Society for Ambulatory Assessment

Third quarter 2006 (July to September)

Andersen LB, Harro M, Sardinha LB (Jul 2006). Physical activity and clustered cardiovascular risk in children: A cross-sectional study (The European Youth Heart Study). Lancet, Vol 368(9532),. pp. 299-304.

Background: Atherosclerosis develops from early childhood; physical activity could positively affect this process. This study’s aim was to assess the associations of objectively measured physical activity with clustering of cardiovascular disease risk factors in children and derive guidelines on the basis of this analysis. Methods: We did a cross-sectional study of 1732 randomly selected 9-year-old and 15-year-old school children from Denmark, Estonia, and Portugal. Risk factors included in the composite risk factor score (mean of Z scores) were systolic blood pressure, triglyceride, total cholesterol/HDL ratio, insulin resistance, sum of four skinfolds, and aerobic fitness. Individuals with a risk score above 1 SD of the composite variable were defined as being at risk. Physical activity was assessed by accelerometry. Findings: Odds ratios for having clustered risk for ascending quintiles of physical activity (counts per min; cpm) were 3.29 (95% CI 1.96-5.52), 3.13 (1.87-5.25), 2.51 (1.47-4.26), and 2.03 (1.18-3.50), respectively, compared with the most active quintile. The first to the third quintile of physical activity had a raised risk in all analyses. The mean time spent above 2000 cpm in the fourth quintile was 116 min per day in 9-year-old and 88 min per day in 15-year-old children. Interpretation: Physical activity levels should be higher than the current international guidelines of at least 1 h per day of physical activity of at least moderate intensity to prevent clustering of cardiovascular disease risk factors.

Badr H, Basen-Engquist K, Taylor C, Carmack L, de Moor C (Oct 2006). States Associated with Transitory Physical Symptoms Among Breast and Ovarian Cancer Survivors. Journal of Behavioral Medicine, 29(5):461-475.

This study used electronic diaries to examine patterns of mood and physical symptoms within and across days in two independent samples of cancer patients. Twenty-three breast cancer survivors (post-treatment) and 33 ovarian cancer survivors (on chemotherapy) recorded mood and physical symptoms 4 times daily for 7 consecutive days. A series of repeated-measures multilevel models using SAS Proc Mixed were calculated to estimate the degree to which physical symptoms (e.g., pain, fatigue, and nausea) were associated with participants’ moods. Across days, mood vectors with a pleasantness component (i.e., happy-sad and calm-anxious) and mood vectors with an arousal component (i.e., active-passive and peppy-tired) were significantly associated with physical symptom severity. Specifically, breast cancer survivors with greater fatigue and pain reported more negative moods ([eta]2<=0.33). Ovarian cancer survivors with greater fatigue ([eta]2<=0.35), pain ([eta]2<=0.04), and nausea ([eta]2<=0.04) also reported more negative moods. Diurnal analyses showed that happy-sad ([eta]2<=0.16), active-passive ([eta]2<=0.27), and peppy-tired moods ([eta]2<=0.33) were significantly negatively associated with fatigue at each of the four daily assessment times in both samples. Although correlational, our findings are consistent with previous studies suggesting that variations in both pleasant and aroused mood covary with changes in real-time physical symptom reports.

Baker SR (Sep 2006). Towards an idiothetic understanding of the role of social problem solving in daily event, mood and health experiences: A prospective daily diary approach. British Journal of Health Psychology, 11(3):513-531.

Objectives. Utilising D’Zurilla’s (1986, 1990) transactional social problem solving model as the theoretical framework, the present study sought to examine the dynamics of the social problem solving process in relation to intraindividual experiences of events, mood, and physical health in daily life.
Design. The study incorporated both idiographic and nomothetic strategies, combining a daily diary approach within a prospective design. As such, each individual’s experience of events, mood, and health were assessed on a daily basis, and the prospective relations between social problem solving and these day-to-day experiences examined.Methods. Participants’ (university students) completed a measure of social problem solving at baseline followed, approximately 5 weeks later, by daily self-reports of mood (positive & negative), events (hassles & uplifts), and physical health (health status & URI symptoms) for a period of 14 days. The data were analysed using multilevel hierarchical modelling.Results. Days on which individuals had greater than their average hassles were associated with higher negative and lower positive mood (i.e. domain specific & cross-over effects), whilst greater uplifts were linked to positive mood only. With regard to health, individuals reported worse status and more URI symptoms on days with greater than their average negative (hassles, negative mood) but not positive influences (uplifts, positive mood). Both social problem solving orientations and skills dimensions were associated prospectively with daily health outcomes, and these relationships were not moderated by day-to-day experiences of mood or events.Conclusions. The data clarify the importance of social problem solving to within-person daily event, mood, and health experiences. The implications of these findings for contemporary transactional social problem solving models are discussed.

Beal DJ, Trougakos JP, Weiss HM (Sep 2006). Episodic Processes in Emotional Labor: Perceptions of Affective Delivery and Regulation Strategies. Journal of Applied Psychology, 91(5):1053-1065.

This study examined emotional labor processes from a within-person, episodic framework. The authors hypothesized that the influence of negative emotions on affective delivery would be lessened by regulation strategies for supervisor perceptions but not self-perceptions. In addition, difficulty maintaining display rules was hypothesized to mediate the relation between negative emotions and self-perceptions of affective delivery. Finally, the influence of surface acting strategies on these processes as well as correlations with individual differences was investigated. Hypotheses were tested using ecological momentary assessment of a sample of cheerleading instructors. Results suggest that surface actors can regulate emotions effectively on an episode-to-episode basis but find the episode more difficult. In addition, surface actors exhibit more general tendencies to devalue themselves and experience fewer positive emotions.

Bisconti, TL, Bergeman CS, Boker SM (Sep 2006). Social Support as a Predictor of Variability: An Examination of the Adjustment Trajectories of Recent Widows. Psychology and Aging, 21(3):590-599.

The variability pattern of emotional well-being in recent widows across a 98-day period beginning in the first month post-loss has previously been modeled by dynamical systems and shown to be an oscillating process that damps across time. The goal of the present study was to examine how variables that comprise the social support network predict characteristics of these emotional shifts in 28 recent widows. In the present study, emotional support seeking led to a steeper overall trend, whereas perceived control for social support led to a shallower overall trend. When examining intraindividual variability, instrumental support seeking predicted a slower damping rate. Understanding the individual differences in the variability patterns of recent widows is a necessary step in identifying the etiology of adjustment to widowhood.

Bullimore MA, Reuter KS, Jones LA, Mitchell GL, Zoz J, Rah MJ. (Aug 2006). The Study of Progression of Adult Nearsightedness (SPAN): design and baseline characteristics. Optom Vis Sci.; 83(8):594-604.

Purpose: The Study of Progression of Adult Nearsightedness (SPAN) is a 5-year observational study to determine the risk factors associated with adult myopia progression. Candidate risk factors include: a high proportion of time spent performing near tasks, performing near tasks at a close distance, high accommodative convergence/accommodation (AC/A) ratio, and high accommodative lag. Methods: Subjects between 25 and 35 years of age, with at least -0.50 D spherical equivalent of myopia (cycloplegic autorefraction), were recruited from the faculty and staff of The Ohio State University. Progression is defined as an increase in myopia of at least -0.75 D spherical equivalent as determined by cycloplegic autorefraction. Annual testing includes visual acuity, noncycloplegic autorefraction and autokeratometry, phoria, accommodative lag, response AC/A ratio, cycloplegic autorefraction, videophakometry, ultrasound, and partial coherence interferometry (IOLMaster). Participants’ near activities were assessed using the experience sampling method (ESM). Subjects carried a pager for two 1-week periods and were paged randomly throughout the day. Each time they were paged, they dialed into an automated telephone survey and reported their visual activity at that time. From these responses, the proportion of time spent performing near work was estimated. Results: Three-hundred ninety-six subjects were enrolled in SPAN. The mean (+/- standard deviation) age at baseline was 30.7 +/- 3.5 years, 66% were female, 80% were white, 11% were black, and 8% were Asian/Pacific Islander. The mean level of myopia (spherical equivalent) was -3.54 +/- 1.77 D, the mean axial length by IOLMaster was 24.6 +/- 1.1 mm, and subjects were 1.7 +/- 4.0 Delta exophoric. Refractive error was associated with the number of myopic parents (F = 3.83, p = 0.023), and the number of myopic parents was associated with the age of myopia onset (chi2 = 13.78, p = 0.001). In a multivariate analysis, onset of myopia (early vs. late) still had a significant effect on degree of myopia (F = 115.1, p < 0.001), but the number of myopic parents was no longer significant (F = 0.65, p = 0.52). For the ESM, the most frequently reported visual task was computer use (mean, 18.9%; range, 0-60.0%) and, overall, subjects reported near work activity 34.1% of the time (range, 0-67.3%). Conclusions: The design of SPAN and the baseline characteristics of the cohort have been described. Parental history of myopia is related to the degree of myopia at baseline, but this effect is mediated by the age of onset of myopia.

Cranford JA, Shrout PE, Iida M (Jul 2006). A Procedure for Evaluating Sensitivity to Within-Person Change: Can Mood Measures in Diary Studies Detect Change Reliably?. Personality and Social Psychology Bulletin, 32(7):917-929.

The recent growth in diary and experience sampling research has increased research attention on how people change over time in natural settings. Often however, the measures in these studies were originally developed for studying between-person differences, and their sensitivity to within-person changes is usually unknown. Using a Generalizability Theory framework, the authors illustrate a procedure for developing reliable measures of change using a version of the Profile of Mood States (POMS; McNair, Lorr, & Droppleman, 1992) shortened for diary studies. Analyzing two data sets, one composed of 35 daily reports from 68 persons experiencing a stressful examination and another composed of daily reports from 164 persons over a typical 28-day period, we demonstrate that three-item measures of anxious mood, depressed mood, anger, fatigue, and vigor have appropriate reliability to detect within-person change processes.

De Cocker K, Cardon G, De Bourdeaudhuij I (Aug 2006). Validity of the inexpensive Stepping Meter in counting steps in free living conditions: a pilot study. Br J Sports Med., 40(8):714-6.

Objectives: To evaluate if inexpensive Stepping Meters are valid in counting steps in adults in free living conditions. Methods: For six days, 35 healthy volunteers wore a criterion Yamax Digiwalker and five Stepping Meters every day until all 973 pedometers had been tested. Steps were recorded daily, and the differences between counts from the Digiwalker and the Stepping Meter were expressed as a percentage of the valid value of the Digiwalker step counts. The criterion used to determine if a Stepping Meter was valid was a maximum deviation of 10% from the Digiwalker step counts. Results: A total of 252 (25.9%) Stepping Meters met the criterion, whereas 74.1% made an overestimation or underestimation of more than 10%. In more than one third (36.6%) of the invalid Stepping Meters, the deviation was greater than 50%. Most (64.8%) of the invalid pedometers overestimated the actual steps taken. Conclusions: Inexpensive Stepping Meters cannot be used in community interventions as they will give participants the wrong message.

Dejnabadi H, Jolles BM, Casanova E, Fua P, Aminian K (Jul 2006). Estimation and visualization of sagittal kinematics of lower limbs orientation using body-fixed sensors. IEEE Trans Biomed Eng., 53(7):1385-93.

A new method of estimating lower limbs orientations using a combination of accelerometers and gyroscopes is presented. The model is based on estimating the accelerations of ankle and knee joints by placing virtual sensors at the centers of rotation. The proposed technique considers human locomotion and biomechanical constraints, and provides a solution to fusing the data of gyroscopes and accelerometers that yields stable and drift-free estimates of segment orientation. The method was validated by measuring lower limb motions of eight subjects, walking at three different speeds, and comparing the results with a reference motion measurement system. The results are very close to those of the reference system presenting very small errors (Shank: rms = 1.0, Thigh: rms = 1.6 degrees) and excellent correlation coefficients (Shank: r = 0.999, Thigh: r = 0.998). Technically, the proposed ambulatory system is portable, easily mountable, and can be used for long-term monitoring without hindrance to natural activities. Finally, a gait analysis tool was designed to visualize the motion data as synthetic skeletons performing the same actions as the subjects.

De Vries SI, Bakker I, Hopman-Rock M, Hirasing RA, van Mechelen W (Jul 2006). Clinimetric review of motion sensors in children and adolescents. J Clin Epidemiol., 59(7):670-80.

Background and Objectives: To review the clinimetric quality of motion sensors used to assess physical activity in healthy children and adolescents (2-18 years). Methods: A systematic literature search was performed in PubMed, Embase, and SpycINFO. The clinimetric quality of two pedometers (Digi-Walker, Pedoboy), four one-dimensional accelerometers (LSI, Caltrac, Actiwatch, CSA/ActiGraph), and three three-dimensional accelerometers (Tritrac-R3D, RT3, Tracmor2) was evaluated and compared using a 20-item checklist. Results: Overall, the quality of the studies (n = 35), and therefore the level of evidence for the reproducibility, validity, and feasibility of the motion sensors was modest (mean = 6.4 +/- 1.6 out of 14 points). There was strong evidence for a good reproducibility of the Caltrac in adolescents (12-18 years), a poor reproducibility of the Digi-Walker in children (8-12 years), a good validity of the CSA/ActiGraph in children and adolescents (8-18 years), and a good validity of the Tritrac-R3D in children (8-12 years). Conclusions: The CSA/ActiGraph and the Caltrac are the only motion sensors in which the reproducibility, validity, and feasibility have been examined in different age groups. Further studies of the reproducibility of motion sensors in preschool children, improvement of the quality of clinimetric studies, and evaluation of the acceptability of motion sensors are warranted.

Glaser J, van Os J, Portegijs PJM (Aug 2006). Childhood trauma and emotional reactivity to daily life stress in adult frequent attenders of general practitioners. Journal of Psychosomatic Research, 61(2):229-236.

Objectives: Childhood trauma (CT) has consistently been associated with neuroticism-a personality trait reflecting vulnerability to stress. However, not much is known about the impact of a history of trauma on moment-to-moment emotions and experiences in the flow of daily life. The relationship between CT and emotional reactivity to daily life stress was investigated. Methods: Ninety frequent attenders of general practitioners, of which 29 fulfilled criteria for CT (sexual and/or physical trauma before the age of 19 years), were studied with the Experience Sampling Method (a structured diary technique assessing current context and mood in daily life) to assess: (a) appraised subjective stress related to daily events and activities, and (b) emotional reactivity conceptualized as changes in negative affect (NA). Results: Multilevel regression analysis revealed that subjects with a history of CT reported significantly increased emotional reactivity to daily life stress, as reflected in an increase in NA. This effect was significantly stronger for subjects who experienced trauma before the age of 10 years. Conclusion: These results confirm that CT may have long-lasting and enduring effects on adult psychological functioning, as exposed individuals continually react more strongly to small stressors occurring in the natural flow of everyday life. The finding that emotional stress reactivity is most pronounced for subjects who experienced trauma early in life confirms prior evidence suggesting that the effects of trauma are more detrimental when trauma occurs at a younger age.

Holtkamp K, Herpertz-Dahlmann B, Hebebrand K, Mika C, Kratzsch J, Hebebrand J (Aug 2006). Physical activity and restlessness correlate with leptin levels in patients with adolescent anorexia nervosa. Biol Psychiatry., 1;60(3):311-3.

Background: In food-restricted rats, leptin suppresses semistarvation-induced hyperactivity (SIH) and decreases exploratory behavior. Leptin ameliorates anxiety-related movement in ob/ob mice. In this study, we assessed the relationship between leptin and qualities of physical activity and restlessness in acute anorexia nervosa (AN). Methods: Serum leptin, body mass index (BMI), % body fat, and self- and expert-ratings of qualities of physical activity and restlessness were assessed in 26 inpatients with acute AN. Accelerometry was also performed. Regression analyses were used to predict activity and restlessness using BMI, % body fat, and leptin levels as predictor variables. Results: Leptin levels significantly contributed to the prediction of all measures of activity and restlessness. Conclusions: This is the first study linking hypoleptinemia in AN patients to subjective and objective measures of higher physical activity and motor and inner restlessness. Leptin may directly or indirectly (or both) influence behaviors and cognitions contributing to hyperactivity and motor restlessness.

Jago R, Baranowski T, Baranowski JC (Jul-Aug 2006). Observed, GIS, and Self-reported Environmental Features and Adolescent Physical Activity. American Journal of Health Promotion, 20(6):422-428.

Purpose: Examine associations among observed, self-reported, and Geographical Information Systems (GIS) environmental features and physical activity among adolescent males. Design: Cross-sectional study. Setting: Boy Scout troops and neighborhoods in Houston, Texas. Subjects: Two hundred and ten 10- to 14-year-old Boy Scouts. Measures: Accelerometry to obtain minutes of sedentary, light, and moderate to vigorous activity per day. GIS sources were used to identify the numbers of parks, gymnasiums, trails, bus stops, grocery stores, and restaurants within a 1-mile radius of participant residences as well as residential density, connectivity, and crime. Participants provided a self-report of their environment. Analysis: Principal component analysis was used to reduce the number of GIS and self-reported items. Four factors were previously obtained from direct observations of the neighborhoods. Correlations were conducted among factors and physical activity. Regression models were run in which minutes of sedentary behavior, light, or moderate to vigorous physical activity were the dependent variables and environmental factors were the independent variables. Nonsignificant variables were removed in a backward deletion process. Results: Three GIS factors, Parks, Crime, and Gyms, were obtained as were two self-reported factors: difficulty and access and safety. Factor scores were interrelated and associated with the four observed factors. Only observed sidewalk characteristics were correlated with physical activity and were retained in the regression models. Conclusion: Environmental factors were interrelated. Only sidewalk characteristics were associated with sedentary behavior and light intensity physical activity.

Lande MB, Carson NL, Roy J, Meagher CC (Jul 2006). Effects of childhood primary hypertension on carotid intima media thickness: a matched controlled study. Hypertension, 48(1):40-4.

To determine whether carotid intima media thickness is increased in children with primary hypertension, the current study compared carotid intima media thickness in hypertensive children with that of normotensive control subjects matched closely for body mass index and determined the relationship between carotid intima media thickness and hypertension severity determined by ambulatory blood pressure monitoring. Children with newly diagnosed office hypertension (n=28) had carotid intima media thickness, left ventricular mass index, and ambulatory blood pressure monitoring performed. Carotid intima media thickness was performed in normotensive control subjects (n=28) matched pairwise to hypertensive subjects for age (+/-1 year), gender, and body mass index (+/-10%). Eighty-two percent of subjects were overweight or obese (body mass index > or =85th percentile). The median carotid intima media thickness of hypertensive subjects was greater than that of matched controls (0.67 versus 0.63 mm; P=0.045). In the hypertensive subjects, carotid intima media thickness correlated strongly with several ambulatory blood pressure monitoring parameters, with the strongest correlation for daytime systolic blood pressure index (r=0.57; P=0.003). In the hypertensive group, the prevalence of left ventricular hypertrophy was 32%, but unlike carotid intima media thickness, left ventricular mass index did not correlate with ambulatory blood pressure monitoring. Together, the findings that hypertensive subjects had increased carotid intima media thickness compared with matched controls and that higher carotid intima media thickness correlated with more severe hypertension by ambulatory blood pressure monitoring provide strong evidence that carotid intima media thickness is increased in childhood primary hypertension, independent of the effects of obesity.

Leoncini G, Ratto E, Viazzi F, Vaccaro V, Parodi A, Falqui V, Conti N, Tomolillo C, Deferrari G, Pontremoli R (Sep 2006). Increased ambulatory arterial stiffness index is associated with target organ damage in primary hypertension. Hypertension, 48(3):397-403.

Increased arterial stiffness has been shown to predict cardiovascular mortality in patients with primary hypertension. Asymptomatic organ damage is known to precede cardiovascular events. We investigated the relationship between a recently proposed index of stiffness derived from ambulatory blood pressure (BP) and target organ damage in 188 untreated patients with primary hypertension. Ambulatory arterial stiffness index was defined as 1 minus the regression slope of diastolic over systolic BP readings obtained from 24-hour recordings. Albuminuria was measured as the albumin:creatinine ratio, left ventricular mass index was assessed by echocardiography, and carotid abnormalities were evaluated by ultrasonography. The prevalence of microalbuminuria, left ventricular hypertrophy (LVH), and carotid abnormalities was 12%, 38%, and 19%, respectively. Ambulatory arterial stiffness index was positively related to age, triglycerides, office and 24-hour systolic BP, 24-hour pulse pressure, urinary albumin excretion, and carotid intima-media thickness. Patients with microalbuminuria, carotid abnormalities, or LVH showed higher ambulatory arterial stiffness index as compared with those without it. After adjusting for confounding factors, each SD increase in ambulatory arterial stiffness index entails an &2 times higher risk of microalbuminuria, carotid abnormalities, and LVH and doubles the risk of the occurrence of >or=1 sign of organ damage. Ambulatory arterial stiffness index is associated with organ damage in patients with primary hypertension. These data strengthen the role of this index as a marker of risk and help to explain the high cardiovascular mortality reported in patients with high ambulatory arterial stiffness index.

Martinez MA, Sancho T, Garcia P, Moreno P, Rubio JM, Palau FJ, Anton JL, Cirujano FJ, Sanz J, Puig JG, MAPA Working Group (Aug 2006). Home blood pressure in poorly controlled hypertension: relationship with ambulatory blood pressure and organ damage. Blood Press Monit., 11(4):207-13.

Objektives: (1) To assess whether home blood pressure measurement is a reliable alternative to ambulatory blood pressure monitoring for the evaluation of treated patients with inadequate blood pressure control at the clinic; and (2) to evaluate the relationship between home blood pressure and several target-organ damage markers. Basic methods: A cross-sectional study was performed in 225 treated hypertensive patients with persistently high blood pressure values at the clinic (systolic blood pressure 140 mmHg and/or diastolic blood pressure 90 mmHg). All study participants underwent clinic blood pressure measurement, 24-h ambulatory blood pressure and home blood pressure monitoring. A subgroup of patients underwent the following procedures: carotid echography (n=74), microalbuminuria determination (n=88) and echocardiography (n=43). We defined out-of-clinic normotension as an average ambulatory or home blood pressure less than 135 mmHg (systolic) and 85 mmHg (diastolic). Main results: The sensitivity, specificity and positive and negative predictive values of the home blood pressure method for predicting out-of-clinic normotension (with the ambulatory method used as reference), expressed as percentages, were 50, 87, 64 and 79%, respectively. Systolic home blood pressure correlated significantly with left ventricular mass (r=0.33, P<0.05) and microalbuminuria (r=0.24, P<0.05). Similar correlation coefficients were found for systolic ambulatory blood pressure (r=0.32, P<0.05 and r=0.24, P<0.05, respectively). Clinic blood pressure did not correlate with either left ventricular mass or microalbuminuria (r=0.19, P=0.09 and r=0.19, P=0.24, respectively). Diastolic home blood pressure, but not ambulatory blood pressure, correlated negatively with mean carotid intima-media thickness (r=-0.27, P<0.05). Conclusions: Our results suggest that, in patients with poorly controlled hypertension at the clinic, home blood pressure represents a complementary test rather than an alternative to ambulatory blood pressure, and correlates with several target-organ damage markers.

Matsumura K, Ohtsubo T, Oniki H, Fujii K, Iida M (Jul 2006). Gender-related association of serum uric acid and left ventricular hypertrophy in hypertension. Circ J, 70(7):885-8.

Background: The aim of the present study was to determine whether sex differences contribute to the association of serum uric acid and left ventricular hypertrophy in individuals with hypertension. Methods and results: Seventy participants with essential hypertension (34 men, 36 women; 54.4 +/- 1.6 years old) were enrolled to undergo echocardiography to calculate the left ventricular mass index (LVMI). Twenty-four-hour ambulatory blood pressure monitoring was done to assess blood pressure level precisely. The LVMI was significantly correlated with serum uric acid (r = 0.295, p = 0.013) in all participants. After controlling for factors such as age, sex, mean 24-h systolic blood pressure, creatinine clearance, and duration of hypertension, serum uric acid was still found to be significantly and independently associated with LVMI. Because serum uric acid was significantly higher in men than in women (6.8 +/- 0.3 and 5.1 +/- 0.2 mg/dl, respectively), subsequent analysis was performed by gender. Multiple regression analysis revealed that the LVMI was significantly and independently associated with serum uric acid in women, but not in men. Conclusions: The potential effect of uric acid on LV hypertrophy is more pronounced in female than in males with essential hypertension.

McCarthy DE, Piasecki TM, Fiore MC (Aug 2006). Life Before and After Quitting Smoking: An Electronic Diary Study. Journal of Abnormal Psychology, 115(3):454-466.

This article describes a multidimensional, multivariate, and multilevel approach to the assessment of nicotine withdrawal. In this prospective study, 70 adult smokers assigned to an active or placebo nicotine patch condition completed multiple daily assessments using an electronic diary. Average and individual growth curves were estimated for affective and nonaffective withdrawal symptoms. All symptoms but hunger increased significantly on the quit day and remained elevated for three weeks. Variability in symptom experiences across individuals increased from pre- to post-quit. Relations between symptom reports (e.g., negative affect or craving) and episodic events (e.g., stressful events or seeing someone smoke) changed from pre-quit to post-quit. Pre-quit increases in negative affect and quit-day increases in craving were inversely related to abstinence three months after the quit day, suggesting that anticipatory and immediate reactions to quitting influence success.

McKibbin CL, Patterson TL, Norman G (Sep 2006). A lifestyle intervention for older schizophrenia patients with diabetes mellitus: A randomized controlled trial. Schizophrenia Research, 86(1-3):36-44.

Purpose: We tested the feasibility and preliminary efficacy of a lifestyle intervention for middle-aged and older patients with schizophrenia and type-2 diabetes mellitus, using a randomized pre-test, post-test control group design. Method: Individuals with a diagnosis of schizophrenia or schizoaffective disorder over the age of 40 were randomly assigned to 24-week Diabetes Awareness and Rehabilitation Training (DART; n = 32) groups or Usual Care plus Information (UCI; n = 32) comparison groups. Participants were recruited from board-and-care facilities and day treatment programs. Fifty-seven patients completed baseline and 6-month assessments consisting of an interview, measures of body mass index, blood pressure, fasting blood chemistry, and accelerometry. A mixed-model analysis of variance was used to analyze the data. Results: A significant group × time interaction was found for body weight, with patients in the DART group losing a mean of 5 lb and those in the UCI gaining a mean 6 lb. Significant group × time interactions were also found for triglycerides, diabetes knowledge, diabetes self-efficacy, and self-reported physical activity, but not for fasting plasma glucose or glycosylated hemoglobin. Conclusions: Group-based lifestyle interventions are feasible and produce positive health changes in middle-aged and older patients with schizophrenia and diabetes mellitus.

Newton JL, Gibson GJ, Tomlinson M, Wilton K, Jones D (Jul 2006). Fatigue in primary biliary cirrhosis is associated with excessive daytime somnolence. Hepatology, 44(1):91-8.

A significant proportion of patients with primary biliary cirrhosis (PBC) suffer from severe fatigue. The aim of this study was to characterize patterns of daytime sleep in patients with PBC (using both objective and subjective assessment approaches) and to study the association between sleep abnormality and fatigue severity. Fatigue severity was assessed in 48 female subjects with PBC (using a disease-specific quality of life instrument (the PBC-40) and a generic fatigue measure (Fatigue Impact Scale [FIS]) as well as 48 case-matched normal controls. All participants also completed the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS, which assesses daytime hypersomnolence). Objective sleep assessment was performed using accelerometry over 7 days. Global sleep quality assessed by the PSQI was significantly lower in the PBC group compared to controls (P < .0001). ESS scores were significantly higher in patients with PBC than controls (P = .0001), suggesting significantly greater daytime somnolence in the patients with PBC. Objective sleep assessment confirmed that subjects with PBC were sleeping on average almost twice as long as controls during the daytime. Both degree of daytime somnolence (ESS) and actual daytime sleep activity (accelerometry) correlated strongly with fatigue severity in the patient group (r2 = 0.5, P < .0001 and r2 = 0.2, P < .01, respectively). In conclusion, Sleep abnormality, in the form of excessive daytime somnolence, is present in a significant proportion of patients with PBC, with the degree of daytime somnolence correlating strongly with the degree of fatigue. Existing agents effective at reducing daytime somnolence (such as modafinil) hold potential for the treatment of fatigue in PBC.

Palmas W, Moran A, Pickering T, Eimicke JP, Teresi J, Schwartz JE, Field L, Weinstock RS, Shea S (Aug 2006). Ambulatory pulse pressure and progression of urinary albumin excretion in older patients with type 2 diabetes mellitus. Hypertension; 48(2):301-8.

We studied whether ambulatory blood pressure monitoring added to office blood pressure in predicting progression of urine albumin excretion over 2 years of follow-up in a multiethnic cohort of older people with type-2 diabetes mellitus. Participants in the Informatics for Diabetes Education and Telemedicine study underwent a baseline evaluation that included office and 24-hour ambulatory blood pressure measurement and a spot urine measurement of albumin-to-creatinine ratio (ACR). Measurements of albumin-to-creatinine ratio were repeated 1 and 2 years later. In bivariate analyses, ambulatory 24-hour pulse pressure was the blood pressure variable most strongly associated with follow-up ACR. Repeated-measures mixed linear models (n = 1040) were built adjusting for baseline ACR ratio, clustered randomization, time to follow-up, and multiple covariates. When both were entered into the model, ambulatory 24-hour pulse pressure and office pulse pressure were independently associated with follow-up ACR (beta [SE] = 0.010 [0.002], P < 0.001, and 0.004 [0.001], P = 0.002, respectively). Cox proportional hazards models examined associations with progression of albuminuria in 954 participants without macroalbuminuria at baseline, adjusting for all of the covariates independently associated with follow-up ACR in mixed linear models. Ambulatory 24-hour pulse pressure, but not office pulse pressure, was independently associated with progression of albuminuria (P = 0.015 and 0.052, respectively). The adjusted hazards ratio (95% CI) per each 10-mm Hg increment in ambulatory pulse pressure was 1.23 (1.04 to 1.42). In conclusion, ambulatory pulse pressure may provide additional information to predict progression of albuminuria in elderly diabetic subjects above and beyond office blood pressure.

Parry MJ, McFetridge-Durdle J (Jul-Aug 2006). Ambulatory impedance cardiography: a systematic review. Nurs Res., 55(4):283-91.

Background: Standard noninvasive impedance cardiography has been used to examine the cardiovascular responses of individuals to a wide range of stimuli in critical care and laboratory settings. It has been shown to be a reliable alternative to invasive thermodilution techniques and an acceptable alternative to the use of a pulmonary artery catheter. Ambulatory impedance cardiography provides a similar assessment of cardiac function to standard noninvasive impedance cardiography, but it does so while individuals engage in activities of daily living. It offers portability and the option of managing complex patients in outpatient settings. Objective: To critically examine through a literature analysis the validity, reliability, and sensitivity of ambulatory impedance cardiography for the assessment of cardiac performance during activities of daily living. ;Methods: The Cochrane Database of Systematic Reviews (CDSR), The Cochrane Database of Methodology Reviews (CDMR), The Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA), and The Cochrane Methodology Register (CMR; 1966-2005); MEDLINE (1950-2005); and CINAHL (1982-2005) were searched using the following terms: ambulatory cardiac performance, impedance cardiac performance, AIM cardiac performance monitor, thoracic electrical bio-impedance, impedance cardiography, ambulatory impedance monitor, bio-impedance technology, ambulatory impedance cardiography, bio-electric impedance; also included were reference lists of retrieved articles. Studies were selected if they used an ambulatory impedance monitor to examine one or more of the following cardiovascular responses: pre-ejection period (PEP), left ventricular ejection time (LVET), stroke volume (SV), or a combination of these. Results: Studies have been predominantly descriptive and have been focused on a young, male population with a normal body mass index (BMI; 25-29 kg/m). Inconsistencies in determining specific markers of cardiac function (e.g., PEP and SV) across studies necessitated that results be reported by outcome for each study separately. Discussion: Ambulatory impedance monitors are valid and reliable instruments used for the physiologic measurement of cardiac performance. Sensitivity is established utilizing within-individual measurements of relative change. This is especially important in light of an aging population and technical advances in healthcare. Further research is warranted using nursing interventions that focus on an older, female population who have a BMI greater than 30 kg/m. Availability of noninvasive ambulatory measures of cardiac function has the potential to improve care for a variety of patient populations, including those with hypertension, heart failure, pain, anxiety, and depressive symptoms.

Peeters F, Berkhof J, Delespaul P (Aug 2006). Diurnal Mood Variation in Major Depressive Disorder. Emotion, 6(3):383-391.

Depression disturbs mood, but a clear picture of diurnal mood rhythms in depression has yet to emerge. This study examined variations in positive affect (PA) and negative affect (NA), two dimensions of mood that generate diurnal patterns among healthy individuals. Repeated measurements of NA and PA in daily life were obtained over 6 days from 47 depressed outpatients and 39 healthy individuals using the Experience Sampling Method. Relative to healthy individuals, depressed individuals exhibited increasing PA levels during the day with a later acrophase. In contrast, depressed persons’ NA exhibited a more pronounced diurnal rhythm and was more variable from moment to moment than healthy individuals’. Ambulatory mood measurements in depression suggest distinct diurnal disturbances of positive and negative affect.

Rittig S, Matthiesen TB, Pedersen EB, Djurhuus JC (Aug 2006). Circadian variation of angiotensin II and aldosterone in nocturnal enuresis: relationship to arterial blood pressure and urine output. J Urol., 176(2):774-80.

Purpose: We investigated the circadian rhythm of solute excretion and regulating hormones as well as blood pressure in patients with monosymptomatic nocturnal enuresis. Materials and Methods: We included 15 patients with a mean age +/- SE of 13.4 +/- 0.9 years who had monosymptomatic nocturnal enuresis with at least 3 wet nights weekly and a control group of 10 healthy children with a similar age and sex distribution. During inpatient circadian studies urine was collected during 6 periods and blood was drawn at 7 time points during 24 hours. Heart rate and blood pressure was recorded with an ambulatory blood pressure monitor every 30 to 60 minutes. RESULTS: The total patient group excreted a significantly larger nocturnal urine volume than controls (p <0.01). Five patients had marked nocturnal polyuria (nocturnal urine volume greater than the mean in the control group +2 SD), whereas urine output in the remaining patients without polyuria were similar to controls. Nocturnal polyuria was caused mainly by increased nocturnal solute excretion, especially Na. Serum aldosterone and plasma angiotensin II showed a marked circadian rhythm in normal children with a nocturnal increase concomitant with a significant decrease in mean arterial blood pressure during sleep. In contrast, the group of patients with nocturnal polyuria showed a lack of circadian rhythm in all excretion variables as well as an attenuated rhythm in plasma angiotensin II and mean arterial blood pressure. Interestingly this group had normal circadian rhythms of the circadian rhythm markers plasma cortisol and heart rate. Conclusions: The study suggests that an abnormally large nocturnal excretion of Na caused by selectively attenuated circadian rhythms of Na regulating hormones might be an important pathogenic factor in monosymptomatic nocturnal enuresis.

Ruiz JR, Rizzo NS, Hurtig-Wennlof A, Ortega FB, Warnberg J, Sjostrom M (Aug 2006). Relations of total physical activity and intensity to fitness and fatness in children: the European Youth Heart Study. Am J Clin Nutr., 84(2):299-303.

Background: It is unclear how the amount and intensity of physical activity (PA) are associated with cardiovascular fitness (CVF) and body fatness in children. Objektive: We aimed to examine the associations of total PA and intensity levels to CVF and fatness in children. Design: A cross-sectional study of 780 children aged 9-10 y from Sweden and Estonia was conducted. PA was measured by accelerometry and was expressed as min/d of total PA, moderate PA, and vigorous PA. CVF was measured with a maximal ergometer bike test and was expressed as W/kg. Body fat was derived from the sum of 5 skinfold-thickness measurements. Multiple regression analysis was used to determine the degree to which variance in CVF and body fat was explained by PA, after control for age, sex, and study location. Results: Lower body fat was significantly associated with higher levels of vigorous PA, but not with moderate or total PA. Those children who engaged in >40 min vigorous PA/d had lower body fat than did those who engaged in 10-18 min vigorous PA/d. Total PA, moderate PA, and vigorous PA were positively associated with CVF. Those children who engaged in >40 min vigorous PA/d had higher CVF than did those who accumulated <18 min vigorous PA/d. Conclusions: The results suggest that PA of vigorous intensity may have a greater effect on preventing obesity in children than does PA of lower intensity, whereas both total and at least moderate to vigorous PA may improve children’s CVF.

Schasfoort FC, Bussmann JB, Martens WL & Stam HJ (Aug 2006). Objective measurement of upper limb activity and mobility during everyday behavior using ambulatory accelerometry: the upper limb activity monitor. Behav Res Methods; 38(3):439-46.

Ambulatory accelerometry is a technique that allows objective measurement of aspects of everyday human behavior. The aim of our research has been to develop, validate, and apply this technique, which recently resulted in an upper limb activity monitor (ULAM). The ULAM consists of body-mounted acceleration sensors connected to a waist-worn data recorder and allows valid and objective assessment of activity of both upper limbs during performance of also automatically detected mobility-related activities: lying, sitting, standing, walking, cycling, and general movement. The ULAM can be used to determine (limitations of) upper limb activity and mobility in freely moving subjects with upper limb disorders. This article provides a detailed description of its characteristics, summarizes the results of a feasibility study and four application studies in subjects having upper limb complex regional pain syndrome, discusses the most important practical, technical, and methodological issues that were encountered, and describes current and future research projects related to measuring (limitations of) upper limb activity.

Schomer DL (Aug 2006). Ambulatory EEG telemetry: how good is it?. J Clin Neurophysiol., 23(4):294-305.

When someone asks the question, how good is ambulatory EEG telemetry, there is no correct answer. There are many manufacturers of ambulatory EEG technology. Each device has its own strengths and weaknesses. What one is really interested in when one asks such a question needs to be defined in terms of expectations and technical capabilities for the piece of equipment under discussion. Systems exist or can be easily modified to be as sophisticated as the best of the inpatient units. However, is that level of sophistication needed for the ambulatory based recordings? Again, the answer to that is dependent on the ordering physician’s expectations. Below is a discussion of the different clinical expectations that are frequently encountered and the needed requirements for an ambulatory system to properly address them.

Sharpe J, Stedman TJ, Byrne NM (Jul 2006). Letter to the Editors: Accelerometry is a valid measure of physical inactivity but not of energy expended on physical activity in people with schizophrenia. Schizophrenia Research, 85(1-3):300-301.

The relationship between physical inactivity and weight gain, obesity and related co-morbid conditions such as cardiovascular disease and diabetes is well established. People with schizophrenia have high rates of physical inactivity, obesity, cardiovascular disease and diabetes. The RT3 was used as a measure of physical activity in people with schizophrenia and it is a poor measure of activity energy expenditure in this sedentary group of men with schizophrenia. There was a tendency for the RT3 to overestimate the amount of energy expended on physical activity and the limits of agreement between the actual physical activity and that estimated by the RT3 for each individual were wide. However, the RT3 appears to be a valid measure of inactivity and therefore could be used for research or clinical purposes to quantify the contribution of sedentary behavior to weight gain or medical conditions associated with inactivity such as cardiovascular disease and diabetes. Further, the effectiveness of interventions to reduce sedentary behavior could be objectively monitored by the RT3.

Shiffman S, Paty J (Aug 2006). Smoking Patterns and Dependence: Contrasting Chippers and Heavy Smokers. Journal of Abnormal Psychology, 115(3):509-523.

The authors used ecological momentary assessment to contrast smoking patterns among chippers (CHs; n = 26)-smokers who smoke despite an apparent absence of tobacco dependence-with those seen in heavy smokers (HSs; n = 28). Smoking and nonsmoking settings (activity, mood, etc.) were assessed by means of electronic diary. CHs were not social smokers; like HSs, they smoked half their cigarettes while alone. When smoking, CHs’ urge levels equaled those of HSs; between cigarettes, CHs had few urges, whereas HSs reported moderate urges. CHs’ smoking was particularly associated with indulgent activities: relaxation, socializing, eating, and drinking alcohol. Outside of these indulgent settings, CHs’ (but not HSs’) smoking was associated with negative affect. In idiographic analyses, CHs’ smoking was under much stronger stimulus control than was that of HSs. The authors propose that the disappearance of stimulus control over use is a characteristic of dependence.

Tate DF, Jackvony EH, Wing RR (Aug 2006). A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med., 14-28;166(15):1620-5.

Background: Several studies have shown that e-mail counseling improves weight loss achieved in self-directed Internet programs. Computer-tailored feedback offers a population-based alternative to human e-mail counseling. Methods: One hundred ninety-two adults, aged 49.2 +/- 9.8 years, having a body mass index (calculated as weight in kilograms divided by height in meters squared) of 32.7 +/- 3.5, were randomized to 1 of 3 Internet treatment groups: No counseling, computer-automated feedback, or human e-mail counseling. All participants received 1 weight loss group session, coupons for meal replacements, and access to an interactive Web site. The human e-mail counseling and computer-automated feedback groups also had access to an electronic diary and message board. The human e-mail counseling group received weekly e-mail feedback from a counselor, and the computer-automated feedback group received automated, tailored messages. RESULTS: Retention was 82% at 3 months and 80% at 6 months for all 3 groups. At 3 months, completers in both the computer-automated feedback (-5.3 +/- 4.2 kg) and human e-mail counseling (-6.1 +/- 3.9 kg) groups had significantly greater weight losses compared with the no counseling group (-2.8 +/- 3.5 kg) and these groups did not differ from each other. At 6 months, weight losses were significantly greater in the human e-mail counseling group (-7.3 +/- 6.2 kg) than in the computer-automated feedback (-4.9 +/- 5.9 kg) or no counseling (-2.6 +/- 5.7 kg) groups. Intent-to-treat analyses using single or multiple imputation techniques showed the same pattern of significance. Conclusions: Providing automated computer-tailored feedback in an Internet weight loss program was as effective as human e-mail counseling at 3 months. Further research is needed to improve the efficacy of automated computer-tailored feedback as a population-based weight loss approach.

Tong EMW, Bishop GD, Enkelmann HC (Aug 2006). The role of the Big Five in appraisals. Personality and Individual Differences, 41(3):513-523.

Using Hierarchical Linear Modelling, this study examined individual differences in appraisal styles. Data were collected using Ecological Momentary Assessment from police officers in Singapore who participated while on their work-routines. Average levels of 11 appraisals showed significant individual-difference variability. The Big Five personality traits were examined for whether they accounted for these individual difference variations. Only Neuroticism and Conscientiousness significantly explained individual-difference variability in appraisals. Also, replicating past studies, all Big Five traits except for Openness correlated significantly with daily emotions.

Tropeano AI, Boutouyrie P, Pannier B, Joannides R, Balkestein E, Katsahian S, Laloux B, Thuillez C, Struijker-Boudier H, Laurent S (Jul 2006). Brachial pressure-independent reduction in carotid stiffness after long-term angiotensin-converting enzyme inhibition in diabetic hypertensives. Hypertension, 48(1):80-6.

Hypertension and diabetes are associated with an increased arterial stiffness. A direct blood pressure-independent effect of angiotensin-converting enzyme inhibitors on arterial stiffness has never been unequivocally demonstrated. In this mechanistic study, we used an experimental design in which patients responding to 1 month treatment with 4 mg perindopril were randomized double-blind to either 4 mg perindopril or 8 mg perindopril for 6 months. We determined carotid distensibility with echotracking and applanation tonometry at baseline and after the 7-month treatment period in 57 essential hypertensive patients with type 2 diabetes (age 63+/-7 years). We monitored ambulatory blood pressure at baseline and after treatment. After 7 months treatment, 24-hour ambulatory blood pressure significantly decreased, with no significant difference between 4 mg and 8 mg perindopril. Carotid distensibility increased more after 8 mg perindopril compared with 4 mg perindopril (8 mg: from 13.1+/-5.9 to 16.0+/-6.7 kPa(-1)x10(-3); 4 mg: from 13.2+/-5.2 to 12.7+/-5.9 kPa(-1)x10(-3); ANOVA, dose-period interaction, P<0.05). Carotid internal diameter and elastic modulus were significantly lower after 8 mg perindopril compared with 4 mg perindopril, independent of blood pressure reduction. These results indicate a dose-dependent and blood pressure-independent reduction in carotid stiffness under chronic treatment with an angiotensin-converting enzyme inhibitor. They suggest that arterial distensibility was increased through an inward remodeling, leading to a reduction in wall stress, thus reducing elastic modulus. They also suggest that long-term administration of high doses (8 mg) of perindopril is required to improve carotid structure and function in hypertensive patients with type 2 diabetes.

Uen S, Un I, Fimmers R, Vetter H, Mengden T (Aug 2006). Myocardial ischemia during everyday life in patients with arterial hypertension: prevalence, risk factors, triggering mechanism and circadian variability. Blood Press Monit., 11(4):173-82.

Introduction: The objective of the present study was to investigate the prevalence, the risk factors, the hemodynamic triggering mechanisms, the circadian variability of ST segment depression (ST depression) and the effect of day and night fall in blood pressure on the prevalence of ST depression in hypertensive patients. Materials and methods: In a multicentric study in Germany, 1,244 CardioTens registrations (combined 24-h ambulatory blood pressure measurement/electrocardiography with ST segment triggering; Meditech, Budapest, Hungary) from patients with arterial hypertension were consecutively monitored and evaluated centrally at the University of Bonn. Inclusion criterion was treated or untreated arterial hypertension. The ST segment was measured in accordance with the “1 : 1 : 1 rule” (horizontal or descending ST depression by 1 mm, 1 min duration, 1 min interval from the previous episode). Results: ST segment depression was observed in 250 (20.1%) patients; 90.3% of the transient ST-segment depression was silent (without angina pectoris). Ambulatory 24-h blood pressure measurement, but not office-based blood pressure measurement, was predictive for the occurrence of ST-segment depression. Risk factors for ST-segment depression were the Sokolow index > or =3.5 mV, smoking status, severity of coronary heart disease, use of diuretics, reduced left ventricular function, pulse pressure > or =60 mmHg and increase of double product (1,000 mmHg/min). A significant rise of the systolic/diastolic blood pressure (+8+ or -18/+7+ or -10 mmHg), of the heart rate (+12+ or -13/min) and of the double product (+2,471+ or -2,517 mmHg/min) was found during the transient ST depression as compared with the corresponding 24-h ambulatory blood pressure measurement mean values (P<0.0001 for all parameters specified). In most intermittent ST depressions, a rise of the double product was seen (n=789 episodes), and in the remaining 239 ST depressions, a fall of the double product was observed. ST depressions with fall of the double product showed a circadian distribution with a peak in the late evening. ST depression accompanied by a rise in double product showed two peaks (one in the early morning and one in the late evening). The prevalence of ST depression was significantly higher (28.6%) in extreme dippers than in dippers (18.2%), risers (21.8%) and non-dippers (19.6%). Conclusions: ST depressions have a high prevalence of 20.1% in hypertensive patients. Clinical predictors for the occurrence of ST-segment depression were classical risk factors and cardiac target organ damage. Office-based blood pressure measurement was not a useful measuring tool for forecasting the likelihood of ST-segment depression. ST depressions were triggered inter alia by variations of blood pressure and the heart rate. The circadian variability of the ST depressions is crucially affected by the pressure double product characteristics on which the ST depression is based.

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