Society for Ambulatory Assessment

Third quarter 2009 (July to September)

Ad N, Henry L, Hunt S, Barnett S, Stone L. (Jul 2009). The Cox-Maze III procedure success rate: comparison by electrocardiogram, 24-hour holter monitoring and long-term monitoring. Ann Thorac Surg, 88(1), 101-5

BACKGROUND: The detection of atrial arrhythmia recurrence is more accurate when using long-term (5 days to 3 weeks) continuous monitoring devices. In this study, we focus on the comparison of the recurrence of atrial arrhythmias in patients after the Cox-Maze III procedure obtained by three modalities: electrocardiography (ECG), 24-hour Holter monitoring, and long-term monitoring (LTM). METHODS: Patients with follow-up longer than 6 months who reported sinus rhythm while not taking antiarrhythmic drugs were eligible. Atrial arrhythmias longer than 30 s were considered a recurrence. The ECG, 24-hour Holter monitoring, and LTM (5 days) reports were ascertained and compared at the same time. RESULTS: Patients (n = 291) underwent the full Cox-Maze III procedure, with 194 eligible for the study and 76 agreeing to participate. The average time to monitoring after surgery was 9.8 (+/- 7.7) months. The ECGs determined 96% of patients in sinus rhythm, Holter monitoring determined 91% in sinus rhythm, and LTM indicated 84% in sinus rhythm. Comparing ECG results and LTM results revealed that 9 patients (12%) had a significant rhythm change. Holter monitoring did not capture all the patients having events lasting longer than 1 hour. No additional information was captured by the use of LTM in patients with paroxysmal atrial fibrillation. CONCLUSIONS: This study reconfirmed that ECG overestimated the success rate after the Cox-Maze III operation by 12% compared with LTM. These changes may carry clinical significance when determining the success of the Cox-Maze III procedure and determining the medical management, including antiarrhythmic and anticoagulation therapy, of the patients who were found to have significant events.

Adams P, Abela JR, Auerbach R, Skitch S. (Aug 2009). Self-Criticism, Dependency, and Stress Reactivity: An Experience Sampling Approach to Testing Blatt and Zuroff’s (1992) Theory of Personality Predispositions to Depression in High-Risk Youth. Pers Soc Psychol Bull, 35(11),1440-51

S. J. Blatt and D. C. Zuroff’s 1992 theory of personality predispositions to depression posits that individuals who possess high levels of self-criticism and/or dependency are vulnerable to developing depression following negative events. The current study used experience sampling methodology to test this theory in a sample of 49 children ages 7 to 14. Children completed measures of dependency, self-criticism, and depressive symptoms. Subsequently, children were given a handheld computer that signaled them to complete measures of depressive symptoms and negative events at randomly selected times over 2 months. Results of hierarchical linear modeling analyses indicated that higher levels of both self-criticism and dependency were associated with greater elevations in depressive symptoms following negative events. Furthermore, each personality predisposition remained a significant predictor of such elevations after controlling for the interaction between the other personality predisposition and negative events. The results suggest that dependency and self-criticism represent distinct vulnerability factors to depression in youth.

Barta WD, Kurth ME, Stein MD, Tennen H, Kiene SM. (Sep 2009). Craving and self-efficacy in the first five weeks of methadone maintenance therapy: a daily process study. J Stud Alcohol Drugs, 70(5), 735-40

OBJECTIVE: Among individuals initiating methadone maintenance therapy for heroin addiction, low craving and high self-efficacy are thought to predict treatment response; however, in the case of craving, findings have been inconsistent. This study will test two hypotheses: (1) craving and self-efficacy both predict treatment response and (2) withdrawal symptoms and sleep quality predict greater craving and greater self-efficacy, respectively. METHOD: An exploratory study using electronic diary data and multilevel models examined these hypotheses. A sample of 21 heroin users was recruited during the first 1-2 days of methadone maintenance therapy to take part in a 5-week diary study. Comparisons were made between days before participants reached a 70 mg or greater dose and subsequent days. This is in keeping with research showing that this dosage corresponds to optimal opioid receptor blockade. RESULTS: Analysis of 449 diary records nested within 21 participants showed a marked decline in heroin use on days subsequent to the 70 mg methadone dosage plateau. Controlling for methadone dosage plateau, the likelihood of heroin use was lower on days in which participants reported both high self-efficacy and low craving, as compared with other days. Support was found for hypothesized direct associations between craving and withdrawal symptoms and between self-efficacy and sleep quality. CONCLUSIONS: Consistent with a previously published theory, the effect of low craving on positive response to methadone maintenance therapy is evident on days distinguished by high self-efficacy. Also, improving patients’ sleep quality may enhance the benefits of methadone maintenance therapy.

Ben-Zeev D, Young MA, Madsen JW. (Aug 2009). Retrospective recall of affect in clinically depressed individuals and controls. Cognition and Emotion, 23(5), 1021-1040

The current study examined the nature of retrospective recall of affect in depressed participants and nonclinical controls. Utilizing the Experience Sampling Method, we compared average momentary affect reports to retrospective summaries of the same period of time. Both groups exhibited exaggerated retrospective summaries of positive affect (PA) and negative affect (NA). Greater bias for PA than NA was found in the controls but not the depressed. Across groups, depressed individuals exhibited more absolute inaccuracy in their recall of NA but not PA. For depressed and nonclinical individuals, retrospective summaries of PA were better predicted by an average of all weekly momentary PA than a combination of the most intense (“peak”) PA and most recent (“end”) PA experiences. For nonclinical participants, retrospective NA was better predicted by an average of all weekly momentary NA. For depressed individuals, however, no clear advantage to predicting retrospective NA by average weekly NA relative to a combination of peak NA and end NA was found. Based on our findings, clinicians should realize that depressive cognition may not lie in recall that is less positive and more negative than “reality” but in retrospective intensifications of all affect that are, compared to normal, relatively greater for negative than for positive affect.

Bharathi AV, Kuriyan R, Kurpad AV, Thomas T, Ebrahim S, Kinra S, Lyngdoh T, Reddy SK, Dorairaj P, Vaz M. (Aug 2009). Assessment of physical activity using accelerometry, an activity diary, the heart rate method and the Indian Migration Study questionnaire in South Indian adults. Public Health Nutr. [Epub ahead of print]

OBJECTIVE: To validate questionnaire-based physical activity level (PAL) against accelerometry and a 24 h physical activity diary (24 h AD) as reference methods (Protocol 2), after validating these reference methods against the heart rate-oxygen consumption (HRVO2) method (Protocol 1). DESIGN: Cross-sectional study. SETTING: Two villages in Andhra Pradesh state and Bangalore city, South India. SUBJECTS: Ninety-four participants (fifty males, forty-four females) for Protocol 2; thirteen males for Protocol 1. RESULTS: In Protocol 2, mean PAL derived from the questionnaire (1.72 (sd 0.20)) was comparable to that from the 24 h AD (1.78 (sd 0.20)) but significantly higher than the mean PAL derived from accelerometry (1.36 (sd 0.20); P < 0.001). Mean bias of PAL from the questionnaire was larger against the accelerometer (0.36) than against the 24 h AD (-0.06), but with large limits of agreement against both. Correlations of PAL from the questionnaire with that of the accelerometer (r = 0.28; P = 0.01) and the 24 h AD (r = 0.30; P = 0.006) were modest. In Protocol 1, mean PAL from the 24 h AD (1.65 (sd 0.18)) was comparable, while that from the accelerometer (1.51 (sd 0.23)) was significantly lower (P < 0.001), than mean PAL obtained from the HRVO2 method (1.69 (sd 0.21)). CONCLUSIONS: The questionnaire showed acceptable validity with the reference methods in a group with a wide range of physical activity levels. The accelerometer underestimated PAL in comparison with the HRVO2 method.

Björling EA (Sep 2009). The momentary relationship between stress and headaches in adolescent girls. Headache, 49(8), 1186-97

OBJECTIVE: The objective of this study was to compare the relationship between repeated momentary reports of stress and headaches in female adolescents with varying degrees of headache frequency. BACKGROUND: Headaches are the most common form of pain reported by adolescents affecting more than a third of all adolescents. High levels of stress during adolescence may predispose an adolescent to experience headaches in adulthood. Randomized, momentary data collection of stress and headaches provides the most accurate data regarding the adolescent experience of these variables. METHODS: The research methodology, ecological momentary assessment, is a valid approach to better understand the relationship between stress and headaches in adolescence. Data were obtained by each participant’s use of an electronic diary (ED), which captured repeated momentary reports of perceived stress, head pain, and stress-related symptoms in female adolescents with varying degrees of recurrent headache. Seven times per day for the 21-day study period, teen girls responded to ED questions about their current stress levels, head pain, and stress-related symptoms. Based on participants’ momentary reports of headaches, Low Headache, Moderate Headache, and Chronic Headache groups were created. General estimating equation models were used to analyze the relationship between momentary variables as well as the lag effect between stress and head pain. RESULTS: Thirty-one participants, aged 14-18 years, completed 2841 randomized ED reports and reported 674 occurrences of headache. The Chronic Headache and Moderate Headache groups reported significantly increased levels of stress, head pain, and headaches. The relationship between momentary stress and head pain was significantly strong both within and across participants. The strength of this relationship increased with increased headache activity. A significant lag effect was found between stress and headaches; however, the effect of depression as a moderator of the stress and headache relationship remains unclear. CONCLUSION: Perceived stress and head pain was highly correlated in these female adolescents. Given the large population of teens affected by headaches, a plausible next step would be to validate these results in other samples and to determine methods with which to identify teens who may be at risk for a pattern of increasing stress and headaches.

Cain AE, Depp CA, Jeste DV. (Jul 2009). Ecological momentary assessment in aging research: a critical review. J Psychiatr Res, 43(11), 987-96

Ecological momentary assessment (EMA) gathers respondent data on affective, behavioral, and contextual experiences as close in time to those experiences as possible. Potential advantages of EMA in aging research include reducing memory biases and gathering intra-individual data, yet there is little understanding about implementation. The goal of this critical review was to assess the feasibility and applications of EMA in psychological and behavioral research on aging. Through a comprehensive search of the online electronic databases, Psycinfo and Pubmed, for English-language peer-reviewed journals published between 1990 and 2007, we identified 40 articles using EMA methods in older adults. Studies sampled participants between five times per day over one day to once a week for 210 days. Samples were generally not cognitively impaired, evenly split between healthy and clinical populations, and only 6 of 40 studies focused on psychiatric diagnoses. The most common assessment content solicited ratings on affect (n=15), activities of daily living (n=12), physical activities (n=10), and social exchanges (n=8). A total of 90% of the studies that reported compliance reported rates over 80%. Uses of EMA varied widely, with research goals including validation of global measures, detection of subtle treatment effects, and for testing hypotheses about causal intra-individual relationships. Although these measures appear feasible and useful in aging research, recommendations for future studies include adapting measures to enable data collection among older participants with cognitive impairments and/or psychopathology, along with greater use of electronic data capture to improve compliance and increase ease of implementation.

Carpenter MJ,  Saladin ME, DeSantis S, Gray KM, LaRowe SD, Upadhyaya HP. (Jun-Jul 2009). Laboratory-based, cue-elicited craving and cue reactivity as predictors of naturally occurring smoking behavior. Addictive Behaviors, 34(6-7), 536-541

Cigarette craving, one hallmark sign of nicotine dependence, is often measured in laboratory settings using cue reactivity methods. How lab measures of cue reactivity relate to real world smoking behavior is unclear, particularly among non-treatment seeking smokers. Within a larger study of hormonal effects on cue reactivity (N = 78), we examined the predictive relationship of cue reactivity to smoking, each measured in several ways. Results indicated that cue-evoked craving in response to stressful imagery, and to a lesser extent, in vivo smoking cues, significantly predicted smoking behavior during the week following testing. However, this predictive relationship was absent upon controlling for reactivity to neutral cues. Nicotine dependence may moderate the relationship between cue reactivity and actual smoking, such that this predictive relationship is less robust among highly dependent smokers than among smokers low in nicotine dependence. The question of whether cue-elicited craving predicts smoking among smokers not in treatment is best answered with a qualified yes, depending on how craving is manipulated and measured. Our findings highlight important methodological and theoretical considerations for cue reactivity research.

Chastin SF, Dall PM, Tigbe WW, Grant MP, Ryan CG, Rafferty D, Granat MH. (Aug 2009). Compliance with physical activity guidelines in a group of UK-based postal workers using an objective monitoring technique. Eur J Appl Physiol, 106(6), 893-9

Compliance with physical activity (PA) recommendations was assessed using objective PA monitoring of ambulatory activity, in two healthy groups of individuals with active and sedentary occupations. The study showed generally low compliance with the guidelines (53% with 10,000 steps a day; 10% with 30 min of moderate activity a day; and 1% with 30 min of moderate activity a day in bouts of at least 10 min (ACSM)). Adherence to guidelines decreased as more rigorous conditions were applied to the PA data. Use of an objective monitor revealed that health enhancing bouts of activity were performed in periods of approximately 1-min duration, which may be due to unavoidable environmental interruptions. These bouts of activity are much shorter than those advocated in the ACSM guidelines, raising questions regarding how actual behaviour, based on objective monitoring, can be reconciled with guidelines based on self-reported PA.

Chen Z, Brown EN, Barbieri R. (Jul 2009). Assessment of autonomic control and respiratory sinus arrhythmia using point process models of human heart beat dynamics. IEEE Trans Biomed Eng, 56(7), 1791-802

Tracking the autonomic control and respiratory sinus arrhythmia (RSA) from electrocardiogram and respiratory measurements is an important problem in cardiovascular control. We propose a point process adaptive filter algorithm based on an inverse Gaussian model to track heart beat intervals that incorporates respiratory measurements as a covariate and provides an analytic form for computing a dynamic estimate of RSA gain. We use Kolmogorov-Smirnov tests and autocorrelation function analyses to assess model goodness-of-fit. We illustrate the properties of the new dynamic estimate of RSA in the analysis of simulated heart beat data and actual heart beat data recorded from subjects in a four-state postural study of heart beat dynamics: control, sympathetic blockade, parasympathetic blockade, and combined sympathetic and parasympathetic blockade. In addition to giving an accurate description of the heart beat data, our adaptive filter algorithm confirms established findings pointing at a vagally mediated RSA and provides a new dynamic RSA estimate that can be used to track cardiovascular control between and within a broad range of postural, pharmacological, and age conditions. Our paradigm suggests a possible framework for designing a device for ambulatory monitoring and assessment of autonomic control in both laboratory research and clinical practice.

Christensen A, Osterberg LG, Hansen EH. (Aug 2009). Electronic monitoring of patient adherence to oral antihypertensive medical treatment: a systematic review. J Hypertens, 27(8), 1540-51

Poor patient adherence is often the reason for suboptimal blood pressure control. Electronic monitoring is one method of assessing adherence. The aim was to systematically review the literature on electronic monitoring of patient adherence to self-administered oral antihypertensive medications. We searched the Pubmed, Embase, Cinahl and Psychinfo databases and websites of suppliers of electronic monitoring devices. The quality of the studies was assessed according to the quality criteria proposed by Haynes et al. Sixty-two articles were included; three met the criteria proposed by Haynes et al. and nine reported the use of electronic adherence monitoring for feedback interventions. Adherence rates were generally high, whereas average study quality was low with a recent tendency towards improved quality. One study detected investigator fraud based on electronic monitoring data. Use of electronic monitoring of patient adherence according to the quality criteria proposed by Haynes et al. has been rather limited during the past two decades. Electronic monitoring has mainly been used as a measurement tool, but it seems to have the potential to significantly improve blood pressure control as well and should be used more widely.

Cliff DP, Reilly JJ, Okely AD. (Sep 2009). Methodological considerations in using accelerometers to assess habitual physical activity in children aged 0-5 years. J Sci Med Sport, 12(5), 557-67

This paper reviews the evidence behind the methodological decisions accelerometer users make when assessing habitual physical activity in children aged 0-5 years. The purpose of the review is to outline an evidence-guided protocol for using accelerometry in young children and to identify gaps in the evidence base where further investigation is required. Studies evaluating accelerometry methodologies in young children were reviewed in two age groups (0-2 years and 3-5 years) to examine: (i) which accelerometer should be used, (ii) where the accelerometer should be placed, (iii) which epoch should be used, (iv) how many days of monitoring are required, (v) how many minutes of monitoring per day are required, (vi) how data should be reduced, (vii) which cut-point definitions for identifying activity intensity should be used, and (viii) which physical activity outcomes should be reported and how. Critique of the available evidence provided a basis for the development of a recommended users protocol in 3-5-year olds, although several issues require further research. Because of the absence of methodological studies in children under 3 years, a protocol for the use of accelerometers in this age range could not be specified. Formative studies examining the utility, feasibility and validity of accelerometer-based physical activity assessments are required in children under 3 years of age. Recommendations for further research are outlined, based on the above findings, which, if undertaken, will enhance the accuracy of accelerometer-based assessments of habitual physical activity in young children.

Daniel KD, Kim GY, Vassiliou CC, Galindo M, Guimaraes AR, Weissleder R, Charest A, Langer R, Cima MJ. (Jul 2009). Implantable diagnostic device for cancer monitoring. Biosens Bioelectron, 24(11), 3252-7

Biopsies provide required information to diagnose cancer but, because of their invasiveness, they are difficult to use for managing cancer therapy. The ability to repeatedly sample the local environment for tumor biomarker, chemotherapeutic agent, and tumor metabolite concentrations could improve early detection of metastasis and personalized therapy. Here we describe an implantable diagnostic device that senses the local in vivo environment. This device, which could be left behind during biopsy, uses a semi-permeable membrane to contain nanoparticle magnetic relaxation switches. A cell line secreting a model cancer biomarker produced ectopic tumors in mice. The transverse relaxation time (T(2)) of devices in tumor-bearing mice was 20+/-10% lower than devices in control mice after 1 day by magnetic resonance imaging (p<0.01). Short term applications for this device are numerous, including verification of successful tumor resection. This may represent the first continuous monitoring device for soluble cancer biomarkers in vivo.

Dellava JE, Hoffman DJ. (Jul 2009). Validity of resting energy expenditure estimated by an activity monitor compared to indirect calorimetry. Br J Nutr, 102(1), 155-9

The use of activity monitors (triaxial accelerometers) to estimate total energy expenditure in kilocalories is dependent on the estimation of resting energy expenditure (REE). However, the REE estimated by activity monitors has not been validated against more precise techniques, such as indirect calorimetry (IC). Therefore, the objective of the present study was to compare REE estimated by the Actical activity monitor (ActMon) to that measured by IC and standard prediction equations of REE. Fifty healthy adults between 18 and 43 years of age were measured for weight and percentage of body fat using a digital scale and bioelectrical impedance. The REE estimated by the ActMon was only 129 kJ/d higher, but not statistically different (P>0.05), than the REE measured with IC. Using multiple linear regression, there was a positive relationship for men, but not for women, between fat mass (kg) and percentage of body fat and the difference in REE estimated by the ActMon compared to IC (P < 0.001). Therefore, in the cohort studied, the use of an activity monitor to estimate REE is valid when compared to IC, but not to a standard prediction equation of REE.

Desantis AS, Adam EK, Mendelsohn KA, Doane LD. (Jul 2009). Concordance between Self-Reported and Objective Wakeup Times in Ambulatory Salivary Cortisol Research. Int J Behav Med

BACKGROUND: Hypothalamic-pituitary-adrenal (HPA) axis functioning has implications for physical and mental health. One important indicator of HPA axis functioning, the salivary cortisol awakening response (CAR), is sensitive to whether participants provide their samples at the requested times after waking. PURPOSE: To examine the extent to which adolescents report morning wakeup times accurately, test the impact of inaccurate waketime reporting on compliance with a salivary cortisol sampling protocol designed to estimate the CAR, and to examine the implications of non-compliance for CAR estimates. METHOD: In a sample of 91 late adolescents, objective waketimes determined using actigraphy were compared to self-reported waketimes. Associations between accuracy of waketimes and compliance with requested morning cortisol sampling timings (wakeup and 30 min post-awakening) were examined, as were implications of non-compliance for the size of the CAR. RESULTS: In terms of accuracy, 72% of self-reported waketimes were within 5 min and 90% were within 15 min of objective waketimes. Individuals who were more than 5 min discrepant in their waketime reporting, however, had a 90% decrease in their likelihood of being compliant-taking both morning cortisol samples within the requested time frames after waking. However, CARs were significantly lower only among individuals whose subjective and objective waketimes differed by more than 15 min. CONCLUSIONS: Self-reported waketimes were reasonably accurate when compared to objective estimates of time of waking. When available, however, estimates of compliance are improved by knowledge of objective waketimes, resulting in increased accuracy of CAR estimates.

Dollman J, Okely AD, Hardy L, Timperio A, Salmon J, Hills AP. (Sep 2009). A hitchhiker’s guide to assessing young people’s physical activity: Deciding what method to use. J Sci Med Sport, 12(5), 518-25

Researchers and practitioners interested in assessing physical activity in children are often faced with the dilemma of what instrument to use. While there is a plethora of physical activity instruments to choose from, there is currently no guide regarding the suitability of common assessment instruments. The purpose of this paper is to provide a user’s guide for selecting physical activity assessment instruments appropriate for use with children and adolescents. While recommendations regarding specific instruments are not provided, the guide offers information about key attributes and considerations for the use of eight physical activity assessment approaches: heart rate monitoring; accelerometry; pedometry; direct observation; self-report; parent report; teacher report; and diaries/logs. Attributes of instruments and other factors to be considered in the selection of assessment instruments include: population (age); sample size; respondent burden; method/delivery mode; assessment time frame; physical activity information required (data output); data management; measurement error; cost (instrument and administration) and other limitations. A decision flow chart has been developed to assist researchers and practitioners to select an appropriate method of assessing physical activity. Five real-life scenarios are presented to illustrate this process in light of key instrument attributes. It is important that researchers, practitioners and policy makers understand the strengths and limitations of different methods of assessing physical activity, and are guided on selection of the most appropriate instrument/s to suit their needs.

Engel SG, Kahler KA, Lystad CM, Crosby RD, Simonich HK, Wonderlich SA, Peterson CB, Mitchell JE. (Jul 2009). Eating behavior in obese BED, obese non-BED, and non-obese control participants: a naturalistic study. Behav Res Ther, 47(10), 897-900

Laboratory studies have shown considerable differences between the eating behavior, particularly binge eating behavior, of participants with and without binge eating disorder (BED). However, these findings were not replicated in two field experiments employing ecological momentary assessment (EMA) in which obese BED and obese non-BED participants reported comparable binge eating behavior. In the current study, we examined differences in binge eating with an innovative assessment scheme employing both EMA and a standardized computer-based dietary recall program to avoid some of the limitations of past laboratory and field research. Obese BED, obese non-BED, and non-obese control participants reported significant differences in eating patterns, loss of control, overeating, and binge eating behavior. Of particular importance was the finding that BED participants engaged in more overeating and more binge eating episodes than non-BED participants. These findings suggest that the use of EMA in combination with dietary recall may be a relatively objective and useful approach to assessing binge eating behavior. The findings further suggest that individuals with BED are observably different from those without the disorder, which may have implications for eating disorder diagnoses in DSM-V.

Foo MD, Uy MA, Baron RA. (Jul 2009). How do feelings influence effort? An empirical study of entrepreneurs’ affect and venture effort. J Appl Psychol, 94(4),  1086-94

How do feelings influence the effort of entrepreneurs? To obtain data on this issue, the authors implemented experience sampling methodology in which 46 entrepreneurs used cell phones to provide reports on their affect, future temporal focus, and venture effort twice daily for 24 days. Drawing on the affect-as-information theory, the study found that entrepreneurs’ negative affect directly predicts entrepreneurs’ effort toward tasks that are required immediately. Results were consistent for within-day and next-day time lags. Extending the theory, the study found that positive affect predicts venture effort beyond what is immediately required and that this relationship is mediated by future temporal focus. The mediating effects were significant only for next-day outcomes. Implications of findings on the nature of the affect-effort relationship for different time lags are discussed.

Friedman O, Shukla Y, Logan AG. (Sep 2009). Relationship Between Self-Reported Sleep Duration and Changes in Circadian Blood Pressure. Am J Hypertens  [Epub ahead of print]

BackgroundAbnormalities in sleep duration and circadian blood pressure (BP) rhythm are both independently associated with increased risk of death and cardiovascular disease. The relationship, however, between these two entities remains unclear. This study was undertaken to determine whether abnormal sleep duration is associated with nondipping status and elevated morning surge.MethodsIn a cross-sectional study, we assessed the relationship between self-reported sleep duration and circadian BP profiles from 24-h ambulatory BP monitoring (ABPM) in 108 normotensive and 417 hypertensive subjects, independent of relevant sociodemographic, anthropometric, and medical factors.ResultsOn average, subjects reported sleeping 6.5 +/- 1.7 h with 18.5% sleeping </=5 h and 7.6%, >/=9 h. There were 199 (37.9%) nondippers in our cohort and the mean morning surge was 18.7 +/- 1.7 mm Hg. The adjusted odds ratio for nondipping (<10% nocturnal systolic BP fall) associated with a 1-h decrement in sleep duration was 1.12 (P = 0.04) and with age per 5-year increment, 1.15 (P = 0.0003). The adjusted odds ratio for an elevated morning surge (>/=18.0 mm Hg) associated with a 1-h increment in sleep duration was 1.13 (P = 0.02).ConclusionsOur study indicates that a sleep deficit is associated with nondipping and a decreased morning surge, whereas a sleep surfeit is associated with less nondipping and an increased morning surge. These findings provide a possible link for the heightened risk of cardiovascular disease associated with disturbances in circadian BP rhythm and the extremes of sleep quantity.

Fukuo W, Yoshiuchi K, Ohashi K, Togashi H, Sekine R, Kikuchi H, Sakamoto N, Inada S, Sato F, Kadowaki T, Akabayashi A. (Jul 2009). Development of a hand-held personal digital assistant-based food diary with food photographs for Japanese subjects. J Am Diet Assoc, 109(7), 1232-6

Hand-held personal digital assistant (PDA)-based food diaries have been developed for self-monitoring of dietary intake, but the accuracy of these diaries is unclear for patients with diabetes. The aim of the study was to assess the accuracy and feasibility of use of a new PDA-based food diary, including food photographs. The study included 44 Japanese participants without diabetes (mean age 23 years) and 16 Japanese patients with type 2 diabetes (mean age 53 years). The PDA-based food diary was used for 7 consecutive days. Information about all dietary intake on the 7th day of PDA self-monitoring was collected by a 24-hour recall interview on the 8th day. The PDA-based data for dietary intake on the 7th day were then compared to the 24-hour recall data for the same period. Feasibility was assessed based on the frequency and timeliness of self-monitoring. There was no significant difference in daily totals for energy, protein, carbohydrate, and fat between the two methods in each group. Pearson’s correlation and intraclass correlation coefficients showed strong significant relationships for all variables between the two methods in both groups. Bland-Altman plots did not indicate any bias in estimated daily caloric intake. Participants recorded 98% of their meals in the PDA, with 75% of entries recorded within 6 hours after the meal starting time. The findings suggest that the PDA-based food diary is a potential clinical method to estimate dietary intake and may be a beneficial tool for self-monitoring of dietary intake.

Godfrey A, Conway R, Leonard M, Meagher D, Olaighin G. (Aug 2009). A classification system for delirium subtyping with the use of a commercial mobility monitor. Gait Posture, 30(2), 245-52

The usefulness of motor subtypes of delirium is unclear due to inconsistency in subtyping methods and a lack of validation with objective measures of activity. The activity of 40 patients was measured over 24h with a commercial accelerometer-based activity monitor. Accelerometry data from patients with DSM-IV delirium that were readily divided into hyperactive, hypoactive and mixed motor subtypes, were used to create classification trees that were subsequently applied to the remaining cohort to define motoric subtypes. The classification trees used the periods of sitting/lying, standing, stepping and number of postural transitions as measured by the activity monitor as determining factors from which to classify the delirious cohort. The use of a classification system shows how delirium subtypes can be categorised in relation to overall activity and postural changes, which was one of the most discriminating measures examined. The classification system was also implemented to successfully define other patient motoric subtypes. Motor subtypes of delirium defined by observed ward behaviour differ in electronically measured activity levels.

Gorelick ML, Bizzini M, Maffiuletti NA, Munzinger JP, Munzinger U. (Jul 2009). Test-retest reliability of the IDEEA system in the quantification of step parameters during walking and stair climbing. Clin Physiol Funct Imaging, 29(4), 271-6

The aim of this investigation was to evaluate the inter- and intra-session reliability of spatio-temporal gait variables collected during walking and stair climbing with the Intelligent Device for Energy Expenditure and physical Activity (IDEEA) accelerometer-based system. Eighteen healthy subjects (10 men, 8 women) completed a standardized indoor circuit comprised of walking and stair climbing. Intra-and inter-session reliability was investigated for several pertinent spatio-temporal gait variables using intraclass correlations [ICC (3,1)]. Intra-session reliability during walking showed a high reliability of the IDEEA with ICCs ranging between 0.84 (number of steps) and 0.97 (single limb support/double limb support). The ICCs for stair climbing were slightly lower than those during walking with values ranging between 0.74 (step duration) and 0.92 (number of steps). Inter-session reliability during walking showed a high reliability of the IDEEA between all trials, with values ranging between 0.87 (speed) to 0.98 (step duration). The ICCs of stair climbing were again lower than those during walking with values ranging from 0.64 (swing duration) to 0.79 (number of steps). The IDEEA accelerometer-based system provided a highly reliable measurement of spatio-temporal variables, in healthy subjects, during walking with moderately reduced correlations during stair climbing.

Halsey LG, Green JA, Wilson RP, Frappell PB. (Jul 2009). Accelerometry to Estimate Energy Expenditure during Activity: Best Practice with Data Loggers. Physiol Biochem Zool, 82(4), 396-404

Measurement of acceleration can be a proxy for energy expenditure during movement. The variable overall dynamic body acceleration (ODBA), used in recent studies, combines the dynamic elements of acceleration recorded in all three dimensions to measure acceleration and hence energy expenditure due to body movement. However, the simplicity of ODBA affords it limitations. Furthermore, while accelerometry data loggers enable measures to be stored, recording at high frequencies represents a limit to deployment periods as a result of logger memory and/or battery exhaustion. Using bantam chickens walking at different speeds in a respirometer while wearing an accelerometer logger, we investigated the best proxies for rate of oxygen consumption (Vo(2)) from a range of different models using acceleration. We also investigated the effects of sampling acceleration at different frequencies. The best predictor of Vo(2) was a multiple regression including individual measures of dynamic acceleration in each of the three dimensions. However, R(2) was relatively high for ODBA as well and also for certain measures of dynamic acceleration in single dimensions. The aforementioned are single variables, therefore easily derived onboard a data logger and from which a simple calibration equation can be derived. For calibrations of Vo(2) against ODBA, R(2) was consistent as sampling number decreased down to 600 samples of each acceleration channel per ODBA data point, beyond which R(2) tended to be considerably lower. In conclusion, data storage can be maximized when using acceleration as a proxy for Vo(2) by consideration of reductions in (1) number of axes measured and (2) sampling frequency.

Hanlon M, Anderson R. (Sep 2009). Real-time gait event detection using wearable sensors. Gait Posture, 30(4), 523-7

Real-time gait event detection is a requirement for functional electrical stimulation and gait biofeedback. This gait event detection should ideally be achieved using an ambulatory system of durable, lightweight, low-cost sensors. Previous research has reported issues with durability in footswitch systems. Therefore, this study describes the development and assessment of novel detection algorithms using footswitch and accelerometer sensors on 12 healthy individuals. Subjects were equipped with one force sensitive resistor on the heel, one accelerometer at the foot, and one accelerometer at the knee. Subjects performed 10, 8-m walking trials in each of three conditions: normal, slow, and altered (reduced knee ROM) walking. Data from a subset of four subjects were used to develop prediction algorithms for initial contact (IC). Subsequently, these algorithms were tested on the remaining eight subjects against standard forceplate IC data (threshold of 5 N on a rising edge). The footswitch force threshold algorithm was most accurate for IC detection (mean absolute error of 2.4+/-2.1 ms) and was significantly more accurate (p<0.001) than the optimal accelerometer algorithm (mean absolute error of 9.5+/-9.0 ms). The optimal accelerometer algorithm used data from both accelerometers, with IC determined from the second derivative of foot fore-aft acceleration. The error results for footswitch and accelerometer algorithms are lower (approximately 60%) than in previous research on ambulatory real-time gait event detection systems. Currently, footswitch systems must be recommended over accelerometer systems for accurate detection of IC, however, further research into accelerometer algorithms is merited due to its advantages as a durable, low-cost sensor.

Hemmink GJ, Weusten BL, Bredenoord AJ, Timmer R, Smout AJ. (Aug 2009). Aerophagia: excessive air swallowing demonstrated by esophageal impedance monitoring. Clin Gastroenterol Hepatol, 7(10), 1127-9

BACKGROUND & AIMS: Patients with aerophagia suffer from the presence of an excessive volume of intestinal gas, which is thought to result from excessive air ingestion. However, this has not been shown thus far. The aim of this study was therefore to assess swallowing and air swallowing frequencies in patients with suspected aerophagia. METHODS: Ambulatory 24-hour pH-impedance monitoring was performed in patients in whom excessive amounts of intestinal gas were visualized on plain abdominal radiograms. All patients had symptoms of bloating, abdominal distention, flatulence, or excessive belching. Reflux parameters and the number of swallows and air swallows were assessed. RESULTS: The most common symptoms were bloating, abdominal distention, and constipation. Only 3 patients reported excessive belching and 1 patient reported flatulence as their predominant symptom. During the 24-hour measurement, patients showed high incidences of air swallows (521 +/- 63) and gastric belches (126 +/- 37). Patients had normal swallowing frequency (741 +/- 71). CONCLUSIONS: This study presents objective parameters that confirm the existence of excessive air swallowing or aerophagia using esophageal impedance monitoring.

Hendrick P, Bell ML, Bagge PJ, Milosavljevic S. (Aug 200). Can accelerometry be used to discriminate levels of activity? Ergonomics, 52(8), 1019-1025

The aims of this study were to investigate the associations between an activity logbook and the RT3 accelerometer and to assess whether the RT3 can discriminate activity levels in healthy adults. Ten participants completed two trials wearing an RT3 accelerometer over a 4-6 h period and completed a detailed activity log. Results showed a poor correlation between the RT3 in moderate activities (r = 0.22) in comparison to low (r = 0.52) and hard (r = 0.70) from the logbook. A significant difference was found in average RT3 vector magnitude (VM) counts/min in each activity level (p < 0.0001). Discriminant analysis demonstrated that an RT3VM counts/min value of approximately 500 was found to have high sensitivity (88%), and specificity (88%) for discriminating between low and moderate activity levels from the logbook. This study found that accelerometry has the potential to discriminate activity levels in free living. This study is the first to investigate whether tri-axial accelerometry can discriminate different levels of free-living activity recorded in an activity logbook. The RT3 accelerometer can discriminate between low and moderate physical activities and offers a methodology that may be applicable to future research in occupational settings.

Heron KE, Smyth JM. (Jul 2009). Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol

Purpose Psychosocial and health behaviour treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives. These ecological momentary interventions (EMIs) are treatments that are provided to people during their everyday lives (i.e. in real time) and in natural settings (i.e. real world). The goal of the present review is to synthesize and critique mobile technology-based EMI aimed at improving health behaviours and psychological and physical symptoms. Methods Twenty-seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified. Results There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviours and physical and psychological symptoms. Limitations of the existing literature were identified and recommendations and considerations for research design, sample characteristics, measurement, statistical analyses, and clinical implementation are discussed. Conclusions Mobile technology-based EMI can be effectively implemented as interventions for a variety of health behaviours and psychological and physical symptoms. Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive.

Hovi P, Andersson S, Räikkönen K, Strang-Karlsson S, Järvenpää AL, Eriksson JG, Pesonen AK, Heinonen K, Pyhälä R, Kajantie E. (Sep 2009). Ambulatory Blood Pressure in Young Adults with Very Low Birth Weight. J Pediatr. [Epub ahead of print]

OBJECTIVE: We hypothesized that, as compared with a matched control group born at term, young adults with very low birth weight (VLBW <1.5 kg) would have higher 24-hour ambulatory blood pressure. STUDY DESIGN: We studied 118 18- to 27-year-old subjects born with VLBW within the greater Helsinki area and 120 term-born control subjects with similar age, sex, and birth hospital. The mean birth weight for VLBW subjects was 1.1 kg (standard deviation [SD], 0.2) and for controls, 3.6 kg (SD, 0.5). Gestational ages were 29.2 (SD, 2.3) and 40.1 (SD, 1.0) weeks. Current education of higher-educated parents served as an indicator of childhood socioeconomic status. Ambulatory blood pressure was measured during a 24-hour period with an oscillometric device (Spacelabs 90207). RESULTS: VLBW subjects had, with sex, age, and body mass index adjustment, a 2.4 mm Hg (95% confidence interval, 0.2 to 4.6) higher 24-hour systolic pressure. We found hypertension in 11 VLBW subjects and in 3 term-born subjects, giving an adjusted odds ratio of 4.0 (1.1 to 14.8). When socioeconomic status was taken into account, results remained unchanged. CONCLUSIONS: Higher rates of hypertension and higher 24-hour blood pressure among young adults with VLBW may indicate higher risk for adverse cardiovascular outcomes.

Kalpakjian CZ, Farrell DJ, Albright KJ, Chiodo A, Young EA. (Aug 2009). Association of daily stressors and salivary cortisol in spinal cord injury. Rehabil Psychol, 54(3), 288-98

OBJECTIVE: Examine the diurnal variation of salivary cortisol in adults with spinal cord injury (SCI) and the effect of stressors on cortisol and mood. METHOD: Ecological momentary assessment (EMA) to capture cortisol, stress, and mood from 25 persons with SCI and 26 without SCI. Data were analyzed using linear mixed models. RESULTS: There were no systematic differences between groups on missing data. Diurnal variation of cortisol of participants with SCI reflected an expected pattern. No significant group differences for cortisol diurnal pattern, stress, or mood; when group interactions were significant, results indicated lower cortisol reactivity to stress in participants with SCI. Stress had a significant impact on positive, negative and agitated moods. CONCLUSIONS: Stress in daily life and its association with cortisol and mood were largely similar between persons with and without SCI. A key methodological contribution is the demonstration of using EMA to collect biological and behavioral data in the field from participants with SCI. The use of EMA in rehabilitation psychology research has great potential to advance our understanding of the dynamics of daily life with disability.

Köblitz AR, Magnan RE, McCaul KD, O’Neill HK, Crosby R, Dillard AJ. (Jul 2009). Smokers’ thoughts and worries: a study using ecological momentary assessment. Health Psychol, 28(4), 484-92

OBJECTIVE: The purpose of this study was to investigate smokers’ thoughts and worries about their smoking behavior. Researchers have sometimes asked smokers to make such self-assessments but typically using retrospective summary judgments. DESIGN: Using ecological momentary assessment, community and student smokers reported five times daily during two separate 1-week intervals. MAIN OUTCOME MEASURES: Smokers reported their thoughts about smoking, worries about smoking, and level of contemplation to quit smoking. RESULTS: Smokers reported thinking negatively about their smoking 26.8% of the time they had a cigarette. The most frequent thoughts reported by smokers related to immediate reinforcement of smoking (e.g., “How I smell like cigarettes”). However, smokers reported more intense worry about thoughts related to health concerns (e.g., “Symptoms I’m having because of smoking”). The occurrence of negative thoughts was significantly and positively related to contemplation about quitting, worry about smoking, and risk perceptions. Finally, self-reported worry intensity was more strongly related to contemplation of quitting than negative thought occurrence. CONCLUSION: Our results show that thoughts about smoking (i.e., cognitions) and feelings about smoking (i.e., worry) are loosely connected and it is feelings rather than cognitions that are most related to contemplation to quit.

Kumahara Kumahara H, Tanaka H, Schutz Y. (Aug 2009). Are pedometers adequate instruments for assessing energy expenditure? Eur J Clin Nutr. [Epub ahead of print]

Objective:Assessing energy expenditure (EE) is important for the control of obesity. Daily step counts have become popular and constitute one practical technique for evaluating the physical activity (PA) in large population studies. However, information on the capacity of pedometers to track EE in free-living conditions remains scanty.Subjects and methods:The 24-h EE of 71 healthy adults was measured by indirect calorimetry in a large respiratory chamber. Two accelerometers were attached to the waist, one for counting the total daily steps (ACC(STEP)) and another for measuring the anteroposterior whole body acceleration calculated as the root mean square of the acceleration signal at every second (ACC(RMS)).Results:The ACC(STEP) was not associated with PA-related EE (PAEE) or 24-h EE. Body weight (BW) was the main determinant of both the values (explaining 30 and 75% of the variance, respectively). Approximately 8% (P<0.001) of the variance in PAEE was attributed to the ACC(RMS) after BW was accounted for, whereas the ACC(STEP) did not explain any additional variance. A multiple stepwise regression analysis revealed that BW, height and ACC(RMS) were highly significant determinants of 24-h EE and accounted for as much as 83% of the total variance.Conclusions:Recording the number of steps per day does not provide accurate information on EE, and at best is only a crude predictor of the general PA in terms of displacement. In contrast, accelerometry signals are considered to be a more meaningful factor in the assessment of EE rather than step counts under sedentary conditions.

Liu K, Liu T, Shibata K, Inoue Y, Zheng R. (Sep 2009). Novel approach to ambulatory assessment of human segmental orientation on a wearable sensor system. J Biomech. [Epub ahead of print]

A new method using a double-sensor difference based algorithm for analyzing human segment rotational angles in two directions for segmental orientation analysis in the three-dimensional (3D) space was presented. A wearable sensor system based only on triaxial accelerometers was developed to obtain the pitch and yaw angles of thigh segment with an accelerometer approximating translational acceleration of the hip joint and two accelerometers measuring the actual accelerations on the thigh. To evaluate the method, the system was first tested on a 2 degrees of freedom mechanical arm assembled out of rigid segments and encoders. Then, to estimate the human segmental orientation, the wearable sensor system was tested on the thighs of eight volunteer subjects, who walked in a straight forward line in the work space of an optical motion analysis system at three self-selected speeds: slow, normal and fast. In the experiment, the subject was assumed to walk in a straight forward way with very little trunk sway, skin artifacts and no significant internal/external rotation of the leg. The root mean square (RMS) errors of the thigh segment orientation measurement were between 2.4 degrees and 4.9 degrees during normal gait that had a 45 degrees flexion/extension range of motion. Measurement error was observed to increase with increasing walking speed probably because of the result of increased trunk sway, axial rotation and skin artifacts. The results show that, without integration and switching between different sensors, using only one kind of sensor, the wearable sensor system is suitable for ambulatory analysis of normal gait orientation of thigh and shank in two directions of the segment-fixed local coordinate system in 3D space. It can then be applied to assess spatio-temporal gait parameters and monitoring the gait function of patients in clinical settings.

Mathers M, Canterford L, Olds T, Hesketh K, Ridley K, Wake M. (Jul 2009). Electronic media use and adolescent health and well-being: cross-sectional community study. Acad Pediatr, 9(5), 307-14

OBJECTIVE: To describe time adolescents spend using electronic media (television, computer, video games, and telephone); and to examine associations between self-reported health/well-being and daily time spent using electronic media overall and each type of electronic media. METHODS: Design-Cross-sectional data from the third (2005) wave of the Health of Young Victorians Study, an Australian school-based population study. Outcome Measures-Global health, health-related quality of life (HRQoL; KIDSCREEN), health status (Pediatric Quality of Life Inventory 4.0; PedsQL), depression/anxiety (Kessler-10), and behavior problems (Strengths and Difficulties Questionnaire). Exposure Measures-Duration of electronic media use averaged over 1 to 4 days recalled with the Multimedia Activity Recall for Children and Adolescents (MARCA) computerized time-use diary. Analysis-Linear and logistic regression; adjusted for demographic variables and body mass index z score. RESULTS: A total of 925 adolescents (mean +/- standard deviation age, 16.1+/-1.2 years) spent, on average, 3 hours 16 minutes per day using electronic media (television, 128 minutes per day; video games, 35; computers, 19; telephone, 13). High overall electronic media use was associated with poorer behavior, health status, and HRQoL. Associations with duration of specific media exposures were mixed; there was a favorable association between computer use (typing/Internet) and psychological distress, whereas high video game use was associated with poorer health status, HRQoL, global health, and depression/anxiety. Television and telephone durations were not associated with any outcome measure. CONCLUSIONS: Despite television’s associations with obesity, time spent in other forms of media use appear more strongly related to adolescent health and well-being. This study supports efforts to reduce high video game use and further exploration of the role of computers in health enhancement.

Mazze R, Strock E, Morgan B, Wesley D, Bergenstal R, Cuddihy R. (Jul 2009). Diurnal glucose patterns of exenatide once weekly: a 1-year study using continuous glucose monitoring with ambulatory glucose profile analysis. Endocr Pract, 15(4), 326-34

OBJECTIVE: To use continuous glucose monitoring (CGM) to characterize diurnal glucose patterns produced by a novel formulation of exenatide consisting of biodegradable polymeric microspheres that entrap exenatide and provide extended release enabling once-weekly administration. METHODS: We performed a subgroup analysis of patients with type 2 diabetes who participated in a multicenter trial (DURATION-1: Effects of Exenatide Long-Acting Release on Glucose Control and Safety in Subjects With Type 2 Diabetes Mellitus) comparing once-weekly with twice-daily formulations of exenatide. We are the only center to use CGM with ambulatory glucose profile (AGP) analysis to characterize glucose exposure, variability, and stability in participants assigned to exenatide once weekly. RESULTS: Seven of the 303 patients in the larger study population were included in the subgroup analysis. Mean age (57.6 +/- 7 years), weight (102 +/- 17 kg), body mass index (34 +/- 3 kg/m2), and duration of diabetes (5 +/- 2 years) were comparable to characteristics of the larger study population. At 30 weeks and 52 weeks, participants treated with exenatide once weekly had a mean reduction in hemoglobin A1c level of 1.3 +/- 0.3% and 1.0 +/- 0.3%, respectively (P<.05). CGM analysis revealed a significant (P<.01) decrease in diurnal glucose exposure for 4 participants during nocturnal and daytime periods. Excess glucose exposure (compared with reference values) decreased in 6 of 7 participants, as did glucose variability. Glucose stability improved in 5 participants. The percentage of glucose values less than 70 mg/dL initially increased during the first half of the study then decreased to baseline levels by study end. CONCLUSIONS: Individual glucose profiles revealed that changes in hemoglobin A1c did not consistently parallel alterations in glucose exposure, variability, and stability. AGPs provided a visual representation of improved glucose responses to exenatide once weekly.

McGowan NJ, Gough K, Padfield PL. (Jul 2009). Nocturnal dipping is reproducible in the long term. Blood Press Monit. [Epub ahead of print]

OBJECTIVE: To examine the long-term reproducibility of nocturnal dipping as a dichotomous and continuous variable. METHODS: Retrospective review of an ambulatory blood pressure monitor (ABPM) database of approximately 15 000 patients. Reproducibility of ABPM was assessed by repeatability coefficient. Kappa (kappa) statistic and intraclass correlation coefficient were used to quantify dipping as a dichotomous and continuous variable, respectively. RESULTS: There were 512 never-treated patients with two ABPM assessments, a mean of 29 (+/-19) months apart. Blood pressure was 2/0 mmHg (awake) and 2/1 mmHg (asleep) higher on the second ABPM. The repeatability coefficient for awake systolic and awake diastolic pressure was 5.9 and 6.2%, respectively. When the dipper/non-dipper (dichotomous) classification was applied to both ABPMs, dipping status was unchanged in 76% of patients, kappa = 0.29. When nocturnal dip was expressed as a continuous variable, the mean nocturnal dip was 14% and the median absolute change between assessments was 3.8%, intraclass correlation coefficient = 0.60. The time interval between assessments was subdivided into (i) within 6 months, (ii) 6 months to 1 year, (iii) 1-2 years, (iv) 2-3 years and (v) more than 3 years. There was remarkable consistency independent of time interval for dipping expressed as a continuous variable but not as dipper/non-dipper. CONCLUSION: These findings show that in the long term, nocturnal dip is more stable when expressed as a continuous variable. As recent evidence show cardiovascular risk to be inversely related to nocturnal blood pressure in a continuous manner, surely it makes more sense to express nocturnal dip in a similar way to aid stratification of overall cardiovascular risk.

McClung HL, Sigrist LD, Smith TJ, Karl JP, Rood JC, Young AJ, Bathalon GP. (Jul 2009). Monitoring energy intake: a hand-held personal digital assistant provides accuracy comparable to written records. J Am Diet Assoc, 109(7), 1241-5

New approaches to assess energy intake (EI) may have advantages over traditional written methods, but validity of these emerging methodologies must be demonstrated. This exploratory study compared EI obtained using a hand-held personal digital assistant (PDA) and traditional written records with total energy expenditure measured by doubly labeled water (TEE(DLW)). Twenty-six volunteers (aged 23+/-4 years, body mass index [calculated as kg/m(2)] 24+/-2) participated in a randomized (either PDA or written record group) and matched (for sex, age, and body mass index) study for 7 consecutive days between June 2005 and April 2006 to record EI. Group comparisons were made with t and Mann-Whitney U tests. Bland-Altman plots were used to compare limits of agreement between methods. Volunteers remained weight stable during the study period (0.2+/-0.8 kg; P>0.05). Reported EI by written record and PDA were similar to TEE(DLW); 105% vs 92% of TEE(DLW), respectively (P>0.05). There was a significant relationship between reported EI by PDA and TEE(DLW) (r=0.60, P<0.05), but not for written record (r=0.45, P>0.05). Limits of agreement indicated both written record and PDA had large variability (range 1,394 to -1,472 kcal/day). Findings suggest the bias in using a PDA is similar to that observed when using a written record for estimation of EI in weight-stable volunteers.

McDoniel SO, Wolskee P, Shen J. (Aug 2009). Treating obesity with a novel hand-held device, computer software program, and Internet technology in primary care: The SMART motivational trial. Patient Educ Couns.  [Epub ahead of print]

OBJECTIVE: The purpose of this study was to evaluate the short-term motivational effect of a technology-based weight reduction program for obese adults. METHODS: One hundred and eleven obese (37.0+/-5.8kg/m(2)) middle aged (45.5+/-10.8 years) adults (62% female) were randomly assigned to a usual care or experimental (SMART: self-monitoring and resting metabolic rate technology) group. The usual care group received a standard nutritional program in accordance to national guidelines. All participants received a comprehensive weight management program consisting of motivational interviewing (MI) sessions and automated e-mail behavioral newsletters. Bodyweight, arterial blood pressure, and psychobehavioral constructs were assessed over 12 weeks. RESULTS: Completer analysis (n=80) indicated a significant improvement in bodyweight (-3.9%), systolic arterial pressure (-4mmHg), and all motivational constructs following the 12-week study (p</=.05). However, there were no significant differences between groups at any time period. CONCLUSION: Based on these data, a 12-week comprehensive weight reduction program consisting of MI and automated e-mail behavioral newsletters with or without SMART is efficacious in treating obese adults. PRACTICE IMPLICATIONS: Although both treatment programs were equally effective, clinicians should consider a treatment program that meets the need of the patient. This study was registered at NCT00750022.

Miller DJ, Vachon DD,  Lynam  DR. (Aug 2009). Neuroticism, negative affect, and negative affect instability: Establishing convergent and discriminant validity using ecological momentary assessment. Personality and Individual Differences

Few investigations have examined the role of affective instability within a broad model of general personality functioning. The present study employed self-report and ecological momentary assessments (EMA) to examine the relations between self-reported Five-Factor Model Neuroticism, EMA average negative affect, and EMA negative affect instability. Results suggest that Neuroticism and negative affect instability are related yet distinct constructs, and that Neuroticism better represents average negative affect across time. Results also suggest that negative affect instability is related to low Agreeableness and specific externalizing facets of Neuroticism, such as Angry Hostility and Impulsiveness. The implications of these findings and potential areas for future research are discussed.

Mizumori T, Inano S, Sumiya M, Kobayashi Y, Watamoto T, Yatani H. (Jul 2009). Ambulatory bruxism recording system with sleep-stage analyzing function. J Prosthodont Res, 53(3), 150-4

PURPOSE: The aim of this study was to develop an ambulatory bruxism recording system capable of sleep-stage analysis. METHODS: A portable EMG system was used to record masseter muscle activity. An EMG sensor was attached onto the masseter muscle belly at either side. EMG data were stored on a notebook type personal computer. A sound level meter was used to assess the sound level of bruxism. Sound level (dB) readings were taken every second and recorded on the same computer. A prototype of sleep sensor, a wristwatch-style biological signal sensor-recorder device, recorded and stored pulse wave, acceleration and temperature on a memory card. All stored data were transferred to a personal computer and analyzed. RESULTS: The whole system was transportable within a protective case and weighed approximately 5kg. Raw EMG signals were processed to derive integrated EMG data. TOSHIBA Sleep Analysis Program classified sleep-stages as awake, shallow sleep, deep sleep and REM based on the activity of the autonomic nervous system that was estimated from the fluctuations of pulse intervals. An EMG, sound level and sleep-stage analysis program was developed to analyze all data simultaneously. Using this program, the masseter muscle activity, sound level and sleep-stage could be quantified and correlated. CONCLUSION: We developed an ambulatory bruxism recording system that analyzes sleep-stage. We expect that this system will enable us to measure sleep bruxism activity in each sleep-stage on an electromyographical and auditory basis at the subject’s home.

Moskowitz DS, Russell JJ, Sadikaj G, Sutton R.(Aug 2009). Measuring people intensively. Canadian Psychology/Psychologie canadienne 50(3). Special issue: Developments in psychological measurement and assessment, 131-140

An overview is provided of measures that are administered repeatedly in daily life. Variations of this methodology have been referred to as ecological momentary assessment, diary methods, daily process measures, and most broadly as intensive repeated measures in naturalistic settings (IRM-NS). Contrasts are drawn between IRM-NS methods on the basis of different sampling strategies, such as time-contingent recording, signal-contingent recording, and event-contingent recording. Common threats to the internal validity, construct validity, and external validity of IRM-NS measures are reviewed, along with ways to reduce these threats. The statistical analysis of IRM-NS data is considered, with a particular focus on the investigation of intraindividual variability. An extended example is provided of an IRM-NS measure, an event-contingent recording method for the assessment of interpersonal behaviour.

Murphy SL, Smith DM. (Sep 2009). Ecological Measurement of Fatigue and Fatigability in Older Adults With Osteoarthritis. J Gerontol A Biol Sci Med Sci. [Epub ahead of print]

BACKGROUND: Fatigue is associated with loss of independence in older adults; however, little is known about optimal treatment or how fatigue manifests in daily life activities. “Fatigability” was recently proposed to clarify the fatigue-activity relationship. The purpose of this study was to present a new measurement method of fatigability and begin to test its validity. METHODS: Our sample included 40 adults with knee or hip osteoarthritis (OA) and 20 healthy controls. Fatigue was measured by ecological momentary assessment several times a day along with continuous measurement of physical activity using a wrist-worn accelerometer. Fatigability was measured as the fatigue increase after a period of high activity. RESULTS: Compared with controls, participants with OA were approximately four times more likely to have an increase in fatigue after a high activity interval (37.0% vs 9.8%). Among people with OA, average fatigue and fatigability were not highly related (r = .13). Fatigue was most strongly associated with reported physical function, pain, and vitality, whereas fatigability was most strongly associated with body mass index, OA severity, and knee strength. CONCLUSIONS: Although fatigue among people with OA was more associated with subjective reports of physical function and symptoms, pairing fatigue reports with physical activity tapped objective factors that may be related to the biomechanical demands of daily life activities. Thus, fatigability measurement may help discern how symptoms relate to daily life function and help to refine treatment approaches in OA.

Myin-Germeys I, Oorschot M, Collip D, Lataster J, Delespaul P, van Os J. (Sep 2009). Experience sampling research in psychopathology: opening the black box of daily life. Psychol Med, 39(9), 1533-47

A growing body of research suggests that momentary assessment technologies that sample experiences in the context of daily life constitute a useful and productive approach in the study of behavioural phenotypes and a powerful addition to mainstream cross-sectional research paradigms. Momentary assessment strategies for psychopathology are described, together with a comprehensive review of research findings illustrating the added value of daily life research for the study of (1) phenomenology, (2) aetiology, (3) psychological models, (4) biological mechanisms, (5) treatment and (6) gene-environment interactions in psychopathology. Overall, this review shows that variability over time and dynamic patterns of reactivity to the environment are essential features of psychopathological experiences that need to be captured for a better understanding of their phenomenology and underlying mechanisms. The Experience Sampling Method (ESM) allows us to capture the film rather than a snapshot of daily life reality of patients, fuelling new research into the gene-environment-experience interplay underlying psychopathology and its treatment.

Nyberg GA, Nordenfelt AM, Ekelund U, Marcus C. (Sep 2009). Physical Activity Patterns Measured by Accelerometry in 6- to 10-yr-Old Children. Med Sci Sports Exerc. [Epub ahead of print]

PURPOSE:: To examine differences in patterns of objectively measured physical activity (PA) among weekdays and weekend days and across different time blocks during the day in relation to age and gender. This knowledge is important when planning preventive initiatives aimed at increasing levels of PA in children. METHODS:: This is a cross-sectional analysis in 653 girls and 640 boys (6-10 yr) measured during 1 wk with accelerometry. Periods of the day were divided into school time (8:00 a.m. to 1:30 p.m.), after school care time (1:30-4:00 p.m.), and evening time (4:00-9:00 p.m.). Multivariate ANOVA was used to analyze mean PA. RESULTS:: Mean daily PA differed significantly across age groups (6-10 yr) in both boys and girls (P < 0.001). Mean (SE) daily PA was significantly lower during weekends compared with weekdays in all age groups (girls 782 (6.7) vs 681 (7.7) counts per min (CPM), P < 0.001; boys 853 (7.1) vs 729 (8.0) CPM, P < 0.001). This decline was similar across low, medium, and highly active children. Mean PA was highest during after school care time on weekdays (girls 879 (9.8) and boys 990 (10.0) CPM) compared with all other periods. The difference in mean PA between boys and girls was highest during school time (P < 0.001) and after school care time (P < 0.001). CONCLUSIONS:: The decline in PA in children may start already at the age of 6 yr. The school setting may be an important arena for targeting activity levels in girls because the difference in PA levels between girls and boys is most pronounced during school time. In both girls and boys, PA levels are disproportionally low during weekends and might be important targets for interventions aimed to increase PA.

Parkinson B, Simons, G. (Aug 2009). Affecting others: Social appraisal and emotion contagion in everyday decision making. Personality and Social Psychology Bulletin, 35(8), 1071-1084

In a diary study of interpersonal affect transfer, 41 participants reported on decisions involving other people over 3 weeks. Reported anxiety and excitement were reliably related to the perceived anxiety and excitement of another person who was present during decision making. Risk and importance appraisals partially mediated effects of other’s anxiety on own anxiety as predicted by social appraisal theory. However, other’s emotion remained a significant independent predictor of own emotion after controlling for appraisals, supporting the additional impact of more direct forms of affect transfer such as emotion contagion. Significant affect-transfer effects remained even after controlling for participants’ perceptions of the other’s emotion in addition to all measured appraisals, confirming that affect transfer does not require explicit registration of someone else’s feelings. This research provides some of the clearest evidence for the operation of both social appraisal and automatic affect transfer in everyday social life.

Pfaltz MC, Michael T, Grossman P, Blechert J, Wilhelm FH. (Sep 2009). Respiratory Pathophysiology of Panic Disorder: An Ambulatory Monitoring Study. Psychosom Med. [Epub ahead of print]

Objective: To assess the external validity of laboratory baselines in panic disorder (PD), frequently associated with respiratory pattern abnormalities like increased respiratory variability and sighing, implying a stable pathophysiologic trait characteristic. Methods: Physical activity and a variety of breath-by-breath volumetric, timing, and variability measures of respiration were recorded in the daily life of 26 patients with PD and 26 healthy controls (HC), using a novel ambulatory monitoring system optimized for reliable assessment of respiratory pattern. Data were stratified for physical activity to eliminate its confounding effects. Results: Groups showed strong and consistent diurnal patterns in almost all respiratory variables. However, patients with PD did not differ from HC regarding any of the respiratory timing, volumetric and variability measures, with negligible group effect sizes for all measures. Patients with fewer self-reported respiratory symptoms of anxiety exhibited more pronounced rapid shallow breathing as well as diminished total breath time and its variability. Conclusions: Despite state-of-the-art ambulatory assessment and sufficient statistical power to detect respiratory alterations previously observed in the laboratory, we found no evidence for such alterations in PD patients’ daily life. Neither the total PD group nor patients with particularly pronounced respiratory symptomatology displayed increased respiratory variability. These results caution against interpreting results from laboratory baselines in PD as reflecting a stable trait characteristic. Rather, they likely represent a state-trait interaction due to enhanced reactivity of PD patients to novel environments. These results challenge aspects of respiratory theories of PD that were based on laboratory findings.

Pierce JP. (Sep 2009). Electronic recording, self-report, and bias in measuring cigarette consumption. Health Psychology, 28(5), 527-528

Comments on an article by Saul Shiffman (see record 2009-14439-001) regarding the global assessment of cigarette smoking and whether or not this type of assessment is characterized by major digit preference or “heaping.” He raises questions about whether such digit preference results in a biased assessment of consumption. However, there are problems with this hypothesis, as Shiffman notes that self-reported smoking is characterized by the consistency of the digit preference across days, not differences related to framing. Shiffman’s study does demonstrate that ecological momentary assessment (EMA) reporting provided a better estimate of who smoked in the previous 2–3 hrs than the daily self-report measure. However, this should not be surprising as the existence of digit preference suggests that the actual timing of cigarette intake is not being carefully computed in the self-report measures.

Preston KL, Vahabzadeh M, Schmittner J, Lin JL, Gorelick DA, Epstein DH. (Sep 2009). Cocaine craving and use during daily life. Psychopharmacology (Berl). [Epub ahead of print]

RATIONALE: Craving is often assumed to cause ongoing drug use and relapse and is a major focus of addiction research. However, its relationship to drug use has not been adequately documented. OBJECTIVES: The aim of this study was to investigate the relationship between craving and drug use in real time and in the daily living environments of drug users. METHODS: In a prospective, longitudinal, cohort design (ecological momentary assessment), 112 cocaine-abusing individuals in methadone maintenance treatment rated their craving and mood at random times (two to five times daily, prompted by electronic diaries) as they went about their everyday activities. They also initiated an electronic diary entry each time they used cocaine. Drug use was monitored by thrice-weekly urine testing. RESULTS: During periods of urine-verified cocaine use, ratings of cocaine craving increased across the day and were higher than during periods of urine-verified abstinence. During the 5 h prior to cocaine use, ratings of craving significantly increased. These patterns were not seen in ratings of heroin craving or mood (e.g., feeling happy or bored). CONCLUSIONS: Cocaine craving is tightly coupled to cocaine use in users’ normal environments. Our findings provide previously unavailable support for a relationship that has been seriously questioned in some theoretical accounts. We discuss what steps will be needed to determine whether craving causes use.

Presziosa A, Grassi A, Gaggioli A, Riva G. (Aug 2009). Therapeutic applications of the mobile phone. British Journal of Guidance & Counselling, 37(3), 313-325

As the availability of new communication technologies increases, mental health professionals have incorporated these innovations into their practice and research. Up to now several studies have presented promising results in using the power and convenience of the Internet for clinical care. While multiple contributions focus on the potential and the advantages of therapies delivered through the Internet, mental health practitioners may take into account new technological opportunities to improve their practice. Mobile phone diffusion is expanding worldwide at breath-taking speed. In fewer than 20 years, mobile phones have gone from being rare and expensive pieces of equipment used primarily by the business elite, to a pervasive low-cost personal item. In many countries, mobile phones now outnumber land-line telephones, with most adults and many children now owning mobile phones. With high levels of mobile telephone penetration, a mobile culture has evolved, where the phone becomes a key social and cultural tool. The purpose of this paper is to explore the potentialities that mobile phones may offer in clinical care. The paper will investigate in which areas of clinical interventions mobile phones have already been successfully applied. Moreover, the paper will discuss these opportunities by presenting the results of two different studies based on the use of the mobile phone for anxiety management.

Rodrigues CS, Bloch KV, da Rocha Nogueira A. (Jul 2009). Office blood pressure and 24-hour ambulatory blood pressure measurements: high proportion of disagreement in resistant hypertension. J Clin Epidemiol, 62(7),745-51

OBJECTIVE: To evaluate the accuracy and quantify the agreement between office blood pressure (BP) and daytime ambulatory BP monitoring in the assessment of BP control of patients with a clinical diagnosis of resistant hypertension. STUDY DESIGN AND SETTING: Office BP measurements were done in a cohort of 228 true resistant (TR) or white-coat resistant (WCR) hypertensives classified by ambulatory BP in a hypertension clinic in Rio de Janeiro in this validity study. The agreement between the daytime ambulatory BP and office BP was analyzed using the graphic methods of Altman — Bland and survival — agreement plots. RESULTS: The likelihood ratio of a positive test result of office BP was 1.99 for the assessment of uncontrolled BP in TR patients and 1.05 for the WCR hypertensive patients. The Altman and Bland plot showed a significant difference between the two methods, and the presence of a fixed and a proportional bias. The survival-agreement plot showed that a tolerance limit of 20 mm Hg of difference between systolic office BP and systolic daytime ambulatory BP would generate a proportion of disagreement equal to 57.5%. CONCLUSION: The office BP is still an important tool to monitor BP control of patients with TR hypertension, whereas the monitoring of patients with WCR hypertension requires ambulatory BP.

Sanchez DT, Garcia JA. (Sep 2009). When race matters: racially stigmatized others and perceiving race as a biological construction affect biracial people’s daily well-being. Pers Soc Psychol Bull, 35(9),1154-64

Stigmatized group members experience greater well-being in the presence of similar others, which may be driven by the perception that similar others value their shared stigmatized identities (i.e., high public regard). Using experience sampling methodology, this hypothesis is tested with biracial people (29 Asian/White, 23 Black/ White, and 26 Latino/White biracial participants). This study proposes that the greater percentage of stigmatized similar others in one’s daily context would predict greater daily well-being for biracial people through higher public regard, but only if biracial people believe that race has biological meaning. These findings add to a growing, but limited, literature on biracial individuals. These findings are situated within the broader literature on stigma and similar others, as well as new theories regarding the consequences of believing race has biological meaning.

Schrama T. (Aug 2009). A wireless portable physiology recorder for psychophysiology research based on a personal digital assistant. Behav Res Methods, 41(3), 827-32

Psychophysiology research is increasingly relying on portable instruments that can assess physiological responses during real-life situations at locations outside of research labs, such as at school, home, work, and outdoors. In this article, I report on the feasibility of a personal digital assistant-based portable physiology recording system with online signal graphing and wireless digital telemetry for psychophysiology research. I demonstrate that such a system can measure electrocardiogram and electrodermal activity and send this data over a wireless communication link to a PC. It enables users to inspect the integrity of the acquired signals on the portable device and on a PC base station, and it allows users to place time markers for online data analysis.

Shiffman S. (Sep 2009). How many cigarettes did you smoke? Assessing cigarette consumption by global report, Time-Line Follow-Back, and ecological momentary assessment. Health Psychol, 28(5), 519-26

OBJECTIVE: This study evaluated and compared several methods of assessing daily cigarette consumption. DESIGN: Comparison of measures of daily cigarette consumption from several sources, from 232 smokers entering a smoking cessation program. MAIN OUTCOME MEASURES: Global reports of average smoking, Time-Line Follow-Back (TLFB) recall for the week preceding the study (premonitoring TLFB), 2 weeks’ cigarette recordings using electronic diaries and ecological momentary assessment (EMA), and TLFB recall of smoking during EMA (monitored TLFB). RESULTS: Global reports and premonitoring TLFB showed severe digit bias: six times as many values as expected were rounded at 10. Monitored TLFB also showed substantial digit bias (four times). EMA data showed none. EMA averaged 2.6 cigarettes lower than monitored TLFB, but exceeded TLFB on 32% of days. Across days, EMA and TLFB only correlated 0.29. Daily variations in TLFB did not correlate with variations in carbon monoxide (CO) measures taken on 3 days, but EMA measures did; among participants whose CO varied, r = .69. CO correlated with EMA cigarettes recorded in the preceding 2 hours, suggesting timely recording of cigarettes. CONCLUSION: TLFB measures are limited for precise assessment of cigarette consumption. EMA measures appear to be useful for tracking smoking, and likely other health-relevant events.

Shiffman S, Kirchner TR, Ferguson SG, Scharf DM. (Jul 2009). Patterns of intermittent smoking: An analysis using Ecological Momentary Assessment. Addictive Behaviors,  34(6-7), 514-519

Non-daily smokers comprise a substantial proportion of US smokers, but there has been little study of their patterns of smoking, which are often assumed to reflect “social smoking.” We used Ecological Momentary Assessment methods to study smoking patterns in 27 non-daily smoking adults who recorded each cigarette smoked over three weeks by leaving a voice mail message indicating their circumstances at the time of smoking. All told, 689 cigarettes were recorded over 589 person-days of observation. On average, participants smoked on 67% of days, averaging 2.1 (SD = 0.91) cigarettes per day on days they smoked; 22% of all cigarettes were smoked in bouts (within an hour of another cigarette). Altogether, 19% of cigarettes were smoked when drinking alcohol and 29% when participants were socializing. Smoking patterns varied widely across participants. A pair of hierarchical cluster analyses distinguished three groups: Those who smoked primarily (81% of cigarettes) in the daytime (Early smokers; n = 15, 58% of total sample), those who smoked primarily (75% of cigarettes) at night (Late smokers; n = 7, 27%), and a distinct, classic “Social smoking” group (n = 4, 15% of total sample), who smoked mostly at night but also primarily when socializing or drinking (86% of their cigarettes), in the evening (71% of their cigarettes), on weekends (65% of their cigarettes), and in bouts (71% of their cigarettes). Overall, results suggest that non-daily smoking patterns are quite heterogeneous, and that many non-daily smokers may not be primarily social smokers.

Smyth JM, Wonderlich SA, Sliwinski MJ, Crosby RD, Engel SG, Mitchell JE, Calogero RM. (Jul 2009). Ecological momentary assessment of affect, stress, and binge-purge behaviors: day of week and time of day effects in the natural environment. Int J Eat Disord, 42(5), 429-36

OBJECTIVE: The present study examined ecological momentary assessments of binge/vomit behavior, mood, and type and severity of stressors in a sample of 133 women with bulimia nervosa. METHOD: Participants completed an ecological momentary assessment protocol for a period of 2 weeks. RESULTS: Mixed-effects and multilevel logistic models revealed significant variation across time of day and day of the week in the occurrence of binging, vomiting, positive and negative affect, and the severity and types of stressful events. DISCUSSION: These findings explicate how momentary and daily experiences vary in the natural environments of women with bulimia nervosa, and document critical time periods for intervention.

Soares-Miranda L, Sandercock G, Valente H, Vale S, Santos R, Mota J. (Sep 2009). Vigorous physical activity and vagal modulation in young adults. Eur J Cardiovasc Prev Rehabil. [Epub ahead of print]

BACKGROUND: Aerobic exercise leads to reduced sympathetic and increased cardiac vagal modulation, providing an antiarrhythmic effect. The optimal exercise intensity to promote this adaptation remains undefined. The aims of the present investigation were twofold. First, to examine differences in heart rate variability (HRV) measures in participants with different levels of objectively measured physical activity (PA). Second, to identify the characteristic of PA which most influences the cardiac autonomic nervous system (cANS) function in young adults. METHODS: Cross-sectional evaluation of 84 adults examining relationships between PA amount and intensities, measured by accelerometry, cANS function derived from HRV. Groups were created based on tertiles of PA and analysis of covariance was used to assess between-group differences in HRV. Stepwise regression analysis was used to determine the characteristic of PA, which best predicted vagal HRV indices. RESULTS: There were significantly higher levels of vagal HRV indices in the most active group compared with the least active group. Regression analysis revealed that the number of bouts of vigorous PA undertaken was the best predictor of the vagal HRV indices assessed. CONCLUSION: This study suggests that vagal modulation is enhanced with high levels of PA and that it is the number of bouts of vigorous PA that is most closely associated with cANS function.

Solhan MB, Trull TJ, Jahng S, Wood PK. (Sep 2009). Clinical assessment of affective instability: comparing EMA indices, questionnaire reports, and retrospective recall. Psychol Assess, 21(3), 425-36

Traditional self-report measures of psychopathology may be influenced by a variety of recall biases. Ecological momentary assessment (EMA) reduces these biases by assessing individuals’ experiences as they occur in their natural environments. This study examines the discrepancy between trait questionnaire, retrospective report, and EMA measures of affective instability in psychiatric outpatients either with a borderline personality diagnosis (n = 58) or with a current episode of major depressive disorder or dysthymia (n = 42). The authors examined the agreement of 3 trait measures of affective instability-the Affective Instability subscale of the Personality Assessment Inventory-Borderline Features scale (L. C. Morey, 1991), the Affect Intensity Measure (R. J. Larsen, E. Diener, & R. Emmons, 1986), and the Affect Lability Scales (P. D. Harvey, B. R. Greenberg, & M. R. Serper, 1989)-and 1 retrospective mood recall task with EMA indices of mood and mood instability. Results indicate only modest to moderate agreement between momentary and questionnaire assessments of trait affective instability; agreement between recalled mood changes and EMA indices was poor. Implications for clinical research and practice and possible applications of EMA methodology are discussed.

Steele RM, van Sluijs EM, Cassidy A, Griffin SJ, Ekelund U. (Sep 2009). Targeting sedentary time or moderate- and vigorous-intensity activity: independent relations with adiposity in a population-based sample of 10-y-old British children. Am J Clin Nutr. [Epub ahead of print]

PMID: 19776141 [PubMed - as supplied by publisher] BACKGROUND: It is unclear whether subcomponents of physical activity (PA) are associated with adiposity independent of time spent while sedentary. OBJECTIVE: The objective was to examine associations between objectively measured PA and its subcomponents [ie, time spent at light-intensity PA, moderate-intensity PA (MPA), vigorous-intensity PA (VPA), and moderate-plus-vigorous-intensity PA (MVPA)], independent of sedentary time, and self-reported leisure screen time (television and electronic game use) with indexes of adiposity in a population-based sample of British children. DESIGN: A cross-sectional study was conducted in 1862 UK children aged 9-10 y. PA and sedentary activity were measured by accelerometry, and indicators of adiposity were waist circumference, body mass index (BMI), and fat mass index calculated from bioimpedance measurements. Screen time was assessed by self-report. We examined the associations between PA subcomponents and adiposity by multilevel linear models adjusted for birth weight, maternal BMI, energy intake, and sleep duration. RESULTS: Objectively measured sedentary time was positively associated with waist circumference (P = 0.04) and fat mass index (P = 0.05), independent of age and sex. However, this association was attenuated after adjustment for MVPA and other covariates. VPA (all P < 0.0001), combined MVPA (all P < 0.01), and total activity (counts/min) (all P < 0.001) were all inversely associated with each of the adiposity indexes, independent of sedentary time and other important covariates. Associations were weaker for MPA: P = 0.05, 0.87, and 0.1 for waist circumference, BMI, and fat mass index, respectively. CONCLUSIONS: Time spent in VPA appears to be more strongly associated with adiposity than sedentary time. Interventions may therefore need to incorporate higher intensity-based activities to curb the growing obesity epidemic.

Stone MR, Rowlands AV, Eston RG. (Aug 2009). Characteristics of the activity pattern in normal weight and overweight boys. Prev Med, 49(2-3), 205-8

OBJECTIVE: To assess whether the activity pattern differs between normal weight and overweight boys across weekdays and weekend days. METHODS: Physical activity was recorded every 2 s by accelerometry in 32 normal weight and 15 overweight boys aged 8-10 years for four weekdays and two weekend days (South-West England 2007). Summary activity measures and activity pattern characteristics (frequency, intensity and duration of > or =4 s (short) and > or =5-min (long) bouts of > or =light, > or =moderate, > or =vigorous, and > or =hard activity) were recorded. RESULTS: Normal weight boys accumulated more > or =hard activity (p<0.05) but other summary measures did not differ by weight status. However, the activity pattern differed in overweight relative to normal weight boys. The most frequent short bouts were shorter and less intense (p<0.05). All long bouts were less intense and > or =moderate long bouts were shorter and less frequent (p<0.05). Overall, less activity was accumulated on weekends (frequency of more intense short bouts, intensity of most frequent long bouts and duration of > or =light, > or =moderate (and for overweight boys > or =vigorous) short bouts dropped-off) (p<0.05). CONCLUSION: Despite equivalent summary activity measures overweight boys exhibited fewer and shorter bouts, particularly sustained > or =moderate bouts, relative to normal weight boys suggesting that the activity pattern may be important for weight control.

Sund ZM, Powell T, Greenwood R, Jarad NA. (Sep 2009). Remote daily real-time monitoring in patients with COPD –a feasibility study using a novel device. Respir Med, 103(9), 1320-8

New technologies have allowed remote real-time electronic recording of symptoms and spirometry. The feasibility of utilising this technology in COPD patients has not been investigated. This is a feasibility study. The primary objective is to determine whether the use of an electronic diary with a portable spirometer can be performed by COPD patients with a moderate to severe disease. Secondary objectives are to investigate the value of this method in early detection of acute exacerbations of COPD (AECOPD). In this 6-month study, 18 patients recorded daily their symptom score and spirometry. Data was sent on real time. AECOPD which was defined according to pre-set criteria were noted. Spirometry values and scores for health-related quality of life were compared between the start and the end of the study. Hospitalisation rate due to AECOPD was compared with a parallel period in the previous year. On average, patients were able to record 77% of their total study days. The system detected 73% of AECOPD. In further 27% of AECOPD patients sought treatment although the change in symptoms did not meet AECOPD definition. The number of COPD-related hospitalisations significantly reduced compared to the previous year. There was a significant increase in FEV(1) and FVC from the start to the end of the study. The remote monitoring device used in this study can be used in COPD patients. AECOPD was detected early in the majority of cases. Hospitalisation rate due to AECOPD was reduced and FEV(1) and FVC values increased during the study.

Udachina A, Thewissen V, Myin-Germeys I, Fitzpatrick S, O’kane A, Bentall RP. (Sep 2009). Understanding the relationships between self-esteem, experiential avoidance, and paranoia: structural equation modelling and experience sampling studies. J Nerv Ment Dis, 197(9), 661-8

Hypothesized relationships between experiential avoidance (EA), self-esteem, and paranoia were tested using structural equation modeling in a sample of student participants (N = 427). EA in everyday life was also investigated using the Experience Sampling Method in a subsample of students scoring high (N = 17) and low (N = 15) on paranoia. Results showed that paranoid students had lower self-esteem and reported higher levels of EA than nonparanoid participants. The interactive influence of EA and stress predicted negative self-esteem: EA was particularly damaging at high levels of stress. Greater EA and higher social stress independently predicted lower positive self-esteem. Low positive self-esteem predicted engagement in EA. A direct association between EA and paranoia was also found. These results suggest that similar mechanisms may underlie EA and thought suppression. Although people may employ EA to regulate self-esteem, this strategy is maladaptive as it damages self-esteem, incurs cognitive costs, and fosters paranoid thinking.

van Weering MG, Vollenbroek-Hutten MM, Tönis TM, Hermens HJ. (Jul 2009). Daily physical activities in chronic lower back pain patients assessed with accelerometry. Eur J Pain, 13(6), 649-54

BACKGROUND: Normalization of activities in daily living is an important goal in rehabilitation treatment of chronic lower back pain (CLBP) patients. Clinicians indicate that CLBP patients often show deconditioning but also CLBP patients who seem to be too active are seen. The objective of the present cross-sectional study was to gain more insight into the daily activity pattern of CLBP patients compared to controls, using accelerometry. METHODS: Daily activities were assessed by measuring body movement with a tri-axial accelerometer that was worn for seven consecutive days during waking hours. Measurements were performed in the daily environment (in-doors and out-doors) of the participant. Differences between activity level, time of day and work status were tested. RESULTS: Data were obtained from 29 CLBP patients and 20 controls. Results show that the overall activity levels of patients (mean 0.75; SD 0.43) are not significantly different from those of controls (mean 0.71; SD 0.44). However, patients show significantly higher activity levels in the morning (p<0.001) and significantly lower activity levels in the evening (p<0.01) compared to controls. No significant differences in activity levels were found between leisure time and working days within either group; furthermore no significant differences in activity levels were found between patients with different work status. CONCLUSION: Overall activity levels do not differ significantly between CLBP patients and controls, but the distribution of activities over the day differs significantly.

van Zundert RM, Engels RC. (Aug 2009). Parental Factors in Association with Adolescent Smoking Relapse. Eur Addict Res, 15(4), 209-215

The present study examined the role of parents in smoking relapse among adolescents who embarked on a serious attempt to quit. Participants were 135 adolescents aged 15-20 years who smoked daily and participated in an ecological momentary assessment study. Daily questions about their quitting experiences were administered during 4 weeks. Longitudinal logistic regression analyses were applied to test whether parental smoking, expected parental support, parental norms about cessation, and smoking cessation-specific parenting at baseline predicted the first lapse into smoking as well as mild and heavy relapse during the 4-week period, and abstinence at follow-up 2 months later. Neither parental smoking nor hardly any of the parenting variables explained successful smoking cessation among adolescents, except for expected parental support. Although parents have been found to be influential in the development of adolescent smoking, our findings suggest that parents’ influence is limited when it concerns actual smoking cessation and relapse.

Varela M, Cuesta D, Madrid JA, Churruca J, Miro P, Ruiz R, Martinez C. (Jul 2009). Holter monitoring of central and peripheral temperature: possible uses and feasibility study in outpatient settings. J Clin Monit Comput, 23(4), 209-16

BACKGROUND: Conventional clinical thermometry has important limitations. A continuous monitoring of temperature may offer significant advantages, including the use of chronobiological and complexity analysis of temperature profile and eventually the identification of a “pre-febrile” pattern. OBJECTIVE: We present a clinical model designed to measure, store and/or transmit in real time a central and a peripheral temperature reading. The results of its use in a healthy, free-living population is reported. METHODS: Thirty subjects (15 women, 15 men, 20-70 years old), were monitored for 24 h while following their normal life. Temperatures were recorded every minute at the external auditory channel (EAC) and on the skin, at the intersection of the 5th intercostal space and the anterior axillary line. A Cosinor analysis and Approximate Entropy (ApEn) (m = 2, r = 0.15*SD, N = 180) were calculated for both temperatures. RESULTS: Median temperature was 35.55 degrees C [interquartile range (IR) 0.77 degrees C] in the external auditory channel (EAC) and 34.62 degrees C (IR 1.61) in the specified skin location. Median gradient between AEC and skin was 0.93 (IR 1.57). A circadian rhythm was present both in EAC and skin temperature, with a mean amplitude of 0.44 degrees C and an acrophase at 21:02 for the EAC and 0.70 degrees C and 00:42 for the skin. During the night there was a sizable increase in peripheral temperature, with a decrease in gradient and a loss of complexity in the temperature profile, most significantly in the peripheral temperature. CONCLUSIONS: Continuous monitoring of central and peripheral temperature may be a helpful tool in both ambulatory and admitted patients and may offer new approaches in clinical thermometry.

Walther S, Horn H, Razavi N, Koschorke P, Müller TJ, Strik W. (Sep 2009). Quantitative Motor Activity Differentiates Schizophrenia Subtypes. Neuropsychobiology, 60(2), 80-86

Background: Motor symptoms are frequent in schizophrenia and relevant to the diagnosis of subtypes. However, the assessment has been limited to observations recorded in scales and experimental designs. The aim of this study was to use wrist actigraphy to obtain motor activity data in 3 schizophrenia subtypes. Methods: In total, 60 patients with schizophrenia (35 paranoid, 12 catatonic, 13 disorganized) were investigated using continuous wrist actigraphy over 24 h in an inpatient setting on average 38 days after admission. Data of the wakeful hours of the day were analyzed. Results: The activity level was predicted by schizophrenia subtype and by the type of antipsychotic medication. The movement index and mean duration of uninterrupted immobility were found to be predicted only by the schizophrenia subtype. Age, gender, duration of illness and chlorpromazine equivalents did not contribute to the variance of the activity data. A MANOVA demonstrated the significant differences in the 3 parameters between schizophrenia subtypes (p = 0.001). Patients with catatonic schizophrenia had lower activity levels, a lower movement index and a longer duration of immobility than those with paranoid schizophrenia. Conclusions: Schizophrenia subtypes can be differentiated using objective measures of quantitative motor activity. The increased duration of immobility appears to be the special feature of catatonic schizophrenia.

Wichers M, Schrijvers D, Geschwind N, Jacobs N, Myin-Germeys I, Thiery E, Derom C, Sabbe B, Peeters F, Delespaul P, van Os J. (Jul 2009). Mechanisms of gene-environment interactions in depression: evidence that genes potentiate multiple sources of adversity. Psychol Med, 39(7), 1077-86

BACKGROUND: Previous work suggests that daily life stress-sensitivity may be an intermediary phenotype associated with both genetic risk for depression and developmental stress exposures. In the current analysis we hypothesized that genetic risk for depression and three environmental exposures over the course of development [prenatal stress, childhood adversity and adult negative life events (NLEs)] combine synergistically to produce the phenotype of stress-sensitivity. METHOD: Twin pairs (n=279) participated in a momentary assessment study using the Experience Sampling Method (ESM), collecting appraisals of stress and negative affect (NA) in the flow of daily life. Prospective data on birthweight and gestational age, questionnaire data on childhood adversity and recent NLEs, and interview data on depression were used in the analyses. Daily life stress-sensitivity was modelled as the effect of ESM daily life stress appraisals on ESM NA. RESULTS: All three developmental stress exposures were moderated by genetic vulnerability, modelled as dizygotic (DZ) or monozygotic (MZ) co-twin depression status, in their effect on daily life stress-sensitivity. Effects were much stronger in participants with MZ co-twin depression and a little stronger in participants with DZ co-twin depression status, compared to those without co-twin depression. NLE main effects and NLE genetic moderation were reducible to birthweight and childhood adversity. CONCLUSIONS: The findings are consistent with the hypothesis that adult daily life stress-sensitivity is the result of sensitization processes initiated by developmental stress exposures. Genes associated with depression may act by accelerating the process of stress-induced sensitization.

Yoon Y, Cho JH, Yoon G. (Aug 2009). Non-constrained blood pressure monitoring using ECG and PPG for personal healthcare. J Med Syst, 33(4), 261-6

Blood pressure (BP) is one of the important vital signs that need to be monitored for personal healthcare. Arterial blood pressure (BP) was estimated from pulse transit time (PTT) and PPG waveform. PTT is a time interval between an R-wave of electrocardiography (ECG) and a photoplethysmography (PPG) signal. This method does not require an aircuff and only a minimal inconvenience of attaching electrodes and LED/photo detector sensors on a subject. PTT computed between the ECG R-wave and the maximum first derivative PPG was strongly correlated with systolic blood pressure (SBP) (R = -0.712) compared with other PTT values, and the diastolic time proved to be appropriate for estimation diastolic blood pressure (DBP) (R = -0.764). The percent errors of SBP using the individual regression line (4-11%) were lower than those using the regression line obtained from all five subjects (9-14%). On the other hand, the DBP estimation did not show much difference between the individual regression (4-10%) and total regression line (6-10%). Our developed device had a total size of 7 x 13.5 cm and was operated by single 3-V battery. Biosignals can be measured for 72 h continuously without external interruptions. Through a serial network communication, an external personal computer can monitor measured waveforms in real time. Our proposed method can be used for non-constrained, thus continuous BP monitoring for the purpose of personal healthcare.

Young DR, Jerome GJ, Chen C, Laferriere D, Vollmer WM. (Jul 2009). Patterns of physical activity among overweight and obese adults. Prev Chronic Dis, 6(3),  A90

INTRODUCTION: Little is known about patterns of physical activity in overweight and obese adults, although they are at high risk for chronic disease and can benefit from physical activity. We describe patterns of moderate-to-vigorous physical activity (MVPA) and MVPA in bouts of 10 minutes or longer in overweight and obese adults. METHODS: Overweight and obese participants (n = 1,648) who were screened for the multicenter Weight Loss Maintenance Trial wore RT3 accelerometers for at least 3 weekdays and 1 weekend day. We determined minutes spent in moderate physical activity, vigorous physical activity, and MVPA overall, by weekday vs weekend, and by time of day. We also measured bouts of at least 10 minutes of sustained MVPA. RESULTS: Participants were active for an average of 15.8 minutes per day. Among those who engaged in bouts of MVPA, the average bout was 33.3 minutes long. Participants who were younger than 50 years, male, non-African American, or overweight were more active than were those who were older than 50, female, African American, or obese. Participants were more active on weekends than on weekdays and in the morning than in the afternoon or evening. Only 2% of participants were active for 60 or more minutes per day. CONCLUSION: We found differences in physical activity patterns by demographic characteristics, day, and time of day. Weekend mornings may be an opportune time to promote additional physical activity.

Zanobetti A, Stone PH, Speizer FE, Schwartz JD, Coull BA, Suh HH, Nearing BD, Mittleman MA, Verrier RL, Gold DR. (Sep 2009). T-wave alternans, air pollution and traffic in high-risk subjects. Am J Cardiol, 104(5), 665-70

Particulate pollution has been linked to risk for cardiac death; possible mechanisms include pollution-related increases in cardiac electrical instability. T-wave alternans (TWA) is a marker of cardiac electrical instability measured as differences in the magnitude between adjacent T waves. In a repeated-measures study of 48 patients aged 43 to 75 years, associations of ambient and home indoor particulate pollution, including black carbon (BC) and reports of traffic exposure, with changes in 0.5-hourly maximum TWA (TWA-MAX), measured by 24-hour Holter electrocardiographic monitoring, were investigated. Each patient was observed up to 4 times within 1 year after percutaneous intervention for myocardial infarction, acute coronary syndromes without infarction, or stable coronary artery disease, for a total of 5,830 0.5-hour observations. Diary data for each 0.5-hour period defined whether a patient was home or not home, or in traffic. Increases in TWA-MAX were independently associated with the previous 2-hour mean ambient BC (2.1%, 95% confidence interval 0.9% to 3.3%) and with being in traffic in the previous 2 hours (6.1%, 95% confidence interval 3.4% to 8.8%). When subjects were home, indoor home BC effects were largest and most precise; when subjects were away from home, ambient central site BC effects were strongest. Increases in pollution increased the odds of TWA-MAX > or =75th percentile (odds ratio 1.4, 95% confidence interval 1.2 to 1.6 for a 1 microg/m(3) increase in 6-hour mean BC). In conclusion, after hospitalization for coronary artery disease, being in traffic and short-term ambient or indoor BC exposure increased TWA, a marker of cardiac electrical instability.


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