Society for Ambulatory Assessment

Second quarter 2009 (April to June)

Agarwal R. (Jun 2009). Volume-Associated Ambulatory Blood Pressure Patterns in Hemodialysis Patients. Hypertension [Epub ahead of print]

Although volume excess causes hypertension, whether it also affects circadian patterns of arterial pressures among hemodialysis patients remains unknown. To test the notion of whether volume overload is associated with a unique blood pressure (BP) “signature,” a posthoc analysis was performed among 145 patients participating in the Dry-Weight Reduction in Hypertensive Hemodialysis Patients randomized, controlled trial. Using 400 ambulatory BP recordings over 8 weeks composed of 35 302 measurements, the trended cosinor model was found to be the best descriptor of BP chronobiology. The trended cosinor model may be described as a pattern of sinusoidal oscillation around a straight line with an upward trend during the interdialytic period that has an intercept at the postdialysis time. Augmented volume removal therapy reduced the intercept systolic BP and increased the rate of rise in systolic BP over the interdialytic interval but had no effect on the systolic BP fluctuation (amplitude). Thus, an elevated intercept and blunted slope pattern characterize the “volume-overload BP pattern” on ambulatory BP monitoring. Similar changes were seen for diastolic BP. Augmented volume removal therapy neither restored dipping nor was associated with a lag phenomenon for either the wake or the sleep systolic BP. Lowering of systolic BP was greater than diastolic BP such that pulse pressure was reduced. An observational cohort of 37 patients followed for 6 months confirmed these findings. Randomized trials are now needed to evaluate the clinical impact of augmented volume removal therapy on hard outcomes, because reduction of pulse pressure with this simple expedient has the potential to improve survival in hemodialysis patients.

Ball K, Cleland VJ, Timperio AF, Salmon J, Crawford DA. (May 2009). Socioeconomic Position and Childrens Physical Activity and Sedentary Behaviors: Longitudinal Findings From the CLAN Study. J Phys Act Health, 6, 289-98.

BACKGROUND: This study aimed to examine cross-sectional and longitudinal associations between socioeconomic position (SEP) and physical activity and sedentary behaviors amongst children and adolescents. METHODS: Maternal education was reported by parents of 184 5-6 year-old and 358 10-12 year-old children in 2001. In 2001 and 2004, physical activity was assessed by accelerometry. Older children self-reported and parents of younger children proxy-reported physical activity and television (TV) viewing behaviors. Linear regression was used to predict physical activity and sedentary behaviors, and changes in these behaviors, from maternal education. RESULTS: Among all children, accelerometer-determined and self/parent-reported moderate and vigorous physical activity declined over three years. Girls of higher SEP demonstrated greater decreases in TV viewing behaviours than those of low SEP. In general, no prospective associations were evident between SEP and objectively-assessed physical activity. A small number of prospective associations were noted between SEP and self-reported physical activity, but these were generally weak and inconsistent in direction. CONCLUSIONS: This study did not find strong evidence that maternal education was cross-sectionally or longitudinally predictive of children’s physical activity or sedentary behaviors. Given the well-documented inverse relationship of SEP with physical activity levels in adult samples, findings suggest that such disparities may emerge after adolescence.

Ball AM, Wielgus K, Hertzog M, Fischer P, Farr L (Apr 2009). Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy. Support Care Cancer [Epub ahead of print]

PURPOSE: The purpose of this study was to examine patterns of circadian activity rhythms and their relationship with fatigue, anxiety/depression, and demographic/medical variables in women receiving breast cancer adjuvant therapy treatments (Tx) at three times within a randomized clinical trial (RCT) designed to improve sleep and modify fatigue. METHODS: A RCT enrolled 219 women with stage I-IIIA breast cancer who were randomized 2 days prior to starting chemotherapy to a behavioral therapy sleep intervention or healthy eating control group. All cases with available data (n = 190) were included in a descriptive, correlational, repeated measures analysis. Activity data were collected continuously by wrist actigraphy for 7 days at three times: the start (Tx 1), continuation (Tx 3), and recovery (30 days after last Tx) of chemotherapy. Circadian activity rhythm parameters were generated using Action4 software (Ambulatory Monitoring, Inc.). Measures collected simultaneously included Piper Fatigue Scale, Hospital Anxiety and Depression Scale, and demographic/medical variables. RESULTS: Circadian activity rhythm parameters at three times in both groups were disrupted compared to healthy adults, but similar to values of cancer patients. Significant changes in mesor, amplitude, peak activity, and 24 h autocorrelation values were found over time in both groups. The intervention group’s amplitude and circadian quotient values were significantly more robust. More robust activity rhythms were associated with lower fatigue, depressive symptoms, body mass index, and higher performance status in both groups. CONCLUSIONS: Disrupted patterns of circadian activity rhythms were prevalent and associated with distressing fatigue and depressive symptoms during chemotherapy and at recovery. The intervention resulted in more robust rhythms.

Björling EA (Apr 2009). The Momentary Relationship Between Stress and Headaches in Adolescent Girls. Headache [Epub ahead of print]

Objective.- The objective of this study was to compare the relationship between repeated momentary reports of stress and headaches in female adolescents with varying degrees of headache frequency. Background.- Headaches are the most common form of pain reported by adolescents affecting more than a third of all adolescents. High levels of stress during adolescence may predispose an adolescent to experience headaches in adulthood. Randomized, momentary data collection of stress and headaches provides the most accurate data regarding the adolescent experience of these variables. Methods.- The research methodology, ecological momentary assessment, is a valid approach to better understand the relationship between stress and headaches in adolescence. Data were obtained by each participant’s use of an electronic diary (ED), which captured repeated momentary reports of perceived stress, head pain, and stress-related symptoms in female adolescents with varying degrees of recurrent headache. Seven times per day for the 21-day study period, teen girls responded to ED questions about their current stress levels, head pain, and stress-related symptoms. Based on participants’ momentary reports of headaches, Low Headache, Moderate Headache, and Chronic Headache groups were created. General estimating equation models were used to analyze the relationship between momentary variables as well as the lag effect between stress and head pain. Results.- Thirty-one participants, aged 14-18 years, completed 2841 randomized ED reports and reported 674 occurrences of headache. The Chronic Headache and Moderate Headache groups reported significantly increased levels of stress, head pain, and headaches. The relationship between momentary stress and head pain was significantly strong both within and across participants. The strength of this relationship increased with increased headache activity. A significant lag effect was found between stress and headaches; however, the effect of depression as a moderator of the stress and headache relationship remains unclear. Conclusion.- Perceived stress and head pain was highly correlated in these female adolescents. Given the large population of teens affected by headaches, a plausible next step would be to validate these results in other samples and to determine methods with which to identify teens who may be at risk for a pattern of increasing stress and headaches.

Brondolo, E.; Grantham, K.I.; Karlin, W.; Taravella, J.; Mencía-Ripley, A.; Schwartz, J.E.; Pickering, T.G.; Contrada, R.J. (Apr 2009). Trait hostility and ambulatory blood pressure among traffic enforcement agents: The effects of stressful social interactions. Journal of Occupational Health Psychology, 14, 110-121.

This study investigated the hypothesis that trait hostility is associated with heightened cardiovascular reactivity to potentially stressful social interactions but not to nonsocial activities in the workplace. Participants were 73 (39 women) New York City traffic enforcement agents (TEAs) who patrol the streets and issue summonses for vehicular and parking violations. During their patrols, TEAs face potentially stressful interactions when they encounter motorists and pedestrians who may be angry about receiving summonses. Mood and ambulatory blood pressure were initially measured when TEAs were recently hired and attending classes at the training academy (Time 1), and were subsequently assessed again once the TEAs began independently patrolling the city streets (Time 2). Random effects regression models yielded a significant interaction of hostility and work activity on ambulatory systolic blood pressure at Time 2. For those high in hostility, but not for those low in hostility, systolic blood pressure levels were higher while interacting with members of the public than during nonsocial work activities. The findings support the notion that situational factors affect the association of hostility to cardiovascular reactivity, and that interpersonal stressors in the workplace elicit cardiovascular activation among those high in hostility.

Brown DE, Sievert LL, Morrison LA, Reza AM, Mills PS (Apr 2009).Do Japanese American women really have fewer hot flashes than European Americans? The Hilo Women’s Health Study. Menopause [Epub ahead of print]

OBJECTIVE:: Many studies have found a significantly lower frequency of reported hot flashes (HFs) in Japanese and Japanese American (JA) populations, leading to speculation about possible dietary, genetic, or cultural differences. These studies have relied on subjective reports of HFs. Accordingly, the purpose of this study was to compare both reported and objective HFs measured by sternal and nuchal skin conductance among JA and European American (EA) women. METHODS:: Two surveys of HF frequencies were carried out among women of either EA or JA ethnicity; aged 45 to 55 years; living in Hilo, Hawaii; and not using exogenous hormones. The first was a postal questionnaire (n = 325); the second was carried out during a clinical study of HFs (n = 134). Women in the second group underwent 24-hour ambulatory and 3-hour laboratory monitoring for objective HFs measured through skin conductance at sternal and nuchal sites. Subjective HFs were recorded on the monitor or in a diary. RESULTS:: JAs were significantly less likely to report having had HFs in the previous 2 weeks compared with EAs (postal sample: JAs, 30.9%; EAs, 43.9%; chi = 6.9, P < 0.01; monitored sample: JAs, 26.1%; EAs, 46.6%; chi = 5.3, P < 0.05). JAs were also significantly less likely to report experiencing other symptoms (15 of 30 in the postal sample; 6 of 30 in the monitored sample) than EAs. However, JAs did not significantly differ in likelihood of reporting subjective HFs during the 24-hour ambulatory period (JAs, 51.1%; EAs, 55.8%; chi = 0.3, NS), nor in percentage of individuals displaying one or more objective HFs as measured by the skin conductance monitor (JAs, 77.8%; EAs, 72.1%; chi = 0.5, NS). JAs also did not have a significantly fewer number of objective HFs (t = 0.2, NS) nor of subjective HFs (t = 0.8, NS) during the monitoring period, and these results were unchanged when analyses controlled for menopause status and body mass index. CONCLUSIONS:: The common finding of fewer reported HFs in people of Japanese ancestry may be a consequence of reporting bias: JAs report fewer symptoms of many conditions compared with people from other ethnic groups. This is probably due to cultural conceptions of what is appropriate to report.

Burd C, Mitchell JE, Crosby RD, Engel SG, Wonderlich SA, Lystad C, Le Grange D, Peterson CB, Crow S (May 2009). An assessment of daily food intake in participants with anorexia nervosa in the natural environment. Int J Eat Disord, 42, 371-4.

OBJECTIVE: To examine the caloric intake in women with anorexia nervosa (AN) and how it varies by day as a function of the presence or absence of binge eating and/or purging behaviors. METHOD: Female participants with AN (n = 84, mean age = 24.4, range 18-51) were recruited from three different sites. Data on food intake were obtained through the use of 24-h dietary recall using the Nutritional Data Systems for Research, and data on binge eating and purging behaviors were collected on palmtop computers using an ecological momentary assessment paradigm. Daily macronutrient intake was compared on days during which binge eating and/or purging behaviors did or did not occur. RESULTS: On days during which binge eating and purging behaviors both occurred, participants reported significantly greater kilocalorie intake when compared with days when neither behavior occurred, or when only binge eating or purging occurred. Binge eating episodes were only modest in size on days when purging did not occur. Energy intake overall was higher than expected. DISCUSSION: Intake on days where binge eating occurred varied dramatically based on whether or not purging occurred. Whether markedly increased binge eating intake was causally related to purging is unclear. Nonetheless eating episodes were at times quite large and equivalent to those reported by participants with bulimia nervosa in other research.

Bussmann, J.B.J., Ebner-Priemer, U.W. & Fahrenberg, J. (2009). Ambulatory Activity Monitoring: Progress in Measurement of Activity, Posture, and Specific Motion Patterns in Daily Life. European Psychologist, 14, 142-152.

Behavior is central to psychology in almost any definition. Although observable activity is a core aspect of behavior, assessment strategies have tended to focus on emotional, cognitive, or physiological responses. When physical activity is assessed, it is done so mostly with questionnaires. Converging evidence of only a moderate association between self-reports of physical activity and objectively measured physical activity does raise questions about the validity of these self-reports. Ambulatory activity monitoring, defined as the measurement strategy to assess physical activity, posture, and movement patterns continuously in everyday life, has made major advances over the last decade and has considerable potential for further application in the assessment of observable activity, a core aspect of behavior. With new piezoresistive sensors and advanced computer algorithms, the objective measurement of physical activity, posture, and movement is much more easily achieved and measurement precision has improved tremendously. With this overview, we introduce to the reader some recent developments in ambulatory activity monitoring. We will elucidate the discrepancies between objective and subjective reports of activity, outline recent methodological developments, and offer the reader a framework for developing insight into the state of the art in ambulatory activity-monitoring technology, discuss methodological aspects of time-based design and psychometric properties, and demonstrate recent applications. Although not yet main stream, ambulatory activity monitoring—especially in combination with the simultaneous assessment of emotions, mood, or physiological variables—provides a comprehensive methodology for psychology because of its suitability for explaining behavior in context.

Butler JM, Whalen CK, Jamner LD (May 2009). Bummed out now, feeling sick later: weekday versus weekend negative affect and physical symptom reports in high school freshmen. J Adolesc Health, 44, 452-7.

PURPOSE: This study examined adolescent negative affect (NA) in daily life on school days and weekend days during the spring and associations with physical symptoms during the following summer. METHODS: Using experience sampling methodology (ESM), participants provided electronic diary (eDiary) reports of NA on weekdays (Thursday and Friday) and weekend days during their 9th grade year. In telephone interviews during the winter and summer months they reported physical symptoms. Multiple regression analyses were conducted to examine associations between weekday NA, weekend NA, and their interaction and four constellations of physical symptoms reported in summer (pain, respiratory, gastrointestinal, and immune symptoms). RESULTS: Findings indicated that weekend NA was associated with later reports of pain, respiratory, and immune symptoms. For gastrointestinal symptoms only adolescents who reported low NA on both weekend and school days reported fewer gastric symptoms than other adolescents. CONCLUSIONS: Mapping the predictors and correlates of weekend NA may be important not only for understanding teenage mood patterns but also for enhancing the interpretation of physical symptom reporting by adolescents.

Cain AE, Depp CA, Jeste DV (Jul 2009). Ecological momentary assessment in aging research: a critical review. J Psychiatr Res, 43, 987-96.

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 210 days. 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.

Chang TY, Lai YA, Hsieh HH, Lai JS, Liu CS. (Jun 2009). Effects of environmental noise exposure on ambulatory blood pressure in young adults. Environ Res [Epub ahead of print]

Epidemiological studies have demonstrated that environmental noise exposure is associated with hypertension in middle-aged and older populations, but the relationship in the young subpopulation and between the genders is still unclear. This panel study investigated effects of environmental noise exposure on 24-h ambulatory blood pressure in 60 adults aged 18-32 years. Individual noise exposure and personal blood pressure were measured simultaneously for 30 males and 30 females. Linear mixed-effects regression models were applied to estimate effects. Total subjects (56.6+/-16.5A-weighted decibels (dBA)) had transient elevations of 1.15 (95% CI=0.86-1.43)mmHg SBP and 1.16 (0.93-1.38)mmHg DBP at daytime, as well as 0.74 (0.21-1.26)mmHg SBP and 0.77 (0.34-1.20)mmHg DBP at nighttime, significantly associated with a 5-dBA increase in noise exposure. Such effects on SBP and DBP still persisted at the 30- and 60-min time-lagged noise exposure. Per 5-dBA increase in 24-h average noise exposure was significantly associated with sustained increments of 1.15 (0.76-1.54)mmHg SBP and 1.27 (0.96-1.58)mmHg DBP in males (57.4+/-16.0dBA), as well as the higher levels of 1.65 (1.36-1.94)mmHg SBP and 1.51 (1.27-1.75)mmHg DBP in females (55.9+/-17.0dBA). We found that environmental noise exposure may have elevated effects on adults’ blood pressure. Young females are more susceptible to noise exposure than males.

Chastin SF, Dall PM, Tigbe WW, Grant MP, Ryan CG, Rafferty D, Granat MH (Jun 2009). Compliance with physical activity guidelines in a group of UK-based postal workers using an objective monitoring technique. Eur J Appl Physiol [Epub ahead of print]

Compliance with physical activity (PA) recommendations was assessed using objective PA monitoring of ambulatory activity, in two healthy groups of individuals with active and sedentary occupations. The study showed generally low compliance with the guidelines (53% with 10,000 steps a day; 10% with 30 min of moderate activity a day; and 1% with 30 min of moderate activity a day in bouts of at least 10 min (ACSM)). Adherence to guidelines decreased as more rigorous conditions were applied to the PA data. Use of an objective monitor revealed that health enhancing bouts of activity were performed in periods of approximately 1-min duration, which may be due to unavoidable environmental interruptions. These bouts of activity are much shorter than those advocated in the ACSM guidelines, raising questions regarding how actual behaviour, based on objective monitoring, can be reconciled with guidelines based on self-reported PA.

Chen C, Jerome GJ, Laferriere D, Young DR, Vollmer WM. (May 2009). Procedures Used to Standardize Data Collected by RT3 Triaxial Accelerometers in a Large-Scale Weight-Loss Trial. J Phys Act Health, 6, 354-9.

BACKGROUND: Accelerometers measure intensity, frequency, and duration of physical activity. However, the scarcity of reports on data reduction makes comparing accelerometer results across studies difficult. METHODS: Participants were asked to wear a triaxial accelerometer (RT3) for ?10 hours for at least 4 days, including one weekend day. We summarize our data-cleaning procedures and assess the impact of defining a usable day of measurements as at least 6, 8, or 10 hours of wear time, and of standardizing data to a 12-hour day. RESULTS: Eighty-two percent of participants met wear time requirements; 93% met requirements when we defined a day as 8-or-more hours of wear time. Normalization of data to a 12-hour day had little impact on estimates of daily moderate-to-vigorous physical activity (MVPA; 16.9 vs. 17.1 minutes); restricting MVPA to activities occurring in bouts of 10 minutes or longer had greater impact (16.9 vs. 6.3 minutes per day). CONCLUSION: Our account of accelerometry quality-control and data-cleaning procedures documents the small impact of variations in daily wear time requirements on MVPA estimates, and the larger impact of evaluating total MVPA vs. MVPA occurring in extended bouts. This paper should allow other researchers to duplicate or revise our methods as needed.

Chen Z, Brown EN, Barbieri R (Jul 2009). Assessment of autonomic control and respiratory sinus arrhythmia using point process models of human heart beat dynamics. IEEE Trans Biomed Eng, 56, 1791-802.

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 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.

Davis JN, Tung A, Chak SS, Ventura EE, Byrd-Williams CE, Alexander KE, Lane CJ, Weigensberg MJ, Spruijt-Metz D, Goran MI (Jul 2009). Aerobic and strength training reduces adiposity in overweight Latina adolescents. Med Sci Sports Exerc, 41, 1494-503.

PURPOSE: To date, no study has examined the synergistic effects of a nutrition and combination of aerobic and strength training (CAST) on both adiposity and metabolic parameters in overweight Latina adolescent females. The goal was to assess if a 16-wk nutrition plus CAST pilot study had stronger effects on reducing adiposity and on improving glucose/insulin indices compared with control (C), nutrition only (N), and a nutrition plus strength training (N + ST) groups. METHODS: In a 16-wk randomized trial, 41 overweight Latina girls (15.2 +/- 1.1 yr) were randomly assigned to C (n = 7), N (n = 10), N + ST (n = 9), or N + CAST (n = 15). All intervention groups received modified carbohydrate nutrition classes (once a week), whereas the N + ST also received strength training (twice a week) and the N + CAST received a combination of strength and aerobic training (twice a week). The following were measured before and after intervention: strength by one repetition maximum, physical activity by the 7-d accelerometry and the 3-d physical activity recall, dietary intake by 3-d records, body composition by dual-energy x-ray absorptiometry (DEXA), glucose/insulin indices by oral glucose tolerance test, and intravenous glucose tolerance test with minimal modeling. Across intervention group, effects were tested using ANCOVA with post hoc pairwise comparisons. RESULTS: There were significant overall intervention effects for all adiposity measures (weight, body mass index [BMI], BMI z-scores, and DEXA total body fat), with a decrease of 3% in the N + CAST group compared with a 3% increase in the N + ST group (P < or = 0.05). There was also an intervention effect for fasting glucose with the N group increasing by 3% and the N + CAST group decreasing by 4% (P < or = 0.05). CONCLUSION: The CAST was more effective than nutrition alone or nutrition plus strength training for reducing multiple adiposity outcomes and fasting glucose in overweight Latina girls. However, further research investigating and identifying intervention approaches that improve both adiposity and insulin indices, particularly in high-risk populations, are warranted.

Deforche B, De Bourdeaudhuij I, D’hondt E, Cardon G (May 2009). Objectively measured physical activity, physical activity related personality and body mass index in 6- to 10-yr-old children: a cross-sectional study. Int J Behav Nutr Phys Act, 6, 25.

ABSTRACT: BACKGROUND: The prevalence and level of overweight in childhood is rapidly increasing. One potential contributor to the rise in overweight is a decline in physical activity (PA). The purpose of this study was to compare levels and patterns of PA and PA related personality in normal-weight (NW) and overweight (OW) 6- to 10-yr-old children. METHODS: Subjects were grouped into OW (N = 59, BMI = 24.2 +/- 4.8 kg/m2) or NW (N = 61, BMI = 15.7 +/- 1.5 kg/m2) according to International Obesity Task Force cut-offs. PA was assessed by accelerometry. Parents filled in a questionnaire on PA and sedentary behaviour and PA related personality of their child (born tired, moves slowly, is often tired, lacks energy, avoids physical efforts, prefers watching playing children instead of joining them, is always active, needs to let himself/herself go, has a lot of energy). RESULTS: NW children spent on average 77 min/day in MVPA, whereas OW children only 57 min/day (p = .001). OW children had fewer 5, 10 and 20 min bouts of MVPA (p = .01). OW and NW children showed identical PA patterns on both week days and weekends, although at different levels. According to parents’ report, a greater percentage of OW children was not engaged in any sport (46% versus 23%, chi2 = 6.3, p = .01). OW children had a less active personality (p < .001), watched more TV during weekend (p < .01), but no differences were found in outside play or non-active play. BMI of mother and father explained 29% of the variance in children’s BMI z-score (p < .001). PA related personality, screen behaviour during weekend and MVPA explained an additional 12% (p < 0.01). CONCLUSION: The results of this study demonstrate that NW children spent on average 20 min per day more in MVPA. PA patterns were similar in NW versus OW children, although at different levels. Greatest differences in PA according to weight status were found in the afternoon during after school hours. This is the first study to show distinct PA related personality traits in OW children compared to NW peers.

Devito Dabbs A, Dew MA, Myers B, Begey A, Hawkins R, Ren D, Dunbar-Jacob J, O’Connell E, McCurry K (May 2009). Evaluation of a hand-held, computer-based intervention to promote early self-care behaviors after lung transplant. Clin Transplant [Epub ahead of print]

Background: Lung transplant recipients are expected to perform self-care behaviors to maximize transplant-related health outcomes. Despite high non-adherence rates in performing these self-care behaviors, and the dire clinical consequences of such non-adherence, interventions are lacking. Pocket Personal Assistant for Tracking Health (Pocket PATH) is a hand-held device developed for patients to record health data, review data trends, and report condition changes to the transplant team. Methods: A pilot trial was conducted to compare self-care agency, self-care behaviors, and health-related quality of life (HRQOL) between recipients randomized to use Pocket PATH (n = 15) vs. standard care (n = 15) for the first two months following hospital discharge after lung transplantation. Results: Baseline characteristics were equivalent across groups. Patients in the Pocket PATH group showed significantly higher ratings of self-care agency, performed self-care behaviors at significantly higher rates, and reported significantly better HRQOL than standard care controls. Conclusion: Pocket PATH is more efficacious than standard care in promoting early self-care agency, self-care behaviors, and HRQOL in lung recipients. A large-scale randomized controlled trial is needed to test the impact of Pocket PATH on long-term self-care behaviors.

Ebner-Priemer, U.W. & Trull, T.J. (2009). Ambulatory Assessment - An Innovative and Promising Approach for Clinical Psychology. European Psychologist, 14, 109-119.

Convergent experimental data, autobiographical studies, and investigations on daily life have all demonstrated that gathering information retrospectively is a highly dubious methodology. Retrospection is subject to multiple systematic distortions (i.e., affective valence effect, mood congruent memory effect, duration neglect; peak end rule) as it is based on (often biased) storage and recollection of memories of the original experience or the behavior that are of interest. The method of choice to circumvent these biases is the use of electronic diaries to collect self-reported symptoms, behaviors, or physiological processes in real time. Different terms have been used for this kind of methodology: ambulatory assessment, ecological momentary assessment, experience sampling method, and real-time data capture. Even though the terms differ, they have in common the use of computer-assisted methodology to assess self-reported symptoms, behaviors, or physiological processes, while the participant undergoes normal daily activities. In this review we discuss the main features and advantages of ambulatory assessment regarding clinical psychology and psychiatry: (a) the use of realtime assessment to circumvent biased recollection, (b) assessment in real life to enhance generalizability, (c) repeated assessment to investigate within person processes, (d) multimodal assessment, including psychological, physiological and behavioral data, (e) the opportunity to assess and investigate context-specific relationships, and (f) the possibility of giving feedback in real time. Using prototypic examples from the literature of clinical psychology and psychiatry, we demonstrate that ambulatory assessment can answer specific research questions better than laboratory or questionnaire studies.

Eguchi K, Kuruvilla S, Ogedegbe G, Gerin W, Schwartz JE, Pickering TG (May 2009). What is the optimal interval between successive home blood pressure readings using an automated oscillometric device? J Hypertens, 27, 1172-7.

OBJECTIVES: To clarify whether a shorter interval between three successive home blood pressure (HBP) readings (10 s vs. 1 min) taken twice a day gives a better prediction of the average 24-h BP and better patient compliance. DESIGN: We enrolled 56 patients from a hypertension clinic (mean age: 60 +/- 14 years; 54% female patients). The study consisted of three clinic visits, with two 4-week periods of self-monitoring of HBP between them, and a 24-h ambulatory BP monitoring at the second visit. Using a crossover design, with order randomized, the oscillometric HBP device (HEM-5001) could be programmed to take three consecutive readings at either 10-s or 1-min intervals, each of which was done for 4 weeks. Patients were asked to measure three HBP readings in the morning and evening. All the readings were stored in the memory of the monitors. RESULTS: The analyses were performed using the second-third HBP readings. The average systolic BP/diastolic BP for the 10-s and 1-min intervals at home were 136.1 +/- 15.8/77.5 +/- 9.5 and 133.2 +/- 15.5/76.9 +/- 9.3 mmHg (P = 0.001/0.19 for the differences in systolic BP and diastolic BP), respectively. The 1-min BP readings were significantly closer to the average of awake ambulatory BP (131 +/- 14/79 +/- 10 mmHg) than the 10-s interval readings. There was no significant difference in patients’ compliance in taking adequate numbers of readings at the different time intervals. CONCLUSION: The 1-min interval between HBP readings gave a closer agreement with the daytime average BP than the 10-s interval.

Ekelund U, Brage S, Griffin SJ, Wareham NJ; ProActive UK Research Group (Jun 2009). Objectively measured moderate- and vigorous-intensity physical activity but not sedentary time predicts insulin resistance in high-risk individuals. Diabetes Care, 32, 1081-6.

OBJECTIVE: Low levels of physical activity appear to be associated with insulin resistance. However, the detailed associations of these complex relationships remain elusive. We examined the prospective associations between self-reported TV viewing time, objectively measured time spent sedentary, at light-intensity activity, and at moderate- and vigorous-intensity physical activity (MVPA) with insulin resistance. RESEARCH DESIGN AND METHODS: In 192 individuals (81 men and 111 women) with a family history of type 2 diabetes, we measured physical activity and anthropometric and metabolic variables at baseline and after 1 year of follow-up in the ProActive UK trial. Physical activity was measured objectively by accelerometry. Insulin resistance was expressed as fasting insulin and the homeostasis model assessment score (HOMA-IR). RESULTS: Baseline MVPA was a significant predictor of fasting insulin at follow-up (beta = -0.004 [95% CI -0.007 to -0.0001], P = 0.022), and the association approached significance for HOMA-IR (beta = -0.003 [-0.007 to 0.000002], P = 0.052), independent of time spent sedentary, at light-intensity activity, sex, age, smoking status, waist circumference, and self-reported TV viewing. Time spent sedentary and at light-intensity activity were not significantly associated with insulin resistance. The change in MVPA between baseline and follow-up was inversely related to fasting insulin (beta = -0.003 [-0.007 to -0.0003], P = 0.032) and the HOMA-IR score (beta = -0.004 [-0.008 to -0.001], P = 0.015) at follow-up, after adjustment for baseline phenotype in addition to the same confounders as above. CONCLUSIONS: These results highlight the importance of promoting moderate-intensity activity such as brisk walking for improving insulin sensitivity and possibly other metabolic risk factors to prevent type 2 diabetes.

Finan PH, Zautra AJ, Davis MC (May 2009). Daily affect relations in fibromyalgia patients reveal positive affective disturbance. Psychosom Med, 71, 474-82.

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.

Friedberg, F.; Sohl, S.J. (Apr 2009). Longitudinal change in chronic fatigue syndrome: What home-based assessments reveal. Journal of Behavioral Medicine, 32, 209-218.

The purpose of this 2-year prospective study was to compare standard self-report and ecologically-based outcome measures in patients with chronic fatigue syndrome (CFS). Standard measures assessed physical function, fatigue impact, psychological variables, and global impression of change ratings. Ecological measures included actigraphy, a structured activity record, and an electronic fatigue/energy diary. Results for this high functioning sample (N = 75) revealed that self-report global improvement was significantly associated with lower momentary fatigue and fatigue impact, and a higher frequency of standing up (at home), but not with actigraphy or psychological variables. However, actigraphy change was significantly correlated with change in self-report physical function. At follow-up, only a small minority (<20%) scored in the healthy adult range for fatigue impact and physical function. The findings suggest that home-based measures of symptom severity and physical functioning may provide evidence of change (or lack of change) that is important for interpreting standard self-report outcomes in CFS.

Gimpel C, Wühl E, Arbeiter K, Drozdz D, Trivelli A, Charbit M, Gellermann J, Dusek J, Jankauskiene A, Emre S, Schaefer F; for ESCAPE Trial Group (Jun 2009). Superior consistency of ambulatory blood pressure monitoring in children: implications for clinical trials. J Hypertens [Epub ahead of print]

BACKGROUND: Casual office blood pressure (CBP) measurements are still standard in antihypertensive drug trials. In pediatric hypertensive trials, ethical considerations, very low disease prevalence and the marked impact of white-coat hypertension create the need for very sensitive and reproducible techniques of BP assessment. We hypothesized that ambulatory BP monitoring (ABPM) may identify treatment effects more sensitively than CBP and thereby reduce sample sizes required in pediatric antihypertensive trials. METHODS: Standard deviations (SDs) were used to assess population variability of CBP and ABPM at baseline and after 6 months standardized antihypertensive treatment from a trial investigating the BP-lowering effect of ramipril in children with chronic kidney disease. RESULTS: In 157 hypertensive children, ramipril had a similar mean BP-lowering effect on clinic and ambulatory 24-h BP for systolic (-10 vs. -11 mmHg, P = NS) and diastolic values (-9 vs. -11 mmHg, P = NS). However, the SDs of the CBP responses were up to 39% larger than those of ABPM (SBP 15.5 vs. 9.4; DBP 13.8 vs. 8.8; both P < 0.0001). Using power analysis, we demonstrate that, depending on the magnitude of the expected antihypertensive effect and trial design, the utilization of ABPM in antihypertensive drug efficacy studies allows reduction of sample sizes by 57-75%. This reduction of cohort size with ABPM is substantially greater than previously observed for adults. CONCLUSION: The primary use of ABPM can substantially reduce the number of children put at potential risk in blinded antihypertensive drug trials by up to three quarters.

Glaser JP, Van Os J, Thewissen V, Myin-Germeys I. (Jun 2009). Psychotic reactivity in borderline personality disorder. Acta Psychiatr Scand [Epub ahead of print]

Objective: To investigate the stress relatedness and paranoia specificity of psychosis in borderline personality disorder (BPD). Method: Fifty-six borderline patients, 38 patients with cluster C personality disorder, 81 patients with psychotic disorder and 49 healthy controls were studied with the experience sampling method (a structured diary technique) to assess: i) appraised subjective stress and ii) intensity of psychotic experiences. Results: All patient groups experienced significantly more increases in psychotic experiences in relation to daily life stress than healthy controls, borderline patients displaying the strongest reactivity. Borderline patients, moreover, reported significantly more hallucinatory reactivity than healthy controls and subjects with cluster C personality disorder. Paranoid reactivity to daily life stress did not differ between the patient groups. Conclusion: These results are the first to ecologically validate stress-related psychosis in BPD. However, psychotic reactivity was not limited to expression of paranoia but involved a broader range of psychotic experiences including hallucinations.

Godfrey A, Conway R, Leonard M, Meagher D, Olaighin G. (Jun 2009). A classification system for delirium subtyping with the use of a commercial mobility monitor. Gait Posture [Epub ahead of print]

The usefulness of motor subtypes of delirium is unclear due to inconsistency in subtyping methods and a lack of validation with objective measures of activity. The activity of 40 patients was measured over 24h with a commercial accelerometer-based activity monitor. Accelerometry data from patients with DSM-IV delirium that were readily divided into hyperactive, hypoactive and mixed motor subtypes, were used to create classification trees that were subsequently applied to the remaining cohort to define motoric subtypes. The classification trees used the periods of sitting/lying, standing, stepping and number of postural transitions as measured by the activity monitor as determining factors from which to classify the delirious cohort. The use of a classification system shows how delirium subtypes can be categorised in relation to overall activity and postural changes, which was one of the most discriminating measures examined. The classification system was also implemented to successfully define other patient motoric subtypes. Motor subtypes of delirium defined by observed ward behaviour differ in electronically measured activity levels.

Godfrey A, Conway R, Leonard M, Meagher D, Olaighin GM (Jun 2009). A continuous wavelet transform and classification method for delirium motoric subtyping. IEEE Trans Neural Syst Rehabil Eng, 7, 298-307.

The usefulness of motor subtypes of delirium is unclear due to inconsistency in subtyping methods and a lack of validation with objective measures of activity. The activity of 40 patients was measured over 24 h with a discrete accelerometer-based activity monitor. The continuous wavelet transform (CWT) with various mother wavelets were applied to accelerometry data from three randomly selected patients with DSM-IV delirium that were readily divided into hyperactive, hypoactive, and mixed motor subtypes. A classification tree used the periods of overall movement as measured by the discrete accelerometer-based monitor as determining factors for which to classify these delirious patients. This data used to create the classification tree were based upon the minimum, maximum, standard deviation, and number of coefficient values, generated over a range of scales by the CWT. The classification tree was subsequently used to define the remaining motoric subtypes. The use of a classification system shows how delirium subtypes can be categorized in relation to overall motoric behavior. The classification system was also implemented to successfully define other patient motoric subtypes. Motor subtypes of delirium defined by observed ward behavior differ in electronically measured activity levels.

Gonzalez RC, Alvarez D, Lopez AM, Alvarez JC (Apr 2009). Ambulatory estimation of mean step length during unconstrained walking by means of COG accelerometry. Comput Methods Biomech Biomed Engin [Epub ahead of print]

It has been reported that spatio-temporal gait parameters can be estimated using an accelerometer to calculate the vertical displacement of the body’s centre of gravity. This method has the potential to produce realistic ambulatory estimations of those parameters during unconstrained walking. In this work, we want to evaluate the crude estimations of mean step length so obtained, for their possible application in the construction of an ambulatory walking distance measurement device. Two methods have been tested with a set of volunteers in 20 m excursions. Experimental results show that estimations of walking distance can be obtained with sufficient accuracy and precision for most practical applications (errors of 3.66 +/- 6.24 and 0.96 +/- 5.55%), the main difficulty being inter-individual variability (biggest deviations of 19.70 and 15.09% for each estimator). Also, the results indicate that an inverted pendulum model for the displacement during the single stance phase, and a constant displacement per step during double stance, constitute a valid model for the travelled distance with no need of further adjustments. It allows us to explain the main part of the erroneous distance estimations in different subjects as caused by fundamental limitations of the simple inverted pendulum approach.

Gorely T, Atkin AJ, Biddle SJ, Marshall SJ. (Jun 2009). Family circumstance, sedentary behaviour and physical activity in adolescents living in England: Project STIL. Int J Behav Nutr Phys Act, 11, 6-33.

ABSTRACT: BACKGROUND: Identification of non-modifiable correlates of physical activity and sedentary behaviour in youth contributes to the development of effective targeted intervention strategies. The purpose of this research was to examine the relationships between family circumstances (e.g. socio-economic status, single vs. dual parent household, presence/absence of siblings) and leisure-time physical activity and sedentary behaviours in adolescents. METHODS: A total of 1171 adolescents (40% male; mean age 14.8 years) completed ecological momentary assessment diaries every 15 minutes for 3 weekdays outside of school hours and 1 weekend day. Analysed behaviours were sports/exercise, active travel, TV viewing, computer use, sedentary socialising (hanging-out, using the telephone, sitting and talking) and total sedentary behaviour. Linear regression was employed to estimate levels of association between individual family circumstance variables and each behaviour. RESULTS: Compared to girls from higher socioeconomic status (SES) groups, girls from low SES groups reported higher weekend TV viewing and higher weekday total sedentary behaviour. For boys, single parent status was associated with greater total sedentary behaviour compared to those from dual parent households. Boys and girls from low socio-economic neighbourhoods reported lower participation in sports/exercise compared to those living in higher socio-economic neighbourhoods. CONCLUSION: Associations were not consistent across behaviours or between genders. Overall, findings indicate that boys from single parent households and girls from low socio-economic families may be at increased risk of high sedentary behaviour. Those living in low socioeconomic neighbourhoods may be at increased risk of reduced participation in sports and exercise.

Hanna F, Molfenter SM, Cliffe RE, Chau T, Steele CM (Jun 2009). Anthropometric and Demographic Correlates of Dual-Axis Swallowing Accelerometry Signal Characteristics: A Canonical Correlation Analysis. Dysphagia [Epub ahead of print]

Swallowing accelerometry has been proposed as a potential minimally invasive tool for collecting assessment information about swallowing. The first step toward using sounds and signals for dysphagia detection involves characterizing the healthy swallow. The purpose of this article is to explore systematic variations in swallowing accelerometry signals that can be attributed to demographic factors (such as participant gender and age) and anthropometric factors (such as weight and height). Data from 50 healthy participants (25 women and 25 men), ranging in age from 18 to 80 years and with approximately equal distribution across four age groups (18-35, 36-50, 51-65, 66 and older) were analyzed. Anthropometric and demographic variables of interest included participant age, gender, weight, height, body fat percent, neck circumference, and mandibular length. Dual-axis (superior-inferior and anterior-posterior) swallowing accelerometry signals were obtained for five saliva and five water swallows per participant. Several swallowing signal characteristics were derived for each swallowing task, including variance, amplitude distribution skewness, amplitude distribution kurtosis, signal memory, total signal energy, peak energy scale, and peak amplitude. Canonical correlation analysis was performed between the anthropometric/demographic variables and swallowing signal characteristics. No significant linear relationships were identified for saliva swallows or for superior-inferior axis accelerometry signals on water swallows. In the anterior-posterior axis, signal amplitude distribution kurtosis and signal memory were significantly correlated with age (r = 0.52, P = 0.047). These findings suggest that swallowing accelerometry signals may have task-specific associations with demographic (but not anthropometric) factors. Given the limited sample size, our results should be interpreted with caution and replication studies with larger sample sizes are warranted.

Harris TJ, Owen CG, Victor CR, Adams R, Cook DG (Jun 2009). What factors are associated with physical activity in older people, assessed objectively by accelerometry? Br J Sports Med, 43, 442-50.

OBJECTIVES: To assess physical activity (PA) levels measured objectively using accelerometers in community-dwelling older people and to examine the associations with health, disability, anthropometric measures and psychosocial factors. DESIGN: Cross-sectional survey. SETTING: Single general practice (primary care centre), United Kingdom. PARTICIPANTS: Random selection of 560 community-dwelling older people at least 65 years old, registered with the practice. 43% (238/560) participated. ASSESSMENT OF RISK FACTORS: Participants completed a questionnaire assessing health, disability, psychosocial factors and PA levels; underwent anthropometric assessment; and wore an accelerometer (Actigraph) for 7 days. MAIN OUTCOME MEASURES: Average daily accelerometer step-counts and time spent in different PA levels. Associations between step-counts and other factors were examined using linear regression. RESULTS: Average daily step-count was 6443 (95% CI 6032 to 6853). Men achieved 754 (84 to 1424) more steps daily than women. Step-count declined steadily with age. Independent predictors of average daily step-count were: age; general health; disability; diabetes; body mass index; exercise self-efficacy; and perceived exercise control. Activities associated independently with higher step-counts included number of long walks and dog-walking. Only 2.5% (6/238) of participants achieved the recommended 150 minutes weekly of at least moderate-intensity activity in > or = 10 minute bouts; 62% (147/238) achieved none. CONCLUSIONS: This is the first population-based sample of older people with objective PA and anthropometric measures. PA levels in older people are well below recommended levels, emphasising the need to increase PA in this age group, particularly in those who are overweight/obese or have diabetes. The independent effects of exercise self-efficacy and exercise control on PA levels highlight their role as potential mediators for intervention studies.

Helgeson VS, Lopez LC, Kamarck T (May 2009). Peer relationships and diabetes: retrospective and ecological momentary assessment approaches. Health Psychol, 28, 273-82.

OBJECTIVE: To examine the association of positive and negative aspects of friendship to psychological well-being, self-care behavior, and blood glucose control and to determine whether these relations were moderated by gender. DESIGN: Adolescents with Type 1 diabetes (n = 76) completed baseline measures of friendship quality, depressive symptoms, and self-care. A measure of metabolic control was obtained from medical records. Adolescents also tested blood glucose periodically over the course of 4 days and completed ecological momentary assessments of interpersonal interactions and mood using PDAs. MAIN OUTCOME MEASURES: For between-groups analyses, primary outcomes were depressive symptoms, self-care behavior, and metabolic control. For within-groups analyses, primary outcomes were mood and blood glucose. RESULTS: Results showed baseline reports of peer conflict but not support were associated with outcomes, particularly among girls. Conflict was more strongly related to poor metabolic control for girls than boys. Momentary interaction enjoyment and interaction upset were associated with mood, but were unrelated to blood glucose. Aggregate indices of enjoyable interactions were associated with fewer depressive symptoms and better self-care-especially among girls. CONCLUSIONS: These results suggest that the positive and negative aspects of peer relationships are related to the psychological well-being and physical health of adolescents with diabetes.

Henriques-Forsythe MN, Ivonye CC, Jamched U, Kamuguisha LK, Olejeme KA, Onwuanyi AE (Jun 2009). Is telemetry overused? Is it as helpful as thought? Cleve Clin J Med, 76, 368-72.

Cardiac telemetry is widely used in hospitals, but it is expensive and labor-intensive. Therefore, it should be used only in those most likely to benefit. The authors review the available evidence and offer their recommendations.

Hersh MA, Hussong AM (May 2009). The association between observed parental emotion socialization and adolescent self-medication. J Abnorm Child Psychol, 37, 493-506.

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.

Hoppmann, C.A. & Riediger, M. (2009). Ambulatory Assessment in Lifespan Psychology: An Overview of Current Status and New Trends. European Psychologist. European Psychologist, 14, 98-108.

Ambulatory assessment represents a powerful research tool in lifespan psychology because it allows assessing the within-person variability of developmental processes as it occurs within context-specific influences of people’s natural environments. Following a discussion of historical origins, we review four current research themes in developmentally relevant ambulatory assessment studies that use electronic devices as assessment instruments: (a) affective-motivational development, (b) social contexts of development, (c) age-related challenges and everyday functioning, and (d) cognitive development. Overall, the reviewed research demonstrates that ambulatory assessment complements traditional developmental study designs and laboratory assessments in important ways. Acknowledging the strengths and limitations of ambulatory assessment approaches, we propose that ambulatory assessment will benefit lifespan psychology most if it becomes an integral part of multimethod investigations of developmental phenomena that balance the external and internal validity of findings. Future research should strengthen the lifespan perspective in ambulatory assessment approaches, combine multiple indicators (subjective and objective) of successful development, and attend to the fact that individual development often interacts with significant others.

Houtveen, J.H. & de Geus, E.J.C (2009). Noninvasive psychophysiological ambulatory recordings: study design and data analysis strategies. European Psychologist, 14, 132-141.

Rapid technical developments have greatly facilitated noninvasive 24-hour recording of physiological signals at relatively low costs, including blood pressure, activity of the autonomic nervous system, respiratory behavior, and activity of the hypothalamic-pituitary-adrenocortical axis. Ambulatory noninvasive recordings can be used to study the baseline levels of these physiological variables as well as their reactivity to naturalistic stressors. Levels and reactivity can be compared across groups differing in exposure to risk factors (e.g., stress, genotypes) or used to sharpen the clinical profile of individual subjects (e.g., in panic or somatoform disorders). The focus of the current paper is on the importance of a priori choices in study design and data analysis strategies when ambulatory recording specifically targets the reciprocal relationship between physiological and psychological events. These choices are illustrated with ambulatory-assessed indices of the cardiac autonomic nervous system, blood pressure, respiration, and cortisol secretion.

Janz KF, Kwon S, Letuchy EM, Eichenberger Gilmore JM, Burns TL, Torner JC, Willing MC, Levy SM (Jul 2009). Sustained effect of early physical activity on body fat mass in older children. Am J Prev Med, 37, 35-40.

BACKGROUND: Physical activity is assumed to reduce excessive fatness in children. This study examined whether the benefits of early childhood moderate-to-vigorous physical activity (MVPA) on fatness are sustained throughout childhood. METHODS: MVPA minutes per day (min/d) and fat mass (kilograms; kg) were measured using accelerometry and dual-energy x-ray absorptiometry in 333 children aged 5, 8, and 11 years who were participating in the Iowa Bone Development Study. Mixed regression models were used to test whether MVPA at age 5 years had an effect on fat mass at age 8 years and age 11 years, after adjustment for concurrent height, weight, age, maturity, and MVPA. The analysis was repeated to control for fat mass at age 5 years. Using mixed-model least-squares means, adjusted means of fat mass at age 8 years and age 11 years were compared between the highest and lowest quartiles of MVPA at age 5 years. Data were collected between 1998 and 2006 and analyzed in 2008. RESULTS: For boys and girls, MVPA at age 5 years was a predictor of adjusted fat mass at age 8 years and age 11 years (p<0.05). In girls, the effect of MVPA at age 5 years was not significant when fat mass at age 5 years was included. Boys and girls in the highest quartile of MVPA at age 5 years had a lower fat mass at age 8 years and age 11 years than children in the lowest MVPA quartile at age 5 years (p<0.05; mean difference 0.85 kg at age 8 years and 1.55 kg at age 11 years). CONCLUSIONS: Some effects of early-childhood MVPA on fatness appear to persist throughout childhood. Results indicate the potential importance of increasing MVPA in young children as a strategy to reduce later fat gains.

Kelsall A, Decalmer S, McGuinness K, Woodcock A, Smith JA (May 2009). Sex differences and predictors of objective cough frequency in chronic cough. Thorax, 64, 393-8.

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. A study was conducted to determine the predictors of objective cough frequency in patients presenting to a tertiary referral clinic with chronic cough. METHODS: 100 subjects (65 women) of mean (SD) age 55.8 (11.0) years and median cough duration 4 years (IQR 2.0-10.0) with unexplained chronic cough completed flow-volume loops (mean (SD) forced expiratory volume in 1 s 103 (15.2)% predicted; forced expiratory flow (FEF(50)) 68.8 (24.1)% predicted), methacholine challenge (42% positive), citric acid cough reflex sensitivity (C5; 0.12 M (IQR 0.06-0.50)) and the Leicester Cough Questionnaire. 24-h ambulatory cough monitoring was performed in 86 subjects; manually counted coughs were quantified as the number of explosive cough sounds per hour. RESULTS: Women coughed significantly more than men (geometric mean 16.6 coughs/h (95% CI 13.1 to 21.0) vs 9.4 coughs/h (95% CI 6.4 to 13.9), p = 0.01)). The cough reflex was also more sensitive in women than in men (median logC5 -0.9 M vs -0.6 M, p = 0.002), but cough-related quality of life was similar in women and men (12.0 (3.6) and 12.2 (3.2), respectively, p = 0.76). Linear regression analysis showed that 38.6% of the variation in cough rate was predicted by sex (p = 0.01), logC5 (p<0.001) and age (p = 0.002) 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 antitussive agents.

Kent L, O’Neill B, Davison G, Nevill A, Elborn JS, Bradley JM (Jun 2009). Validity and reliability of cardiorespiratory measurements recorded by the LifeShirt during exercise tests. Respir Physiol Neurobiol, 167, 162-7.

The LifeShirt is a novel ambulatory monitoring system that records cardiorespiratory measurements outside the laboratory. Validity and reliability of cardiorespiratory measurements recorded by the LifeShirt were assessed and two methods of calibrating the LifeShirt were compared. Participants performed an incremental treadmill test and a constant work rate test (65% peak oxygen uptake) on four occasions (>48 h apart) and wore the LifeShirt, COSMED system and Polar Sport Tester simultaneously. The LifeShirt was calibrated using two methods: comparison to a spirometer; and 800 ml fixed-volume bag. Ventilation, respiratory rate, expiratory time and heart rate recorded by the LifeShirt were compared to measurements recorded by laboratory equipment. Sixteen adults participated (6M:10 F); mean (SD) age 23.1 (2.9) years. Agreement between the LifeShirt and laboratory equipment was acceptable. Agreement for ventilation was improved by calibrating the LifeShirt using a spirometer. Reliability was similar for the LifeShirt and the laboratory equipment. This study suggests that the LifeShirt provides a valid and reliable method of ambulatory monitoring.

Kimhy D, Delespaul P, Ahn H, Cai S, Shikhman M, Lieberman JA, Malaspina D, Sloan RP (May 2009). Concurrent Measurement of “Real-World” Stress and Arousal in Individuals With Psychosis: Assessing the Feasibility and Validity of a Novel Methodology. Schizophr Bull [Epub ahead of print]

Background: Psychosis has been repeatedly suggested to be affected by increases in stress and arousal. However, there is a dearth of evidence supporting the temporal link between stress, arousal, and psychosis during “real-world” functioning. This paucity of evidence may stem from limitations of current research methodologies. Our aim is to the test the feasibility and validity of a novel methodology designed to measure concurrent stress and arousal in individuals with psychosis during “real-world” daily functioning. Method: Twenty patients with psychosis completed a 36-hour ambulatory assessment of stress and arousal. We used experience sampling method with palm computers to assess stress (10 times per day, 10 AM -> 10 PM) along with concurrent ambulatory measurement of cardiac autonomic regulation using a Holter monitor. The clocks of the palm computer and Holter monitor were synchronized, allowing the temporal linking of the stress and arousal data. We used power spectral analysis to determine the parasympathetic contributions to autonomic regulation and sympathovagal balance during 5 minutes before and after each experience sample. Results: Patients completed 79% of the experience samples (75% with a valid concurrent arousal data). Momentary increases in stress had inverse correlation with concurrent parasympathetic activity (rho = -.27, P < .0001) and positive correlation with sympathovagal balance (rho = .19, P = .0008). Stress and heart rate were not significantly related (rho = -.05, P = .3875). Conclusion: The findings support the feasibility and validity of our methodology in individuals with psychosis. The methodology offers a novel way to study in high time resolution the concurrent, “real-world” interactions between stress, arousal, and psychosis. The authors discuss the methodology’s potential applications and future research directions.

Klumb, P., Elfering, A. & Herre, C. (2009). Ambulatory Assessment in Industrial/Organizational Psychology - Fruitful Examples and Methodological Issues. European Psychologist, 14, 120-131.

In this review, we demonstrate the contribution of ambulatory assessment (AA) research to I/O psychology by reference to four dynamic phenomena, the investigation of which we judge to benefit most from the application of AA techniques: (a) work strain and coping with work stressors, (b) the work/nonwork interface, (c) social interactions at the workplace, and (d) job attitudes and work-related emotions. As we see it, the greatest potential of these studies lies in the analysis of how interindividual differences modulate intraindividual processes. After demonstrating the value of the method, we outline and discuss ways of tackling a number of methodological issues raised in the studies reviewed: selective participation and attrition, altered reporting behavior and reactivity, noncompliance with study instructions, low acceptance, and development of reduced scales or single-item measures. Future studies can pave the way for the broad acceptance and utilization of AA methods by contributing to the resolution of these issues.

Landon C (May 2009). Novel methods of ambulatory physiologic monitoring in patients with neuromuscular disease. Pediatrics, 123, Suppl 4, S250-2.

This is a summary of the presentation on novel methods of ambulatory physiologic monitoring in patients with neuromuscular disease, presented as part of the program on pulmonary management of pediatric patients with neuromuscular disorders at the 30th annual Carrell-Krusen Neuromuscular Symposium on February 20, 2008.

Lau HY, Tong KY, Zhu H (May 2009). Support vector machine for classification of walking conditions of persons after stroke with dropped foot. Hum Mov Sci [Epub ahead of print]

Walking with dropped foot represents a major gait disorder, which is observed in hemiparetic persons after stroke. This study explores the use of support vector machine (SVMs) to classify different walking conditions for hemiparetic subjects. Seven participants with dropped foot (category 4 of functional ambulatory category) walked in five different conditions: level ground, stair ascent, stair descent, upslope, and downslope. The kinematic data were measured by two portable sensor units, each comprising an accelerometer and gyroscope attached to the lower limb on the shank and foot segments. The overall classification accuracy of stair ascent, stair descent, and other walking conditions was 92.9% using input features from the sensor attached to the shank. It was further improved to 97.5% by adding two more inputs from the sensor attached to the foot. Stair ascent was also classified by the inputs from the foot sensor unit with 96% accuracy. The performance of an SVM was shown to be superior to that of other machine learning methods using artificial neural networks (ANN) and radial basis function neural networks (RBF). The results suggested that the SVM classification method could be applied as a tool for pathological gait analysis, pattern recognition, control signals in functional electrical stimulation (FES) and rehabilitation robot, as well as activity monitoring during rehabilitation of daily activities.

Li Z, Snieder H, Harshfield GA, Treiber FA, Wang X (May 2009). A 15-year longitudinal study on ambulatory blood pressure tracking from childhood to early adulthood. Hypertens Res, 32, 404-10.

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.

Luo S, Zhang G. (May 2009). What Leads to Romantic Attraction: Similarity, Reciprocity, Security, or Beauty? Evidence From a Speed-Dating Study. J Pers. [Epub ahead of print]

Years of attraction research have established several “principles” of attraction with robust evidence. However, a major limitation of previous attraction studies is that they have almost exclusively relied on well-controlled experiments, which are often criticized for lacking ecological validity. The current research was designed to examine initial attraction in a real-life setting-speed-dating. Social Relations Model analyses demonstrated that initial attraction was a function of the actor, the partner, and the unique dyadic relationship between these two. Meta-analyses showed intriguing sex differences and similarities. Self characteristics better predicted women’s attraction than they did for men, whereas partner characteristics predicted men’s attraction far better than they did for women. The strongest predictor of attraction for both sexes was partners’ physical attractiveness. Finally, there was some support for the reciprocity principle but no evidence for the similarity principle.

Mancini M, Zampieri C, Carlson-Kuhta P, Chiari L, Horak FB (Apr 2009). Anticipatory postural adjustments prior to step initiation are hypometric in untreated Parkinson’s disease: an accelerometer-based approach. Eur J Neurol [Epub ahead of print]

Background and purpose: Anticipatory postural adjustments (APAs), prior to step initiation, are bradykinetic in advanced Parkinson’s disease (PD) and may be one of the factors associated with ‘start hesitation’. However, little is known about APAs in the early stage of PD. In this study, we determined whether body-worn accelerometers could be used to characterize step initiation deficits in subjects with early-to-moderate, untreated PD. Methods: Eleven PD and 12 healthy control subjects were asked to take two steps. Postural adjustments were compared from center of pressure (COP) and from acceleration of the trunk at the center of mass level (L5). Results: Our findings show that APAs measured from the peak COP displacement toward the swing leg and the peak trunk acceleration toward the stance leg were smaller in untreated PD compared with control subjects. The magnitude of APAs measured from peak COP displacements and accelerations were correlated. Conclusion: These results suggest that quantitative analysis of step initiation from one accelerometer on the trunk could provide useful information for the characterization of patients in early stages of PD, when clinical evidence of start hesitation may not be detectable. Ambulatory monitoring of step initiation is also promising for monitoring patient progression in the home environment, and eventually providing feedback for preventing freezing of gait episodes.

Mazze R, Strock E, Morgan B, Wesley D, Bergenstal R, Cuddihy R (Jul-Aug 2009). Diurnal glucose patterns of exenatide once weekly: a 1-year study using continuous glucose monitoring with ambulatory glucose profile analysis. Endocr Pract, 15, 326-34.

OBJECTIVE: To use continuous glucose monitoring (CGM) to characterize diurnal glucose patterns produced by a novel formulation of exenatide consisting of biodegradable polymeric microspheres that entrap exenatide and provide extended release enabling once-weekly administration. METHODS: We performed a subgroup analysis of patients with type 2 diabetes who participated in a multicenter trial (DURATION-1: Effects of Exenatide Long-Acting Release on Glucose Control and Safety in Subjects With Type 2 Diabetes Mellitus) comparing once-weekly with twice-daily formulations of exenatide. We are the only center to use CGM with ambulatory glucose profile (AGP) analysis to characterize glucose exposure, variability, and stability in participants assigned to exenatide once weekly. RESULTS: Seven of the 303 patients in the larger study population were included in the subgroup analysis. Mean age (57.6 +/- 7 years), weight (102 +/- 17 kg), body mass index (34 +/- 3 kg/m2), and duration of diabetes (5 +/- 2 years) were comparable to characteristics of the larger study population. At 30 weeks and 52 weeks, participants treated with exenatide once weekly had a mean reduction in hemoglobin A1c level of 1.3 +/- 0.3% and 1.0 +/- 0.3%, respectively (P<.05). CGM analysis revealed a significant (P<.01) decrease in diurnal glucose exposure for 4 participants during nocturnal and daytime periods. Excess glucose exposure (compared with reference values) decreased in 6 of 7 participants, as did glucose variability. Glucose stability improved in 5 participants. The percentage of glucose values less than 70 mg/dL initially increased during the first half of the study then decreased to baseline levels by study end. CONCLUSIONS: Individual glucose profiles revealed that changes in hemoglobin A1c did not consistently parallel alterations in glucose exposure, variability, and stability. AGPs provided a visual representation of improved glucose responses to exenatide once weekly.

McAuliff, B.D.; Kovera, M.B.; Nunez, G. (Jun 2009). Can jurors recognize missing control groups, confounds, and experimenter bias in psychological science? Law and Human Behavior, 33, 247-257.

This study examined the ability of jury-eligible community members (N=248) to detect internal validity threats in psychological science presented during a trial. Participants read a case summary in which an expert testified about a study that varied in internal validity (valid, missing control group, confound, and experimenter bias) and ecological validity (high, low). Ratings of expert evidence quality and expert credibility were higher for the valid versus missing control group versions only. Internal validity did not influence verdict or ratings of plaintiff credibility and no differences emerged as a function of ecological validity. Expert evidence quality, expert credibility, and plaintiff credibility were positively correlated with verdict. Implications for the scientific reasoning literature and for trials containing psychological science are discussed.

McClellan CB, Schatz JC, Puffer E, Sanchez CE, Stancil MT, Roberts CW (Jun 2009). Use of handheld wireless technology for a home-based sickle cell pain management protocol. J Pediatr Psychol, 34, 564-73.

PURPOSE: To evaluate use of a handheld electronic wireless device to implement a pain management protocol for participants with sickle cell disease (SCD). METHODS: Participants were 19 patients with SCD aged 9-20 who experienced vaso-occlusive pain. A single-session training on the use of cognitive-behavioral coping skills was followed by instruction on how to practice these skills and monitor daily pain experience using the device. Daily pain experience and practice of coping skills were collected for the 8-week intervention period using wireless technology. RESULTS: High rates of participation, daily diary completion and consumer satisfaction support the use of handheld wireless devices to implement this protocol. A comparison of the rates of self and device-recorded skills practice provides important information about the use of electronic monitoring for behavioral interventions. CONCLUSION: Wireless data transfer technology has significant potential to become a practical method to improve symptom monitoring and communication between patients and providers.

McGregor SJ, Busa MA, Skufca J, Yaggie JA, Bollt EM (Jun 2009). Control entropy identifies differential changes in complexity of walking and running gait patterns with increasing speed in highly trained runners. Chaos, 19, 026109.

Regularity statistics have been previously applied to walking gait measures in the hope of gaining insight into the complexity of gait under different conditions and in different populations. Traditional regularity statistics are subject to the requirement of stationarity, a limitation for examining changes in complexity under dynamic conditions such as exhaustive exercise. Using a novel measure, control entropy (CE), applied to triaxial continuous accelerometry, we report changes in complexity of walking and running during increasing speeds up to exhaustion in highly trained runners. We further apply Karhunen-Loeve analysis in a new and novel way to the patterns of CE responses in each of the three axes to identify dominant modes of CE responses in the vertical, mediolateral, and anterior/posterior planes. The differential CE responses observed between the different axes in this select population provide insight into the constraints of walking and running in those who may have optimized locomotion. Future comparisons between athletes, healthy untrained, and clinical populations using this approach may help elucidate differences between optimized and diseased locomotor control.

McLure SA, Summerbell CD, Reilly JJ (May 2009). Objectively measured habitual physical activity in a highly obesogenic environment. Child Care Health Dev, 35, 369-75.

BACKGROUND: While the prevalence of overweight and obesity among children continues to grow nationally, prevalence in the North-East of England is among the highest in the UK. The objective of this study was to investigate the habitual physical activity levels in a particularly obesogenic environment in the North-East of England. METHODS: Eight primary schools were selected using a stratified random sampling frame ranking average deprivation levels. Participating children (n = 246, mean age 10 years) wore an accelerometer (Actigraph, GT-256) over five consecutive days (weekend plus three weekdays). Total daily moderate-to-vigorous intensity physical activity was calculated using thresholds by Puyau and colleagues. RESULTS: Only 7% (17/246) of children were sufficiently active. Boys were more physically active than girls (766 +/- 268 vs. 641 +/- 202 counts/min, 95% CI for the difference 63-186 cpm.). Total physical activity was not influenced significantly by deprivation levels or weight status, and there were no significant differences in physical activity between school or weekend days. CONCLUSIONS: The North-East of England is a recognized ‘hot spot’ for paediatric obesity and the present study shows that low levels of habitual physical activity are typical. Choice of accelerometry threshold affects both the apparent amount of physical activity and the ability to detect groups with particularly low levels of physical activity.

Mifsud G, Duval K, Doucet E (May 2009). Low body fat and high cardiorespiratory fitness at the onset of the freshmen year may not protect against weight gain. Br J Nutr, 101, 1406-12.

The purpose of this study was to examine the effects of pre-university adiposity and physical fitness on changes of body weight and adiposity during the freshmen year. Twenty-nine freshmen (sixteen females and thirteen males) completed the study. Body weight and composition (dual-energy X-ray absorptiometry), waist circumference (WC), energy intake (7 d food diary) and activity-related energy expenditure (accelerometry) were measured in September, December and at the end of March. Peak oxygen uptake (VO2peak) was assessed at baseline only. Significant increases in body weight (1.9 (SD 2.0) kg, P < 0.05), BMI (0.6 (SD 0.7) kg/m2, P < 0.05), WC (2.7 (SD 3.0) cm, P < 0.05) and % body fat (BF) (3.1 (SD 2.3) %, P < 0.01) were noted in males, especially over the course of the first semester. No significant changes were observed in females. Results from correlation analyses showed that, baseline %BF was negatively associated with changes in body weight (r - 0.53, P < 0.01) and %BF (r - 0.41, P < 0.05) over the academic year. Baseline %BF predicted 27 % (P < 0.05) of the change in weight. Alcohol intake explained 34 % (P < 0.01) and 17 % (P < 0.05) of the changes in WC and %BF, respectively. The change in body weight and %BF were also positively associated with baseline VO2peak (r 0.51, P < 0.01; r 0.48, P < 0.01, respectively) while dietary restraint was negatively related to the changes in %BF (r - 0.43, P < 0.05). In summary, lower pre-university adiposity, higher VO2peak and higher alcohol intake are associated with greater changes in adiposity and body weight during the freshmen year.

Mizuike C, Ohgi S, Morita S (Jul 2009).Analysis of stroke patient walking dynamics using a tri-axial accelerometer. Gait Posture, 30, 60-4.

The purpose of this study was to describe the characteristics of stroke patient gait using the acceleration signals which were obtained during walking. Sixty-three stroke hemiplegic patients and 21 age-matched healthy elderly individuals took part in this study. A wireless tri-axial accelerometer, fixed to a belt at the level of the L3 spinous process, was used to measure trunk acceleration. Subjects were instructed to walk at a self-selected, comfortable walking speed. The acceleration signal was sampled at the rate of 200 Hz. Gait parameters and functional recovery tests were also evaluated. We analyzed the correlation between the gait parameters, functional recovery and acceleration. Acceleration was utilized as the root mean square (RMS), normalized RMS by velocity and average step length, as a measure of gait smoothness, and autocorrelation (AC) as a measure of stride similarity and regularity. The raw RMS and AC values of the stroke were significantly lower than the matched healthy elderly (p<0.01) in all axes. In contrast, the stroke patients’ normalized RMS values were higher than the controls (p<0.05) in all axes. These results suggest that accelerometry gait parameters can discriminate between the stroke patients and the control group. The values of normalized RMS correlated with the smoothness or dynamics of the walking pattern, which reflects motor recovery and gait abilities. This study suggests that normalized RMS of accelerometer recordings from the trunk is valid in objectively measuring walking movements as an index of treatment outcome for patients in rehabilitation.

Mönkemüller K, Neumann H, Fry LC, Kolfenbach S, Malfertheiner P (Apr 2009).[Catheter-free pH-metry using the Bravo capsule versus standard pH-metry in patients with non-erosive reflux disease (NERD)] Z Gastroenterol, 47, 351-6.

BACKGROUND: pH-monitoring is considered the gold standard for the detection of acid reflux in patients with non-erosive reflux disease (NERD). Preliminary pH studies performed over periods longer than 24 hours have shown that in up to one-third of subjects abnormal pH exposure is detected only on the second day of monitoring. Therefore, pH-monitoring during 48 hours may yield more information about pathological acid reflux in patients being investigated for NERD. AIM: The aim of this study was to compare conventional 24-hour pH-monitoring with the new wireless 48-hour Bravo pH-monitoring in patients with NERD. PATIENTS AND METHODS: Patients with typical reflux symptoms, a positive reflux disease questionnaire and negative endoscopy (NERD) and without any form of acid suppressive therapy were included in this prospective study. The patients were divided into two groups: group A for conventional 24-hour pH-monitoring and group B for wireless 48-h Bravo pH-monitoring. RESULTS: 76 patients with a diagnosis of NERD based on a positive RDQ questionnaire and negative endoscopy were included. (47 woman, 29 men, median age: 49 years). 54 underwent conventional pH-monitoring and 22 underwent 48-h pH-monitoring with the new wireless BRAVO system. The overall incidence of acid reflux was 55 % in patients with NERD. Acid reflux was detected less frequently when using Bravo as compared to conventional pH-monitoring. In addition, the Bravo pH-metry showed a large day-to-day variability. CONCLUSIONS: Prolonged pH-monitoring over a period longer than 24 hours did not improve the detection of acid reflux in patients with NERD. Thus, it appears that the Bravo pH-metry does not offer an advantage over standard pH-metry in the daily clinical practice.

Morren, M.; van Dulmen, S.; Ouwerkerk, J.; Bensing, J. (Apr 2009). Compliance with momentary pain measurement using electronic diaries: A systematic review. European Journal of Pain, 13, 354-365.

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

Nyholm, D.; Constantinescu, R.; Holmberg, B.; Dizdar, N.; Askmark, H. (May 2009). Comparison of apomorphine and levodopa infusions in four patients with Parkinson’s disease with symptom fluctuations. Acta Neurologica Scandinavica, 119, 345-348.

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

Parfitt G, Pavey T, Rowlands AV (Jun 2009). Children’s physical activity and psychological health: the relevance of intensity. Acta Paediatr, 98, 1037-43.

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 (< or =1.9 METs) through to vigorous activity (> or =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.

Raftery G, Bridges M, Heslop P, Walker DJ (Jun 2009). Are fibromyalgia patients as inactive as they say they are? Clin Rheumatol, 28, 711-4.

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.

Rinka MP, Van Zundert RM, Boogerd EA, Vermulst AA, Engels RC (Jun 2009). Nicotine withdrawal symptoms following a quit attempt: An ecological momentary assessment study among adolescents. Nicotine Tob Res. 2009, 11, 722-9.

Introduction: The present study describes growth curves of withdrawal symptoms among 138 daily smoking adolescents before, during, and after a quit attempt. Methods: Participants reported their levels of withdrawal symptoms (craving, negative affect, and hunger) three times a day over a period of 28 days: 1 week prior to and 3 weeks following a quit attempt. Results: All withdrawal symptoms were quite stable at a relatively low level during the 5 days prior to the quit day. At Day 8, withdrawal symptoms (especially craving) increased substantially. A significant decrease in symptoms was visible during the week following the quit day, and within 2 weeks postquit, both abstinent and relapsed adolescents had reverted to levels comparable to those during the prequit period. The course over time for craving and hunger were best described by a quadratic term, and a linear model best suited negative affect. Individual intercepts and slopes of the growth curves were used to predict abstinence during the last week of the study and at the 2-month follow-up. Analyses revealed that higher levels of craving at the beginning of the prequit week and on the target quit day (intercepts) decreased the odds of being abstinent during the last week of the study. In addition, the quadratic term for hunger predicted abstinence during the last week. Finally, among all three symptoms, none of the growth model characteristics predicted abstinence at follow-up. Discussion: The findings generally suggest that smoking cessation among daily smoking adolescents does not largely depend on how their withdrawal symptoms evolve over time after achieving abstinence.

Rodrigues CS, Bloch KV, da Rocha Nogueira A (Jul 2009). Office blood pressure and 24-hour ambulatory blood pressure measurements: high proportion of disagreement in resistant hypertension. J Clin Epidemiol, 62, 745-51.

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 20 mm Hg 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.

Sakai M, Wei D (Jul 2009). Separation of electrocardiographic and encephalographic components based on signal averaging and wavelet shrinkage techniques.Comput Biol Med, 39, 620-9.

During ambulatory monitoring, it is often required to record the electroencephalogram (EEG) and the electrocardiogram (ECG) simultaneously. It would be ideal if both EEG and ECG can be obtained with one measurement. We introduce an algorithm combining the wavelet shrinkage and signal averaging techniques to extract the EEG and ECG components from an EEG lead signal to a noncephalic reference (NCR). The evaluation using simulation data and measured data showed that the normalized power spectrum unvaried in all frequency bands for the EEG components, and the sensitivity and specificity of R-wave detection for the ECG component were nearly 100%.

Santos-Silva R, Sartori DE, Truksinas V, Truksinas E, Alonso FF, Tufik S, Bittencourt LR (May 2009). Validation of a portable monitoring system for the diagnosis of obstructive sleep apnea syndrome. Sleep, 32, 629-36.

STUDY OBJECTIVE: To evaluate if a portable monitor could accurately measure the apnea-hypopnea index (AHI) in patients with a suspicion of obstructive sleep apnea (OSA). DESIGN: Prospective and randomized. SETTING: Sleep laboratory. PARTICIPANTS: 80 participants: 70 patients with clinical OSA suspicion and 10 subjects without suspicion of OSA. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Three-order randomized evaluations were performed: (1) STD (Stardust II) used at the participants’ home (STD home), (2) STD used simultaneously with PSG in the sleep lab (STD+PSG lab), and (3) PSG performed without the STD (PSG lab). Four AHI values were generated and analyzed: (a) STD home; (b) STD from STD+PSG lab; (c) PSG from STD+PSG (named PSG+STD lab); and (d) PSG lab. Two technicians, blinded to study details, performed the analyses of all evaluations. There was a strong correlation between AHI from the STD and PSG recordings for all 4 AHI values (all correlations above 0.87). Sensitivity, specificity, and positive and negative predictive values at AHI cut-off values of 5, 15, and 30 events/hour were calculated. AHI values from the PSG lab and PSG+STD lab were compared to STD home and STD+PSG lab and showed the best results when STD and PSG were performed simultaneously. In all analyses, the area under ROC curve was at least 0.90. With multiple comparisons, diagnostic agreement was between 91% and 75%. The Bland Altman analyses showed strong agreement between AHI values from the STD and PSG recordings, especially when comparing the AHI from simultaneous STD and PSG recordings. CONCLUSION: These data suggest that the STD is accurate in confirming the diagnosis of OSA where there is a suspicion of the disorder. Better agreement occurred during simultaneous recordings.

Shiffman S, Kirchner TR (May 2009). Cigarette-by-cigarette satisfaction during ad libitum smoking. J Abnorm Psychol, 118, 348-59.

Smoking is thought to produce immediate reinforcement, and subjective satisfaction with smoking is thought to influence subsequent smoking. The authors used ecological momentary assessment (A. A. Stone & S. Shiffman, 1994) to assess cigarette-by-cigarette smoking satisfaction in 394 heavy smokers who subsequently attempted to quit. Across 14,882 cigarettes rated, satisfaction averaged 7.06 (0-10 scale), but with considerable variation across cigarettes and individuals. Women and African American smokers reported higher satisfaction. More satisfied smokers were more likely to lapse after quitting (HR = 1.1, p < .03), whereas less satisfied smokers derived greater benefit from patch treatment to help them achieve abstinence (HR = 1.23, p < .001). Cigarettes smoked in positive moods were more satisfying, correcting for mood at the time of rating. The best predictor of subsequent smoking satisfaction was the intensity of craving prior to smoking. Understanding subjective smoking satisfaction provides insight into sources of reinforcement for smoking.

Shiffman S, Kirchner TR, Ferguson SG, Scharf DM (Jun-Jul 2009). Patterns of intermittent smoking: An analysis using Ecological Momentary Assessment. Addict Behav, 34, 514-9.

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.

Shimbo D, Kuruvilla S, Haas D, Pickering TG, Schwartz JE, Gerin W (May 2009). Preventing misdiagnosis of ambulatory hypertension: algorithm using office and home blood pressures. J Hypertens [Epub ahead of print]

OBJECTIVES: An algorithm for making a differential diagnosis between sustained and white coat hypertension (WCH) has been proposed - patients with office hypertension undergo home blood pressure monitoring (HBPM) and those with normal HBP levels undergo ambulatory blood pressure monitoring (ABPM). We tested whether incorporating an upper office blood pressure (OBP) cut-off in the algorithm, higher than the traditional 140/90 mmHg, reduces the need for HBPM and ABPM. METHODS: Two hundred twenty-nine normotensive and untreated mildly hypertensive participants (mean age 52.5 +/- 14.6 years, 54% female participants) underwent OBP measurements, HBPM, and 24-h ABPM. Using the algorithm, sensitivity, specificity, and positive and negative predictive values (PPV, NPV) for sustained hypertension and WCH were assessed. We then modified the algorithm utilizing a systolic and diastolic OBP cut-off at a specificity of 95% for ambulatory hypertension - those with office hypertension but OBP levels below the upper cut-off underwent HBPM and subsequent ABPM, if appropriate. RESULTS: Using the original algorithm, sensitivity and PPV for sustained hypertension were 100% and 93.8%, respectively. Despite a specificity of 44.4%, NPV was 100%. These values correspond to specificity, NPV, sensitivity, and PPV for WCH, respectively. Using the modified algorithm, the diagnostic accuracy for sustained hypertension and WCH did not change. However, far fewer participants needed HBPM (29 vs. 84) and ABPM (8 vs. 15). CONCLUSION: In this sample, the original and modified algorithms are excellent at diagnosing sustained hypertension and WCH. However, the latter requires far fewer participants to undergo HBPM and ABPM. These findings have important implications for the cost-effective diagnosis of sustained hypertension and WCH.

Sloane R, Snyder DC, Demark-Wahnefried W, Lobach D, Kraus WE (Jun 2009). Comparing the 7-day physical activity recall with a triaxial accelerometer for measuring time in exercise. Med Sci Sports Exerc, 41, 1334-40.

PURPOSE: The primary study aim was to evaluate associations of estimated weekly minutes of moderate-to-vigorous-intensity exercise from self-reports of the telephone-administered 7-Day Physical Activity Recall (7-Day PAR) with data captured by the RT3 triaxial accelerometer. METHODS: This investigation was undertaken as part of the FRESH START study, a randomized clinical trial that tested an iteratively tailored diet and exercise mailed print intervention among newly diagnosed breast and prostate cancer survivors. A convenience sample of 139 medically eligible subjects living within a 60-mile radius of the study center provided both 7-Day PAR and accelerometer data at enrollment. Ultimately, substudy subjects (n = 115) were found eligible for the FRESH START study and randomized to one of two study treatment arms. Follow-up assessments at year 1 (n = 103) and year 2 (n = 99) provided both the 7-Day PAR and the accelerometer data. RESULTS: There was moderate agreement between the 7-Day PAR and the accelerometer with longitudinal serial correlation coefficients of 0.54 (baseline), 0.24 (year 1), and 0.53 (year 2), all P values <0.01, although the accelerometer estimates for weekly time in moderate-to-vigorous physical activity (PA) were much higher than those of the 7-Day PAR at all time points. The two methods were poorly correlated in assessing sensitivity to change from baseline to year 1 (rho = 0.11, P = 0.30). Using mixed models repeated-measures analysis, both methods exhibited similar nonsignificant treatment arm x time interaction P values (7-Day PAR = 0.22, accelerometer = 0.23). CONCLUSIONS: The correlations for three serial time points were in agreement with findings of other studies that compared self-reported time in exercise with PA captured by accelerometry. However, these methods capture somewhat different dimensions of PA and provide differing estimates of change over time.

Smyth JM, Wonderlich SA, Sliwinski MJ, Crosby RD, Engel SG, Mitchell JE, Calogero RM (Jul 2009). Ecological momentary assessment of affect, stress, and binge-purge behaviors: day of week and time of day effects in the natural environment. Int J Eat Disord, 42, 429-36.

OBJECTIVE: The present study examined ecological momentary assessments of binge/vomit behavior, mood, and type and severity of stressors in a sample of 133 women with bulimia nervosa. METHOD: Participants completed an ecological momentary assessment protocol for a period of 2 weeks. RESULTS: Mixed-effects and multilevel logistic models revealed significant variation across time of day and day of the week in the occurrence of binging, vomiting, positive and negative affect, and the severity and types of stressful events. DISCUSSION: These findings explicate how momentary and daily experiences vary in the natural environments of women with bulimia nervosa, and document critical time periods for intervention.

Sonnentag, S.; Jelden, S. (Apr 2009). Job stressors and the pursuit of sport activities: A day-level perspective. Journal of Occupational Health Psychology, 14, 165-181.

This article addresses the relation between day-specific experiences of job stressors and the pursuit of off-job activities. Following the limited-resources model of self-regulation, the authors proposed that job stressors and long working hours are negatively related to pursuit of sport activities after work because, after stressful days, employees have no resources left for initiating and persisting in effortful behaviors such as sport. Routines for off-job activities were hypothesized to be positively related to the pursuit of sport activities after work. Seventy-eight police employees completed a daily survey over 5 working days and indicated that they perceive sport to be highly useful for recovery. Random coefficient modeling showed that job stressors (particularly situational constraints) encountered on a specific day were negatively related to self-regulatory resources and to the amount of time spent on sport activities after work, whereas the relation with low-effort activities was positive. Thus, after a stressful day when an effective recovery activity such as sport is highly needed, persons tend to engage less in such an activity. This article addresses the relation between day-specific experiences of job stressors and the pursuit of off-job activities. Following the limited-resources model of self-regulation, the authors proposed that job stressors and long working hours are negatively related to pursuit of sport activities after work because, after stressful days, employees have no resources left for initiating and persisting in effortful behaviors such as sport. Routines for off-job activities were hypothesized to be positively related to the pursuit of sport activities after work. Seventy-eight police employees completed a daily survey over 5 working days and indicated that they perceive sport to be highly useful for recovery. Random coefficient modeling showed that job stressors (particularly situational constraints) encountered on a specific day were negatively related to self-regulatory resources and to the amount of time spent on sport activities after work, whereas the relation with low-effort activities was positive. Thus, after a stressful day when an effective recovery activity such as sport is highly needed, persons tend to engage less in such an activity.

Spruill TM, Gerin W, Ogedegbe G, Burg M, Schwartz JE, Pickering TG (Jun 2009). Socioeconomic and psychosocial factors mediate race differences in nocturnal blood pressure dipping. Am J Hypertens, 22, 637-42.

BACKGROUND: Reduced 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. METHODS: The 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. RESULTS: As 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. CONCLUSIONS: We 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.

Sund ZM, Powell T, Greenwood R, Jarad NA (Apr 2009). Remote daily real-time monitoring in patients with COPD - A feasibility study using a novel device. Respir Med [Epub ahead of print]

New technologies have allowed remote real-time electronic recording of symptoms and spirometry. The feasibility of utilising this technology in COPD patients has not been investigated. This is a feasibility study. The primary objective is to determine whether the use of an electronic diary with a portable spirometer can be performed by COPD patients with a moderate to severe disease. Secondary objectives are to investigate the value of this method in early detection of acute exacerbations of COPD (AECOPD). In this 6-month study, 18 patients recorded daily their symptom score and spirometry. Data was sent on real time. AECOPD which was defined according to pre-set criteria were noted. Spirometry values and scores for health-related quality of life were compared between the start and the end of the study. Hospitalisation rate due to AECOPD was compared with a parallel period in the previous year. On average, patients were able to record 77% of their total study days. The system detected 73% of AECOPD. In further 27% of AECOPD patients sought treatment although the change in symptoms did not meet AECOPD definition. The number of COPD-related hospitalisations significantly reduced compared to the previous year. There was a significant increase in FEV(1) and FVC from the start to the end of the study. The remote monitoring device used in this study can be used in COPD patients. AECOPD was detected early in the majority of cases. Hospitalisation rate due to AECOPD was reduced and FEV(1) and FVC values increased during the study.

Taber DR, Stevens J, Murray DM, Elder JP, Webber LS, Jobe JB, Lytle LA (May 2009). The effect of a physical activity intervention on bias in self-reported activity. Ann Epidemiol, 19, 316-22.

PURPOSE: A positive outcome in self-reported behavior could be detected erroneously if an intervention caused over-reporting of the targeted behavior. Data collected from a multi-site randomized trial were examined to determine if adolescent girls who received a physical activity intervention over-reported their activity more than girls who received no intervention. METHODS: Activity was measured using accelerometers and self-reports (3-Day Physical Activity Recall, 3DPAR) in cross-sectional samples preintervention (6th grade, n = 1,464) and post-intervention (8th grade, n = 3,114). Log-transformed accelerometer minutes were regressed on 3DPAR blocks, treatment group, and their interaction, while adjusting for race, body mass index, and timing of data collection. RESULTS: Preintervention, the association between measures did not differ between groups, but post-intervention 3DPAR blocks were associated with fewer log-accelerometer minutes of moderate-vigorous physical activity (MVPA) in intervention girls than in control girls (p = 0.002). The group difference was primarily in the upper 15% of the 3DPAR distribution, where control girls had >1.7 more accelerometer minutes of MVPA than intervention girls who reported identical activity levels. Group differences in this subsample were 8.5%-16.2% of the mean activity levels; the intervention was powered to detect a difference of 10%. CONCLUSION: Self-report measures should be interpreted with caution when used to evaluate a physical activity intervention.

Treuth MS, Baggett CD, Pratt CA, Going SB, Elder JP, Charneco EY, Webber LS (May 2009). A longitudinal study of sedentary behavior and overweight in adolescent girls. Obesity (Silver Spring), 17, 1003-8.

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.

Trudel X, Brisson C, Larocque B, Milot A (May 2009). Masked hypertension: different blood pressure measurement methodology and risk factors in a working population. J Hypertens [Epub ahead of print]

OBJECTIVES: To estimate the prevalence of masked hypertension when the same ambulatory device is used for both manual and ambulatory blood pressure measurements and to measure associations with lifestyle risk factors in a working population. METHODS: White-collar workers were recruited from three public organizations. Blood pressure was measured at the workplace using Spacelabs 90207 for manual measurements (mean of the first three readings taken by a trained assistant) followed by ambulatory measurements (mean of every other reading obtained during the working day). Masked hypertension was defined as a manual blood pressure measurement of 140/90 mmHg or less and ambulatory blood pressure measurement of at least 135/85 mmHg. Smoking, alcohol intake, BMI and leisure physical activity were also assessed. RESULTS: Blood pressure measurements were obtained from 2370 workers (80% participation, 61% women; mean age = 44 years). Masked hypertension was diagnosed in 15.02% of the participants. The prevalence was higher in men [adjusted odds ratio (OR) = 2.38, 95% confidence interval (CI) = 1.86-3.05]. The prevalence in men increased with age (adjusted OR = 2.08 for 40-49 years, 95% CI = 1.33-3.26 and adjusted OR = 1.91 for >/=50 years, 95% CI = 1.20-3.04) and BMI (adjusted OR = 1.78 for BMI >/= 27, 95% CI = 1.21-2.64). The prevalence in women increased with BMI (adjusted OR = 1.65 for BMI >/=27, 95% CI = 1.14-2.39) and alcohol intake (adjusted OR = 2.12 for at least six drinks per week, 95% CI = 1.34-3.35). CONCLUSION: Masked hypertension is frequent and still present when blood pressure is measured out of the office, using the same device for manual and ambulatory measurements. Sex, age, BMI and alcohol intake are associated with masked hypertension.

Tsai SY, Burr RL, Thomas KA. (Jun 2009). Effect of external motion on correspondence between infant actigraphy and maternal diary. Infant Behav Dev, 32, 340-3.

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.

Uen S, Fimmers R, Brieger M, Nickenig G, Mengden T (May 2009). Reproducibility of wrist home blood pressure measurement with position sensor and automatic data storage. BMC Cardiovasc Disord, 9,20.

BACKGROUND: Wrist blood pressure (BP) devices have physiological limits with regards to accuracy, therefore they were not preferred for home BP monitoring. However some wrist devices have been successfully validated using established validation protocols. Therefore this study assessed the reproducibility of wrist home BP measurement with position sensor and automatic data storage. METHODS: To compare the reproducibility of three different(BP) measurement methods: 1) office BP, 2) home BP (Omron wrist device HEM- 637 IT with position sensor), 3) 24-hour ambulatory BP(24-h ABPM) (ABPM-04, Meditech, Hun)conventional sphygmomanometric office BP was measured on study days 1 and 7, 24-h ABPM on study days 7 and 14 and home BP between study days 1 and 7 and between study days 8 and 14 in 69 hypertensive and 28 normotensive subjects. The correlation coefficient of each BP measurement method with echocardiographic left ventricular mass index was analyzed. The schedule of home readings was performed according to recently published European Society of Hypertension (ESH)- guidelines. RESULTS: The reproducibility of home BP measurement analyzed by the standard deviation as well as the squared differences of mean individual differences between the respective BP measurements was significantly higher than the reproducibility of office BP (p < 0.001 for systolic and diastolic BP) and the reproducibility of 24-h ABPM (p < 0.001 systolic BP, p = 0.127 diastolic BP). The reproducibility of systolic and diastolic office versus 24-h ABPM was not significantly different (p = 0.80 systolic BP, p = 0.1 diastolic BP). The correlation coefficient of 24-h ABMP (r = 0.52) with left ventricular mass index was significantly higher than with office BP (r = 0.31). The difference between 24-h ABPM and home BP (r = 0.46) was not significant. CONCLUSION: The short-term reproducibility of home BP measurement with the Omron HEM-637 IT wrist device was superior to the reproducibility of office BP and 24- h ABPM measurement. Furthermore, home BP with the wrist device showed similar correlations to targeted organ damage as recently reported for upper arm devices. Although wrist devices have to be used cautious and with defined limitations, the use of validated devices with position sensor according to recently recommended measurement schedules might have the potential to be used for therapy monitoring.

Vahlkvist S, Pedersen S (May 2009). Fitness, daily activity and body composition in children with newly diagnosed, untreated asthma. Allergy [Epub ahead of print]

Background: Information about how the asthma disease affects the life style and health in children is sparse. Aim: To measure fitness, daily physical activity and body composition in children with newly diagnosed, untreated asthma and healthy controls, and to assess the association between the level of asthma control and these parameters. Methods: Daily physical activity measured using accelerometry, cardiovascular fitness and body composition (per cent fat, per cent lean tissue and bone mineral density) were measured in 57 children with newly diagnosed, untreated asthma and in 157 healthy age- and sex-matched controls. The level of asthma control was assessed by measurements of a variety of asthma outcomes. Results: Children with asthma were less fit (35.1 vs 39.3 ml O(2)/min/kg) (P < 0.001), had a higher body per cent fat (22.8 vs 19.5%) (P < 0.01) and a higher frequency of overweight (24.6 vs 14.2%) (P < 0.05) than healthy controls. Per cent body fat correlated negativly to overall daily activity (P < 0.001) and to time spent in high or vigorous activity (P < 0.001). Fitness corrrelated positively to time spent in high and vigorous activity (P < 0.001). Within the asthma group, the level of asthma control, fitness and the time spent in vigorous activity correlated positively (P < 0.02). Conclusion: Children with untreated asthma are less fit and have a higher body per cent fat and frequency of obesity than their healthy peers. Uncontrolled asthma is associated with a reduced fitness and daytime spent in intensive activity. Overweight children are physically less active than normal weight children.

van Weering MG, Vollenbroek-Hutten MM, Tönis TM, Hermens HJ (Jul 2009). Daily physical activities in chronic lower back pain patients assessed with accelerometry. Eur J Pain, 13, 649-54.

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

Verdecchia P, Angeli F, Cavallini C, Mazzotta G, Repaci S, Pede S, Borgioni C, Gentile G, Reboldi G (May 2009). The voltage of R wave in lead aVL improves risk stratification in hypertensive patients without ECG left ventricular hypertrophy. J Hypertens [Epub ahead of print]

OBJECTIVES: We tested the hypothesis that the voltages of QRS on ECG improve risk stratification in hypertensive patients without left ventricular hypertrophy on ECG. METHODS AND RESULTS: We studied 2042 initially untreated patients with hypertension (mean age 49 years, 46% women) without left ventricular hypertrophy on ECG and no history of cardiovascular disease. At entry, all patients underwent diagnostic tests, including 24-h ambulatory blood pressure monitoring and echocardiography. Among the different ECG voltages, the R wave in lead aVL showed the closest association with left ventricle (LV) mass (r = 0.31; P < 0.001), followed by the R wave in D1 (r = 0.25) and the S wave in V3 (r = 0.22). Patients were followed up for a mean of 7.7 years (range 1-22 years), and treatment was tailored individually. During follow-up, there were 188 major cardiovascular events. The relationship between LV voltage and outcome was assessed using a Cox model with adjustment for age, sex, diabetes, smoking, total cholesterol, serum creatinine, LV mass on echocardiography and average 24-h ambulatory blood pressure. A 0.1 mV higher R wave voltage in lead aVL was associated with a 9% higher risk of cardiovascular disease (95% confidence interval = 0.04-0.15%; P < 0.001). Other ECG voltages and minor repolarization changes were not related to clinical outcome. CONCLUSION: Our results show for the first time that the voltage of the R wave in lead aVL improves cardiovascular risk stratification in hypertensive patients without left ventricular hypertrophy on ECG. Its prognostic value is independent of LV mass on echocardiography and 24-h ambulatory blood pressure.

Warthen, M.W.; Tiffany, S.T. (Apr 2009). Evaluation of cue reactivity in the natural environment of smokers using ecological momentary assessment. Experimental and Clinical Psychopharmacology, 17, 70-77.

The cue reactivity (CR) paradigm has been used extensively to assess smokers’ craving responses to smoking-related stimuli. To date, nearly all CR research has been conducted in laboratory settings; there has been no experimental research of the impact of smoking cues on smokers’ craving in their natural environment. The present research combined CR procedures with ecological momentary assessment (CREMA); the latter has been used successfully to monitor a variety of behaviors in real time using handheld personal digital assistants (PDAs). Participants were 43 daily, heavy smokers ages 18 and older. PDAs were sent home with participants over an 8-day CREMA period. PDAs were used to record each cigarette smoked and to administer daily CR trials. CR stimuli consisted of photographs and imagery scripts that were either smoking related or neutral. CR trials were also administered in the laboratory, by means of PDAs, at the beginning and end of the CREMA period. Results from CREMA trials indicated that smoking-related cues significantly increased craving, compared with neutral cues for both photographs and imagery scripts. This pattern was also observed in the laboratory-based trials. Findings indicate that CREMA is well suited for the investigation of cue-elicited craving under real-world conditions.

Whalen CK, Henker B, Ishikawa SS, Emmerson NA, Swindle R, Johnston JA (May 2009). Atomoxetine Versus Stimulants in the Community Treatment of Children With ADHD: An Electronic Diary Study. J Atten Disord [Epub ahead of print]

Objective: To compare the morning and afternoon/evening functioning of children with ADHD treated in the community with either atomoxetine or long-acting stimulants and reported to be doing well. Method: 109 8- to 12-year-olds and their mothers participated in one of three groups: stimulants (STIM, N = 26), atomoxetine (ATMX, N = 25), or comparison (COMP, N = 58). Mothers completed morning and evening electronic diaries installed on personal digital assistants throughout an entire week, rating the child’s behaviors and moods as well as their own moods and perceptions. Results: There was no evidence that ongoing pharmacotherapy fully normalized the behaviors of children with ADHD: Mothers in both ADHD groups reported higher rates of child inattention, hyperactivity/impulsivity, oppositionality, and negative affect and lower levels of parenting efficacy and positive affect than did COMP mothers. Although the behavioral profiles were generally comparable for the STIM and ATMX groups, there were indications of better functioning in the ATMX group during mornings only. Conclusion: Children treated in the community with either STIM or ATMX appear to have similar behavioral profiles, suggesting that medication decisions be guided by other factors such as comorbid disorders, child and parent preferences, and effects on nontargeted behaviors and moods.

Wichers M, Schrijvers D, Geschwind N, Jacobs N, Myin-Germeys I, Thiery E, Derom C, Sabbe B, Peeters F, Delespaul P, van Os J (Jul 2009). Mechanisms of gene-environment interactions in depression: evidence that genes potentiate multiple sources of adversity. Psychol Med, 39, 1077-86.

BACKGROUND: Previous work suggests that daily life stress-sensitivity may be an intermediary phenotype associated with both genetic risk for depression and developmental stress exposures. In the current analysis we hypothesized that genetic risk for depression and three environmental exposures over the course of development [prenatal stress, childhood adversity and adult negative life events (NLEs)] combine synergistically to produce the phenotype of stress-sensitivity. METHOD: Twin pairs (n=279) participated in a momentary assessment study using the Experience Sampling Method (ESM), collecting appraisals of stress and negative affect (NA) in the flow of daily life. Prospective data on birthweight and gestational age, questionnaire data on childhood adversity and recent NLEs, and interview data on depression were used in the analyses. Daily life stress-sensitivity was modelled as the effect of ESM daily life stress appraisals on ESM NA. RESULTS: All three developmental stress exposures were moderated by genetic vulnerability, modelled as dizygotic (DZ) or monozygotic (MZ) co-twin depression status, in their effect on daily life stress-sensitivity. Effects were much stronger in participants with MZ co-twin depression and a little stronger in participants with DZ co-twin depression status, compared to those without co-twin depression. NLE main effects and NLE genetic moderation were reducible to birthweight and childhood adversity. CONCLUSIONS: The findings are consistent with the hypothesis that adult daily life stress-sensitivity is the result of sensitization processes initiated by developmental stress exposures. Genes associated with depression may act by accelerating the process of stress-induced sensitization.

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