Society for Ambulatory Assessment

Third quarter 2008 (July to September)

Anderson DE, McNeely JD, Chesney MA, Windham BG. (Sep 2008). Breathing Variability at Rest is Positively Associated With 24-h Blood Pressure Level. Am J Hypertens. Epub ahead of print.

BackgroundPrevious research has reported that inhibition of breathing can be observed in hypertensive patients at rest during the daytime, as well as in sleep at night. The present study hypothesized that the variability of breathing and end-tidal CO(2) (PetCO(2)) in seated women at rest is positively associated with their 24-h blood pressure level.MethodsBreath-to-breath measures of breathing rate and tidal volume were recorded via inductive plethysmography in each of 54 women during two 20-min sessions of seated rest, and in 32 women during night time sleep. PetCO(2) was also recorded during these sessions via a respiratory gas monitor. Ambulatory blood pressure was recorded for 24 h between the two clinic sessions via oscillometry.ResultsBreath pauses >10 s were observed significantly more often in women in the upper than the lower tertile of 24-h systolic blood pressure. Breath-to-breath variability in breathing rate, tidal volume, and minute ventilation were greater in the higher blood pressure tertile women. Variability in PetCO(2) was also greater in high blood pressure tertile. These associations were independent of age, weight, and body surface area (BSA). Breathing variability was inversely correlated with heart rate variability (HRV).ConclusionGreater variability in breathing at rest that is independent of metabolic activity characterizes women with elevated blood pressure. The linear association of breathing variability with 24-h blood pressure level is consistent with the hypothesis that intermittent breathing inhibition may predispose to the development of some forms of hypertension.

Arioz DT, Saglam H, Demirel R, Koken G, Cosar E, Sahin FK, Dursun H, Aral I, Onrat E, Yilmazer M. (Sep 2008). Arterial stiffness and dipper/nondipper blood pressure status in women with preeclampsia. Adv Ther, 25(9), 925-34.

INTRODUCTION: The aim of this study was to investigate the clinical relevance of dipper status in women with preeclampsia by comparing arterial stiffness index (SI) values, and dipper and nondipper status. METHODS: A total of 60 pregnant women in their third trimester were enrolled in the study. SI values were measured using a digital photoplethysmographic method (Pulse Trace System, Micro Medical Ltd., Gillingham, Kent, UK). Twenty-four-hour ambulatory blood pressure was measured by a SpaceLabs 90217 oscillometric device (SpaceLabs Inc., Redmond, WA, USA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were recorded. Those preeclamptic women whose mean nighttime blood pressure measurements were at least 10% lower compared with mean daytime measurements were classified as dipper status, and those with a decrease of less than 10% were classified as nondipper status. RESULTS: Seventeen women were preeclamptic with a dipper status, 13 women had nondipper status preeclampsia, and 30 women were normotensive. SI values were significantly higher in preeclamptic women compared with normotensive women (8.8+/-1.2 m/s vs. 5.9+/-0.8 m/s, P<0.001), but SI values of preeclamptic women with dipper status and preeclamptic women with nondipper status did not differ significantly from each other (P=0.485). CONCLUSION: There was no significant difference in SI values between the dipper and nondipper preeclamptic groups. These results indicate that dipper and nondipper measurements may not be suitable for clinical follow-up of preeclamptic women.

Arora VM, Georgitis E, Siddique J, Vekhter B, Woodruff JN, Humphrey HJ, Meltzer DO. (Sep 2008). Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities. JAMA, 300(10), 1146-53.

CONTEXT: Further restrictions in resident duty hours are being considered, and it is important to understand the association between workload, sleep loss, shift duration, and the educational time of on-call medical interns. OBJECTIVE: To assess whether increased on-call intern workload, as measured by the number of new admissions on-call and the number of previously admitted patients remaining on the service, was associated with reductions in on-call sleep, increased total shift duration, and lower likelihood of participation in educational activities. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of medical interns at a single US academic medical center from July 1, 2003, through June 24, 2005. Of the 81 interns, 56 participated (69%), for a total of 165 general medicine inpatient months resulting in 1100 call nights. MAIN OUTCOME MEASURES: On-call sleep duration, estimated by wrist watch actigraphy; total shift duration, measured from paging logs; and participation in educational activities (didactic lectures or bedside teaching), measured by experience sampling method via a personal digital assistant. RESULTS: Mean (SD) sleep duration on-call was 2.8 (1.5) hours and mean (SD) shift duration was 29.9 (1.7) hours. Interns reported spending 11% of their time in educational activities. Early in the academic year (July to October), each new on-call admission was associated with less sleep (-10.5 minutes [95% confidence interval {CI}, -16.8 to -4.2 minutes]; P < .001) and a longer shift duration (13.2 minutes [95% CI, 3.2-23.3 minutes]; P = .01). A higher number of previously admitted patients remaining on the service was associated with a lower odds of participation in educational activities (odds ratio, 0.82 [95% CI, 0.70-0.96]; P = .01]. Call nights during the week and early in the academic year were associated with the most sleep loss and longest shift durations. CONCLUSION: In this study population, increased on-call workload was associated with more sleep loss, longer shift duration, and a lower likelihood of participation in educational activities.

Barnes DE, Blackwell T, Stone KL, Goldman SE, Hillier T, Yaffe K; for the Study of Osteoporotic Fractures. (Jul 2008). Cognition in Older Women: The Importance of Daytime Movement. J Am Geriatr Soc. Epub ahead of print.

OBJECTIVES: To determine whether an objective measure of daytime movement is associated with better cognitive function in women in their 80s. DESIGN: Cross-sectional. SETTING: A study of health and aging. PARTICIPANTS: Two thousand seven hundred thirty-six older women without evidence of dementia. MEASUREMENTS: Daytime movement was assessed using actigraphy, which involved wearing a watch-like device that objectively quantified accelerometer motion over a mean of 3.0+/-0.8 days. Cognitive function was measured using the Trail-Making Test, Part B (Trails B) and the Mini-Mental State Examination (MMSE). Cognitive impairment was defined as performing 1.5 standard deviations (SDs) worse than the mean on a given test. RESULTS: Participants had a mean age of 83+/-4; 10% were African American. After adjustment for age, race, and education, women in the highest movement quartiles had better mean cognitive test scores (20+/-0.3 seconds faster on Trails B and 0.3+/-0.2 points higher on MMSE, both P<.001) than those in the lowest quartile and were less likely to be cognitively impaired (odds ratio (OR)=0.61, 95% confidence interval (CI)=0.41-0.92 for Trails B; OR=0.68, 95% CI=0.44-1.07 for MMSE). Associations were similar in different subgroups and were independent of self-reported walking, medical comorbidities, physical function, and other health-related behaviors. CONCLUSION: Daytime movement as measured objectively using actigraphy was associated with better cognitive function and lower odds of cognitive impairment in women in their 80s. Additional studies are needed to clarify the direction of the association and to explore potential mechanisms.

Basterfield L, Adamson AJ, Parkinson KN, Maute U, Li PX, Reilly JJ. (Sep 2008). Surveillance of physical activity in the UK is flawed: validation of the Health Survey for England physical activity questionnaire. Arch Dis Child. Epub ahead of print.

OBJECTIVE: Public health surveillance of physical activity in children in the UK depends on a parent-reported physical activity questionnaire which has not been validated. We aimed to validate this questionnaire against measurement of physical activity using accelerometry in 6-7 year olds. METHODS: In 130, 6-7 year olds (64 boys; 66 girls) we estimated habitual moderate-vigorous intensity physical activity (MVPA) using the Health Survey for England parent-report questionnaire for physical activity. For the same time period and the same children we measured MVPA objectively using 7-day accelerometry with the Actigraph accelerometer. RESULTS: The questionnaire over-estimated MVPA significantly (paired t test, p<0.01). Mean error (bias) when using the questionnaire was 122 minutes/day (CI 124-169). Mean time spent in MVPA was 146 minutes/day (CI 124-169) using the questionnaire and 24 minutes/day (CI 22-26) using the accelerometer. Rank order correlations between MVPA measured by accelerometer and estimated by the questionnaire were not statistically significant. CONCLUSIONS: Public health surveillance of physical activity should not rely on this questionnaire. Levels of habitual physical activity in children are likely to be substantially lower than those reported in UK Health Surveys.

Beckham JC, Flood AM, Dennis MF, Calhoun PS. (Aug 2008). Ambulatory Cardiovascular Activity and Hostility Ratings in Women with Chronic Posttraumatic Stress Disorder. Biol Psychiatry. Epub ahead of print.

BACKGROUND: The objective of the current study is to evaluate the relationship between hostility and ambulatory cardiovascular activity in women with and without posttraumatic stress disorder (PTSD). METHODS: One hundred and one women completed 24 hours of ambulatory monitoring and standardized diagnostic and hostility measures. Generalized estimating equations analysis was used to examine the effects of group and hostility factor scores (hostile beliefs, overt hostility, and covert hostility) on ambulatory heart rate (AHR) and ambulatory systolic (ASBP) and diastolic (ADBP) blood pressure. RESULTS: After controlling for covariates, there was an interaction between PTSD and both hostile beliefs and overt hostility for AHR. Increases in hostility were associated with greater increases in heart rate among women with PTSD relative to those without PTSD. There was a similar interaction between hostile beliefs and group for ADBP. CONCLUSIONS: Increased AHR and blood pressure have been linked to poor cardiovascular outcomes in nonpsychiatric populations. Individuals with PTSD display increased hostility, a construct that has also been linked to poorer cardiovascular outcomes. Increases in hostile beliefs were associated with a greater increase in ADBP among women with PTSD as compared with control subjects. These data suggest that PTSD might in part moderate the relationship between hostility and cardiovascular outcomes.

Berger AM, Wielgus KK, Young-McCaughan S, Fischer P, Farr L, Lee KA. (Aug 2008). Methodological challenges when using actigraphy in research. J Pain Symptom Manage, 36(2), 191-9.

Actigraphy has become a valuable clinical and research tool to objectively evaluate sleep, daytime activity, and circadian activity rhythms in healthy individuals as well as persons with primary and comorbid insomnia. However, procedures used for sampling, data processing, and analysis are not consistently reported in the literature. The wide variability in how actigraphy is reported makes it difficult to compare findings across studies. The procedures and reporting methods from 21 studies that used actigraphs to assess sleep and wake in adult patients with cancer are reviewed to highlight the differences in reporting strategies. Patients with cancer were chosen to illustrate the methodological challenges related to procedures and reporting in one population. The aim of this article was to advance standards of information presented in publications to enable comparisons across research studies that use actigraphy. Specific methodological challenges when using actigraphy in research include instrumentation, selection of pertinent variables, sampling, and data processing and analysis. Procedural decisions are outlined and discussed, and suggestions are made for standardized actigraphy information to include in research reports. More consistent procedures and reporting will advance the science of sleep, daytime activity, and circadian activity rhythms and their association with other health-related variables.

Bhattacharyya, Mimi R.; Molloy, Gerard J.; Steptoe, Andrew (Aug 2008). Depression is associated with flatter cortisol rhythms in patients with coronary artery disease. Journal of Psychosomatic Research, Vol 65(2), 107-113.

Objective: Depression is associated with coronary heart disease, but the underlying mechanisms are not fully understood. Cortisol is involved in the development of coronary artery disease (CAD), but evidence directly linking depression with cortisol in patients with CAD is limited. This study evaluated cortisol output over the day in patients with suspected CAD in relation to depressive symptoms. Methods: Eighty-eight patients who were being investigated for suspected CAD (defined by clinical symptoms plus positive exercise tests or myocardial perfusion scans) took eight saliva samples over the day and evening. Depressed mood was assessed with the Beck Depression Inventory. Actigraphy was used to define time of waking objectively. Results: The cortisol awakening response and cortisol rhythm over the remainder of the day and evening were analyzed separately. Fifty-two (61.9%) patients were later found to have definite CAD on angiography, while the remainder did not. The cortisol slope over the day was flatter in more depressed patients with CAD (P<.001) but was not related to depression in patients without CAD (P=.68). This effect was due to the combination of lower cortisol early in the day and higher cortisol in the evening in more depressed CAD patients, independent of age, gender, medication, and times of waking and sleeping (P=.003). Additionally, cortisol measured on waking and 15 and 30 min after waking was greater in CAD than in non-CAD patients (P=.04), but was not related to depression. Conclusions: The flatter cortisol rhythms of more depressed CAD patients may contribute to the progression of coronary atherosclerosis.

Bohnert, Amy M.; Richards, Maryse H.; Kolmodin, Karen E.; Lakin, Brittany L. (Sep 2008). Young urban African American adolescents’ experience of discretionary time activities. Journal of Research on Adolescence, Vol 18(3), 517-539.

This cross-sectional study examined the daily discretionary time experiences of 246 (107 boys, 139 girls) fifth through eighth grade urban African American adolescents using the Experience Sampling Method. Relations between the types of activities (i.e., active structured, active unstructured, passive unstructured) engaged in during discretionary time and self-reported levels of motivated engagement, positive affect, confidence, and perceived alienation were explored. Results indicated that active structured activities occupied a small but important amount of young adolescents’ discretionary time. Adolescents experienced the highest mean levels of motivated engagement and confidence, and the lowest mean levels of alienation when involved in these types of activities. Higher levels of positive affect were associated with participation in active as opposed to passive activities. Findings suggest that urban African American young adolescents experience more positive emotional states when they are involved in active, structured activities.

Broderick JE, Schwartz JE, Vikingstad G, Pribbernow M, Grossman S, Stone AA. (Sep 2008). The accuracy of pain and fatigue items across different reporting periods. Pain, 139(1), 146-57.

The length of the reporting period specified for items assessing pain and fatigue varies among instruments. How the length of recall impacts the accuracy of symptom reporting is largely unknown. This study investigated the accuracy of ratings for reporting periods ranging from 1 day to 28 days for several items from widely used pain and fatigue measures (SF36v2, Brief Pain Inventory, McGill Pain Questionnaire, Brief Fatigue Inventory). Patients from a community rheumatology practice (N=83) completed momentary pain and fatigue items on average of 5.4 times per day for a month using an electronic diary. Averaged momentary ratings formed the basis for comparison with recall ratings interspersed throughout the month referencing 1-day, 3-day, 7-day, and 28-day periods. As found in previous research, recall ratings were consistently inflated relative to averaged momentary ratings. Across most items, 1-day recall corresponded well to the averaged momentary assessments for the day. Several, but not all, items demonstrated substantial correlations across the different reporting periods. An additional 7 day-by-day recall task suggested that patients have increasing difficulty actually remembering symptom levels beyond the past several days. These data were collected while patients were receiving usual care and may not generalize to conditions where new interventions are being introduced and outcomes evaluated. Reporting periods can influence the accuracy of retrospective symptom reports and should be a consideration in study design.

Buchman AS, Wilson RS, Bennett DA. (Aug 2008). Total daily activity is associated with cognition in older persons. Am J Geriatr Psychiatry, 16(8), 697-701.

Objectives: The authors tested the hypothesis that total daily physical activity is related to the level of cognition in older persons. Design: Cross-sectional study. Setting: Retirement communities across the Chicago metropolitan area. Participants: Five hundred twenty-one older persons without dementia. Measurements: Participants underwent structured evaluation of cognition and objective measures of total daily physical activity were collected using actigraphy. Results: In a linear regression model adjusted for age, sex, and education, total daily activity was associated with a global measure of cognition. By contrast, self-report physical activity was not associated with cognition. Further analyses showed that total daily activity was related to all five cognitive subscales. Conclusions: Objective measures of total daily physical activity were associated with a broad range of cognitive abilities in older persons. These findings support the link between physical activity and cognition in the elderly.

Chantler I, Mitchell D, Fuller A. (Aug 2008). Actigraphy Quantifies Reduced Voluntary Physical Activity in Women With Primary Dysmenorrhea. J Pain. Epub ahead of print.

We assessed whether an activity data logger was able to detect and measure the reduced physical activity reported by women with moderate to severe primary dysmenorrhea. Twelve young women with a history of primary dysmenorrhea and 12 young women without a history of dysmenorrhea wore an activity data logger on their hip for 3 days when menstruating and for 3 matched days of the week when not menstruating. A visual analog scale was use to assess intensity of pain. When menstruating, the women with a history of primary dysmenorrhea, compared with when they were not menstruating, were significantly less active by about 40% on their day of worst pain (P < .001), day of intermediate pain (P < .001), and day of least pain (P < .001). There was no significant difference in the voluntary physical activity of the group on the 3 menstrual days. The women without a history of dysmenorrhea experienced mild menstrual pain but no significant decrease in physical activity (P = .82). We show that data loggers are able to detect and quantify the decrease in physical activity reported by the women with a history of moderate to severe dysmenorrhea and that menstrual pain but not menstruation itself was associated with decreased voluntary physical activity. PERSPECTIVE: We have shown that a miniature activity data logger, when worn on the hip of women with a history of dysmenorrhea, detected a 40% decrease in physical activity when the women were experiencing moderate to severe primary dysmenorrhea. Actigraphy is a useful tool for measuring pain-related debilitation and its management.

Coleman KJ, Rosenberg DE, Conway TL, Sallis JF, Saelens BE, Frank LD, Cain K. (Sep 2008). Physical activity, weight status, and neighborhood characteristics of dog walkers. Prev Med, 47(3), 309-12.

OBJECTIVE: This study examined how demographics, physical activity, weight status, and neighborhood characteristics varied among households with and without dogs. METHOD: Participants aged 20 to 65 years (n=2199, 52% male, 75% white, mean age=45) were recruited from 32 neighborhoods in the Seattle, WA and Baltimore, MD regions during 2002-2005. Dog ownership, dog walking, education, height, weight, and family income were self-reported. Minutes of moderate to vigorous physical activity (MVPA) were measured objectively by 7-day accelerometry. RESULTS: Dog walking was associated with a higher proportion of participants who met national recommendations for MVPA (53%) when compared to those who had but did not walk their dog (33%) and to non-dog owners (46%). There were significantly fewer obese dog walkers (17%) when compared to both owners who did not walk their dogs (28%) and non-owners (22%). Dog owners who walked their dogs were more likely to live in high-walkable neighborhoods when compared to dog owners who did not walk their dogs. CONCLUSION: Dog walking may promote physical activity and contribute to weight control. Dog walking appears to be a mechanism by which residents of high-walkable neighborhoods obtain their physical activity.

Compton, Rebecca J.; Robinson, Michael D.; Ode, Scott; Quandt, Lorna C.; Fineman, Stephanie L.; Carp, Joshua (Jul 2008). Error-monitoring ability predicts daily stress regulation. Psychological Science, Vol 19(7), 702-708.

This study examined whether individual differences in error-related self-regulation predict emotion regulation in daily life, as suggested by a common-systems view of cognitive and emotional self-regulation. Participants (N=47) completed a Stroop task, from which error-related brain potentials and behavioral measures of error correction were computed. Participants subsequently reported on daily stressors and anxiety over a 2-week period. As predicted by the common-systems view, a physiological marker of error monitoring and a behavioral measure of error correction predicted emotion regulation in daily life. Specifically, participants higher in cognitive control, as assessed neurally and behaviorally, were less reactive to stress in daily life. The results support the notion that cognitive control and emotion regulation depend on common or interacting systems.

Corder K, Ekelund U, Steele RM, Wareham NJ, Brage S. (Sep 2008). Assessment of physical activity in youth. J Appl Physiol, 105(3), 977-87.

Despite much progress with physical activity assessment, the limitations concerning the accurate measurement of physical activity are often amplified in young people due to the cognitive, physiological, and biomechanical changes that occur during natural growth as well as a more intermittent pattern of habitual physical activity in youth compared with adults. This mini-review describes and compares methods to assess habitual physical activity in youth and discusses main issues regarding the use and interpretation of data collected with these techniques. Self-report instruments and movement sensing are currently the most frequently used methods for the assessment of physical activity in epidemiological research; others include heart rate monitoring and multisensor systems. Habitual energy expenditure can be estimated from these input measures with varying degree of uncertainty. Nonlinear modeling techniques, using accelerometry perhaps in combination with physiological parameters like heart rate or temperature, have the greatest potential for increasing the prediction accuracy of habitual physical activity energy expenditure. Although multisensor systems may be more accurate, this must be balanced against feasibility, a balance that shifts with technological and scientific advances and should be considered at the beginning of every new study.

Eggermont LH, Scherder EJ. (Sep 2008). Ambulatory but sedentary: impact on cognition and the rest-activity rhythm in nursing home residents with dementia. J Gerontol B Psychol Sci Soc Sci, 63(5), 279-87.

Physical activity has been positively associated with cognition and the rest-activity rhythm. In the present study, nursing staff classified ambulatory nursing home residents with moderate dementia either as active (n=42) or as sedentary (n=34). We assessed the rest-activity rhythm by means of actigraphy, and we administered neuropsychological tests to assess cognitive functioning. Compared with the group that was considered sedentary, the group that was considered active had a significantly better rest-activity rhythm, indicating agreement between nursing staff classifications and data gathered by the actigraph. Cognitive function was related neither to active-sedentary classification nor to actigraph measures. Similar ambulatory nursing home residents with dementia may show considerable differences in their level of daily physical activity and in their rest-activity rhythm, but the precise relationship among all variables requires further investigation.

Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA. (Aug 2008). Prognostic significance of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease. Blood Press Monit. Epub ahead of print.

OBJECTIVE: To assess the prognostic significance of nighttime and daytime blood pressure (BP), their ratio and the nighttime dipping pattern for mortality and recurrent cardiovascular (CV) events in patients with CV disease at baseline. BACKGROUND: The prognostic value of ambulatory BP has not been reported in hypertensive patients with a history of CV disease. METHODS: We performed a meta-analysis on individual data of 302 patients with hypertension and CV disease from three prospective studies performed in Europe. RESULTS: Age of the patients averaged 69+/-9 years; 50% were men and 62% were under antihypertensive treatment at the time of ambulatory BP monitoring. Office, daytime and nighttime BP averaged 161+/-20/86+/-12, 144+/-16/83+/-11 and 132+/-18/72+/-12 mmHg. Total follow-up time amounted to 2049 patient - years. Multivariable Cox regression analysis revealed that nighttime BP, but not daytime BP significantly predicted CV mortality (P<=0.05) and major CV events (P<=0.01) after adjustment for office BP and other confounders. When both nighttime and daytime BP were entered into the models, the predictive power of nighttime BP remained significant (P<=0.05); daytime BP did not add prognostic precision to nighttime BP. The systolic nightday BP ratio predicted all outcomes, and outcome was significantly worse in reverse dippers and nondippers than in dippers, both before and after adjustment for 24-h BP (P<=0.05). CONCLUSION: Nighttime BP is the better predictor of death and recurrent CV events in hypertensive patients with a history of CV disease. The night-day BP ratio and the dipping pattern significantly predict outcome, even after adjustment for 24-h BP.

Frings, Lars; Wagner, Kathrin; Maiwald, Thomas; Carius, Astrid; Schinkel, Anika; Lehmann, Christiane; Schulze-Bonhage, Andreas (Aug 2008). Early detection of behavioral side effects of antiepileptic treatment using handheld computers. Epilepsy & Behavior, Vol 13(2), 402-406.

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

Gacek P, Conner TS, Tennen H, Kranzler HR, Covault J. (Sep 2008). Tryptophan hydroxylase 2 gene and alcohol use among college students. Addict Biol. 13(3-4), 440-8.

Genes that regulate serotonin activity are regarded as promising predictors of heavy alcohol use. Tryptophan hydroxylase (TPH2) plays an important role in serotonergic neurotransmission by serving as the rate-limiting enzyme for serotonin biosynthesis in the midbrain and serotonergic neurons. Despite the link between TPH2 and serotonergic function, TPH2′s role in the pathogenesis of alcohol-use disorders remains unclear. The goal of this study was to examine whether a variation in the TPH2 gene is associated with risky alcohol consumption. Specifically, this study examined whether the TPH2 G-703T polymorphism predicted alcohol consumption among college students. In two successive years, 351 undergraduates were asked to record their alcohol use each day for 30 days using an Internet-based electronic diary. Participants’ DNA was collected and polymerase chain reaction genotyping was performed. Results show that alcohol consumption was not associated with the TPH2 G-703T polymorphism alone, or the interaction of TPH2 with two other candidate polymorphisms (TPH1 C218A and the SLC6A4 tri-allelic 5-HTTLPR), or negative life events. In conclusion, this study supports recent null findings relating TPH2 to drinking outcomes. It also extends these findings by showing null interactions with the TPH1 C218A polymorphism, the SLC6A4 tri-allelic 5-HTTLPR polymorphism and environmental stressors in predicting sub-clinical alcohol use among Caucasian American young adults.

Garcia Ruiz PJ, Sanchez Bernardos V. (Juli 2008). Evaluation of ActiTrac (ambulatory activity monitor) in Parkinson’s Disease. J Neurol Sci, 270(1-2), 67-9.

At present, the evaluation of Parkinson’s Disease (PD) relies mainly on Unified Parkinson’s Disease Rating Scale (UPDRS). Other objective measures have been proposed, including functional studies, timed tests and ambulatory activity monitors (AAM). We carried out a prospective study to analyze the utility and correlation of the AAM: ActiTrac with UPDRS scores and timed tests in patients with PD. We studied 28 patients with idiopathic PD (age: 62 +/- 11 years; duration of illness: 7.7 +/- 4.4 years; clinical stage 2.3 +/- 0.39). Motor evaluation included UPDRS and five timed tests: Purdue Pegboard test and those proposed in CAPIT protocol, pronation-supination (PS), finger dexterity (FD), movement between two points (MTP) and walking test (WT). Clinical evaluation was performed in off condition, at 9 a.m., (12h off their medication). Finally, ActiTrac was placed on the wrist (more affected side) continuously for at least 72h. ActiTrac activity was correlated (Spearman) with total UPDRS (r: - 0.53, p < 0.005) and motor UPDRS (r:- 0.46, p: 0.01); UPDRS rigidity subscore (r:- 0.52, p < 0.01); UPDRS bradykinesia subscore (r:- 0.48; p:0.01); FD (r: - 0.47 p: 0.01), WT (r: - 0.49, p < 0.01) and Purdue test (r:0.54; p < 0.01). ActiTrac seems to be a reasonably accurate method to evaluate motor activity in PD.

Gasowski J, Li Y, Kuznetsova T, Richart T, Thijs L, Grodzicki T, Clarke R, Staessen JA. (Sep 2008). Is “usual” blood pressure a proxy for 24-h ambulatory blood pressure in predicting cardiovascular outcomes? Am J Hypertens, 21(9), 994-1000.

BACKGROUND: The 24-h ambulatory blood pressure (ABP) is a stronger predictor of cardiovascular disease than conventional blood pressure (CBP), but it remains unclear how it compares with “usual” blood pressure (UBP), estimated after CBP has been corrected for regression dilution bias (RDB). METHODS: We compared the associations of cardiovascular mortality (n = 50), cardiovascular events (n = 101), and cardiac events (n = 71) with systolic CBP, UBP, and ABP over 13 years of follow-up (median) in 1,167 randomly selected Belgians. We estimated the correction factor to compute UBP from CBP at the midpoint of follow-up (6.5 years) in 723 untreated individuals without cardiovascular disease. RESULTS: Cardiovascular disease increased across quartiles of systolic CBP, UBP, and ABP (P for trend < or =0.02). For each 10 mm Hg increment in systolic ABP, the multivariate-adjusted hazard ratios for cardiovascular mortality and for cardiovascular and cardiac events were 1.38, 1.27, and 1.33, respectively (P < 0.001 for all). For CBP, the corresponding hazard ratios were 1.10 (P = 0.21), 1.09 (P = 0.12), and 1.14 (P = 0.06); and for UBP, they were 1.18 (P = 0.21), 1.16 (P = 0.12), and 1.23 (P = 0.06), respectively. The risk function for cardiovascular disease in relation to ABP was significantly steeper than that for CBP, but not UBP. In Cox models, including CBP or UBP in the presence of ABP, only ABP predicted cardiovascular outcomes. CONCLUSIONS: Correcting CBP for RDB resulted in a steeper slope of events on blood pressure than observed for CBP. The association with UBP was not statistically significant and did not enhance the prediction of outcome to the level of ABP.

Graham, James M. (Sep 2008). Self-expansion and flow in couples’ momentary experiences: An experience sampling study. Journal of Personality and Social Psychology, Vol 95(3), 679-694.

The self-expansion model of close relationships posits that when couples engage in exciting and activating conjoint activities, they feel connected with their partners and more satisfied with their relationships. In the present study, the experience sampling method was used to examine the predictions of the self-expansion model in couples’ momentary experiences. In addition, the author generated several new hypotheses by integrating the self-expansion model with existing research on flow. Over the course of 1 week, 20 couples were signaled at quasi-random intervals to provide data on 1,265 unique experiences. The results suggest that the level of activation experienced during an activity was positively related to experience-level relationship quality. This relationship was consistent across free-time and nonfree-time contexts and was mediated by positive affect. Activation was not found to predict later affect unless the level of activation exceeded what was typical for the individual. Also examined was the influence of interpersonal context and activity type on self-expansion. The results support the self-expansion model and suggest that it could be considered under the broader umbrella of flow.

Hamilton, Nancy A.; Affleck, Glenn; Tennen, Howard; Karlson, Cynthia; Luxton, David; Preacher, Kristopher J.; Templin, Jonathan L. (Jul 2008). Fibromyalgia: The role of sleep in affect and in negative event reactivity and recovery. Health Psychology, Vol 27(4),. 490-497.

Objective: Fibromyalgia (FM) syndrome is a chronic pain condition characterized by diffuse muscle pain, increased negative mood, and sleep disturbance. Until recently, sleep disturbance in persons with FM has been modeled as the result of the disease process or its associated pain. The current study examined sleep disturbance (i.e., sleep duration and sleep quality) as a predictor of daily affect, stress reactivity, and stress recovery. Design and Measures: A hybrid of daily diary and ecological momentary assessment methodology was used to evaluate the psychosocial functioning of 89 women with FM. Participants recorded numeric ratings of pain, fatigue, and positive and negative affect 3 times throughout the day for 30 consecutive days. At the end of each day, participants completed daily diary records of positive and negative life events. In addition, participants reported on their sleep duration and sleep quality each morning. Results: After accounting for the effects of positive events, negative events, and pain on daily affect scores, it was found that sleep duration and quality were prospectively related to affect and fatigue. Furthermore, the effects of inadequate sleep on negative affect were cumulative. In addition, an inadequate amount of sleep prevented affective recovery from days with a high number of negative events. Conclusions: These results lend support to the hypothesis that sleep is a component of allostatic load and has an upstream role in daily functioning.

Han J, Shin HB, Jeong DU, Park KS. (Sep 2008). Detection of apneic events from single channel nasal airflow using 2nd derivative method. Comput Methods Programs Biomed, 91(3), 199-207.

Detection of sleep apnea is one of the major tasks in sleep studies. Several methods, analyzing the various features of bio-signals, have been applied for automatic detection of sleep apnea, but it is still required to detect apneic events efficiently and robustly from a single nasal airflow signal under varying situations. This study introduces a new algorithm that analyzes the nasal airflow (NAF) for the detection of obstructive apneic events. It is based on mean magnitude of the second derivatives (MMSD) of NAF, which can detect respiration strength robustly under offset or baseline drift. Normal breathing epochs are extracted automatically by examining the stability of SaO(2) and NAF regularity for each subject. The standard MMSD and period of NAF, which are regarded as the values at the normal respiration level, are determined from the normal breathing epochs. In this study, 24 Polysomnography (PSG) recordings diagnosed as obstructive sleep apnea (OSA) syndrome were analyzed. By analyzing the mean performance of the algorithm in a training set consisting of three PSG recordings, apnea threshold is determined to be 13% of the normal MMSD of NAF. NAF signal was divided into 1-s segments for analysis. Each segment is compared with the apnea threshold and classified into apnea events if the segment is included in a group of apnea segments and the group satisfies the time limitation. The suggested algorithm was applied to a test set consisting of the other 21 PSG recordings. Performance of the algorithm was evaluated by comparing the results with the sleep specialist’s manual scoring on the same record. The overall agreement rate between the two was 92.0% (kappa=0.78). Considering its simplicity and lower computational load, the suggested algorithm is found to be robust and useful. It is expected to assist sleep specialists to read PSG more quickly and will be useful for ambulatory monitoring of apneas using airflow signals.

Hansen TW, Thijs L, Boggia J, Li Y, Kikuya M, Björklund-Bodegård K, Richart T, Ohkubo T, Jeppesen J, Torp-Pedersen C, Lind L, Sandoya E, Imai Y, Wang J, Ibsen H, O’Brien E, Staessen JA; International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators. (Aug 2008). Prognostic value of ambulatory heart rate revisited in 6928 subjects from 6 populations. Hypertension, 52(2), 229-35.

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

Hozawa A, Inoue R, Ohkubo T, Kikuya M, Metoki H, Asayama K, Hara A, Hirose T, Kanno A, Obara T, Hoshi H, Hashimoto J, Totsune K, Satoh H, Imai Y. (Aug 2008). Predictive value of ambulatory heart rate in the Japanese general population: the Ohasama study. J Hypertens, 26(8), 1571-6.

BACKGROUND: Resting heart rate can predict cardiovascular disease mortality or all-cause mortality. Because of the effect of the alert reaction, heart rates measured out-of-office should have better predictive power than those obtained at clinics. However, only a few studies have described the relationship between heart rate measured by ambulatory blood pressure monitoring devices and cardiovascular disease prediction. METHODS: We studied 1444 individuals from the Japanese general population who did not have a history of cardiovascular diseases including arrhythmia. We used multiple adjusted Cox proportional hazards to calculate the mortality risk of daytime heart rate, night-time heart rate, and the day-night heart rate dip ratio [day-night heart rate dip ratio = (daytime heart rate--night-time heart rate)/daytime heart rate x 100]. RESULTS: After 12 years of follow-up, 101, 195, and 296 participants died due to cardiovascular diseases, noncardiovascular diseases, and all causes, respectively. As shown by others, neither daytime nor night-time heart rate predicted cardiovascular disease mortality, whereas both predicted noncardiovascular disease mortality. The day-night heart rate dip ratio was significantly related to all-cause mortality. When night-time heart rate and day-night heart rate dip ratio were simultaneously included into the same Cox model, only night-time heart rate significantly and independently predicted all-cause mortality (relative hazard per 10 bpm increase = 1.29, 95% confidence interval, 1.07-1.54). CONCLUSION: Night-time heart rate value seems to have the most important predictor of all-cause mortality among ambulatory heart rate parameters in this population.

Impett, Emily A.; Gordon, Amie M.; Strachman, Amy (Sep 2008). Attachment and daily sexual goals: A study of dating couples. Personal Relationships, Vol 15(3),. pp. 375-390.

This research provides the first empirical investigation of how both partners’ attachment orientations contribute to daily sexual goals. Both members of 84 dating couples who attended a large urban university on the West Coast in the United States completed a measure of attachment orientation, and 1 member completed a measure of sexual goals for 14 consecutive days. Analyses showed that attachment anxiety was associated with engaging in sex to please one’s partner and express love, whereas attachment avoidance was associated with engaging in sex to avoid negative relational consequences and was negatively associated with engaging in sex to express love. Daily sexual goals were also associated with the partner’s attachment orientation. Gender moderated many of these associations. Theoretical and practical implications are discussed.

Janz KF, Medema-Johnson HC, Letuchy EM, Burns TL, Gilmore JM, Torner JC, Willing M, Levy SM. (Aug 2008). Subjective and objective measures of physical activity in relationship to bone mineral content during late childhood: the Iowa Bone Development Study. Br J Sports Med, 42(8), 658-63.

OBJECTIVE: This study compared accelerometry to self-report for the assessment of physical activity (PA) in relation to bone mineral content (BMC). In addition, we compared the ability of these measures to assess PA in boys versus girls. METHODS: Participants in this cross-sectional study included 449 children (mean age 11 years) from the Iowa Bone Development Study. PA was measured via 3-5 days of accelerometry using the Actigraph and 7 day self-report questionnaire using the Physical Activity Questionnaire for Children (PAQ-C). Hip, spine, and whole body BMC were measured via dual energy x ray absorptiometry (DXA). RESULTS: Partial correlation analysis (controlling for height, weight, and maturity) showed the Actigraph was significantly associated with hip (r = 0.40), spine (r = 0.20), and whole body (r = 0.33) BMC in boys, as was the PAQ-C (r = 0.28 hip, r = 0.19 spine, and r = 0.22 whole body). Among girls, only the Actigraph was significantly associated with hip (r = 0.18) and whole body (r = 0.16) BMC. Both the Actigraph and PAQ-C were significant in hip, spine, and whole body multivariable linear regression models (after controlling for body size and maturity) in boys. Only the Actigraph entered hip BMC regression model in girls. CONCLUSIONS: Our study supports previous work showing associations between everyday PA and BMC in older children. These associations are more likely to be detected with an objective versus subjective measure of PA, particularly in girls.

Jones H, George K, Edwards B, Atkinson G. (Sep 2008). Exercise Intensity and Blood Pressure During Sleep. Int J Sports Med. Epub ahead of print.

Exercise, of appropriate intensity and duration, could help maintain normotension if post-exercise hypotension persists over subsequent everyday activities. Therefore, we monitored ambulatory blood pressure (BP) for 24 h following four separate exercise bouts which differed in intensity, duration and total work completed. At 08:00 h, six normotensive males completed a no exercise control and, in two further trials, 30 min of cycling at 70 % V O (2peak) and 40 % V O (2peak). A fourth trial involved cycling at 40 % V O (2peak) for a time which equated total work with that in the most intense exercise trial. Between 20 min and 24 h after exercise, ambulatory BP, heart rate (HR) and wrist-activity were compared between trials using general linear models. Participants slept normally at night. Post-exercise changes in BP and HR were not affected by exercise intensity or total work completed from 20 min after exercise until nocturnal sleep-onset (p > 0.21). During sleep, mean arterial BP was lower following exercise at 70 % V O (2peak) compared to the other trials (p = 0.03), including the 40 % V O (2peak) trial equated for total work (90 % CI for difference = - 22.1 to - 0.1). We conclude that daytime exercise can elicit a physiologically meaningful lower BP during sleep and exercise intensity is the most important factor in this phenomenon.

Kop WJ, Weinstein AA, Deuster PA, Whittaker KS, Tracy RP. (Juli 2008). Inflammatory markers and negative mood symptoms following exercise withdrawal. Brain Behav Immun. Epub ahead of print.

Objective: Physical inactivity is associated with elevated inflammatory markers, but little is known about the time trajectories of reduced physical activity and inflammatory markers. Changes in inflammatory markers in response to withholding regular aerobic exercise were prospectively examined and correlated with increased negative mood symptoms and fatigue that accompany exercise withdrawal. Methods: Participants with regular exercise habits (N=40, mean age of 31.3+/-7.5 years, 55% women) were randomized to aerobic exercise withdrawal or to continue regular exercise for 2 weeks. Protocol adherence was documented using ambulatory actigraphy. Inflammatory markers (interleukin-6, C-reactive protein, fibrinogen and soluble intercellular adhesion molecule-1) were assessed at weekly intervals. Negative mood was measured with the Profile of Mood States (POMS) and the Beck Depression Inventory (BDI), and fatigue with the Multidimensional Fatigue Inventory (MFI). Autonomic nervous system activity was examined using heart rate variability-based indices. Results: Changes in inflammatory markers did not differ between exercise withdrawal and control groups (multivariate p interaction=0.25). Exercise withdrawal resulted in increased negative mood symptoms and fatigue from baseline to day 14 compared to controls (p DeltaPOMS=0.008, p DeltaBDI=0.002; p DeltaMFI=0.003), but these responses were not associated with changes in inflammatory markers (p-values >0.10). Inflammatory markers were also not correlated with autonomic nervous system dysregulation (p-values >0.10). Conclusion: Inflammatory markers were not increased following 2 weeks of exercise withdrawal. Negative mood symptoms and fatigue were not accounted for by changes in inflammatory markers. Compensatory feedback mechanisms may operate among healthy individuals to promote resilience from the effects of reduced exercise.

Kubiak, Thomas; Vögele, Claus; Siering, Mareike; Schiel, Ralf; Weber, Hannelore (Jul 2008). Daily hassles and emotional eating in obese adolescents under restricted dietary conditions - The role of ruminative thinking. Appetite, Vol 51(1), 206-209.

Emotional eating is conceptualized as eating in response to negative affect or distress and is discussed as a mechanism leading to eating binges. Recent evidence suggests that eating may not only be triggered by negative affect, but also ruminative thinking. We report results of an experience sampling study examining the role of rumination for emotional eating in 16 obese adolescents (M = 15.5 years, S.D. = 1.4; range 14-17, body mass index M = 31.1kgm-super(-2), S.D. = 5.5) under restricted dietary conditions. We hypothesized that daily hassles type of stress predicted the individuals’ desire to eat, with the predictive value further increased when negative affect and rumination were accounted for. The results of mixed regression modeling were in line with our predictions, suggesting a significant contribution of ruminative thinking to the mechanisms of negative affect induced eating.

Leahey TM, Crowther JH. (Sep 2008). An ecological momentary assessment of comparison target as a moderator of the effects of appearance-focused social comparisons. Body Image, 5(3), 307-11.

This research examined whether comparison target moderates the effects of naturally occurring appearance-focused social comparisons on women’s affect, appearance esteem, and dieting thoughts. During daily activities, body-satisfied (BS) women and body-dissatisfied (BD) women recorded their comparison targets and reactions to comparison information. For BS women, upward comparisons with peers were associated with more positive affect (PA) and appearance esteem and less guilt than upward comparisons with media images and downward comparisons with peers were associated with less PA than downward comparisons with media images. For BD women, upward comparisons with peers were associated with more appearance esteem and diet thoughts than upward comparisons with media images and downward comparisons with peers were associated with less PA, appearance esteem, and diet thoughts and more guilt than downward comparisons with media images.

Lee J, Steele CM, Chau T. (Sep 2008). Time and time-frequency characterization of dual-axis swallowing accelerometry signals. Physiol Meas, 29(9) , 1105-20.

Single-axis swallowing accelerometry has shown potential as a non-invasive clinical swallowing assessment tool. Previous swallowing accelerometry research has focused exclusively on the anterior-posterior vibration detected on the surface of the neck. However, hyolaryngeal motion during pharyngeal swallowing occurs in both the anterior-posterior and superior-inferior directions, suggesting that dual-axis accelerometry may be worthy of investigation. With this motivation, the present paper provides a characterization of dual-axis swallowing accelerometry signals from healthy adults in the time and time-frequency domains. Time-domain analysis revealed that signals in the two axes exhibited different probability density functions, and minimal cross-correlation and mutual information. Time-frequency analysis highlighted inter-axis dissimilarities in the scalograms, pseudo-spectra and temporal evolution of low- and high-frequency content. Therefore, it was concluded that the two axes contain different information about swallowing and that the superior-inferior axis should be further investigated in future swallowing accelerometry studies.

Lindamer LA, McKibbin C, Norman GJ, Jordan L, Harrison K, Abeyesinhe S, Patrick K. (Sep 2008). Assessment of physical activity in middle-aged and older adults with schizophrenia. Schizophr Res, 104(1-3), 294-301.

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

Maloney AE, Carter Bethea T, Kelsey KS, Marks JT, Paez S, Rosenberg AM, Catellier DJ, Hamer RM, Sikich L. (Juli 2008). A Pilot of a Video Game (DDR) to Promote Physical Activity and Decrease Sedentary Screen Time. Obesity (Silver Spring). Epub ahead of print.

Objective:We examined the feasibility of Dance Dance Revolution (DDR), a dance video game, in participants’ homes, to increase physical activity (PA) and to decrease sedentary screen time (SST).Methods And Procedures:Sixty children (7.5 +/- 0.5 years) were randomized in a 2:1 ratio to DDR or to wait-list control (10-week delay). DDR use was logged, PA was measured objectively by accelerometry. SST was self-reported at weeks 0 and 10. At week 28, after both groups had access to DDR, accelerometry and SST were repeated.Results:Mean use of DDR was 89 +/- 82 (range 0-660 min) min per week (mpw). The DDR group showed increased vigorous PA and a reduction in light PA; the control group showed no increase in moderate and/or vigorous PA (MVPA) although they also had a reduction in light PA. Differences between the groups were not observed. The DDR group also reported a decrease in SST of -1.2 +/- 3.7 h per week (hpw) (P < 0.05), whereas the controls reported an increase of +3.0 +/- 7.7 hpw (nonsignificant). The difference in SST between the groups was significant, with less SST in the DDR group. Between weeks 10 and 28, numeric reductions in SST were reported in both groups. In the DDR group, SST at week 28 (8.8 +/- 6.0 hpw) was lower than baseline (10.5 +/- 5.5 hpw; P < 0.03).Discussion:This pilot study suggests that DDR reduces SST and may facilitate slight increases in vigorous PA. Further study is needed to better characterize children and contexts in which DDR may promote a healthy lifestyle.

McCarthy, Danielle E.; Piasecki, Thomas M.; Lawrence, Daniel L.; Jorenby, Douglas E.; Shiffman, Saul; Baker, Timothy B (Sep 2008). Psychological mediators of bupropion sustained-release treatment for smoking cessation. Addiction, Vol 103(9), 1521-1533.

Aim: The study aimed to test simultaneously our understanding of the effects of bupropion sustained-release (SR) treatment on putative mediators and our understanding of determinants of post-quit abstinence, including withdrawal distress, cigarette craving, positive affect and subjective reactions to cigarettes smoked during a lapse. The specificity of bupropion SR effects was also tested in exploratory analyses. Design: Data from a randomized, placebo-controlled clinical trial of bupropion SR were submitted to mediation analyses. Setting: Center for Tobacco Research and Intervention, Madison, WI, USA. Participants: A total of 403 adult, daily smokers without contraindications to bupropion SR use. Intervention: Participants were assigned randomly to receive a 9-week course of bupropion SR or placebo pill and to receive eight brief individual counseling sessions or no counseling. Measurements: Ecological momentary assessment ratings of smoking behavior and putative mediators were collected pre- and post-quit. Findings: Results of structural equation and hierarchical linear models did not support the hypothesis that bupropion SR treatment improves short-term abstinence by reducing withdrawal distress or affecting the subjective effects of a lapse cigarette, but provided partial support for mediation by cigarette craving reduction and enhanced positive affect. Bupropion SR effects on point-prevalence abstinence at 1 month post-quit were also mediated partially by enhanced motivation to quit and self-efficacy. Conclusions: Results provided some support for models of bupropion SR treatment and relapse and suggested that motivational processes may partially account for bupropion SR efficacy.

McFetridge-Durdle JA, Routledge FS, Parry MJ, Dean CR, Tucker B. (Sep 2008). Ambulatory impedance cardiography in hypertension: a validation study. Eur J Cardiovasc Nurs, 7(3), 204-13.

The management of hypertension is improved by knowledge of the hemodynamics underlying blood pressure. Impedance Cardiography (ICG) provides data on a range of hemodynamic variables that affect blood pressure. However, ICG captures only fixed descriptions of hemodynamic characteristics. Improvements in ambulatory technology have led to the development of the Ambulatory Impedance Monitor (AIM) which records hemodynamic data during the activities of daily living. The purpose of this study was to evaluate the sensitivity of the AIM to detect hemodynamic changes associated with postural shift in persons with hypertension. Using a repeated measures cross-over design, sitting and standing hemodynamic measures were taken in seventeen persons with hypertension while wearing the AIM-BpTRU system designed for standard office use and the AIM-Spacelabs system designed for ambulatory monitoring. Both AIM-blood pressure monitoring systems detected significant changes from sitting to standing posture in heart rate (p=0.03), stroke volume (p=0.002), left ventricular ejection time (p<0.001), systemic vascular resistance (p=0.03) and diastolic blood pressure (p<0.001). Additionally, both systems generated measures of cardiac function that were positively correlated (p<0.001) and not significantly different (p>0.05). Our findings support previous work and demonstrate that the AIM provides valid and reliable estimates of cardiac function in persons with hypertension.

McMurray RG, Ward DS, Elder JP, Lytle LA, Strikmiller PK, Baggett CD, Young DR. (Sep 2008). Do overweight girls overreport physical activity? Am J Health Behav, 32(5), 538-46.

OBJECTIVE: To determine if overweight adolescent girls are more likely to overreport physical activity compared to normal-weight girls. METHODS: Participation in physical activities and perceived intensity of activities were assessed from the previous day physical activity recall (PDPAR) in 1021 girls aged 11-14 years old (37% overweight). Daily minutes of moderate to vigorous physical activity (MVPA) were measured using accelerometry. RESULTS: Girls in the “at-risk for overweight” and “overweight” categories had 17.7% and 19.4% fewer minutes of MVPA per block reported on the PDPAR compared to normal-weight girls (P<0.05). CONCLUSIONS: Overweight adolescent girls tend to overreport their total amount of physical activity.

Morren M, Dulmen SV, Ouwerkerk J, Bensing J. (Juli 2008). Compliance with momentary pain measurement using electronic diaries: A systematic review. Eur J Pain. Epub ahead of print.

Electronic diaries are increasingly used to assess daily pain in many different forms and populations. This systematic review aims to survey the characteristics of studies using electronic pain diaries and to examine how these characteristics affect compliance. A literature search of 11 electronic databases was conducted. Studies were evaluated on the basis of predetermined inclusion criteria by two independent reviewers. Study characteristics were grouped into four categories: general, population, electronic diary, and sampling procedure (i.e., response, attrition, and compliance rates) including strategies to enhance compliance. The 62 included publications reported from 43 different datasets. Papers were usually written in English and published as from 2000. Samples mostly consisted of female chronic pain patients aged 19-65 years from western countries. Most diaries held less than 20 items and were completed up to 6 times daily at fixed or prompted times for 1 month at most. Less than 25% of the studies reported both response and attrition rates; however, a majority reported compliance. Compliance was generally high, and positively associated with shorter diaries, age, having a user’s manual, financial compensation and using an alarm. It is important that the various study characteristics are catalogued carefully, especially response and attrition rates, because they can affect compliance. Measures of momentary pain are often developed for the purpose of a certain study; standardisation and validation of these measures is recommended. Finally, authors should mention whether they report on data that has also been used in previous studies.

Murphy SL, Strasburg DM, Lyden AK, Smith DM, Koliba JF, Dadabhoy DP, Wallis SM. (Sep 2008). Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: A pilot study. Arthritis Rheum, 59(10), 1480-1487.

OBJECTIVE: To examine effects of activity strategy training (AST), a structured rehabilitation program taught by occupational therapists and designed to teach adaptive strategies for symptom control and engagement in physical activity (PA). METHODS: A randomized controlled pilot trial was conducted at 4 sites (3 senior housing facilities and 1 senior center) in southeastern, lower Michigan. Fifty-four older adults with hip or knee osteoarthritis (mean +/- SD age 75.3 +/- 7.1 years) participated. At each site, older adults were randomly assigned to 1 of 2 programs: exercise plus AST (Ex + AST) or exercise plus health education (Ex + Ed). The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period, and were conducted concurrently within each site. Pain, total PA and PA intensity (measured objectively by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors questionnaire), arthritis self-efficacy, and physical function were assessed at baseline and posttest. RESULTS: At posttest, participants who received Ex + AST had significantly higher levels of objective peak PA (P = 0.02) compared with participants who received Ex + Ed. Although not statistically significant, participants in Ex + AST tended to have larger pain decreases, increased total objective and subjective PA, and increased physical function. No effects were found for arthritis self-efficacy. CONCLUSION: Although participants were involved in identical exercise programs, participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education. Future studies will be needed to examine larger samples and long-term effects of AST.

Nagai M, Hoshide S, Ishikawa J, Shimada K, Kario K. (Aug 2008). Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension. J Hypertens, 26(8), 1636-41.

OBJECTIVE: Recent studies have demonstrated a relationship between brain atrophy and hypertension. Systolic hypertension in the elderly has been found to be a risk factor for cognitive impairment. We studied the relationship of ambulatory blood pressure with brain atrophy and cognitive function. METHODS: We performed ambulatory blood pressure monitoring and brain magnetic resonance imaging in 55 unmedicated elderly hypertensive patients (72.7 +/- 6.0 years old). The volume of total brain matter was measured using an intensity contour-mapping algorithm. Cognitive function was assessed by mini-mental state examination score. RESULTS: Total brain matter volume and cognitive function were significantly correlated (r = 0.314, P = 0.02). Total brain matter volume was significantly negatively correlated with age (r = -0.365, P = 0.006), 24-h systolic blood pressure (r = -0.343, P = 0.01), awake systolic blood pressure (r = -0.278, P = 0.04) and sleep systolic blood pressure (r = -0.491, P = 0.0001), and significantly positively correlated with male sex (r = 0.493, P = 0.0001), body mass index (r = 0.282, P = 0.04) and nocturnal systolic blood pressure dipping (r = 0.323, P = 0.02). Mini-mental state examination score was significantly negatively correlated with age (r = -0.277, P = 0.04) and sleep systolic blood pressure (r = -0.360, P = 0.007), and significantly positively correlated with nocturnal systolic blood pressure dipping (r = 0.402, P = 0.002). In multiple linear regression analysis adjusted for age, sex, and body mass index, sleep systolic blood pressure (P = 0.009) was more significantly negatively associated with total brain matter volume than was either 24-h (P = 0.035) or awake (P = 0.020) systolic blood pressure. CONCLUSIONS: In elderly hypertensive patients, absolute ambulatory systolic blood pressure level (particularly during sleep) and nocturnal dipping in systolic blood pressure were strong indicators of brain matter volume and cognitive function.

Nyholm D, Constantinescu R, Holmberg B, Dizdar N, Askmark H. (Sep 2008). Comparison of apomorphine and levodopa infusions in four patients with Parkinson’s disease with symptom fluctuations. Acta Neurol Scand. Epub ahead of print.

The Authors Journal compilation (c) 2008 Blackwell Munksgaard.Background - Motor fluctuations in patients with advanced Parkinson’s disease may be successfully treated with subcutaneous apomorphine infusion or intraduodenal levodopa/carbidopa infusion. No comparative trials of these two alternatives were performed. Aims of the study - We present a subanalysis from a randomized crossover clinical trial where levodopa infusion as monotherapy was compared with any other combination of pharmacotherapy in fluctuating patients. Four patients used apomorphine infusion and oral levodopa in the comparator arm. The results of these four patients are presented in detail. Methods - The duration of the trial was 3 + 3 weeks. Patients were video-recorded half-hourly on two non-consecutive days of both treatment arms. Blinded video ratings were used. Patient self-assessments of motor function and quality-of-life (QoL) parameters were captured using an electronic diary. Results - Ratings in moderate to severe ‘off’ state ranged 0-44% on apomorphine infusion and 0-6% on levodopa infusion. Moderate to severe dyskinesias were not recorded in any of the treatments. QoL was reported to be improved in all patients on duodenal levodopa infusion. Conclusions - Monotherapy with duodenal infusion of levodopa was more efficacious and brought greater QoL than combination therapy with apomorphine infusion in these fluctuating patients.

Perez-Lloret S, Toblli JE, Cardinali DP, Malateste JC, Milei J. (Juli 2008). Nocturnal hypertension defined by fixed cut-off limits is a better predictor of left ventricular hypertrophy than non-dipping. Int J Cardiol, 127(3), 387-9.

The classification of subjects as nocturnal hypertensives in accordance with non-dipping (i.e. systolic blood pressure - BP - fall <10%) is less reproducible as compared to the fixed cut-off limits method (nocturnal BP means >120/70 mm Hg). The present study was carried out to assess if nocturnal hypertension defined by fixed cut-off limits may be a better predictor of left ventricular hypertrophy (LVH) than to non-dipping. Echocardiography and 24-h ambulatory blood pressure monitoring were performed in 223 subjects. Logistic regression showed that nocturnal hypertension defined by fixed cut-off limits was a significant predictor of LVH (OR=11.1, 95%CI=3.0-40.1) whereas non-dipping was not (OR=1.4, 95%CI=0.4-5.5). No interaction was detected (p<.3). These results suggest that the definition of nocturnal hypertension based on fixed cut-off values is a better predictor of left ventricular hypertrophy than non-dipping.

Petrini P, Rylander C. (Aug 2008). Clinical safety surveillance study of the safety and efficacy of long-term home treatment with ReFacto((R)) utilizing a computer-aided diary: a Nordic multicentre study. Haemophilia. Epub ahead of print.

A Nordic multicentre, open-label, non-interventional postmarketing surveillance study was carried out during a period of 24 months evaluating safety and efficacy of ReFacto as prophylactic or on-demand replacement therapy in patients with haemophilia A treated by self-medication. Fifty-seven patients were enrolled and studied for safety; efficacy was evaluated in 39 patients who received ReFacto for 24 months and recorded sufficient diary data on a hand-held computer. The compliance of using the device was good in small children, variable in adults and poor in teenagers. The fact that the overall compliance was low constituted a limitation of the number of patients with reliable diary data. Overall safety was rated as excellent or good by the clinicians for all patients at all visits and overall efficacy at 24 months evaluated to be excellent (74%) or good (26%). It was noticed that >=50% of patients/parents reported no absences from school or work owing to bleeding episodes during the study period. Among patients on regular prophylaxis, 6 of the 30 patients (20%) receiving ReFacto experienced no bleeding episodes. A median of four bleeding episodes occurred during the 24-month study period, and 93% of the episodes were resolved with <=2 ReFacto infusions. In the 7 on-demand patients, there was a median of 18 bleeding episodes, 87% of which resolved with <=2 ReFacto infusions. Interestingly, 42% of the ReFacto infusions taken by the patients classified to the on-demand group were registered as prophylactic treatment. In conclusion, ReFacto demonstrated good safety and efficacy in prophylaxis as well as treatment of bleeding episodes.

Rosenbaum D, Brandes M, Hardes J, Gosheger G, Rödl R. (Aug 2008). Physical activity levels after limb salvage surgery are not related to clinical scores-objective activity assessment in 22 patients after malignant bone tumor treatment with modular prostheses. J Surg Oncol, 98(2), 97-100.

BACKGROUND: The aim of the present study was to objectively assess the physical activity levels of patients after tumor prosthesis implantation with two objective measurement devices. METHODS: The DynaPort ADL monitor permitted up to 24 hr monitoring of lower-extremity physical activities in daily life with respect to posture and locomotion. The step activity monitor (SAM) was worn for a whole week to collect the daily number of gait cycles. The devices were worn during the waking hours by 22 patients with knee prostheses after wide tumor resection. RESULTS: In the MSTS and TESS scores the patients achieved over 80% of the maximum score indicating a good clinical outcome. The most prominent activity was sitting which accounted for 54 +/- 18% of the recorded time, followed by standing (27 +/- 16%), locomotion (10 +/- 6%), and lying (8 +/- 6%). During locomotion, the average walking activity accumulated to 4,786 +/- 1,770 step cycles per day (range 2,045-8,135) corresponding to a yearly 1.75 million steps. There was no significant correlation between clinical scores and step count measures. CONCLUSIONS: Even though this activity level was lower than for a group of healthy adults it was comparable to the activity level for other patients, for example, with hip arthroplasty as reported in the literature.

Sardinha LB, Baptista F, Ekelund U. (Sep 2008). Objectively measured physical activity and bone strength in 9-year-old boys and girls. Pediatrics, 122(3), e728-36.

OBJECTIVE: The purpose of this work was to analyze the relationship between intensity and duration of physical activity and composite indices of femoral neck strength and bone-mineral content of the femoral neck, lumbar spine, and total body. METHODS: Physical activity was assessed by accelerometry in 143 girls and 150 boys (mean age: 9.7 years). Measurement of bone-mineral content, femoral neck bone-mineral density, femoral neck width, hip axis length, and total body fat-free mass was performed with dual-energy radiograph absorptiometry. Compressive [(bone-mineral density x femoral neck width/weight)] and bending strength [(bone-mineral density x femoral neck width(2))/(hip axis length x weight)] express the forces that the femoral neck has to withstand in weight bearing, whereas impact strength [(bone-mineral density x femoral neck width x hip axis length)/(height x weight)] expresses the energy that the femoral neck has to absorb in an impact from standing height. RESULTS: Analysis of covariance (fat-free mass and age adjusted) showed differences between boys and girls of approximately 9% for compressive, 10% for bending, and 9% for impact strength. Stepwise regression analysis using time spent at sedentary, light, moderate, and vigorous physical activity as predictors revealed that vigorous physical activity explained 5% to 9% of femoral neck strength variable variance in both genders, except for bending strength in boys, and approximately 1% to 3% of total body and femoral neck bone-mineral content variance. Vigorous physical activity was then used to categorize boys and girls into quartiles. Pairwise comparison indicated that boys in the third and fourth quartiles (accumulation of >26 minutes/day) demonstrated higher compressive (11%-12%), bending (10%), and impact (14%) strength than boys in the first quartile. In girls, comparison revealed a difference between the fourth (accumulation of >25 minutes/day) and first quartiles for bending strength (11%). We did not observe any relationship between physical activity and lumbar spine strength. CONCLUSIONS: Femoral neck strength is higher in boys than girls. Vigorous intensity emerged as the main physical activity predictor of femoral neck strength but did not explain gender differences. Daily vigorous physical activity for at least approximately 25 minutes seems to improve femoral neck bone health in children.

Schasfoort FC, Formanoy MA, Bussmann JB, Peters JW, Tibboel D, Stam HJ. (Juli 2008). Objective and continuous measurement of peripheral motor indicators of pain in hospitalized infants: a feasibility study. Pain, 137(2), 323-31.

Measurement of pain in pre-verbal infants is complex. Until now, pain behavior has mainly been assessed intermittently using observational tools. Therefore, we determined the feasibility of long-term, objective and continuous measurement of peripheral motor parameters through body-fixed sensors to discriminate between pain and no pain in hospitalized pre-verbal infants. Two pain modes were studied: for procedural pain 10 measurements were performed before, during and after routine heel lances in 9 infants (age range infants: 5-175 days), and for post-operative pain 14 infants (age range 45-400 days) were measured for prolonged periods (mean 7h) using the validated COMFORT-behavior scale as reference method. Several peripheral motor parameters were studied: three body part activity parameters derived from acceleration sensors attached to one arm and both legs, and two muscle activity parameters derived from electromyographic (EMG) sensors attached to wrist flexor and extensor muscles. Results showed that the accelerometry-based parameters legs activity and overall extremity activity (i.e. mean of arm and legs) were significantly higher during heel lance than before or after lance (p0.001), whereas arm activity accelerometry data and wrist muscle activity EMG data showed no significant change. For the post-operative pain measurements, relationships were found between accelerometry-based overall extremity activity and COMFORT-behavior (r=0.76, p<0.001), and between EMG-based wrist flexor activity and COMFORT-behavior (r=0.55, p<0.001, for a subgroup of 7 infants). We conclude that long-term, objective and continuous measurement of peripheral motor parameters is feasible, has high potential, and is promising to assess pain in pre-verbal hospitalized infants.

Schoebi, Dominik (Aug 2008). The coregulation of daily affect in marital relationships. Journal of Family Psychology, Vol 22(4),. Special issue: Public health perspectives on family interventions. pp. 595-604.

This study examined whether changes in individuals’ affective states are associated with their partners’ affect when spouses come together in daily life after having spent time apart while pursuing individual activities, as well as whether such associations are moderated by individual differences in interpersonal insecurity and perspective taking. For 7 consecutive days, spouses from 166 married couples reported their affect 6 times per day on 2 dimensions, hard affect (angry-calm) and soft affect (sad/depressed-upbeat/content). Within-couple analyses indicated that spouses’ changes in hard affect covaried, particularly when they scored high on interpersonal insecurity. Moreover, husbands’ changes in soft affect covaried with their wives’ soft affect when the husbands scored high on perspective taking. The results emphasize the interconnectedness of spouses’ feelings when they reunite, and they identify key individual difference variables that strengthen interpersonal transmission of emotion in close relationships.

Sherwood NE, Martinson BC, Crain AL, Hayes MG, Pronk NP, O’Connor PJ. (Jul 2008). A new approach to physical activity maintenance: rationale, design, and baseline data from the Keep Active Minnesota Trial. BMC Geriatr, 8, 17.

BACKGROUND: Since many individuals who initiate physical activity programs are highly likely to return to a sedentary lifestyle, innovative strategies to efforts to increase the number of physically active older adults who successfully maintain beneficial levels of PA for a substantial length of time are needed. METHODS/DESIGN: The Keep Active Minnesota Trial is a randomized controlled trial of an interactive phone- and mail-based intervention to help 50-70 year old adults who have recently increased their physical activity level, maintain that activity level over a 24-month period in comparison to usual care. Baseline, 6, 12, and 24 month measurement occurred via phone surveys with kilocalories expended per week in total and moderate-to-vigorous physical activity (CHAMPS Questionnaire) as the primary outcome measures. Secondary outcomes include hypothesized mediators of physical activity change (e.g., physical activity enjoyment, self-efficacy, physical activity self-concept), body mass index, and depression. Seven day accelerometry data were collected on a sub-sample of participants at baseline and 24-month follow-up. DISCUSSION: The Keep Active Minnesota study offers an innovative approach to the perennial problem of physical activity relapse; by focusing explicitly on physical activity maintenance, the intervention holds considerable promise for modifying the typical relapse curve. Moreover, if shown to be efficacious, the use of phone- and mail-based intervention delivery offers potential for widespread dissemination.

Shiffman S, Ferguson SG. (Aug 2008). The effect of a nicotine patch on cigarette craving over the course of the day: results from two randomized clinical trials. Curr Med Res Opin. Epub ahead of print.

OBJECTIVES: The objective of this analysis was to assess the efficacy of a 21 mg/24-h nicotine patch for the reduction of craving throughout the waking day, compared both to placebo, and to a 15 mg/16-h patch differing pharmacokinetic profile over the day. The primary end-point was craving during the evening hours, because previous research suggested that smoking relapse was particularly likely at that time.RESEARCH DESIGN AND METHODS: Data were drawn from two similar randomized clinical trials among nicotine-dependent smokers who were quitting smoking: Study 1 compared the 21 mg/24-h patch to a placebo patch, while Study 2 compared the 21 mg/24-h patch to a 15 mg/16-h nicotine patch. In both studies, subjects (Study 1: n = 102; Study 2: n = 244) were prompted by an electronic diary to rate their craving multiple times per day during a 1 week baseline period, and for up to 2 weeks after quitting. For analysis, the day was divided into five blocks: morning (up to 10:59 a.m.), mid-day (11:00 a.m.-1:59 p.m.), afternoon (2:00 p.m.-4:59 p.m.), evening (5:00 p.m.-8:59 p.m.), and late night (9:00 p.m. onwards). The individual craving ratings were divided into three intervals based on time since quitting: Days 1-3, 4-7, and 8-14. RESULTS: The 21 mg/24-h nicotine patch resulted in significantly lower craving during all post-quit intervals, at each time of day, both compared to placebo (Study 1), and compared to the 15 mg/16-h nicotine patch (Study 2). Study 2 saw a significant treatment by interval interaction: in later time intervals, the difference in craving experience between 24- and 16-h patch conditions shrunk - while remaining significantly different - as overall levels of craving experienced by subjects in the two groups dropped. Adverse events reported in both studies tended to be mild and transient, consistent with the well characterized adverse event profile of nicotine patches.CONCLUSIONS: Study 1 demonstrated that a 21 mg/24-h patch was effective in reducing craving throughout the day, including the evening period when relapse risk is heightened. A further study comparing the 21 mg/24-h patch to a 15 mg/16-h nicotine patch found that craving was significantly lower at all times of day for smokers using the 21 mg/24-h patch. The studies were limited in that craving was only monitored for the first 2 weeks of quitting (when craving is most prominent), and cannot elucidate the impact of patch use on craving outside of this time. Also, there was substantial attrition of the sample over time, partly due to relapse in all conditions.

Shiffman, Saul; Gwaltney, Chad J. (Aug 2008). Does heightened affect make smoking cues more salient? Journal of Abnormal Psychology, Vol 117(3), 618-624.

Negative affect (NA) states are robustly related to relapse. However, the mechanisms for this relationship are not well understood. Whereas most models have proposed that NA directly promotes lapsing, some models suggest that NA may promote lapses indirectly by increasing reactivity to smoking cues. This hypothesis was tested in secondary analyses of a study in which 248 smokers used ecological momentary assessment to self-monitor affective valence, smoking cues, and lapses during an attempt to quit smoking. The smoking cues the authors examined were others’ smoking and consumption of alcohol or coffee. The odds of lapsing when exposed to smoking cues were compared across conditions of positive affect, neutral affect, and NA. Consistent main effects of affective valence were seen but not the hypothesized interaction. Indeed, analyses showed that the effect of cues was typically diminished under conditions of NA. No evidence was found to support the hypothesis that smoking cues and lapsing are more closely linked under NA conditions.

Stergiou GS, Nasothimiou E, Giovas P, Kapoyiannis A, Vazeou A. (Aug 2008). Diagnosis of hypertension in children and adolescents based on home versus ambulatory blood pressure monitoring. J Hypertens, 26(8), 1556-62.

OBJECTIVE: To investigate the usefulness of home blood pressure measurements in comparison with ambulatory monitoring in the diagnosis of sustained, white-coat hypertension and masked hypertension in children and adolescents. SUBJECTS AND METHODS: One hundred and two subjects, referred for elevated blood pressure, were assessed with clinic (two visits), home (6 days) and awake ambulatory blood pressure measurements [64 boys, mean age 12.8 +/- 2.9 (SD) years, range 6-18 years]. RESULTS: Office hypertension was diagnosed in 38 subjects, ambulatory hypertension in 31 and home hypertension in 23 (P = 0.07). On the basis of clinic and ambulatory blood pressure, 52% of subjects were normotensive, 20% hypertensive, 18% had white-coat hypertension and 11% masked hypertension, whereas on the basis of clinic and home blood pressure, 55, 15, 23 and 8%, respectively. There was an agreement between ambulatory and home blood pressure in the diagnosis of hypertension in 82 cases (80%). When a 5-mmHg gray zone of diagnostic uncertainty was applied above and below the diagnostic thresholds, there were only eight cases with clinically important disagreement. By taking ambulatory blood pressure as the reference method for the diagnosis of hypertension, the sensitivity, specificity and positive and negative predictive values of home blood pressure were 55, 92, 74 and 82%, respectively, for the diagnosis of white-coat hypertension 89, 92, 70 and 98%, respectively, and for masked hypertension 36, 96, 50 and 93%, respectively. CONCLUSION: In children and adolescents, there is a reasonable agreement between home and ambulatory blood pressure measurements as diagnostic methods in hypertension. Home blood pressure appears to be a useful diagnostic test in this population, particularly for the detection of white-coat hypertension.

Sugden JA, Sniehotta FF, Donnan PT, Boyle P, Johnston DW, McMurdo ME. (Aug 2008). The feasibility of using pedometers and brief advice to increase activity in sedentary older women-a pilot study. BMC Health Serv Res, 8, 169.

BACKGROUND: People over the age of 70 carry the greatest burden of chronic disease, disability and health care use. Participation in physical activity is crucial for health, and walking accounts for much of the physical activity undertaken by sedentary individuals. Pedometers are a useful motivational tool to encourage increased walking and they are cheap and easy to use. The aim of this pilot study was to evaluate the feasibility of the use of pedometers plus a theory-based intervention to assist sedentary older women to accumulate increasing amounts of physical activity, mainly through walking. METHODS: Female participants over the age of 70 were recruited from primary care and randomised to receive either pedometer plus a theory-based intervention or a theory-based intervention alone. The theory-based intervention consisted of motivational techniques, goal-setting, barrier identification and self-monitoring with pedometers and daily diaries. The pedometer group were further randomised to one of three target groups: a 10%, 15% or 20% monthly increase in step count to assess the achievability and acceptability of a range of targets. The primary outcome was change in daily activity levels measured by accelerometry. Secondary outcome measures were lower limb function, health related quality of life, anxiety and depression. RESULTS: 54 participants were recruited into the study, with an average age of 76. There were 9 drop outs, 45 completing the study. All participants in the pedometer group found the pedometers easy to use and there was good compliance with diary keeping (96% in the pedometer group and 83% in the theory-based intervention alone group). There was a strong correlation (0.78) between accelerometry and pedometer step counts i.e. indicating that walking was the main physical activity amongst participants. There was a greater increase in activity (accelerometry) amongst those in the 20% target pedometer group compared to the other groups, although not reaching statistical significance (p = 0.192). CONCLUSION: We have demonstrated that it is feasible to use pedometers and provide theory-based advice to community dwelling sedentary older women to increase physical activity levels and a larger study is planned to investigate this further.

van Sluijs EM, Page A, Ommundsen Y, Griffin SJ. (Sep 2008). Behavioural and social correlates of sedentary time in young people. Br J Sports Med. Epub ahead of print.

OBJECTIVE: To identify behavioural and social correlates of objectively-measured sedentary time in young people. DESIGN: Cross-sectional analysis of data from the European Youth Heart Study (EYHS). SETTING: Schools in Denmark, Estonia, Portugal and Norway. PARTICIPANTS: Invited using a two-stage cluster sampling procedure. Analyses include 2107 children (9-10 years) and adolescents (14-15 years). Assessment of independent variables: Seven behavioral and 15 social variables assessed by parental and computerized child questionnaires. MAIN OUTCOME MEASURE: Sedentary activity as assessed by accelerometry (10-minute blocks at <200 counts/minute). Analyses were stratified by country and interactions with grade and gender were investigated. RESULTS: Adolescents were more sedentary than children (335.4 (SD: 90.4) vs. 217.2 (SD: 75.6) minutes/day, p<0.001). Patterns of associations differed across countries. High computer use and no television viewing before school in Norway, and being sedentary during school-breaks in Estonia were positively associated with sedentary time. No behavioural variables were associated with sedentary time in the Danish and Portuguese models. Socioeconomic position was positively associated with sedentary time in Portugal and Estonia, father inverted exclamation mark|s body mass index negatively in the Estonian model. Norwegian participants with a games console at home and Portuguese participants with a television in their bedroom were more sedentary. CONCLUSIONS: A single strategy aimed at reducing sedentary behaviour is unlikely to be effective across Europe as the target populations and behaviours of focus differ between countries. Targeting high socioeconomic groups in Portugal and Estonia or focusing on reducing computer use in Norway might be effective intervention strategies to reduce overall sedentary time.

van Weering MG, Vollenbroek-Hutten MM, Tönis TM, Hermens HJ. (Aug 2008). Daily physical activities in chronic lower back pain patients assessed with accelerometry. Eur J Pain. Epub ahead of print.

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

Walker PP, Burnett A, Flavahan PW, Calverley PM. (Aug 2008). Lower limb activity and its determinants in COPD. Thorax, 63(8), 683-9.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) walk less than healthy older people and their self-reported activity predicts exacerbation risk. The relationship between lower limb activity and total daily activity is not known, nor are there any data which relate objectively assessed daily activity to laboratory assessments made before and after rehabilitation. METHODS: Lower limb activity was measured by leg actigraphy over 3 days in 45 patients with moderate to severe COPD and 18 controls of similar age. Thirty-three patients with COPD entered an 8-week rehabilitation programme in which the change in leg activity was measured and related to other outcomes. RESULTS: In patients with COPD the mean level of activity measured by whole body and leg activity monitors was closely related (r = 0.92; p<0.001), but leg activity was consistently reduced compared with controls of similar age (p = 0.001). Mean leg activity, mean intensity of leg activity and the time that patients spent mobile at home were all related to forced expiratory volume in 1 s (FEV(1)) (r = 0.57, p = 0.001; r = 0.5, p = 0.003; and r = 0.51, p = 0.002, respectively), but intensity of activity and time spent mobile were not related. Subjects completing pulmonary rehabilitation showed significant improvements in mean activity (p = 0.001) and spent more time moving (p = 0.014). These changes were unrelated to improvement in muscle strength or walking distance but correlated with baseline FEV(1) (r = 0.8, p<0.001). CONCLUSIONS: Total daily activity in patients with COPD is closely related to leg activity which is reduced compared with controls of similar age. Individuals differ in the time spent mobile during the day, but subjective and objectively assessed activity improves after rehabilitation and is predicted by FEV(1). The change in activity is unrelated to improvements in corridor walking and health status.

Xue-Rui T, Ying L, Da-Zhong Y, Xiao-Jun C. (Aug 2008). Changes of blood pressure and heart rate during sexual activity in healthy adults. Blood Press Monit, 13(4), 211-7.

OBJECTIVE: This study is to observe the changes of blood pressure (BP), heart rate (HR), double product (DP) and heart rate variability during sexual activity in healthy adults before we cover patients with chronic cardiovascular disease. METHODS: Forty-nine participants grouped by sex, 22 males, aged 40.6+/-7.8 years; 27 females, aged 40.3+/-7.8 years, underwent simultaneous ambulatory monitoring of BP and HR for 24 h. During the monitoring period, sexual activity of the participants with man-on-top in their familiar environment was performed. Participants were requested to measure BP manually at the beginning of each sexual phase and three times after orgasm in every 10-min interval and 60 min after orgasm. For each individual, eight measuring values, respectively, about BP, HR, DP and heart rate variability were obtained from baseline to 1 h after orgasm. The data were statistically analyzed with paired t-test and the significant level was set at P<0.05. RESULTS: In both groups, the peak BP did not appear at orgasm, but at the beginning of plateau and dropped to baseline level at 10 min after orgasm (male 141.41+/-17.13/91.05+/-13.69 vs. 120.14+/-11.07/72.86+/-7.78 mmHg, female 121.67+/-16.61/77.37+/-15.03 vs. 109.37+/-10.54/67.19+/-9.41 mmHg). The peak HR occurred at the beginning of orgasm, and dropped to baseline level 10-20 min after orgasm (male 96.36+/-11.96 vs. 75.41+/-9.02 bpm, female 90.19+/-10.38 vs. 71.44+/-5.68 bpm). DP of both groups elevated at the beginning of plateau and orgasm then decreased to baseline level 10 min after orgasm (male 12964.27+/-2659.17 vs. 9134.09+/-1469.58 mmHg bpm, female 10044.48+/-1777.89 vs. 7841.30+/-1023.79 mmHg bpm). All the results showed that BP, HR and DP have mild to moderate changes during sexual activity in healthy adults. CONCLUSION: Using ambulatory technology to monitor BP and HR helps us to get the real data in participants during sexual activity. BP, HR and DP increase just slightly for a short time and recover to baseline level soon after sexual activity in healthy adults. The physical exhaustion during sexual activity is within the range of the daily-life workload.

Yoshiuchi K, Yamamoto Y, Akabayashi A. (Juli 2008). Application of ecological momentary assessment in stress-related diseases. Biopsychosoc Med, 2, 13.

ABSTRACT: Many physical diseases have been reported to be associated with psychosocial factors. In these diseases, assessment relies mainly on subjective symptoms in natural settings. Therefore, it is important to assess symptoms and/or relationships between psychosocial factors and symptoms in natural settings. Symptoms are usually assessed by self-report when patients visit their doctors. However, self-report by recall has an intrinsic problem; “recall bias”. Recently, ecological momentary assessment (EMA) has been proposed as a reliable method to assess and record events and subjective symptoms as well as physiological and behavioral variables in natural settings. Although EMA is a useful method to assess stress-related diseases, it has not been fully acknowledged, especially by clinicians. Therefore, the present brief review introduces the application and future direction of EMA for the assessment and intervention for stress-related diseases.

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