Society for Ambulatory Assessment

Fourth quarter 2014 (October to December)

Abraham, Lucy; Humphrey, Louise; Arbuckle, Rob; Dennerstein, Lorraine; Simon, James A.; Mirkin, Sebastian et al. (2014): Qualitative cross-cultural exploration of breast symptoms and impacts associated with hormonal treatments for menopausal symptoms to inform the development of new patient-reported measurement tools. In: Maturitas. DOI: 10.1016/j.maturitas.2014.11.019.

To explore cross-cultural experiences of women taking estrogen plus progestin therapies (EPT) and develop a symptom-based electronic diary and impact questionnaire for EPT-related breast symptoms. (1) Concept elicitation interviews were conducted with women in the US (n=14), Italy (n=15), Mexico (n=15) and China (n=15) to explore breast symptoms associated with EPT. Patients completed the Breast Sensitivity Questionnaire (BSQ) to evaluate understanding and comprehensiveness. (2) Based on concept elicitation, a 6-item eDiary (Breast Pain/Tenderness Daily Diary - BPT-DD) was generated and the BSQ modified forming the 18-item Breast Sensations Impact Questionnaire (BSIQ). (3) The measures were pilot-tested and then cognitively debriefed with US women receiving EPT. All qualitative data was subject to thematic analysis. Concept elicitation identified breast pain/tenderness, swollen breasts and sensitivity to contact as important symptoms, impacting women’s emotional well-being, relationships with family/friends, social life, sleep, ability to move freely, contact, clothing and sexual activity. Experiences were relatively consistent across the country samples. Based on pilot testing and cognitive debriefing, the BPT-DD was reduced to 4 items (and renamed the Breast Pain Daily Diary - BP-DD) and the BSIQ was reduced to 13 items due to conceptual redundancy. Women taking EPT in the US, China, Mexico and Italy reported breast sensations that have a detrimental impact on quality of life. Two new measures were developed to assess the severity and impact of breast pain specific to EPT. This work highlights that EPT-related symptoms should be part of treatment decision-making, and treatments with less burdensome side effects are needed.

Allard, Michele; Husky, Mathilde; Catheline, Gwenaelle; Pelletier, Amandine; Dilharreguy, Bixente; Amieva, Helene et al. (2014): Mobile technologies in the early detection of cognitive decline. In: PLoS One 9 (12), S. e112197. DOI: 10.1371/journal.pone.0112197.

The identification of biological and pathophysiological processes implicated in different forms of dementia is itself dependent on reliable descriptions of cognitive performance and capacities. However, traditional instruments are often unable to detect subtle declines in cognitive functions due to natural variation at the time of testing. Mobile technologies permit the repeated assessment of cognitive functions and may thereby provide more reliable descriptions of early cognitive difficulties that are inaccessible to clinic or hospital-based instruments. This assessment strategy is also able to characterize in real-time the dynamic associations between cognitive performance and specific daily life behaviors or activities. In a cohort of elderly rural residents, 60 individuals were administered neuropsychological and neuroimaging exams as well as a one-week period of electronic ambulatory monitoring of behavior, semantic memory performance, and daily life experiences. Whereas imaging markers were unrelated to traditional neuropsychological test scores, they were significantly associated with mobile assessments of semantic memory performance. Moreover, certain daily life activities such as reading or completing crossword puzzles were associated with increases in semantic memory performance over the subsequent hours of the same day. The revolution in mobile technologies provides unprecedented opportunities to overcome the barriers of time and context that characterize traditional hospital and clinical-based assessments. The combination of both novel and traditional methods should provide the best opportunity for identifying the earliest risk factors and biomarkers for Alzheimer’s disease and other forms of dementia.

Audrain-McGovern, Janet; Wileyto, E. Paul; Ashare, Rebecca; Cuevas, Jocelyn; Strasser, Andrew A. (2014): Reward and affective regulation in depression-prone smokers. In: Biological Psychiatry 76 (9), S. 689–697. DOI: 10.1037/t03774-000;

Background: There is a disproportionately high smoking prevalence among individuals who are prone to depression. While depression has been conceptualized as a disorder of dysregulated positive affect and disrupted reward processing, little research has been conducted to determine the role of smoking in these processes among depression-prone smokers. Methods: Depression-prone smokers (DP+; n = 34) and smokers not depression-prone (DP−; n = 49) underwent two laboratory sessions, one while smoking abstinent and one while smoking ad libitum, to assess the relative reinforcing value of smoking and reward sensitivity. Using experience sampling methods, participants completed self-report measures of subjective reward, positive affect, and negative affect across 3 days while smoking as usual and 3 days while smoking abstinent. Results: DP+ were two times more likely to work for cigarette puffs versus money in a progressive ratio, choice task (odds ratio 2.05; 95% confidence interval 1.04 to 4.06, p = .039) compared with DP−. Reward sensitivity as measured by the signal detection task did not yield any significant findings. Mixed models regressions revealed a three-way interaction (depression group, smoking phase, and time) for subjective reward, negative affect, and positive affect. For all three of these outcomes, the slopes for DP− and DP+ differed significantly from each other (ps < .05) and the effect of smoking (versus abstinence) over time was greater for DP+ than DP− smokers (ps < .05). Conclusions: These findings indicate that the effects of smoking on reward and positive affect regulation are specific to DP+ smokers and highlight novel targets for smoking cessation treatment in this population.

Baig, Mirza Mansoor; GholamHosseini, Hamid; Connolly, Martin J. (2014): Mobile healthcare applications: system design review, critical issues and challenges. In: Australas Phys Eng Sci Med. DOI: 10.1007/s13246-014-0315-4.

Mobile phones are becoming increasingly important in monitoring and delivery of healthcare interventions. They are often considered as pocket computers, due to their advanced computing features, enhanced preferences and diverse capabilities. Their sophisticated sensors and complex software applications make the mobile healthcare (m-health) based applications more feasible and innovative. In a number of scenarios user-friendliness, convenience and effectiveness of these systems have been acknowledged by both patients as well as healthcare providers. M-health technology employs advanced concepts and techniques from multidisciplinary fields of electrical engineering, computer science, biomedical engineering and medicine which benefit the innovations of these fields towards healthcare systems. This paper deals with two important aspects of current mobile phone based sensor applications in healthcare. Firstly, critical review of advanced applications such as; vital sign monitoring, blood glucose monitoring and in-built camera based smartphone sensor applications. Secondly, investigating challenges and critical issues related to the use of smartphones in healthcare including; reliability, efficiency, mobile phone platform variability, cost effectiveness, energy usage, user interface, quality of medical data, and security and privacy. It was found that the mobile based applications have been widely developed in recent years with fast growing deployment by healthcare professionals and patients. However, despite the advantages of smartphones in patient monitoring, education, and management there are some critical issues and challenges related to security and privacy of data, acceptability, reliability and cost that need to be addressed.

Baquero, Giselle A.; Banchs, Javier E.; Ahmed, Shameer; Naccarelli, Gerald V.; Luck, Jerry C. (2015): Surface 12 lead electrocardiogram recordings using smart phone technology. In: J Electrocardiol 48 (1), S. 1–7. DOI: 10.1016/j.jelectrocard.2014.09.006.

IMPORTANCE: AliveCor ECG is an FDA approved ambulatory cardiac rhythm monitor that records a single channel (lead I) ECG rhythm strip using an iPhone. In the past few years, the use of smartphones and tablets with health related applications has significantly proliferated. OBJECTIVE: In this initial feasibility trial, we attempted to reproduce the 12 lead ECG using the bipolar arrangement of the AliveCor monitor coupled to smart phone technology. METHODS: We used the AliveCor heart monitor coupled with an iPhone cellular phone and the AliveECG application (APP) in 5 individuals. RESULTS: In our 5 individuals, recordings from both a standard 12 lead ECG and the AliveCor generated 12 lead ECG had the same interpretation. CONCLUSIONS: This study demonstrates the feasibility of creating a 12 lead ECG with a smart phone. The validity of the recordings would seem to suggest that this technology could become an important useful tool for clinical use. This new hand held smart phone 12 lead ECG recorder needs further development and validation.

Berendsen, Brenda A J; Hendriks, Marike R C; Willems, Paul; Meijer, Kenneth; Schaper, Nicolaas C.; Savelberg, Hans H C M (2014): A 20 min window is optimal in a non-wear algorithm for tri-axial thigh-worn accelerometry in overweight people. In: Physiol Meas 35 (11), S. 2205–2212. DOI: 10.1088/0967-3334/35/11/2205.

A valid non-wear algorithm for activity monitors is crucial to avoid the misclassification of sedentary time as non-wear time, and vice versa. Characteristics of the algorithm, such as time windows, should be well defined and tested. Furthermore, using tri-axial data might influence the algorithm’s performance. This study assessed the optimal time window length in a non-wear algorithm for overweight adults, applied to tri-axial data from sixteen participants. Ten time windows, from 10 up to 120 min, were tested with a diary as a criterion measure. We assessed the bias in non-wear time, sensitivity and specificity. The optimal time window length was based on ten participants; the validation of this time window was carried out with six other participants. The time window of 20 min showed the highest and 120 min showed the lowest mean amount of correctly classified non-wear time, at 94% and 70% respectively. Sensitivity and specificity were considered optimal in the 20 min time window. Validation of this time window demonstrated a sensitivity and specificity of 86% and 83% respectively. A 20 min time window showed the best non-wear estimations. The current study utilized tri-axial raw data and 1 s epoch data which might have facilitated the application of a short time window and thereby decreased the risk of misclassifying non-wear.

BinDhim, Nasser F.; Hawkey, Alexandra; Trevena, Lyndal (2014): A Systematic Review of Quality Assessment Methods for Smartphone Health Apps. In: Telemed J E Health. DOI: 10.1089/tmj.2014.0088.

Abstract Introduction: There are large numbers of health-related applications (apps) available in various app stores for many smartphone devices. Consequently, increasing numbers of articles are attempting to evaluate the content and the quality of health-related smartphone apps for specific health conditions. The aim of this article is to describe and summarize the methodologies used to determine the quality of health-related apps targeting health consumers and to propose a set of criteria for evaluating the quality of smartphone health-related apps. Materials and Methods: In 2013, literature searches were performed using Medline and CINAHL, and we included all articles that had the aim of assessing the quality of health-related smartphone apps. The assessment method used in these studies was summarized and scored using a set of quality criteria developed for this study. Results: From 606 articles generated by the search, only 10 met the inclusion criteria. Based on our quality criteria, the mean score was 5.05 out of 8 (range, 2-7). Eighty percent of the studies did not identify the app store country in which the apps were found. Forty percent of the studies did not clearly mention whether they only had assessed the app description or had downloaded the app content for evaluation. Sixty percent of the studies did not provide a list of the apps they had evaluated. Overall, we identified six evaluation methodologies used to assess the quality of health-related apps described in Results. Conclusions: This article provides a summary of currently used methods for assessing the quality of smartphone health-related apps and proposes a set of criteria to enable future studies to consistently review health-related app quality in a standardized manner.

Borgogna, Nicholas; Lockhart, Ginger; Grenard, Jerry L.; Barrett, Tyson; Shiffman, Saul; Reynolds, Kim D. (2014): Ecological Momentary Assessment of Urban Adolescents’ Technology Use and Cravings for Unhealthy Snacks and Drinks: Differences by Ethnicity and Sex. In: J Acad Nutr Diet. DOI: 10.1016/j.jand.2014.10.015.

BACKGROUND: Adolescents’ technology use is generally associated with food cravings, but it is not clear whether specific types of technology elicit particular types of cravings or whether personal characteristics play a role in these associations. OBJECTIVE: We examined whether momentary associations between four technology types (ie, television, video games, computer messaging, and phone messaging) and cravings for unhealthy snack foods and sweetened drinks were moderated by youths’ sex, ethnicity, body mass index, and age. METHODS: Urban adolescents (N=158) aged 14 to 17 years provided momentary information about their technology use and food cravings during the course of 1 week and completed survey reports of their personal characteristics. We used multilevel modeling to determine momentary associations and interactions. RESULTS: Non-Hispanic adolescents showed stronger associations between television exposure and cravings for sweet snacks, salty snacks, and sweetened drinks. Being Hispanic was associated with stronger associations between phone messaging and cravings for sweet snacks, salty snacks, and sweetened drinks. Males showed stronger associations between video game use and salty snack cravings. CONCLUSIONS: As the public health field continues to monitor the effects of technology use on adolescents’ eating and overall health, it will be important to determine the extent to which these groups are differentially affected by different forms of technology.

Bowen, Kimberly S.; Uchino, Bert N.; Birmingham, Wendy; Carlisle, McKenzie; Smith, Timothy W.; Light, Kathleen C. (2014): The stress-buffering effects of functional social support on ambulatory blood pressure. In: Health Psychology 33 (11), S. 1440–1443. DOI: 10.1037/t06207-000;

Objective: Social support is a reliable predictor of cardiovascular health. According to the buffering hypothesis, stress is 1 mechanism by which support is able to affect physiological processes. However, most of the experimental evidence for the hypothesis comes from laboratory studies. Ambulatory blood pressure (ABP) protocols examine participants in their natural environment, where they are more likely to encounter personally relevant real-world stressors. Furthermore, prior work shows that examining support by its specific functional components reveals additional independent links to health. Methods: The current study aimed to examine the stress-buffering effects of functional social support on ABP. One hundred eighty-eight participants completed a 1-day ABP assessment along with measures of functional social support and both global perceived stress and momentary stress at time of reading. Results: Results indicated main effects for both stress measures. Global support, emotional, tangible, and informational support only moderated the effects of momentary stress, but not global stress, in predicting ABP. Informational support was the most consistent stress-buffering predictor of ABP, predicting both ambulatory systolic and diastolic blood pressure. Conclusions: The predicted values in ABP for informational support achieved health-relevant differences, emphasizing the value of examining functional support beyond global support alone.

Brenner, Christopher J.; Ben-Zeev, Dror (2014): Affective forecasting in schizophrenia: Comparing predictions to real-time Ecological Momentary Assessment (EMA) ratings. In: Psychiatric Rehabilitation Journal 37 (4), S. 316–320. DOI: 10.1037/t15771-000;

Objective: “Affective forecasting” refers to the predictions people make about future affective experiences. These predictions influence decision making, which in turn might impact individuals’ level of functioning, goal-directed behavior, and pursuit of potentially rewarding activities. In the current study, we explored affective forecasting in people diagnosed with schizophrenia. Method: Twenty-four participants with schizophrenia or schizoaffective disorder were asked to provide affective forecasts for an upcoming week. They were subsequently given a handheld mobile device that prompted them to complete “in-the-moment” positive affect (i.e., feeling active, excited, interested) and negative affect (i.e., jittery, scared, hostile, upset, guilty) ratings 6 times daily, over the next 7 days. Paired-sample t tests were used to compare forecasts to average weekly momentary ratings. Results: Participants expected more emotionally charged weeks than they actually experienced—both positive affect forecasts and negative affect forecasts were more intense than the average weekly ratings. Conclusions and Implications for Practice: The findings of the study have implications for psychiatric rehabilitation; outlining the differences between consumer forecasts (e.g., excessively pessimistic predictions, unrealistic expectations) and actual experience can serve as a component of psychosocial interventions, including motivational interviewing, goal setting, thought challenging, and vocational rehabilitation. Mobile technologies can be incorporated for short-term data collection in the context of these rehabilitation efforts.

Bruining, Nico; Caiani, Enrico; Chronaki, Catherine; Guzik, Przemyslaw; van der Velde, Enno (2014): Acquisition and analysis of cardiovascular signals on smartphones: potential, pitfalls and perspectives: by the Task Force of the e-Cardiology Working Group of European Society of Cardiology. In: Eur J Prev Cardiol 21 (2 Suppl), S. 4–13. DOI: 10.1177/2047487314552604.

Smartphones, mobile applications (‘apps’), social media, analytics, and the cloud are profoundly changing the practice of medicine and the way health decisions are made. With the constant progress of technology, the measurement of vital signals becomes easier, cheaper, and practically a standard approach in clinical practice. The interest in measuring vital signals goes beyond medical professionals to the general public, patients, informal caregivers, and healthy individuals, who frequently lack any formal medical training. On smartphone platforms such as iOS and Android, a proliferation of health or medical ‘apps’ acquire and analyse a variety of vital signs through embedded sensors, interconnected devices or peripherals utilising on occasion analytics and social media. Smartphone vendors compete with traditional medical device manufacturers in the grey area between health care, wellness, and fitness, as US and EU regulatory bodies are setting and revising rules for these new technologies. On the other hand, in the absence of robust validation results, clinicians are hesitant to trust measurements by apps or recommend specific apps to their patients, partly also due to lack of a cost reimbursement policy. This review focuses on the acquisition and analysis on smartphones of three important vital signs in the cardiovascular and respiratory field as well as in rehabilitation i.e. heart or pulse rate, blood pressure, and blood oxygenation. The potential, pitfalls, and perspectives on mobile devices and smartphone apps for health management by patients and healthy individuals are discussed.

Burbank, Allison J.; Lewis, Shannon D.; Hewes, Matthew; Schellhase, Dennis E.; Rettiganti, Mallikarjuna; Hall-Barrow, Julie et al. (2015): Mobile-based asthma action plans for adolescents. In: J Asthma, S. 1–4. DOI: 10.3109/02770903.2014.995307.

Abstract Purpose: To examine feasibility and utilization of a mobile asthma action plan (AAP) among adolescents. Methods: Adolescents (aged 12-17 years) with persistent asthma had their personalized AAP downloaded to a smartphone application. Teens were prompted by the mobile application to record either daily symptoms or peak flow measurements and to record medications. Once data were entered, the application provided immediate feedback based on the teen’s AAP instructions. Asthma Control Test (ACT(R)) and child asthma self-efficacy scores were examined pre- and post-intervention. Results: Adolescents utilized the mobile AAP a median 4.3 days/week. Participant satisfaction was high with 93% stating that they were better able to control asthma by utilizing the mobile AAP. For participants with uncontrolled asthma at baseline, median (interquartile range) ACT scores improved significantly from 16 (5) to 18 (8) [p = 0.03]. Median asthma attack prevention self-efficacy scores improved from 34 (3.5) to 36 (5.3) [p = 0.04]. Conclusions: Results suggest that personalized mobile-based AAPs are a feasible method to communicate AAP instructions to teens.

Businelle, Michael S.; Ma, Ping; Kendzor, Darla E.; Reitzel, Lorraine R.; Chen, Minxing; Lam, Cho Y. et al. (2014): Predicting quit attempts among homeless smokers seeking cessation treatment: An ecological momentary assessment study. In: Nicotine & Tobacco Research 16 (10), S. 1371–1378. DOI: 10.1037/t32635-000;

Introduction: Homeless adults are more likely to smoke tobacco and are less likely to successfully quit smoking than smokers in the general population, despite comparable numbers of cessation attempts and desire to quit. To date, studies that have examined smoking cessation in homeless samples have used traditional lab/clinic-based assessment methodologies. Real-time assessment of key variables may provide new insights into the process of quitting among homeless smokers. Methods: The purpose of the current study was to identify predictors of a quit attempt using real-time assessment methodology during the 6 days prior to a scheduled quit attempt among homeless adults seeking care at a shelter-based smoking cessation clinic. Parameters for multiple variables (i.e., motivation for quitting, smoking expectancies, quit self-efficacy, smoking urges, negative affect, positive affect, restlessness, hostility, and stress) were calculated and were used as predictors of biochemically verified quit date abstinence (i.e., ≥13 hr abstinent) using logistic regression analyses. Results: Participants (n = 57) were predominantly male (59.6%), non-White (68.4%), and smoked an average of 18 cigarettes per day. A total of 1,132 ecological momentary assessments (83% completion rate) were collected at random times (i.e., up to 4 assessments/day) during the 6 days prior to a scheduled quit attempt. Results indicated that declining (negative slope) negative affect, restlessness, and stress predicted quit date abstinence. Additionally, increasing positive coping expectancies across the prequit week predicted quit date abstinence. Conclusions: Study findings highlight multiple variables that may be targeted during the precessation period to increase smoking cessation attempts in this difficult to treat population of smokers.

Bussing, Regina; Reid, Adam M.; McNamara, Joseph P H; Meyer, Johanna M.; Guzick, Andrew G.; Mason, Dana M. et al. (2014): A pilot study of actigraphy as an objective measure of SSRI activation symptoms: Results from a randomized placebo controlled psychopharmacological treatment study. In: Psychiatry Res. DOI: 10.1016/j.psychres.2014.11.070.

Selective serotonin reuptake inhibitors (SSRIs) are an efficacious and effective treatment for pediatric obsessive-compulsive disorder (OCD) but have received scrutiny due to a potential side effect constellation called activation syndrome. While recent research introduced a subjective measure of activation syndrome, objective measures have not been tested. This pilot study, using data from a larger randomized-controlled trial, investigated the potential of actigraphy to provide an objective measure of activation symptoms in 44 youths with OCD beginning an SSRI medication regimen. Data were collected over the first four weeks of a multi-site, parallel, double-blind, randomized, placebo controlled psychopharmacological treatment study and statistical modeling was utilized to test how activation syndrome severity predicts daily and nightly activity levels. Results indicated that youths with higher activation symptoms had lower daytime activity levels when treatment averages were analyzed; in contrast youths who experienced onset of activation symptoms one week were more likely to have higher day-time and night-time activity ratings that week. Results support actigraphy as a potential objective measure of activation symptoms. Subsequent studies are needed to confirm these findings and test clinical applications for use by clinicians to monitor activation syndrome during SSRI treatment. National Institutes of Health (5UO1 MH078594-01); NCT00382291.

Chang, Ta-Yuan; Liu, Chiu-Shong; Hwang, Bing-Fang; Hsieh, Hsiu-Hui; Bao, Bo-Ying; Chen, Chiou-Jong et al. (2014): Acute effects of noise exposure on 24-h ambulatory blood pressure in hypertensive adults. In: J Hypertens. DOI: 10.1097/HJH.0000000000000418.

OBJECTIVE:: Noise exposure is associated with elevated blood pressure, but the effects on susceptible workers have not been reported. This repeated-measure study investigated the effects of noise exposure on 24-h ambulatory blood pressure among hypertensive, pre-hypertensive, and normotensive adults. METHODS:: We enrolled 113 volunteers in an occupational cohort in 2009. Individual noise exposure and personal blood pressure were measured simultaneously over 24 h on working and non-working days. Linear mixed-effects regressions were used to estimate the effects on SBP and DBP by controlling for potential confounders. RESULTS:: Each A-weighted decibel (dBA) increase in a 30-min time-lagged exposure was associated with transient elevations of work-time SBP [0.30 (95% confidence interval: 0.06, 0.54) mmHg] on working days as well as sleep-time SBP [0.39 (0.12, 0.66) mmHg] and DBP [0.33 (0.14, 0.51) mmHg] on non-working days among 19 hypertensive adults. In contrast, 46 normotensive workers had transient increases in work-time SBP [0.16 (0.03, 0.29) mmHg] and DBP [0.25 (0.15, 0.34) mmHg] on working days as well as sleep-time SBP [0.17 (0.06, 0.29) mmHg] and DBP [0.21 (0.14, 0.29) mmHg] on non-working days caused by a 1-dBA increase in the current exposure. All groups had sustained increases in 24-h average ambulatory SBP and DBP induced by noise exposure on 2 days, but the hypertensive workers had the most pronounced increase in SBP. CONCLUSION:: Hypertensive adults are more susceptible to noise exposure with a greater effect on ambulatory SBP. These results suggest a need for more protection for this subpopulation.

Daniels, Kevin; Glover, Jane; Mellor, Nadine (2014): An experience sampling study of expressing affect, daily affective well‐being, relationship quality, and perceived performance. In: Journal of Occupational and Organizational Psychology 87 (4), S. 781–805.

Few studies have directly examined the processes through which workers use job resources, such as job control and social support, to regulate affect. We focused on affective expression, which is a specific form of affect regulation. We investigated the extent to which workers used both job control and social support to express affect. Thirty‐nine call centre workers provided data up to four times a day over five consecutive working days (number of observations = 272). Executing job control to allow workers to express affect was related to using social support to express affect. Workers’ understanding of their personal goals mediated relationships between using social support to express affect and four outcomes (negative affect, positive affect, perceived performance, and quality of workplace relationships). Perceived empathy mediated relationships between using social support to express affect and three outcomes (negative affect, positive affect, and quality of workplace relationships). The findings indicated that (1) one job resource can be used to facilitate using another job resource for affect regulation and (2) different job resources may play different roles in conferring benefits from affective expression. Practitioner points· Jobs cannot be treated as static entities with fixed characteristics. Rather workers will use resources embedded in job design for specific purposes. · Job redesign interventions intended to enhance affective well‐being need to take account of the social and cognitive processes that mediate the relationship between work and affective well‐being. · Job redesign interventions need to integrate information about dynamic processes in which use of one job resource can enable use of another job resource.

Del Rosario, Michael B; Wang, Kejia; Wang, Jingjing; Liu, Ying; Brodie, Matthew; Delbaere, Kim et al. (2014): A comparison of activity classification in younger and older cohorts using a smartphone. In: Physiol Meas 35 (11), S. 2269–2286. DOI: 10.1088/0967-3334/35/11/2269.

Automatic recognition of human activity is useful as a means of estimating energy expenditure and has potential for use in fall detection and prediction. The emergence of the smartphone as a ubiquitous device presents an opportunity to utilize its embedded sensors, computational power and data connectivity as a platform for continuous health monitoring. In the study described herein, 37 older people (83.9 +/- 3.4 years) performed a series of activities of daily living (ADLs) while a smartphone (containing a triaxial accelerometer, triaxial gyroscope and barometric pressure sensor) was placed in the front pocket of their trousers. These results are compared to a similar trial conducted previously in which 20 young people (21.9 +/- 1.65 years) were asked to perform the same ADLs using the same smartphone (again in the front pocket of their trousers).In each trial, the participants were asked to perform several activities (standing, sitting, lying, walking on level ground, up and down staircases, and riding an elevator up and down) in a free-living environment. During each acquisition session, the internal sensor signals were recorded and subsequently used to develop activity classifiers based on a decision tree algorithm that classified ADL in epochs of ~1.25 s. When training and testing with the younger cohort, using a leave-one-out cross validation procedure, a total classification sensitivity of 80.9% +/- 9.57% ([Formula: see text] = 0.75 +/- 0.12) was obtained. Retraining and testing on the older cohort, again using cross validation, gives a comparable total class sensitivity of 82.0% +/- 8.88% ([Formula: see text] =0.74 +/- 0.12).When trained with the younger group and tested on the older group, a total class sensitivity of 69.2% +/- 24.8% (95% confidence interval [69.6%, 70.6%]) and [Formula: see text] = 0.60 +/- 0.27 (95% confidence interval [0.58, 0.59]) was obtained. When trained on the older group and tested on the younger group, a total class sensitivity of 80.5% +/- 6.80% (95% confidence interval [79.0%, 80.6%]) and [Formula: see text] = 0.74 +/- 0.08 (95% confidence interval [0.73, 0.75]) was obtained.An instance of the decision tree classifier developed was implemented on the smartphone as a software application. It was capable of performing real-time activity classification for a period of 17 h on a single battery charge, illustrating that smartphone technology provides a viable platform on which to perform long-term activity monitoring.

Dennis, Michael L.; Scott, Christy K.; Funk, Rodney R.; Nicholson, Lisa (2014): A Pilot Study to Examine the Feasibility and Potential Effectiveness of Using Smartphones to Provide Recovery Support for Adolescents. In: Subst Abus, S. 0. DOI: 10.1080/08897077.2014.970323.

ABSTRACT. Background: Smartphone applications can potentially provide recovery monitoring and support in real-time, real-life contexts. Study aims included determining feasibility of: a) Adolescents completing ecological momentary assessments (EMA) and utilizing phone-based ecological momentary interventions (EMI); and b) Using EMA and EMI data to predict substance use in the subsequent week. Methods: Twenty-nine adolescents were recruited at discharge from residential treatment, regardless of their discharge status or length of stay. During the 6-week pilot, youth were prompted to complete an EMA at 6 random times per day and were provided access to a suite of recovery support EMI. Youth completed 87% of the 5,580 EMAs. Based on use in the next 7 days, EMA observations were classified into 3 risk groups: “Current Use” in the past 30 minutes (3% of observations), “Unrecognized Risk” (42%), or “Recognized Risk” (55%). All youth had observations in 2 or more risk groups and 38%, in all three. Youth accessed an EMI on-average 162 times each week. Results: Participants were: 31% female, 48% African American, 21% Caucasian, 7% Hispanic, 24% Mixed/Other, average age 16.6 years. During the 90 days prior to entering treatment, youth reported using alcohol (38%), marijuana (41%), and other drugs (7%). When compared to the “Recognized Risk” group’s use in the following week (31%), both the “Unrecognized Risk” (50%, OR = 2.08) and “Current Use” (96%, OR = 50.30) groups reported significantly higher rates of use in the next week. When an EMI was accessed 2 or more times within the hour following an EMA, the rate of using during the next week was significantly lower than when EMIs were not accessed (32% vs. 43%, OR = 0.62). Conclusions: Results demonstrate the feasibility of using smartphones for recovery monitoring and support with adolescents, with potential to reduce use.

Depp, Colin A.; Ceglowski, Jenni; Wang, Vicki C.; Yaghouti, Faraz; Mausbach, Brent T.; Thompson, Wesley K.; Granholm, Eric L. (2014): Augmenting psychoeducation with a mobile intervention for bipolar disorder: A randomized controlled trial. In: J Affect Disord 174C, S. 23–30. DOI: 10.1016/j.jad.2014.10.053.

BACKGROUND: Psychosocial interventions for bipolar disorder are frequently unavailable and resource intensive. Mobile technology may improve access to evidence-based interventions and may increase their efficacy. We evaluated the feasibility, acceptability and efficacy of an augmentative mobile ecological momentary intervention targeting self-management of mood symptoms. METHODS: This was a randomized single-blind controlled trial with 82 consumers diagnosed with bipolar disorder who completed a four-session psychoeducational intervention and were assigned to 10 weeks of either: 1) mobile device delivered interactive intervention linking patient-reported mood states with personalized self-management strategies, or 2) paper-and-pencil mood monitoring. Participants were assessed at baseline, 6 weeks (mid-point), 12 weeks (post-treatment), and 24 weeks (follow up) with clinician-rated depression and mania scales and self-reported functioning. RESULTS: Retention at 12 weeks was 93% and both conditions were associated with high satisfaction. Compared to the paper-and-pencil condition, participants in the augmented mobile intervention condition showed significantly greater reductions in depressive symptoms at 6 and 12 weeks (Cohens d for both were d=0.48). However, these effects were not maintained at 24-weeks follow up. Conditions did not differ significantly in the impact on manic symptoms or functional impairment. LIMITATIONS: This was not a definitive trial and was not powered to detect moderators and mediators. CONCLUSIONS: Automated mobile-phone intervention is feasible, acceptable, and may enhance the impact of brief psychoeducation on depressive symptoms in bipolar disorder. However, sustainment of gains from symptom self-management mobile interventions, once stopped, may be limited.

Ebenfeld, Lara; Kleine Stegemann, Stefan; Lehr, Dirk; Ebert, David Daniel; Jazaieri, Hooria; van Ballegooijen, Wouter et al. (2014): Efficacy of a hybrid online training for panic symptoms and agoraphobia: study protocol for a randomized controlled trial. In: Trials 15, S. 427. DOI: 10.1186/1745-6215-15-427.

BACKGROUND: Recently, internet-based interventions have been proposed as effective treatments for people with panic disorder (PD). However, little is known about the clinical effects of integrating mobile technology into these interventions. Because users carry their smartphones with them throughout the day, we hypothesize that this technology can be used to significantly support individuals with monitoring and overcoming their PD symptoms. The aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed hybrid intervention that combines internet/PC with smartphone delivery to treat the symptoms of PD. The intervention is based on cognitive behavioral therapy and consists of six modules over a total of six weeks. METHODS/DESIGN: A two-arm randomized controlled trial (RCT) will be conducted to evaluate the effects of a hybrid online training module for PD. Based on a power calculation (d =0.60; 1-beta of 80%; alpha =0.05), 90 participants with mild to moderate panic symptoms with or without agoraphobia (as assessed by the Panic and Agoraphobia Scale) will be recruited from the general population and randomly assigned to either the intervention group or a six-month waitlist control group. The primary outcome measure will be the severity of panic symptoms. Secondary outcomes will include depression, quality of life, and an observer-based rating of panic severity. Furthermore, data regarding acceptance and the usability of the smartphone app will be assessed. Assessments will take place at baseline as well as eight weeks, three months, and six months after randomization. Moreover, a cost-effectiveness analysis will be performed from a societal perspective. Data will be analyzed on an intention-to-treat basis and per protocol. DISCUSSION: To our knowledge, this RCT is one of the first to examine the efficacy of a hybrid online training for adult PD. This study seeks to contribute to the emerging field of hybrid online training. If the intervention is efficacious, then research on this hybrid online training should be extended. The cost-effectiveness analysis will also indicate whether online training is an economical tool for treating PD among adults. TRIAL REGISTRATION: German Clinical Trial Register: DRKS00005223 (registered on 15 August 2013).

Engeser, Stefan; Baumann, Nicola (2014): Fluctuation of flow and affect in everyday life: A second look at the paradox of work. In: Journal of Happiness Studies.

Studies with the Experience Sampling Method (ESM) have shown that individuals experience more flow at work than at leisure. This indicates that people enjoy working but paradoxically at the same time leisure activities are preferred (“paradox of work”). We took a second look at the paradox of work by measuring flow directly, including affect measures, and differentiating between active and passive leisure activities. We also adopted a dynamical approach based on the idea that the transitions of experiences has to be taken into account to get the total picture. For the period of 1 week, data of 100 employees with different professions were collected with the ESM (in total 4,504 measurements). In accordance with existing work, we found that flow was high during work. It was slightly (albeit significantly) higher than during active leisure activities and considerably higher than during passive leisure activities. At the same time, negative activation was low during passive and active leisure activities and lower than during work and vice versa for valence (happiness). Thus, leisure activities do have a positive affective quality that could explain why people prefer leisure to work. Regarding the dynamical approach, we tested whether flow during work would lead to higher valence in leisure but could not support this assumption. We discussed the findings and made suggestions for future research. In an additional analysis, we reveal that perceived outcome experience could partially explain why work and leisure experience differed.

Faurholt-Jepsen, Maria; Vinberg, Maj; Frost, Mads; Christensen, Ellen; Bardram, Jakob; Kessing, Lars (2014): Daily electronic monitoring of subjective and objective measures of illness activity in bipolar disorder using smartphones inverted question mark the MONARCA II trial protocol: a randomized controlled single-blind parallel-group trial. In: BMC Psychiatry 14 (1), S. 309. DOI: 10.1186/s12888-014-0309-5.

BackgroundPatients with bipolar disorder often show decreased adherence with mood stabilizers and frequently interventions on prodromal depressive and manic symptoms are delayed.Recently, the MONARCA I randomized controlled trial investigated the effect of electronic self-monitoring on smartphones on depressive and manic symptoms. The findings suggested that patients using the MONARCA system had more sustained depressive symptoms than patients using a smartphone for normal communicative purposes, but had fewer manic symptoms during the trial. It is likely that the ability of these self-monitored measures to detect prodromal symptoms of depression and mania may be insufficient compared to automatically generated objective data on measures of illness activity such as phone usage, social activity, physical activity, and mobility. The Monsenso system, for smartphones integrating subjective and objective measures of illness activity was developed and will be tested in the present trial.MethodsThe MONARCA II trial uses a randomized controlled single-blind parallel-group design. Patients with bipolar disorder according to ICD-10 who previously have been treated at the Copenhagen Clinic for Affective Disorder, Denmark are included and randomized to either daily use of the Monsenso system including an feedback loop between patients and clinicians (the intervention group) or to the use of a smartphone for normal communicative purposes (the control group) for a 9-months trial period. The trial was started in September 2014 and recruitment is ongoing. The outcomes are: differences in depressive and manic symptoms; rate of depressive and manic episodes (primary); automatically generated objective data on measures of illness activity; number of days hospitalized; psychosocial functioning (secondary); perceived stress; quality of life; self-rated depressive symptoms; self-rated manic symptoms; recovery; empowerment and adherence to medication (tertiary) between the intervention group and the control group during the trial. Ethical permission has been obtained. Positive, neutral and negative findings will be published.DiscussionIf the system is effective in reducing depressive and/or manic symptoms (and other symptoms of bipolar disorder) and the rate of episodes, there will be basis for extending the use to the treatment of bipolar disorder in general and in larger scale.Trial NCT02221336. Registered 26th of September 2014.

Fernandez-Llatas, Carlos; Pileggi, Salvatore F.; Ibanez, Gema; Valero, Zoe; Sala, Pilar (2015): Cloud computing for context-aware enhanced m-Health services. In: Methods Mol Biol 1246, S. 147–155. DOI: 10.1007/978-1-4939-1985-7_10.

m-Health services are increasing its presence in our lives due to the high penetration of new smartphone devices. This new scenario proposes new challenges in terms of information accessibility that require new paradigms which enable the new applications to access the data in a continuous and ubiquitous way, ensuring the privacy required depending on the kind of data accessed. This paper proposes an architecture based on cloud computing paradigms in order to empower new m-Health applications to enrich their results by providing secure access to user data.

Fischer, Frida Marina; Wey, Daniela; Valente, Daniel; Luz, Andrea Aparecida da; Pinheiro, Fernando; Fonseca, Barbara Cristina et al. (2014): Sleep patterns and sleepiness among young students: A longitudinal study before and after admission as trainees and apprentices. In: Chronobiol Int, S. 1–8. DOI: 10.3109/07420528.2014.993765.

In developing countries, youngsters start to work during the high school years. Several studies have shown the difficulties associated with double shift, i.e. to work and study concomitantly, and its negative health consequences. Work and study time, as social synchronizers, have significant effects on the sleep-wake cycle (SWC). The purpose of this study was to evaluate sleep patterns and sleepiness in young students before and after entering the workforce as apprentices or trainees. Participants were 40 adolescents (26 males), 15-18 years old (mean = 15.8 years old) engaged in a first-job program at a non-governmental organization (NGO) while attending evening high school in the outskirts of the city of Sao Paulo, Brazil. The participants wore actigraphs (Ambulatory Monitoring, Inc.) and registered subjective sleepiness on KSS (Karolinska Sleepiness Scale) along 7 consecutive days, before and after admission to the job. Descriptive analyses were performed, and the variables were tested by means of the t-test and repeated measures ANOVA taking factors day of the week and time of the day into consideration. The participants’ sleep duration on weekdays exhibited significant difference before and after starting work (F = 4.55; p = 0.04); the mean sleep duration was 492 min (SD = 44 min) before admission to the job to decrease to 405 min (SD = 58 min) after starting work. The mid-sleep time exhibited significant difference on weekdays before and after starting work (04:57 h; SD = 45 min versus 03:30 h; SD = 54 min; F = 4.91; p = 0.03). Finally, also sleepiness on weekdays (F = 6.41; p = 0.04) and at the waking time (F = 10.75; p < 0.01) exhibited significant difference before and after admission to the job. This article emphasizes the fact that social synchronizers like working during the day and studying in the evening changed the participants’ SWC and were associated with sleep restriction. Brazilian governmental incentives notwithstanding, simultaneous performance of several activities by young workers should be considered as an occupational health hazard. Employment policies targeting young workers should take the dual shift - study and work - and its effects on the sleep-wake cycle into account.

Foody, Ciara; James, Jack E.; Leader, Geraldine (2014): Parenting stress, salivary biomarkers, and ambulatory blood pressure: A comparison between mothers and fathers of children with autism spectrum disorders. In: Journal of Autism and Developmental Disorders.

Parents of children with autism spectrum disorders (ASD) may experience higher levels of stress and health problems than parents of children with typical development. However, most research has focused on mothers, with emphasis on parent-reported stress and wellbeing. This study compared parenting responsibility, distress, anxiety, depression, cortisol, alpha-amylase, and cardiovascular activity between 19 mother–father dyads of children with ASD. Mothers reported higher parenting responsibility, distress, anxiety, and depression than fathers, while fathers had higher blood pressure and heart rate variability. Mothers and fathers had lower than average morning cortisol levels, suggesting stress effects on the hypothalamic–pituitary–adrenal-axis. Parents of children with ASD may benefit from routine health screening (particularly adrenal and cardiovascular function) and referral for stress reduction interventions or supports.

Frissen, Aleida; Lieverse, Ritsaert; Drukker, Marjan; Delespaul, Philippe; Lataster, Tineke; Myin-Germeys, Inez; van Os, Jim (2014): Evidence that childhood urban environment is associated with blunted stress reactivity across groups of patients with psychosis, relatives of patients and controls. In: Social Psychiatry and Psychiatric Epidemiology 49 (10), S. 1579–1587. DOI: 10.1037/t29468-000;

Purpose: Psychosis is associated with urban upbringing, and increased emotional reactivity is associated with psychosis. The aim of this study was to examine to what degree urban upbringing impacts emotional reactivity, and how this may be relevant for psychotic disorder and familial risk of psychotic disorder. Methods: Patients with a diagnosis of non-affective psychotic disorder (n = 57), 59 first degree relatives of patients and 75 healthy comparison subjects were studied with the experience sampling method (a random time sampling technique to assess affective experience in relation to fluctuating stressors in the flow of daily life), to measure a change in negative affect in relation to subjective stress. Urban exposure was defined at 5 levels, considering the population density and the number of moves between birth and the 15th birthday, using data from the Dutch Central Bureau of Statistics and the equivalent database in Belgium. Results: Multilevel random regression analyses showed that urban upbringing was consistently and strongly associated with a reduced increase in negative affect in relation to SS in adulthood in a dose–response fashion in all three groups. Regression coefficients in the patient group decreased from 0.148 (p < 0.001) in the lowest urbanicity level to 0.094 (p < 0.001) in the highest urbanicity level. Conclusion: The findings suggest that urban upbringing may occasion “habituation” rather than “sensitization” across groups, which may or may not be relevant for the onset of psychotic disorder.

Fulcher, Krysten K.; Alosco, Michael L.; Miller, Lindsay; Spitznagel, Mary Beth; Cohen, Ronald; Raz, Naftali et al. (2014): Greater physical activity is associated with better cognitive function in heart failure. In: Health Psychology 33 (11), S. 1337–1343. DOI: 10.1037/t00742-000.

Objective: Nearly 6 million Americans have heart failure (HF), up to 80% of which exhibit cognitive deficits on testing. Physical inactivity is common in HF, yet little is known about the possible contribution of physical inactivity to cognitive dysfunction in this population. Method: Older adults with HF (N = 93; Mage = 68.5 years, 33.7% women) completed neuropsychological testing, as well as cardiac and physical activity assessment as part of a larger protocol. HF severity was measured via impedance cardiography. Physical activity was assessed via an Actigraph accelerometer and operationalized using daily step count and time engaged in moderate-vigorous activity (minutes/day). Results: Linear regression analyses controlling for sex, high blood pressure, diabetes, depressive symptomatology, and HF severity showed that greater physical activity (both step count and minutes spent in moderate-vigorous activity) was associated with better executive function/attention, processing speed, and scores on a screening measure of cognition. Conclusions: These findings indicate that physical activity is an independent predictor of cognitive function in persons with HF. Future work is needed to clarify the mechanisms by which physical activity benefits cognitive function in HF and determine whether interventions to promote physical activity can attenuate cognitive decline over time.

Gaher, Raluca M.; Simons, Jeffrey S.; Hahn, Austin M.; Hofman, Nicole L.; Hansen, Jamie; Buchkoski, Jerome (2014): An experience sampling study of PTSD and alcohol-related problems. In: Psychology of Addictive Behaviors 28 (4), S. 1013–1025. DOI: 10.1037/t04522-000.

Posttraumatic stress disorder (PTSD) represents a debilitating psychiatric condition that is affecting the lives of many returning veterans. PTSD and alcohol use and dependence are highly comorbid. The purpose of this study was to understand the functional mechanisms between PTSD and alcohol use and problems. Specifically, the role of negative urgency and emotional intelligence were investigated as vulnerability and resiliency factors, respectively. This study utilized experience sampling to test associations between PTSD symptoms and alcohol use and related problems in a sample of 90 OIF/OEF veterans. Participants completed 8 brief questionnaires daily for 2 weeks on palmtop computers. Elevations in PTSD symptoms during the day were associated with subsequent increases in alcohol use and associated problems that night. PTSD symptoms were associated with greater problems above and beyond the effect of drinking level at both the within- and between- person level. Emotional intelligence was associated with lower negative urgency, fewer PTSD symptoms, and less alcohol use and associated problems. The effects of emotional intelligence were primarily indirect via negative urgency and the effects of negative urgency on alcohol use and problems were indirect via its positive association with PTSD symptoms. Hypothesized cross-level effects of emotional intelligence and negative urgency were not supported. The findings suggest a functional association between PTSD symptoms and alcohol consumption. The association between PTSD symptoms and alcohol consumption is consistent with a self-medication model. However, the significant associations between PTSD symptoms and alcohol problems, after controlling for use level, suggest a broader role of dysregulation.

Galeana-Zapien, Hiram; Torres-Huitzil, Cesar; Rubio-Loyola, Javier (2014): Mobile phone middleware architecture for energy and context awareness in location-based services. In: Sensors (Basel) 14 (12), S. 23673–23696. DOI: 10.3390/s141223673.

The disruptive innovation of smartphone technology has enabled the development of mobile sensing applications leveraged on specialized sensors embedded in the device. These novel mobile phone applications rely on advanced sensor information processes, which mainly involve raw data acquisition, feature extraction, data interpretation and transmission. However, the continuous accessing of sensing resources to acquire sensor data in smartphones is still very expensive in terms of energy, particularly due to the periodic use of power-intensive sensors, such as the Global Positioning System (GPS) receiver. The key underlying idea to design energy-efficient schemes is to control the duty cycle of the GPS receiver. However, adapting the sensing rate based on dynamic context changes through a flexible middleware has received little attention in the literature. In this paper, we propose a novel modular middleware architecture and runtime environment to directly interface with application programming interfaces (APIs) and embedded sensors in order to manage the duty cycle process based on energy and context aspects. The proposed solution has been implemented in the Android software stack. It allows continuous location tracking in a timely manner and in a transparent way to the user. It also enables the deployment of sensing policies to appropriately control the sampling rate based on both energy and perceived context. We validate the proposed solution taking into account a reference location-based service (LBS) architecture. A cloud-based storage service along with online mobility analysis tools have been used to store and access sensed data. Experimental measurements demonstrate the feasibility and efficiency of our middleware, in terms of energy and location resolution.

Gard, David E.; Sanchez, Amy H.; Cooper, Kathryn; Fisher, Melissa; Garrett, Coleman; Vinogradov, Sophia (2014): Do people with schizophrenia have difficulty anticipating pleasure, engaging in effortful behavior, or both? In: Journal of Abnormal Psychology 123 (4), S. 771–782. DOI: 10.1037/t05056-000.

Motivation deficits are common in schizophrenia, but little is known about underlying mechanisms, or the specific goals that people with schizophrenia set in daily life. Using neurobiological heuristics of pleasure anticipation and effort assessment, we examined the quality of activities and goals of 47 people with and 41 people without schizophrenia, utilizing ecological momentary assessment. Participants were provided cell phones and called 4 times a day for 7 days, and were asked about their current activities and anticipation of upcoming goals. Activities and goals were later coded by independent raters on pleasure and effort. In line with recent laboratory findings on effort computation deficits in schizophrenia, relative to healthy participants, people with schizophrenia reported engaging in less effortful activities and setting less effortful goals, which were related to patient functioning. In addition, patients showed some inaccuracy in estimating how difficult an effortful goal would be, which in turn was associated with lower neurocognition. In contrast to previous research, people with schizophrenia engaged in activities and set goals that were more pleasure-based, and anticipated goals as being more pleasurable than controls. Thus, this study provided evidence for difficulty with effortful behavior and not anticipation of pleasure. These findings may have psychosocial treatment implications, focusing on effort assessment or effort expenditure. For example, to help people with schizophrenia engage in more meaningful goal pursuits, treatment providers may leverage low-effort pleasurable goals by helping patients to break down larger, more complex goals into smaller, lower-effort steps that are associated with specific pleasurable rewards.

Gevonden, M. J.; Myin-Germeys, I.; van den Brink, W; van Os, J.; Selten, J. P.; Booij, J. (2014): Psychotic reactions to daily life stress and dopamine function in people with severe hearing impairment. In: Psychol Med, S. 1–10. DOI: 10.1017/S0033291714002797.

Background. Minor stresses measured in daily life have repeatedly been associated with increased momentary psychotic experiences, both in individuals with psychotic disorders and in persons who are genetically at an increased risk for these disorders. Severe hearing impairment (SHI) is an environmental risk factor for psychotic disorder, possibly due to the experience of social exclusion. The aim of the current study is to investigate whether people with SHI exhibit higher levels of psychotic reactivity to social stressors in daily life than normal-hearing controls and whether this reactivity is associated with decreased baseline dopamine (DA) D2/3 receptor availability and/or elevated DA release following a dexamphetamine challenge. Method. We conducted an experience sampling study in 15 young adults with SHI and 19 matched normal-hearing controls who had previously participated in a single photon emission computed tomography study measuring DA D2/3 receptor availability and DA release in response to dexamphetamine. Results. The association between social stress and momentary psychotic experiences in daily life was stronger among SHI participants than among normal-hearing controls. Interactions between social stress and baseline striatal DA D2/3 receptor availability or DA release were not significant in multilevel models of momentary psychotic experiences including age, sex and tobacco use. Conclusions. While both elevated striatal DA release and elevated psychotic stress reactivity have been found in the same population defined by an environmental risk factor, SHI, their inter-relationship cannot be established. Further research is warranted to clarify the association between biological and psychological endophenotypes and psychosis risk.

Glasgow, Mark L.; Rudra, Carole B.; Yoo, Eun-Hye; Demirbas, Murat; Merriman, Joel; Nayak, Pramod et al. (2014): Using smartphones to collect time-activity data for long-term personal-level air pollution exposure assessment. In: J Expo Sci Environ Epidemiol. DOI: 10.1038/jes.2014.78.

Because of the spatiotemporal variability of people and air pollutants within cities, it is important to account for a person’s movements over time when estimating personal air pollution exposure. This study aimed to examine the feasibility of using smartphones to collect personal-level time-activity data. Using Skyhook Wireless’s hybrid geolocation module, we developed “Apolux” (Air, Pollution, Exposure), an AndroidTM smartphone application designed to track participants’ location in 5-min intervals for 3 months. From 42 participants, we compared Apolux data with contemporaneous data from two self-reported, 24-h time-activity diaries. About three-fourths of measurements were collected within 5 min of each other (mean=74.14%), and 79% of participants reporting constantly powered-on smartphones (n=38) had a daily average data collection frequency of <10 min. Apolux’s degree of temporal resolution varied across manufacturers, mobile networks, and the time of day that data collection occurred. The discrepancy between diary points and corresponding Apolux data was 342.3 m (Euclidian distance) and varied across mobile networks. This study’s high compliance and feasibility for data collection demonstrates the potential for integrating smartphone-based time-activity data into long-term and large-scale air pollution exposure studies.Journal of Exposure Science and Environmental Epidemiology advance online publication, 26 November 2014; doi:10.1038/jes.2014.78.

Glenn, Tasha; Monteith, Scott (2014): New measures of mental state and behavior based on data collected from sensors, smartphones, and the Internet. In: Curr Psychiatry Rep 16 (12), S. 523. DOI: 10.1007/s11920-014-0523-3.

With the rapid and ubiquitous acceptance of new technologies, algorithms will be used to estimate new measures of mental state and behavior based on digital data. The algorithms will analyze data collected from sensors in smartphones and wearable technology, and data collected from Internet and smartphone usage and activities. In the future, new medical measures that assist with the screening, diagnosis, and monitoring of psychiatric disorders will be available despite unresolved reliability, usability, and privacy issues. At the same time, similar non-medical commercial measures of mental state are being developed primarily for targeted advertising. There are societal and ethical implications related to the use of these measures of mental state and behavior for both medical and non-medical purposes.

Goetz, Thomas; Haag, Ludwig; Lipnevich, Anastasiya A.; Keller, Melanie M.; Frenzel, Anne C.; Collier, Antonie P M (2014): Between-domain relations of students’ academic emotions and their judgments of school domain similarity. In: Front Psychol 5, S. 1153. DOI: 10.3389/fpsyg.2014.01153.

With the aim to deepen our understanding of the between-domain relations of academic emotions, a series of three studies was conducted. We theorized that between-domain relations of trait (i.e., habitual) emotions reflected students’ judgments of domain similarities, whereas between-domain relations of state (i.e., momentary) emotions did not. This supposition was based on the accessibility model of emotional self-report, according to which individuals’ beliefs tend to strongly impact trait, but not state emotions. The aim of Study 1 (interviews; N = 40; 8th and 11th graders) was to gather salient characteristics of academic domains from students’ perspective. In Study 2 (N = 1709; 8th and 11th graders) the 13 characteristics identified in Study 1 were assessed along with academic emotions in four different domains (mathematics, physics, German, and English) using a questionnaire-based trait assessment. With respect to the same domains, state emotions were assessed in Study 3 (N = 121; 8th and 11th graders) by employing an experience sampling approach. In line with our initial assumptions, between-domain relations of trait but not state academic emotions reflected between-domain relations of domain characteristics. Implications for research and practice are discussed.

Goldschmidt, Andrea B.; Crosby, Ross D.; Cao, Li; Engel, Scott G.; Durkin, Nora; Beach, Heather M. et al. (2014): Ecological momentary assessment of eating episodes in obese adults. In: Psychosomatic Medicine 76 (9), S. 747–752. DOI: 10.1037/t15771-000;

Objective: The context of eating episodes in obesity is poorly understood. This study examined emotional, physiological, and environmental correlates of pathological and nonpathological eating episodes in a heterogeneous sample of obese adults. Methods: Community-based participants (n = 50; 84% female [n = 42]; mean [standard deviation] body mass index = 40.3 [8.5]; mean [standard deviation] age = 43.0 [11.9]) recorded all eating episodes and their emotional, physiological, and environmental correlates via ecological momentary assessment for 2 weeks. Generalized estimating equations examined relations between these variables and eating episodes characterized by both self-identified loss of control (LOC) while eating and overeating (binge eating; BE), LOC only, overeating only (OE), and neither LOC nor OE (nonpathological eating). Results: Episodes involving loss of control (BE and LOC) were associated with heightened preepisode and postepisode negative effects (Wald W2 range, 15.67-24.39; p values G .001), whereas those involving overeating (BE and OE) were associated with the lowest preepisode and postepisode hunger (Wald X² range, 18.14-39.75; p values < .001). LOC episodes were followed by heightened postepisode cravings (Wald X² = 25.87; p < .001) and were most likely to occur when participants were alone (Wald X² = 13.20; p = .004). Conclusion: BE and LOC eating were more consistently associated with emotional and physiological cues than OE and nonpathological eating, whereas most environmental variables did not differ among eating episode types. Results support distinctions among the different constructs characterizing aberrant eating and may be used to inform interventions for obesity and related eating pathology.

Goodman, Anna; Page, Angie S.; Cooper, Ashley R. (2014): Daylight saving time as a potential public health intervention: an observational study of evening daylight and objectively-measured physical activity among 23,000 children from 9 countries. In: Int J Behav Nutr Phys Act 11, S. 84. DOI: 10.1186/1479-5868-11-84.

BACKGROUND: It has been proposed that introducing daylight saving measures could increase children’s physical activity, but there exists little research on this issue. This study therefore examined associations between time of sunset and activity levels, including using the bi-annual ‘changing of the clocks’ as a natural experiment. METHODS: 23,188 children aged 5-16 years from 15 studies in nine countries were brought together in the International Children’s Accelerometry Database. 439 of these children were of particular interest for our analyses as they contributed data both immediately before and after the clocks changed. All children provided objectively-measured physical activity data from Actigraph accelerometers, and we used their average physical activity level (accelerometer counts per minute) as our primary outcome. Date of accelerometer data collection was matched to time of sunset, and to weather characteristics including daily precipitation, humidity, wind speed and temperature. RESULTS: Adjusting for child and weather covariates, we found that longer evening daylight was independently associated with a small increase in daily physical activity. Consistent with a causal interpretation, the magnitude of these associations was largest in the late afternoon and early evening and these associations were also evident when comparing the same child just before and just after the clocks changed. These associations were, however, only consistently observed in the five mainland European, four English and two Australian samples (adjusted, pooled effect sizes 0.03-0.07 standard deviations per hour of additional evening daylight). In some settings there was some evidence of larger associations between daylength and physical activity in boys. There was no evidence of interactions with weight status or maternal education, and inconsistent findings for interactions with age. CONCLUSIONS: In Europe and Australia, evening daylight seems to play a causal role in increasing children’s activity in a relatively equitable manner. Although the average increase in activity is small in absolute terms, these increases apply across all children in a population. Moreover, these small effect sizes actually compare relatively favourably with the typical effect of intensive, individual-level interventions. We therefore conclude that, by shifting the physical activity mean of the entire population, the introduction of additional daylight saving measures could yield worthwhile public health benefits.

Gorostidi, Manuel; Vinyoles, Ernest; Banegas, Jose R.; de la Sierra, Alejandro (2015): Prevalence of white-coat and masked hypertension in national and international registries. In: Hypertens Res 38 (1), S. 1–7. DOI: 10.1038/hr.2014.149.

In the past two decades, techniques for the measurement of blood pressure outside the medical setting have unmasked highly prevalent situations. A significant proportion of patients with office blood pressure levels above the thresholds for diagnosing hypertension or above the limits where those being treated are considered to be adequately controlled actually show normal ambulatory blood pressure levels. These patients have white-coat hypertension if untreated or false resistance to antihypertensive therapy because of the white-coat effect if treated. However, some individuals with normal office blood pressure measurements show elevated ambulatory blood pressure levels, and thus have masked hypertension if untreated or masked uncontrolled hypertension if treated. When looking for white-coat hypertension in patients with elevated office blood pressure levels or when looking for masked hypertension in office-controlled patients, up to one in three patients in each scenario would have white-coat or masked hypertension. Although related clinical factors, such as age, gender and global cardiovascular risk, are associated with both conditions, their abilities to predict such a misclassification are very low. Thus, assessing individual blood pressure levels by means of an ambulatory technique, particularly ambulatory blood pressure monitoring, is now considered a priority in diagnosing hypertension and in evaluating hypertension control.

Hammonds, Tracy; Rickert, Krista; Goldstein, Carly; Gathright, Emily; Gilmore, Sarah; Derflinger, Bethany et al. (2014): Adherence to Antidepressant Medications: A Randomized Controlled Trial of Medication Reminding in College Students. In: J Am Coll Health, S. 0. DOI: 10.1080/07448481.2014.975716.

Abstract. Objectives: To determine if medication reminding via smartphone app increases adherence to antidepressant medications in college students. Participants: College students (N = 57) enrolled at a state-funded institution who had a current prescription for an antidepressant and regularly used a smartphone device. Methods: Participants were randomized to either a reminder group or a control group. Both groups were asked to complete a survey and undergo a manual pill count at the beginning of the study and 30-days later. Results: There was a strong trend suggesting that the use of a medication reminder app was beneficial for adherence to antidepressant medication regimens. Factors influencing medication adherence in college students included health beliefs, use of illicit drugs, and type of professional care received. Conclusions: Use of a medication reminder may increase adherence to antidepressant medications in college students.

Handojoseno, Aluysius Maria Ardi; Shine, James Macquarie; Nguyen, Tuan Nghia; Tran, Yvonne; Lewis, Simon John Geoffrey; Nguyen, Hung T. (2014): Analysis and Prediction of the Freezing of Gait using EEG Brain Dynamics. In: IEEE Trans Neural Syst Rehabil Eng. DOI: 10.1109/TNSRE.2014.2381254.

Freezing of Gait (FOG) is a common symptom in the advanced stages of Parkinson’s disease (PD), which significantly affects patients’ quality of life. Treatment options offer limited benefit and there are currently no mechanisms able to effectively detect FOG before it occurs, allowing time for a sufferer to avert a freezing episode. Electroencephalography (EEG) offers a novel technique that may be able to address this problem. In this paper, we investigated the univariate and multivariate EEG features determined by both Fourier and wavelet analysis in the confirmation and prediction of FOG. The EEG power measures and network properties from 16 patients with PD and FOG were extracted and analyzed. It was found that both power spectral density and wavelet energy could potentially act as biomarkers during FOG. Information in the frequency domain of the EEG was found to provide better discrimination of EEG signals during transition to freezing than information coded in the time domain. The performance of the FOG prediction systems improved when the information from both domains was used. This combination resulted in a sensitivity of 86.0%, specificity of 74.4%, and accuracy of 80.2% when predicting episodes of freezing, outperforming current accelerometry-based tools for the prediction of FOG.

Hardy, Sam A.; Zhang, Zhiyong; Skalski, Jonathan E.; Melling, Brent S.; Brinton, Chauncy T. (2014): Daily religious involvement, spirituality, and moral emotions. In: Psychology of Religion and Spirituality 6 (4), S. 338–348.

This study examined relations among intraindividual variability in daily religious activities, daily spiritual experiences, and daily moral emotions (empathy, gratitude, and forgiveness). We hypothesized that spiritual experiences would mediate relations between religious activities and moral emotions, the quality of religious activities would moderate links to spiritual experiences, and the quality of spiritual experiences would moderate links to moral emotions. The sample included 139 individuals ages 18–69 who completed daily online surveys for up to 50 days. Participants completed multiple daily items reporting their religious activities, spiritual experiences, and moral emotions. Multilevel regression analyses found that daily religious activities were linked to daily moral emotions by way of daily spiritual experiences. Furthermore, the quality of the daily religious activities and spiritual experiences moderated links in the mediation model. Thus, we found evidence of mediating and moderating processes in associations between religious activities, spiritual experiences, and moral emotions on a daily basis.

Hartley, Samantha; Haddock, Gillian; Vasconcelos E Sa, Debora; Emsley, Richard; Barrowclough, Christine (2014): The influence of thought control on the experience of persecutory delusions and auditory hallucinations in daily life. In: Behav Res Ther 65C, S. 1–4. DOI: 10.1016/j.brat.2014.12.002.

Attempts to control or suppress thoughts are often unsuccessful and may even lead to an increase in the unwanted content. Intrusive thoughts and thought control are influential in the experience of psychosis, although recent findings have arisen from non-clinical samples and data tend to be retrospective in nature. The current study utilised repeated momentary assessments (experience sampling methodology) delivered as part of participants’ daily routine to examine the associations between thought control and the experience of persecutory delusions and auditory hallucinations. The findings revealed that thought control was related to the subsequent severity and distress in relation to psychotic symptoms. Moreover, most of these effects persisted over two subsequent monitoring timepoints, although their size was diminished. These findings add weight to models of psychosis that include a role for thought control, and also highlight opportunities for targeted momentary interventions. Future work might seek to elucidate which specific aspects of thought control are important, alongside the use of more multifaceted measures of psychotic experiences.

Hawkins, Ashley A.; Furr, R. Michael; Arnold, Elizabeth Mayfield; Law, Mary Kate; Mneimne, Malek; Fleeson, William (2014): The structure of borderline personality disorder symptoms: A multi-method, multi-sample examination. In: Personality Disorders: Theory, Research, and Treatment 5 (4), S. 380–389.

We examined the factor structure of borderline personality disorder (BPD) symptoms by using a multimethod, multisample approach. The factorial structure of BPD has previously been examined through the lens of broad retrospective reports of symptoms without directly contrasting results from different samples of participants, with studies producing inconsistent patterns of results. We go beyond previous work by examining symptoms from multiple timeframes and by examining results across and within 2 diagnostic groups—individuals with and without BPD. Participants (n = 281) completed a structured clinical interview for personality disorders, 2 weekly reports of BPD symptoms, and 2 weeks of in-the-moment “immediate” symptom reports, assessed 5 times daily. Across all participants, results revealed a robust 1-factor structure that replicated across all assessment methods. Moreover, these results replicated within each diagnostic group, with the lone exception of an unclear structure in interview assessment among participants who had a BPD diagnosis. Results have implications regarding the nature, assessment, and treatment of BPD.

Heebner, Nicholas R.; Akins, Jonathan S.; Lephart, Scott M.; Sell, Timothy C. (2014): Reliability and validity of an accelerometry based measure of static and dynamic postural stability in healthy and active individuals. In: Gait Posture. DOI: 10.1016/j.gaitpost.2014.12.009.

Postural stability is an important measure in both research and clinical practice. A portable, easy to use device that can provide higher resolution than current clinical tests may allow for better identification of patients or athletes with postural stability deficits. The purpose of this study was to evaluate the ability of a tri-axial accelerometer to quantify postural stability in a healthy athletic population. Ten subjects were recruited to determine the reliability of the accelerometer to measure dynamic postural stability and thirteen were recruited to compare the accelerometer measures across tasks of varying difficulty. Subjects were asked to complete four static postural stability tasks with eyes open and eyes closed and two dynamic postural stability tasks for a total of ten tasks. During each task postural stability was measured using a tri-axial accelerometer and force platform. Differences between postural stability scores between tasks and the correlation between the two measures were assessed. The accelerometer demonstrated moderate to good test-retest reliability (ICC=0.732 to 0.899). Only the medial-lateral axis of the accelerometer showed significant differences between static tasks but all directions were able to show significant differences between static and dynamic tasks. Additionally, Spearman’s ranked correlations showed little to no correlation between the accelerometer and force platform scores. Accelerometers are a reliability tool for postural stability that measure low difficulty tasks best in the medial-lateral direction. Low correlation between the accelerometer and force platform suggest that these two methods are not measuring the same components of postural stability.

Heffner, Jaimee L.; Vilardaga, Roger; Mercer, Laina D.; Kientz, Julie A.; Bricker, Jonathan B. (2015): Feature-level analysis of a novel smartphone application for smoking cessation. In: Am J Drug Alcohol Abuse 41 (1), S. 68–73. DOI: 10.3109/00952990.2014.977486.

Abstract Background: Currently, there are over 400 smoking cessation smartphone apps available, downloaded an estimated 780,000 times per month. No prior studies have examined how individuals engage with specific features of cessation apps and whether use of these features is associated with quitting. OBJECTIVES: Using data from a pilot trial of a novel smoking cessation app, we examined: (i) the 10 most-used app features, and (ii) prospective associations between feature usage and quitting. METHODS: Participants (n = 76) were from the experimental arm of a randomized, controlled pilot trial of an app for smoking cessation called “SmartQuit,” which includes elements of both Acceptance and Commitment Therapy (ACT) and traditional cognitive behavioral therapy (CBT). Utilization data were automatically tracked during the 8-week treatment phase. Thirty-day point prevalence smoking abstinence was assessed at 60-day follow-up. RESULTS: The most-used features - quit plan, tracking, progress, and sharing - were mostly CBT. Only two of the 10 most-used features were prospectively associated with quitting: viewing the quit plan (p = 0.03) and tracking practice of letting urges pass (p = 0.03). Tracking ACT skill practice was used by fewer participants (n = 43) but was associated with cessation (p = 0.01). CONCLUSIONS: In this exploratory analysis without control for multiple comparisons, viewing a quit plan (CBT) as well as tracking practice of letting urges pass (ACT) were both appealing to app users and associated with successful quitting. Aside from these features, there was little overlap between a feature’s popularity and its prospective association with quitting. Tests of causal associations between feature usage and smoking cessation are now needed.

Heiy, Jane E.; Cheavens, Jennifer S. (2014): Back to basics: A naturalistic assessment of the experience and regulation of emotion. In: Emotion 14 (5), S. 878–891.

Emotion regulation research links regulatory responding to important outcomes in psychological well-being, physical health, and interpersonal relations, but several fundamental questions remain. As much of the previous research has addressed generalized regulatory habits, far less is known about the ways in which individuals respond to emotions in daily life. The literature is particularly sparse in explorations of positive emotion regulation. In the current study, we provide an assessment of naturalistic experiences and regulation of emotion, both positive and negative in valence. Using an electronic experience sampling methodology, participants reported on their use of 40 regulatory strategies in response to 14 emotions for 10 consecutive days. On average, participants used 15 different regulatory strategies in response to negative emotions over this time, most frequently relying on acceptance, behavioral activation, and rumination. Participants used a similarly large repertoire of strategies, approximately 16 total, in response to positive emotions, particularly savoring, future focus, and behavioral activation. Participants’ mood ratings following strategy use, however, indicated that the most frequently used strategies were often not the most effective strategies. The results of this study provide estimates of the frequency and effectiveness of a large number of emotion regulation strategies in response to both negative and positive emotions. Such findings characterize naturalistic emotion regulation, and estimates of normative emotion regulation processes are imperative to determining the ways in which deviations (e.g., small emotion regulation repertoires, insufficient attention to regulation of positive emotions) impact emotional functioning.

Hendriks, Martijn; Ludwigs, Kai; Veenhoven, Ruut (2014): Why are locals happier than internal migrants? The role of daily life. In: Social Indicators Research.

Several survey studies have found that internal migrants report lower levels of happiness than locals, even after accounting for socio-economic factors. Traditional global self-ratings reveal that the migrant–local happiness-gap is also present in the data we present. The reasons for the migrant–local happiness-gap are as yet unclear. This paper aims to open this ‘black box’ by exploring the role of daily activities among a population that has generally been overlooked despite their high migration frequency: young adults. An innovative smartphone application is used that combines two techniques for multiple moment assessment: the experience sampling method and the day reconstruction method. Based on the application data, we examine whether internal migrants spend their time differently than locals and in which situations they feel noticeably less happy than locals. The data reveal that internal migrants distribute less time to happiness-producing activities such as active leisure, social drinking/parties, and activities outside home/work/transit. Internal migrants feel less happy than locals when spending time with friends and while eating. Possible explanations focusing on the role of social capital are discussed. Further analyses reveal that daily life experiences greatly enhance the explanation of the migrant–local happiness-gap. This paper demonstrates the potential value of real-time data and phone applications in solving happiness puzzles.

Heron, Kristin E.; Scott, Stacey B.; Sliwinski, Martin J.; Smyth, Joshua M. (2014): Eating behaviors and negative affect in college women’s everyday lives. In: International Journal of Eating Disorders 47 (8), S. 853–859. DOI: 10.1037/t15771-000;

Objective: A growing body of research seeks to understand the relationship between mood and eating behaviors. Ecological Momentary Assessment (EMA) methods provide a method for assessing these processes in natural settings. We used EMA to examine the relationship between mood and eating behaviors in everyday life among women with subclinical disordered eating behaviors. Method: Participants (N = 127, age M = 19.6 years, BMI M = 25.5) completed five daily EMA reports on palmtop computers for 1 week. Assessments included measures of negative affect (NA) and eating‐related behavior during eating (eating large amounts of food, loss of control over eating, and restricting food intake) and noneating episodes (skip eating to control weight/shape). Time‐lagged multilevel models tested mood–eating behavior relationships. Results: Higher NA did not precede any unhealthy eating and weight control behaviors. However, NA was higher when women reported eating large quantities of food, losing control over eating, and restricting food intake during their most recent eating episode, but not after skipping eating to control weight/shape. Discussion: These findings elucidate the processes in daily life that may influence the development and maintenance of unhealthy eating and weight control behaviors that, in turn, can inform interventions.

Hilliard, Marisa E.; Hahn, Amy; Ridge, Alana K.; Eakin, Michelle N.; Riekert, Kristin A. (2014): User Preferences and Design Recommendations for an mHealth App to Promote Cystic Fibrosis Self-Management. In: JMIR Mhealth Uhealth 2 (4), S. e44. DOI: 10.2196/mhealth.3599.

BACKGROUND: mHealth apps hold potential to provide automated, tailored support for treatment adherence among individuals with chronic medical conditions. Yet relatively little empirical research has guided app development and end users are infrequently involved in designing the app features or functions that would best suit their needs. Self-management apps may be particularly useful for people with chronic conditions like cystic fibrosis (CF) that have complex, demanding regimens. OBJECTIVE: The aim of this mixed-methods study was to involve individuals with CF in guiding the development of engaging, effective, user-friendly adherence promotion apps that meet their preferences and self-management needs. METHODS: Adults with CF (n=16, aged 21-48 years, 50% male) provided quantitative data via a secure Web survey and qualitative data via semi-structured telephone interviews regarding previous experiences using apps in general and for health, and preferred and unwanted features of potential future apps to support CF self-management. RESULTS: Participants were smartphone users who reported sending or receiving text messages (93%, 14/15) or emails (80%, 12/15) on their smartphone or device every day, and 87% (13/15) said it would be somewhat or very hard to give up their smartphone. Approximately one-half (53%, 8/15) reported having health apps, all diet/weight-related, yet many reported that existing nutrition apps were not well-suited for CF management. Participants wanted apps to support CF self-management with characteristics such as having multiple rather than single functions (eg, simple alarms), being specific to CF, and minimizing user burden. Common themes for desired CF app features were having information at one’s fingertips, automation of disease management activities such as pharmacy refills, integration with smartphones’ technological capabilities, enhancing communication with health care team, and facilitating socialization within the CF community. Opinions were mixed regarding gamification and earning rewards or prizes. Participants emphasized the need for customization options to meet individual preferences and disease management goals. CONCLUSIONS: Unique capabilities of emerging smartphone technologies (eg, social networking integration, movement and location detection, integrated sensors, or electronic monitors) make many of these requests possible. Involving end users in all stages of mHealth app development and collaborating with technology experts and the health care system may result in apps that maintain engagement, improve integration and automation, and ultimately impact self-management and health outcomes.

Hirst, Jane E.; Mackillop, Lucy; Loerup, Lise; Kevat, Dev A.; Bartlett, Katy; Gibson, Oliver et al. (2015): Acceptability and user satisfaction of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus. In: J Diabetes Sci Technol 9 (1), S. 111–115. DOI: 10.1177/1932296814556506.

The increase in gestational diabetes mellitus (GDM) is challenging maternity services. We have developed an interactive, smartphone-based, remote blood glucose (BG) monitoring system, GDm-health. The objective was to determine women’s satisfaction with using the GDm-health system and their attitudes toward their diabetes care. In a service development program involving 52 pregnant women (September 2012 to June 2013), BG was monitored using GDm-health from diagnosis until delivery. Following birth, women completed a structured questionnaire assessing (1) general satisfaction, (2) equipment issues, and (3) relationship with the diabetes care team. Responses were scored on a 7-point Likert-type scale. Reliability and validity of the questionnaire were assessed using statistical methods. Of 52 women, 49 completed the questionnaire; 32 had glucose tolerance test confirmed GDM (gestation at recruitment 29 +/- 4 weeks (mean +/- SD), and 17 women previous GDM recommended for BG monitoring (18 +/- 6 weeks). In all, 45 of 49 women agreed their care was satisfactory and the best for them, 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively, 42 of 49 agreed GDm-health fitted into their lifestyle, and 46 of 49 agreed they had a good relationship with their care team. Written comments supported these findings, with very positive reactions from the majority of women. Cronbach’s alpha was .89 with factor analysis corresponding with question thematic trends. This pilot demonstrates that GDm-health is acceptable and convenient for a large proportion of women. Effects on clinical and economic outcomes are currently under investigation in a randomized trial ( NCT01916694).

Hislop, Jane; Law, James; Rush, Robert; Grainger, Andrew; Bulley, Cathy; Reilly, John J.; Mercer, Tom (2014): An investigation into the minimum accelerometry wear time for reliable estimates of habitual physical activity and definition of a standard measurement day in pre-school children. In: Physiol Meas 35 (11), S. 2213–2228. DOI: 10.1088/0967-3334/35/11/2213.

The purpose of this study was to determine the number of hours and days of accelerometry data necessary to provide a reliable estimate of habitual physical activity in pre-school children. The impact of a weekend day on reliability estimates was also determined and standard measurement days were defined for weekend and weekdays.Accelerometry data were collected from 112 children (60 males, 52 females, mean (SD) 3.7 (0.7)yr) over 7 d. The Spearman-Brown Prophecy formula (S-B prophecy formula) was used to predict the number of days and hours of data required to achieve an intraclass correlation coefficient (ICC) of 0.7. The impact of including a weekend day was evaluated by comparing the reliability coefficient (r) for any 4 d of data with data for 4 d including one weekend day.Our observations indicate that 3 d of accelerometry monitoring, regardless of whether it includes a weekend day, for at least 7 h d(-1) offers sufficient reliability to characterise total physical activity and sedentary behaviour of pre-school children. These findings offer an approach that addresses the underlying tension in epidemiologic surveillance studies between the need to maintain acceptable measurement rigour and retention of a representatively meaningful sample size.

Hoeppner, Bettina B.; Kahler, Christopher W.; Gwaltney, Chad J. (2014): Relationship between momentary affect states and self-efficacy in adolescent smokers. In: Health Psychology 33 (12), S. 1507–1517.

Objective: Relapse to smoking after making a quit attempt is both common and rapid in adolescent smokers. Momentary self-efficacy (SE)—that is, momentary shifts in one’s confidence in the ability to abstain from smoking—predicts the occurrence and timing of relapse among adolescent smokers. Therefore, it is important to identify factors that are associated with changes in momentary SE early in a quit attempt. This study examined the relationship between affect states (including positive, negative, and nicotine withdrawal states) and momentary SE at various stages of a quit attempt. Method: Adolescent daily smokers interested in making a quit attempt (n = 202) completed ecological momentary assessments (EMA) each day for 1 week leading up to and 2 weeks after a quit attempt. In each assessment, they reported current SE and affect state. Results: Results of linear mixed models indicated that most of the examined affect states were related to momentary SE. Contrary to expectation, they were related to momentary SE both immediately before and after the quit attempt. Moderation effects were observed for select affect states, where higher baseline SE was related to lower momentary SE in the presence of increasing negative high activation, boredom, and difficulty concentrating. Conclusions: Our findings suggest that both positive and negative affect states are related to SE, and that thereby positive affect enhancement may be a promising, underutilized treatment target.

Holmes, Millicent; Fuller‐Tyszkiewicz, Matthew; Skouteris, Helen; Broadbent, Jaclyn (2014): Improving prediction of binge episodes by modelling chronicity of dietary restriction. In: European Eating Disorders Review 22 (6), S. 405–411. DOI: 10.1037/t04353-000.

This study evaluates the influences of chronicity of, and time lag between, dietary restriction and binge outcome for predicting binge episode onset. Sixty‐two women aged 18 to 40 years old completed an online survey at random intervals seven times daily for a 7‐day period. Participants self‐reported engagement in dietary restriction and/or binging, and temptation to binge. Consecutive instances of reported dietary restriction better predicted subsequent binges than single instances. As the time lag between the first report of dietary restriction and binge onset increased, a clear linear trend emerged, such that the value of restriction for predicting binges increased with the number of consecutive assessments in which they reported dietary restriction. A similar pattern was found when predicting temptation to binge. Present findings suggest that duration of restriction is a crucial determinant of binge onset. These findings have implications for clinical practice by highlighting the time course from dietary restriction to binging.

Howells, Annika; Ivtzan, Itai; Eiroa-Orosa, Francisco Jose (2014): Putting the ‘app’ in happiness: A randomised controlled trial of a smartphone-based mindfulness intervention to enhance wellbeing. In: Journal of Happiness Studies.

Smartphones are revolutionizing approaches to wellbeing investment. Those seeking greater happiness can engage with thousands of downloadable self-help applications instantly, yet their effectiveness remains largely unknown. This investigation explored the viability of delivering a positive psychological intervention in application format to authentic happiness seekers. A smartphone-based randomized-controlled trial was conducted with a diverse self-selecting pool, randomly assigned to engage with an empirically supported mindfulness intervention (n = 57) or a control intervention (n = 64) for 10 days. The study explored smartphone methodology, the importance of empirically based content for wellbeing enhancement and the extent to which user experience related to wellbeing gains. Results of repeated measures ANOVAs showed statistically significant increases in positive affect with a medium effect size and reduced depressive symptoms with a small effect size, although no statistically significant differences in satisfaction with life, flourishing or negative affect were found. No statistically significant gains were observed in the control condition. Ratings of task enjoyment were positively correlated (Pearson’s r) with positive affect increase. Findings support the viability of smartphone-based interventions to significantly enhance elements of wellbeing, underscoring the importance of application content and the role of person-activity fit. This investigation presents implications for happiness seeking strategies in the real world whilst showcasing a dynamic method of intervention delivery that can benefit future research and practice. If the greatest mission of positive psychology is to enhance global flourishing, the potential of smartphone-based interventions may play a vital role.

Hurlburt, Russell T.; Heavey, Christopher L. (2015): Investigating pristine inner experience: Implications for experience sampling and questionnaires. In: Conscious Cogn 31, S. 148–159. DOI: 10.1016/j.concog.2014.11.002.

We argue that inquiring about directly apprehended (“pristine”) inner experience requires four overlapping methodological characteristics: effectively limiting investigation to specific, clearly identified moments; effectively limiting investigation to pristine experience; bracketing presuppositions; and iteratively acquiring skills. We compare and contrast Descriptive Experience Sampling (DES), other (non-DES) experience sampling methods, and questionnaires and conclude that whereas non-DES sampling methods and questionnaires appear to inquire about pristine inner experience, they fall short on all four methodological counts and therefore might be better understood as investigating an ill-defined mixture of presuppositions, judgments about experience, and pristine experience itself. Typical experience sampling studies and questionnaires can be valid and useful, but their validity and utility does not (or at least does not necessarily) arise from their phenomenological fidelity.

Husky, Mathilde; Olié, Emilie; Guillaume, Sébastien; Genty, Catherine; Swendsen, Joel; Courtet, Philippe (2014): Feasibility and validity of ecological momentary assessment in the investigation of suicide risk. In: Psychiatry Research 220 (1-2), S. 564–570. DOI: 10.1037/t15771-000;

Ecological Momentary Assessment has been used to investigate a wide range of behaviors and psychiatric conditions. Previous investigations have consistently obtained promising results with high acceptance and compliance rates, and with only minor reactive effects for specific variables. Despite the promise of this methodology for the study of severe psychiatric populations, little is known about its feasibility in samples at risk for suicide. In the present study, four samples at varying risk for suicide completed an Ecological Momentary Assessment study by responding to five electronic assessments per day over a one-week period. Samples included healthy controls (n = 13), affective controls (n = 21), past suicide attempters (n = 20), and recent suicide attempters (n = 42). The results demonstrate satisfactory participation rates and high compliance with daily life repeated assessments across all groups. Importantly, negative thoughts or suicidal ideation were not reactive to the duration of the study, indicating that the repeated assessment of such cognitions in daily life have little or no effect on their frequency. The findings provide support for the use of Ecological Momentary Assessment in the study of suicidal ideation and suggest that mobile technologies represent new opportunities for the assessment of high-risk cognitive states experienced by patients in daily life.

Juarascio, Adrienne S.; Manasse, Stephanie M.; Goldstein, Stephanie P.; Forman, Evan M.; Butryn, Meghan L. (2014): Review of Smartphone Applications for the Treatment of Eating Disorders. In: Eur Eat Disord Rev. DOI: 10.1002/erv.2327.

mHealth tools may be a feasible modality for delivering evidence-based treatments and principles (EBPs), and may enhance treatment for eating disorders (EDs). However, research on the efficacy of mHealth tools for EDs and the extent to which they include EBPs is lacking. The current study sought to (i) review existing apps for EDs, (ii) determine the extent to which available treatment apps utilize EBPs, and (iii) assess the degree to which existing smartphone apps utilize recent advances in smartphone technology. Overall, existing ED intervention apps contained minimal EBPs and failed to incorporate smartphone capabilities. For smartphone apps to be a feasible and effective ED treatment modality, it may be useful for creators to begin taking utilizing the abilities that set smartphones apart from in-person treatment while incorporating EBPs. Before mHealth tools are incorporated into treatments for EDs, it is necessary that the feasibility, acceptability, and efficacy be evaluated. Copyright (c) 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Kannisto, Kati Anneli; Koivunen, Marita Hannele; Välimäki, Maritta Anneli (2014): Use of mobile phone text message reminders in health care services: A narrative literature review. In: Journal of Medical Internet Research Vo 16 (10), S. 55–68.

Background: Mobile text messages are a widely recognized communication method in societies, as the global penetration of the technology approaches 100% worldwide. Systematic knowledge is still lacking on how the mobile telephone text messaging (short message service, SMS) has been used in health care services. Objective: This study aims to review the literature on the use of mobile phone text message reminders in health care. Methods: We conducted a systematic literature review of studies on mobile telephone text message reminders. The data sources used were PubMed (MEDLINE), CINAHL, Proquest Databases/ PsycINFO, EMBASE, Cochrane Library, Scopus, and hand searching since 2003. Studies reporting the use of SMS intended to remind patients in health services were included. Given the heterogeneity in the studies, descriptive characteristics, purpose of the study, response rates, description of the intervention, dose and timing, instruments, outcome measures, and outcome data from the studies were synthesized using a narrative approach. Results: From 911 initial citations, 60 studies were included in the review. The studies reported a variety of use for SMS. Mobile telephone text message reminders were used as the only intervention in 73% (44/60) of the studies, and in 27% (16/60) of the remaining studies, SMS was connected to another comprehensive health intervention system. SMS reminders were sent to different patient groups: patients with HIV/AIDS (15%, 9/60) and diabetes (13%, 8/60) being the most common groups. The response rates of the studies varied from 22-100%. Typically, the text message reminders were sent daily. The time before the specific intervention to be rendered varied from 10 minutes (eg, medication taken) to 2 weeks (eg, scheduled appointment). A wide range of different evaluation methods and outcomes were used to assess the impact of SMS varying from existing databases (eg, attendance rate based on medical records), questionnaires, and physiological measures. About three quarters of the studies (77%, 46/60) reported improved outcomes: adherence to medication or to treatment reportedly improved in 40% (24/60) of the studies, appointment attendance in 18% (11/60) of the studies, and non-attendance rates decreased in 18% (11/60) of the studies. Other positive impacts were decreased amount of missed medication doses, more positive attitudes towards medication, and reductions in treatment interruptions. Conclusions: We can conclude that although SMS reminders are used with different patient groups in health care, SMS is less systematically studied with randomized controlled trial study design. Although the amount of evidence for SMS application recommendations is still limited, having 77% (46/60) of the studies showing improved outcomes may indicate its use in health care settings. However, more well-conducted SMS studies are still needed.

Kapur, Kush; Li, Xue; Blood, Emily A.; Hedeker, Donald (2014): Bayesian mixed-effects location and scale models for multivariate longitudinal outcomes: an application to ecological momentary assessment data. In: Stat Med. DOI: 10.1002/sim.6345.

In the statistical literature, the methods to understand the relationship of explanatory variables on each individual outcome variable are well developed and widely applied. However, in most health-related studies given the technological advancement and sophisticated methods of obtaining and storing data, a need to perform joint analysis of multivariate outcomes while explaining the impact of predictors simultaneously and accounting for all the correlations is in high demand. In this manuscript, we propose a generalized approach within a Bayesian framework that models the changes in the variation in terms of explanatory variables and captures the correlations between the multivariate continuous outcomes by the inclusion of random effects at both the location and scale levels. We describe the use of a spherical transformation for the correlations between the random location and scale effects in order to apply separation strategy for prior elicitation while ensuring positive semi-definiteness of the covariance matrix. We present the details of our approach using an example from an ecological momentary assessment study on adolescents. Copyright (c) 2014 John Wiley & Sons, Ltd.

Khoo Chee Han, Christopher; Shanmugam, Rukmanikanthan Al; Choon Siew Kit, David (2014): Accuracy, Consistency, and Reproducibility of the Triaxial Accelerometer in the iPod Touch: A Pilot Study. In: JMIR Mhealth Uhealth 2 (4), S. e39. DOI: 10.2196/mhealth.3008.

BACKGROUND: The use of a mobile consumer communicative device as a motion analysis tool for patients has been researched and documented previously, examining the triaxial accelerometer embedded in such devices. However, there have been few reports in the literature testing the sensitivity of an embedded triaxial accelerometer. OBJECTIVE: Our goal in this study was to test the accuracy, consistency, and reproducibility of the triaxial accelerometer in the iPod Touch. METHODS: In this pilot study, we subjected the triaxial accelerometer in the iPod Touch to a free fall from a height of 100 cm in order to test its accuracy, consistency, and reproducibility under dynamic conditions. RESULTS: The resultant vectorial sum acceleration was mean 0.999 g (standard gravity; SD 1.51%; 95% CI 0.99-1.01), indicating very high accuracy and sensitivity under dynamic conditions. CONCLUSIONS: Our results highlighted the reproducibility of the capability of the triaxial accelerometer in the iPod Touch to capture data accurately and consistently. Thus, the device has huge potential as a motion analysis tool for measuring gait and studying balance and mobility in patients before and after surgery.

Kirby, Tony; Thornber-Dunwell, Michelle (2014): Phone apps could help promote sexual health in MSM. In: The Lancet 384 (9952), S. 1415.

This article focuses on promoting sexual health in men who have sex with men (MSM) through phone apps. Since the advent of smartphone technology, people worldwide of all sexualities have been using various downloadable apps to help them meet people for dates, casual sex, and in some cases, group sex. For many (but by no means all) men who have sex with men (MSM), smartphone apps such as Grindr, Hornet, FindFred, Growlr, Scruff , and many others have become part of daily life. These MSM will look at a list of other men in their area, start up a conversation, and can ultimately end up engaging in casual sex. Some of the MSM using apps to meet partners are also using a range of recreational drugs during these sexual encounters. Thus, experts say, it is vital that apps off er links for users to fi nd drug counseling and support as well as promoting good sexual health.

Komulainen, Emma; Meskanen, Katarina; Lipsanen, Jari; Lahti, Jari Marko; Jylha, Pekka; Melartin, Tarja et al. (2014): The effect of personality on daily life emotional processes. In: PLoS One 9 (10), S. e110907. DOI: 10.1371/journal.pone.0110907.

Personality features are associated with individual differences in daily emotional life, such as negative and positive affectivity, affect variability and affect reactivity. The existing literature is somewhat mixed and inconclusive about the nature of these associations. The aim of this study was to shed light on what personality features represent in daily life by investigating the effect of the Five Factor traits on different daily emotional processes using an ecologically valid method. The Experience Sampling Method was used to collect repeated reports of daily affect and experiences from 104 healthy university students during one week of their normal lives. Personality traits of the Five Factor model were assessed using NEO Five Factor Inventory. Hierarchical linear modeling was used to analyze the effect of the personality traits on daily emotional processes. Neuroticism predicted higher negative and lower positive affect, higher affect variability, more negative subjective evaluations of daily incidents, and higher reactivity to stressors. Conscientiousness, by contrast, predicted lower average level, variability, and reactivity of negative affect. Agreeableness was associated with higher positive and lower negative affect, lower variability of sadness, and more positive subjective evaluations of daily incidents. Extraversion predicted higher positive affect and more positive subjective evaluations of daily activities. Openness had no effect on average level of affect, but predicted higher reactivity to daily stressors. The results show that the personality features independently predict different aspects of daily emotional processes. Neuroticism was associated with all of the processes. Identifying these processes can help us to better understand individual differences in daily emotional life.

Krause, Amanda E.; North, Adrian C.; Hewitt, Lauren Y. (2014): The Role of Location in Everyday Experiences of Music. In: Psychology of Popular Media Culture.

Mehrabian and Russell’s (1974) Pleasure–Arousal–Dominance model states that a propensity to approach/avoid an environment can be conceptualized in terms of the pleasure and arousal it elicits and one’s degree of dominance therein. Using the Experience Sampling Method, 177 individuals provided responses concerning Mehrabian and Russell’s model throughout 1 wk regarding music experiences that occurred in their daily life (including how the music was heard and how their responses related to the listening location). Results indicate that the time of day and day of week are related to where music is experienced, and that the consequences of what was heard are related to both time and location. Although music was experienced more often in private locations than in public overall, interesting patterns of music experiences that occurred in public locations demonstrate in detail how music listening varies by location. Specifically, portable devices were associated with positive responses, which contrasted sharply with the responses to music broadcasted publicly in public settings. Participants’ ratings of choice, liking, and arousal demonstrated the importance of considering choice as an indication of dominance, such that music usage is consistent with Mehrabian and Russell’s model, and has functions that vary according to the specific characteristics of the situation.

Kuerbis, Alexis; Armeli, Stephen; Muench, Frederick; Morgenstern, Jon (2014): Profiles of confidence and commitment to change as predictors of moderated drinking: A person-centered approach. In: Psychology of Addictive Behaviors 28 (4), S. 1065–1076. DOI: 10.1037/t01528-000.

Identifying who, among problem drinkers, is best suited for moderation and has the greatest likelihood to control drinking has important public health implications. The current study aimed to identify profiles of problem drinkers who may be more or less successful in moderating drinking within the context of a randomized clinical trial of a brief treatment for alcohol use disorder. A person-centered approach was implemented, utilizing composite, baseline daily diary values of confidence and commitment to reduce drinking. Problem drinkers (N = 89) were assessed, provided feedback about their drinking, and randomly assigned to 1 of 3 conditions: 2 brief alcohol use disorder treatments or a third group asked to change on their own. Global self-report assessments were administered at baseline and Week 8 (end of treatment). Daily diary composites were created from data collected via an interactive voice recording system during the week prior to baseline. A K-means cluster analysis identified 3 groups: high, moderate, and low confidence and commitment to change drinking. Group differences were explored, and then group membership was entered into generalized estimating equations to predict drinking trajectories over time. Findings revealed that the groups differentially reduced their drinking, such that the high group had greater reduction in drinking and a faster rate of reduction than the other 2 groups, and the moderate group had greater reduction than the low group. Findings suggest that baseline motivation and self-efficacy are important for predicting prognoses related to successful moderated drinking. Limitations and arenas for future research are discussed.

Kuhn, Eric; Eftekhari, Afsoon; Hoffman, Julia E.; Crowley, Jill J.; Ramsey, Kelly M.; Reger, Greg M.; Ruzek, Josef I. (2014): Clinician perceptions of using a smartphone app with prolonged exposure therapy. In: Administration and Policy in Mental Health and Mental Health Services Research 41 (6), S. 800–807.

Clinician perceptions of clinical innovations affect their adoption and spread. This study investigated mental health clinicians’ (n = 163) perceptions of a patient-facing smartphone application (app) for prolonged exposure (PE) therapy for posttraumatic stress disorder, before its public release. After reading a description of the app, participants rated perceptions of it based on diffusion of innovations theory constructs. Perceptions were generally favorable regarding the app’s relative advantage over existing PE practices, compatibility with their values and needs, and complexity. Age (< 40 years), smartphone ownership, and having used apps in care related to more favorable perceptions. Smartphone ownership, relative advantage, and complexity significantly predicted intention to use the app if it were available. These findings suggest that clinicians are receptive to using a PE app and that dissemination efforts should target sub-groups of PE clinicians to maximize adoption.

Kumar, Amit; Killingsworth, Matthew A.; Gilovich, Thomas (2014): Waiting for Merlot: Anticipatory consumption of experiential and material purchases. In: Psychological Science 25 (10), S. 1924–1931.

Experiential purchases (money spent on doing) tend to provide more enduring happiness than material purchases (money spent on having). Although most research comparing these two types of purchases has focused on their downstream hedonic consequences, the present research investigated hedonic differences that occur before consumption. We argue that waiting for experiences tends to be more positive than waiting for possessions. Four studies demonstrate that people derive more happiness from the anticipation of experiential purchases and that waiting for an experience tends to be more pleasurable and exciting than waiting to receive a material good. We found these effects in studies using questionnaires involving a variety of actual planned purchases, in a large-scale experience-sampling study, and in an archival analysis of news stories about people waiting in line to make a purchase. Consumers derive value from anticipation, and that value tends to be greater for experiential than for material purchases.

Kurti, Allison N.; Logan, Henrietta; Manini, Todd; Dallery, Jesse (2014): Physical Activity Behavior, Barriers to Activity, and Opinions About a Smartphone-Based Physical Activity Intervention Among Rural Residents. In: Telemed J E Health. DOI: 10.1089/tmj.2014.0034.

Abstract Background: Rural Americans engage in less physical activity (PA) and experience higher rates of consequent health problems (i.e., obesity, cardiovascular disease) than urban Americans. Although geographic barriers have historically made this population hard to reach, rural individuals are increasingly gaining access to smartphones. Thus, the purpose of this study was to evaluate PA behavior and barriers to PA among rural residents and to gauge their receptiveness to a smartphone-based PA intervention that is currently in the development stage. Materials and Methods: Rural Floridian adults (n=113), 18 years of age and older, completed surveys to assess PA behavior, PA barriers, and opinions about an intervention to increase PA. Specifically, they were asked to imagine a program that would require them to do PA with their mobile phones and whether they viewed intended aspects of the program as helpful. The present work is therefore formative research that sought to determine the feasibility and acceptability of a smartphone-based intervention among rural residents. Results of the survey will inform the development of a tailored, smartphone-based PA intervention. Results: The 37.2% of participants with low PA levels (<600 metabolic equivalent [MET]-min per week) were more likely to report personal and environmental barriers to PA than the 47.8% of participants with moderate PA levels (>/=600 MET-min per week). More barriers were reported among participants who self-reported as white and among participants of older age, lower education level, and lower socioeconomic status. Additionally, 75.9% of participants reported features of the intervention as at least somewhat helpful. Conclusions: The growing ubiquity of smartphones among rural residents, combined with participants’ positive response to the program description, supports the acceptability of a smartphone-based PA intervention for rural communities. Given the participants’ receptiveness, future research should evaluate the efficacy of smartphone-delivered health behavior interventions among this population.

Kwon, Sungjun; Kim, Jeehoon; Kang, Seungwoo; Lee, Youngki; Baek, Hyunjae; Park, Kwangsuk (2014): CardioGuard: A Brassiere-Based Reliable ECG Monitoring Sensor System for Supporting Daily Smartphone Healthcare Applications. In: Telemed J E Health 20 (12), S. 1093–1102. DOI: 10.1089/tmj.2014.0008.

Abstract We propose CardioGuard, a brassiere-based reliable electrocardiogram (ECG) monitoring sensor system, for supporting daily smartphone healthcare applications. It is designed to satisfy two key requirements for user-unobtrusive daily ECG monitoring: reliability of ECG sensing and usability of the sensor. The system is validated through extensive evaluations. The evaluation results showed that the CardioGuard sensor reliably measure the ECG during 12 representative daily activities including diverse movement levels; 89.53% of QRS peaks were detected on average. The questionnaire-based user study with 15 participants showed that the CardioGuard sensor was comfortable and unobtrusive. Additionally, the signal-to-noise ratio test and the washing durability test were conducted to show the high-quality sensing of the proposed sensor and its physical durability in practical use, respectively.

Lackner, J. M.; Jaccard, J.; Keefer, L.; Firth, R.; Carosella, A. M.; Sitrin, M.; Brenner, D. (2014): The accuracy of patient-reported measures for GI symptoms: a comparison of real time and retrospective reports. In: Neurogastroenterol Motil 26 (12), S. 1802–1811. DOI: 10.1111/nmo.12466.

BACKGROUND: Obtaining accurate information about gastrointestinal (GI) symptoms is critical to achieving the goals of clinical research and practice. The accuracy of patient data is especially important for functional GI disorders (e.g., IBS) whose symptoms lack a biomarker and index illness severity and treatment response. Retrospective patient-reported data are vulnerable to forgetting and various cognitive biases whose impact has not been systematically studied in patients with GI disorders. The aim of this study was to document the accuracy of patient-reported GI symptoms over a reporting period (1 week) most representative of the time frame used in research and clinical care. METHODS: Subjects were 273 Rome III-diagnosed IBS patients (mean age = 39 years, 89% F) who completed end of day GI symptom ratings for 7 days using an electronic diary. On Day 8, Subjects recalled the frequency and/or intensity of IBS symptoms over the past 7 days. Reports were then compared against a validation criterion based on aggregated end of day ratings. KEY RESULTS: At the group level, subjects recalled most accurately abdominal pain and urgency intensity at their worst, urgency days, and stool frequency. When data were analyzed at the individual level, a subgroup of subjects had difficulty recalling accurately symptoms that showed convergence between recall and real time reports at the group level. CONCLUSIONS & INFERENCES: Although many patients’ recollection for specific GI symptoms (e.g., worst pain, stool frequency) is reasonably accurate, a non-trivial number of other symptoms (e.g., typical pain) are vulnerable to distortion from recall biases that can reduce sensitivity of detecting treatment effects in clinical and research settings.

Laing, Brian Yoshio; Mangione, Carol M.; Tseng, Chi-Hong; Leng, Mei; Vaisberg, Ekaterina; Mahida, Megha et al. (2014): Effectiveness of a smartphone application for weight loss compared with usual care in overweight primary care patients: a randomized, controlled trial. In: Ann Intern Med 161 (10 Suppl), S. S5-12. DOI: 10.7326/M13-3005.

BACKGROUND: Many smartphone applications (apps) for weight loss are available, but little is known about their effectiveness. OBJECTIVE: To evaluate the effect of introducing primary care patients to a free smartphone app for weight loss. DESIGN: Randomized, controlled trial. ( NCT01650337). SETTING: 2 academic primary care clinics. PATIENTS: 212 primary care patients with body mass index of 25 kg/m2 or greater. INTERVENTION: 6 months of usual care without (n = 107) or with (n = 105) assistance in downloading the MyFitnessPal app (MyFitnessPal). MEASUREMENTS: Weight loss at 6 months (primary outcome) and changes in systolic blood pressure and behaviors, frequency of app use, and satisfaction (secondary outcomes). RESULTS: After 6 months, weight change was minimal, with no difference between groups (mean between-group difference, -0.30 kg [95% CI, -1.50 to 0.95 kg]; P = 0.63). Change in systolic blood pressure also did not differ between groups (mean between-group difference, -1.7 mm Hg [CI, -7.1 to 3.8 mm Hg]; P = 0.55). Compared with patients in the control group, those in the intervention group increased use of a personal calorie goal (mean between-group difference, 2.0 d/wk [CI, 1.1 to 2.9 d/wk]; P < 0.001), although other self-reported behaviors did not differ between groups. Most users reported high satisfaction with MyFitnessPal, but logins decreased sharply after the first month. LIMITATIONS: Despite being blinded to the name of the app, 14 control group participants (13%) used MyFitnessPal. In addition, 32% of intervention group participants and 19% of control group participants were lost to follow-up at 6 months. The app was given to patients by research assistants, not by physicians. CONCLUSION: Smartphone apps for weight loss may be useful for persons who are ready to self-monitor calories, but introducing a smartphone app is unlikely to produce substantial weight change for most patients. PRIMARY FUNDING SOURCE: Robert Wood Johnson Foundation Clinical Scholars Program, National Institutes of Health/National Center for Advancing Translational Sciences for the UCLA Clinical and Translational Science Institute, and the Resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly under the National Institutes of Health/National Institute on Aging.

Lalloo, Chitra; Jibb, Lindsay A.; Rivera, Jordan; Agarwal, Arnav; Stinson, Jennifer N. (2014): “There’s a Pain App for That”: Review of Patient-Targeted Smartphone Applications for Pain Management. In: Clin J Pain. DOI: 10.1097/AJP.0000000000000171.

OBJECTIVES:: There are a growing number of pain self-management apps available for users to download on personal smartphones. The purpose of this study was to critically appraise the content and self-management functionality of currently available pain apps. METHODS:: An electronic search was conducted between May and June 2014 of the official stores for the four major operating systems. Two authors independently identified patient-focused apps with a stated goal of pain management. Discrepancies regarding selection were resolved through discussion with a third party. Metadata from all included apps were abstracted into a standard form. The content and functionality of each app as it pertained to pain self-management was rated. RESULTS:: A total of 279 apps met the inclusion criteria. Pain self-care skill support was the most common self-management function (77.4%). Apps also purported providing patients with the ability to engage in pain education (45.9%), self-monitoring (19%), social support (3.6%) and goal-setting (0.72%). No apps were comprehensive in terms of pain self-management, with the majority of apps including only a single self-management function (58.5%). Additionally, only 8.2% of apps included a healthcare professional in their development, not a single app provided a theoretical rationale, and only 1 app underwent scientific evaluation. DISCUSSION:: Currently available pain self-management apps for patients are simplistic, lack the involvement of healthcare professionals in their development, and have not been rigorously tested for effectiveness on pain-related health outcomes. There is a need to develop and test theoretically- and evidence-based apps to better support patients with accessible pain care self-management.

Lamprecht, Marnie L.; Bradley, Andrew P.; Tran, Tommy; Boynton, Alison; Terrill, Philip I. (2015): Multisite accelerometry for sleep and wake classification in children. In: Physiol Meas 36 (1), S. 133–147. DOI: 10.1088/0967-3334/36/1/133.

Actigraphy is a useful alternative to the gold standard polysomnogram for non-invasively measuring sleep and wakefulness. However, it is unable to accurately assess sleep fragmentation due to its inability to differentiate restless sleep from wakefulness and quiet wake from sleep. This presents significant limitations in the assessment of sleep-related breathing disorders where sleep fragmentation is a common symptom. We propose that this limitation may be caused by hardware constraints and movement representation techniques. Our objective was to determine if multisite tri-axial accelerometry improves sleep and wake classification. Twenty-four patients aged 6-15 years (median: 8 years, 16 male) underwent a diagnostic polysomnogram while simultaneously recording motion from the left wrist and index fingertip, upper thorax and left ankle and great toe using a custom accelerometry system. Movement was quantified using several features and two feature selection techniques were employed to select optimal features for restricted feature set sizes. A heuristic was also applied to identify movements during restless sleep. The sleep and wake classification performance was then assessed and validated against the manually scored polysomnogram using discriminant analysis. Tri-axial accelerometry measured at the wrist significantly improved the wake detection when compared to uni-axial accelerometry (specificity at 85% sensitivity: 71.3(14.2)% versus 55.2(24.7)%, p < 0.01). Multisite accelerometry significantly improved the performance when compared to the single wrist placement (specificity at 85% sensitivity: 82.1(12.5)% versus 71.3(14.2)%, p < 0.05). Our results indicate that multisite accelerometry offers a significant performance benefit which could be further improved by analysing movement in raw multisite accelerometry data.

Lanata, Antonio; Valenza, Gaetano; Nardelli, Mimma; Gentili, Claudio; Scilingo, Enzo Pasquale (2015): Complexity index from a personalized wearable monitoring system for assessing remission in mental health. In: IEEE J Biomed Health Inform 19 (1), S. 132–139. DOI: 10.1109/JBHI.2014.2360711.

This study discusses a personalized wearable monitoring system, which provides information and communication technologies to patients with mental disorders and physicians managing such diseases. The system, hereinafter called the PSYCHE system, is mainly comprised of a comfortable t-shirt with embedded sensors, such as textile electrodes, to monitor electrocardiogram-heart rate variability (HRV) series, piezoresistive sensors for respiration activity, and triaxial accelerometers for activity recognition. Moreover, on the patient-side, the PSYCHE system uses a smartphone-based interactive platform for electronic mood agenda and clinical scale administration, whereas on the physician-side provides data visualization and support to clinical decision. The smartphone collects the physiological and behavioral data and sends the information out to a centralized server for further processing. In this study, we present experimental results gathered from ten bipolar patients, wearing the PSYCHE system, with severe symptoms who exhibited mood states among depression (DP), hypomania(HM), mixed state (MX), and euthymia (EU), i.e., the good affective balance. In analyzing more than 400 h of cardiovascular dynamics, we found that patients experiencing mood transitions from a pathological mood state (HM, DP, or MX-where depressive and hypomanic symptoms are simultaneously present) to EU can be characterized through a commonly used measure of entropy. In particular, the SampEn estimated on long-term HRV series increases according to the patients’ clinical improvement. These results are in agreement with the current literature reporting on the complexity dynamics of physiological systems and provides a promising and viable support to clinical decision in order to improve the diagnosis and management of psychiatric disorders.

Linas, Beth S.; Latkin, Carl; Westergaard, Ryan P.; Chang, Larry W.; Bollinger, Robert C.; Genz, Andrew; Kirk, Gregory D. (2014): Capturing illicit drug use where and when it happens: an ecological momentary assessment of the social, physical and activity environment of using versus craving illicit drugs. In: Addiction. DOI: 10.1111/add.12768.

AIMS: To understand the environmental and contextual influences of illicit cocaine and heroin use and craving using mobile health (mHealth) methods. DESIGN: Interactive mHealth methods of ecological momentary assessment (EMA) were utilized in the Exposure Assessment in Current Time (EXACT) study to assess drug use and craving among urban drug users in real time. Participants were provided with mobile devices and asked to self-report every time they either craved (without using) or used heroin or cocaine for 30 days from November 2008 through May 2013. SETTING: Baltimore, MD, USA. PARTICIPANTS: A total of 109 participants from the AIDS Linked to the IntraVenous Experience (ALIVE) study. MEASUREMENTS: For each drug use or craving event, participants answered questions concerning their drug use, current mood and their social, physical and activity environments. Odds ratios (OR) of drug use versus craving were obtained from logistic regression models with generalized estimating equations of all reported events. FINDINGS: Participants were a median of 48.5 years old, 90% African American, 52% male and 59% HIV-infected. Participants were significantly more likely to report use rather than craving drugs if they were with someone who was using drugs [adjusted odds ratio (aOR) = 1.45, 95% confidence interval (CI) = 1.13, 1.86), in an abandoned space (aOR = 6.65, 95% CI = 1.78, 24.84) or walking/wandering (aOR = 1.68, 95% CI = 1.11, 2.54). Craving drugs was associated with being with a child (aOR = 0.26, 95% CI = 0.12, 0.59), eating (aOR = 0.54, 95% CI = 0.34, 0.85) or being at the doctor's office (aOR = 0.31, 95% CI = 0.12, 0.80). CONCLUSIONS: There are distinct drug using and craving environments among urban drug users, which may provide a framework for developing real-time context-sensitive interventions.

Luque, Rafael; Casilari, Eduardo; Moron, Maria-Jose; Redondo, Gema (2014): Comparison and characterization of Android-based fall detection systems. In: Sensors (Basel) 14 (10), S. 18543–18574. DOI: 10.3390/s141018543.

Falls are a foremost source of injuries and hospitalization for seniors. The adoption of automatic fall detection mechanisms can noticeably reduce the response time of the medical staff or caregivers when a fall takes place. Smartphones are being increasingly proposed as wearable, cost-effective and not-intrusive systems for fall detection. The exploitation of smartphones' potential (and in particular, the Android Operating System) can benefit from the wide implantation, the growing computational capabilities and the diversity of communication interfaces and embedded sensors of these personal devices. After revising the state-of-the-art on this matter, this study develops an experimental testbed to assess the performance of different fall detection algorithms that ground their decisions on the analysis of the inertial data registered by the accelerometer of the smartphone. Results obtained in a real testbed with diverse individuals indicate that the accuracy of the accelerometry-based techniques to identify the falls depends strongly on the fall pattern. The performed tests also show the difficulty to set detection acceleration thresholds that allow achieving a good trade-off between false negatives (falls that remain unnoticed) and false positives (conventional movements that are erroneously classified as falls). In any case, the study of the evolution of the battery drain reveals that the extra power consumption introduced by the Android monitoring applications cannot be neglected when evaluating the autonomy and even the viability of fall detection systems.

McCrorie, Paul Rw; Fenton, Candida; Ellaway, Anne (2014): Combining GPS, GIS, and accelerometry to explore the physical activity and environment relationship in children and young people - a review. In: Int J Behav Nutr Phys Act 11 (1), S. 93. DOI: 10.1186/s12966-014-0093-0.

The environment has long been associated with physical activity engagement, and recent developments in technology have resulted in the ability to objectively quantify activity behaviours and activity context. This paper reviews studies that have combined Global Positioning Systems (GPS), Geographic Information Systems (GIS) and accelerometry to investigate the PA-environment relationship in children and young people (5-18 years old). Literature searches of the following bibliographic databases were undertaken: Sportdiscus, Medline, Embase, CINAHL, Psychinfo and Applied Social Sciences Index and Abstracts (ASSIA). Fourteen studies met the inclusion criteria, and covered topics including greenspace use, general land use, active travel, and the built environment. Studies were largely cross-sectional and took place across developed countries (UK, USA, Canada, New Zealand, and Australia). Findings suggest that roads and streets, school grounds, and the home location are important locations for total PA, and moderate to vigorous PA (MVPA). The relationship between greenspace was positive, however, multiple definitions and outcome measures add complexity to the results. MVPA was more likely in those exposed to higher levels of greenspace compared to sedentary individuals. Total MVPA time in greenspace is low, but when framed as a proportion of the total can be quite high. Domestic gardens may be an important area for higher intensity activity.Researchers are encouraged to show transparency in their methods. As a relatively new area of research, with ever-evolving technology, future work is best placed in developing novel, but robust, methods to investigate the PA and environment relationship. Further descriptive work is encouraged to build on a small but increasing knowledge base; however, longitudinal studies incorporating seasonal/weather variation would also be extremely beneficial to elicit some of the nuances associated with land use. A greater understanding of geographic variation (i.e. within and between countries), as well as urban/suburban and rural dwelling is welcomed, and future work should also include the investigation of psycho-social health as an outcome, as well as differences in socio-economic status, sex and adiposity.

Miller, Megan A.; Rothenberger, Scott D.; Hasler, Brant P.; Donofry, Shannon D.; Wong, Patricia M.; Manuck, Stephen B. et al. (2014): Chronotype predicts positive affect rhythms measured by ecological momentary assessment. In: Chronobiol Int, S. 1–9. DOI: 10.3109/07420528.2014.983602.

Evening chronotype, a correlate of delayed circadian rhythms, is associated with depression. Altered positive affect (PA) rhythms may mediate the association between evening chronotype and depression severity. Consequently, a better understanding of the relationship between chronotype and PA may aid in understanding the etiology of depression. Recent studies have found that individuals with evening chronotype show delayed and blunted PA rhythms, although these studies are relatively limited in sample size, representativeness and number of daily affect measures. Further, published studies have not included how sleep timing changes on workday and non-workdays, or social jet lag (SJL) may contribute to the chronotype-PA rhythm link. Healthy non-depressed adults (n = 408) completed self-report affect and chronotype questionnaires. Subsequently, positive and negative affects were measured hourly while awake for at least two workdays and one non-workday by ecological momentary assessment (EMA). Sleep variables were collected via actigraphy and compared across chronotype groups. A cosinor variant of multilevel modeling was used to model individual and chronotype group rhythms and to calculate two variables: (1) amplitude of PA, or the absolute amount of daily variation from peak to trough during one period of the rhythm and (2) acrophase, or the time at which the peak amplitude of affect rhythms occurred. On workdays, individuals with evening chronotype had significantly lower PA amplitudes and later workday acrophase times than their morning type counterparts. In contrast to predictions, SJL was not found to be a mediator in the relationship between chronotype and PA rhythms. The association of chronotype and PA rhythms in healthy adults may suggest the importance of daily measurement of PA in depressed individuals and would be consistent with the hypothesis that evening chronotype may create vulnerability to depression via delayed and blunted PA rhythms.

Mills, Jacqueline; Fuller-Tyszkiewicz, Matthew; Holmes, Millicent (2014): State body dissatisfaction and social interactions: An experience sampling study. In: Psychology of Women Quarterly 38 (4), S. 551–562. DOI: 10.1037/t06423-000;

To date, there has been limited empirical scrutiny of the correlates and consequences of day-to-day state body dissatisfaction fluctuations within naturalistic contexts. We used ecological momentary assessment (a form of naturalistic observation) to evaluate whether state body dissatisfaction was concurrently and/or prospectively associated with occurrence and quality of social interactions. Women (N = 121), aged 18 to 40, completed a brief trait-based survey and then nominated a 7-day period within which to receive seven text messages daily, at random intervals, prompting them to complete measures of body dissatisfaction at that moment. If they were currently or had recently engaged in social interactions, they were also asked to fill out questions rating the quality of these interactions (operationalized in terms of enjoyment of, and control in, the interaction). Findings suggest that the relationship between state body dissatisfaction and aspects of social interactions is complex and may vary over time. Cross-sectionally, state body dissatisfaction and social interaction quality were negatively associated. Prospectively, however, body dissatisfaction predicted subsequent avoidance of social interactions. Interestingly, when women chose to avoid social interactions, their body dissatisfaction worsened, yet when they did engage in social interactions, they reported improved body satisfaction. Importantly, the links between state body dissatisfaction and social interactions may be moderated by body mass index and trait body satisfaction levels. Potential mechanisms underlying the association between state body dissatisfaction and quality and quantity of social interactions are discussed, and future research avenues are proposed to further understand their inter-relation.

Miranda, Robert, JR; MacKillop, James; Treloar, Hayley; Blanchard, Alexander; Tidey, Jennifer W.; Swift, Robert M. et al. (2014): Biobehavioral mechanisms of topiramate's effects on alcohol use: an investigation pairing laboratory and ecological momentary assessments. In: Addict Biol. DOI: 10.1111/adb.12192.

Topiramate reduces drinking, but little is known about the mechanisms that precipitate this effect. This double-blind randomized placebo-controlled study assessed the putative mechanisms by which topiramate reduces alcohol use among 96 adult non-treatment-seeking heavy drinkers in a laboratory-based alcohol cue reactivity assessment and in the natural environment using ecological momentary assessment methods. Topiramate reduced the quantity of alcohol heavy drinkers consumed on drinking days and reduced craving while participants were drinking but did not affect craving outside of drinking episodes in either the laboratory or in the natural environment. Topiramate did not alter the stimulant or sedative effects of alcohol ingestion during the ascending limb of the blood alcohol curve. A direct test of putative mechanisms of action using multilevel structural equation mediation models showed that topiramate reduced drinking indirectly by blunting alcohol-induced craving. These findings provide the first real-time prospective evidence that topiramate reduces drinking by reducing alcohol's priming effects on craving and highlight the importance of craving as an important treatment target of pharmacotherapy for alcoholism.

Morrison, Leanne G.; Hargood, Charlie; Lin, Sharon Xiaowen; Dennison, Laura; Joseph, Judith; Hughes, Stephanie et al. (2014): Understanding usage of a hybrid website and smartphone app for weight management: a mixed-methods study. In: J Med Internet Res 16 (10), S. e201. DOI: 10.2196/jmir.3579.

BACKGROUND: Advancements in mobile phone technology offer huge potential for enhancing the timely delivery of health behavior change interventions. The development of smartphone-based health interventions (apps) is a rapidly growing field of research, yet there have been few longitudinal examinations of how people experience and use these apps within their day-to-day routines, particularly within the context of a hybrid Web- and app-based intervention. OBJECTIVE: This study used an in-depth mixed-methods design to examine individual variation in (1) impact on self-reported goal engagement (ie, motivation, self-efficacy, awareness, effort, achievement) of access to a weight management app (POWeR Tracker) when provided alongside a Web-based weight management intervention (POWeR) and (2) usage and views of POWeR Tracker. METHODS: Thirteen adults were provided access to POWeR and were monitored over a 4-week period. Access to POWeR Tracker was provided in 2 alternate weeks (ie, weeks 1 and 3 or weeks 2 and 4). Participants' goal engagement was measured daily via self-report. Mixed effects models were used to examine change in goal engagement between the weeks when POWeR Tracker was and was not available and whether the extent of change in goal engagement varied between individual participants. Usage of POWeR and POWeR Tracker was automatically recorded for each participant. Telephone interviews were conducted and analyzed using inductive thematic analysis to further explore participants' experiences using POWeR and POWeR Tracker. RESULTS: Access to POWeR Tracker was associated with a significant increase in participants' awareness of their eating (beta1=0.31, P=.04) and physical activity goals (beta1=0.28, P=.03). The level of increase varied between individual participants. Usage data showed that participants used the POWeR website for similar amounts of time during the weeks when POWeR Tracker was (mean 29 minutes, SD 31 minutes) and was not available (mean 27 minutes, SD 33 minutes). POWeR Tracker was mostly accessed in short bursts (mean 3 minutes, SD 2 minutes) during convenient moments or moments when participants deemed the intervention content most relevant. The qualitative data indicated that nearly all participants agreed that it was more convenient to access information on-the-go via their mobiles compared to a computer. However, participants varied in their views and usage of the Web- versus app-based components and the informational versus tracking tools provided by POWeR Tracker. CONCLUSIONS: This study provides evidence that smartphones have the potential to improve individuals' engagement with their health-related goals when used as a supplement to an existing online intervention. The perceived convenience of mobile access to information does not appear to deter use of Web-based interventions or strengthen the impact of app access on goal engagement. A mixed-methods design enabled exploration of individual variation in daily usage of the app-based tools.

Moses Passini, Christina; Pihet, Sandrine; Favez, Nicolas (2014): Assessing specific discipline techniques: A mixed-methods approach. In: Journal of Child and Family Studies 23 (8), S. 1389–1402. DOI: 10.1037/t00815-000.

This study explored, in a community sample of mothers of toddlers, parenting beliefs and values, to gain insight into the parent–child relationship. Acceptance of specific discipline techniques (DTs), and their actual use in daily life were examined. A mixed-methods approach comprising three different methods was used: (1) parenting beliefs and values were explored with Q-methodology; (2) acceptance of the DTs was assessed with the questionnaire Dimensions of Discipline Inventory; and (3) actual use of those DTs in daily-life incidents of discipline was documented using ecological momentary assessment for ten consecutive days. The results showed the mothers’ parenting beliefs and values reflected a warm parent–child relationship. The mothers rated explaining rules, timeout, removal of privileges, and social reinforcement as moderately to highly acceptable. However, planned ignoring received a low acceptance rating. Mothers’ high acceptability ratings of the DTs contrasted with moderate use when they were faced with their misbehaving child, with the exception of explaining rules, which was always manifested. Yelling and spanking received the lowest acceptance ratings. Nonetheless, in daily life, yelling was employed as often as timeout. These findings suggest the need for more attention to be paid to both acceptance and daily use of specific DTs in order to highlight DTs which parents may have difficulty implementing.

Nadell, Melanie J.; Mermelstein, Robin J.; Hedeker, Donald; Marquez, David X. (2014): Work and Non-Work Physical Activity Predict Real-Time Smoking Level and Urges in Young Adults. In: Nicotine Tob Res. DOI: 10.1093/ntr/ntu244.

INTRODUCTION: Physical activity (PA) and smoking are inversely related. However, evidence suggests that some types of PA, namely work-related PA, may show an opposite effect. Despite growing knowledge, there remains a paucity of studies examining the context of these behaviors in naturalistic settings or in young adults, a high-risk group for escalation. METHODS: Participants were 188 young adults (mean age = 21.32; 53.2% female; 91% current smokers) who participated in an electronic diary week to assess daily smoking and urges and a PA recall to examine daily PA. PA was coded into non-work-related and work-related activity to examine differential effects. We considered both participants' weekly average PA and their daily deviations from their average. RESULTS: Mixed-effects regression models revealed that higher weekly average non-work PA was associated with lower smoking level and urges. Daily deviations in non-work PA did not predict urges; however, increased daily non-work PA relative to participants' weekly average was associated with lower smoking for females but higher levels for males. Regarding work PA, only higher weekly average work PA was associated with higher smoking level for both genders; work PA did not predict urges. CONCLUSIONS: Results extend previous literature by documenting differential associations between non-work and work PA and young adult smoking and suggest that young adults engaged in work PA should be considered a high-risk group for escalation. Findings provide theoretical and clinical implications for the use of PA in intervention and highlight the necessity of considering PA as a multidimensional construct when examining its links to health behavior.

Naslund, John A.; Aschbrenner, Kelly A.; Barre, Laura K.; Bartels, Stephen J. (2014): Feasibility of Popular m-Health Technologies for Activity Tracking Among Individuals with Serious Mental Illness. In: Telemed J E Health. DOI: 10.1089/tmj.2014.0105.

Abstract Obesity prevalence is nearly double among individuals with serious mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder, or major depressive disorder, compared with the general population. Emerging mobile health (m-health) technologies are increasingly available and offer the potential to support lifestyle interventions targeting weight loss, yet the practical feasibility of using these technologies in this high-risk group has not been established. We evaluated the feasibility and acceptability of popular m-health technologies for activity tracking among overweight and obese individuals with SMI. We provided wearable activity monitoring devices (FitBit [San Francisco, CA] Zip or Nike Inc. [Beaverton, OR] FuelBand) and smartphones (Apple [Cupertino, CA] iPhone(R) 4S) for accessing the smartphone application for each device to participants with SMI enrolled in a weight loss program. Feasibility of these devices was measured by the frequency of use over time. Acceptability was measured through qualitative follow-up interviews with participants. Ten participants with SMI wore the devices for a mean of 89% (standard deviation=13%) of the days in the study. Five participants wore the devices 100% of the time. Participants reported high satisfaction, stating the devices were easy to use, helpful for setting goals, motivational, and useful for self-monitoring. Several participants liked the social connectivity feature of the devices where they could see each other’s progress on the smartphone application, noting that “friendly” competition increased motivation to be more physically active. This study supports using popular m-health technologies for activity tracking among individuals with SMI. These findings can inform the design of weight loss interventions targeting this vulnerable patient population.

Offer, Shira (2014): The costs of thinking about work and family: Mental labor, work–family spillover, and gender inequality among parents in dual‐earner families. In: Sociological Forum 29 (4), S. 916–936.

One of the aspects unaccounted for in previous assessments of employed parents ‘distribution of time is the mental dimension of tasks and demands. This aspect, referred to as mental labor, is conceptualized as the planning, organization, and management of everyday activities. Using the experience sampling method, a unique form of time diary, and survey data from the 500 Family Study (N = 402 mothers with 16,451 signals and 291 fathers with 11,322 signals), this study examined the prevalence, context, and emotional correlates of mental labor among parents in dual‐earner families. Results show that fathers reported thinking more frequently about job‐related matters than mothers but these concerns did not spill over into unpaid work. By contrast, mothers’ job‐related thoughts tended to spill over into unpaid work and free‐time activities. When engaging in mental labor, mothers and fathers were equally likely to think about family matters, but these thoughts were only detrimental to emotional well‐being in mothers. Among both mothers and fathers, paid work was relatively insulated from thoughts about family matters. Overall, findings highlight mothers’ double burden and suggest that mental labor may contribute to mothers’ emotional stress and gender inequality among dual‐earner families.

Orloff, Natalia C.; Hormes, Julia M. (2014): Pickles and ice cream! Food cravings in pregnancy: hypotheses, preliminary evidence, and directions for future research. In: Front Psychol 5, S. 1076. DOI: 10.3389/fpsyg.2014.01076.

Women in the United States experience an increase in food cravings at two specific times during their life, (1) perimenstrually and (2) prenatally. The prevalence of excess gestational weight gain (GWG) is a growing concern due to its association with adverse health outcomes in both mothers and children. To the extent that prenatal food cravings may be a determinant of energy intake in pregnancy, a better understanding of craving etiology could be crucial in addressing the issue of excessive GWG. This paper reviews the available literature to corroborate and/or dispute some of the most commonly accepted hypotheses regarding the causes of food cravings during pregnancy, including a role of (1) hormonal changes, (2) nutritional deficits, (3) pharmacologically active ingredients in the desired foods, and (4) cultural and psychosocial factors. An existing model of perimenstrual chocolate craving etiology serves to structure the discussion of these hypotheses. The main hypotheses discussed receive little support, with the notable exception of a postulated role of cultural and psychosocial factors. The presence of cravings during pregnancy is a common phenomenon across different cultures, but the types of foods desired and the adverse impact of cravings on health may be culture-specific. Various psychosocial factors appear to correlate with excess GWG, including the presence of restrained eating. Findings strongly suggest that more research be conducted in this area. We propose that future investigations fall into one of the four following categories: (1) validation of food craving and eating-related measures specifically in pregnant populations, (2) use of ecological momentary assessment to obtain real time data on cravings during pregnancy, (3) implementation of longitudinal studies to address causality between eating disorder symptoms, food cravings, and GWG, and (4) development of interventions to ensure proper prenatal nutrition and prevent excess GWG.

Parke, Michael R.; Seo, Myeong-Gu; Sherf, Elad N. (2014): Regulating and Facilitating: The Role of Emotional Intelligence in Maintaining and Using Positive Affect for Creativity. In: Journal of Applied Psychology.

Although past research has identified the effects of emotional intelligence on numerous employee outcomes, the relationship between emotional intelligence and creativity has not been well established. We draw upon affective information processing theory to explain how two facets of emotional intelligence—emotion regulation and emotion facilitation—shape employee creativity. Specifically, we propose that emotion regulation ability enables employees to maintain higher positive affect (PA) when faced with unique knowledge processing requirements, while emotion facilitation ability enables employees to use their PA to enhance their creativity. We find support for our hypotheses using a multimethod (ability test, experience sampling, survey) and multisource (archival, self-reported, supervisor-reported) research design of early career managers across a wide range of jobs.

Pavlickova, Hana; Turnbull, Oliver H.; Myin-Germeys, Inez; Bentall, Richard P. (2014): The inter-relationship between mood, self-esteem and response styles in adolescent offspring of bipolar parents: An experience sampling study. In: Psychiatry Res. DOI: 10.1016/j.psychres.2014.11.046.

The response styles theory of depression (Nolen-Hoeksema, 1991) proposes three main strategies individuals employ in response to low mood: rumination, active coping (distraction and problem-solving) and risk taking. Although recent research has suggested this theory has utility in understanding the symptoms of bipolar disorder (BD), the role of these processes in conferring vulnerability to the condition is poorly understood. Twenty-three adolescent children of patients with BD and 25 offspring of well parents completed the Experience Sampling Method (ESM; Csikszentmihalyi and Larson, 1987) diary for six days. Longitudinal analyses were carried out to examine inter-relationships between mood, self-esteem and response styles. Increased negative as well as positive mood resulted in greater rumination in both groups. Low self-esteem triggered greater risk-taking at the subsequent time point in the at-risk group, while negative affect instigated increased active coping in the control group. In both groups, engagement in risk-taking improved mood at the subsequent time point, whilst rumination dampened self-esteem. Differential longitudinal associations between mood, self-esteem and response styles between at-risk and control children suggest early psychological vulnerability in the offspring of BD parents, with important indications for early intervention.

Pavlovic, Jelena M.; Buse, Dawn C.; Sollars, C. Mark; Haut, Sheryl; Lipton, Richard B. (2014): Trigger factors and premonitory features of migraine attacks: summary of studies. In: Headache 54 (10), S. 1670–1679. DOI: 10.1111/head.12468.

OBJECTIVE: In this second of a 2-part series, we review the available literature on trigger factors and premonitory features in migraine. BACKGROUND: In the absence of biological markers of preceding attacks of migraine, trigger factors and premonitory symptoms are valuable though methodologically challenging phenomena to study. DESIGN/METHODS: We focus on selected studies of retrospective surveys, diary studies, and clinical trials. We review the heterogeneity of selected studies and their conclusions performed to date and highlight that prospective electronic diary studies provide most reliable information that can be used for future development of preemptive therapy. CONCLUSION: We conclude that trigger factors and premonitory symptoms are very common, but that the frequency estimates vary widely based on the study approach and population. We recommend that multimodal approaches are necessary for the comprehensive study of predictive biophenotypes as determined by triggers and premonitory symptoms, including retrospective and prospective cohort studies and case-crossover studies.

Pugach, Oksana; Hedeker, Donald; Mermelstein, Robin (2014): A Bivariate Mixed-Effects Location-Scale Model with application to Ecological Momentary Assessment (EMA) data. In: Health Serv Outcomes Res Methodol 14 (4), S. 194–212.

A bivariate mixed-effects location-scale model is proposed for estimation of means, variances, and covariances of two continuous outcomes measured concurrently in time and repeatedly over subjects. Modeling the two outcomes jointly allows examination of BS and WS association between the outcomes and whether the associations are related to covariates. The variance-covariance matrices of the BS and WS effects are modeled in terms of covariates, explaining BS and WS heterogeneity. The proposed model relaxes assumptions on the homogeneity of the within-subject (WS) and between-subject (BS) variances. Furthermore, the WS variance models are extended by including random scale effects. Data from a natural history study on adolescent smoking are used for illustration. 461 students, from 9th and 10th grades, reported on their mood at random prompts during seven consecutive days. This resulted in 14,105 prompts with an average of 30 responses per student. The two outcomes considered were a subject’s positive affect and a measure of how tired and bored they were feeling. Results showed that the WS association of the outcomes was negative and significantly associated with several covariates. The BS and WS variances were heterogeneous for both outcomes, and the variance of the random scale effects were significantly different from zero.

Rancourt, Diana; Leahey, Tricia M.; LaRose, Jessica Gokee; Crowther, Janis H. (2015): Effects of weight-focused social comparisons on diet and activity outcomes in overweight and obese young women. In: Obesity (Silver Spring) 23 (1), S. 85–89. DOI: 10.1002/oby.20953.

OBJECTIVE: To investigate social comparison processes as a potential mechanism by which social networks impact young women’s weight control thoughts and behaviors and to examine whether social comparisons with close social ties (i.e., friends) have a greater influence on weight control outcomes relative to more emotionally distant ties. METHODS: Using Ecological Momentary Assessment, overweight young adult women (N = 46; M age = 19; M BMI = 29) reported the nature and effects of weight-focused social comparisons on dieting and exercising intentions and on behaviors during their daily routine. RESULTS: Relative to social comparisons to targets of the same weight, weight-focused comparisons to both thinner and heavier individuals led to increased thoughts of dieting and exercising. Moreover, comparisons to thinner targets also increased the likelihood of engaging in actual dieting and exercising behaviors. Weight comparisons to friends amplified these effects. CONCLUSIONS: Weight-focused social comparisons may be one mechanism by which social networks impact weight control thoughts and behaviors. Obesity interventions with young adults may achieve better outcomes by harnessing social comparison processes in treatment.

Riediger, Michaela; Wrzus, Cornelia; Wagner, Gert G. (2014): Happiness is pleasant, or is it? Implicit representations of affect valence are associated with contrahedonic motivation and mixed affect in daily life. In: Emotion 14 (5), S. 950–961. DOI: 10.1037/t03782-000.

People typically want to feel good. At times, however, they seek to maintain or enhance negative affect or to dampen positive affect. The prevalence of such contrahedonic motivation has been related to simultaneous experiences of positive and negative (i.e., mixed) affect. We investigated the role that implicit mental representations of affect valence may play in this regard in a study with N = 400 participants aged 11–88 years. Results demonstrated the age-fairness and reliability of the affect-valence Implicit Association Test, a newly developed implicit measure of interindividual differences in mental representations of affect valence. The older participants were, the more distinctively they implicitly associated happiness with pleasantness and/or unhappiness with unpleasantness. Participants furthermore carried mobile phones as assessment instruments with them for 3 weeks while pursuing their daily routines. The phones prompted participants on average 54 times to report their momentary affective experience and affect-regulation motivation. Contrahedonic motivation and mixed affect were most prevalent among adolescents and least prevalent among older adults, and thus showed a similar pattern of age differences as the affect-valence Implicit Association Test. Furthermore, the more distinctive participants’ implicit associations of happiness with pleasantness, and/or unhappiness with unpleasantness, the less likely participants were to report contrahedonic motivation and mixed affect in their daily lives. These findings contribute to a refined understanding of the mixed-affect perspective on contrahedonic motivation by demonstrating the respective role of implicit affect-valence representations.

Roth, Walter R.; Vilardaga, Roger; Wolfe, Nathanael; Bricker, Jonathan B.; McDonell, Michael G. (2014): Practical considerations in the design and development of smartphone apps for behavior change. In: J Contextual Behav Sci 3 (4), S. 269–272. DOI: 10.1016/j.jcbs.2014.08.006.

The fast adoption of smartphone applications (apps) by behavioral scientists pose a new host of opportunities as well as knowledge and interdisciplinary challenges. Therefore, this brief report will discuss the lessons we have learned during the development and testing of smartphone apps for behavior change, and provide the reader with guidance and recommendations about this design and development process. We hope that the guidance and perspectives presented in this brief report will empower behavioral scientists to test the efficacy of smartphone apps for behavior change, further advance the contextual behavioral etiology of behavioral disorders and help move the field towards personalized behavior change technologies.

Sanchez, Amy H.; Lavaysse, Lindsey M.; Starr, Jessica N.; Gard, David E. (2014): Daily life evidence of environment-incongruent emotion in schizophrenia. In: Psychiatry Research 220 (1-2), S. 89–95. DOI: 10.1037/t15771-000;

Researchers have recently hypothesized that negative emotion in positive situations may be one mechanism for understanding emotion dysfunction in schizophrenia. Using ecological momentary assessment, we examined the relationship between emotion experience and environmental context in the daily lives of participants with and without schizophrenia. Participants with (n = 47) and without schizophrenia (n = 41) were provided a cellular telephone and called four times a day for one week. During each call participants rated their emotion experiences, described their current activities, and rated enjoyment from those activities. In line with previous research, participants with schizophrenia reported higher negative emotion overall relative to participants without schizophrenia, but equivalent levels of positive emotion and activity enjoyment. In line with the environment-incongruent negative emotion hypothesis, participants with schizophrenia evidenced a weaker relationship between reported enjoyment of current activities and current negative emotion compared to participants without schizophrenia. In addition, lower neurocognition predicted this weak relationship between negative emotion and context in the schizophrenia group. These findings provide ecologically valid support for environment-incongruent negative emotion in schizophrenia, and suggest that people with schizophrenia with more impaired neurocognition may have more difficulties regulating negative emotion.

Sawada, Natsumi; Gagné, Faby M.; Séguin, Louise; Kramer, Michael S.; McNamara, Helen; Platt, Robert W. et al. (2014): Maternal Prenatal Felt Security and Infant Health at Birth Interact to Predict Infant Fussing and Crying at 12 Months Postpartum. In: Health Psychology.

Infants born with medical problems are at risk for less optimal developmental outcomes. This may be, in part, because neonatal medical problems are associated with maternal distress, which may adversely impact infants. However, the reserve capacity model suggests that an individual’s bank of psychosocial resources buffers the adverse effects of later-encountered stressors. This prospective longitudinal study examined whether preexisting maternal psychosocial resources, conceptualized as felt security in close relationships, moderate the association between neonatal medical problems and infant fussing and crying 12 months postpartum. Maternal felt security was measured by assessing its indicators in 5,092 pregnant women. At birth, infants were classified as healthy or having a medical problem. At 12 months, experience sampling was used to assess daily maternal reports of fussing and crying in 135 mothers of infants who were healthy or had medical problems at birth. Confirmatory factor analyses revealed that attachment, relationship quality, self-esteem, and social support can be conceptualized as indicators of a single felt security factor. Multiple regression analyses revealed that prenatal maternal felt security interacts with infant health at birth to predict fussing and crying at 12 months. Among infants born with medical problems, higher felt security predicted decreased fussing and crying. Maternal felt security assessed before birth dampens the association between neonatal medical problems and subsequent infant behavior. This supports the hypothesis that psychosocial resources in reserve can be called upon in the face of a stressor to reduce its adverse effects on the self or others.

Schuz, Natalie; Ferguson, Stuart G. (2014): Australian Smokers’ and Nonsmokers’ Exposure to Antismoking Warnings in Day-to-Day Life: A Pilot Study. In: Nicotine Tob Res. DOI: 10.1093/ntr/ntu253.

INTRODUCTION: Smokers and nonsmokers can encounter a variety of antismoking messages in their everyday life. Antismoking warnings often involve fear appeals to which particularly smokers may react in a defensive manner by avoiding or derogating the messages, or downplaying their personal risk. However, previous studies testing the effects of antismoking warnings have either been retrospective or lab-based, thus introducing potential recall biases and yielding limited ecological validity. We used ecological momentary assessment (EMA) to give an overview on the number, type, and locations where individuals encounter such messages and to examine their immediate reactions. METHODS: In an EMA study, 33 smokers and 37 never-smokers logged every encounter with antismoking warnings during 2.5 weeks (1,237 participant days of monitoring). After randomly selected encounters, several markers of defensiveness were assessed. RESULTS: On average, nonsmokers reported noticing significantly fewer warnings than smokers (M = 0.49/day vs. M = 2.14/day). Both groups saw the majority of warnings on cigarette packages. Smokers reported a significantly higher level of message derogation and a significantly lower level of message acceptance than nonsmokers. There were no differences in feelings of vulnerability between smokers and nonsmokers upon encountering the warnings. CONCLUSIONS: The overall number of encounters with antismoking warnings in people’s everyday life is relatively low, particularly among smokers. Smokers are likely to avoid messages and respond defensively, thus limiting their potential effectiveness.

Selya, Arielle S.; Updegrove, Nicole; Rose, Jennifer S.; Dierker, Lisa; Tan, Xianming; Hedeker, Donald et al. (2015): Nicotine-dependence-varying effects of smoking events on momentary mood changes among adolescents. In: Addict Behav 41, S. 65–71. DOI: 10.1016/j.addbeh.2014.09.028.

INTRODUCTION: Theories of nicotine addiction emphasize the initial role of positive reinforcement in the development of regular smoking behavior, and the role of negative reinforcement at later stages. These theories are tested here by examining the effects of amount smoked per smoking event on smoking-related mood changes, and how nicotine dependence (ND) moderates this effect. The current study examines these questions within a sample of light adolescent smokers drawn from the metropolitan Chicago area (N=151, 55.6% female, mean 17.7years). INSTRUMENTS: Ecological momentary assessment data were collected via handheld computers, and additional variables were drawn from a traditional questionnaire. METHODS: Effects of the amount smoked per event on changes in positive affect (PA) and negative affect (NA) after vs. before smoking were examined, while controlling for subject-averaged amount smoked, age, gender, and day of week. ND-varying effects were examined using varying effect models to elucidate their change across levels of ND. RESULTS: The effect of the amount smoked per event was significantly associated with an increase in PA among adolescents with low-to-moderate levels of ND, and was not significant at high ND. Conversely, the effect of the amount smoked was significantly associated with a decrease in NA only for adolescents with low levels of ND. CONCLUSIONS: These findings support the role of positive reinforcement in early stages of dependent smoking, but do not support the role of negative reinforcement beyond early stages of smoking. Other potential contributing factors to the relationship between smoking behavior and PA/NA change are discussed.

Shadur, Julia M.; Hussong, Andrea M. (2014): Friendship intimacy, close friend drug use, and self-medication in adolescence. In: Journal of Social and Personal Relationships 31 (8), S. 997–1018. DOI: 10.1037/t05466-000;

The current study tested between-person hypotheses that global negative affect, friendship intimacy, and close friend drug use predict increased substance use, and the within-person hypothesis that friendship intimacy and close friend substance use moderate the temporal relationship between daily negative affect and subsequent substance use (i.e., self-medication). Experience sampling methodology captured daily variations in mood and substance use, and multilevel modeling techniques were used to parse between- versus within-person effects. Findings supported between-person hypotheses that greater negative affect and lower friendship intimacy predicted greater substance use, and a consistent trend indicated that friendship intimacy and close friend drug use interact to predict substance use overall (though not for self-medication). Risk and protective mechanisms indicate that the effect of friendship intimacy on adolescent use depends on close friend drug use.

Shiyko, Mariya P.; Burkhalter, Jack; Li, Runze; Park, Bernard J. (2014): Modeling nonlinear time-dependent treatment effects: An application of the generalized time-varying effect model (TVEM). In: Journal of Consulting and Clinical Psychology 82 (5), S. 760–772.

Objective: The goal of this article is to introduce to social and behavioral scientists the generalized time-varying effect model (TVEM), a semiparametric approach for investigating time-varying effects of a treatment. The method is best suited for data collected intensively over time (e.g., experience sampling or ecological momentary assessments) and addresses questions pertaining to effects of treatment changing dynamically with time. Thus, of interest is the description of timing, magnitude, and (nonlinear) patterns of the effect. Method: Our presentation focuses on practical aspects of the model. A step-by-step demonstration is presented in the context of an empirical study designed to evaluate effects of surgical treatment on quality of life among early stage lung cancer patients during posthospitalization recovery (N = 59; 61% female, M age = 66.1 years). Frequency and level of distress associated with physical symptoms were assessed twice daily over a 2-week period, providing a total of 1,544 momentary assessments. Results: Traditional analyses (analysis of covariance [ANCOVA], repeated-measures ANCOVA, and multilevel modeling) yielded findings of no group differences. In contrast, generalized TVEM identified a pattern of the effect that varied in time and magnitude. Group differences manifested after Day 4. Conclusions: Generalized TVEM is a flexible statistical approach that offers insight into the complexity of treatment effects and allows modeling of nonnormal outcomes. The practical demonstration, shared syntax, and availability of a free set of macros aim to encourage researchers to apply TVEM to complex data and stimulate important scientific discoveries.

Shrier, Lydia A.; Scherer, Emily Blood (2014): It depends on when you ask: Motives for using marijuana assessed before versus after a marijuana use event. In: Addictive Behaviors 39 (12), S. 1759–1765. DOI: 10.1037/t00742-000;

Background: Marijuana use motives are typically evaluated retrospectively using measures that summarize or generalize across episodes of use, which may compromise validity. Using Ecological Momentary Assessment data, we examined the main reason for a specific marijuana use event measured both prospectively and retrospectively. We then determined reason types, event characteristics, and user characteristics that predicted change in reason. Methods: Thirty-six medical outpatients age 15 to 24 years who used marijuana two times a week or more used a handheld computer to select their main reason for use from the five categories of the Marijuana Motives Measure (Simons, Correia, & Carey, 1998) just before and after each time they used marijuana over two weeks (n = 263 events with before/after reason). The reasons were examined individually and according to dimensions identified in motivational models of substance use (positive/negative, internal/external). Results: The reason assessed before use changed to a different reason after use for 20% of events: 10% of events for pleasure; 21%, to cope; 35%, to be more social; 55%, to expand my mind; and 100%, to conform. In the multivariable model, external and expansion reasons each predicted change in reason for use (p < 0.0001 and p = 0.001, respectively). Youth were also more likely to change their reason if older (p = 0.04), if male (p = 0.02), and with weekend use (p = 0.002). Conclusion: Retrospective assessments of event-specific motives for marijuana use may be unreliable and therefore invalid for a substantial minority of events, particularly if use is for external or expansion reasons. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)

Sladek, Michael R.; Doane, Leah D. (2014): Daily diary reports of social connection, objective sleep, and the cortisol awakening response during adolescents’ first year of college. In: Journal of Youth and Adolescence.

Poor sleep and alterations in the stress-sensitive hypothalamic–pituitary–adrenal (HPA) axis may be mechanisms through which loneliness impacts adolescents’ well-being. Few researchers have explored whether daily variation in experiences of social connection predict day-to-day variation in sleep and HPA axis activity among adolescents navigating the college context. Using daily diary reports of social connection, objective measures of sleep (actigraphy), and naturalistic salivary assessment, the present study examined within-person associations between first-year college students’ social connection during the day and sleep that night, as well as diurnal cortisol activity the following day. The present study also explored trait-level loneliness as a moderator of these associations after adjusting for baseline loneliness assessed in high school. Seventy-one first-year college students (23 % male; M age = 18.85; 52 % non-Hispanic White) completed daily diary reports, wore a wrist-based accelerometer (actigraph watch), and provided saliva samples five times daily across three consecutive weekdays. The results from hierarchical linear models indicated that within-person increases in daily social connection were significantly associated with longer time spent in bed and more actual time asleep that night only for adolescents high on loneliness. Within-person increases in daily social connection were associated with a greater cortisol awakening response (CAR) the next day, regardless of trait loneliness. These findings illustrate that more daily social connection with others than usual may predict improved sleep quantity for lonely adolescents and a physiological index of anticipating upcoming daily demands (CAR) in general. Future intervention programs might consider including strategies focused on enhancing daily social interactions among adolescents starting college, particularly for lonely adolescents.

Smith, Lindsey P.; Hua, Jenna; Seto, Edmund; Du, Shufa; Zang, Jiajie; Zou, Shurong et al. (2014): Development and validity of a 3-day smartphone assisted 24-hour recall to assess beverage consumption in a Chinese population: a randomized cross-over study. In: Asia Pac J Clin Nutr 23 (4), S. 678–690. DOI: 10.6133/apjcn.2014.23.4.10.

This paper addresses the need for diet assessment methods that capture the rapidly changing beverage consumption patterns in China. The objective of this study was to develop a 3-day smartphone-assisted 24-hour recall to improve the quantification of beverage intake amongst young Chinese adults (n=110) and validate, in a small subset (n=34), the extent to which the written record and smartphone-assisted recalls adequately estimated total fluid intake, using 24-hour urine samples. The smartphone-assisted method showed improved validity compared with the written record-assisted method, when comparing reported total fluid intake to total urine volume. However, participants reported consuming fewer beverages on the smartphone-assisted method compared with the written record-assisted method, primarily due to decreased consumption of traditional zero-energy beverages (i.e. water, tea) in the smartphone-assisted method. It is unclear why participants reported fewer beverages in the smartphone-assisted method than the written record -assisted method. One possibility is that participants found the smartphone method too cumbersome, and responded by decreasing beverage intake. These results suggest that smartphone-assisted 24-hour recalls perform comparably but do not appear to substantially improve beverage quantification compared with the current written record-based approach. In addition, we piloted a beverage screener to identify consumers of episodically consumed SSBs. As expected, a substantially higher proportion of consumers reported consuming SSBs on the beverage screener compared with either recall type, suggesting that a beverage screener may be useful in characterizing consumption of episodically consumed beverages in China’s dynamic food and beverage landscape.

Stevens, D. J.; McKenzie, K.; Cui, H. W.; Noble, J. G.; Turney, B. W. (2014): Smartphone apps for urolithiasis. In: Urolithiasis. DOI: 10.1007/s00240-014-0738-0.

There are an increasing number of healthcare smartphone applications (‘apps’) available. Urolithiasis presents a major healthcare burden. Patients are increasingly keen to educate themselves regarding the diagnosis and management of their condition. There is no formal regulation of healthcare apps, including a large number of apps relating to urolithiasis. This review aims to examine the range of apps available, and the prevalence of healthcare professional input. Four international smartphone app stores were searched: Apple’s App Store, Google Play (Android), BlackBerry App World and the Windows Phone App store. A total of 42 unique apps were downloaded and analysed. Recorded data included the cost ( pound/$), publisher information, number of ratings, average rating and any documentation of medical professional involvement. Twenty-one (50 %) apps required payment for download. The mean cost was pound3.58 ($6.04) with range pound0.61- pound34.90 ($1.03-$58.87). Thirty-three (79 %) of the 42 apps were designed to be used by patients. Fifteen (36 %) of the 42 apps had clear input from health professionals. Twenty-two apps offered patient information, including dietary advice on lowering calcium intake, which is contrary to current evidence-based practice. We conclude that urolithiasis apps have future potential to inform both patients and healthcare professionals on stone management. However, inaccuracies in the recommendations made by some apps can be misleading or even harmful due to a lack of specialist involvement. We recommend improving the usefulness of these apps by seeking a ‘quality stamp’ from recognised urological organisations and greater clinician involvement in future app development.

Stut, Wim; Deighan, Carolyn; Armitage, Wendy; Clark, Michelle; Cleland, John G.; Jaarsma, Tiny (2014): Design and Usage of the HeartCycle Education and Coaching Program for Patients With Heart Failure. In: JMIR Res Protoc 3 (4), S. e72. DOI: 10.2196/resprot.3411.

BACKGROUND: Heart failure (HF) is common, and it is associated with high rates of hospital readmission and mortality. It is generally assumed that appropriate self-care can improve outcomes in patients with HF, but patient adherence to many self-care behaviors is poor. OBJECTIVE: The objective of our study was to develop and test an intervention to increase self-care in patients with HF using a novel, online, automated education and coaching program. METHODS: The online automated program was developed using a well-established, face-to-face, home-based cardiac rehabilitation approach. Education is tailored to the behaviors and knowledge of the individual patient, and the system supports patients in adopting self-care behaviors. Patients are guided through a goal-setting process that they conduct at their own pace through the support of the system, and they record their progress in an electronic diary such that the system can provide appropriate feedback. Only in challenging situations do HF nurses intervene to offer help. The program was evaluated in the HeartCycle study, a multicenter, observational trial with randomized components in which researchers investigated the ability of a third-generation telehealth system to enhance the management of patients with HF who had a recent (<60 days) admission to the hospital for symptoms or signs of HF (either new onset or recurrent) or were outpatients with persistent New York Heart Association (NYHA) functional class III/IV symptoms despite treatment with diuretic agents. The patients were enrolled from January 2012 through February 2013 at 3 hospital sites within the United Kingdom, Germany, and Spain. RESULTS: Of 123 patients enrolled (mean age 66 years (SD 12), 66% NYHA III, 79% men), 50 patients (41%) reported that they were not physically active, 56 patients (46%) did not follow a low-salt diet, 6 patients (5%) did not restrict their fluid intake, and 6 patients (5%) did not take their medication as prescribed. About 80% of the patients who started the coaching program for physical activity and low-salt diet became adherent by achieving their personal goals for 2 consecutive weeks. After becoming adherent, 61% continued physical activity coaching, but only 36% continued low-salt diet coaching. CONCLUSIONS: The HeartCycle education and coaching program helped most nonadherent patients with HF to adopt recommended self-care behaviors. Automated coaching worked well for most patients who started the coaching program, and many patients who achieved their goals continued to use the program. For many patients who did not engage in the automated coaching program, their choice was appropriate rather than a failure of the program.

Swendeman, Dallas; Comulada, W. Scott; Ramanathan, Nithya; Lazar, Maya; Estrin, Deborah (2014): Reliability and validity of daily self-monitoring by smartphone application for health-related quality-of-life, antiretroviral adherence, substance use, and sexual behaviors among people living with hiv. In: AIDS and Behavior.

This paper examines inter-method reliability and validity of daily self-reports by smartphone application compared to 14-day recall web-surveys repeated over 6 weeks with people living with HIV (PLH). A participatory sensing framework guided participant-centered design prioritizing external validity of methods for potential applications in both research and self-management interventions. Inter-method reliability correlations were consistent with prior research for physical and mental health quality-of-life (r = 0.26–0.61), antiretroviral adherence (r = 0.70–0.73), and substance use (r = 0.65–0.92) but not for detailed sexual encounter surveys (r = 0.15–0.61). Concordant and discordant pairwise comparisons show potential trends in reporting biases, for example, lower recall reports of unprotected sex or alcohol use, and rounding up errors for frequent events. Event-based reporting likely compensated for modest response rates to daily time-based prompts, particularly for sexual and drug use behaviors that may not occur daily. Recommendations are discussed for future continuous assessment designs and analyses.

Thompson, Wesley K.; Gershon, Anda; O’Hara, Ruth; Bernert, Rebecca A.; Depp, Colin A. (2014): The prediction of study‐emergent suicidal ideation in bipolar disorder: A pilot study using ecological momentary assessment data. In: Bipolar Disorders 16 (7), S. 669–677. DOI: 10.1037/t15771-000;

Objectives: Bipolar disorder is associated with idiosyncratic precursors of clinically important states such as suicidal ideation. Ecological momentary assessment (EMA) – high frequency data collection in a subject’s usual environment – provides the potential for development of temporal, individualized prediction of risk states. The present study tested the ability of EMA data to predict individual symptom change in clinician‐rated suicidal ideation. Methods: Thirty‐five adults diagnosed with inter‐episode bipolar disorder completed daily measures of affect in their home environments using diaries administered over an eight‐week assessment timeline. Suicidal ideation was assessed monthly at in‐person visits using the Inventory of Depressive Symptomatology–Clinician Rated. We used a novel application of functional linear models (FLMs) to generate prospective predictions of suicidal ideation at in‐person clinician assessments based on intensively sampled trajectories of daily affect. Results: Eight instances of suicidal ideation scores > 0 were recorded during the study period on six participants. Utilizing trajectories of negative and positive affect, cross‐validated predictions attained 88% sensitivity with 95% specificity for elevated suicidal ideation one week prior to in‐person clinician assessment. This model strongly outperformed prediction models using cross‐sectional data obtained at study visits alone. Conclusions: Utilizing EMA data with FLM prediction models substantially increases the accuracy of prediction of study‐emergent suicidal ideation. Prediction algorithms employing intensively sampled longitudinal EMA data could sensitively detect the warning signs of suicidal ideation to facilitate improved suicide risk assessment and the timely delivery of preventative interventions.

Thrul, Johannes; Buhler, Anneke; Ferguson, Stuart G. (2015): An internet-based ecological momentary assessment study relying on participants’ own mobile phones: insights from a study with young adult smokers. In: Eur Addict Res 21 (1), S. 1–5. DOI: 10.1159/000363231.

BACKGROUND: In this paper we describe a novel Internet-based cell phone-optimized assessment technique (ICAT) to conduct an ecological momentary assessment (EMA) study. Participants could access the assessment instrument via the web browsers of their mobile phones. METHODS: We report results from 92 young adult smokers (18-25 years old) who completed the baseline assessment and the first of 4 waves (3 days/wave) of EMA. Random prompts were issued via text messages sent to the participants. The participants were also instructed to self-initiate reports of smoking situations. RESULTS: Compliance with the study protocols was low. In total, the participants completed 885 assessments during the 3 days of monitoring. Only 50.2% of random prompts were responded to, and 52.4% of those were completed within the first 10 min after issuing. Furthermore, reports of smoking situations were rarely self-initiated. In a multivariate regression analysis, age (positively) and female gender (negatively) predicted the number of completed assessments. CONCLUSIONS: This study adds to the limited experiences made with ICAT in substance use research. Similar to the few prior ICAT studies, compliance was low compared to traditional EMA studies. While using ICAT is technically feasible, specific improvements should be implemented to tap ICAT’s full potential in future studies. (c) 2014 S. Karger AG, Basel.

Tončić, Marko; Anić, Petra (2014): Everyday activities: Beneficial effects of eudaimonic and hedonic motivation on subjective well-being. In: Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues.

The study focuses on the impact of time and motives for everyday activities on mood and daily satisfaction. One hundred twenty-one undergraduate students participated in study using experience sampling method. The short PANAS scale, one item momentary satisfaction measure and state orientation to happiness scale were used. The measures were administered five times a day for 7 days via hand-held devices. The data were modeled using a linear mixed-effects approach. The models fitted the data reasonably well, especially for satisfaction and positive affect (PA) sharing similar parameter estimates. Both showed a nonlinear increase through the week while PA showed a similarly shaped circa-diurnal rhythm too. Negative affect (NA) showed almost no rhythm at all. Both hedonic and eudaimonic motives increased satisfaction and PA. Hedonic motives had a negative impact on NA. Generally, on momentary level, hedonic motives have a greater impact while longer intervals seem to emphasize the importance of eudaimonic motives.

Trujillo, Matthew D.; Garcia, Randi L.; Shelton, J. Nicole (2014): “I Thought You Were Japanese”: Ethnic Miscategorization and Identity Assertion. In: Cultural Diversity and Ethnic Minority Psychology.

Across 2 studies we examined how ethnic minorities respond to ethnic miscategorization. Using a 21-day experience sampling procedure (Study 1), we found that ethnic minorities exhibited greater ethnic identity assertion when they had reported being ethnically miscategorized the previous day. Similarly, we found that ethnic minorities who were ethnically miscategorized (vs. not) by a White partner in the laboratory exhibited greater ethnic identity assertion and expressed greater dislike of their partner (Study 2). In both studies, these effects were stronger for individuals whose ethnic identity was central to their self-concept. The implications of these findings for ethnic identity development and intergroup relations are discussed.

Trull, Timothy J.; Ebner-Priemer, Ulrich (2014): The Role of Ambulatory Assessment in Psychological Science. In: Curr Dir Psychol Sci 23 (6), S. 466–470. DOI: 10.1177/0963721414550706.

We describe the current use and future promise of an innovative methodology, ambulatory assessment (AA), that can be used to investigate psychological, emotional, behavioral, and biological processes of individuals in their daily life. The term AA encompasses a wide range of methods used to study people in their natural environment, including momentary self-report, observational, and physiological. We emphasize applications of AA that integrate two or more of these methods, discuss the smart phone as a hub or access point for AA, and discuss future applications of AA methodology to the science of psychology. We pay particular attention to the development and application of Wireless Body Area Networks (WBANs) that can be implemented with smart phones and wireless physiological monitoring devices, and we close by discussing future applications of this approach to matters relevant to psychological science.

Tully, Laura M.; Lincoln, Sarah Hope; Hooker, Christine I. (2014): Lateral prefrontal cortex activity during cognitive control of emotion predicts response to social stress in schizophrenia. In: Neuroimage Clin 6, S. 43–53. DOI: 10.1016/j.nicl.2014.08.012.

LPFC dysfunction is a well-established neural impairment in schizophrenia and is associated with worse symptoms. However, how LPFC activation influences symptoms is unclear. Previous findings in healthy individuals demonstrate that lateral prefrontal cortex (LPFC) activation during cognitive control of emotional information predicts mood and behavior in response to interpersonal conflict, thus impairments in these processes may contribute to symptom exacerbation in schizophrenia. We investigated whether schizophrenia participants show LPFC deficits during cognitive control of emotional information, and whether these LPFC deficits prospectively predict changes in mood and symptoms following real-world interpersonal conflict. During fMRI, 23 individuals with schizophrenia or schizoaffective disorder and 24 healthy controls completed the Multi-Source Interference Task superimposed on neutral and negative pictures. Afterwards, schizophrenia participants completed a 21-day online daily-diary in which they rated the extent to which they experienced mood and schizophrenia-spectrum symptoms, as well as the occurrence and response to interpersonal conflict. Schizophrenia participants had lower dorsal LPFC activity (BA9) during cognitive control of task-irrelevant negative emotional information. Within schizophrenia participants, DLPFC activity during cognitive control of emotional information predicted changes in positive and negative mood on days following highly distressing interpersonal conflicts. Results have implications for understanding the specific role of LPFC in response to social stress in schizophrenia, and suggest that treatments targeting LPFC-mediated cognitive control of emotion could promote adaptive response to social stress in schizophrenia.

Udachina, Alisa; Varese, Filippo; Myin-Germeys, Inez; Bentall, Richard P. (2014): The role of experiential avoidance in paranoid delusions: An experience sampling study. In: British Journal of Clinical Psychology 53 (4), S. 422–432. DOI: 10.1037/t20074-000;

Objectives. The study examined (1) the role of experiential avoidance (EA), conceptualized as intolerance towards aversive mental states, in paranoid delusions and (2) the mechanisms underlying EA. Design. A 6‐day prospective momentary assessment study. Methods. Paranoid patients (N = 41) were studied using the experience sampling method (ESM), a structured diary technique, assessing psychopathology and current context in daily life. Results. The results showed that both low self‐esteem and EA contributed to paranoid thinking. The relationship between low self‐esteem and paranoia was partially mediated by EA and the relationship between EA and paranoia was partially mediated by low self‐esteem. The detrimental effect of EA on self‐esteem was more pronounced under high activity‐related stress. Both EA and social stress were independently associated with low self‐esteem. EA was associated with self‐esteem instability. Conclusions. Our results implicate mental control strategies in the development of paranoia and are compatible with the attributional model of paranoia, which suggests that persecutory delusions arise as a result of dysfunctional attempts to avoid unpleasant thoughts about the self. Practitioner points. Interventions for paranoid individuals should target low tolerance towards negative mental states, for example using mindfulness and ACT therapeutic approaches. Interventions designed for individuals suffering from persecutory delusions should also address unfavourable views about the self. Limitations. Avoidance of unpleasant mental states may operate outside the individual’s awareness and self‐report measures of EA may be unable to adequately tap this process. Self‐reflection abilities of psychotic patients may be impaired.

van Mulder, Timothi; Verwulgen, Stijn; Beyers, Koen; Scheelen, Linda; Elseviers, Monique; van Damme, Pierre; Vankerckhoven, Vanessa (2014): Assessment of acceptability and usability of new delivery prototype device for intradermal vaccination in healthy subjects. In: Hum Vaccin Immunother, S. 0. DOI: 10.4161/21645515.2014.979655.

Abstract Background The objectives of this study was to assess the acceptability and usability of a newly developed intradermal prototype device, VAX-ID, in healthy subjects. Materials & Methods In April 2012 an investigational study was conducted in healthy subjects aged 18 to 65 years. To compare injection site and route of administration, subjects were allocated to four subgroups, either receiving subsequently two intradermal (ID) injections (one in the forearm & one in the deltoid) or an ID (forearm) and an intramuscular (IM) (deltoid) injection. All injections contained saline solution. Acceptability was assessed with a subjects’ questionnaire and a daily electronic diary for 5 days. Usability was assessed with a vaccinators’ questionnaire and an expert panel. A 10-point Visual Analogue Scale was used to score several statements on usability and acceptability. Results A total of 102 healthy subjects were enrolled in the study (age: 19-63). No statistically significant differences were seen in demographic characteristics between the ID and IM groups. Anxiety before injection, pain during injection and duration of injection were rated significantly lower for ID compared to IM. One day after the injections, redness was reported more often after ID injection in the forearm versus ID in the deltoid; pain at injection site was reported significantly more often after IM versus ID injection. The new VAX-ID prototype device was found easy to handle, easy to use and safe. Conclusion The new VAX-ID prototype device was shown to have a high degree of acceptability as well as usability. Further studies with VAX-ID will be conducted using vaccine antigen allowing assessment of immunogenicity and safety. Additionally, these studies will help to further improve VAX-ID in terms of accuracy of delivered dose and feedback to the vaccinator. (NCT01963338).

van Os, Jim; Delespaul, Philippe; Barge, Daniela; Bakker, Roberto P. (2014): Testing an mHealth Momentary Assessment Routine Outcome Monitoring Application: A Focus on Restoration of Daily Life Positive Mood States. In: PLoS One 9 (12), S. e115254. DOI: 10.1371/journal.pone.0115254.

BACKGROUND: Routine Outcome Monitoring (ROM) is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM). METHOD: In a sample of 34 patients with major depressive disorder, treated with antidepressants, the combined effect of treatment and natural course was examined over a period of 18 weeks with Ecological Momentary Assessment (EMA). EMA consisted of repeated, within-subject, mini-measurements of experience (eg positive affect, negative affect, medication side effects) and context (eg stressors, situations, activities) at 10 unselected semi-random moments per day, for a period of six days, repeated three times over the 18-week period (baseline, week 6 and week 18). RESULTS: EMA measures of emotional and behavioural adjustment were sensitive to the effects of treatment and natural course over the 18-week period, particularly EMA measures focussing on positive mood states and the ability to use natural rewards (impact of positive events on positive mood states), with standardized effect sizes of 0.4-0.5. EMA measures of activities, social interaction, stress-sensitivity and negative mood states were also sensitive to change over time. CONCLUSION: This study supports the use of mROM as a means to involve the patient in the process of needs assessment and treatment. EMA data are meaningful to the patient, as they reflect daily life circumstances. Assessment of treatment response with mROM data allows for an interpretation of the effect of treatment at the level of daily life emotional and social adjustment - as an index of health, obviating the need for an exclusive focus on traditional measures of ‘sickness’.

van Rijsbergen, Gerard D.; Burger, Huibert; Hollon, Steven D.; Elgersma, Hermien J.; Kok, Gemma D.; Dekker, Jack et al. (2014): How do you feel? Detection of recurrent Major Depressive Disorder using a single-item screening tool. In: Psychiatry Research 220 (1-2), S. 287–293. DOI: 10.1037/t04757-000.

Mood is a key element of Major Depressive Disorder (MDD), and is perceived as a highly dynamic construct. The aim of the current study was to examine whether a single-item mood scale can be used for mood monitoring. One hundred thirty remitted out-patients were assessed using the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I), Visual Analogue Mood Scale (VAMS), 17-item Hamilton Depression Rating Scale (HAM-D₁₇), and Inventory of Depressive Symptomatology-Self Report (IDS-SR). Of all patients, 13.8% relapsed during follow-up assessments. Area under the curves (AUCs) for the VAMS, HAM-D₁₇ and IDS-SR were 0.94, 0.91, and, 0.86, respectively. The VAMS had the highest positive predictive value (PPV) without any false negatives at score 55 (PPV = 0.53; NPV = 1.0) and was the best predictor of current relapse status (variance explained for VAMS: 60%; for HAM-D₁₇: 49%; for IDS-SR: 34%). Only the HAM-D₁₇ added significant variance to the model (7%). Assessing sad mood with a single-item mood scale seems to be a straightforward and patient-friendly avenue for life-long mood monitoring. Using a diagnostic interview (e.g., the SCID) in case of a positive screen is warranted. Repeated assessment of the VAMS using Ecological Momentary Assessment (EMA) might reduce false positives.

Vandercammen, Leen; Hofmans, Joeri; Theuns, Peter (2014): Relating specific emotions to intrinsic motivation: on the moderating role of positive and negative emotion differentiation. In: PLoS One 9 (12), S. e115396. DOI: 10.1371/journal.pone.0115396.

Despite the fact that studies on self-determination theory have traditionally disregarded the explicit role of emotions in the motivation eliciting process, research attention for the affective antecedents of motivation is growing. We add to this emerging research field by testing the moderating role of emotion differentiation -individual differences in the extent to which people can differentiate between specific emotions- on the relationship between twelve specific emotions and intrinsic motivation. To this end, we conducted a daily diary study (N = 72) and an experience sampling study (N = 34). Results showed that the relationship between enthusiasm, cheerfulness, optimism, contentedness, gloominess, miserableness, uneasiness (in both studies 1 and 2), calmness, relaxation, tenseness, depression, worry (only in Study 1) on one hand and intrinsic motivation on the other hand was moderated by positive emotion differentiation for the positive emotions and by negative emotion differentiation for the negative emotions. Altogether, these findings suggest that for people who are unable to distinguish between different specific positive emotions the relationship between those specific positive emotions and intrinsic motivation is stronger, whereas the relationship between specific negative emotions and intrinsic motivation is weaker for people who are able to distinguish between the different specific negative emotions. Theoretical and practical implications are discussed.

Verwey, Renee; van der Weegen, Sanne; Spreeuwenberg, Marieke; Tange, Huibert; van der Weijden, Trudy; Witte, Luc de (2014): Upgrading physical activity counselling in primary care in the Netherlands. In: Health Promot Int. DOI: 10.1093/heapro/dau107.

The systematic development of a counselling protocol in primary care combined with a monitoring and feedback tool to support chronically ill patients to achieve a more active lifestyle. An iterative user-centred design method was used to develop a counselling protocol: the Self-management Support Programme (SSP). The needs and preferences of future users of this protocol were identified by analysing the literature, through qualitative research, and by consulting an expert panel. The counselling protocol is based on the Five A’s model. Practice nurses apply motivational interviewing, risk communication and goal setting to support self-management of patients in planning how to achieve a more active lifestyle. The protocol consists of a limited number of behaviour change consultations intertwined with interaction with and responses from the It’s LiFe! monitoring and feedback tool. This tool provides feedback on patients’ physical activity levels via an app on their smartphone. A summary of these levels is automatically sent to the general practice so that practice nurses can respond to this information. A SSP to stimulate physical activity was defined based on user requirements of care providers and patients, followed by a review by a panel of experts. By following this user-centred approach, the organization of care was carefully taken into account, which has led to a practical and affordable protocol for physical activity counselling combined with mobile technology.

Walerius, Danielle M.; Reyes, Rachel A.; Rosen, Paul J.; Factor, Perry I. (2014): Functional Impairment Variability in Children With ADHD Due to Emotional Impulsivity. In: J Atten Disord. DOI: 10.1177/1087054714561859.

OBJECTIVE: The present study utilized ecological momentary assessment (EMA) to examine the effects of emotional impulsivity on overall functional impairment and functional impairment variability (FIV) of children with and without ADHD. METHOD: Parents of 74 children, 8- to 12-year-olds (42 with ADHD, 32 without ADHD), completed EMA assessment protocol ratings of their child’s mood (3 times daily) and functional impairment (1 time daily) over the course of 28 days. RESULTS: Hierarchical regression analyses supported the interaction of ADHD diagnostic status and greater EMA-derived emotional impulsivity in the estimation of total functional impairment (Total FI) and FIV. Thus, greater emotional impulsivity was found to be related to greater Total FI and FIV among children with ADHD but not among children without ADHD. CONCLUSION: This study suggests that children with ADHD and greater emotional impulsivity demonstrate greater overall levels of functional impairment, with the severity of their impairment varying significantly over time.

Walz, Laura C.; Nauta, Maaike H.; Aan Het Rot, Marije (2014): Experience sampling and ecological momentary assessment for studying the daily lives of patients with anxiety disorders: A systematic review. In: Journal of Anxiety Disorders 28 (8), S. 925–937.

Anxiety disorders are highly prevalent. Symptoms may occur unpredictably (e.g., panic attacks) or predictably in specific situations (e.g., social phobia). Consequently, it may be difficult to assess anxiety and related constructs realistically in the laboratory or by traditional retrospective questionnaires. Experience sampling methods (ESM) and ecological momentary assessment (EMA) can deepen the understanding of the course of anxiety disorders by frequently assessing symptoms and other variables in the natural environment. We review 34 ESM/EMA studies on adult panic disorder, generalized anxiety disorder, social phobia, post-traumatic stress disorder, and obsessive–compulsive disorder, as well as anxiety disorders in youth. Benefits of ESM/EMA for the study of anxiety disorders include generating insight into the temporal variability of symptoms and into the associations among daily affect, behaviors, and situational cues. Further, ESM/EMA has been successfully combined with ambulatory assessment of physiological variables and with treatment evaluations. We provide suggestions for future research, as well as for clinical applications.

Wells, Nancy M.; Myers, Beth M.; Henderson, Charles R Jr (2014): School gardens and physical activity: A randomized controlled trial of low-income elementary schools. In: Prev Med 69 Suppl 1, S. S27-33. DOI: 10.1016/j.ypmed.2014.10.012.

OBJECTIVE: This study examines effects of a school garden intervention on elementary school children’s physical activity (PA). METHOD: Twelve schools in New York were randomly assigned to receive the school garden intervention (n=6) or to the waitlist control group that later received gardens (n=6). PA was measured by self-report survey (Girls Health Enrichment Multi-site Study Activity Questionnaire) (N=227) and accelerometry (N=124, 8 schools) at baseline (Fall 2011) and follow-up (Spring 2012, Fall 2012, Spring 2013). Direct observation (N=117, 4 schools) was employed to compare indoor (classroom) and outdoor (garden) PA. Analysis was by general linear mixed models. RESULTS: Survey data indicate garden intervention children’s reports of usual sedentary activity decreased from pre-garden baseline to post-garden more than the control group children’s (Delta=-.19, p=.001). Accelerometry data reveal that during the school day, children in the garden intervention showed a greater increase in percent of time spent in moderate and moderate-to-vigorous PA from baseline to follow-up than the control group children (Delta=+.58, p=.010; Delta=+1.0, p=.044). Direct observation within-group comparison of children at schools with gardens revealed that children move more and sit less during an outdoor garden-based lesson than during an indoor, classroom-based lesson. CONCLUSION: School gardens show some promise to promote children’s PA. CLINICAL TRIALS REGISTRATION: # NCT02148315.

Wenzel, Mario; Kubiak, Thomas; Ebner-Priemer, Ulrich W. (2014): Ambulatory assessment as a means of longitudinal phenotypes characterization in psychiatric disorders. In: Neuroscience Research.

Ambulatory Assessment (AA) comprises the use of in-field methods to assess individuals’ behavior, physiology, and the experience as they unfold in naturalistic settings. We propose that AA is favorable for the investigation of gene–environment interactions and for the search for endophenotypes, being able to assess the experienced environment and to track basic regulatory processes, such as stress reactivity, affective instability, and reward experience, which are potential common factors that underlie psychiatric disorders. In this article, we (a) first describe briefly the rationale of AA and summarize the key advantages of the approach, (b) highlight within-subject regulatory processes, such as stress reactivity, affective instability, and reward experience, (c) describe studies that used AA to examine genetic influences in psychiatric disorders, and (d) briefly review longitudinal studies that have investigated phenotypes of psychiatric disorders. The reported studies yielded promising, although sometimes inconclusive evidence for genetic effects on endophenotypes of psychiatric disorders. Moreover, most studies were twin or family studies, especially in stress-sensitivity research; thus, it is unclear which specific single nucleotide polymorphisms contribute to the endophenotypes of psychiatric disorders. We do hope that within-subject regulatory processes will enable us to clarify the fundamental psychological dimensions that cut across traditional disorders and link them to their genetic underpinnings.

Wrzus, Cornelia; Luong, Gloria; Wagner, Gert G.; Riediger, Michaela (2014): Can’t Get It Out of My Head: Age Differences in Affective Responsiveness Vary With Preoccupation and Elapsed Time After Daily Hassles. In: Emotion.

To better understand age differences in negative affective responses to daily hassles, the current study investigated how responses may depend on how much time has elapsed after the hassle and how much one still thinks about the hassle. In an experience-sampling approach with mobile phones, 397 participants aged 12 to 88 years reported their momentary activating (e.g., angry) and deactivating (e.g., disappointed) negative affect and occurrences of hassles, on average 55 times over 3 weeks. On measurement occasions when a hassle had occurred, participants also reported how long ago it occurred and how much they were currently preoccupied with thoughts about the hassle. Multilevel modeling results showed that, compared with more recent hassles, people across the entire age-range of the sample reported lower activating, yet higher deactivating, negative affect when hassles occurred a longer time ago. Age differences only emerged in situations when individuals were still preoccupied with a past hassle. In these situations, deactivating negative affect was higher with stronger preoccupation and more elapsed time after the hassles; these effects were more pronounced with older age. Activating negative affect was higher the more people reported being preoccupied with the hassle and this effect was also more pronounced with age. The results foster an understanding of age differences in negative affective responses to daily hassles by considering preoccupation with hassles and investigating activating and deactivating negative affect separately. We discuss under which circumstances affective responsiveness and age differences therein are more or less pronounced.

Yamasaki, Akira; Kawasaki, Yuji; Takeda, Kenichi; Harada, Tomoya; Fukushima, Takehito; Takata, Miki et al. (2014): The relationships among sleep efficiency, pulmonary functions, and quality of life in patients with asthma. In: Int J Gen Med 7, S. 505–512. DOI: 10.2147/IJGM.S72713.

BACKGROUND: Sleep disturbance is commonly observed in patients with asthma, especially in those with poorly controlled asthma. Evaluating sleep quality to achieve good control of asthma is important since nocturnal asthmatic symptoms such as cough, wheezing, and chest tightness may disturb sleep. Actigraphy is an objective, ambulatory monitoring method for tracking a patient’s sleep and wake activities and for assessing sleep quality, as reflected by total sleep time, sleep efficiency, duration of awakening after sleep onset (WASO), and sleep onset latency. PATIENTS AND METHODS: Fifty patients with asthma were enrolled in this study. Sleep quality was assessed employing wristwatch-type actigraphy (Actiwatch 2). The level of asthma control was assessed by the Asthma Control Questionnaire (ACQ), and asthma-related quality of life was assessed by the Asthma Quality of Life Questionnaire (AQLQ). The parameters for sleep quality were compared using ACQ scores, AQLQ scores, and pulmonary function test results. RESULTS: The total sleep time was 387.2 minutes, WASO was 55.8 minutes, sleep efficiency was 87.01%, sleep onset latency was 8.17 minutes, and the average ACQ was 0.36. Neither sleep efficiency nor WASO correlated with respiratory functions, ACQ scores, or AQLQ scores. CONCLUSION: Sleep-related parameters assessed by actigraphy in well-controlled asthma do not correlate with pulmonary functions, the asthma control level, or daytime quality of life. Sleep quality should be evaluated independently when asthma is well-controlled.

Zhang, Melvyn Wb; Tsang, Tammy; Cheow, Enquan; Ho, Cyrus Sh; Yeong, Ng Beng; Ho, Roger Cm (2014): Enabling Psychiatrists to be Mobile Phone App Developers: Insights Into App Development Methodologies. In: JMIR Mhealth Uhealth 2 (4), S. e53. DOI: 10.2196/mhealth.3425.

BACKGROUND: The use of mobile phones, and specifically smartphones, in the last decade has become more and more prevalent. The latest mobile phones are equipped with comprehensive features that can be used in health care, such as providing rapid access to up-to-date evidence-based information, provision of instant communications, and improvements in organization. The estimated number of health care apps for mobile phones is increasing tremendously, but previous research has highlighted the lack of critical appraisal of new apps. This lack of appraisal of apps has largely been due to the lack of clinicians with technical knowledge of how to create an evidence-based app. OBJECTIVE: We discuss two freely available methodologies for developing Web-based mobile phone apps: a website builder and an app builder. With these, users can program not just a Web-based app, but also integrate multimedia features within their app, without needing to know any programming language. METHODS: We present techniques for creating a mobile Web-based app using two well-established online mobile app websites. We illustrate how to integrate text-based content within the app, as well as integration of interactive videos and rich site summary (RSS) feed information. We will also briefly discuss how to integrate a simple questionnaire survey into the mobile-based app. A questionnaire survey was administered to students to collate their perceptions towards the app. RESULTS: These two methodologies for developing apps have been used to convert an online electronic psychiatry textbook into two Web-based mobile phone apps for medical students rotating through psychiatry in Singapore. Since the inception of our mobile Web-based app, a total of 21,991 unique users have used the mobile app and online portal provided by WordPress, and another 717 users have accessed the app via a Web-based link. The user perspective survey results (n=185) showed that a high proportion of students valued the textbook and objective structured clinical examination videos featured in the app. A high proportion of students concurred that a self-designed mobile phone app would be helpful for psychiatry education. CONCLUSIONS: These methodologies can enable busy clinicians to develop simple mobile Web-based apps for academic, educational, and research purposes, without any prior knowledge of programming. This will be beneficial for both clinicians and users at large, as there will then be more evidence-based mobile phone apps, or at least apps that have been appraised by a clinician.


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