Society for Ambulatory Assessment

First quarter 2006 (January to March)

Ben-Dov, I.Z., Ben-Arie, L., Mekler, J.& Bursztyn, M. (2006). Normal ambulatory blood pressure: a clinical-practice-based analysis of recent American Heart Association recommendations. American Journal of Medicine, 119(1), 69.e13-18.

The American Heart Association Council on High Blood Pressure Research recently issued recommendations for blood pressure measurement in humans. According to these recommendations, normal 24-hour ambulatory blood pressure is defined as less than 130/80 mm Hg. Concurrently, normal daytime and nighttime blood pressure levels are defined as less than 135/85 mm Hg and less than 120/70 mm Hg, respectively. Our aim was to investigate the intrinsic compatibility of these blood pressure cutoffs in clinical practice. SUBJECTS AND We analyzed 4121 consecutive ambulatory blood pressure measurement sessions. Age was 57 +/- 7 years, 53% were female, and 64% and 9% were treated for hypertension and diabetes, respectively. Body mass index was 27 +/- 4 kg/m2, and manual blood pressure was 148 +/- 22/85 +/- 12 mm Hg. Subjects were classified as having normal 24-hour blood pressure if the corresponding value was less than 130/80 mm Hg. Normal awake-sleep blood pressure was diagnosed if awake blood pressure was less than 135/85 mm Hg and sleep blood pressure was less than 120/70 mm Hg. Concordance between the cutoffs was found in 92% of the subjects (kappa = 0.77). Among the 8% of discordant subjects, only 1% were hypertensive applying the 24-hour (but not awake-sleep) blood pressure values, whereas 7% were hypertensive according to awake-sleep but not 24-hour blood pressure values (P <.0001). In real-life ambulatory blood pressure measurement, a generally good agreement was found between the recently issued ambulatory blood pressure normality suggestions. However, some subjects are classified as hypertensive only according to one of these methods, more often by the awake-sleep cutoff of 135/85 and 120/70 mm Hg. This discordance may be significant in large-scale clinical blood pressure monitoring.

Chen, H. (2006). Flow on the net-detecting web users’ positive affects and their flow states. Computers in Human Behavior, 22(2), 221-233.

The correlations between positive affects and flow symptoms on the Web are analyzed in an attempt to increase our understanding of the positive aspects of Web users’ on-line behaviors. The digital version of the experience sampling method was employed to collect situated data from 233 Web users with a pop-up questionnaire on subjects’ Web browsers. This study concludes: (1) Web users are more likely to experience positive moods on the Web; (2) positivity of affects and enjoyable feelings are consequences of flow; (3) three factors underlying Web users’ flow experiences labeled as antecedents, experiences, and consequences represent the process that an individual could experience during his/her engagement on the Web. Findings in this study provide insights into Web users’ internal behaviors and the process of approaching optimal flow experience. In addition, the on-line experience sampling method was proven to be a useful and practical data collection tool.

Chen, H. (2006). Digitization of the Experience Sampling Method: Transformation, Implementation, and Assessment. Social Science Computer Review, 24(1), 106-118.

The implementation and the assessment of the digital experience sampling method are reported in this article. The experience sampling method is transformed into a digital format and is examined in the Web environment to elicit online Web users’ experiences through multiple iterations of an online questionnaire. By sampling Web users’ online experiences and detecting Web users’ situated experiences from a time point very close to their actual experiences, this tool may collect reliable and valid data with minimal distortion. This tool may effectively and unambiguously tap Web users’ internal experiences associated with their use of the Web. Two empirical studies are reported to verify the usefulness of this method.

Collins, L.M. (2006). Analysis of longitudinal data: The integration of theoretical model, temporal design, and statistical model. Annual Review of Psychology, 57, 505-528.

This article argues that ideal longitudinal research is characterized by the seamless integration of three elements: (a) a well-articulated theoretical model of change observed using (b) a temporal design that affords a clear and detailed view of the process, with the resulting data analyzed by means of (c) a statistical model that is an operationalization of the theoretical model. Two general varieties of theoretical models are considered: models in which the time-related change of primary interest is continuous, and those in which it is characterized by movement between discrete states. In addition, two general types of temporal designs are considered: the longitudinal panel design and the intensive longitudinal design. For each general category of theoretical models, some of the analytic possibilities available for longitudinal panel designs and for intensive longitudinal designs are discussed. The article concludes with brief discussions of two issues particularly relevant to longitudinal research-missing data and measurement-and a few words about exploratory research.

Eid, M. & Diener, E. (Eds.). Handbook of multimethod measurement in psychology. Washington, DC: American Psychological Association.

The Handbook of Multimethod Measurement in Psychology is the first integrative guide to theoretical, methodological, and applied aspects of multimethod measurement in psychological research. Although multitrait-multimethod analysis and multimethod research strategies have become increasingly important in all areas of psychological research, comprehensive handbooks of multimethod measurement that integrate all phases of the data-gathering and assessment process have been missing. The Handbook of Multimethod Measurement in Psychology fills this long-standing gap. This volume provides a single, understandable resource for learning the meaning, advantages, and limitations of different methods. The editors have brought together outstanding researchers from all areas of psychology. Contributors give detailed explanations about exactly what has to be considered when conducting a multimethod study, what the strength of the convergent validity and method-specificity in different areas of research is, and what methods should be selected for proving validity in specific research contexts. The authors discuss theoretical concepts, then lay out the most important measurement tools-including, among many others, global self-assessment, informant assessment, observational methods, and nonreactive methods-followed by statistical models for analyzing multitrait-multimethod data. Contributors also explore applications of multimethod research in different areas of psychology as well as broader perspectives on the meaning and purpose of multimethod approaches. Destined to be a classic, the Handbook of Multimethod Measurement in Psychology is an indispensable resource for researchers and students in psychology seeking to enrich their work by using multimethod approaches.

Freedman, M.J., Lester, K.M., McNamara, C., Milby, J.B. & Schumacher, J.E. (2006). Cell phones for ecological momentary assessment with cocaine-addicted homeless patients in treatment. Journal of Substance Abuse Treatment, 30(2), 105-111.

This is the first study to examine whether cell phones could be used to collect ecological momentary assessment (EMA) data with homeless crack cocaine-addicted adults in treatment. The study adapted an EMA method to examine behavior in real time using cell phones and computer-automated telephone interviewing. Participants treated in an intensive outpatient treatment program were given cell phones for a 2-week period to record current states of cocaine craving and using episodes. Results showed cell phone technology could reliably deliver a computerized survey; this homeless population would use a cell phone to report craving and using episodes, and drug use reported via EMA was in agreement with urine toxicology results for 73% of participants. Of 30 participants, 24 (80%) completed the full 2-week protocol. Participants indicated the survey made them more aware of phenomena leading to cravings and use, suggesting the usefulness of EMA as a potential intervention.

Jacobs, N., Rijsdijk, F., Derom, C., Vlietinck, R., Delespaul, P., van Os, J. & Myin-Germeys, I. (2006). Genes Making One Feel Blue in the Flow of Daily Life: A Momentary Assessment Study of Gene-Stress Interaction. Psychosomatic Medicine, 68(2), 201-206.

Individual differences in stress reactivity constitute a crucially important mechanism of risk for depression. Because stress can be conceptualized as the continuous occurrence of minor daily hassles, this study focused on emotional reactivity to stress in the flow of daily life and examined to what degree individual differences in emotional reactivity could be explained by genetic and/or environmental factors. Two hundred seventy-five female twin pairs (170 monozygotic and 105 dizygotic) participated in this experience sampling study (ESM). ESM is a validated structured diary technique assessing stressors and mood in daily life. Individual emotional stress reactivity was conceptualized as changes in negative affect in relation to appraised subjective stress in relation to daily events. Structural equation modeling was used to fit univariate models. The best fitting model was chosen based on likelihood and parsimony. Genetic factors (explaining 12% individual differences) and individual-specific environmental factors (explaining 88%) influenced daily life stress reactivity. The demonstration of a small genetic influence on the dynamic relationship between minor stress and affective response in the flow of daily life sheds light on the gene-environment interactions that contribute to the risk of developing stress related disorders such as depression.

Karantonis, D.M., Narayanan, M.R., Mathie, M., Lovell, N.H. & Celler, B.G. (2006). Implementation of a real-time human movement classifier using a triaxial accelerometer for ambulatory monitoring. IEEE Transactions on Information Technology in Biomedicine, 10(1), 156-167.

The real-time monitoring of human movement can provide valuable information regarding an individual’s degree of functional ability and general level of activity. This paper presents the implementation of a real-time classification system for the types of human movement associated with the data acquired from a single, waist-mounted triaxial accelerometer unit. The major advance proposed by the system is to perform the vast majority of signal processing onboard the wearable unit using embedded intelligence. In this way, the system distinguishes between periods of activity and rest, recognizes the postural orientation of the wearer, detects events such as walking and falls, and provides an estimation of metabolic energy expenditure. A laboratory-based trial involving six subjects was undertaken, with results indicating an overall accuracy of 90.8% across a series of 12 tasks (283 tests) involving a variety of movements related to normal daily activities. Distinction between activity and rest was performed without error; recognition of postural orientation was carried out with 94.1% accuracy, classification of walking was achieved with less certainty (83.3% accuracy), and detection of possible falls was made with 95.6% accuracy. Results demonstrate the feasibility of implementing an accelerometry-based, real-time movement classifier using embedded intelligence.

Kimhy, D., Delespaul, P., Corcoran, C., Ahn, H., Yale, S. & Malaspina, D. (2006). Computerized experience sampling method (ESMc): Assessing feasibility and validity among individuals with schizophrenia. Journal of Psychiatric Research, 40(3), 221-230.

The Experience Sampling Method (ESM) is an ecologically valid, time-sampling of self-reports developed to study the dynamic process of person-environment interactions. ESM with digital wristwatch and booklets (paper-based ESM; ESMp) has been used extensively to study schizophrenia. The present study is designed to test the feasibility and validity of using Computerized ESM (ESMc) among individuals with schizophrenia. ESMc is advantageous in allowing for recording of precise time-stamps of responses. We used PDAs (“Personal Digital Assistant”; Palm handheld computers) to collect data on momentary psychotic symptoms, mood, and thoughts over a one day period among 10 hospitalized schizophrenia patients and 10 healthy controls. ESMc was equally acceptable to both groups, with similar ratings of comfort carrying the PDAs and operating them, interference with daily activities, as well as response rates. The schizophrenia patients reported significantly higher ratings of auditory and visual hallucinations, suspiciousness, sense of unreality, lack of thought control, fear of losing control, difficulty expressing thoughts, as well as depression/ sadness, loneliness and less cheerfulness. Significant inverse relationships were found among both groups between ratings of feeling cheerful and being stressed, irritated, and sad/depressed. Among the schizophrenia subjects, the correlation between ratings of suspiciousness on ESMc and Scale for Assessment of Positive Symptoms (SAPS) approached significance, as well as the link between suspiciousness and stress. Our results support the feasibility and validity of using ESMc for assessment of momentary psychotic symptoms, mood, and experiences among individuals with schizophrenia. The authors discuss the potential applications of combining ESMc with ambulatory physiological measures.

Krakoff, L.R. (2006). Cost-effectiveness of ambulatory blood pressure: a reanalysis. Hypertension, 47(1), 29-34.

Accurate diagnosis of hypertension and prognosis for future cardiovascular events can be enhanced through the use of 24-hour ambulatory blood pressure monitoring. It has been suggested that the use of ambulatory monitoring as a secondary screening for hypertension might be cost-effective. Many needed studies that are related to the calculation of cost-effectiveness for ambulatory monitoring have become available in recent years. More accurate estimates for cost of care, costs for testing, prevalence of white-coat hypertension, and incidence of the transition from normal pressures to hypertension have been reported. This study presents calculations of the cost savings likely to take place when ambulatory blood pressure monitoring is implemented for newly detected hypertensive subjects. These calculations are based on current estimates for cost of testing, cost of treatment, prevalence of white-coat hypertension at baseline, and varying the incidence of new hypertension after the initial screening. The results indicate a potential savings of 3% to 14% for cost of care for hypertension and 10% to 23% reduction in treatment days when ambulatory blood pressure monitoring is incorporated into the diagnostic process. At current reimbursement rates, the cost of ambulatory blood pressure monitoring for secondary screening on an annual basis would be <10% of treatment costs. Calculated savings for use of ambulatory blood pressure monitoring can take place when annual treatment costs are as little as 300 dollars. These estimates should be considered for the management of recently detected hypertension, especially when the risk of future cardiovascular is disease is low.

Li, Y., Wang, J.G., Dolan, E., Gao, P.J., Guo, H.F., Nawrot, T., Stanton, A.V., Zhu, D.L., O’Brien, E. & Staessen, J.A. (2006). Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension, 47(3), 359-364.

We hypothesized that 1 minus the slope of diastolic on systolic pressure during 24-hour ambulatory monitoring (ambulatory arterial stiffness index [AASI]) might reflect arterial stiffness. We compared AASI with established measures of arterial stiffness and studied its distribution in Chinese and European populations. We used 90207 SpaceLabs monitors and the SphygmoCor device to measure AASI, central and peripheral pulse pressures, the central (CAIx) and peripheral (PAIx) systolic augmentation indexes, and aortic pulse wave velocity. In 166 volunteers, the correlation coefficient between AASI and pulse wave velocity was 0.51 (P<0.0001). In 348 randomly recruited Chinese subjects, AASI correlated (P<0.0001) with CAIx (r=0.48), PAIx (r=0.50), and central pulse pressure (r=0.50). AASI increased with age and mean arterial pressure but decreased with body height. Both before and after adjustment for arterial wave reflections by considering height and heart rate as covariates, AASI correlated more (P<0.0001) closely with CAIx and PAIx than 24-hour pulse pressure. Among normotensive subjects, the 95th percentile of AASI was 0.55 in Chinese and 0.57 in 1617 Europeans enrolled in the International Database on Ambulatory Blood Pressure Monitoring. The upper boundary of the 95% prediction interval of AASI in relation to age ranged from 0.53 at 20 years to 0.72 at 80 years. In conclusion, AASI is a new index of arterial stiffness that can be easily measured under ambulatory conditions. Pending additional validation in outcome studies, normal values of AASI are probably <0.50 and 0.70 in young and older subjects, respectively.

McKay, J.R., Franklin, T.R., Patapis, Nicholas, & Lynch, K.G. (2006). Conceptual, methodological, and analytical issues in the study of relapse. Clinical Psychology Review, 26(2), 109-127.

This article examines conceptual, methodological, and analytic issues in research on relapse to alcohol and other drug use. The review notes the continued move in relapse research from a primary reliance on retrospective assessment of factors surrounding the onset of relapse episodes to an increased focus on the use of new technologies to obtain “near real time” data on proximal factors in relapses. Recent advances in neurobiology have yielded important gains in our understanding of vulnerability to relapse in alcohol and other drug abusers. New statistical techniques are also available to analyze data on relapse. From a theoretical standpoint, there has been an increasing appreciation for the complicated and dynamic interplay of distal and proximal factors in the relapse process. At this point, the strongest and most detailed data on factors in the onset and course of relapse have been generated by studies of smoking relapses that have made use of Ecological Momentary Assessment (EMA) technology. However, there is still limited “near real” time data on proximal factors in alcohol and other drug relapses, and no such data on factors that influence the course of these relapses, once they have begun. Nevertheless, important methodological advances have been and continue to be made in the study of relapse, and our knowledge about the nature and process of relapse has increased considerably over the past 10 years.

Moskowitz, D.S. & Young, S.N. (2006). Ecological momentary assessment: what it is and why it is a method of the future in clinical psychopharmacology. Journal of Psychiatry & Neuroscience, 31, 13-20.

Current methods of assessment in clinical psychopharmacology have several serious disadvantages, particularly for the study of social functioning. We aimed to review the strengths and weaknesses of current methods used in clinical psychopharmacology and to compare them with a group of methods, developed by personality/social psychologists, termed ecological momentary assessment (EMA), which permit the research participant to report on symptoms, affect and behaviour close in time to experience and which sample many events or time periods. EMA has a number of advantages over more traditional methods for the assessment of patients in clinical psychopharmacological studies. It can both complement and, in part, replace existing methods. EMA methods will permit more sensitive assessments and will enable more wide-ranging and detailed measurements of mood and behaviour. These types of methods should be adopted more widely by clinical psychopharmacology researchers.

Rau, R. (2006). Differences in work stress are more related to isolated systolic hypertension than to hypertension. Work and Stress, 20, 84-97.

The objective was to study whether the relationships between elevated blood pressure and (a) work stress as related to the stressor overtime, and (b) unwinding after work, depend on what kind of criteria are used for the diagnosis of hypertension. A total of 126 healthy men (aged 20–66 years) employed in white-collar jobs were tested over 24 hours by means of ambulatory blood pressure monitoring on a regular working day. Four groups were defined according to their blood pressure status: normotensives (NT), hypertensives (HT), isolated systolic hypertensives (ISH), and isolated diastolic hypertensives (IDH). No differences of age, body mass index, overtime work, and disturbed unwinding were found between the normotensives and the hypertensives. ISH was found to be related to working overtime and to disturbed unwinding but not to biological risk factors; IDH, however, was related exclusively to the biological risk factor high body mass index. Thus, significant differences associated with overtime were found between ISH and both NT and IDH, with the isolated systolic hypertensives carrying out more than twice as much overtime as the normotensives or isolated diastolic hypertensives. More men with a disturbed ability to relax and vital exhaustion were found in the ISH group than in the NT group. It seems that, in addition to the usual diagnosis of hypertension, the classification of ISH and IDH adds new information about the relationship between blood pressure elevation and both work stress and disturbed unwinding.

Schasfoort, F.C., Bussmann, J.B., Krijnen, H.J. & Stam, H.J. (2006). Upper limb activity over time in complex regional pain syndrome type 1 as objectively measured with an upper limb-activity monitor: an explorative multiple case study. European Journal of Pain: Ejp, 10(1), 31-39.

An upper limb-activity monitor (ULAM) has been developed to determine activity limitations in complex regional pain syndrome type 1 (CRPS1). The ULAM is based on 24h ambulatory monitoring of body segment accelerations and enables valid and objective quantification of mobility and upper limb activity in transversal studies. To explore upper limb activity over time in acute upper limb CRPS1 as measured with the ULAM in a longitudinal study, and to compare this to time courses of other outcome measures for activity limitations and impairments. Four subjects were measured four times during a treatment protocol. Several ULAM outcome measures related to upper limb usage and mobility, three questionnaires (RASQ, DASH, RAND36), and six impairment outcome indicators (VAS-momentary pain, VAS-pain resulting from effort, volume, temperature, active range of motion, strength) were used. Objectively measured upper limb activity frequently improved; improvements of >5% were found for 63% of the ULAM outcome measures at final assessment. The ULAM outcome measures had a time course more similar to the body-part and CRPS1 specific questionnaire RASQ than the other questionnaires. The time course of impaired temperature was most often in accordance with the ULAM, and both VAS scores showed least accordance. Clear changes in upper limb activity over time were frequently found as objectively measured with the ULAM, and relationships among the time courses of the ULAM and other outcome measures were largely explainable. The ULAM can validly assess upper limb activity over time in CRPS1, but between-measurement variability needs careful consideration.

Shrout, P. E.; Herman, C.M. & Bolger, N. (2006). The costs and benefits of practical and emotional support on adjustment: A daily diary study of couples experiencing acute stress. Personal Relationships, 13(1), 115-134.

Emotional support from intimate partners has been shown to have both costs and benefits for daily anxious and depressed moods (N. Bolger, A. Zuckerman, & R. C. Kessler, 2000). We examine whether similar costs and benefits are found for practical support, and when fatigue, vigor, and anger are outcomes. Results are based on daily diary reports from 68 recent law school graduates and their intimate partners during the month before the New York State bar examination. Partners’ reports of practical support provision to the examinee were beneficial in that they were associated with decreased examinee fatigue and increased examinee vigor. In contrast, examinees’ recognition of emotional support receipt was costly in that it was associated with increases in anger, as well as anxious and depressed mood. Results highlight the distinction between emotional and practical support and are consistent with findings that suggest that invisible (provided but not recognized) support leads to the best outcomes.

Sorbi, M.J., Peters, M.L., Kruise, D.A., Maas, C.J., Kerssens, J.J., Verhaak, P.F. & Bensing, J.M. (2006). Electronic Momentary Assessment in Chronic Pain I: Psychological Pain Responses as Predictors of Pain Intensity. Clinical Journal of Pain, 22(1), 55-66.

Electronic momentary assessment was employed to substantiate the relevance of psychological functioning in chronic pain. More than 7100 electronic diaries from 80 patients with varying IASP classified types of chronic pain served to investigate to what extent fear-avoidance, cognitive and spousal solicitous and punishing pain responses explained fluctuations in pain intensity and whether patients with pre-chronic, recently chronic and persistently chronic pain differed in this regard. Psychological pain responses explained 40% of the total variance in pain intensity: almost 24% concerned pain variance that occurred between the CPD patients and 16% pertained to pain variance due to momentary differences within these patients. Separately tested fear-avoidance and cognitive responses each explained about 28% of the total pain variance, while spousal responses explained 9%. Catastrophizing emerged as the strongest pain predictor, followed by pain-related fear and bodily vigilance. Results did not differ with the duration of chronicity. Exaggerated negative interpretations of pain, and fear that movement will induce or increase pain strongly predicted CPD pain intensity. Spousal responses-assessed only when the spouse was with the patient who at that moment was in actual pain-may more strongly affect immobility due to pain than pain intensity per se (see part II of the study). The findings substantiate the importance of catastrophizing, fear and vigilance identified primarily in low back pain and extend this to other forms of chronic pain. The compelling evidence of momentary within-patients differences underscores that these must be accounted for in chronic pain research and practice.

Sorbi, M.J., Peters, M.L., Kruise, D.A., Maas, C.J., Kerssens, J.J., Verhaak, P.F. & Bensing, J.M. (2006). Electronic Momentary Assessment in Chronic Pain II: Pain and Psychological Pain Responses as Predictors of Pain Disability. Clinical Journal of Pain, 22(1), 67-81.

More than 7100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain responses). We also tested the differences between prechronic, recently chronic, and persistently chronic pain in the prediction of disability (impaired physical and mental capacity, pain interference with activities, immobility due to pain). Pain intensity explained 8% to 19% of the disability variance. Beyond this psychological functioning explained 7% to 16%: particularly fear-avoidance and cognitive pain responses predicted chronic pain disorder disability; spousal responses predicted immobility better than other aspects of disability. Immobility due to actual pain occurred infrequently. When it did, however, it was better predicted by avoidance behavior in the patient and by spousal discouragement of movement than by actual pain intensity. The prediction of immobility due to pain by, respectively, avoidance behavior and catastrophizing was better in chronic pain (>6 months) and that of physical impairment by catastrophizing better in persistently chronic pain (>12 months) than in pain of shorter duration. The psychological prediction of chronic pain disorder disability was determined beyond that accounted for by pain intensity. Nonetheless, psychological functioning explained substantial variance in chronic pain disorder disability. The psychological prediction of immobility and physical impairment was stronger with longer pain duration. Patient characteristics and momentary states of disability-and in particular of immobility-should be carefully distinguished and accounted for in chronic pain disorder.

Stinson, J.N., Petroz, G.C., Tait, G., Feldman, B.M., Streiner, D., McGrath, P.J. & Stevens, B.J. (2006). e-Ouch: Usability Testing of an Electronic Chronic Pain Diary for Adolescents With Arthritis. Clinical Journal of Pain, 22(3), 295-305.

The aim of this study was to evaluate the usability of the e-Ouch electronic chronic pain diary in adolescents with juvenile idiopathic arthritis. A qualitative usability testing approach with semistructured, audiotaped interviews with two iterative cycles was used. A purposive sample of 10 adolescents per cycle was drawn from a rheumatology clinic in a university-affiliated pediatric tertiary care center. Participants were provided with a brief demonstration of the diary and then asked to use the diary “thinking aloud” to record the pain they experienced: (1) when they woke up that morning, (2) during that afternoon, and (3) from the previous evening. Adolescents were then asked a series of open-ended questions addressing ease of use of the diary. Qualitative thematic analysis was used to generate categories and emerging themes from interview data. All of the adolescents stated the e-Ouch diary was very easy to learn, use, and understand and was satisfying to complete. Participants took less than 9 minutes to complete all three of the diary entries with minimal errors. The usability evaluation revealed aspects of the interface that were suboptimal (eg, VAS slider) and impeded the performance of certain tasks. Adolescents generated ideas on how the diary interface could be improved. A multifaceted usability approach provided important insight regarding the use of technology by adolescents with arthritis and, more specifically, for understanding how adolescents can more effectively use an electronic chronic pain diary.

Whalen, C.K., Henker, B., Ishikawa, S.S., Jamner, L.D., Floro, J.N., Johnston, J.A. & Swindle, R. (2006). An Electronic Diary Study of Contextual Triggers and ADHD: Get Ready, Get Set, Get Mad. Journal of the American Academy of Child & Adolescent Psychiatry, 45(2), 166-174.

This study was designed to examine context effects or provocation ecologies in the daily lives of children with ADHD. Across 7 days, mothers and children (27 children with attention-deficit/hyperactivity disorder [ADHD] taking stimulant medication; 25 children without ADHD; ages 7-12 years) provided electronic diary reports every 30 +/- 5 minutes during nonschool hours. Child and maternal perceptions of behaviors, moods, and interaction quality during preparatory and transitional (“getting ready”) activities were compared with those during other activities. Maternal reports revealed that child symptomatic behaviors and negative moods, maternal negative moods, and parent-child disagreement were elevated in the ADHD but not in the comparison group while getting ready versus other activities. Children’s self-ratings also revealed situational effects, indicating that school-age children with ADHD can give meaningful self-reports using carefully structured electronic diaries. Even when children with ADHD are receiving stimulant pharmacotherapy, the preparatory tasks of daily living are especially challenging and linked disproportionately to child behavior problems, parent negative affect, and contentious interactions. Treatment targeted on these transitional hurdles may improve child behavior patterns and enhance parent-child relationships and family harmony.

Willum-Hansen, T., Staessen, J.A., Torp-Pedersen, C., Rasmussen, S., Thijs, L., Ibsen, H. & Jeppesen, J. (2006). Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation, 113(5), 664-670.

Few population studies addressed the prognostic significance of aortic pulse wave velocity (APWV) above and beyond other cardiovascular risk factors. We studied a sex- and age-stratified random sample of 1678 Danes aged 40 to 70 years. We used Cox regression to investigate the prognostic value of APWV, office pulse pressure (PP), and 24-hour ambulatory PP while adjusting for mean arterial pressure (MAP) and other covariates. Over a median follow-up of 9.4 years, the incidence of fatal and nonfatal cardiovascular end points, cardiovascular mortality, and fatal and nonfatal coronary heart disease amounted to 154, 62, and 101 cases, respectively. We adjusted for sex, age, body mass index, MAP measured in the office (conventional PP and APWV) or by ambulatory monitoring (24-hour PP), smoking, and alcohol intake. With these adjustments, APWV maintained its prognostic significance in relation to each end point (P<0.05), whereas office and 24-hour PP lost their predictive value (P>0.19), except for office PP in relation to coronary heart disease (P=0.02). For each 1-SD increment in APWV (3.4 m/s), the risk of an event increased by 16% to 20%. In sensitivity analyses, APWV still predicted all cardiovascular events after standardization to a heart rate of 60 beats per minute, after adjustment for 24-hour MAP instead of office MAP, and/or after additional adjustment for the ratio of total to HDL serum cholesterol and diabetes mellitus at baseline. In a general Danish population, APWV predicted a composite of cardiovascular outcomes above and beyond traditional cardiovascular risk factors, including 24-hour MAP.

Wittmann, W.W. & Klumb, P.L. (2006). How to Fool Yourself With Experiments in Testing Theories in Psychological Research. In R.R. Bootzin & P.E. McKnight (Eds.), Strengthening research methodology: Psychological measurement and evaluation (pp. 185-211). Washington, DC: American Psychological Association.

The synthesis of the Northwestern school of thought concerning basic and applied research with ideas and challenges from its critics paid off, as demonstrated in this chapter with examples from different areas of research. Similar successes resulted in large-scale evaluation projects in the German health and rehabilitation system (Wittmann, Niibling, & Schmidt, 2002), as well as research about the relationships among working memory, intelligence, knowledge, and complex problem-solving performance in complex computer-based business games (Wittmann & Suess, 1999) not reported here. The key concepts in all reported examples had been the application of symmetry principles in relating predictors, causes, and effects. Of special additional importance was incorporating psychometric principles into the experimental treatment to improve its measurement and to shed light into the black box. Investing more in the assessment of criteria and taking a larger slice out of human behavior over longer periods helped as well. We are reminded that time-series designs are the strongest quasi-experimental ones in terms of internal validity. Tools coined as ambulatory assessment have been developed to better assess behavior, feelings, emotions, and performance in real-life field settings. Fahrenberg and Myrtek (1996, 2001) contributed to their development and described the potential and promises. We are confident that assessment, measurement, theory testing, and construct validation will reach new horizons by integrating these tools into our research designs.

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