldays and Nights in Adolescents? J Pers. – Epub ahead of print

We tested the hypotheses that (1) high pessimism and low optimism (LOT-R overall and subscale scores) would predict high ambulatory blood pressure (ABP) level and 24-hour load (percentage of ABP values exceeding the pediatric 95th percentile) among healthy Black and White adolescents (n=201; 14-16 yrs) across 2 consecutive school days and (2) that the relationships for the pessimism and optimism subscales would show nonlinear effects. The hypotheses were confirmed for pessimism but not for optimism. The results suggest that high pessimism may have different effects than low optimism on ABP and that even moderate levels of pessimism may effect blood pressure regulation. These results suggest that optimism and pessimism are not the opposite poles on a single continuum but ought to be treated as separate constructs.

Reilly, J.J., Penpraze, V., Hislop, J., Davies, G., Grant, S. & Paton, J.Y. (Feb 2008). Objective measurement of physical activity and sedentary behaviour: review with new data. Arch Dis Child. – Epub ahead of print

Objective methods are being used increasingly for the quantification of amount of physical activity, intensity of physical activity, and amount of sedentary behaviour in children. The accelerometer is currently the objective method of choice. In this review we address the advantages of objective measurement over more traditional subjective methods, notably the avoidance of bias, greater confidence in the amount of activity and sedentary behaviour measured, and improved ability to relate variation in physical activity and sedentary behaviour to variation in health outcomes. We also consider unresolved practical issues in paediatric accelerometry by critical review of existing evidence and by providing new evidence.

Rosenberg, D.E., Bull, F.C., Marshall, A.L. (Jan 2008). Assessment of sedentary behavior with the International Physical Activity Questionnaire. Journal of Physical Activity & Health. 5:30-44.

Purpose: This study explored definitions of sedentary behavior and examined the relationship between sitting time and physical inactivity using the sitting items from the International Physical Activity Questionnaire (IPAQ). Methods: Participants (N = 289, 44.6% male, mean age = 35.93) from 3 countries completed self-administered long- and short-IPAQ sitting items. Participants wore accelerometers; were classified as inactive (no leisure-time activity), insufficiently active, or meeting recommendations; and were classified into tertiles of sitting behavior. Results: Reliability of sitting time was acceptable for men and women. Correlations between total sitting and accelerometer counts/min <100 were significant for both long (r = .33) and short (r = .34) forms. There was no agreement between tertiles of sitting and the inactivity category (kappa = .02, P = .68). Conclusion: Sedentary behavior should be explicitly measured in population surveillance and research instead of being defined by lack of physical activity.

Rowlands, A.V., Pilgrim, E.L. & Eston, R.G. (Apr 2008). Patterns of habitual activity across weekdays and weekend days in 9-11-year-old children. Prev Med. 46:317-24.

OBJECTIVE.: To characterize the pattern of activity in boys and girls across weekdays and weekend days. METHODS.: Physical activity was recorded every 2 s by uniaxial accelerometry in 84 children, aged 9-11 years, for up to four weekdays and two weekend days. Activity bouts (>/=4 s and >/=5 min) greater than light (>/=LIGHT), moderate (>/=MOD) and vigorous (>/=VIG) intensity were recorded. The study took place in the South-West of England in 2007. RESULTS.: The mean duration of activity bouts decreased as intensity increased from 11.0+/-1.3 s for >/=LIGHT activity to 6.1+/-1.0 s for >/=VIG activity. The frequency, duration and intensity of bouts were greater in boys than girls, and the frequency and duration of bouts were greater on weekdays than weekend days. Girls accumulated more activity sporadically than boys, whereas boys accumulated more activity in >/=5-min bouts. CONCLUSION.: Sex differences and weekday/weekend differences in activity were largely due to the intensity of the most frequent bouts of activity and frequency of the most intense bouts. Information regarding the pattern of children’s habitual activity can be used to inform activity interventions and assess the aspects of the activity pattern that are related to health.

Ryan, M., Livingstone, M.B., Ducluzeau, P.H., Sallé, A., Genaitay, M. & Ritz, P. (Mar 2008). Is a failure to recognize an increase in food intake a key to understanding insulin-induced weight gain? Diabetes Care. 31:448-50.

The present study aimed to assess the contribution of energy intake to positive energy balance and weight gain with insulin therapy. Changes in energy intake (self-report and weighed food intake), dietary behavior (auto-questionnaires), resting energy expenditure (REE) (indirect calorimetry), physical activity (accelerometry), and glucosuria were monitored over the first 6 months of insulin therapy in 46 diabetic adults. No change in REE, activity, or glucosuria could explain weight gain in the type 1 (4.1 +/- 0.6 kg, P < 0.0001) or type 2 (1.8 +/- 0.8 kg, P = 0.02) diabetic groups. An increase in energy intake provides the most likely explanation for weight gain with insulin. However, it is not being recognized because of significant underestimation of self-reported food intake, which appears to be associated with increased dietary restraint.

Scharf, D.M., Dunbar, M.S., Shiffman, S. (Jan 2008). Smoking during the night: Prevalence and smoker characteristics. Nicotine & Tobacco Research. 10:167-178.

We report on the smoking patterns and characteristics of individuals who smoke at night. We also explore the relationship between night smoking, nicotine dependence, and cessation outcomes. Participants (N = 691) were heavy smokers enrolled in cessation research clinics. Data were from three studies. Using ecological momentary assessment, participants monitored their smoking (ad libitum, day and night) on electronic diaries (EDs) during a 2-week baseline period and for 4 weeks following a target quit day. A total of 41% of smokers recorded at least one episode of night smoking. Within this group, night smoking occurred on 26% of nights, averaging two episodes per night. ED data correlated with a single self-report item assessing the frequency of night smoking. Night smoking was associated with greater nicotine dependence and daily caffeine consumption. It also predicted risk for lapsing beyond traditional measures of nicotine dependence. Night smoking is common, is associated with nicotine dependence, and it represents additional risk for cessation failure. People who smoke at night may need nicotine replacement therapy overnight. Future research should determine whether treatments that improve sleep quality also improve cessation outcomes in night smokers.

Schubert, C. (Feb 2008). Research on psychosomatic complexity: Another example of the usefulness of diaries for symptoms research. Journal of Psychosomatic Research. 64:237-238.

Comments on the article by C. Burton, D. Weller, and M. Sharpe (see record 2007-06629-011) regarding the usefulness of electronic diaries for symptoms research. Burton et al. concluded from the comparison of 32 papers that electronic diaries are both acceptable to users and sufficiently accurate for research purposes. However, in their list of issues still to be resolved with electronic diaries, I miss the point that electronic diary studies–supposed to answer questions too complex for simpler designs–have not yet identified truly complex psychosomatic phenomena such as feedback mechanisms and dynamic networks. We need further approaches and methods that are specifically designed to grasp the multilayered characteristics of human nature. Then, diary studies could really be “fit for complex self-report data.”

Silbermann, A., Henkel, A., Müller, A. & de Zwaan, M. (Feb 2008). The Application of Ecological Momentary Assessment to the Study of Compulsive Buying. Psychother Psychosom Med Psychol – Epub ahead of print

Although compulsive buying is a disorder that has begun to receive attention from researchers in recent years, relatively little is known about the relationship between compulsive buying, mood, and daily stressful events. In our pilot study ecological momentary assessment (EMA) was used to examine the described relationships for the first time. 26 patients, who met criteria for compulsive buying, self-monitored their pathological behaviour, their momentary mood and the occurrence of stressful events four times a day on a handheld computer for a period of two weeks. On days with excessive buying behaviour patients reported significantly more daily stressful events compared to days without pathological buying. Before the buying episode patients recorded significantly more positive emotions. The most common consequence of compulsive buying was a significant decrease of positive affects. Thus the results of the current study suggest that mood states and daily stressful events are associated with compulsive buying behaviour. Although mood got worse immediately after excessive buying, this negative consequence did not reduce the frequency of pathological behaviour. This could implicate a high presence-orientation and impulsivity of the patients.

Simmons, R.K., Griffin, S.J., Steele, R., Wareham, N.J., Ekelund, U., On behalf of the ProActive Research Team (May 2008). Increasing overall physical activity and aerobic fitness is associated with improvements in metabolic risk: cohort analysis of the ProActive trial. Diabetologia. 51:787-794.

AIMS/HYPOTHESIS: Our aim was to examine the association between change in physical activity energy expenditure (PAEE), total body movement (counts per day) and aerobic fitness (maximum oxygen consumption [[Formula: see text]]) over 1 year and metabolic risk among individuals with a family history of diabetes. METHODS: Three hundred and sixty-five offspring of people with type 2 diabetes underwent measurement of energy expenditure (PAEE measured using the flex heart rate method), total body movement (daily activity counts from accelerometry data), [Formula: see text] predicted from a submaximal graded treadmill exercise test and anthropometric and metabolic status at baseline and 1 year (n = 321) in the ProActive trial. Clustered metabolic risk was calculated by summing standardised values for waist circumference, fasting triacylglycerol, insulin and glucose, blood pressure and the inverse of HDL-cholesterol. Linear regression was used to quantify the association between changes in PAEE, total body movement and fitness and clustered metabolic risk at follow-up. RESULTS: Participants increased their activity by 0.01 units PAEE kJ kg(-1) day(-1) over 1 year. Total body movement increased by an average of 9,848 counts per day. Change in total body movement (beta = -0.066, p = 0.004) and fitness (beta = -0.056, p = 0.003) was associated with clustered metabolic risk at follow-up, independently of age, sex, smoking status, socioeconomic status and baseline metabolic score. CONCLUSIONS/INTERPRETATION: Small increases in activity and fitness were associated with a reduction in clustered metabolic risk in this cohort of carefully characterised at-risk individuals. Further research to quantify the reduction in risk of type 2 diabetes associated with feasible changes in these variables should inform preventive interventions.

Sisson, S.B. & Tudor-Locke, C. (Jan 2008). Comparison of cyclists’ and motorists’ utilitarian physical activity at an urban university. Preventive Medicine: An International Journal Devoted to Practice and Theory. 46:77-79.

Objective: Preliminary comparison of cyclists and motorists on: (1) distance lived from campus and, (2) the impact of transportation mode on physical activity. Methods: A purposive sample of students (n=50; cyclists=26, motorists=24) living <5 miles from Arizona State University campus wore an accelerometer and completed a travel log for two on-campus days during fall 2005-spring 2006. Residence distance to campus was calculated by geocoded addresses (n=45; cyclists=23 vs. motorists=22). Final outcome variables were: distance lived from campus, accelerometer time moderate-to-vigorous physical activity, steps/day, total time moderate-to-vigorous physical activity (logged minutes cycling+accelerometer-derived moderate-to-vigorous physical activity), and minutes total active commuting (logged walking+cycling). Results: Groups were significantly different for: distance lived from campus (cyclists=0.6±0.6 vs. motorists=2.0±1.1 miles; p<0.000); steps/day (cyclists=11,051±4295 vs. motorists=9174±3319; p=0.046); total time moderate-to-vigorous physical activity (cyclists=85.7±37.0 vs. motorists=50.3±23.8 minutes; p<0.001); minutes in motorized transport (cyclists=24.9±27.5 vs. motorists=61.6±32.9; p<0.001); and total active transport (cyclists=59.4± 32.4 vs. motorists=29.5±20.0; p<0.001). Conclusion: Among students living within 5 miles of campus, cyclists lived relatively closer to campus, accumulated more minutes of physical activity, and spent more time in active transportation than students who used motorized means.

Smith, W.R., Penberthy, L.T., Bovbjerg, V.E., McClish, D.K., Roberts, J.D., Dahman, B., Aisiku, I.P., Levenson, J.L. & Roseff, S.D. (Jan 2008).Daily assessment of pain in adults with sickle cell disease. Ann Intern Med. 148:94-101.

BACKGROUND: Researchers of sickle cell disease have traditionally used health care utilization as a proxy for pain and underlying vaso-occlusion. However, utilization may not completely reflect the amount of self-reported pain or acute, painful episodes (crises). OBJECTIVE: To examine the prevalence of self-reported pain and the relationship among pain, crises, and utilization in adults with sickle cell disease. DESIGN: Prospective cohort study. SETTING: Academic and community practices in Virginia. PATIENTS: 232 patients age 16 years or older with sickle cell disease. MEASUREMENTS: Patients completed a daily diary for up to 6 months, recording their maximum pain (on a scale of 0 to 9); whether they were in a crisis (crisis day); and whether they used hospital, emergency, or unscheduled ambulatory care for pain on the previous day (utilization day). Summary measures included both simple proportions and adjusted probabilities (for repeated measures within patients) of pain days, crisis days, and utilization days, as well as mean pain intensity. RESULTS: Pain (with or without crisis or utilization of care) was reported on 54.5% of 31 017 analyzed patient-days (adjusted probability, 56%). Crises without utilization were reported on 12.7% of days and utilization on only 3.5% (unadjusted). In total, 29.3% of patients reported pain in greater than 95% of diary days, whereas only 14.2% reported pain in 5% or fewer diary days (adjusted). The frequency of home opiate use varied and independently predicted pain, crises, and utilization. Mean pain intensity on crisis days, noncrisis pain days, and total pain days increased as the percentage of pain days increased (P < 0.001). Intensity was significantly higher on utilization days (P < 0.001). However, utilization was not an independent predictor of crisis, after controlling for pain intensity. LIMITATIONS: The study was done in a single state. Patients did not always send in their diaries. CONCLUSION: Pain in adults with sickle cell disease is the rule rather than the exception and is far more prevalent and severe than previous large-scale studies have portrayed. It is mostly managed at home; therefore, its prevalence is probably underestimated by health care providers, resulting in misclassification, distorted communication, and undertreatment.

Snir, R. & Zohar, D. (Jan 2008). Workaholism as discretionary time investment at work: An experience-sampling study. Applied Psychology: An International Review. 57:109-127.

Adopting an operational definition of workaholism as discretionary investment of considerable time at work, the purpose of the present study was to test hypotheses regarding the cognitive aspect of workaholism, as well as the positive and negative/addictive views of this construct. The study employed an experience-sampling method (ESM), using a sample of 65 full-time employees who completed the ESM forms at four random times during the day for one week. Results indicated that workaholism was associated with continued cognitive engagement with work, accompanied by a preference for work over leisure activity and higher positive affect during work activity than during leisure activity. No significant differences were found between workaholics and non-workaholics with regard to the likelihood of performing work-related activities during leisure activity, or in the levels of physical discomfort and negative affect during the weekend. These results highlight the utility of an operational framework for studying the variety of workaholism correlates. Theoretical and applied implications are discussed.

Steele, B.G., Belza, B., Cain, K.C., Coppersmith, J., Lakshminarayan, S., Howard, J. & Haselkorn, J.K. (Mar 2008).A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease. Arch Phys Med Rehabil. 89:404-12.

OBJECTIVES: To evaluate the effectiveness of an exercise adherence intervention to maintain daily activity, adherence to exercise, and exercise capacity over 1 year after completion of an outpatient pulmonary rehabilitation program. DESIGN: A 2-group, experimental design was used with randomization into intervention and usual care groups. SETTING: Outpatient pulmonary rehabilitation program in a university-affiliated medical center. PARTICIPANTS: One hundred six subjects (98 men; 98 with chronic obstructive pulmonary disease) with a mean age of 67 years and chronic lung disease. INTERVENTION: Twelve-week adherence intervention (weekly phone calls and home visit) including counseling on establishing, monitoring, and problem-solving in maintaining a home exercise program. MAIN OUTCOME MEASURES: Primary outcomes included daily activity (accelerometer), exercise adherence (exercise diary), and exercise capacity (six-minute walk test). All measures were performed at baseline, after the pulmonary rehabilitation program (8 wk), after the adherence intervention (20 wk), and at 1 year. RESULTS: A rank-based analysis of covariance showed less decline at 20 weeks in exercise adherence (intervention mean, +3 min; control mean, -13 min; P=.015) and exercise capacity (intervention mean, -10.7 m; control mean, -35.4 m; P=.023). There were no differences in daily activity at 20 weeks or any differences in any primary variable at 1 year. CONCLUSIONS: The intervention enhanced exercise adherence and exercise capacity in the short term but produced no long-term benefit. These findings are in part attributed to the disappointing measurement characteristics of the accelerometer used to measure daily activity. The intervention was acceptable to participants. Further study is needed to fashion interventions that have more persistent benefit.

Stiglmayr, C.E., Ebner-Priemer, U.W., Bretz, J., Behm, R., Mohse, M., Lammers, C.H., Anghelescu, I.G., Schmahl, C., Schlotz, W., Kleindienst, N. & Bohus, M. (Feb 2008). Dissociative symptoms are positively related to stress in borderline personality disorder. Acta Psychiatr Scand. 117:139-47.

OBJECTIVE: According to DSM-IV criteria, dissociative symptoms in borderline personality disorder (BPD) occur in response to stress. Empirical evidence is, however, lacking. METHOD: Using ambulatory monitoring, we assessed dissociative symptoms and subjective ratings of stress every 60 min for 48 h on a palmtop computer in BPD-patients (n = 51), clinical controls (CC; major depression n = 25; panic disorder n = 26), and healthy controls (HC; n = 40). Data analyses were primarily based on hierarchical linear models. RESULTS: In all groups, states of increased stress were paralleled by increased scores of dissociation, thus confirming the hypothesized association between stress and dissociation. The increase in dissociation was more pronounced in BPD-patients when compared with CC and HC. Additionally, BPD-patients reported heightened dissociative experience compared with CC and HC, even after controlling for stress. CONCLUSION: Our data suggest that BPD-patients might be prone to dissociation when experiencing stress and are characterized by a generally heightened level of dissociation.

Sumukadas, D., Laidlaw, S. & Witham, M.D. (Feb 2008). Using the RT3 accelerometer to measure everyday activity in functionally impaired older people. Aging Clin Exp Res. 20:15-8.

BACKGROUND AND AIMS: Triaxial accelerometry may provide a simple measure of physical activity in older people, but the effect of different walking aids and accelerometer placements on measurement is not known. This study aimed to examine the effect of accelerometer placement, use of walking aids, and different types of physical activity on Stay- Healthy RT3 triaxial accelerometer readings in older people. METHODS: Twenty subjects aged over 65 years and five younger volunteers were recruited from Medicine for the Elderly services. Subjects performed six minutes each of standardized standing activity, sitting activity, sitting at rest, walking, and stair climbing. Counts generated from RT3 accelerometers worn anteriorly over both hips were recorded in subjects using different walking aids during these standardized activities. RESULTS: There were significant differences between counts generated by the left and right hip positions. The intraclass correlation coefficient of RT3 counts between left and right hip positions was 0.48, 0.39 and 0.99 for sedentary tasks (standing, sitting and rest), stair and walking tasks respectively. Counts ranged between 250-3000 min-1 during the walking task. Counts were proportional to the distance walked. Resting, sitting or standing all generated counts below 250 min-1, but there was no clear demarcation between these activities. The use of different walking aids did not affect the counts generated for any activity. CONCLUSIONS: Walking can be distinguished from other activities by upper and lower cutoffs. The RT3 accelerometer should be used on the same side of the body. Different walking aids do not appear to affect RT3 counts in older people.

Thewissen, V., Bentall, R.P., Lecomte, T., van Os, J. & Myin-Germeys, I. (Feb 2008). Fluctuations in self-esteem and paranoia in the context of daily life. J Abnorm Psychol. 117:143-53.

Studies investigating the relationship between self-esteem and paranoia have specifically focused on self-esteem level, but have neglected the dynamic aspects of self-esteem. In the present article, the authors investigated the relationship between self-esteem and paranoia in two different ways. First, 154 individuals ranging across the continuum in level of paranoia were studied with the Experience Sampling Method (a structured self-assessment diary technique) to assess the association between trait paranoia and level and fluctuation of self-esteem in daily life. Results showed that trait paranoia was associated with both lower levels and higher instability of self-esteem. Second, the temporal relationship between momentary (state) paranoia and self-esteem was investigated in the daily life of these individuals. Results showed that a decrease in self-esteem was associated with an immediate increase in paranoia. The findings indicate that paranoid individuals are not only characterized by a lower level of self-esteem but also by more fluctuations in their self-esteem and that fluctuations in self-esteem predict the degree of subsequent paranoia. These results are consistent with the hypothesis that paranoia is associated with dysfunctional strategies of self-esteem regulation.

Thieden, E. (Feb 2008). Sun exposure behaviour among subgroups of the Danish population. Based on personal electronic UVR dosimetry and corresponding exposure diaries. Dan Med Bull. 55:47-68.

Solar ultraviolet radiation (UVR) is known to be the most important etiological factor in skin cancer development. The main objective of this thesis was to achieve an objective, basic knowledge of the individual UVR exposure dose pattern and to reveal the factors and with which power they influence on the UVR dose among the Danes. Eight open prospective, observational studies and one study analyzing the compliance and reliability of data were performed in healthy Danish volunteers with an age range of 4-68 years. The subjects were chosen to cover an age span group of children, adolescents, and indoor workers and in addition, groups with expected high UVR exposure, sun worshippers, golfers, and gardeners. We developed a personal, electronic UVR dosimeter in a wristwatch (SunSaver). The subjects wore the UVR dosimeter that measured time-stamped UVR doses in standard erythema doses (SED) and completed diaries with data on their sun exposure behaviour. This resulted in corresponding UVR dosimeter and diary data from 346 sun-years where one sun-year is one person participating in one summer half-year (median 119 days). The annual UVR doses were calculated based on the personal and ambient measured UVR doses. We found a huge variation in annual UVR exposure dose within the total population sample, median 173 SED (range, 17-980 SED). The inter-group variation in annual UVR dose was from median 132 SED among indoor workers to median 224 SED among gardeners. No significant correlation was found between annual UVR dose and age either within the total population or among the adults. But the subjects below 20 years of age had an increase in annual UVR dose of 5 SED per year. Young people before the age of 20 years did not get a higher proportion of the lifetime UVR dose than expected (25%) when assuming a life expectancy of 80 years. There was no significant difference in annual UVR dose between males and females in the total population sample. But, among children, girls received a significantly higher UVR dose than boys due to more days with risk behaviour (sunbathing or exposing shoulders outdoors). This exposure pattern, with females having more risk behaviour than males, was also found among adolescents and adults. Sunbathing or exposing shoulders (risk behaviour) outside the beach resulted in a median of 2.5 SED per day in northern Europe and 3.2 SED per day in southern Europe, while the corresponding values were 4.6 SED and 6.9 SED per day at the beach. UVR doses above 10 SED per day were connected with risk behaviour. The subjects had a median of 13 days with risk behaviour (range, 0-93 days). The subjects used sunscreen on a median of five days (range, 0-130 days), but have a median of seven days with risk behaviour without sunscreen applied (range, 0-47 days). They had a median of one sunburn per sun-year (range 0-10). Fifty percent of the UVR dose was received between 12.00 and 15.00. Only the gardeners received the main part of their UVR dose on workdays. Conclusions : – High UVR doses are connected with risk behaviour. Reduction of cumulative lifetime UVR dose could be obtained by minimizing risk behaviour. – Sunburns were highly correlated to risk behaviour. – Use of sunscreen correlated with days “sunbathing with the intention to tan”, indicating that sunscreens were used to avoid sunburn during risk behaviour. – Scheduling lunch breaks and other breaks indoors at noon, where ambient UVR peaks, could reduce the occupational UVR exposure significantly. – In the winter-half-year in Denmark. the UVR dose received from solar exposure is negligible and no UVR precautions are needed. This study documented that high subject compliance rate and data reliability could be obtained in long-time UVR dosimeter study as ours by being service minded but persistent, offering dosimeter maintenance service within 24 hours and scrutinizing data for errors and mistakes just after data collection.

Thomas, S., Kühnlein, A., Heinrich, S., Praml, G., Nowak, D., von Kries, R. & Radon, K. (Apr 2008). Personal exposure to mobile phone frequencies and well-being in adults: A cross-sectional study based on dosimetry. Bioelectromagnetics – Epub ahead of print

The use of mobile phone telecommunication has increased in recent years. In parallel, there is growing concern about possible adverse health effects of cellular phone networks. We used personal dosimetry to investigate the association between exposure to mobile phone frequencies and well-being in adults. A random population-based sample of 329 adults living in four different Bavarian towns was assembled for the study. Using a dosimeter (ESM-140 Maschek Electronics), we obtained an exposure profile over 24 h for three mobile phone frequency ranges (measurement interval 1 s, limit of determination 0.05 V/m). Exposure levels over waking hours were totalled and expressed as mean percentage of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) reference level. Each participant reported acute symptoms in a day-long diary. Data on five groups of chronic symptoms and potential confounders were assessed during an interview. The overall exposure to high-frequency electromagnetic fields was markedly below the ICNIRP reference level. We did not find any statistically significant association between the exposure and chronic symptoms or between the exposure and acute symptoms. Larger studies using mobile phone dosimetry are warranted to confirm these findings.

Thurman, S.K. & McGrath, M.C. (Jan 2008). Environmentally based assessment practices: Viable alternatives to standardized assessment for assessing emergent literacy skills in young children. Reading & Writing Quarterly: Overcoming Learning Difficulties. 24:7-24.

Ecological validity is an important construct in the assessment of young children. The argument is made that using environmentally based assessment practices as well as understanding the child’s ecology will help assure that assessments are carried out in an ecologically valid manner. The discussion focuses on play-based assessment, curriculum-based assessment, and dynamic assessment. Each of these approaches is based on authentic procedures and is typically carried out in the child’s natural environment. In addition, there is a discussion of how specific environments can be delineated as well as stressing the importance of developing operational definitions of specific skills in the natural environment.

Tidey, J.W., Monti, P.M. & Rohsenow, D.J. (Jan 2008). Moderators of naltrexone’s effects on drinking, urge, and alcohol effects in non-treatment-seeking heavy drinkers in the natural environment. Alcoholism: Clinical and Experimental Research. 32:58-66.

Background: Naltrexone (NTX) has proven to be effective with alcoholics in treatment, with most controlled clinical trials showing beneficial effects on heavy drinking rates. However, little is known about the behavioral mechanisms underlying the effects of NTX on drinking, or about patient characteristics that may moderate NTX’s effects on drinking. In this study, ecological momentary assessment (EMA) techniques were used to investigate some of the putative mechanisms of naltrexone’s effects on drinking in heavy drinkers who were not seeking treatment for alcohol problems. Polymorphisms in the D4 dopamine receptor (DRD4) gene and the μ-opiate receptor (OPRM1) gene, family history of alcohol problems, age of onset of alcoholism and gender were explored as potential moderators of NTX’s effects. Methods: After a 1-week placebo lead-in period, heavy drinkers (n = 180), 63% of whom were alcohol-dependent, were randomized to 3 weeks of daily naltrexone (50 mg) or placebo. Throughout the study, participants used EMA on palm-pilot computers to enter, in real time, drink data, urge levels, and subjective effects of alcohol consumption. Results: Naltrexone reduced percentage drinking days in all participants and reduced percent heavy drinking days in DRD4-L individuals; NTX decreased urge levels in participants with younger age of alcoholism onset; NTX increased time between drinks in participants who had more relatives with alcohol problems; and NTX reduced the stimulating effects of alcohol in women. OPRM1 status did not moderate any of NTX’s effects. Conclusions: These results confirm earlier findings of NTX’s effects on drinking and related subjective effects, and extend them by describing individual difference variables that moderate these effects in the natural environment, using data collected in real time.

Trivedi, R., Sherwood, A., Strauman, T.J. & Blumenthal, J.A. (Mar 2008). Laboratory-based blood pressure recovery is a predictor of ambulatory blood pressure. Biol Psychol. 77:317-23.

The recovery phase of the stress response is an individual difference characteristic that may predict cardiovascular risk. The purpose of this study was to examine whether laboratory-based blood pressure (BP) recovery predicts ambulatory BP (ABP). One hundred and eighty-two participants underwent a standard laboratory stress protocol, involving a 20-min baseline rest period, and four stressors presented in a counterbalanced order, each followed by a 10-min recovery period. Participants also wore an ABP monitor for 24h during a typical workday. Hierarchical regression analyses showed that BP recovery accounted for significant additional variance for daytime SBP (p<0.001), nighttime SBP (p<0.001), daytime DBP (p<0.001), and nighttime DBP (p<0.001), after controlling for baseline and reactivity BP. Results suggest that persistence of the BP response following stress may be a more salient characteristic of the stress response in understanding its potential impact on longer term cardiovascular regulation.

Vella, E.J., Kamarck, T.W. & Shiffman, S. (Mar 2008). Hostility moderates the effects of social support and intimacy on blood pressure in daily social interactions. Health Psychology, 27(2, Suppl):155-162.

Objective: This study sought to determine the role of hostility in moderating the effects of positive social interactions on ambulatory blood pressure (ABP). Design: Participants (341 adults) completed the Cook-Medley Hostility Scale and underwent ABP monitoring, assessed every 45 min during waking hours across 6 days. An electronic diary measuring mood and social interactions was completed at each ABP assessment. Main Outcome Measures: The dependent variables from the ABP monitor included systolic blood pressure, diastolic blood pressure, and heart rate. Results: Different patterns of ambulatory diastolic blood pressure (ADBP) responding to social interactions perceived as intimate or supportive among high- versus low-hostile individuals were observed. Higher intimacy ratings were linked to reductions in ADBP among low-hostile but not high-hostile individuals. Conversely, high-hostile, but not low-hostile, individuals showed increases in ADBP to situations rated high in social support. Although findings for ambulatory systolic blood pressure were nonsignificant, the pattern of results was similar to ADBP. Conclusion: Hostile individuals may find offers of support stressful and may fail to benefit from intimacy during daily life. The pathogenic effects of hostility may be mediated in part by responses to social interactions, both positive and negative. (PsycINFO Database Record (c) 2008 APA, all rights reserved)(from the journal abstract)

Waters, A.J. & Li, Y. (Mar 2008). Evaluating the utility of administering a reaction time task in an ecological momentary assessment study. Psychopharmacology. 197:25-35.

RATIONALE: Cognitive processes underlying drug use have typically been assessed in laboratory settings. More detailed and ecologically valid data may be possible if assessments were conducted in an ecological momentary assessment (EMA) setting. OBJECTIVES: We evaluated the feasibility and utility of administering a reaction time task on a hand-held computer (personal digital assistant, PDA) in an EMA setting. MATERIALS AND METHODS: Twenty-two smokers and 22 non-smokers carried around the PDA for 1 week as they went about their daily lives. They were beeped at random times four times per day (random assessments, RAs). Participants were also instructed to press an “anxiety assessment” (AA) button on the PDA whenever they felt suddenly anxious. At each assessment (RA, AA), participants responded to items assessing subjective, pharmacological, and contextual variables, and subsequently completed a Stroop task (classic-Stroop, emotional-Stroop, or smoking-Stroop task). RESULTS: Participants responded to 81.2% of RAs, completed assessments in an average of 4.44 min, reported no interruptions on the majority of assessments (62.4%), and produced data with adequate reliability. Using generalized estimating equation (GEE) analyses, age was associated with the classic-Stroop effect, state anxiety was associated with the emotional-Stroop effect, and Fagerstrom Test for Nicotine Dependence scores were associated with the smoking-Stroop effect. CONCLUSIONS: The study provided evidence for the feasibility and utility of the approach.

Webber, L.S., Catellier, D.J., Lytle, L.A., Murray, D.M., Pratt, C.A., Young, D.R., Elder, J.P., Lohman, T.G., Stevens, J., Jobe, J.B., Pate, R.R., TAAG Collaborative Research Group (Mar 2008). Promoting physical activity in middle school girls: Trial of Activity for Adolescent Girls. Am J Prev Med. 34:173-84.

BACKGROUND: Physical activity is important for weight control and good health; however, activity levels decline in the adolescent years, particularly in girls. DESIGN: Group randomized controlled trial. SETTING/PARTICIPANTS: Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States. Random, cross-sectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th graders in 2005 (n=3504) and 2006 (n=3502). INTERVENTION: A 2-year study-directed intervention (fall 2003 to spring 2005) targeted schools, community agencies, and girls to increase opportunities, support, and incentives for increased physical activity. Components included programs linking schools and community agencies, physical education, health education, and social marketing. A third-year intervention used school and community personnel to direct intervention activities. MAIN OUTCOME MEASURES: The primary outcome, daily MET-weighted minutes of moderate-to-vigorous physical activity (MET-weighted MVPA), was assessed using accelerometry. Percent body fat was assessed using anthropometry. RESULTS: After the staff-directed intervention (pre-stated primary outcome), there were no differences (mean= -0.4, 95% CI= -8.2 to 7.4) in adjusted MET-weighted MVPA between 8th-grade girls in schools assigned to intervention or control. Following the Program Champion-directed intervention, girls in intervention schools were more physically active than girls in control schools (mean difference 10.9 MET-weighted minutes of MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or 80 kcal per week. There were no differences in fitness or percent body fat at either 8th-grade timepoint. CONCLUSION: A school-based, community-linked intervention modestly improved physical activity in girls.

Wittmeier, K.D., Mollard, R.C. & Kriellaars, D.J. (Feb 2008). Physical activity intensity and risk of overweight and adiposity in children. Obesity (Silver Spring) . 16:415-20.

BACKGROUND: Physical activity recommendations for children focus on duration of activity and underemphasize intensity. OBJECTIVE: To evaluate the relationship between physical activity (intensity and duration) and the odds of being overweight, >20% body fat and >25% body fat. METHODS AND PROCEDURES: Body fat, BMI and physical activity (accelerometry) were measured in children (n = 251) aged 8-10 years. Physical activity was quantified as time in moderate physical activity (MPA) and vigorous physical activity (VPA). RESULTS: Prevalence of overweight and obesity were 18 and 11.6%, respectively. Regression indicated that VPA, not MPA, is associated with body fat (r = 0.35, P < 0.001) and BMI (r = 0.26, P < 0.001). Odds ratio demonstrated a significant impact of MPA and VPA on body composition. Children performing < or =5 min/day of VPA are 4.0 times more likely to have > or =20% body fat (P < 0.001), 2.9 times more likely to have > or =25% body fat (P < 0.05) and 5.2 times more likely to be classified as overweight (P < 0.01) compared to children performing > or =15 min/day. Those performing < or =15 min/day of MPA vs. >45 min/day MPA are at 4.2 increased odds of having > or =20% body fat (P < 0.001), and 3.0 increased odds of having > or =25% (P < 0.01). DISCUSSION: Lower durations of both MPA and VPA are associated with increased odds of overweight and adiposity. Forty-five minutes of MPA and fifteen minutes of VPA were associated with reduced body fat and BMI. We recommend that these amounts are used to develop minimum physical activity intensity guidelines for the prevention and treatment of obesity.

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