Society for Ambulatory Assessment

First quarter 2009 (January to March)

Agarwal R, Peixoto AJ, Santos SF, Zoccali C (Feb 2009). Out-of-office blood pressure monitoring in chronic kidney disease. Blood Press Monit, 14(1):2-11.

Blood pressure (BP) control is vital to the management of patients with chronic kidney disease (CKD) yet most treatment decisions use BPs obtained in the clinic. The purpose of this report is to review the importance of self-measured and automatic ambulatory BPs in the management of patients with CKD. Compared with clinic-obtained BPs, self-measured BP more accurately defines hypertension in CKD. Masked hypertension seems to be associated with higher risk of end-stage renal disease in CKD patients. Conversely, white-coat hypertension seems to be associated with better renal outcomes than those who have persistent hypertension. Ambulatory BP monitoring is the only tool to monitor BP during sleep, diagnose nondipping, and, as self-measured BPs, have greater prognostic power in CKD compared with clinic BP. In hemodialysis patients, self-measured BP, but not pre/post-dialysis BP, shares the combination of high sensitivity and high specificity of greater than 80% to make a diagnosis of hypertension with the reference standard of ambulatory BP monitoring. In addition, self-measured and ambulatory BPs seem to be better correlates of left-ventricular hypertrophy and mortality in hemodialysis patients compared with pre/post-dialysis BP. Emerging data suggest that out-of-office BP monitoring is superior to BP obtained in the clinic when predicting target-organ damage and prognosis. Out-of-office BP monitoring is recommended for the management of hypertension in all stages of CKD.

Bangash F, Agarwal R (Mar 2009). Masked hypertension and white-coat hypertension in chronic kidney disease: a meta-analysis. Clin J Am Soc Nephrol, 4(3):656-64.

BACKGROUND AND OBJECTIVES: Poor hypertension control observed in patients with chronic kidney disease (CKD) may in part be due to the suboptimal assessment of BP with clinic BP measurements alone. The goal of this meta-analysis was to estimate the prevalence and determinants of white-coat and masked hypertension in the adult CKD population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Articles reporting prevalence of masked and white-coat hypertension in patients with CKD were obtained from two major databases. We then performed a meta-analysis to derive pooled estimates of prevalence and determinants of these two conditions. RESULTS: Among 980 patients with CKD identified in six studies, the overall prevalence of masked hypertension was 8.3% and of white-coat hypertension was 18.3%. More alarming, 40.4% of patients who had CKD and were thought to have normotension (or adequately treated hypertension) in fact had hypertension at home. Also 30.0% of patients who had CKD and were thought to have hypertension had normotension at home. The thresholds for classification of clinic and ambulatory BP as hypertensive strongly influenced the risk for diagnosis of masked hypertension in favor of white-coat hypertension. CONCLUSIONS: Because clinic BP measurements alone lead to substantial misclassification in BP, we estimate that the prevalence of poorly controlled hypertension is likely less than currently estimated. Out-of-office BP monitoring may improve the management of hypertension in patients with CKD. Standardized definitions for the diagnosis of masked and white-coat hypertension would facilitate research.

Biddle SJ, Gorely T, Marshall SJ, Cameron N. (Feb 2009). The prevalence of sedentary behavior and physical activity in leisure time: A study of Scottish adolescents using ecological momentary assessment. Prev Med. 48(2):151-5.

OBJECTIVE: To report time and prevalence of leisure time sedentary and active behaviors in adolescents. METHOD: Cross-sectional, stratified, random sample from schools in 14 districts in Scotland, 2002-03, using ecological momentary assessment (n=385 boys, 606 girls; mean age 14.1 years; range 12.6-16.7 years). This is a method of capturing current behavioral episodes. We used 15 min time intervals. RESULTS: Television viewing occupied the most leisure time. The five most time consuming sedentary activities occupied 228 min per weekday and 396 min per weekend day for boys, and 244 min per weekday and 400 min per weekend day for girls, with TV occupying one-third to one-half of this time. In contrast, 62 min was occupied by active transport and sports/exercise per weekday and 91 min per weekend day for boys, with 55 min per weekday and 47 min per weekend day for girls. A minority watched more than 4 h of TV per day, with more at weekends. Other main sedentary behaviors for boys were homework, playing computer/video games, and motorised transport and, for girls, homework, motorised transport, and sitting and talking. CONCLUSION: Scottish adolescents engage in a variety of sedentary and active behaviors. Research into sedentary behavior must assess multiple behaviors and not rely solely on TV viewing.

Binder S, Deuschl G, Volkmann J (2009). Effect of cabergoline on parkinsonian tremor assessed by long-term actigraphy. Eur Neurol, 61(3):149-53.

BACKGROUND: Tremor is one of the cardinal symptoms in Parkinson’s disease, but only few clinical studies have focussed on its therapy as the primary endpoint. One reason is the substantial fluctuation of tremor severity over time, which is difficult to capture and may render momentary clinical assessments unreliable. METHODS: We evaluated the usefulness of a novel wrist-worn actigraph allowing long-term recordings of tremor in a pilot study, in which we assessed the therapeutic effect of cabergoline on tremor in 10 patients with tremor-dominant Parkinson’s disease. Clinical data were obtained by using the Unified Parkinson’s Disease Rating Scale (UPDRS Part III, item 20) and simultaneously a patient’s tremor diary. RESULTS: We found a significant reduction in UPDRS motor and tremor scores, in tremor duration and tremor amplitude by actigraphy and diaries. Furthermore, we found significant correlations between actigraphy measurements and patient ratings of tremor intensity and occurrence in diaries. CONCLUSION: Long-term actigraphy is a reliable method to assess tremor occurrence and severity and may be used to document antitremor effects in clinical studies.

Burton C, Weller D, Sharpe M. (Jan 2009). Functional somatic symptoms and psychological states: an electronic diary study. Psychosom Med. 71(1):77-83.

OBJECTIVE: To investigate the links between functional physical symptoms and psychological states in a sample of patients with persistent medically unexplained symptoms. Despite the epidemiological evidence for links between physical symptoms and mental processes, prior diary studies have shown inconsistent associations and generally been limited to single symptom and psychological variable pairs. METHODS: Twenty-six patients with at least three functional physical symptoms completed twice daily self-report measures of symptoms, fatigue, anxiety, stress, mood, and symptom concern using electronic diaries over 12 weeks. Associations between physical symptoms and psychological variables were measured by linear mixed effects models at the levels of diary entry and individual. RESULTS: Despite high baseline questionnaire scores for depression and anxiety, diary ratings of anxiety and stress were relatively low. Fixed effects regression coefficients varied between symptoms and psychological variables; for instance, the fixed effects regression coefficient (95% Confidence Intervals) for fatigue as the outcome variable was 0.39 (0.31-0.47) with low mood and 0.05 (-0.01-0.10) with stress as the predictor. Random effects coefficients showed less variation between individuals for fatigue and musculoskeletal pain than for other symptoms. CONCLUSION: Self-reported mood and symptom concern were more strongly associated with functional physical symptoms than anxiety or stress. We suggest that one reason patients with functional somatic symptoms reject psychosomatic explanations is because they do not experience sufficient correlation between symptoms and psychological states.

Cain AE, Depp CA, Jeste DV. (Mar 2009). Ecological momentary assessment in aging research: A critical review. J Psychiatr Res. [Epub ahead of print]

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

Chen Z, Brown E, Barbieri R. (Mar 2009). Assessment of Autonomic Control and Respiratory Sinus Arrhythmia Using Point Process Models of Human Heart Beat Dynamics. IEEE Trans Biomed Eng. [Epub ahead of print]

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

Cliff DP, Reilly JJ, Okely AD (Jan 2009). Methodological considerations in using accelerometers to assess habitual physical activity in children aged 0-5 years. J Sci Med Sport. [Epub ahead of print]

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

Conraads VM, Vrints CJ (Feb 2009). Managing Heart Failure Patients - When good-old-fashioned clinical care is not enough. Heart. [Epub ahead of print]

Chronic heart failure (CHF) is the terminus of most other chronic cardiac diseases. For many patients, CHF is a dead-end road. In advanced stages of the disease, emphasis switches from curative approaches to palliation. Hence, quality of life prevails over quantity and the major target of management programmes is to provide adequate ambulatory care to avoid repetitive hospital admissions. In this issue of the journal, Hoppe, et al.(1) introduce a new miniature fully implantable device, which allows wireless monitoring of pulmonary artery pressure curves. The main purpose of such technical innovations is to facilitate the routine evaluation of patients’ haemodynamic status and to transmit diagnostic information to health professionals. Barriers that prevent easy and rapid access to management programmes might be overcome by introducing remote care. Healthcare systems, whether governmental or privately run, are increasingly promoting telemedicine and telecare. Besides a firm belief in better management and care of patients, cost-effectiveness rules this evolution. It is the task of the medical community to guide the other players in this field. Both by providing expert advise in the design of novel techniques and by testing their clinical efficacy.

Corder K, van Sluijs EM, Wright A, Whincup P, Wareham NJ, Ekelund U (Mar 2009). Is it possible to assess free-living physical activity and energy expenditure in young people by self-report? Am J Clin Nutr, 89(3):862-70.

BACKGROUND: It is unclear whether it is possible to accurately estimate physical activity energy expenditure (PAEE) by self-report in youth. OBJECTIVE: We assessed the validity and reliability of 4 self-reports to assess PAEE and time spent at moderate and vigorous intensity physical activity (MVPA) over the previous week in British young people between 4 and 17 y of age. DESIGN: PAEE and MVPA were derived from the Children’s Physical Activity Questionnaire, Youth Physical Activity Questionnaire, and Swedish Adolescent Physical Activity Questionnaire; a lifestyle score indicative of habitual activity was derived from the Child Heart and Health Study in England Questionnaire. These data were compared with criterion methods, PAEE, and MVPA derived from simultaneous measurements by doubly labeled water and accelerometry in 3 age groups: 4-5 y (n = 27), 12-13 y (n = 25), and 16-17 y (n = 24). Validity was assessed by using Spearman correlations and the Bland-Altman method, and reliability was assessed by using intraclass correlation coefficients. RESULTS: The strength of association between questionnaire and criterion methods varied (r = 0.09 to r = 0.46). Some questionnaires were able to accurately assess group-level PAEE and MVPA for some age groups, but the error was large for individual-level estimates throughout. Reliability of the Youth Physical Activity Questionnaire and Child Heart and Health Study in England Questionnaire was good (intraclass correlation coefficient: 0.64-0.92). CONCLUSIONS: Absolute PAEE and MVPA estimated from these self-reports were not valid on an individual level in young people, although some questionnaires appeared to rank individuals accurately. Age (the outcome of interest) and whether individual or group-level estimates are necessary will influence the best choice of self-report method when assessing physical activity in youth.

Crosby RD, Wonderlich SA, Engel SG, Simonich H, Smyth J, Mitchell JE. (Mar 2009). Daily mood patterns and bulimic behaviors in the natural environment. Behav Res Ther. 47(3):181-8.

OBJECTIVE: Negative affect has been purported to play an important role in the etiology and maintenance of bulimic behaviors. The objective of this study was to identify daily mood patterns in the natural environment exhibited by individuals with bulimia nervosa and to examine the relationship between these patterns and bulimic behaviors. METHOD: One hundred thirty-three women aged 18-55 meeting DSM-IV criteria for bulimia nervosa were recruited through clinical referrals and community advertisements. Ecological momentary assessment was used to collect multiple ratings of negative affect, binge eating and purging each day for a two-week period using palmtop computers. Latent growth mixture modeling was used to identify daily mood patterns. RESULTS: Nine distinct daily mood patterns were identified. The highest rates of binge eating and purging episodes occurred on days characterized by stable high negative affect or increasing negative affect over the course of the day. CONCLUSIONS: These findings support the conclusion that negative mood states are intimately tied to bulimic behaviors and may in fact precipitate such behavior.

de la Sierra A, Redon J, Banegas JR, Segura J, Parati G, Gorostidi M, de la Cruz JJ, Sobrino J, Llisterri JL, Alonso J, Vinyoles E, Pallarés V, Sarría A, Aranda P, Ruilope LM, Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry Investigators (Mar 2009). Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients. Hypertension, 53(3):466-72.

Ambulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In addition to 24-hour values, the circadian variation of BP adds prognostic significance in predicting cardiovascular outcome. However, the magnitude of circadian BP patterns in large studies has hardly been noticed. Our aims were to determine the prevalence of circadian BP patterns and to assess clinical conditions associated with the nondipping status in groups of both treated and untreated hypertensive subjects, studied separately. Clinical data and 24-hour ambulatory BP monitoring were obtained from 42,947 hypertensive patients included in the Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry. They were 8384 previously untreated and 34,563 treated hypertensives. Twenty-four-hour ambulatory BP monitoring was performed with an oscillometric device (SpaceLabs 90207). A nondipping pattern was defined when nocturnal systolic BP dip was <10% of daytime systolic BP. The prevalence of nondipping was 41% in the untreated group and 53% in treated patients. In both groups, advanced age, obesity, diabetes mellitus, and overt cardiovascular or renal disease were associated with a blunted nocturnal BP decline (P<0.001). In treated patients, nondipping was associated with the use of a higher number of antihypertensive drugs but not with the time of the day at which antihypertensive drugs were administered. In conclusion, a blunted nocturnal BP dip (the nondipping pattern) is common in hypertensive patients. A clinical pattern of high cardiovascular risk is associated with nondipping, suggesting that the blunted nocturnal BP dip may be merely a marker of high cardiovascular risk.

Ebner-Priemer, Ulrich W.; Eid, Michael; Kleindienst, Nikolaus; Stabenow, Simon; Trull, Timothy J. (Feb 2009). Analytic strategies for understanding affective (in)stability and other dynamic processes in psychopathology. Journal of Abnormal Psychology, 118, 195-202.

The dynamics of psychopathological symptoms as a topic of research has been neglected for some time, likely because of the inability of cross-sectional and retrospective reports to uncover the ebb and flow of symptoms. Data gathered with the experience sampling method (ESM) enable researchers to study symptom variability and instability over time as well as the dynamic interplay between the environment, personal experiences, and psychopathological symptoms. ESM data can illuminate these dynamic processes, if time is both considered and integrated into (a) the research question itself, (b) the assessment or sampling method, and (c) the data analytic strategy. The authors highlight the complexity of assessing affective instability and unstable interpersonal relationships and explore sampling and analytic methods. Finally, they propose guidelines for future investigations. For the assessment of affective instability, the authors endorse the use of time-contingent recordings and of instability indices that address temporal dependency. For the assessment of unstable interpersonal relationships, they advocate the use of event-contingent recordings and separate analyses within and across dyads.

Epstein DH, Willner-Reid J, Vahabzadeh M, Mezghanni M, Lin JL, Preston KL. (Jan 2009). Real-time electronic diary reports of cue exposure and mood in the hours before cocaine and heroin craving and use. Arch Gen Psychiatry. 66(1):88-94.

CONTEXT: In ecological momentary assessment (EMA), participants electronically report their activities and moods in their daily environments in real time, enabling a truly prospective approach to the study of acute precipitants of behavioral events. Ecological momentary assessment has greatly enhanced the study of tobacco addiction, but its use has rarely been attempted in individuals with cocaine or heroin addiction. OBJECTIVE: To prospectively monitor the acute daily life precipitants of craving for and use of cocaine and heroin. DESIGN: Cohort study. PARTICIPANTS: A volunteer sample of 114 cocaine- and heroin-abusing outpatients who were being treated with methadone provided EMA data on handheld electronic devices for 14 918 person-days (mean, 130.9; range, 6-189 days per participant). Of these outpatients, a total of 102 (63 men, 39 women) provided acute precraving and/or preuse data and were thus included in the present analyses. MAIN OUTCOME MEASURES: Changes in reports of mood and exposure to 12 putative drug-use triggers at random intervals during the 5 hours preceding each self-reported episode of drug craving or use, analyzed via repeated-measures logistic regression (generalized linear mixed models). RESULTS: During the 5 hours preceding cocaine use or heroin craving, most of the 12 putative triggers showed linear increases. Cocaine use was most robustly associated with increases in participants reporting that they “saw [the] drug” (P < .001), were “tempted to use out of the blue” (P < .001), “wanted to see what would happen if I used” (P < .001), and were in a good mood (P < .001). Heroin craving was most robustly associated with increases in reports of feeling sad (P < .001) or angry (P = .01). Cocaine craving and heroin use showed few reliable associations with any of the putative triggers assessed. CONCLUSIONS: These findings confirm that polydrug-abusing individuals can provide behavioral data in their daily environments using handheld electronic devices and that those data can reveal orderly patterns, including prospectively detectable harbingers of craving and use, which may differ across drugs.

Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA (Feb 2009). Night-day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension. J Hum Hypertens. [Epub ahead of print]

Our objective was to assess the prognostic significance of the night-time dipping pattern and the night-day blood pressure (BP) ratio for mortality and cardiovascular events in hypertensive patients without major cardiovascular disease at baseline. We performed a meta-analysis on individual data of 3468 patients from four prospective studies performed in Europe. Age of the subjects averaged 61+/-13 years; 45% were men and 61% were under antihypertensive treatment at the time of ambulatory BP monitoring. The night-day BP ratio and 24-h BP averaged, respectively, 0.907+/-0.085/0.866+/-0.095 and 138.1+/-16.4/82.3+/-11.0 mm Hg. Total follow-up time amounted to 23 164 patient-years. We used multivariable Cox regression analysis to assess the outcome of reverse dippers, non-dippers and extreme dippers vs dippers, and to assess the hazard ratios associated with 1 standard deviation higher night-day BP ratio. In comparison with dippers, and with adjustment for confounders and 24-h BP, the incidence of cardiovascular events was worse in reverse dippers (P</=0.05), whereas mortality was lower in extreme dippers (P</=0.01); outcome was similar in non-dippers and dippers. The systolic night-day BP ratio independently predicted all-cause mortality and cardiovascular events (P</=0.001), which persisted after additional adjustment for 24-h BP (P</=0.05); appropriate interaction terms indicated that the results were similar in men and women, in younger and older patients and in treated and untreated patients. In conclusion, the dipping pattern and the night-day BP ratio significantly and independently predict mortality and cardiovascular events in hypertensive patients without history of major cardiovascular disease, even after adjustment for 24-h BP.

Finan PH, Zautra AJ, Davis MC (Mar 2009). Daily Affect Relations in Fibromyalgia Patients Reveal Positive Affective Disturbance. Psychosom Med. [Epub ahead of print]

Objectives: To examine daily positive affective disturbance in the context of negative affect (NA) and pain among patients with fibromyalgia (FM) to determine a) if FM patients experience a deficit in daily positive affect (PA) relative to osteoarthritis (OA) patients; b) if FM patients differ from OA patients in the day-to-day relations of PA and NA; and c) if patients diagnosed with both OA and FM differ from patients with either OA-only or FM-only with respect to major outcomes. Methods: A total of 260 women with physician-diagnosed OA (n = 106), FM (n = 53), or OA/FM (n = 101) completed a 30-day electronic diary. Participants were assessed once daily on levels of PA, NA, and pain. Results: Multilevel models indicated that FM patients had less overall PA than OA patients and exhibited a stronger inverse PA-NA relation. Analyses further suggest that the OA/FM group may have been the most impaired of the three included in our study. This group was responsible for a lagged effect of PA on both affects, whereby high PA days resulted in low next-day PA and high next-day NA. Conclusion: FM patients exhibit a PA disturbance compared with OA patients. This disturbance is reflected by an overall deficit in PA and an inability to sustain PA in the face of pain and NA. Patients with both OA and FM may represent a subgroup of FM that is at particular risk for dysregulation of PA.

Forbes Forbes EE, Hariri AR, Martin SL, Silk JS, Moyles DL, Fisher PM, Brown SM, Ryan ND, Birmaher B, Axelson DA, Dahl RE (Jan 2009). Altered striatal activation predicting real-world positive affect in adolescent major depressive disorder. Am J Psychiatry, 166(1):64-73.

OBJECTIVE: Alterations in reward-related brain function and phenomenological aspects of positive affect are increasingly examined in the development of major depressive disorder. The authors tested differences in reward-related brain function in healthy and depressed adolescents, and the authors examined direct links between reward-related brain function and positive mood that occurred in real-world contexts. METHOD: Fifteen adolescents with major depressive disorder and 28 adolescents with no history of psychiatric disorder, ages 8-17 years, completed a functional magnetic resonance imaging guessing task involving monetary reward. Participants also reported their subjective positive affect in natural environments during a 4-day cell-phone-based ecological momentary assessment. RESULTS: Adolescents with major depressive disorder exhibited less striatal response than healthy comparison adolescents during reward anticipation and reward outcome, but more response in dorsolateral and medial prefrontal cortex. Diminished activation in a caudate region associated with this depression group difference was correlated with lower subjective positive affect in natural environments, particularly within the depressed group. CONCLUSIONS: Results support models of altered reward processing and related positive affect in young people with major depressive disorder and indicate that depressed adolescents’ brain response to monetary reward is related to their affective experience in natural environments. Additionally, these results suggest that reward-processing paradigms capture brain function relevant to real-world positive affect.

García-Sáez G, Hernando ME, Martínez-Sarriegui I, Rigla M, Torralba V, Brugués E, de Leiva A, Gómez EJ (Jan 2009). Architecture of a wireless Personal Assistant for telemedical diabetes care. Int J Med Inform. [Epub ahead of print]

PURPOSE: Advanced information technologies joined to the increasing use of continuous medical devices for monitoring and treatment, have made possible the definition of a new telemedical diabetes care scenario based on a hand-held Personal Assistant (PA). This paper describes the architecture, functionality and implementation of the PA, which communicates different medical devices in a personal wireless network. DESCRIPTION OF THE SYSTEM: The PA is a mobile system for patients with diabetes connected to a telemedical center. The software design follows a modular approach to make the integration of medical devices or new functionalities independent from the rest of its components. Physicians can remotely control medical devices from the telemedicine server through the integration of the Common Object Request Broker Architecture (CORBA) and mobile GPRS communications. Data about PA modules’ usage and patients’ behavior evaluation come from a pervasive tracing system implemented into the PA. RESULTS AND DISCUSSION: The PA architecture has been technically validated with commercially available medical devices during a clinical experiment for ambulatory monitoring and expert feedback through telemedicine. The clinical experiment has allowed defining patients’ patterns of usage and preferred scenarios and it has proved the Personal Assistant’s feasibility. The patients showed high acceptability and interest in the system as recorded in the usability and utility questionnaires. Future work will be devoted to the validation of the system with automatic control strategies from the telemedical center as well as with closed-loop control algorithms.

Gorely T, Biddle SJ, Marshall SJ, Cameron N. (Mar 2009). The prevalence of leisure time sedentary behaviour and physical activity in adolescent boys: An ecological momentary assessment approach. Int J Pediatr Obes. 20:1-10. [Epub ahead of print]

Study objective. To use ecological momentary assessment to describe how adolescent boys in the United Kingdom spend their leisure time. Design. Cross-sectional, stratified, random sample from secondary schools in 15 regions within the United Kingdom. The data are from a larger study of adolescent lifestyles (Project STIL). Participants. A total of 561 boys with a mean age of 14.6 years (range 12.7-16.7 years). The majority were white-European (86.5%). Main results. Television viewing occupied the most leisure time on both weekdays (131 minutes) and weekend (202.5 minutes) days. On weekdays the five most time consuming sedentary activities (television viewing, homework, motorised travel, playing computer/video games and shopping/hanging out) occupied on average 272.2 minutes. On weekend days, the five most time consuming sedentary activities (television viewing, shopping/hanging out, motorised travel, sitting and talking and playing computer/video games) occupied 405.5 minutes. In total, 54 minutes were occupied by active transport or sports and exercise per weekday and 81 minutes per weekend day. Only a minority watched more than 4 hours of TV per day (8.9% on weekdays and 33.8% on weekend days). Differences were noted in the means and prevalence between weekend and weekdays, reflecting the greater discretionary time available at the weekend. Conclusions. Adolescent boys engage in a variety of sedentary and active free time behaviours. It appears prudent to encourage adolescents to adopt overall healthy lifestyles by considering the combination of both active and sedentary pursuits an individual engages in and by moving beyond a focus on any one single behaviour.

Graatsma EM, Jacod BC, van Egmond LA, Mulder EJ, Visser GH (Jan 2009). Fetal electrocardiography: feasibility of long-term fetal heart rate recordings. BJOG.116(2):334-7; discussion 337-8.

The feasibility and accuracy of long-term transabdominal fetal electrocardiogram (fECG) recordings throughout pregnancy were studied using a portable fECG monitor. Fifteen-hour recordings of fetal heart rate (FHR) were performed in 150 pregnant women at 20-40 weeks of gestation and 1-hour recordings were performed in 22 women in labour and compared with simultaneous scalp electrode recordings. When >or=60% of fECG signals was present, the recording was defined as good. Eighty-two percent (123/150) of antenatal recordings were of good quality. This percentage increased to 90.7 (136/150 recordings) when only the night part (11 p.m.-7 a.m.) was considered. Transabdominal measurement of FHR and its variability correlated well with scalp electrode recordings (r=0.99, P<0.01; r=0.79, P<0.01, respectively). We demonstrated the feasibility and accuracy of long-term transabdominal fECG monitoring.

Hall CB, Lipton RB, Tennen H, Haut SR (Jan 2009). Early follow-up data from seizure diaries can be used to predict subsequent seizures in same cohort by borrowing strength across participants. Epilepsy Behav. [Epub ahead of print]

Accurate prediction of seizures in persons with epilepsy offers opportunities for both precautionary measures and preemptive treatment. Previously identified predictors of seizures include patient-reported seizure anticipation, as well as stress, anxiety, and decreased sleep. In this study, we developed three models using 30 days of nightly seizure diary data in a cohort of 71 individuals with a history of uncontrolled seizures to predict subsequent seizures in the same cohort over a 30-day follow-up period. The best model combined the individual’s seizure history with that of the remainder of the cohort, resulting in 72% sensitivity for 80% specificity, and 0.83 area under the receiver operating characteristic curve. The possibility of clinically relevant prediction should be examined through electronic data capture and more specific and more frequent sampling, and with patient training to improve prediction.

Hall MH, Matthews KA, Kravitz HM, Gold EB, Buysse DJ, Bromberger JT, Owens JF, Sowers M (Jan 2009). Race and financial strain are independent correlates of sleep in midlife women: the SWAN sleep study. Sleep, 32(1):73-82.

STUDY OBJECTIVES: To examine racial differences in sleep in a large cohort of midlife women and to evaluate whether indices of socioeconomic status (SES) are associated with racial differences in sleep. DESIGN: Cross-sectional study. SETTING: Participants’ homes. PARTICIPANTS: Caucasian (n=171), African American (n=138) and Chinese women (n=59). INTERVENTIONS: None. MEASUREMENTS: Sleep quality was assessed with the Pittsburgh Sleep Quality Index. Polysomnographically assessed sleep duration, continuity, architecture, and NREM electroencephalograhic (EEG) power were calculated over multiple nights. Sleep disordered breathing and periodic leg movements were measured on a separate night. Linear regression analysis was used to model the independent and synergistic effects of race and SES on sleep after adjusting for other factors that impact sleep in midlife women. Indices of SES were self-reported educational attainment and financial strain. RESULTS: Sleep was worse in African American women than Caucasian participants as measured by self-report, visual sleep stage scoring, and NREM EEG power. Slow wave sleep differences were also observed between Chinese and Caucasian participants. Racial differences persisted after adjustment for indices of SES. Although educational attainment was unrelated to sleep, financial strain was associated with decreased sleep quality and lower sleep efficiency. Financial strain-by-race interactions were not statistically significant, suggesting that financial strain has additive effects on sleep, independent of race. CONCLUSIONS: Independent relationships between race and financial strain with sleep were observed despite statistical adjustment for other factors that might account for these relationships. Results do not suggest that assessed indices of SES moderate the race-sleep relationship, perhaps due to too few women of low SES in the study.

Hedeker D, Mermelstein RJ, Berbaum ML, Campbell RT. (Feb 2009). Modeling mood variation associated with smoking: an application of a heterogeneous mixed-effects model for analysis of ecological momentary assessment (EMA) data. Addiction. 104(2):297-307.

AIMS: Mixed models are used increasingly for analysis of ecological momentary assessment (EMA) data. The variance parameters of the random effects, which indicate the degree of heterogeneity in the population of subjects, are considered usually to be homogeneous across subjects. Modeling these variances can shed light on interesting hypotheses in substance abuse research. DESIGN: We describe how these variances can be modeled in terms of covariates to examine the covariate effects on between-subjects variation, focusing on positive and negative mood and the degree to which these moods change as a function of smoking. SETTING: The data are drawn from an EMA study of adolescent smoking. PARTICIPANTS: Participants were 234 adolescents, either in 9th or 10th grades, who provided EMA mood reports from both random prompts and following smoking events. MEASUREMENTS: We focused on two mood outcomes: measures of the subject’s negative and positive affect and several covariates: gender, grade, negative mood regulation and smoking level. FINDINGS AND CONCLUSIONS: Following smoking, adolescents experienced higher positive affect and lower negative affect than they did at random, non-smoking times. Our analyses also indicated an increased consistency of subjective mood responses as smoking experience increased and a diminishing of mood change.

Hersh MA, Hussong AM (Jan 2009). The Association Between Observed Parental Emotion Socialization and Adolescent Self-Medication. J Abnorm Child Psychol. [Epub ahead of print]

The current study examined the moderating influence of observed parental emotion socialization (PES) on self-medication in adolescents. Strengths of the study include the use of a newly developed observational coding system further extending the study of PES to adolescence, the use of an experience sampling method to assess the daily covariation between negative affect and substance use, and a focus on PES styles defined by the interaction of emotion-dismissing and emotion-coaching behaviors. Using multi-leveling modeling, we tested PES as a moderator of daily negative mood-substance use relation in a sample of 65 elevated-risk adolescents (48% male, 58% Caucasian, with a median age of 14). Results showed a three-way interaction between emotion-coaching PES, emotion-dismissing PES and daily negative mood in predicting daily substance use. Results are discussed in terms of the importance of PES styles and their effects on self-medication through compromised emotion regulation and interpersonal processes.

Huijnen IP, Verbunt JA, Roelofs J, Goossens M, Peters M (Jan 2009). The disabling role of fluctuations in physical activity in patients with chronic low back pain. Eur J Pain. [Epub ahead of print]

Patients with chronic low back pain (CLBP) often report a disabling decrease in their activity level due to pain. The nature of the association between disability, activity, and pain over time is however, unclear. An intriguing issue here is whether a high level of pain-related disability is associated with a low activity level or are changes in the level of activity over time pain provoking and thus more disabling? The objectives of this study were to investigate associations between disability, pain intensity, pain-related fear, and characteristics of physical activity in patients with CLBP. A total of 42 patients with CLBP were recruited from the Pain Clinic of the Maastricht University Hospital. Each pain patient carried an electronic diary for one week, in which questions about current pain intensity, and the level of physical activity were completed at 8 moments a day. Disability was scored by the Quebec Back Pain Disability Scale (QBPDS), Fear of movement by the Tampa Scale for Kinesiophobia (TSK). To explain the level of disability regression analyses were performed with disability as dependent variable and pain intensity, pain-related fear, and consecutively the level of physical activity in daily life and fluctuations in physical activity as independent variables. Results, based on 34 patients, showed that activity fluctuations (beta=0.373, p<0.05) rather than the mean activity level over time (beta=-0.052, ns) contributed significantly in explaining disability. The results are discussed in the light of current theories, previous research, and clinical implications.

Jackson DM, Djafarian K, Stewart J, Speakman JR (Feb 2009). Increased television viewing is associated with elevated body fatness but not with lower total energy expenditure in children. Am J Clin Nutr. [Epub ahead of print]

BACKGROUND: Television (TV) viewing in children is associated with a higher body mass index, but it is unknown whether this reflects body fatness, and, if it does, why. OBJECTIVE: The objective was to investigate whether TV viewing is associated with body fatness, physical activity, and total energy expenditure in preschool children. DESIGN: Eighty-nine children were recruited into a cross-sectional study. Total daily energy expenditure (TEE) was measured by doubly labeled water, body composition by dual-energy X-ray absorptiometry, and physical activity by accelerometry. RESULTS: There was a significant positive association between fat mass (corrected for fat-free body mass) and TV viewing (F = 9.05, P = 0.004). Each extra hour of watching TV was associated with an extra 1 kg of body fat. Children who watched more TV were also significantly less physically active (F = 5.16, P = 0.026). Independent of body composition and sex, children with greater physical activity levels had higher TEE (F = 5.15, P = 0.029); however, physical activity did not mediate the relation between TV viewing and adiposity (P > 0.05). CONCLUSIONS: Preschool children who watch more TV are fatter and are less active, and activity influences TEE. However, despite TV viewing being linked to lower physical activity, the relation between TV viewing and fatness is not mediated by physical activity. The results suggest that a relation between TV viewing and fatness is more likely to be due to an effect on food intake.

Jacobi D, Charles MA, Tafflet M, Lommez A, Borys JM, Oppert JM. (Mar 2009). Relationships of self-reported physical activity domains with accelerometry recordings in French adults. Eur J Epidemiol. [Epub ahead of print]

The objective was to examine the relationships of self-reported physical activity (PA) by domain (leisure, occupational, other) with PA and sedentary time as measured objectively by accelerometry. Subjects were adults with low habitual PA levels from a community in northern France. Among subjects in the lowest tertile of a PA score from a screening questionnaire, 160 (37% males, age: 41.0 +/- 10.8 years, BMI: 25.1 +/- 4.1 kg/m(2), mean +/- SD) completed a detailed instrument (Modifiable Activity Questionnaire), and wore an accelerometer (Actigraph) for seven consecutive days. Relationships between questionnaire domains (occupational, leisure, and “non-occupational non-leisure”) and accelerometry measures (total activity and sedentary time) were assessed using Spearman correlation coefficients. In this population, the highest contributor to total reported PA (h/week) was occupational PA. Time spent in non-occupational non-leisure PA ranked second in women and third in men. The most frequent non-occupational non-leisure PA were shopping and household chores. In women, non-occupational non-leisure PA contributed more than occupational or leisure-time PA to total PA energy expenditure (median: 18.0, 9.1, and 4.9 MET-h/week, respectively). Total PA by accelerometry (count/day) was correlated to leisure-time PA in women (r = 0.22, P < 0.05) and to occupational (r = 0.43, P < 0.01) and total reported PA (r = 0.39, P < 0.01) in men (all in MET-h/week). There was an inverse relationship between accelerometry sedentary time (h/day) and non-occupational non-leisure PA (MET-h/week, r = -0.30, P < 0.001). These findings indicate the importance of assessing non-occupational non-leisure PA for a better understanding of how individuals partition their time between active or sedentary occupations.

Johnson EI, Grondin O, Barrault M, Faytout M, Helbig S, Husky M, Granholm EL, Loh C, Nadeau L, Wittchen HU, Swendsen J. (2009). Computerized ambulatory monitoring in psychiatry: a multi-site collaborative study of acceptability, compliance, and reactivity. Int J Methods Psychiatr Res.18(1):48-57.

Computerized ambulatory monitoring overcomes a number of methodological and conceptual challenges to studying mental disorders, however concerns persist regarding the feasibility of this approach with severe psychiatric samples and the potential of intensive monitoring to influence data quality. This multi-site investigation evaluates these issues in four independent samples. Patients with schizophrenia (n = 56), substance dependence (n = 85), anxiety disorders (n = 45), and a non-clinical sample (n = 280) were contacted to participate in investigations using computerized ambulatory monitoring. Micro-computers were used to administer electronic interviews several times per day for a one-week period. Ninety-five percent of contacted individuals agreed to participate in the study, and minimum compliance was achieved by 96% of these participants. Seventy-eight percent of all programmed assessments were completed overall, and only 1% of micro-computers were not returned to investigators. There was no evidence that missing data or response time increased over the duration of the study, suggesting that fatigue effects were negligible. The majority of variables investigated did not change in frequency as a function of study duration, however some evidence was found that socially sensitive behaviors changed in a manner consistent with reactivity.

Karahasanovic, Amela; Hinkel, Unni Nyhamar; Sjøberg, Dag I. K.; Thomas, Richard (Mar 2009). Comparing of feedback-collection and think-aloud methods in program comprehension studies. Behaviour & Information Technology, 28(2), 139-164.

This paper reports an explorative experimental comparison of (i) an experience-sampling method called feedback collection and (ii) the think-aloud methods with respect to their usefulness in studies on program comprehension. Think-aloud methods are widely used in studies of cognitive processes, including program comprehension. Alternatively, as in the feedback-collection method (FCM), cognitive processes can be traced by collecting written feedback from the subjects at regular intervals. We compare FCM with concurrent think-aloud (CTA) and retrospective think-aloud (RTA) regarding type and usefulness of the collected information, costs related to analysis of the collected information and effects of the data collection methods on the subjects’ performance. FCM allowed us to identify a greater number of comprehension problems that prevented progress or caused significant delay (FCM: 30 problems; CTA: 5; RTA: 15). It was less precise in identifying strategies for comprehension than CTA (92% correctness for FCM; 100% for CTA). FCM was less expensive in analysis (transcription and coding) than the other two methods (FCM: 0.7 h of analysis per protocol; CTA: 31 h; RTA: 7.9 h). The results indicate that all three methods of data collection were intrusive and affected the performance of the subjects with respect to time and correctness (small to medium effect size). This research confirms that FCM can be used beneficially in studies that trace the cognitive processes involved in, and identify problems related to, the comprehension of software applications. On the basis of our experience, we recommend that FCM be used in studies that have a large number of subjects and as a complement to other methods for tracing cognitive processes, such as user log files. We recommend a design with two groups (verbalisation and silent control) and a pretest task to be used in studies with FCM or CTA that focus on performances.

Kashdan TB, Collins RL. (Mar 2009). Social anxiety and the experience of positive emotion and anger in everyday life: an ecological momentary assessment approach. Anxiety Stress Coping. 26:1-14. [Epub ahead of print]

A few recent studies have found evidence showing that social anxiety is associated with diminished positive affect and elevated anger. However, prior work has relied on trait self-report measures of global positive mood or anger. In this preliminary study, we examined how trait social anxiety relates to moment-to-moment positive and angry emotional states as people navigate through their natural environment in a given day. Of additional interest was whether any associations were limited to social situations or were evident more broadly in non-social situations as well. For 14 days, 38 non-clinical community adults carried electronic diaries to assess their experience of positive emotions, anger, and their current social context and activity. Participants were randomly prompted up to four times per day, leading to 1702 observations. Results showed that social anxiety was associated with less time spent feeling happy and relaxed and more time spent feeling angry throughout the day. In general, people felt happier when they were with other people compared to being alone. Interestingly, people with relatively higher levels of social anxiety reported fewer and less intense positive emotions and greater anger episodes across social and non-social situations.

Kelsall A, Decalmer SC, McGuinness K, Woodcock A, Smith JA (Jan 2009). Sex differences and predictors of objective cough frequency in chronic cough. Thorax. [Epub ahead of print]

BACKGROUND: Women are consistently over-represented in specialist cough clinics and known to have a more sensitive cough reflex than men. Whether female sex and other patient characteristics are associated with higher cough rates is not known. We aimed to determine the predictors of objective cough frequency in chronic cough patients presenting to a tertiary referral clinic. METHODS: 100 subjects [mean age 55.8yrs (SD+/-11.0), 65 female, median cough duration 4yrs (IQR 2.0-10.0yrs)] with unexplained chronic cough, completed flow-volume loops (FEV1 103% predicted (SD+/-15.2), FEF50; 68.8% predicted, SD+/-24.1), methacholine challenge (42 % positive), citric acid cough reflex sensitivity [C5; 0.12M (IQR 0.06-0.50M)] and the Leicester Cough Questionnaire. 24-hour ambulatory cough monitoring was performed in 86 subjects; manually counted coughs were quantified as the number of explosive cough sounds per hour. RESULTS: Females coughed significantly more than males [geometric mean 16.6 coughs/hr (95%CI 13.1-21.0) versus 9.4coughs/hr (95% CI 6.4-13.9), p=0.01)]. The cough reflex was also more sensitive in females than males (median logC5 -0.9M versus -0.6M, p=0.002) but cough related quality of life was similar (females 12.0 (+/-3.6) versus males 12.2 (+/-3.2), p=0.76). Linear regression analysis showed 41% of the variation in cough rate was predicted by sex (p=0.01), logC5 (p= <0.001) and age (p=0.003) but not lung function or bronchial hyper-reactivity. CONCLUSIONS: Ambulatory objective cough monitoring provides novel insights into factors modulating chronic cough. These findings suggest that effects of sex and age must be taken into account in the study of cough and when designing clinical trials testing novel anti-tussive agents.

Knols RH, de Bruin ED, Aufdemkampe G, Uebelhart D, Aaronson NK (Jan 2009). Reliability of ambulatory walking activity in patients with hematologic malignancies. Arch Phys Med Rehabil, 90(1):58-65.

OBJECTIVES: To determine the relative and absolute reliability of the assessment of ambulatory walking activity during 2 consecutive weeks in patients with hematologic malignancies recovering at home from their medical treatment and to compare the physical activity level of hematologic cancer patients after high-dose chemotherapy with healthy subjects. DESIGN: Test-retest study of 2 consecutive 7-day recordings using the microprocessor-based step accelerometer 3 (SAM3). SETTING: Home and community. PARTICIPANTS: Patients (n=23) with hematologic malignancies recovering from high-dose chemotherapy and healthy controls (n=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The intraclass correlation coefficient (ICC(3,1)) and its 95% confidence interval (CI), SE of measurement procedure and its 95% CI, the smallest detectable difference (SDD), the coefficient of variation (CV), and t tests for the variables total steps and peak activity. RESULTS: The day-to-day and week-to-week CVs for walking activity and peak activity were 35.17% and 13.17% and 18.61% and 6.90%, respectively. For relative reliability, the ICCs for 2 consecutive 7-day recordings including the 95% CI for total steps and peak activity were 0.90 (95% CI, 0.75-0.98) and 0.85 (95% CI, 0.66-0.94), respectively. The absolute reliability for total steps and peak activity including the SE of measurement procedure and the 95% CI were 564 (95% CI, +/-1106) and 2.42 steps (95% CI, +/-4.74), respectively, for 2 consecutive 7-day recordings. The week-to-week SDD was 1564 for total steps and 6.70 for peak activity. The 7-day mean for total step activity was 5355 for the patients with hematologic malignancies and 6364 for healthy subjects (P<0.05). CONCLUSIONS: The results of this study indicate that there is good relative reliability for the assessment of 2 consecutive 7-day recordings of ambulatory walking activity, and it showed that the SDD derived from this sample may be useful in detecting changes in daily walking activity in hematologic cancer patients who are recovering from intensive medical treatment. The study also documented compromised levels of ambulatory walking activity among hematologic cancer patients recovering from high-dose chemotherapy as compared with healthy controls.

Lamoth CJ, van Lummel RC, Beek PJ (Jan 2009). Athletic skill level is reflected in body sway: A test case for accelometry in combination with stochastic dynamics. Gait Posture. [Epub ahead of print]

Recent studies on postural control have shown that the variability of body sway during quiet standing may provide valuable information to characterize changes in postural control due to age, pathology, skill and task. The aim of the present study was to determine - as spade work for possible clinical applications - whether body sway measured with a three-axial accelerometer at the trunk can differentiate between three healthy young populations that differ in athletic skill level. The three groups in question (group size: n=22) consisted of regular bachelor students, physical education students and physical education students specialized in gymnastics. Data were recorded during tandem stance with eyes open or closed and while standing on foam. The acceleration time-series were analysed in anteriorposterior and mediolateral direction. Differences in postural control were quantified in terms of variability, spectral properties and stochastic dynamical measures, i.c., regularity (sample entropy, long-range correlations) and local stability (largest Lyapunov exponent). The results were clear-cut. Standing with eyes closed and on foam increased variability. Compared to standing with eyes open, standing with eyes closed resulted in less regular sway patterns but with greater local stability, whereas standing on foam had an opposite effect. With greater gymnastic skills, acceleration time-series were less variable, less regular and more stable. These results imply that quantifying the stochastic-dynamical structure of postural sway using ambulant accelerometry may provide a useful diagnostic tool.

Langrish JP, Mills NL, Chan JK, Leseman DL, Aitken RJ, Fokkens PH, Cassee FR, Li J, Donaldson K, Newby DE, Jiang L (Mar 2009). Beneficial cardiovascular effects of reducing exposure to particulate air pollution with a simple facemask. Part Fibre Toxicol, 6(1):8. [Epub ahead of print]

ABSTRACT: BACKGROUND: Exposure to air pollution is an important risk factor for cardiovascular morbidity and mortality, and is associated with increased blood pressure, reduced heart rate variability, endothelial dysfunction and myocardial ischaemia. Our objectives were to assess the cardiovascular effects of reducing air pollution exposure by wearing a facemask. METHODS: In an open-label cross-over randomised controlled trial, 15 healthy volunteers (median age 28 years) walked on a predefined city centre route in Beijing in the presence and absence of a highly efficient facemask. Personal exposure to ambient air pollution and exercise was assessed continuously using portable real-time monitors and global positional system tracking respectively. Cardiovascular effects were assessed by continuous 12-lead electrocardiographic and ambulatory blood pressure monitoring. RESULTS: Ambient exposure (PM2.5 86 +/- 61 vs 140 +/- 113 mug/m3; particle number 2.4 +/- 0.4 vs 2.3 +/- 0.4 x 104 particles/cm3), temperature (29 +/- 1 vs 28 +/- 3 degrees C) and relative humidity (63 +/- 10 vs 64 +/- 19%) were similar (P > 0.05 for all) on both study days. During the 2-hour city walk, systolic blood pressure was lower (114 +/- 10 vs 121 +/- 11 mmHg, P < 0.01) when subjects wore a facemask, although heart rate was similar (91 +/- 11 vs 88 +/- 11/min; P > 0.05). Over the 24-hour period heart rate variability increased (SDNN 65.6 +/- 11.5 vs 61.2 +/- 11.4 ms, P < 0.05; LF-power 919 +/- 352 vs 816 +/- 340 ms2, P < 0.05) when subjects wore the facemask. CONCLUSION: Wearing a facemask appears to abrogate the adverse effects of air pollution on blood pressure and heart rate variability. This simple intervention has the potential to protect susceptible individuals and prevent cardiovascular events in cities with high concentrations of ambient air pollution.

Lanningham-Foster L, Foster RC, McCrady SK, Jensen TB, Mitre N, Levine JA. (Mar 2009). Activity-Promoting Video Games and Increased Energy Expenditure. J Pediatr. [Epub ahead of print]

OBJECTIVES: To test the hypothesis that both children and adults would expend more calories and move more while playing activity-promoting video games compared with sedentary video games. STUDY DESIGN: In this single-group study, 22 healthy children (12 +/- 2 years; 11 male, 11 female) and 20 adults (34 +/- 11 years; 10 male, 10 female) were recruited. Energy expenditure and physical activity were measured while participants were resting, standing, watching television seated, sitting and playing a traditional sedentary video game, and while playing an activity-promoting video game (Nintendo Wii Boxing). Physical activity was measured with accelerometers, and energy expenditure was measured with an indirect calorimeter. RESULTS: Energy expenditure was significantly greater than all other activities when children or adults played Nintendo Wii (mean increase over resting, 189 +/- 63 kcal/hr, P < .001, and 148 +/- 71 kcal/hr, P < .001, respectively). When examining movement with accelerometry, children moved significantly more than adults (55 +/- 5 arbitrary acceleration units and 23 +/- 2 arbitrary acceleration units, respectively, P < .001) while playing Nintendo Wii. CONCLUSION: Activity-promoting video games have the potential to increase movement and energy expenditure in children and adults.

Li Z, Snieder H, Harshfield GA, Treiber FA, Wang X. (Mar 2009) A 15-year longitudinal study on ambulatory blood pressure tracking from childhood to early adulthood. Hypertens Res. [Epub ahead of print]

This study evaluates the tracking stability of office blood pressure (BP), ambulatory BP (ABP), BP variability (BPV) and nocturnal BP drops (dipping) from childhood to early adulthood, and their dependence on ethnicity, gender and family history (FH) of essential hypertension (EH). Generalized estimating equations (GEEs) were used to estimate tracking coefficients for 295 European Americans and 252 African Americans, with a maximum of 12 measurements over a 15-year period. Office BP and ABP had moderate-to-relatively high tracking coefficients (r= 0.30-0.59; P</=0.001). Twenty-four hour readings tracked better than office readings for diastolic BP (DBP; 0.57 vs. 0.46, P=1.72 x 10(-6)) and pulse pressure (PP) (0.59 vs. 0.51, P=2.70 x 10(-4)), and equally well for systolic BP (SBP; 0.55 vs. 0.54, P=0.805). Daytime readings tracked better than their night-time counterparts for SBP (0.50 vs. 0.37, P=7.62 x 10(-13)), DBP (0.49 vs. 0.30, P=7.98 x 10(-32)) and PP (0.55 vs. 0.50, P=0.0061). All BPV (r=0.08-0.28; P</=0.001) and dipping measures (r=0.07-0.12; odds ratio, 1.60-1.73; P</=0.001) had low tracking coefficients. Males had significantly higher tracking stability for office SBP, DBP and ambulatory PP than females (P<0.01). Subjects with a positive FH of EH had significantly higher tracking stability for daytime and night-time DBP and dipping indexed by continuous variables than those with a negative FH (P<0.001). No significant ethnic differences were observed. The high tracking stability of 24-h ABP highlights the importance of using ambulatory BP monitoring in both research and clinical settings.

Luecken, Linda J.; Kraft, Amy; Appelhans, Bradley M.; Enders, Craig (Jan 2009). Emotional and cardiovascular sensitization to daily stress following childhood parental loss. Developmental Psychology, 45(1), 296-302.

Adverse childhood events can influence the development of emotional and physiological self-regulatory abilities, with significant consequences for vulnerability to psychological and physical illness. This study evaluated stress sensitization and inoculation models of the impact of early parental death on stress exposure and reactivity in late adolescence/young adulthood. Ambulatory blood pressure (BP) and diary reports of minor stress were collected every 30 min during waking hours over a 24-hr period from 91 late adolescents/young adults (43 early bereaved, 48 nonbereaved). Across the sample, minor stressors were associated with elevated BP and negative affect. The bereaved group had lower BP than did the nonbereaved group. Within the bereaved group, higher perceived caring from the surviving parent was associated with fewer reports of minor stress and lower stress-related negative affect. Higher perceived parental caring during childhood was associated with lower BP across the sample and more frequent hassles in the nonbereaved group. Findings support both the stress inoculation and sensitization models, suggesting that childhood parental loss and parental caring exert important influences on children’s development of stress sensitivity.

Marcus C, Nyberg G, Nordenfelt A, Karpmyr M, Kowalski J, Ekelund U (Mar 2009). A 4-year, cluster-randomized, controlled childhood obesity prevention study: STOPP. Int J Obes (Lond). [Epub ahead of print]

Objective:To assess the efficacy of a school-based intervention programme to reduce the prevalence of overweight in 6 to 10-year-old children.Design:Cluster-randomized, controlled study.Subjects:A total of 3135 boys and girls in grades 1-4 were included in the study.Methods:Ten schools were selected in Stockholm county area and randomized to intervention (n=5) and control (n=5) schools. Low-fat dairy products and whole-grain bread were promoted and all sweets and sweetened drinks were eliminated in intervention schools. Physical activity (PA) was aimed to increase by 30 min day(-1) during school time and sedentary behaviour restricted during after school care time. PA was measured by accelerometry. Eating habits at home were assessed by parental report. Eating disorders were evaluated by self-report.Results:The prevalence of overweight and obesity decreased by 3.2% (from 20.3 to 17.1) in intervention schools compared with an increase of 2.8% (from 16.1 to 18.9) in control schools (P<0.05). The results showed no difference between intervention and controls, after cluster adjustment, in the longitudinal analysis of BMIsds changes. However, a larger proportion of the children who were initially overweight reached normal weight in the intervention group (14%) compared with the control group (7.5%), P=0.017. PA did not differ between intervention and control schools after cluster adjustment. Eating habits at home were found to be healthier among families with children in intervention schools at the end of the intervention. There was no difference between children in intervention and control schools in self-reported eating disorders.Conclusions:A school-based intervention can reduce the prevalence of overweight and obesity in 6 to 10-year-old children and may affect eating habits at home. The effect of the intervention was possibly due to its effect on healthy eating habits at school and at home rather than on increased levels of PA.

McCormick BP, Frey GC, Lee CT, Gajic T, Stamatovic-Gajic B, Maksimovic M (Mar 2009). A pilot examination of social context and everyday physical activity among adults receiving Community Mental Health Services. Acta Psychiatr Scand, 119(3):243-7.

OBJECTIVE: Community mental health center (CMHC) clients include a variety of people with moderate to severe mental illnesses who also report a number of physical health problems. Physical activity (PA) has been identified as one intervention to improve health among this population; however, little is known about the role of social context in PA. The purpose of this study was to examine the role of social context in everyday PA among CMHC clients. METHOD: Data were collected from CMHC clients in two cultures using accelerometery and experience sampling methods. Data were analyzed using hierarchical linear modeling. RESULTS: Independence in housing nor culture was significantly associated with levels of PA. Being alone was significantly negatively related to PA level. CONCLUSION: Social isolation appears to be negatively related to PA at the level of everyday life. Physical activity interventions with this population should consider including social components as a part of PA.

Mitre N, Lanningham-Foster L, Foster R, Levine JA (Jan 2009). Pedometer accuracy for children: can we recommend them for our obese population? Pediatrics, 123(1):e127-31.

OBJECTIVE: In this study, we investigated the accuracy of measuring walking steps with commercially available pedometers and an accelerometer-based step-counter in normal and overweight children. Our primary hypothesis was that commercially available pedometers are not an accurate measure of walking steps in normal and overweight children while walking. Our secondary hypothesis was that the accelerometer-based step-counter provides an accurate measure of walking steps in normal and overweight children. METHODS: Thirteen boys (11 +/- 1 years) and 14 girls (11 +/- 1 years) who ranged in BMI from 15 to 27 kg/m(2) (16 normal and 11 overweight or obese) were recruited. Each child wore 4 pedometers at the waist and 1 accelerometer-based step-counter on each ankle. Steps were manually counted and energy expenditure was measured while the child walked on the treadmill at 0.5, 1.0, 1.5, and 2.0 mph, each for 5 minutes. The step-counting devices were also validated while children walked on level ground at a self-selected pace. RESULTS: For the commercially available pedometers at the lowest speed of 0.5 mph, the percentage error approximated 100% for both of the pedometers. At the fastest speed of 2.0 mph, the percentage error approximated 60%. Conversely the accelerometer-based step-counter showed a percentage error of 24% +/- 22% (mean +/- SD) at 0.5 mph; however, as walking speed increased, the error declined to 5% +/- 8% at 1.0 mph, 4% +/- 5% at 1.5 mph, and 2% +/- 2% at 2.0 mph. The relationship between steps counted and walking energy expenditure showed good linear correlation. CONCLUSIONS: Commercially available pedometers are less accurate for measuring walking and require discretion in their use for children. The accuracy of the accelerometer-based step-counter enables it to be used as a tool to assess and potentially promote physical activity in normal and overweight children.

Mondorf W, Siegmund B, Mahnel R, Richter H, Westfeld M, Galler A, Pollmann H (Feb 2009). Haemoassist- a hand-held electronic patient diary for haemophilia home care. Haemophilia. [Epub ahead of print]

On-demand or prophylactic home-treatment is currently the treatment of choice for haemophilia patients. To allow physicians to monitor the amount of factor concentrates administered, the patients document each factor injection in a paper-diary. Nevertheless, because of the fact that most patients visit their physicians only two to four times a year, there could be considerable delay in detecting medication problems. The aim of this pilot study was to assess whether an electronic documentation tool could successfully replace traditional paper-diaries for haemophilia A patients and enable the physician to have a timely overview of the patient’s treatment. An electronic, hand-held documentation tool, Haemoassist, was developed. In this study, patients using prophylaxis and on-demand therapies documented their factor consumption both electronically and on paper-diaries. Documentations were compared and descriptively evaluated. Patients also completed a survey to evaluate the feasibility and gather their opinions on the Haemoassist system. Ten patients from two haemophilia treatment centres in Germany submitted a total of 548 records via hand-held device during the observation period, from March 2006 to February 2007. Comparison of electronic and paper-based records showed differing responses among patients with some patients entering more electronic and some others more paper-based documentations. In the questionnaires on feasibility and usefulness of Haemoassist, three patients preferred the electronic tool, two patients wanted to continue using paper-based diaries, and one had no preference. The study shows that an electronic documentation system is feasible for haemophilia patients and provides the physician with the opportunity to more closely monitor patients. However, not all patients seem to be qualified for using an electronic tool, and the tool has to run reliably without major errors for ensuring reliability and acceptability. In the future, Haemoassist might support quality assurance in haemophilia treatment and improve guidance in the home-care setting.

Munsch S, Meyer AH, Milenkovic N, Schlup B, Margraf J, Wilhelm FH. (Feb 2009). Ecological momentary assessment to evaluate cognitive-behavioral treatment for binge eating disorder. Int J Eat Disord. [Epub ahead of print]

OBJECTIVE:: Cognitive-behavioral treatment (CBT) for binge eating disorder (BED) is traditionally evaluated using clinical interviews and questionnaires. These retrospective assessment methods are discussed to be problematic due to memory recall error. Ecological momentary assessment (EMA) might be promising for gathering ecologically valid and reliable data. METHOD:: We assessed the feasibility of and reactivity to EMA and compared the treatment efficacy measured by traditional vs. EMA-based instruments in 28 BED individuals participating in short-term CBT. RESULTS:: Patients were highly compliant and we found no reactivity to EMA. Estimated treatment effects for binge eating based on EMA were comparable to questionnaire-based methods. The overall concordance between methods was moderate. DISCUSSION:: Results suggest that binge eating over 1 week can be equally accurately assessed by EMA or by self-report questionnaires in BED treatment trials. EMA contributes to a detailed knowledge of binge eating in daily live and helps to advance treatment options.

Myers MG, Valdivieso M, Kiss A (Feb 2009). Use of automated office blood pressure measurement to reduce the white coat response. J Hypertens, 27(2):280-6.

OBJECTIVE: To examine the possibility of reducing the white coat response using an automated sphygmomanometer designed for office use, the BpTRU. Consecutive patients referred from physicians in the community to an ambulatory blood pressure (ABP) monitoring unit in an academic hospital were included in the study. PARTICIPANTS AND METHODS: A total of 309 patients referred for diagnosis or management of hypertension were studied. Differences between mean awake ABP and BP readings taken by the patient’s own physician using a manual sphygmomanometer or the automated BpTRU device with the patient resting alone in the ABP monitoring unit were compared. RESULTS: BP recorded in the examining room using an automated device (132 +/- 19/75 +/- 12) was similar to the mean awake ABP (134 +/- 12/77 +/- 10) with both values being lower (P < 0.001) than the BP recorded on a routine visit to the patient’s own family physician (152 +/- 18/87 +/- 11). The coefficient of correlation between the systolic/diastolic ABP and the automated office BP (r = 0.62/0.72) was higher (P < 0.001) than with the family physician’s manual BP (r = 0.32/0.48). The prevalence of white coat hypertension in untreated patients (n = 146) was significantly (P < 0.001) lower with automated office BP (16%) compared with the routine family physician BP (55%). CONCLUSION: The white coat response associated with office BP measurements can be virtually eliminated by recording BP with the automated BpTRU device with patients resting alone in a quiet examining room.

Myin-Germeys I, Oorschot M, Collip D, Lataster J, Delespaul P, van Os J. (Feb 2009). Experience sampling research in psychopathology: opening the black box of daily life. Psychol Med. 12:1-15. [Epub ahead of print]

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

Newton JL, Sheth A, Shin J, Pairman J, Wilton K, Burt JA, Jones DE. (Mar 2009). Lower Ambulatory Blood Pressure in Chronic Fatigue Syndrome. Psychosom Med. [Epub ahead of print]

Objective: To examine blood pressure circadian rhythm in subjects with chronic fatigue syndrome (CFS) and appropriate normal and fatigued controls to correlate parameters of blood pressure regulation with perception of fatigue in an observational cohort study. The cause of CFS remains unknown and there are no effective treatments. Methods: To address whether inactivity was a confounder, we performed a 24-hour ambulatory blood pressure monitoring in the following three subject groups: 1) CFS patients (Fukuda Diagnostic criteria) (n = 38); 2) normal controls (n = 120); and 3) a fatigue comparison group (n = 47) with the autoimmune liver disease primary biliary cirrhosis (PBC). All patients completed a measure of fatigue severity (Fatigue Impact Scale). In view of the different demographics between the patient groups, patients were age- and sex-matched on a case-by-case basis to normal controls and blood pressure parameters were compared. Results: Compared with the control population, the CFS group had significantly lower systolic blood pressure (p < .0001) and mean arterial blood pressure (p = .0002) and exaggerated diurnal variation (p = .009). There was a significant inverse relationship between increasing fatigue and diurnal variation of blood pressure in both the CFS and PBC groups (p < .05). Conclusion: Lower blood pressure and abnormal diurnal blood pressure regulation occur in patients with CFS. We would suggest the need for a randomized, placebo-controlled trial of agents to increase blood pressure such as midodrine in CFS patients with an autonomic phenotype.

Nica EI, Links PS. (Feb 2009). Affective instability in borderline personality disorder: experience sampling findings. Curr Psychiatry Rep.;11(1):74-81.

Affective instability, defined as repeated, rapid, and abrupt shifts in mood, is considered the core pathology in borderline personality disorder. The temporal pattern of affective instability can be best captured with the experience sampling method-longitudinal assessment of people’s affective states as they occur in real time and in their natural environment. A review of the experience sampling studies published to date for borderline personality disorder suggests the following mood variability pattern: intense negative mood, more frequent and abrupt mood changes than healthy controls and patients with major depression, and partial triggering of affect by external events. The method also has great potential to investigate the links between affective instability and other psychological and behavioral correlates of the disorder, such as suicide, lack of self-esteem, and erratic behaviors. However, the method requires systematic study to determine best data collection designs and mathematical models of mood variability.

Osse RJ, Tulen JH, Bogers AJ, Hengeveld MW (Feb 2009). Disturbed circadian motor activity patterns in postcardiotomy delirium. Psychiatry Clin Neurosci, 63(1):56-64.

AIMS: More than 20% of patients of 65 years or older may develop a delirium after cardiac surgery. Patients with delirium frequently show a disturbed 24-hr motor activity pattern, but objective and quantitative data are scarce. Our aim was to quantify motor activity patterns in elderly patients with or without a postcardiotomy delirium after elective cardiac surgery. METHODS: Wrist-actigraphy was used to quantify 24-hr motor activity patterns for a 5-day period following cardiac surgery in 79 patients of 65 years or older. Clinical state was monitored daily by means of the Confusion Assessment Method-Intensive Care Unit and the Delirium Rating Scale-Revised 98. RESULTS: The activity Amplitude, and the daytime Activity/minute and Restlessness index were significantly higher and the daytime number of Immobility minutes significantly lower for the patients without delirium or with short delirium episodes, as compared to patients with a sustained delirium (>3 days). CONCLUSIONS: Actigraphy proves to be a valuable instrument for evaluating motor activity patterns in relation to clinical state in patients with a postcardiotomy delirium.

Osse RJ, Tulen JH, Hengeveld MW, Bogers AJ (Mar 2009). Screening methods for delirium: early diagnosis by means of objective quantification of motor activity patterns using wrist-actigraphy. Interact Cardiovasc Thorac Surg, 8(3):344-8; discussion 348.

Delirium after cardiac surgery is a risk factor for adverse outcome and even death. Disturbance of motor activity is a core feature of delirium, but hypoactive delirium often remains unrecognized. We explored wrist-actigraphy as a tool to objectively quantify postoperative recovery of 24-h rest-activity patterns to improve the early recognition of delirium after surgery. Motor activity was recorded by wrist-actigraphy after cardiac surgery in 88 patients over 65 years of age. Patients were assessed daily by using the CAM-ICU. Our final analyses were based on 32 non-delirious patients and 38 patients who were delirious on the first day after surgery. The delirious patients showed lower mean activity levels during the first postoperative night (P<0.05), reduced restlessness during the first day (P<0.05), and a lower mean activity of the 5 h with lowest activity within the first 24 h (P=0.01), as compared to the non-delirious patients. Already at a very early stage after cardiac surgery, a difference in motor activity was observed between patients with and without a delirium. As an unobtrusive method, actigraphy has the potential to be a screening method that may lead to early diagnosis and treatment of delirium.

Parfitt G, Pavey T, Rowlands AV (Feb 2009). Children’s physical activity and psychological health: the relevance of intensity. Acta Paediatr. [Epub ahead of print]

Aim: To examine the relevance of physical activity intensity when assessing the relationship between activity and psychological health in 9-10-year-old children. Methods: Activity was assessed by accelerometry in 57 boys (n = 23) and girls (n = 34). Total activity and time spent in very light (</=1.9 METs) through to vigorous activity (>/=6 METs) were recorded. Psychological health inventories to assess anxiety, depression and aspects of self-worth were completed. Results: Time accumulated in very light activity had positive correlations with anxiety and depression (r > 0.30, p < 0.05) and negative correlations with aspects of physical self-worth (r > -0.29, p < 0.05). Time accumulated in vigorous activity had negative correlations with anxiety and behavioural conduct (r > -0.30, p < 0.05) and positive correlation with aspects of physical self-worth (r > 0.28, p < 0.05). Children spending over 4 h in very light intensity activity had more negative psychological profiles than children spending under 4 h at this intensity. Conclusion: Aspects of psychological health were negatively correlated with very light intensity activity and positively correlated with vigorous intensity activity. Further research should investigate whether reducing time spent in very light intensity activity and increasing time spent in vigorous intensity activity improves psychological health in children.

Pate RR, Stevens J, Webber LS, Dowda M, Murray DM, Young DR, Going S (Mar 2009). Age-related change in physical activity in adolescent girls. J Adolesc Health, 44(3):275-82.

PURPOSE: To determine the annual rate at which physical activity changes in girls during middle school using both objective and self-report measures of physical activity. METHODS: Participants were sixth- and eighth-grade girls from the control schools in the Trial of Activity for Adolescent Girls (TAAG). Random cross-sectional samples initially were drawn from sixth-grade girls (n=786) and 2 years later from eighth-grade girls (n=1545). A cohort of 501 girls was in both the sixth- and the eighth-grade samples. The girls wore an accelerometer for 6 days and completed the 3-Day Physical Activity Recall. Data were summarized using 3.0-, 4.6-, and 6.5-metabolic equivalent cutpoints for accelerometry and self-reported physical activity. Analyses were performed using repeated-measures analysis of variance in PROC MIXED. RESULTS: More than 40% of the girls were white, approximately 20% were African American, and 20% were Hispanic. The annual percent decrease in physical activity in the cross-sectional sample was approximately 4% (-1.76 min moderate-to-vigorous physical activity/day), using accelerometer data. The percent decrease in physical activity based on self-report data was higher, 6% to 13%, depending on the physical activity variable. Declines tended to be larger in African American girls, but the ethnic differences were not statistically significant. CONCLUSIONS: Based on comparisons of cross-sectional samples of sixth- and eighth-grade girls, objectively measured physical activity declined at a rate of 4% per year.

Pluess, Michael; Conrad, Ansgar; Wilhelm, Frank H. (Jan 2009). Muscle tension in generalized anxiety disorder: A critical review of the literature. Journal of Anxiety Disorders, 23(1), 1-11.

Background: Generalized anxiety disorder (GAD) is a prevalent, disabling, and often chronic disorder. With a typical recovery rate of only about 40% with current psychological treatments a better understanding of potential psychophysiological mechanisms is vital. Methods: Since the most discriminative somatic symptom of GAD compared to other anxiety disorders is muscle tension this review qualitatively examines the literature on muscle tension as it relates to GAD and muscle relaxation therapy for GAD patients. Results: Muscle tension in GAD is poorly understood. Experimental studies refute the often-assumed direct relationship between anxiety and muscle tension. However, muscle relaxation therapies have been as effective as cognitive interventions directly addressing the defining symptom worry. Conclusions: Muscle tension in its objective and subjective representations may play a role in GAD through various pathways that are testable. Future research needs to better examine the different aspects and functions of muscle tension in GAD.

Porto LG, Junqueira LF Jr (Jan 2009). Comparison of time-domain short-term heart interval variability analysis using a wrist-worn heart rate monitor and the conventional electrocardiogram. Pacing Clin Electrophysiol, 32(1):43-51.

BACKGROUND: Wrist-worn heart rate monitors have not been extensively validated for heart rate variability analysis. The purpose of this study was to compare time-domain variability of heart interval series (R-Ri) recorded by the Polar S810 monitor (Polar Electro Oy, Kempele, Finland) and the conventional electrocardiogram (ECG). METHODS: Agreement was verified between variability indices of 5-minute R-Ri simultaneously recorded by both devices and processed by unique software, from 33 subjects aged 18 to 42 years, normal or with different clinical conditions, in rest supine and active standing. ECG minus Polar differences were quantified by the Bland-Altman analysis, and tested by the one-sample t-test or Wilcoxon test. RESULTS: In the supine position, the Polar overestimates (P < 0.0001) the absolute and percentage mean or median of the number (-2.00; -0.49%) and mean of R-Ri (-1.85 ms; -0.20%) and pNN50 (-2.20%; -8.68%), and underestimates the standard deviation (SDNN) (0.32 ms; 0.59%) (P = 0.08; P = 0.02) and root mean square successive difference (RMSSD) (0.90 ms; 1.56%) (P = 0.0008; P < 0.0001). The coefficient of variation (CV) showed null difference. On standing, differences were overestimated for the number (-2.61 intervals; -0.64%) and mean of R-Ri (-0.70 ms; -0.09%), and underestimated for rMSSD (1.70 ms; 10.84%) (P < 0.0001 to < 0.02). The SDNN, CV, and pNN50 indices did not show differences (P = 0.12 to 0.73). CONCLUSIONS: The Polar S810 monitor was feasible and reliable for recording short-term R-R interval series, showing excellent agreement with the ECG in providing the time-domain indexes of heart interval variability with differences functionally not relevant. The CV showed the higher agreement in both postures, and the SDNN and pNN50 in the standing posture.

Powell, Rachael; Allan, Julia L.; Johnston, Derek W.; Gao, Chuan; Johnston, Marie; Kenardy, Justin; Pollard, Beth; Rowley, David I. (Feb 2009). Activity and affect: Repeated within-participant assessment in people after joint replacement surgery. Rehabilitation Psychology, 54(1), 83-90.

Objective: Between-participant research has shown that high negative affectivity predicts greater activity limitations and vice versa. This study examined both between- and within-participant associations of negative and positive affectivity with activity levels using ecological momentary assessment. Method: Participants were 25 people who had undergone joint replacement surgery 12 months previously. Participants made multiple reports of their activity and positive and negative affectivity over a single day using a computerized diary. Activity was also objectively recorded using an activity monitor. The following day, participants made a self-report of their activity over the measurement day and general positive and negative affectivity levels were recorded. Results: Higher self-reported walking time over the whole measurement day was associated with higher general positive affectivity but not negative affectivity. However, using ecological momentary assessment, higher diary reports of negative affectivity predicted increased activity levels while positive affectivity neither predicted nor was predicted by activity. Conclusion: These findings demonstrate the importance of within-participant methodology in detecting subtle and immediate effects of individuals’ mood on behavior that may differ from findings investigating between-participant effects over longer time periods.

Raftery G, Bridges M, Heslop P, Walker DJ (Feb 2009). Are fibromyalgia patients as inactive as they say they are? Clin Rheumatol. [Epub ahead of print]

Both fibromyalgia and rheumatoid arthritis (RA) patients self-report similar disability. These diseases are viewed differently by the medical profession as one has ample evidence of tissue damage and inflammation and the other does not. We were interested to see if an objective measure produced similar results. Twelve patients with RA were matched with 12 fibromyalgia patients by sex, age, and Health Assessment Questionnaire (HAQ) score. The 24-h ambulatory activity of these patients was recorded using the Numact monitor. Statistical analysis was performed using independent group t test for the ambulatory activity data and Spearman’s correlation coefficients for HAQ and total energy. There were no significant differences found between the two groups in terms of total activity. Other compared analyses for activity included the number of steps taken, vigor of steps, and time spent standing, which were not statistically different. The correlation coefficients of HAQ and total ambulatory activity for the fibromyalgia group were rho = -0.638 (p = 0.026). Patients with RA and fibromyalgia displaying similar levels of self-reported disability have objective evidence of similar levels of total ambulatory activity. There is a statistically significant correlation between self-reported and objective measurements of disability for the fibromyalgia patients. Either of these measures merits further study as outcome measures for fibromyalgia.

Rodrigues CS, Bloch KV, da Rocha Nogueira A (Jan 2009). Office blood pressure and 24-hour ambulatory blood pressure measurements: high proportion of disagreement in resistant hypertension. J Clin Epidemiol. [Epub ahead of print]

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

Rossi MC, Nicolucci A, Pellegrini F, Bruttomesso D, Bartolo PD, Marelli G, Dal Pos M, Galetta M, Horwitz D, Vespasiani G (Jan 2009). Interactive diary for diabetes: A useful and easy-to-use new telemedicine system to support the decision-making process in type 1 diabetes. Diabetes Technol Ther, 11(1):19-24.

BACKGROUND: Widespread use of carbohydrate (CHO) counting is limited by its complex educational needs, but a telemedicine system could simplify the patients’ training. METHODS: The Diabetes Interactive Diary (DID) was set up on patients’ mobile phones and allowed to record the blood glucose values and quantify the total CHO intake during a meal, by choosing the specific food and the amount ingested from a list of pictures. It also suggested the most appropriate insulin bolus in relation to the patient’s CHO/insulin ratio. Data were sent to the physician by Short Message Service (also known as text message). Two pilot studies were carried out to investigate the feasibility and acceptability of the system and its effectiveness in improving metabolic control. RESULTS: In the first study, 50 patients were involved in a survey with questionnaires administered before and 12 weeks after the start of the DID. The system was considered by almost all the patients as easy to use and very helpful. CHO counting and insulin bolus calculation were ranked as the most useful functions. In the second study, 41 consecutive patients using DID under routine clinical practice conditions were evaluated after a median of 9 months of follow-up. DID was associated with a nonstatistically significant reduction in fasting blood glucose (FBG), postprandial glucose (PPG), and hemoglobin A1c levels. FBG and PPG coefficient of variation (CV) values were significantly reduced: FBG-CV decreased by 6.7% (95% confidence interval -11.9, -1.6; P = 0.02), while PPG-CV decreased by 11.5% (95% confidence interval -19.3, -3.7; P = 0.01). No patients reported serious hypoglycemic episodes requiring medical intervention. CONCLUSIONS: DID can represent a useful, safe, and easy-to-use tool to help the patient with type 1 diabetes promote dietary freedom. Adjustment of insulin doses according to CHO intake allowed the reduction of glucose variability, increasingly recognized as an important, independent risk factor for cardiovascular events.

Rutledge, Thomas; Stucky, Erin; Dollarhide, Adrian; Shively, Martha; Jain, Sonia; Wolfson, Tanya; Weinger, Matthew B.; Dresselhaus, Timothy (Mar 2009). A real-time assessment of work stress in physicians and nurses. Health Psychology, 28, 194-200.

Objective: This study adapted ecological momentary assessment methods to: (a) examine differences in work stress between nurses and physicians, and (b) to study relationships between work stress, work activity patterns, and sleep. Design: A total of 185 physicians and 119 nurses (206 women, 98 men) working in four teaching hospitals participated in an observational study of work stress. Main Outcome Measures: Participants carried handheld computers that randomly prompted them for work activity, patient load, and work stress information. Results: Participants completed more than 9,500 random interval surveys during the study (an average of 30.8 surveys per person-week). Approximately 85% of all surveys were completed in full (73.3%) or partially (11.6%). Emotional stress scores among physicians were nearly 50% higher (26.9[19.0]) than those of nurses (18.1[14.9], r[302] = .37, p < .001). Direct and indirect care activities were associated with higher stress reports by both clinician groups (rs[159] = .14-.26, ps < .01). Sleep quality and quantity were predictors of work stress scores (ps < .05). Finally, higher work stress and lower sleep quality were also associated with poorer memory performance (r[302] = -.12, .17, ps < 05). Conclusions: The findings identify patterns of work stress in relationship to work activities, sleep habits, and provider differences that may be used to assist ongoing hospital work reform efforts.

Salvador R, Watson TJ, Herbella F, Dubecz A, Polomsky M, Jones CE, Raymond DR, Peters JH (Feb 2009). Association of Gastroesophageal Reflux and O(2) Desaturation: A Novel Study of Simultaneous 24-h MII-pH and Continuous Pulse Oximetry. J Gastrointest Surg. [Epub ahead of print]

BACKGROUND: Proof of the relationship between gastroesophageal reflux disease (GERD) and respiratory symptoms remains a challenge. Our aim was to determine the association between reflux events and O(2) desaturation in GERD patients with primary respiratory symptoms (RS) compared to those with primary esophageal symptoms (ES) using ambulatory monitoring systems. METHODS: One thousand eight hundred fifty-one reflux episodes were detected by multichannel intraluminal impedance (MII)-pH testing in 30 patients with symptoms of GERD (20 RS, ten ES.) All patients underwent simultaneous 24-h MII-pH and continuous O(2) saturation monitoring via pulse oximetry. Reflux-associated desaturation events were determined by correlating synchronized 24-h esophageal pH and/or impedance and O(2) desaturation. RESULTS: One thousand one hundred seventeen reflux events occurred in patients with RS and 734 in those with ES. Nearly 60% of these 1,851 reflux events were associated with O(2) desaturation. Markedly more events were associated with O(2) desaturation in patients with RS (74.5%, 832/1,117) than in patients with ES (30.4%, 223/734, p < 0.0001). The difference in reflux desaturation association was more profound with proximal reflux-80.3% with RS vs. 29.4% with ES (p < 0.0001). CONCLUSIONS: A remarkably high prevalence of O(2) desaturation associated with gastroesophageal reflux was noted in patients with RS. Given further study, simultaneous combined esophageal reflux and O(2) saturation monitoring may prove a useful diagnostic tool in this difficult group of patients.

Shiffman S, Kirchner TR, Ferguson SG, Scharf DM. (Jan 2009). Patterns of intermittent smoking: An analysis using Ecological Momentary Assessment. Addict Behav. [Epub ahead of print]

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

Snook EM, Motl RW, Gliottoni RC (Mar 2009). The effect of walking mobility on the measurement of physical activity using accelerometry in multiple sclerosis. Clin Rehabil, 23(3):248-58.

Objective: To examine whether accelerometry provides a measure of physical activity, walking ability or both in a sample of individuals with multiple sclerosis. The secondary purpose was to examine the validity of physical activity measures in people with multiple sclerosis who have ambulatory impairments.Participants: Forty-two individuals with multiple sclerosis without ambulatory impairment (Expanded Disability Status Scale (EDSS) score </= 4.5) and 32 individuals with multiple sclerosis with ambulatory impairment (EDSS >/=5.0).Method: Participants completed the Multiple Sclerosis Walking Scale-12 and Performance Scales, wore an accelerometer for seven days, and completed the Godin Leisure-Time Exercise Questionnaire and short-form of the International Physical Activity Questionnaire.Results: There were significant differences between groups on scores from the five measures. There were large correlations between the accelerometer counts with scores from both the self-report measures of physical activity and the self-report measures of walking mobility in the overall sample. There were large correlations between scores from both measures of physical activity in the overall sample and the subsample with ambulatory impairment.Conclusion: Our data suggest that accelerometers are measuring both physical activity and walking mobility in individuals with multiple sclerosis, whereas self-report measures are measuring physical activity in individuals with multiple sclerosis, including those with ambulatory impairment.

Spruill TM, Gerin W, Ogedegbe G, Burg M, Schwartz JE, Pickering TG. (Mar 2009). Socioeconomic and Psychosocial Factors Mediate Race Differences in Nocturnal Blood Pressure Dipping. Am J Hypertens. [Epub ahead of print]

BackgroundReduced nocturnal blood pressure (BP) dipping is more prevalent among blacks living in the United States than whites and is associated with increased target organ damage and cardiovascular risk. The primary aim of this study was to determine whether socioeconomic and psychosocial factors help to explain racial differences in dipping. In order to address the limited reproducibility of dipping measures, we investigated this question in a sample of participants who underwent multiple ambulatory BP monitoring (ABPM) sessions.MethodsThe study sample included 171 black and white normotensive and mildly hypertensive participants who underwent three ABPM sessions, each 1 month apart, and completed a battery of questionnaires to assess socioeconomic and psychosocial factors.ResultsAs expected, blacks showed less dipping than whites, after adjusting for age, sex, body mass index (BMI), and mean 24-h BP level (mean difference = 3.3%, P = 0.002). Dipping was related to several of the socioeconomic and psychosocial factors examined, with higher education and income, being married, and higher perceived social support, each associated with a larger dipping percentage. Of these, marital status and education were independently associated with dipping and together accounted for 36% of the effect of race on dipping.ConclusionsWe identified a number of socioeconomic and psychosocial correlates of BP dipping and found that reduced dipping among blacks vs. whites is partially explained by marital status (being unmarried) and lower education among blacks. We also present results suggesting that repeated ABPM may facilitate the detection of associations between dipping and other variables.

Stucky ER, Dresselhaus TR, Dollarhide A, Shively M, Maynard G, Jain S, Wolfson T, Weinger MB, Rutledge T (Feb 2009). Intern to attending: assessing stress among physicians. Acad Med, 84(2):251-7.

PURPOSE: Organizations have raised concerns regarding stress in the medical work environment and effects on health care worker performance. This study’s objective was to assess workplace stress among interns, residents, and attending physicians using Ecological Momentary Assessment technology, the gold-standard method for real-time measurement of psychological characteristics. METHOD: The authors deployed handheld computers with customized software to 185 physicians on the medicine and pediatric wards of four major teaching hospitals. The physicians contemporaneously recorded multiple dimensions of physician work (e.g., type of call day), emotional stress (e.g., worry, stress, fatigue), and perceived workload (e.g., patient volume). The authors performed descriptive statistics and t test and linear regression analyses. RESULTS: Participants completed 5,673 prompts during an 18-month period from 2004 to 2005. Parameters associated with higher emotional stress in linear regression models included male gender (t = -2.5, P = .01), total patient load (t = 4.2, P < .001), and sleep quality (t = -2.8, P = .006). Stress levels reported by attendings (t = -3.3, P = .001) were lower than levels reported by residents (t = -2.6, P = .009), and emotional stress levels of attendings and residents were both lower compared with interns. CONCLUSIONS: On inpatient wards, after recent resident duty hours changes, physician trainees continue to show wide-ranging evidence of workplace stress and poor sleep quality. This is among the first studies of medical workplace stress in real time. These results can help residency programs target education in stress and sleep and readdress workload distribution by training level. Further research is needed to clarify behavioral factors underlying variability in housestaff stress responses.

Tasca GA, Illing V, Balfour L, Krysanski V, Demidenko N, Nowakowski J, Bissada H. (Jan 2009). Psychometric properties of self-monitoring of eating disorder urges among treatment seeking women: ecological momentary assessment using a daily diary method. Eat Behav.10(1):59-61.

OBJECTIVES: The psychometric properties of an ecological momentary assessment (EMA) method used to evaluate eating disorder (ED) urges were examined. METHODS: Participants, 139 women who sought treatment for an ED, completed a daily diary measuring ED urges after each meal for a three week period at the start of treatment, and a measure of ED attitudes and behaviors pre- and post-treatment. RESULTS: The construct validity of this method was indicated by a two factor solution representing binge eating urges and ED compensatory behavior urges, and by significant differences between ED diagnostic groups on ED urge type. Correlations of ED urges early in therapy with outcomes provided evidence for predictive validity. Correlations at pre-treatment between ED urges and ED attitudes and behaviors supported criterion validity. EMA of ED urges showed good retest stability. CONCLUSIONS: EMA of ED urges is a valid and reliable approach that is associated with ED symptom severity, and predictive of treatment outcome.

Taylor RW, Murdoch L, Carter P, Gerrard DF, Williams SM, Taylor BJ (Jan 2009). Longitudinal study of physical activity and inactivity in preschoolers: the FLAME study. Med Sci Sports Exerc, 41(1):96-102.

PURPOSE: To investigate patterns of activity and inactivity in a birth cohort of children followed from 3 to 5 yr and to investigate whether changes in activity occurred over time. METHODS: Two hundred and forty-four children (44% female) were seen annually at 3, 4, and 5 yr. Physical activity and inactivity was measured by questionnaire (parent-proxy) and by Actical accelerometers for five consecutive days (24-h monitoring) each year in children and once in each parent for 7 d (69% with data). RESULTS: Retention of participants was high (92%). Viable accelerometry data were obtained for 76-85% of children at each age. Reliability estimates ranged from 0.80 (3 yr) to 0.84 (5 yr). Day of the week, season, sex, hours of childcare, or birth order did not affect daily average accelerometry counts (AAC) at any age. Parental activity correlated weakly with the child’s activity at 3 and 4 yr (r values = 0.17-0.28), but only the father’s activity remained a significant predictor of the child’s activity after adjustment for confounders. Children spent approximately 90 min.d in screen time (television, videos, DVD, and computers) with an additional 90 min in other sedentary activities (reading, drawing, and music). Physical activity was significantly reduced at 4 and 5 yr compared with 3 yr in both sexes, whether measured as AAC (24-h data, awake time only, weekend days, weekdays), time in moderate or vigorous activity, or from parental reports of activity. CONCLUSION: Levels of physical activity declined in boys and girls between the ages 3 and 4-5 yr, whether using objective measures or parental reports of activity.

Temple VA, Stanish HI (Jan 2009). Pedometer-measured physical activity of adults with intellectual disability: predicting weekly step counts. Am J Intellect Dev Disabil, 114(1):15-22.

Pedometers are objective, inexpensive, valid, and reliable measures of physical activity. The minimum number of days of pedometer monitoring needed to estimate average weekly step counts was investigated. Seven days of pedometer data were collected from 154 ambulatory men and women (ns = 88 and 66, respectively) with intellectual disability. Correlations between average weekly steps and 3-day combinations ranged from .80 to .94, and adjusted R(2) for 3 days of monitoring was .886. Results suggest that 3 days of pedometer wear is sufficient to predict average weekly steps among ambulatory adults with intellectual disability. This finding will allow researchers to reduce participant burden and study costs, may guide measurement procedures, and inform missing data protocols.

Theuns DA, Rivero-Ayerza M, Knops P, Res JC, Jordaens L (Mar 2009). Analysis of 57,148 transmissions by remote monitoring of implantable cardioverter defibrillators. Pacing Clin Electrophysiol, 32 Suppl 1:S63-5.

INTRODUCTION: Remote monitoring of implantable cardioverter defibrillators (ICD) is designed to decrease the number of ambulatory visits and facilitate the early detection of adverse events. We examined the impact of remote monitoring on clinical workload by a comprehensive analysis of transmitted events. METHODS: The study population consisted of 146 recipients of ICD capable of remote monitoring. Data were transmitted daily or in case of pre-specified events (e.g., arrhythmia, out-of-range lead and/or shock impedance). Transmitted events were classified as clinical (disease-related) or system-related. Event rates/patient/month were calculated and compared according to events classification and clinical groups. RESULTS: During a mean follow-up of 22 +/- 16 months, a total of 57,148 remote transmissions were recorded. Of these transmissions, 1009 (1.8%) were triggered by a pre-specified event, including induced ventricular fibrillation (VF) episodes during defibrillation threshold testing. The median number of events/patient/month was 0.14. Event rates were similar in patients with primary and secondary prevention indications for ICD (0.15 vs. 0.11). After exclusion of the induced VF episodes, 5.6% of transmitted events were classified as system-related and 94.4% as clinical. The median number of clinical events/patient/month was 0.023. The clinical event-free rates were 62% and 45%, at 1 and 4 years, respectively. CONCLUSION: Remote monitoring of ICD patients is feasible. Despite the large number of data transmissions, remote monitoring imposed a minimal additional burden on the clinical workload. The rate of triggered data transmissions by critical events was, relatively, very low.

Thompson D, Batterham AM, Markovitch D, Dixon NC, Lund AJ, Walhin JP (Feb 2009). Confusion and conflict in assessing the physical activity status of middle-aged men. PLoS ONE. 4(2):e4337.

BACKGROUND: Physical activity (including exercise) is prescribed for health and there are various recommendations that can be used to gauge physical activity status. The objective of the current study was to determine whether twelve commonly-used physical activity recommendations similarly classified middle-aged men as sufficiently active for general health. METHODS AND FINDINGS: We examined the commonality in the classification of physical activity status between twelve variations of physical activity recommendations for general health in ninety men aged 45-64 years. Physical activity was assessed using synchronised accelerometry and heart rate. Using different guidelines but the same raw data, the proportion of men defined as active ranged from to 11% to 98% for individual recommendations (median 73%, IQR 30% to 87%). There was very poor absolute agreement between the recommendations, with an intraclass correlation coefficient (A,1) of 0.24 (95% CI, 0.15 to 0.34). Only 8% of men met all 12 recommendations and would therefore be unanimously classified as active and only one man failed to meet every recommendation and would therefore be unanimously classified as not sufficiently active. The wide variability in physical activity classification was explained by ostensibly subtle differences between the 12 recommendations for thresholds related to activity volume (time or energy), distribution (e.g., number of days of the week), moderate intensity cut-point (e.g., 3 vs. 4 metabolic equivalents or METs), and duration (including bout length). CONCLUSIONS: Physical activity status varies enormously depending on the physical activity recommendation that is applied and even ostensibly small differences have a major impact. Approximately nine out of every ten men in the present study could be variably described as either active or not sufficiently active. Either the effective dose or prescription that underlies each physical activity recommendation is different or each recommendation is seeking the same prescriptive outcome but with variable success.

Treuth MS, Baggett CD, Pratt CA, Going SB, Elder JP, Charneco EY, Webber LS (Jan 2009). A Longitudinal Study of Sedentary Behavior and Overweight in Adolescent Girls. Obesity (Silver Spring). [Epub ahead of print]

The aim of this study is to examine sedentary and light activity in relation to overweight in adolescent girls. Adolescent girls were randomly recruited from 36 schools participating in the Trial of Activity for Adolescent Girls (TAAG). Assessments included age, ethnicity, socioeconomic status, and body composition estimated from weight, height, and triceps skinfold. Sedentary and light activity was measured for 6 days using accelerometry in 6th and in 8th grade among two randomly sampled cross-sections of girls. Sedentary activity increased from the 6th to 8th grade by 51.5 min/day. In the 8th grade, a significantly higher number of hours in sedentary activity for each of the 6-days of measurement were evident with higher tertiles of percent body fat (30-35%, >35% fat) (P < 0.05), but not across all increasing tertiles of BMI (5th to 85th, 85th to 95th, and >95th percentiles). The increase in sedentary activity was observed on weekdays, but not on weekends for percent body fat tertiles. In the cohort of girls measured in both 6th and 8th grades, the mean cross-sectional coefficient estimates were significant for percent body fat, but not BMI for sedentary and light activities. Adolescent girls from the 6th to 8th grade are shifting their time from light to more sedentary activity as measured by accelerometers. In addition, the increase in sedentary activity is not associated with an adverse effect on BMI or percent body fat. The eventual impact of this shift to a more sedentary lifestyle on body composition and other outcomes needs to be evaluated further.

Tsai SY, Burr RL, Thomas KA (Mar 2009). Effect of external motion on correspondence between infant actigraphy and maternal diary. Infant Behav Dev. [Epub ahead of print]

Correspondence between infant actigraphy and mother-recorded diary differed significantly when receiver-operator function area under the curve, correlation, and logistic regression was calculated with and without excluding periods of external motion. External motion occurred in 40% of recording time and significantly changed activity count per epoch.

Vahabzadeh M, Lin JL, Mezghanni M, Epstein DH, Preston KL. (Jan 2009). Automation in an addiction treatment research clinic: Computerised contingency management, ecological momentary assessment and a protocol workflow system. Drug Alcohol Rev. 28(1):3-11.

Abstract Introduction and Aims. A challenge in treatment research is the necessity of adhering to protocol and regulatory strictures while maintaining flexibility to meet patients’ treatment needs and to accommodate variations among protocols. Another challenge is the acquisition of large amounts of data in an occasionally hectic environment, along with the provision of seamless methods for exporting, mining and querying the data. Design and Methods. We have automated several major functions of our outpatient treatment research clinic for studies in drug abuse and dependence. Here we describe three such specialised applications: the Automated Contingency Management (ACM) system for the delivery of behavioural interventions, the transactional electronic diary (TED) system for the management of behavioural assessments and the Protocol Workflow System (PWS) for computerised workflow automation and guidance of each participant’s daily clinic activities. These modules are integrated into our larger information system to enable data sharing in real time among authorised staff. Results. ACM and the TED have each permitted us to conduct research that was not previously possible. In addition, the time to data analysis at the end of each study is substantially shorter. With the implementation of the PWS, we have been able to manage a research clinic with an 80 patient capacity, having an annual average of 18 000 patient visits and 7300 urine collections with a research staff of five. Finally, automated data management has considerably enhanced our ability to monitor and summarise participant safety data for research oversight. Discussion and Conclusions. When developed in consultation with end users, automation in treatment research clinics can enable more efficient operations, better communication among staff and expansions in research methods. [Vahabzadeh M, Lin J-L, Mezghanni M, Epstein DH, Preston KL. Automation in an addiction treatment research clinic: Computerised contingency management, ecological momentary assessment and a protocol workflow system.

Van Zundert, Rinka M. P.; Nijhof, Linda M.; Engels, Rutger C. M. E. (Mar 2009). Testing social cognitive theory as a theoretical framework to predict smoking relapse among daily smoking adolescents. Addictive Behaviors, 34(3), 281-286.

Predictors of adolescent smoking relapse are largely unknown, since studies either focus on relapse among adults, or address (long-term) smoking cessation but not relapse. In the present study, Social Cognitive Theory (SCT) was used as a theoretical framework to examine the first and second lapses, as well as mild and heavy relapse into smoking among 135 daily smoking adolescents who embarked on a serious quit attempt. Baseline predictors were pros of smoking, pros of quitting, self-efficacy, and intensity of smoking. Using an ecological momentary assessment (EMA) study design, participants were monitored three times a day during 4 weeks. A follow-up was administered 2 months after the monitoring period. Perceiving many pros of smoking, reporting a low self-efficacy to quit, and high levels of baseline smoking significantly predicted relapse within 3 weeks after quitting. The effects of pros of smoking and self-efficacy on relapse, however, appeared to be accounted for by differences in intensity of smoking. Besides that pros of quitting showed a marginal effect on abstinence at the 2-month follow-up, no long-term effects were detected.

Verduyn, Philippe; Delvaux, Ellen; Van Coillie, Hermina; Tuerlinckx, Francis; Van Mechelen, Iven (Feb 2009). Predicting the duration of emotional experience: Two experience sampling studies. Emotion, 9(1, 83-91.

The authors present 2 studies to explain the variability in the duration of emotional experience. Participants were asked to report the duration of their fear, anger, joy, gratitude, and sadness episodes on a daily basis. Information was further collected with regard to potential predictor variables at 3 levels: trait predictors, episode predictors, and moment predictors. Discrete-time survival analyses revealed that, for all 5 emotions under study, the higher the importance of the emotion-eliciting situation and the higher the intensity of the emotion at onset, the longer the emotional experience lasts. Moreover, a reappearance, either physically or merely mentally, of the eliciting stimulus during the emotional episode extended the duration of the emotional experience as well. These findings display interesting links with predictions within N. H. Frijda's theory of emotion, with the phenomenon of reinstatement (as studied within the domain of learning psychology), and with the literature on rumination.

Vranceanu AM, Gallo LC, Bogart LM (Feb 2009). Depressive symptoms and momentary affect: the role of social interaction variables. Depress Anxiety. [Epub ahead of print]

Background: Interpersonal functioning may be one important factor in the development and course of depression symptomatology. This study used ecological momentary assessment to test the associations among depressive symptoms, social experiences and momentary affect in women. Methods: Middle-aged women (N=108, M age: 41.6 years, 81% White) completed diary questions on handheld computers for 2 days. Diary items assessed social (conflictive versus supportive) and affective (negative versus positive) experiences at random times during the day. Women also completed a self-report measure of recent depressive symptoms. Results: Multilevel modeling analyses showed that higher levels of symptoms of depression were related to higher negative affect and lower positive affect both directly and indirectly, through experiences of social conflict. Depressive symptoms were not significantly related to socially supportive interactions. In an alternative model testing the reverse association, neither positive nor negative affect significantly predicted social experiences. Generalizability is limited by the homogenous small sample and strict inclusionary criteria (working full-time or part-time, cohabitating or married, healthy). Due to the cross sectional nature of the data as well as the manner in which social and affective experiences were assessed, definitive conclusions regarding the temporal associations among depression symptoms, social functioning, and affect are not possible. Results are consistent with prior reports suggesting the salience of socially conflictive experiences, and the role of affect, in the etiology and maintenance of depression symptoms. Conclusions: Interventions that attempt to decrease socially conflictive experiences via cognitive-behavioral skills training, whereas concomitantly targeting positive and negative affect, could help prevent the development of full-blown depressive episodes in vulnerable individuals.

Whalen CK, Henker B, Ishikawa SS, Floro JN, Emmerson NA, Johnston JA, Swindle R. (Feb 2009). ADHD and Anger Contexts: Electronic Diary Mood Reports from Mothers and Children. J Pediatr Psychol. [Epub ahead of print]

OBJECTIVE: Using electronic diaries (eDiaries), this study examined temporal links between child and maternal anger, as well as positive mood and perceived stress, in children with attention-deficit/hyperactivity disorder (ADHD) versus comparison peers. METHODS: Across 7 days, half-hourly eDiaries were completed independently by mothers and their 8-12-year-old children (51 receiving medication for ADHD and 58 comparison peers). RESULTS: Cross-informant analyses revealed systematic patterns of negative maternal moods in relation to child anger in both groups along with evidence of slower recovery in the ADHD group. Analogously, for both groups, children’s anger reports increased and good-mood reports decreased in relation to maternal anger, whereas elevated stress in relation to maternal anger was restricted to children with ADHD. CONCLUSIONS: The findings indicate that a negative affective climate is more likely to persist in ADHD than in comparison families. They also affirm the utility of child as well as parent eDiary reports and suggest that children may be willing to report low positive mood when reluctant to report negative mood. The promise of incorporating real-time data on mood patterning into tailored treatments for children with ADHD and their families is discussed.

Williamson P, Koro-Ljungberg ME, Bussing R (Mar 2009). Analysis of critical incidents and shifting perspectives: transitions in illness careers among adolescents with ADHD. Qual Health Res, 19(3):352-65.

Adolescence represents a developmental period during which the severity of mental health problems for children with attention deficit/hyperactivity disorder (ADHD) might change. It is a time when teens are consolidating their self-identity and possibly questioning the label of an ADHD diagnosis, treatment, and types of interventions. In this study we investigated the shared critical events related to help seeking reported by 8 teenagers with ADHD, their mothers, and their teachers and how the reported events and constructed shared focus on specific problems might explain teenagers’ transitions in their illness careers. Data collected through a qualitative application of the experience sampling method illuminated diverse illness career transitions, including continuing treatment, transitioning from being treated to untreated or from being untreated to treated, and remaining untreated. Our findings support a model of shifting perspectives on illness and wellness among adolescents with ADHD, rather than a progression of adaptation to a chronic disorder.

Woodiwiss AJ, Molebatsi N, Maseko MJ, Libhaber E, Libhaber C, Majane OH, Paiker J, Dessein P, Brooksbank R, Sareli P, Norton GR (Feb 2009). Nurse-recorded auscultatory blood pressure at a single visit predicts target organ changes as well as ambulatory blood pressure. J Hypertens, 27(2):287-97.

AIM: To determine whether high-quality nurse-recorded auscultatory blood pressure (BP) values obtained at a single visit predict cardiovascular target organ changes as closely as ambulatory BP measurements. METHODS: In a randomly selected population sample (n = 458, 21% receiving antihypertensive treatment; approximately 40% hypertensive), we compared high-quality single visit nurse-recorded auscultatory BP values to same-day 24-h ambulatory BP in their ability to predict multiple target organ changes [left ventricular mass index (LVMI), left ventricle (LV) mean wall thickness (MWT), early-to-late transmitral velocity ratios (E/A), (echocardiography); log of urinary albumin-to-creatinine ratios (log ACR) (24-h urine samples); large artery dysfunction [carotid-femoral pulse wave velocity (PWV) and central augmentation index (Alc) (applanation tonometry)]. RESULTS: Nurse-recorded systolic BP (SBP) measurements obtained at a single visit were as closely associated with LVMI (r = 0.44), LV MWT (r = 0.44), E/A (r = -0.55), log ACR (r = 0.20), PWV (r = 0.62) and AIc (r = 0.41) (P < 0.0001 for all relations) as was 24-h SBP (LVMI; r = 0.33, LV MWT; r = 0.37, E/A; r = -0.35, log ACR; r = 0.24, PWV; r = 0.41, and AIc; r = 0.18, P < 0.001 for all relations) and either day or night SBP. On multivariate regression analysis with both nurse-recorded SBP and 24-h SBP in the same model, nurse-recorded SBP was independently associated with LVMI (P = 0.006), LV MWT (P = 0.03), E/A (P < 0.02), PWV (P < 0.0001) and AIc (P = 0.0002), and 24-h SBP was independently and positively associated with log ACR (P < 0.005), and PWV (P = 0.01). CONCLUSION: One or more, high-quality single visit nurse-recorded auscultatory BP measurements may be equally as effective as ambulatory BP in predicting target organ damage in a population sample of African ancestry.

Yang CC, Hsu YL (Jan 2009). Development of a wearable motion detector for telemonitoring and real-time identification of physical activity. Telemed J E Health, 15(1):62-72.

Characteristics of physical activity are indicative of one’s mobility level, latent chronic diseases, and aging process. Current research has been oriented to provide quantitative assessment of physical activity with ambulatory monitoring approaches. This study presents the design of a portable microprocessor-based accelerometry measuring device to implement real-time physical activity identification. An algorithm was developed to process real-time tri-axial acceleration signals produced by human movement to identify targeted still postures, postural transitions, and dynamic movements. Fall detection was also featured in this algorithm to meet the increasing needs of elderly care in free-living environments. High identification accuracy was obtained in performance evaluation. This device is technically viable for telemonitoring and real-time identification of physical activity, while providing sufficient information to evaluate a person’s activity of daily living and her/his status of physical mobility. Limitations regarding real-time processing and implementation of the system for telemonitoring in the home environment were also observed.

Zhou SH, Helfenbein ED, Lindauer JM, Gregg RE, Feild DQ (Jan 2009). Philips QT interval measurement algorithms for diagnostic, ambulatory, and patient monitoring ECG applications. Ann Noninvasive Electrocardiol, 14 Suppl 1:S3-8.

BACKGROUND: Commonly used techniques for QT measurement that identify T wave end using amplitude thresholds or the tangent method are sensitive to baseline drift and to variations of terminal T wave shape. Such QT measurement techniques commonly underestimate or overestimate the “true” QT interval. METHODS: To find the end of the T wave, the new Philips QT interval measurement algorithms use the distance from an ancillary line drawn from the peak of the T wave to a point beyond the expected inflection point at the end of the T wave. We have adapted and optimized modifications of this basic approach for use in three different ECG application areas: resting diagnostic, ambulatory Holter, and in-hospital patient monitoring. The Philips DXL resting diagnostic algorithm uses an alpha-trimming technique and a measure of central tendency to determine the median QT value of eight most reliable leads. In ambulatory Holter ECG analysis, generally only two or three channels are available. QT is measured on a root-mean-square vector magnitude signal. Finally, QT measurement in the real time in-hospital application is among the most challenging areas of QT measurement. The Philips real time QT interval measurement algorithm employs features from both Philips DXL 12-lead and ambulatory Holter QT algorithms with further enhancements. RESULTS: The diagnostic 12-lead algorithm has been tested against the gold standard measurement database established by the CSE group with results surpassing the industrial ECG measurement accuracy standards. Holter and monitoring algorithm performance data on the PhysioNet QT database were shown to be similar to the manual measurements by two cardiologists. CONCLUSION: The three variations of the QT measurement algorithm we developed are suitable for diagnostic 12-lead, Holter, and patient monitoring applications.

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