Society for Ambulatory Assessment

Second quarter 2008 (April to June)

Atienza AA , King AC, Oliveira BM, Ahn DK, Gardner CD. (Jun 2008). Using hand-held computer technologies to improve dietary intake. Am J Prev Med, 34(6):514-8.

BACKGROUND: Portable hand-held information technology offers much promise not only in assessing dietary intake in the real world, but also in providing dietary feedback to individuals. However, stringent research designs have not been employed to examine whether it can be effective in modifying dietary behaviors. The purpose of this pilot study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing vegetable and whole-grain intake over 8 weeks in mid-life and older adults, using a randomized study design. METHODS: Twenty-seven healthy adults aged > or =50 were randomized and completed the 8-week study. Intervention participants received an instructional session and a PDA programmed to monitor their vegetable and whole-grain intake levels twice per day and to provide daily individualized feedback, goal-setting, and support. Controls received standard, age-appropriate, written nutritional education materials. Dietary intake was assessed via the Block Food Frequency Questionnaire at baseline and 8 weeks. RESULTS: Relative to controls, intervention participants reported significantly greater increases in vegetable servings (1.5-2.5 servings/day; p=0.02), as well as a trend toward greater intake of dietary fiber from grains (3.7-4.5 servings/day; p=0.10). CONCLUSIONS: This study’s findings provide preliminary evidence that using portable hand-held technology to provide daily individualized feedback on dietary behavior in the real world can increase the dietary intake of healthy food groups.

Bishop, G.D., Ngau, F. & Pek, J. (Jun 2008). Domain-specific assessment of anger expression and ambulatory blood pressure. Personality and Individual Differences, Vol 44(8), 1726-1737.

Bongard and al’Absi (2003) proposed domain-specific anger expression as an improved method for measuring the expression of anger with stronger links to cardiovascular parameters. We tested this proposal by relating their domain-specific measure to ambulatory blood pressure. One hundred and forty-nine Singapore young adults responded to a modified version of the State-Trait Anger Expression Inventory that measured anger expression at home, school/work and leisure and then underwent 24 h ambulatory blood pressure monitoring. Results indicated significant differences in reported anger expression in the three domains measured and also showed that domain-specific measures of anger expression were more strongly related to ambulatory blood pressure than was the general measure of anger expression. These results provide additional evidence for the importance of measures of anger expression that take account of the specific context in which anger occurs.

Bouchard DR, Trudeau F. (May 2008). Estimation of energy expenditure in a work environment: Comparison of accelerometry and oxygen consumption/heart rate regression. Ergonomics, 51(5):663-70.

The aim of this study was to compare estimation of energy expenditure (EE) in working environments, either from accelerometry or from an individual oxygen consumption/heart rate (VO(2)/HR) regression curve. The study participants were 46 volunteer workers aged 27+/-6 years old. A significant correlation between EE predicted by the VO(2)/HR curve and the accelerometer was observed (r=0.78, p <0.01). However, more disparities were observed between the two methods when the mean job intensity was not within 16% and 23% higher than resting HR. The accelerometer overestimated by a mean of 34.4% the prediction by VO(2)/HR regression if the intensity of the task was lower than a total of 1000 kcal/shift and underestimated the prediction by a mean of -24.9% if EE estimation of the work shift was higher than a total of 1500 kcal/shift. Despite a high correlation between both methods in the whole group, EE evaluated by accelerometry does not correspond to EE predicted by the VO(2)/HR regression curves when evaluated individually.

Breines JG, Crocker J, Garcia JA. (May 2008). Self-objectification and well-being in women’s daily lives. Pers Soc Psychol Bull, 34(5):583-98. Epub 2008 Feb 15.

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.

Ciolac EG, Guimarães GV, D Àvila VM, Bortolotto LA, Doria EL, Bocchi EA. (May 2008). Acute effects of continuous and interval aerobic exercise on 24-h ambulatory blood pressure in long-term treated hypertensive patients. Int J Cardiol. [Epub ahead of print]

BACKGROUND: Despite antihypertensive therapy, it is difficult to maintain optimal systemic blood pressure (BP) values in hypertensive patients (HPT). Exercise may reduce BP in untreated HPT. However, evidence regarding its effect in long-term antihypertensive therapy is lacking. Our purpose was to evaluate the acute effects of 40-minute continuous (CE) or interval exercise (IE) using cycle ergometers on BP in long-term treated HPT. METHODS: Fifty-two treated HPT were randomized to CE (n=26) or IE (n=26) protocols. CE was performed at 60% of reserve heart rate (HR). IE alternated consecutively 2 min at 50% reserve HR with 1 min at 80%. Two 24-h ambulatory BP monitoring were made after exercise (postexercise) or a nonexercise control period (control) in random order. RESULTS: CE reduced mean 24-h systolic (S) BP (2.6+/-6.6 mm Hg, p=0.05) and diastolic (D) BP (2.3+/-4.6, p=0.01), and nighttime SBP (4.8+/-6.4, p<0.001) and DBP (4.6+/-5.2 mm Hg, p=0.001). IE reduced 24-h SBP (2.8+/-6.5, p=0.03) and nighttime SBP (3.4+/-7.2, p=0.02), and tended to reduce nighttime DBP (p=0.06). Greater reductions occurred in higher BP levels. Percentage of normal ambulatory BP values increased after CE (24-h: 42% to 54%; daytime: 42% to 61%; nighttime: 61% to 69%) and IE (24-h: 31% to 46%; daytime: 54% to 61%; nighttime: 46% to 69%). CONCLUSION: CE and IE reduced ambulatory BP in treated HPT, increasing the number of patients reaching normal ambulatory BP values. These effects suggest that continuous and interval aerobic exercise may have a role in BP management in treated HPT.

Coley B, Jolles BM, Farron A, Aminian K. (Jun 2008). Arm position during daily activity. Gait Posture . [Epub ahead of print]

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 detect the ability to work at a specific position of the shoulder. Nine arm positions were defined based on humerus elevation. The method was tested on 31 healthy volunteer subjects. First, we estimated the ability of the system to detect the different elevation angles and arm positions of each subject. Following that, we evaluated their arm positions during approximately 8h of daily activities. Each arm position was recognized with a good sensitivity (range 80-100%) and specificity (range 96-99%). During daily activity, we estimated the frequency (number/h) that the humerus reached each arm position during the periods of 0-1s (period P1), 1-5s (period P2) and 5-30s (period P3). Our data showed that all subjects had 96% of their arm position reached under the 5th level (100-120 degrees ). No significant difference was observed between dominant and non-dominant sides for the frequency and duration of arm positions (p>0.3). Our evaluation was in accordance with the clinical questionnaire (the Constant score) for the P1 duration, but differed for longer periods P2 and P3. By quantifying the arm positions and their durations for both shoulders, we proposed a new score to evaluate the ability to work at a specific level based on the symmetry index of the arms activity. Using this score, we obtained, on average, good symmetry for healthy subjects. This score can be useful in evaluating the asymmetry in arm function in patients with a shoulder disease. The proposed technique could be used in a number of shoulder diseases where problems in performing daily activities should be expressed in terms of objective measure of arm position.

Conen D, Bamberg F. (Jul 2008). Noninvasive 24-h ambulatory blood pressure and cardiovascular disease: a systematic review and meta-analysis. J Hypertens, 26(7):1290-1299.

OBJECTIVE: We systematically assessed the evidence regarding the association between noninvasive 24-h systolic blood pressure and incident cardiovascular events. METHODS: We searched PubMed, EMBASE, and the Cochrane Library through April 2007. Studies that prospectively followed at least 100 individuals for at least 1 year, and that reported at least one effect estimate of interest were included. Two independent investigators abstracted information on study design, subject characteristics, blood pressure measurements, outcome assessment, effect estimates, and adjustment for potential confounders. RESULTS: We identified 20 eligible articles based on 15 independent cohort studies. The association between 24-h systolic blood pressure and a combined cardiovascular endpoint was assessed in nine cohort studies, including 9299 participants who were followed up to 11.1 years and had 881 outcome events. The summary hazard ratio (95% confidence interval) per 10-mmHg increase of 24-h systolic blood pressure was 1.27 (1.18-1.38) (P < 0.001). Further adjustment for office blood pressure in four studies with 4975 participants and 499 outcome events provided a similar summary estimate [hazard ratio (95% confidence interval) per 10-mmHg increase of 24-systolic blood pressure 1.21 (1.10-1.33) (P < 0.001)]. Office blood pressure was usually assessed on a single occasion. We found no significant variability according to age, sex, population origin, baseline office blood pressure, follow-up time, diabetes, or study quality. There was a consistent association between 24-h systolic blood pressure and stroke, cardiovascular mortality, total mortality, and cardiac events with hazard ratio (95% confidence interval) per 10 mmHg increase of 24-h systolic blood pressure of 1.33 (1.22-1.44), 1.19 (1.13-1.26), 1.12 (1.07-1.17), and 1.17 (1.09-1.25), respectively. CONCLUSION: 24-h systolic blood pressure is a strong predictor of cardiovascular events, providing prognostic information independent of conventional office blood pressure.

Conrad A, Wilhelm FH, Roth WT, Spiegel D, Taylor CB. (July 2008). Circadian affective, cardiopulmonary, and cortisol variability in depressed and nondepressed individuals at risk for cardiovascular disease. J Psychiatr Res, 42(9):769-77. Epub 2007 Sep 19. Depression is a risk factor for cardiovascular disease (CVD) perhaps mediated by hypothalamic-pituitary-adrenal (HPA) axis or vagal dysregulation. We investigated circadian mood variation and HPA-axis and autonomic function in older (55 years) depressed and nondepressed volunteers at risk for CVD by assessing diurnal positive and negative affect (PA, NA), cortisol, and cardiopulmonary variables in 46 moderately depressed and 19 nondepressed volunteers with elevated CVD risk. Participants sat quietly for 5-min periods (10:00, 12:00, 14:00, 17:00, 19:00, and 21:00), and then completed an electronic diary assessing PA and NA. Traditional and respiration-controlled heart rate variability (HRV) variables were computed for these periods as an index of vagal activity. Salivary cortisols were collected at waking, waking+30min, 12:00, 17:00, and 21:00h. Cortisol peaked in the early morning after waking, and gradually declined over the day, but did not differ between groups. PA was lower and NA was higher in the depressed group throughout the day. HRV did not differ between groups. Negative emotions were inversely related to respiratory sinus arrhythmia in nondepressed participants. We conclude that moderately depressed patients do not show abnormal HPA-axis function. Diurnal PA and NA distinguish depressed from nondepressed individuals at risk for CVD, while measures of vagal regulation, even when controlled for physical activity and respiratory confounds, do not. Diurnal mood variations of older individuals at risk for CVD differ from those reported for other groups and daily fluctuations in NA are not related to cardiac autonomic control in depressed individuals.

Dearnley C, Haigh J, Fairhall J. (May 2008). Using mobile technologies for assessment and learning in practice settings: a case study. Nurse Educ Pract, 8(3):197-204. Epub 2007 Aug 30.

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

Dijkstra B, Zijlstra W, Scherder E, Kamsma Y. (May 2008). Detection of walking periods and number of steps in older adults and patients with Parkinson’s disease: accuracy of a pedometer and an accelerometry-based method. Age Ageing. [Epub ahead of print]

The aim of this study was to examine if walking periods and number of steps can accurately be detected by a single small body-fixed device in older adults and patients with Parkinson’s disease (PD). Results of an accelerometry-based method (DynaPort MicroMod) and a pedometer (Yamax Digi-Walker SW-200) worn on each hip were evaluated against video observation. Twenty older adults and 32 PD patients walked straight-line trajectories at different speeds, of different lengths and while doing secondary tasks in an indoor hallway. Accuracy of the instruments was expressed as absolute percentage error (older adults versus PD patients). Based on the video observation, a total of 236.8 min of gait duration and 24,713 steps were assessed. The DynaPort method predominantly overestimated gait duration (10.7 versus 11.1%) and underestimated the number of steps (7.4 versus 6.9%). Accuracy decreased significantly as walking distance decreased. Number of steps were also mainly underestimated by the pedometers, the left Yamax (6.8 versus 11.1%) being more accurate than the right Yamax (11.1 versus 16.3%). Step counting of both pedometers was significantly less accurate for short trajectories (3 or 5 m) and as walking pace decreased. It is concluded that the Yamax pedometer can be reliably used for this study population when walking at sufficiently high gait speeds (>1.0 m/s). The accelerometry-based method is less speed-dependent and proved to be more appropriate in the PD patients for walking trajectories of 5 m or more.

Ebner-Priemer, U.W., Kuo, J., Schlotz, W. (Apr 2008). Distress and affective dysregulation in patients with borderline personality disorder: A psychophysiological ambulatory monitoring study. Journal of Nervous and Mental Disease, Vol 196, 314-320.

Borderline personality disorder (BPD) is characterized by enduring psychological distress and affective dysregulation. Several models have linked both phenomena, but are lacking empirical support. To investigate the relation between psychological distress and components of affective dysregulation (especially inability to label emotions, conflictive emotions, and physiological hyperarousal), we repeatedly assessed these components using a 24-hour ambulatory monitoring approach in a group of 50 BPD patients and 50 healthy controls. Hierarchical linear model analyses identified a clear relation between inability to label emotions and distress in the BPD group (p = 0.0009) but not across all subjects (p = 0.6492). Conflictive emotions were related to psychological distress in both groups (p < 0.0001). This relation is, however, most pertinent to the BPD group who experienced conflicting emotions more frequently. Physiological arousal (heart rate) was related to distress in both groups. Our empirical findings emphasize training in labeling emotions and distress tolerance interventions in treatment for BPD.

Ernst ME, Weber CA, Dawson JD, O’Connor MA, Lin W, Carter BL, Bergus GR. (Jun 2008). How well does a shortened time interval characterize results of a full ambulatory blood pressure monitoring session? J Clin Hypertens, 10(6):431-5.

Ambulatory blood pressure monitoring (ABPM) is useful in evaluating cardiovascular risk but requires significant time. The authors examined how closely shortened time intervals correlate with the systolic blood pressure (BP) determined from a full 24-hour ABPM session in 1004 ABPM recordings. After excluding the first hour, Pearson correlations performed for the mean systolic BP of the subsequent 3-, 5-, and 7-hour periods (4, 6, and 8 hours total) with the entire, and remainder of the session, demonstrated greatest improvement in correlation when the session is increased from 4 to 6 hours. Bland-Altman analysis of the 6-hour time period revealed a mean difference of 5.41 mm Hg compared with the full session mean. The authors conclude that 6-hour ABPM can approximate the overall mean BP obtained from full 24-hour ABPM. However, shortened sessions do not characterize the influence of circadian variation on the 24-hour mean BP and may overestimate the 24-hour BP levels.

Frings L, Wagner K, Maiwald T, Carius A, Schinkel A, Lehmann C, Schulze-Bonhage A. (Jun 2008) Early detection of behavioral side effects of antiepileptic treatment using handheld computers. Epilepsy Behav. [Epub ahead of print]

OBJECTIVE: Treatment-emergent side effects are frequent events, particularly during the uptitration of antiepileptic drugs. So far, monitoring of such adverse events in outpatients has often been limited to intervals of weeks or months. We here report the application of a new device for temporally fine-grained assessment of objective well-being and cognitive performance using personal digital assistants (PDAs). METHODS: Twenty adult patients with epilepsy participated in this pilot study. Ten received add-on treatment with levetiracetam. Ten patients with constant medication served as a control group. Differences between groups with respect to self-rated cognitive condition, psychophysical condition, aggressiveness, and cognitive test performance in a concentration test assessed three times daily (morning, early afternoon, and evening), over the course of 6 days, were analyzed. RESULTS: Levetiracetam-treated patients manifested an early augmentation of self-rated aggressiveness, which increased in intensity over the course of days. Aggressiveness reached a maximum in the early afternoon across days. There were no major changes in cognitive performance, except for an increase in morning performance in the control group. CONCLUSIONS: This study demonstrates the feasibility of a new method of ambulatory assessment of behavioral and cognitive data during titration of antiepileptic drugs. Significant changes in aggressiveness under add-on treatment with levetiracetam were found to be dependent on the time of assessment during the day. These results suggest that PDA-based ambulatory monitoring of patients with epilepsy may be a promising tool for early detection of drug-related side effects and, thus, may constitute a significant improvement in patient care.

Gloster AT, Richard DC, Himle J, Koch E, Anson H, Lokers L, Thornton J. (May 2008). Accuracy of retrospective memory and covariation estimation in patients with obsessive-compulsive disorder. Behav Res Ther, 46(5):642-55.

Assessment methods relying on biased or inaccurate retrospective recall may distort knowledge about the nature of disorders and lead to faulty clinical inferences. Despite concerns about the accuracy of retrospective recall in general and in particular with obsessive-compulsive disorder (OCD) patients, the accuracy of retrospective recall for one’s own symptoms assessed in vivo is unknown in this population. This study used a prospective ecological momentary assessment (EMA) methodology to create a criterion against which to assess recall accuracy in OCD patients. Although results indicated that patients’ retrospective recall of OCD symptoms was fairly accurate, they consistently overestimated the magnitude of OCD symptom covariation with non-OCD facets (e.g., sleep duration, contemporaneous stress level, etc.). Findings suggest that even when recall of OCD symptoms is accurate, patients may be inaccurate in estimating symptom covariation. The findings have implications for the research, case conceptualization, and assessment of OCD, and may extend to other disorders.

Granholm E, Loh C, Swendsen J. (May 2008). Feasibility and validity of computerized ecological momentary assessment in schizophrenia. Schizophr Bull, 34(3):507-14. Epub 2007 Oct 10.

BACKGROUND: Computerized Ecological Momentary Assessment (EMAc) techniques permit the assessment of daily life behaviors and experiences. The present investigation examined the feasibility and validity of this assessment methodology in outpatients with schizophrenia. METHODS: Outpatients with schizophrenia or schizoaffective disorder (n = 54) received a battery of standard laboratory clinical and functional outcome measures and then completed electronic questionnaires on a personal digital assistant (PDA) microcomputer 4 times per day for 1 week. RESULTS: Generally good compliance (87%) with EMAc was found, and participants rated their experience with the study positively. The data collected in daily life demonstrated expected patterns across the assessment week and were significantly associated with scores from standard laboratory instruments measuring similar constructs. CONCLUSIONS: EMAc is a feasible and valid approach to data collection in community-dwelling people with schizophrenia, and it may provide important information that is inaccessible via standard clinical and functional outcome measures administered in the laboratory.

Gunnarsdóttir A, Stenström P, Arnbjörnsson E. (Jun 2008). Wireless Esophageal pH Monitoring in Children. J Laparoendosc Adv Surg Tech A, 18(3):443-7.

ABSTRACT Introduction: A wireless BRAVO() (Medtronic, Shoreview, MN) capsule for pH measurement in the diagnosis of gastroesophageal reflux disease (GERD) is intended to be less uncomfortable, and facilitates activity during the measuring period, compared to the usual method with a naso-esophageal catheter. The aim of this study was to report on our experience with the wireless system in children. A secondary aim was to see if there was any cut-off level for esophageal acid exposure causing esophagitis as verified by pathologic examination. Materials and Methods: A total of 62 wireless 24-hour pH measurements with the BRAVO capsule were carried out over a period of 2 years in 58 children with symptoms of GERD. The median age of the children was 8 +/- 4 years (range, 1-15). They underwent upper endoscopies and the placement of the capsule under general anesthesia. Correlations between endoscope findings and pathologic diagnosis were done. Results: In 10 children, the endoscopies showed esophagitis. The median percent time of pH <4 was 7.0 +/- 9.6% (range, 0-61). The DeMeester score was abnormally high in 33 children. Three children described dysphagia during the measuring time. In 3 patients, we experienced technical problems with the wireless system. Biopsies were taken in 49 children, of which 18 showed esophagitis, with no correlation to the 24-hour pH-measurement findings. Conclusions: Ambulatory pH monitoring, using the wireless pH system, is feasible and was well tolerated by the children. No cut-off level for the acid exposure in correlation to pathologic diagnosis of esophagitis could be found. We recommend the use of the wireless pH-measurement system in children.

Hannon JC, Brown BB. (Jun 2008). Increasing preschoolers’ physical activity intensities: An activity-friendly preschool playground intervention. Prev Med, 46(6):532-6. Epub 2008 Jan 26.

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.

Hansen TW, Thijs L, Boggia J, Li Y, Kikuya M, Björklund-Bodegård K, Richart T, Ohkubo T, Jeppesen J, Torp-Pedersen C, Lind L, Sandoya E, Imai Y, Wang J, Ibsen H, O’Brien E, Staessen JA; on behalf of the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators. (Jun 2008). Prognostic Value of Ambulatory Heart Rate Revisited in 6928 Subjects From 6 Populations. Hypertension. [Epub ahead of print]

The evidence relating mortality and morbidity to heart rate remains inconsistent. We performed 24-hour ambulatory blood pressure monitoring in 6928 subjects (not on beta-blockers; mean age: 56.2 years; 46.5% women) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay, and China. We computed standardized hazard ratios for heart rate, while stratifying for cohort, and adjusting for blood pressure and other cardiovascular risk factors. Over 9.6 years (median), 850, 325, and 493 deaths accrued for total, cardiovascular, and noncardiovascular mortality, respectively. The incidence of fatal combined with nonfatal end points was 805, 363, 439, and 324 for cardiovascular, stroke, cardiac, and coronary events, respectively. Twenty-four-hour heart rate predicted total (hazard ratio: 1.15) and noncardiovascular (hazard ratio: 1.18) mortality but not cardiovascular mortality (hazard ratio: 1.11) or any of the fatal combined with nonfatal events (hazard ratio: </=1.02). Daytime heart rate did not predict mortality (hazard ratio: </=1.11) or any fatal combined with nonfatal event (hazard ratio: </=0.96). Nighttime heart rate predicted all of the mortality outcomes (hazard ratio: >/=1.15) but none of the fatal combined with nonfatal events (hazard ratio: </=1.11). The night:day heart rate ratio predicted total (hazard ratio: 1.14) and noncardiovascular mortality (hazard ratio: 1.12) and all of the fatal combined with nonfatal events (hazard ratio: >/=1.15) with the exception of stroke (hazard ratio: 1.06). Sensitivity analyses, in which we stratified by risk factors or from which we excluded 1 cohort at a time or the events occurring within 2 years of enrollment, showed consistent results. In the general population, heart rate predicts total and noncardiovascular mortality. With the exception of the night:day heart rate ratio, heart rate did not add to the risk stratification for fatal combined with nonfatal cardiovascular events. Thus, heart rate adds little to the prediction of cardiovascular risk.

Harris TJ, Owen CG, Victor CR, Adams R, Cook DG. (May 2008). What factors are associated with physical activity in older people, assessed objectively by accelerometry? Br J Sports Med. [Epub ahead of print]

OBJECTIVES: To assess physical activity (PA) levels measured objectively using accelerometers in community-dwelling older people and to examine the associations with health, disability, anthropometric measures and psychosocial factors. DESIGN: Cross-sectional survey. SETTING: Single general practice (primary care centre) UK. PARTICIPANTS: Random selection of 560 community-dwelling older people >/=65 years, registered with the practice, 43%(238/560) participated. Assessment of Risk Factors: Participants completed a questionnaire assessing health, disability, psychosocial factors and PA levels; underwent anthropometric assessment; and wore an accelerometer (Actigraph) for seven days. MAIN OUTCOME MEASURES: Average daily accelerometer step-counts and time spent in different PA levels. Associations between step-counts and other factors were examined using linear regression. RESULTS: Average daily step-count was 6443(95%C.I.6032-6853). Men achieved 754(84 to 1424) more steps daily than women. Step-count declined steadily with age. Independent predictors of average daily step-count were: age; general health; disability; diabetes; body mass index; exercise self-efficacy; and perceived exercise control. Activities associated independently with higher step-counts included number of long walks and dog-walking. Only 2.5%(6/238) of participants achieved the recommended 150 minutes weekly of >/=moderate intensity activity in >/=10 minute bouts, 62%(147/238) achieved none. CONCLUSIONS: This is the first population-based sample of older people with objective PA and anthropometric measures. PA levels in older people are well below recommended levels, emphasizing the need to increase PA in this age group, particularly in those who are overweight /obese or have diabetes. The independent effects of exercise self-efficacy and exercise control on PA levels highlights their role as potential mediators for intervention studies.

Hausenblas HA, Gauvin L, Symons Downs D, Duley AR. (May 2008). Effects of abstinence from habitual involvement in regular exercise on feeling states: an ecological momentary assessment study. Br J Health Psychol, 13:237-55. Epub 2007 Feb 5.

Regular exercise was experimentally reduced to determine its effects on positive feeling states. Using ecological momentary assessments, 40 participants maintained their regular exercise routine on 3 days and were deprived of their scheduled exercise on 3 other days. They recorded their feeling states, using the Exercise-Induced Feeling Inventory, four times daily as well as prior to and following exercise. Multi-level modelling analyses controlling for diurnal variations in feeling states revealed that positive feeling states were elevated on days when exercise deprivation occurred compared with non-exercise days and when no deprivation manipulation occurred. People with lower exercise dependence symptoms felt better on days when they were deprived from exercise compared with non-exercise days, whereas people with higher exercise dependence symptoms felt about the same when they were deprived from exercise compared with non-exercise days. These findings demonstrate that positive feeling states occur following an acute bout of exercise and that exercise deprivation had a positive impact on feeling states, with the level of exercise dependence symptoms moderating this effect.

Hedeker D, Mermelstein RJ, Demirtas H. (Jun 2008). An application of a mixed-effects location scale model for analysis of Ecological Momentary Assessment (EMA) data. Biometrics, 64(2):627-34. Epub 2007 Oct 26.

For longitudinal data, mixed models include random subject effects to indicate how subjects influence their responses over repeated assessments. The error variance and the variance of the random effects are usually considered to be homogeneous. These variance terms characterize the within-subjects (i.e., error variance) and between-subjects (i.e., random-effects variance) variation in the data. In studies using ecological momentary assessment (EMA), up to 30 or 40 observations are often obtained for each subject, and interest frequently centers around changes in the variances, both within and between subjects. In this article, we focus on an adolescent smoking study using EMA where interest is on characterizing changes in mood variation. We describe how covariates can influence the mood variances, and also extend the standard mixed model by adding a subject-level random effect to the within-subject variance specification. This permits subjects to have influence on the mean, or location, and variability, or (square of the) scale, of their mood responses. Additionally, we allow the location and scale random effects to be correlated. These mixed-effects location scale models have useful applications in many research areas where interest centers on the joint modeling of the mean and variance structure.

Johnson CC, Murray DM, Elder JP, Jobe JB, Dunn AL, Kubik M, Voorhees C, Schachter K. (May 2008). Depressive symptoms and physical activity in adolescent girls. Med Sci Sports Exerc, 40(5):818-26.

PURPOSE: To evaluate the relationship between depressive symptoms and physical activity in a geographically and ethnically diverse sample of sixth-grade adolescent girls. METHODS: The Trial of Activity for Adolescent Girls (TAAG) baseline measurement included a random sample (N = 1721) of sixth-grade girls in 36 schools at six field sites. Measurements were accelerometry and the 3-d Physical Activity Recall (3DPAR) for physical activity, and the Center for Epidemiological Studies-Depression scale (CES-D) for depressive symptoms. RESULTS: Girls with complete data (N = 1397), mean age 12 yr, had an average CES-D score of 14.7 (SD = 9.25) and engaged in an average of about 460 min of sedentary activity, < 24 min of moderate to vigorous physical activity (MVPA), and < 6 min of vigorous physical activity (VPA) in an 18-h day. Thirty-minute segments of MVPA ranged in number from 3.9 to 1.2, and METS for these segments ranged from > 3.0 to > 6.5. Mixed-model regression indicated no relationship between depressive symptoms and physical activity; however, a significant but modest inverse relationship between sedentary activity and depressive symptoms was observed. CONCLUSION: A sufficient sample size, standardized procedures, and validated instruments characterized this study; however, a relationship between depressive symptoms and physical activity was not observed for sixth-grade girls from diverse geographic locations. The average CES-D score was lower than is considered clinically meaningful for either adolescents or adults, and MET-minutes of sedentary activity were high. This combination of data may be different from other studies and could have contributed to the unexpected finding. This unexpected finding is informative, however, because it shows the need for additional research that includes a wider range of possible combinations of data, especially with young adolescent girls.

Junker U, Freynhagen R, Längler K, Gockel U, Schmidt U, Tölle TR, Baron R, Kohlmann T. (Jun 2008). Paper versus electronic rating scales for pain assessment: a prospective, randomised, cross-over validation study with 200 chronic pain patients. Curr Med Res Opin, 24(6):1797-806. Epub 2008 May 15.

OBJECTIVE: Following the recent introduction of hand-held computers to be used by patients instead of conventional pencil-and-paper questionnaires, a validation study under ‘real-life’ conditions was conducted, in order to compare these two clinical instruments when used by chronic pain patients to describe their pain using visual and numerical rating scales. METHOD: Each of 200 chronic pain patients attending a single physician’s practice was given two pain questionnaires to complete, one on paper and one on a hand-held computer; completion of these took place directly before and after consultation, in randomised order. The questions asked in the two questionnaires were identical: present pain, average pain, worst pain and those of the painDETECT questionnaire (the latter distinguishes characteristic symptoms of nociceptive pain). In accordance with standard practice, the paper questionnaire used numerical rating scales and the electronic one employed visual analogue scales, with or without a numerical indicator. RESULTS: Nearly all patients (99%) of the study population (58% female; aged 57+/-14 years) completed both questionnaires. In spite of the expected substantial intra-individual scatter, overall results from the two questionnaire types were highly consistent. Only a few differences of potential statistical significance (p<5%) were observed, and none were found that would have led to different interpretations. No difference was seen between results from the electronic visual analogue scales with and without a numerical indicator. CONCLUSION: Under conditions of routine clinical practice, the hand-held computer questionnaire can give results equivalent to those obtained with the conventional paper questionnaire.

Kavanagh JJ, Menz HB. (July 2008). Accelerometry: A technique for quantifying movement patterns during walking. Gait Posture, 28(1):1-15. Epub 2008 Feb 21.

The popularity of using accelerometer-based systems to quantify human movement patterns has increased in recent years for clinicians and researchers alike. The benefits of using accelerometers compared to more traditional gait analysis instruments include low cost; testing is not restricted to a laboratory environment; accelerometers are small, therefore walking is relatively unrestricted; and direct measurement of 3D accelerations eliminate errors associated with differentiating displacement and velocity data. However, accelerometry is not without its disadvantages, an issue which is scarcely reported in gait analysis literature. This paper reviews the use of accelerometer technology to investigate gait-related movement patterns, and addresses issues of acceleration measurement important for experimental design. An overview of accelerometer mechanics is provided before illustrating specific experimental conditions necessary to ensure the accuracy of gait-related acceleration measurement. A literature review is presented on how accelerometry has been used to examine basic temporospatial gait parameters, shock attenuation, and segmental accelerations of the body during walking. The output of accelerometers attached to the upper body has provided useful insights into the motor control of normal walking, age-related differences in dynamic postural control, and gait patterns in people with movement disorders.

Knouse LE, Mitchell JT, Brown LH, Silvia PJ, Kane MJ, Myin-Germeys I, Kwapil TR. (May 2008). The expression of adult ADHD symptoms in daily life: an application of experience sampling methodology. J Atten Disord, 11(6):652-63. Epub 2007 May 10.

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

Kostandonis D, Papadopoulos V, Toumanidis S, Papamichael C, Kanakakis I, Zakopoulos N. (Jun 2008). Topography and severity of coronary artery disease in white-coat hypertension. Eur J Intern Med, 19(4):280-4. Epub 2008 Jan 24.

BACKGROUND: White-coat hypertension (WCH) has been evaluated as a risk factor for cardiovascular disease. In this study, the role of WCH is evaluated in a cohort of patients with suspected coronary artery disease with both coronary angiography and non-invasive techniques. METHODS: One hundred patients with suspected coronary artery disease underwent coronary angiography, 24-h ambulatory blood pressure monitoring (ABPM), and ultrasound imaging of the myocardium and carotids. The lesions in percentage of stenosis in the left coronary artery stem (LM), left anterior descending ramus (LAD), left circumflex artery (LCX), diagonal artery (D1), and right coronary artery (RCA), along with the Gensini score (GS), were recorded. After a series of manual blood pressure measurements, the patients were divided into two groups (patients with and patients without WCH). RESULTS: GS was higher in the WCH group (P=0.042), a difference that could be attributed to lesions in the LAD (P=0.007). GS correlated significantly with left ventricular end-diastolic diameter (LVEDD – P=0.041), left ventricular end-systolic diameter (LVESD – P=0.005), end-diastolic volume (EDV – P=0.042), end-systolic volume (ESV – P=0.004), LvMass/BSA (P=0.012), right internal carotid artery intima-media thickness (RICA – P=0.018), left internal carotid artery intima-media thickness (LICA – P=0.021), and their mean (MICA – P=0.005) in the WCH group but not in normotensives. CONCLUSIONS: Coronary disease may be more severe among patients with WCH than among those without. In this group, data from myocardial and carotid ultrasound may help to estimate coronary artery disease.

Kristensen PL, Korsholm L, Møller NC, Wedderkopp N, Andersen LB, Froberg K. (Jun 2008). Sources of variation in habitual physical activity of children and adolescents: the European youth heart study. Scand J Med Sci Sports, 18(3):298-308. Epub 2007 Jun 6.

The present study examined the influence of gender, maturity state, seasonality, type of measurement day and socioeconomic status (SES) on habitual physical activity in 8-10-year-old children and 14-16-year-old adolescents (n=1318). Physical activity was assessed objectively by accelerometry. The results showed a significant effect of the type of measurement day on physical activity with a general pattern of lower activity levels in weekends compared with weekdays. Furthermore, higher physical activity levels were observed during the months of spring/summer compared with the months of autumn/winter for the 8-10-year-olds, whereas no significant effect of months was observed for the 14-16-year-olds, possibly due to exam preparations and lack of physical activity registration during the months of summer for this cohort. SES was unrelated to physical activity in the 8-10-year-olds, whereas an inverse association was observed in the 14-16-year-olds. However, a post hoc analysis provided strong evidence that this latter result was biased by the accelerometers inability to pick up bicycling activities. Finally, boys were more physically active compared with girls, and maturity state was unrelated to physical activity. The results could prove useful for working out strategies to prevent inactivity and for adjusting for temporal sources of variation in physical activity in future studies.

Labinson PT, Giacco S, Gift H, Mansoor GA, White WB. (Jun 2008). The importance of the clinical observer in the development of a white-coat effect in African-American patients with hypertension. Blood Press Monit, 13(3):139-42.

INTRODUCTION: As the office-awake blood pressure (BP) difference (white-coat effect) in African-Americans has not been evaluated, we studied the ethnicity, professional status (nurse versus doctor) and sex of the observer on the white-coat effect in African-American patients with hypertension. METHODS: Seated clinical BP measurements were obtained in random order by an African-American male research physician, a Caucasian male research physician, and a Caucasian female nurse who is of similar age and clinical experience. Within 1 week, ambulatory BP recordings were performed. RESULTS: A total of 65 African-American patients [54+/-13 years, 55% women, body mass index (BMI) 31+/-6 kg/m, 62% on drug therapy, 28% current smokers] participated in the study. Twenty-two percent had a systolic white-coat effect >20 mmHg and 49% had a diastolic white-coat effect >10 mmHg (average of all observers). Although there were no differences in the magnitude of the white-coat effect among the three study observers, the primary physician’s diastolic white-coat effect was significantly greater than that of the African-American physician (14+/-12 vs. 9+/-12, P=0.05), but not the systolic white-coat effect (16+/-16 vs. 10+/-16 mmHg, P=0.09). BMI positively correlated with the systolic and diastolic white-coat effect (r=0.30, P=0.02 and r=0.41, P=0.0001), but this correlation was true only for female patients in multiple regression analyses. BMI significantly predicted the systolic (P=0.043) and diastolic (P=0.004) white-coat effects. CONCLUSION: A white-coat effect is relatively common in African-American patients with hypertension and is the largest when the observer is their usual doctor. The clinical observer’s ethnicity or sex does not play an important role in generating a white-coat effect in African-American patients with hypertension.

Lin CT, Chen YC, Huang TY, Chiu TT, Ko LW, Liang SF, Hsieh HY, Hsu SH, Duann JR. (May 2008). Development of wireless brain computer interface with embedded multitask scheduling and its application on real-time driver’s drowsiness detection and warning. IEEE Trans Biomed Eng, 55(5):1582-91.

Biomedical signal monitoring systems have been rapidly advanced with electronic and information technologies in recent years. However, most of the existing physiological signal monitoring systems can only record the signals without the capability of automatic analysis. In this paper, we proposed a novel brain-computer interface (BCI) system that can acquire and analyze electroencephalogram (EEG) signals in real-time to monitor human physiological as well as cognitive states, and, in turn, provide warning signals to the users when needed. The BCI system consists of a four-channel biosignal acquisition/amplification module, a wireless transmission module, a dual-core signal processing unit, and a host system for display and storage. The embedded dual-core processing system with multitask scheduling capability was proposed to acquire and process the input EEG signals in real time. In addition, the wireless transmission module, which eliminates the inconvenience of wiring, can be switched between radio frequency (RF) and Bluetooth according to the transmission distance. Finally, the real-time EEG-based drowsiness monitoring and warning algorithms were implemented and integrated into the system to close the loop of the BCI system. The practical online testing demonstrates the feasibility of using the proposed system with the ability of real-time processing, automatic analysis, and online warning feedback in real-world operation and living environments.

Lindamer LA, McKibbin C, Norman GJ, Jordan L, Harrison K, Abeyesinhe S, Patrick K. (Jun 2008). Assessment of physical activity in middle-aged and older adults with schizophrenia. Schizophr Res. [Epub ahead of print]

BACKGROUND: Regular physical activity (PA) decreases morbidity in the general population; yet, information about the amount and effects of PA in persons with schizophrenia is scant. To develop interventions to increase PA and to assess its potential benefits in this group, accurate measurement of PA is needed. The purpose of this study was to characterize PA and determine the test-retest reliability and concurrent validity of the Yale Physical Activity Scale (YPAS), a self-report measure, in persons with schizophrenia. METHODS: PA was assessed with the YPAS, a scale of motivational readiness for PA, and accelerometry in middle-aged and older persons with a diagnosis of schizophrenia (n=54) and in a comparison group with no known psychiatric diagnosis (n=27). RESULTS: On the YPAS measures, persons with schizophrenia reported on average 11 h per week of PA, whereas the non-psychiatric comparison group reported about 32 h per week. Only about 30% of schizophrenia subjects were classified as being regularly active relative to 62% of the comparison group on PA motivational stages of readiness. On the accelerometry measures, the schizophrenia group had lower levels of light activity than the comparison group, but there were no differences in moderate and vigorous activity or sedentary behavior. Only in the comparison group were there significant associations between YPAS and accelerometer variables. Several YPAS scores demonstrated high test-retest reliability in both groups, and concurrent validity was supported between the YPAS and PA motivational stages of readiness. CONCLUSIONS: We found that the YPAS is a reliable measure of PA in schizophrenia for some indices. Although the YPAS demonstrated concurrent validity with other self-report measures, it did not demonstrate concurrent validity when compared to PA measured by accelerometry in persons with schizophrenia. Use of multiple measures, both subjective and objective, is recommended when assessing PA in schizophrenia.

Lo SH, Liau CS, Hwang JS, Wang JD. (July 2008). Dynamic blood pressure changes and recovery under different work shifts in young women. Am J Hypertens, 21(7):759-64. Epub 2008 May 1.

BackgroundSome studies have reported that shift work can affect blood pressure (BP), but few have studied recovery from BP changes occurring during different shifts.MethodsWe recruited 16 young female nurses working rotating shifts and six working the regular day shift. All received repeated ambulatory BP monitoring (ABPM) during their workdays and following day off.ResultsOur linear mixed-effect model showed that both systolic and diastolic BPs were significantly decreased during sleeping period and significantly increased while on working period, on a work day, but increased during sleeping period after a night shift or evening shift. BP measurements that changed after evening shift usually returned to baseline on consecutive off-duty day after day shift, but they did not completely return to baseline after a night shift (P < 0.05). We also found 69% of those working rotating shifts had at least changed once in dipper/nondipper status. The rates of change in dipper/nondipper status between work day and off-duty day were 33, 44, 50, and 38% for nurses worked in outpatient clinic, night shift, evening shift, and day shift, respectively.ConclusionShift work is significantly associated with BP and possibly dipper/nondipper status in young female nurses. Except for those working night shifts, BP levels returned to baseline the off-duty day after day shift. We recommend that potential influence of shift work be considered when evaluating a person’s BP.

Long AC, Palermo TM, Manees AM. (July 2008). Brief report: using actigraphy to compare physical activity levels in adolescents with chronic pain and healthy adolescents. J Pediatr Psychol, 33(6):660-5. Epub 2008 Jan 7.

OBJECTIVES: This study compared activity levels of adolescents with chronic pain and healthy adolescents, and investigated relations between actigraphy and subjective measures of activity limitations and depression. METHODS: Forty adolescents (n = 20 with chronic pain, n = 20 otherwise healthy; 12-17 years; 72.5% females) participated. Adolescents completed questionnaires regarding pain, activity limitations, and depression. Activity levels were assessed for 7 days using the Actiwatch 64 device, yielding mean and peak activity levels, and time spent in moderate and sedentary activity. RESULTS: Physical activity was lower in adolescents with chronic pain than in healthy peers. Adolescents with chronic pain reported significantly higher levels of activity limitations and depression. Age and gender were related to activity. Higher activity was inversely correlated with pain frequency and depression. Peak activity was also significantly inversely related to self-reported pain intensity and activity limitations. CONCLUSIONS: Actigraphy may be useful for examining physical activity outcomes in adolescents with chronic pain.

Macfarlane DJ, Chan D, Chan KL, Ho EY, Lee CC. (Jun 2008). Using three objective criteria to examine pedometer guidelines for free-living individuals. Eur J Appl Physiol. [Epub ahead of print]

The purpose was to examine in free-living individuals from a high-density city (1) the objectively determined physical activity levels across quartiles derived from pedometer step counts, (2) the pedometer steps day(-1) required to meet health-enhancing guidelines of accruing 30 min day(-1) of moderate physical activity and (3) the agreement between three objective criteria for the pedometer guidelines. Over 7 days 49 Hong Kong Chinese aged 15-55 years (n = 30 males) wore a polar heart rate monitor (HRM), an MTI and Tritrac accelerometer, plus a Yamax pedometer for >/=600 min day(-1). Participants averaged 9,839 +/- 3,088 steps day(-1), whilst accumulating 44.5 +/- 22.6, 43.1 +/- 21.7, and 24.7 +/- 19.3 min day(-1) of moderate physical activity by the Tritrac, MTI and HRM, respectively. Significant differences between quartiles of pedometer-determined activity were predominantly seen in the accelerometry data, especially during moderate and moderate-to-vigorous intensity activity (effect sizes >1.5 between upper and lower quartiles), but not seen in the HRM data. Using both criterion accelerometer datasets, a threshold of 8,000 steps day(-1) accurately categorized ~90% of those achieving, and ~80% of those not achieving, 30 min day(-1) of appropriate activity. They also produced a screening sensitivity of ~95% and a specificity of ~70%, which were considerably higher than those from the HRM data. Overall, the agreement between the three criterion measures suggests 8,000 steps day(-1) might be a valid screening tool as a proxy for classifying those meeting public health physical activity recommendations of 30 min day(-1) of moderate activity.

Moeller NC, Korsholm L, Kristensen PL, Andersen LB, Wedderkopp N, Froberg K. (Apr 2008). Unit-specific calibration of Actigraph accelerometers in a mechanical setup – is it worth the effort? The effect on random output variation caused by technical inter-instrument variability in the laboratory and in the field. BMC Med Res Methodol, 8:19.

BACKGROUND: Potentially, unit-specific in-vitro calibration of accelerometers could increase field data quality and study power. However, reduced inter-unit variability would only be important if random instrument variability contributes considerably to the total variation in field data. Therefore, the primary aim of this study was to calculate and apply unit-specific calibration factors in multiple accelerometers in order to examine the impact on random output variation caused by inter-instrument variability. METHODS: Instrument-specific calibration factors were estimated in 25 MTI- and 53 CSA accelerometers in a mechanical setup using four different settings varying in frequencies and/or amplitudes. Calibration effect was analysed by comparing raw and calibrated data after applying unit-specific calibration factors to data obtained during quality checks in a mechanical setup and to data collected during free living conditions. RESULTS: Calibration reduced inter-instrument variability considerably in the mechanical setup, both in the MTI instruments (raw SDbetween units = 195 counts*min-1 vs. calibrated SDbetween units = 65 counts*min-1) and in the CSA instruments (raw SDbetween units = 343 counts*min-1 vs. calibrated SDbetween units = 67 counts*min-1). However, the effect of applying the derived calibration to children’s and adolescents’ free living physical activity data did not alter the coefficient of variation (CV) (children: CVraw = 30.2% vs. CVcalibrated = 30.4%, adolescents: CVraw = 36.3% vs. CVcalibrated = 35.7%). High correlations (r = 0.99 & r = 0.98, respectively) were observed between raw and calibrated field data, and the proportion of the total variation caused by the MTI- and CSA monitor was estimated to be only 1.1% and 4.2%, respectively. Compared to the CSA instruments, a significantly increased (9.95%) mean acceleration response was observed post hoc in the batch of MTI instruments, in which a significantly reduced inter-instrumental reliability was observed over time. CONCLUSION: The application of unit-specific calibration factors to data collected during free living conditions had no apparent effect on inter-instrument variability. In all probability, the effect of technical calibration was primarily attenuated in the field by other more dominant sources of variation. However, routine technical assessments are still very important for determining the acceleration responses in the batch of instruments being used and, if performed after every field use, for preventing decidedly broken instruments from being returned into the field repeatedly.

Moore HJ, Ells LJ, McLure SA, Crooks S, Cumbor D, Summerbell CD, Batterham AM. (Jun 2008). The development and evaluation of a novel computer program to assess previous-day dietary and physical activity behaviours in school children: the Synchronised Nutrition and Activity Program (SNAP). Br J Nutr, 99(6):1266-74. Epub 2007 Nov 28.

Self-report recall questionnaires used to measure physical activity and dietary intake in children can be labour intensive and monotonous and tend to focus on either dietary intake or physical activity. The web-based software, Synchronised Nutrition and Activity Program (SNAP), was developed to produce a novel, simple, quick and engaging method of assessing energy balance-related behaviours at a population level, combining principles from new and existing 24 h recall methodologies, set within a user-friendly interface. Dietary intake was measured using counts for twenty-one food groups and physical activity levels were measured in min of moderate to vigorous physical activity (MVPA). A combination of the mean difference between methods, type II regression and non-parametric limits of agreement techniques were used to examine the accuracy and precision of SNAP. Method comparison analyses demonstrated a good agreement for both dietary intake and physical activity behaviours. For dietary variables, accuracy of SNAP (mean difference) was within +/- 1 count for the majority of food groups. The proportion of the sample with between-method agreement within +/- 1 count ranged from 0.40 to 0.99. For min of MVPA, there was no substantial fixed or proportional bias, and a mean difference between methods (SNAP – accelerometry) of -9 min. SNAP provides a quick, accurate, low-burden, cost-effective and engaging method of assessing energy balance behaviours at a population level. Tools such as SNAP, which exploit the popularity, privacy and engagement of the computer interface, and linkages with other datasets, could make a substantial contribution to future public health monitoring and research.

Murphy SL, Smith DM, Clauw DJ, Alexander NB. (Jun 2008). The impact of momentary pain and fatigue on physical activity in women with osteoarthritis. Arthritis Rheum, 59(6):849-56.

OBJECTIVE: To examine the daily life patterns of both pain and fatigue symptoms and objective physical activity (using ambulatory monitoring) in women with symptomatic lower extremity osteoarthritis (OA), and to evaluate how momentary symptoms impact physical activity levels. METHODS: Sixty women age >or=55 years (40 with knee or hip OA and 20 matched controls) participated in an observational study involving 2 laboratory visits and a 5-day home data collection period. During the home period physical activity levels were assessed continuously, and symptoms were inputted 6 times a day into an enhanced accelerometer at prespecified time points. RESULTS: In the OA group as compared with the control group over the 5-day period, average physical activity was significantly lower (P = 0.02) and peak physical activity tended to be lower (P = 0.06). Although pain and fatigue overall were of moderate severity in this cohort, fatigue escalated throughout each day. In a hierarchical linear model, fatigue was most strongly associated with physical activity (beta = -30.1, P < 0.0001). Pain was more weakly associated with physical activity and in the direction opposite to what was hypothesized (beta = 16.9, P = 0.04). CONCLUSION: Momentary reports of fatigue negatively predicted physical activity levels and were much more strongly related to physical activity than momentary pain. In order to help women with knee or hip OA manage symptoms and become more physically active, it may be important to emphasize fatigue management.

Nezlek, J. B. (2008). An Introduction to multilevel modeling for social and personality psychology. Social and Personality Psychology Compass, 2, 842-860.

Multilevel modeling is a technique that has numerous potential applications for social and personality psychology. To help realize this potential, this article provides an introduction to multilevel modeling with an emphasis on some of its applications in social and personality psychology. This introduction includes a description of multilevel modeling, a rationale for this technique, and a discussion of applications of multilevel modeling in social and personality psychological research. Some of the subtleties of setting up multilevel analyses and interpreting results are presented, and software options are discussed.

Nezlek, J. B., Kafetsios, K., & Smith, C. V. (2008). Emotions in everyday social encounters: Correspondence between culture and self-construal. Journal of Cross-Cultural Psychology, 39, 366-372.

Relationships between self-construal and emotion experiences in social interactions were examined in two countries. Participants in Greece (a more collectivist culture) and the United Kingdom (a more individualist culture) described the social interactions they had each day for 7 days using a variant of the Rochester Interaction Record. For UK participants, independent self-construal was positively related to positive affect, whereas for Greek participants, independent self-construal was negatively related to positive affect. There were few relationships between interdependent self-construal and affect in either study. The results point to the interplay of cultural values and individual differences in self-construal and their relationships to people’s affective experiences.

Nezlek, J. B., Vansteelandt, K., Van Mechelen, I., & Kuppens, P. (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.

Ortega FB, Ruiz JR, Hurtig-Wennlöf A, Vicente-Rodriguez G, Rizzo NS, Castillo MJ, Sjöström M. (May 2008). Cardiovascular fitness modifies the associations between physical activity and abdominal adiposity in children and adolescents. The European Youth Heart Study. Br J Sports Med. [Epub ahead of print]

OBJECTIVE: To examine the associations between physical activity (PA) and abdominal adiposity, as measured by waist circumference (WC), in children and adolescents, and to test whether cardiovascular fitness (CVF) modifies these associations. METHODS: PA components were measured by accelerometry in 1075 individuals aged 9 or 15 y. CVF was measured by a maximal cycling test. Self-reported maternal educational level, body mass index, children’s birth weight and television viewing were used as confounders. RESULTS: Linear regression did not show any association between the PA variables and WC, after controlling for sex, age and height. When stratifying by CVF level (low/high), time spent at vigorous PA was inversely associated with WC (P<0.05) in the low CVF group. Unexpectedly, in the high CVF group, the PA variables were positively associated with WC (P<0.05). In both groups, the results were unchanged after controlling for the confounders. CVF was inversely associated with WC, after controlling for all PA variables (P<0.01) and confounders (P<0.01). CONCLUSION: CVF is inversely associated with abdominal adiposity and seems to modify the associations between PA and abdominal adiposity. In low fit children and adolescents, time spent in vigorous PA seems to be the key component linked to abdominal adiposity. This finding should be considered in further development of lifestyle intervention strategies. The results found in the high fit group need to be confirmed.

Palatini P. (Jun 2008). Heart rate as predictor of outcome. Blood Press Monit, 13(3):167-8.

The importance of resting heart rate in predicting the development of hypertension and cardiovascular morbidity and mortality has been demonstrated in a large number of studies. The relationship between high heart rate and cardiovascular mortality held true in studies performed in hypertensive participants. In most epidemiologic studies, the predictive power of resting heart rate for all-cause mortality was equal to or even greater than that of total cholesterol, smoking, or systolic blood pressure. Data obtained with ambulatory or home measurement did not show any advantage of heart rate measured out of the office over clinic heart rate, but the available evidence is still limited and more research is needed.

Parker KP, Bliwise DL, Ribeiro M, Jain SR, Vena CI, Kohles-Baker MK, Rogatko A, Xu Z, Harris WB. (May 2008). Sleep/Wake patterns of individuals with advanced cancer measured by ambulatory polysomnography. J Clin Oncol, 26(15):2464-72.

PURPOSE: Sleep/wake disturbances are prevalent in patients with advanced cancer, but 24-hour polysomnography (PSG) examinations of these patterns have not been undertaken. The purpose of this study was to describe these sleep/wake patterns using continuous PSG and to explore relationships with selected demographic and clinical variables. PATIENTS AND METHODS: The sample included patients with advanced cancer (solid tumors); those with neurologic disorders or psychosis, substance abuse, or brain metastasis were excluded. The final sample included 114 participants with a mean age of 51.1 years (+/- 9.1 years). Participants underwent continuous, ambulatory PSG for 42 hours in their home environments. Standard PSG measures were calculated. Analysis included data from 2 nights and the intervening day. Descriptive statistics were used to summarize sleep/wake parameters of the average of the 2 nights and the intervening day. Nonparametric analyses were used to detect differences and relationships among the variables. RESULTS: Compared with normative data, participants had reduced quantity and quality of nocturnal sleep and episodes of sleep scattered throughout the day. Increased daytime sleep was negatively associated with several key parameters of nocturnal sleep quantity and quality. Women, whites, and those who were married/partnered and had more education had better nocturnal sleep. Cancer type and selected medications may be risk factors for disturbed sleep and waking. CONCLUSION: Participants experienced severe difficulty with “state maintenance”, or the ability to maintain both the sleep and waking states. Research designed to identify the etiology of these problems is needed to develop effective interventions.

Paul DR, Kramer M, Stote KS, Spears KE, Moshfegh AJ, Baer DJ, Rumpler WV. (Jun 2008). Estimates of adherence and error analysis of physical activity data collected via accelerometry in a large study of free-living adults.BMC Med Res Methodol., 8:38.

BACKGROUND: Activity monitors (AM) are small, electronic devices used to quantify the amount and intensity of physical activity (PA). Unfortunately, it has been demonstrated that data loss that occurs when AMs are not worn by subjects (removals during sleeping and waking hours) tend to result in biased estimates of PA and total energy expenditure (TEE). No study has reported the degree of data loss in a large study of adults, and/or the degree to which the estimates of PA and TEE are affected. Also, no study in adults has proposed a methodology to minimize the effects of AM removals. METHODS: Adherence estimates were generated from a pool of 524 women and men that wore AMs for 13 – 15 consecutive days. To simulate the effect of data loss due to AM removal, a reference dataset was first compiled from a subset consisting of 35 highly adherent subjects (24 HR; minimum of 20 hrs/day for seven consecutive days). AM removals were then simulated during sleep and between one and ten waking hours using this 24 HR dataset. Differences in the mean values for PA and TEE between the 24 HR reference dataset and the different simulations were compared using paired t-tests and/or coefficients of variation. RESULTS: The estimated average adherence of the pool of 524 subjects was 15.8 +/- 3.4 hrs/day for approximately 11.7 +/- 2.0 days. Simulated data loss due to AM removals during sleeping hours in the 24 HR database (n = 35), resulted in biased estimates of PA (p < 0.05), but not TEE. Losing as little as one hour of data from the 24 HR dataset during waking hours results in significant biases (p < 0.0001) and variability (coefficients of variation between 7 and 21%) in the estimates of PA. Inserting a constant value for sleep and imputing estimates for missing data during waking hours significantly improved the estimates of PA. CONCLUSION: Although estimated adherence was good, measurements of PA can be improved by relatively simple imputation of missing AM data.

Piasecki, T.M., McCarthy, D.E., Fiore, M.C. (Jun 2008). Alcohol consumption, smoking urge, and the reinforcing effects of cigarettes: An ecological study. Psychology of Addictive Behaviors, Vol 22, 230-239.

Smokers (N=74) who volunteered for a smoking cessation study monitored their daily experiences for up to 6 weeks prior to the quit date. Self-reports from 7,707 diary records were used to examine the associations among alcohol consumption (present in 607 diary records), situational factors, smoking, urge to smoke, and subjective consequences of smoking. Alcohol use, smoking urge, and the subjective effects of smoking were context dependent. Momentary reports of smoking and alcohol consumption were associated with one another. Alcohol use predicted smoking even when contextual factors were covaried. Alcohol use was associated with more frequent reports of urge to smoke. Alcohol was also associated with more frequent reports that the last cigarette produced a rush/buzz, was good tasting, and reduced the urge. However, effects for rush/buzz and urge reduction were qualified by interactions between alcohol use and the latency since smoking. Rush/buzz tended to be associated with alcohol use, regardless of smoking recency. Alcohol was associated with urge reduction only when the cigarette being appraised was smoked more than 15 minutes prior to the diary entry.

Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D; American Heart Association; American Society of Hypertension; Preventive Cardiovascular Nurses Association. (July 2008). Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society Of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension, 52(1):10-29. Epub 2008 May 22.

Home blood pressure monitoring (HBPM) overcomes many of the limitations of traditional office blood pressure (BP) measurement and is both cheaper and easier to perform than ambulatory BP monitoring. Monitors that use the oscillometric method are currently available that are accurate, reliable, easy to use, and relatively inexpensive. An increasing number of patients are using them regularly to check their BP at home, but although this has been endorsed by national and international guidelines, detailed recommendations for their use have been lacking. There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors, which is the BP that best predicts cardiovascular risk. Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage. In addition, prospective studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP (Class IIa; Level of Evidence A). This call-to-action article makes the following recommendations: (1) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension; (2) Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to standard international protocols. They should be shown how to use them by their healthcare providers; (3) Two to 3 readings should be taken while the subject is resting in the seated position, both in the morning and at night, over a period of 1 week. A total of >or=12 readings are recommended for making clinical decisions; (4) HBPM is indicated in patients with newly diagnosed or suspected hypertension, in whom it may distinguish between white-coat and sustained hypertension. If the results are equivocal, ambulatory BP monitoring may help to establish the diagnosis; (5) In patients with prehypertension, HBPM may be useful for detecting masked hypertension; (6) HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence; (7) The target HBPM goal for treatment is <135/85 mm Hg or <130/80 mm Hg in high-risk patients; (8) HBPM is useful in the elderly, in whom both BP variability and the white-coat effect are increased; (9) HBPM is of value in patients with diabetes, in whom tight BP control is of paramount importance; (10) Other populations in whom HBPM may be beneficial include pregnant women, children, and patients with kidney disease; and (11) HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed.

Räikkönen, K. & Matthews, K.A. (Jun 2008). Do dispositional pessimism and optimism predict ambulatory blood pressure during schooldays and nights in adolescents? Journal of Personality, Vol 76(3), 605-629.

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 JJ, Penpraze V, Hislop J, Davies G, Grant S, Paton JY. (July 2008). Objective measurement of physical activity and sedentary behaviour: review with new data. Arch Dis Child, 93(7):614-9. Epub 2008 Feb 27.

Objective methods are being used increasingly for the quantification of the 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 compared with 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 critically reviewing the existing evidence and by providing new evidence.

Reisch T, Ebner-Priemer UW, Tschacher W, Bohus M, Linehan MM. (Jul 2008). Sequences of emotions in patients with borderline personality disorder. Acta Psychiatr Scand, 118(1), 42-8.

OBJECTIVE: To investigate sequences of emotions (temporal dependence of emotions) to identify specific patterns of borderline personality disorder (BPD). METHOD: The perceived emotions of 50 BPD patients and 50 healthy controls (HC) were monitored by using a hand-held computer system for a 24-h period in a daily life setting. Participants were prompted four times per hour to assess their current perceived emotions. Differences between BPD patients and HC in terms of activation, persistence and down-regulation of emotions were analyzed. RESULTS: Healthy controls in contrast to BPD patients more often activated joy and interest. BPD patients more often experienced persistence of anxiety and sadness. BPD patients more frequently switched from anxiety to sadness, from anxiety to anger and from sadness to anxiety. Anger was predominantly preceded by anxiety. CONCLUSION: Persistence of sadness and anxiety, as well as emotional oscillating between anxiety, sadness and anger are important aspects of the emotional dysregulation in BPD patients.

Simmons RK, Griffin SJ, Steele R, Wareham NJ, Ekelund U; 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(5):787-94. Epub 2008 Mar 4.

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 [VO2max] 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), [VO2max] 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.

Sorrentino R. M., Nezlek, J., Yasunaga, S. Kouhara, S., Otsubo, Y., & Shuper, P. (2008). Uncertainty orientation and affective experiences: Individual differences within and across cultures. Journal of Cross Cultural Psychology, 39, 129-146.

This study examined whether people with the same self-regulatory style of coping with uncertainty differed in their affective experiences as a function of what may be the dominant coping style of their culture. Two hundred twenty men and women from universities in Japan and Canada described the extent to which they experienced various emotions. Consistent with their expectations, the authors found that participants whose uncertainty orientation matched that of their country (i.e., uncertainty-oriented students in Canada, certainty-oriented students in Japan) experienced more active emotions than mismatched participants (i.e., certainty-oriented students in Canada, uncertainty-oriented students in Japan), who experienced more passive emotions. Moreover, those who matched their country’s coping style also reported experiencing more positive and fewer negative emotions than mismatched students. These results suggest that the theory of uncertainty orientation has important implications for research on affective experiences within and across cultures.

Stergiou GS, Christodoulakis G, Giovas P, Lourida P, Alamara C, Roussias LG. (Jun 2008). Home blood pressure monitoring in children: how many measurements are needed? Am J Hypertens, 21(6):633-8. Epub 2008 Mar 27.

OBJECTIVE: To investigate the minimum schedule of blood pressure (BP) measurements necessary to provide a reliable assessment of home BP (HBP) in children and adolescents. METHODS: Subjects aged 6-18 years referred for elevated BP were assessed with HBP monitoring (6 workdays, duplicate morning and evening measurements) and 24-h ambulatory BP monitoring (ABP). Criteria for HBP reliability were its reproducibility (test-retest correlations and SD of differences (SDDs) between repeated measurements), its stability (average home BP of an increasing number of readings and its SD), and its relationship with ABP. RESULTS: Data from 100 subjects were analyzed (mean age 13 +/- 2.8 (SD) years, 61 boys). The reproducibility of 3-day HBP (r 0.88/0.79, SDDs 5.1/4.9, systolic/diastolic) was superior to that of a single (r 0.79/0.65, SDDs 7.6/7.1) or 2-day HBP (r 0.85/0.72, SDDs 6.1/5.4). By averaging up to 12 readings (3 days), there was a progressive decline in average HBP, with no further decline thereafter. The SD of average HBP was also progressively reduced, with little change after day 3. The association of HBP with ABP was improved by averaging more readings up to 12, with no further improvement when more readings were averaged. The exclusion of first-day measurements slightly increased the SD of average HBP and weakened the correlation with ABP, probably due to reduced number of readings. CONCLUSIONS: In children and adolescents, 3-day monitoring with duplicate morning and evening measurements appears to be the minimum schedule for the reliable assessment of HBP.

Stergiou GS, Christodoulakis GR, Nasothimiou EG, Giovas PP, Kalogeropoulos PG. (July 2008). Can validated wrist devices with position sensors replace arm devices for self-home blood pressure monitoring? A randomized crossover trial using ambulatory monitoring as reference. Am J Hypertens, 21(7):753-8. Epub 2008 Apr 24.

BackgroundElectronic devices that measure blood pressure (BP) at the arm level are regarded as more accurate than wrist devices and are preferred for home BP (HBP) monitoring. Recently, wrist devices with position sensors have been successfully validated using established protocols. This study assessed whether HBP values measured with validated wrist devices are sufficiently reliable to be used for making patient-related decisions in clinical practice.MethodsThis randomized crossover study compared HBP measurements taken using validated wrist devices (wrist-HBP, Omron R7 with position sensor) with those taken using arm devices (arm-HBP, Omron 705IT), and also with measurements of awake ambulatory BP (ABP, SpaceLabs), in 79 subjects (36 men and 43 women) with hypertension. The mean age of the study population was 56.7 +/- 11.8 years, and 33 of the subjects were not under treatment for hypertension.ResultsThe average arm-HBP was higher than the average wrist-HBP (mean difference, systolic 5.2 +/- 9.1 mm Hg, P < 0.001, and diastolic 2.2 +/- 6.7, P < 0.01). Twenty-seven subjects (34%) had a >/=10 mm Hg difference between systolic wrist-HBP and arm-HBP and twelve subjects (15%) showed similar levels of disparity in diastolic HBP readings. Strong correlations were found between arm-HBP and wrist-HBP (r 0.74/0.74, systolic/diastolic, P < 0.0001). However, ABP was more strongly correlated with arm-HBP (r 0.73/0.76) than with wrist-HBP (0.55/0.69). The wrist-arm HBP difference was associated with systolic ABP (r 0.34) and pulse pressure (r 0.29), but not with diastolic ABP, sex, age, arm circumference, and wrist circumference.ConclusionsThere might be important differences in HBP measured using validated wrist devices with position sensor vs. arm devices, and these could impact decisions relating to the patient in clinical practice.Measurements taken using arm devices are more closely related to ABP values than those recorded by wrist devices. More research is needed before recommending the widespread use of wrist monitors in clinical practice.American Journal of Hypertension

Stinson JN, Stevens BJ, Feldman BM, Streiner D, McGrath PJ, Dupuis A, Gill N, Petroz GC. (Jun 2008). Construct validity of a multidimensional electronic pain diary for adolescents with arthritis. Pain, 136(3):281-92. Epub 2007 Aug 27.

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

Summerville, A. & Roese, N.J. (May 2008). Dare to compare: Fact-based versus simulation-based comparison in daily life. Journal of Experimental Social Psychology, Vol 44, 664-671.

We examined the relative frequency of social, counterfactual, past-temporal, and future-temporal comparison in daily life using an experience-sampling method, in which participants were randomly prompted to record thought samples using palmtop computers carried for two weeks. Comparative thought accounted for 12% of all thoughts, and all four comparison types occurred with equivalent frequency. Comparisons may be either fact-based (i.e., based on actuality, as in social and past-temporal comparison) or simulation-based (i.e., based on imagination, as in counterfactual and future-temporal comparison). Because the latter are more “unbounded,” and because greater perceived opportunity invites greater self-improvement, we predicted and found that counterfactual and future-temporal comparison were more likely to be upward (vs. downward) than social and past-temporal comparison. All comparison types focused on approach more than avoidance motives, except for counterfactuals, which showed equivalent focus on both. These findings reveal the prominence of comparative thought in daily life, and underscore the value of an integrative theory that describes social, counterfactual, or temporal comparison using a common theoretical platform.

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.

Thompson P, Beath T, Bell J, Jacobson G, Phair T, Salbach NM, Wright FV. (May 2008). Test-retest reliability of the 10-metre fast walk test and 6-minute walk test in ambulatory school-aged children with cerebral palsy. Dev Med Child Neurol, 50(5):370-6. Epub 2008 Mar 18.

Short-term test-retest reliability of the 10-metre fast walk test (10mFWT) and 6-minute walk test (6MWT) was evaluated in 31 ambulatory children with cerebral palsy (CP), with subgroup analyses in Gross Motor Function Classification System (GMFCS) Levels I (n=9), II (n=8), and III (n=14). Sixteen females and 15 males participated, mean age 9 years 5 months (SD 3y 7mo, range 4y 3mo-18y 2mo). Twenty had spastic diplegia, while the others had another form of CP. Retest interval varied from 1 to 4 weeks (mean 10.6d [SD 6.4]). Intraclass correlation coefficients (ICCs) estimated reliability. The 10mFWT ICC was 0.81 (95% confidence interval [CI] 0.65-0.90) across participants, and >0.59 in GMFCS subgroups (95% CI lower bound >0.01). The 6MWT ICC was 0.98, and >0.90 in GMFCS subgroups (95% CI lower bound >0.64). Bland-Altman plots indicated bias towards higher 6MWT retest distances in GMFCS Level I. Minimum detectable change (95% CI) was 61.9, 64.0, and 47.4m for the 6MWT within GMFCS Levels I, II, and III respectively. The conclusion is that while the 10mFWT showed inadequate test-retest reliability given its wide 95% CI, the 6MWT demonstrated good to excellent reliability. Investigation of the need for a practice walk when administering the 6MWT with children in GMFCS Level I is recommended to establish their fastest pace.

Whalen DJ, Silk JS, Semel M, Forbes EE, Ryan ND, Axelson DA, Birmaher B, Dahl RE. (May 2008). Caffeine consumption, sleep, and affect in the natural environments of depressed youth and healthy controls. J Pediatr Psychol., 33(4):358-67. Epub 2007 Oct 18.

OBJECTIVE: Sleep problems are a cardinal symptom of depression in children and adolescents and caffeine use is a prevalent and problematic issue in youth; yet little is known about caffeine use and its effects on sleep in youth with depression. We examined caffeine use and its relation to sleep and affect in youth’s natural environments. METHODS: Thirty youth with major depressive disorder (MDD) and 23 control youth reported on caffeine use, sleep, and affect in their natural environment using ecological momentary assessment at baseline and over 8 weeks, while MDD youth received treatment. RESULTS: Youth with MDD reported more caffeine use and sleep problems relative to healthy youth. Youth with MDD reported more anxiety on days they consumed caffeine. Caffeine use among youth with MDD decreased across treatment, but sleep complaints remained elevated. CONCLUSIONS: Findings suggest that both sleep quality and caffeine use are altered in pediatric depression; that caffeine use, but not sleep problems, improves with treatment; and that caffeine may exacerbate daily anxiety among youth with depression.

Zakeri I, Adolph AL, Puyau MR, Vohra FA, Butte NF. (Jun 2008). Application of cross-sectional time series modeling for the prediction of energy expenditure from heart rate and accelerometry. J Appl Physiol, 104(6):1665-73. Epub 2008 Apr 10.

Accurate estimation of energy expenditure (EE) in children and adolescents is required for a better understanding of physiological, behavioral, and environmental factors affecting energy balance. Cross-sectional time series (CSTS) models, which account for correlation structure of repeated observations on the same individual, may be advantageous for prediction of EE. CSTS models for prediction of minute-by-minute EE and, hence, total EE (TEE) from heart rate (HR), physical activity (PA) measured by accelerometry, and observable subject variables were developed in 109 children and adolescents by use of Actiheart and 24-h room respiration calorimetry. CSTS models based on HR, PA, time-invariant covariates, and interactions were developed. These dynamic models involve lagged and lead values of HR and lagged values of PA for better description of the series of minute-by-minute EE. CSTS models with random intercepts and random slopes were investigated. For comparison, likelihood ratio tests were used. Log likelihood increased substantially when random slopes for HR and PA were added. The population-specific model uses HR and 1- and 2-min lagged and lead values of HR, HR(2), and PA and 1- and 2-min lagged values of PA, PA(2), age, age(2), sex, weight, height, minimum HR, sitting HR, HR x height, HR x weight, HR x age, PA x weight, and PA x sex interactions (P < 0.001). Prediction error for TEE was 0.9 +/- 10.3% (mean +/- SD). Errors were not correlated with age, weight, height, or body mass index. CSTS modeling provides a useful predictive model for EE and, hence, TEE in children and adolescents on the basis of HR and PA and other observable explanatory subject characteristics of age, sex, weight, and height.

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