Society for Ambulatory Assessment

Third quarter 2010 (July to September)

Abramson JL, Lewis C, Murrah NV (Sep 2010). Relationship of self-reported alcohol consumption to ambulatory blood pressure in a sample of healthy adults. Am J Hypertens, ,23(9), 994-9.

BACKGROUND: Habitual alcohol consumption has shown positive associations with office blood pressure (BP). Less well established, however, is alcohol consumption’s relationship to various measures of ambulatory BP (ABP) in healthy, normotensive persons. METHODS: We investigated alcohol consumption’s relationship to mean ABP, ABP variability, and the ABP arterial stiffness index in a sample of nonsmoking adults who were free of hypertension and cardiovascular disease (CVD; n = 157). Total alcohol consumption, intake of specific alcoholic beverages, and binge drinking were assessed by self-report. ABP was measured every 30 min for 24 h. RESULTS: In multivariable-adjusted linear regression models, higher levels of total weekly alcohol consumption were associated with higher ABP. For those consuming 0, 1-2, and 3 or more alcoholic drinks per week, mean 24-h systolic ABP values were 112.2, 115.2, and 116.6 mm Hg, respectively (P = 0.05), and mean 24-h diastolic ABP values were 70.6, 71.9, and 74.2 mm Hg, respectively (P = 0.02). Beer and liquor consumption showed stronger positive associations with ABP than did wine consumption. Among nonbinge drinkers and binge drinkers, mean 24-h systolic ABP values were 113.3 and 118.6 mm Hg, respectively (P = 0.04) and mean 24-h diastolic ABP values were 71.3 and 75.0 mm Hg, respectively (P = 0.04). Alcohol consumption was not significantly related to ABP variability or the ABP arterial stiffness index. CONCLUSION: Total habitual alcohol consumption, consumption of specific alcoholic drinks, and binge drinking are associated with higher mean ABP in healthy, normotensive adults.

Anestis F, Menze J, Becker S, Litaker D, Fischer J, Seidel I. (Apr 2010). Combining Accelerometry and Heart Rate for Assessing Preschoolers’ Physical Activity. Med Sci Sports Exerc [Epub ahead of print].

Affective lability has been linked to several maladaptive behaviors (Anestis et al., 2009; Coccaro, 1991). Methodology for measuring affective lability varies and includes retrospective self-report and ecological momentary assessment (EMA). In this study, we sought to test these methodologies by examining which better predicted binge eating episodes and general eating disorder symptoms in a sample (n = 131) of women diagnosed with bulimia nervosa (BN). We hypothesized that, while the two forms of measurement would be correlated with one another and predict binge eating episodes, EMA affective lability would be the stronger predictor. Results supported several hypotheses. Specifically, both EMA affective lability and retrospective self-report affective lability significantly predicted global eating disorder symptoms, even when controlling for depression, age, body mass index, and level of education, EMA affective lability exhibited a significantly stronger correlation with binge eating episodes than did retrospective self-report affective lability, and EMA affective lability predicted number of binge eating episodes on any given day controlling for the same list of covariates. Limitations include the use of a clinical sample that may limit the generalizability of our findings. Findings highlight the importance of affect in such behavior.

Badr H, Laurenceau JP, Schart L, Basen-Engquist K, Turk D. (Sep 2010). The daily impact of pain from metastatic breast cancer on spousal relationships: A dyadic electronic diary study. Pain [Epub ahead of print].

Women with metastatic breast cancer (MBC) experience high levels of emotional distress and pain. Although individuals often rely on their intimate partners to provide physical and emotional support when they are in pain, the daily impact of pain on the spousal relationship in the context of advanced cancer is unclear. To understand how relationships are affected by pain, 57 MBC patients and their partners completed electronic diary assessments 6 times a day for 14days. Patients and partners rated the patient’s pain, their own mood (circumplex adjectives), the provision/receipt of social support, and the degree to which cancer interfered with their relationship. Multilevel mediation models with the couple as the unit of analysis were estimated. Partners and patients reported greater relationship interference when patients experienced more pain and less aroused (i.e., more tired, less peppy, less active) mood. Greater tired mood during the day accounted for 17% and 82% of the association between patients’ morning pain and their evening ratings of emotional and physical support from their partners, respectively. Partners did not directly respond to patients’ pain by providing emotional or physical support; however, they were more likely to provide support when patients experienced more tired and less active mood as a consequence of their pain. Results suggest that one way that pain may wear on couples’ relationships is through its adverse effects on patients’ daily mood. They also suggest that partners may base their provision of support on their perception of the adverse effects of pain on patients’ aroused mood.

Baggett CD, Stevens J, Catellier DJ, Evenson KR, McMurray RG, He K, Treuth MS. (Jul 2010). Compensation or displacement of physical activity in middle-school girls: the Trial of Activity for Adolescent Girls. Int J Obes Lond, 34(7), 1193-9.

OBJECTIVE: The ‘activitystat’ hypothesis suggests that increases in moderate-to-vigorous physical activity (MVPA) are accompanied by a compensatory reduction in light physical activity (LPA) and/or an increase in inactivity to maintain a consistent total physical activity level (TPA). The purpose of this study was to identify the evidence of compensation in middle-school girls. SUBJECTS: Participants were 6916, 8th grade girls from the Trial of Activity for Adolescent Girls (TAAG). DESIGN: Inactivity and physical activity were measured over 6- consecutive days using accelerometry (MTI Actigraph). A within-girl, repeated measures design was used to assess associations between physical activity and inactivity using general linear mixed models. RESULTS: Within a given day, for every one MET-minute more of inactivity, there was 3.18 MET-minutes (95% confidence interval (CI): -3.19, -3.17) less of TPA (activity >2 METS) on the same day. Daily inactivity was also negatively associated with TPA on the following day. Each additional minute of MVPA was associated with 1.85 min less of inactivity on the same day (95% CI: -1.89, -1.82). Daily MVPA was also negatively associated with inactivity the following day. CONCLUSION: Our results, based on 6 days of observational data, were not consistent with the ‘activitystat’ hypothesis, and instead indicated that physical activity displaced inactivity, at least in the short term. Longer intervention trials are needed, nevertheless our findings support the use of interventions to increase physical activity over discrete periods of time in middle-school girls.

Beckmann N, Wood RE, Minbashian A. (Aug 2010). It depends how you look at it: On the relationship between neuroticism and conscientiousness at the within- and the between-person levels of analysis. Journal of Research in Personality.

Research on personality structure has primarily focused on patterns of covariation between traits, and less emphasis has been put on the organization of relationships between thoughts, feelings and behaviors as they occur within individuals. Over several weeks 115 managers from large Australian companies were assessed multiple times a day employing experience-sampling methodology. Within- and between-person variation in personality responses was analyzed using hierarchical linear modeling and correlation analyses. Findings indicate that analyzing personality as a within-person phenomenon reveals information not well captured by the trait approach. While conscientiousness and neuroticism were negatively correlated at the between-person level, this relationship was reversed at the within-person level. Results are discussed in terms of the distinctness of the within- and between-person structure of personality.

Bianchi F, Redmond SJ, Narayanan MR, Cerutti S, Lovell NH. (Aug 2010). Barometric Pressure and Triaxial Accelerometry-based Falls Event Detection IEEE Trans Neural Syst Rehabil Eng [Epub ahead of print].

Falls and fall related injuries are a significant cause of morbidity, disability and health care utilization, particularly among the age group of 65 years and over. The ability to detect falls events in an unsupervised manner would lead to improved prognoses for falls victims. Several wearable accelerometry and gyroscope-based falls detection devices have been described in the literature; however, they all suffer from unacceptable false positive rates. This paper investigates the augmentation of such systems with a barometric pressure sensor, as a surrogate measure of altitude, to assist in discriminating real fall events from normal activities of daily living. The acceleration and air pressure data are recorded using a wearable device attached to the subjects waist and analyzed offline. The study incorporates several protocols including simulated falls onto a mattress and simulated activities of daily living, in a cohort of 20 young healthy volunteers (12 male and 8 female; age: 23.7 +/- 3.0 years). A heuristically trained decision tree classifier is used to label suspected falls. The proposed system demonstrated considerable improvements in comparison to an existing accelerometry-based technique; showing an accuracy, sensitivity and specificity of 96.9%, 97.5% and 96.5%, respectively, in the indoor environment, with no false positives generated during extended testing during activities of daily living. This is compared to 85.3%, 75% and 91.5% for the same measures, respectively, when using accelerometry alone. The increased specificity of this system may enhance the usage of falls detectors among the elderly population.

Butte NF, Wong WW, Adolph AL, Puyau MR, Vohra FA, Zakeri IF. (Aug 2010). Validation of cross-sectional time series and multivariate adaptive regression splines models for the prediction of energy expenditure in children and adolescents using doubly labeled water. J Nutr, 140(8), 1516-23.

Accurate, nonintrusive, and inexpensive techniques are needed to measure energy expenditure (EE) in free-living populations. Our primary aim in this study was to validate cross-sectional time series (CSTS) and multivariate adaptive regression splines (MARS) models based on observable participant characteristics, heart rate (HR), and accelerometer counts (AC) for prediction of minute-by-minute EE, and hence 24-h total EE (TEE), against a 7-d doubly labeled water (DLW) method in children and adolescents. Our secondary aim was to demonstrate the utility of CSTS and MARS to predict awake EE, sleep EE, and activity EE (AEE) from 7-d HR and AC records, because these shorter periods are not verifiable by DLW, which provides an estimate of the individual’s mean TEE over a 7-d interval. CSTS and MARS models were validated in 60 normal-weight and overweight participants (ages 5-18 y). The Actiheart monitor was used to simultaneously measure HR and AC. For prediction of TEE, mean absolute errors were 10.7 +/- 307 kcal/d and 18.7 +/- 252 kcal/d for CSTS and MARS models, respectively, relative to DLW. Corresponding root mean square error values were 305 and 251 kcal/d for CSTS and MARS models, respectively. Bland-Altman plots indicated that the predicted values were in good agreement with the DLW-derived TEE values. Validation of CSTS and MARS models based on participant characteristics, HR monitoring, and accelerometry for the prediction of minute-by-minute EE, and hence 24-h TEE, against the DLW method indicated no systematic bias and acceptable limits of agreement for pediatric groups and individuals under free-living conditions.

Chillón P, Ortega FB, Ruiz JR, Veidebaum T, Oja L, Mäestu J, Sjöström M. (Sep 2010). Active commuting to school in children and adolescents: An opportunity to increase physical activity and fitness. Scand J Public Health [Epub ahead of print].

AIMS: The purpose was to describe the patterns of commuting to school in young people and to examine its associations with physical activity (PA) and cardiorespiratory fitness. METHODS: The sample comprised 2271 Estonian and Swedish children and adolescents (1218 females) aged 9-10 years and 15-16 years. Data were collected in 1998/99. Mode of commuting to and from school was assessed by questionnaire. Time spent (min/day) in PA and average PA (counts/min) was measured by accelerometry. Cardiorespiratory fitness was assessed by means of a maximal cycle ergometer test. RESULTS: Sixty-one percent of the participants reported active commuting to school (ACS). Estonian youth showed lower levels of ACS than Swedish (odds ratio, 0.64; 95% confidence interval, 0.53-0.76) and girls reported lower levels than boys (0.74; 0.62-0.88). ACS boys showed higher PA levels than non-ACS boys for moderate, vigorous, MVPA, and average PA levels (all p ? 0.01). Participants who cycled to school had higher cardiorespiratory fitness than walkers or passive travellers (p < 0.001). CONCLUSIONS: Nearly two-thirds of the participants actively commuted to school. ACS may provide an opportunity to increase levels of daily PA, especially in boys, and cardiorespiratory fitness, especially if cycling. Public health strategies should develop and test ACS patterns to get more evidence and promote bike-friendly environments.

Collip D, Oorschot M, Thewissen V, Van Os J, Bentall R, Myin-Germeys I. (Aug 2010). Social world interactions: how company connects to paranoia. Psychol Med [Epub ahead of print].

BACKGROUND: Experimental studies have indicated that social contact, even when it is neutral, triggers paranoid thinking in people who score high on clinical or subclinical paranoia. We investigated whether contextual variables are predictive of momentary increases in the intensity of paranoid thinking in a sample of participants ranging across a psychometric paranoia continuum.MethodThe sample (n=154) consisted of 30 currently paranoid patients, 34 currently non-paranoid patients, 15 remitted psychotic patients, 38 high-schizotypy participants, and 37 control subjects. Based on their total score on Fenigstein’s Paranoia Scale (PS), three groups with different degrees of paranoia were defined. The Experience Sampling Method (ESM), a structured diary technique, was used to assess momentary social context, perceived social threat and paranoia in daily life. RESULTS: There were differences in the effect of social company on momentary levels of paranoia and perceived social threat across the range of trait paranoia. The low and medium paranoia groups reported higher levels of perceived social threat when they were with less-familiar compared to familiar individuals. The medium paranoia group reported more paranoia in less-familiar company. The high paranoia group reported no difference in the perception of social threat or momentary paranoia between familiar and unfamiliar contacts. CONCLUSIONS: Paranoid thinking is context dependent in individuals with medium or at-risk levels of trait paranoia. Perceived social threat seems to be context dependent in the low paranoia group. However, at high levels of trait paranoia, momentary paranoia and momentary perceived social threat become autonomous and independent of social reality.

Coza A, Nigg BM, Fliri L. (JAug 2010). Quantification of soft-tissue vibrations in running: accelerometry versus high-speed motion capture. J Appl Biomech, 26(3), 367-72.

Soft-tissue vibrations can be used to quantify selected properties of human tissue and their response to impact. Vibrations are typically quantified using high-speed motion capture or accelerometry. The aim of this study was to compare the amplitude and frequency of soft-tissue vibrations during running when quantified by highspeed motion capture and accelerometry simultaneously. This study showed: (a) The estimated measurement errors for amplitude and frequency were of the same order of magnitude for both techniques. (b) There were no significant differences in the mean peak frequencies and peak amplitudes measured by the two methods. (c) The video method showed an inability to capture high frequency information. This study has shown that a tradeoff has to be made between the accuracy in amplitude and frequency when these methods are employed to quantify soft tissue vibrations in running.

Ebner-Priemer UW, Kubiak T (2010). The decade of behavior revisited: Future prospects for ambulatory assessment. European Journal of Psychological Assessment, 26(3), 151-153.

In this editorial, we would like to outline the main terms and the key characteristics of ambulatory assessment and then highlight two recent developments that, in our view,will advance ambulatory assessment methodology even further.

Ferguson SG, Shiffman S (Jul 2010). Effect of high-dose nicotine patch on the characteristics of lapse episodes. Health Psychology, Vol 29(4), 358-366.

Objective: Nicotine patch improves treatment outcomes, but lapses are still common. To understand the process of relapse on patch, we investigated differences in the antecedents (withdrawal, setting, triggers) of lapse episodes experienced on high-dose (35 mg) nicotine patches versus placebo. Design: Participants were smokers who lapsed during a randomized, double-blind trial of active patches (n = 100) versus placebo (n = 85). Participants used electronic diaries to monitor their smoking, affect, and activities in real time for 5 weeks during their cessation attempt. Results: We analyzed 490 lapse episodes (active: 266; placebo: 224). Lapses on nicotine patch were characterized by significantly lower positive affect and higher negative affect than placebo lapses. Participants treated with high-dose patch were also significantly more likely to lapse in situations involving little or no craving. Situational antecedents of lapses on patch resembled those on placebo. Conclusion: The results suggest that treatment with patch may set a higher threshold for affective stimuli to provoke lapses, but does not change the proximal cues that trigger lapses. This suggests that behavioral relapse-prevention strategies developed for unmedicated smokers should also apply to those treated with nicotine patch.

Forand NR, Gunthert KC, German RE, Wenze SJ (Sep 2010). Appearance investment and everyday interpersonal functioning: An experience sampling study. Psychology of Women Quarterly, 34(3), 380-393.

Several studies have shown that body satisfaction affects interpersonal functioning. However, few have studied the specific interpersonal correlates of another important body image dimension, appearance investment—that is, the importance a woman places on appearance. We used an experience sampling design with PDA (personal digital assistant) devices to assess how 92 college women’s appearance investment is related to perceptions of everyday social interactions and to investigate the association of these perceptions with mood and self-esteem. For 1 week, participants completed electronic diaries of their mood, self-esteem, and perceptions of one-on-one interactions. High appearance investment was associated with a stronger relationship between perceived communion of the interaction and negative mood and self-esteem. Notably, highly appearance-invested women did not report differences in average momentary levels of perceived communion or agency in interactions, negative mood, or self-esteem when compared to women with lower appearance investment. In contrast, women with low body satisfaction reported lower average perceptions of communion and self-esteem as well as higher average negative mood compared to women with higher body satisfaction, but no relationships among perceptions and self-esteem and mood were found. Thus, self-esteem and negative mood in women high in appearance investment might be contingent on perceptions of communion in interactions, even though they appear to have average levels of mood and self-esteem in general. This mood and self-esteem contingency could predispose appearance-invested women to psychological distress or eating pathology.

Geschwind N, Peeters F, Jacobs N, Delespaul P, Derom C, Thiery E, van Os J, Wichers M (Aug 2010). Meeting risk with resilience: High daily life reward experience preserves mental health. Acta Psychiatrica Scandinavica, 122(2), 129-138.

Objective: To examine prospectively whether high reward experience (the ability to generate positive affect boosts from pleasurable daily events) protects against affective symptoms and whether environmental or genetic risk factors moderate protective effects. Method: At baseline, 498 female twins participated in an experience sampling study measuring reward experience in daily life. They also completed questionnaires on childhood adversity and recent stressful life events (SLE). Affective symptoms were measured at baseline and at four follow-ups using SCL-90 anxiety and depression subscales. Co-twin affective symptoms were used as indicators of genetic risk. Results: Baseline reward experience did not predict follow-up affective symptoms, regardless of level of genetic risk. However, high reward experience was associated with reduced future affective symptoms after previous exposure to childhood adversity or recent SLE. Conclusion: High daily life reward experience increases resilience after environmental adversity; modification of reward experience may constitute a novel area of therapeutic intervention.

Hagstromer M, Ainsworth BE, Oja P, Sjostrom M (Jul 2010). Comparison of a subjective and an objective measure of physical activity in a population sample. J Phys Act Health, 7(4), 541-50.

BACKGROUND: The aim of this study was to compare physical activity components in the long, self-administrated version of IPAQ with an accelerometer in a population sample. METHODS: In total 980 subjects (18-65 years) wore an accelerometer (Actigraph) for 7 consecutive days and thereafter filled in the IPAQ. Measures of total physical activity, time spent in moderate and in vigorous activity as well as time spent sitting as assessed by the IPAQ and the Actigraph were compared. RESULTS: The results showed significant low to moderate correlations (Rs = 0.07-0.36) between the 2 instruments and significantly (P < .001) higher values for sitting and vigorous intensity physical activity from the IPAQ compared with the Actigraph. The higher the values reported by the IPAQ the bigger differences were seen between the instruments. Comparison between the tertiles of total physical activity by the 2 instruments showed significant overall association with consistent agreement in the low and the high tertiles. CONCLUSION: The long form of IPAQ is a valid measure of physical activity in population research. However, the IPAQ likely overestimates actual physical activity as shown by its limited ability to classify adults into low and high categories of physical activity based on accelerometer data.

Halsey LG, Shepard EL, Wilson RP. (Sep 2010). Assessing the development and application of the accelerometry technique for estimating energy expenditure. Comp Biochem Physiol A Mol Integr Physiol [Epub ahead of print].

A theoretically valid proxy of energy expenditure is the acceleration of an animal’s mass due to the movement of its body parts. Acceleration can be measured by an accelerometer and recorded onto a data logging device. Relevant studies have usually derived a measure of acceleration from the raw data that represents acceleration purely due to movement of the animal. This is termed ‘overall dynamic body acceleration’ (ODBA) and to date has proved a robust derivation of acceleration for use as an energy expenditure proxy. Acceleration data loggers are generally easy to deploy and the measures recorded appear robust to slight variation in location and orientation. This review discusses important issues concerning the accelerometry technique for estimating energy expenditure and ODBA; deriving ODBA, calibrating ODBA, acceleration logger recording frequencies, scenarios where ODBA is less likely to be valid, and the power in recording acceleration and heart rate together. While present evidence suggests that ODBA may not quantify energy expenditure during diving by birds and mammals, several recent studies have assessed changes in mechanical work in such species qualitatively through variation in ODBA during periods of submergence. The use of ODBA in field metabolic studies is likely to continue growing, supported by its relative ease of use and range of applications.

Hanson MD, Chen E. (Jul 2010). Daily stress, cortisol, and sleep: the moderating role of childhood psychosocial environments. Health Psychol, 29(4), 394-402.

OBJECTIVE: The purpose of this study was to explore whether childhood family environments moderated the relation between daily stress and daily biological outcomes (sleep, cortisol output) in healthy young adults. DESIGN: There were 87 participants, ages 19 to 25 who provided information on characteristics of their childhood family environment (conflict, parental warmth). MAIN OUTCOME MEASURES: For 1 week they completed a daily stress checklist via electronic diary, provided salivary cortisol samples 4 times a day, and wore an Actiwatch to measure sleep (minutes, efficiency). Data was analyzed using hierarchical linear modeling. RESULTS: Family risk significantly moderated the relation between daily number of stressors and sleep minutes (b = -12.10, p = .02), such that the more difficult one’s childhood environment, the less sleep individuals got on days in which they experienced a greater number of stressors. Parental warmth moderated the relation between stress severity and cortisol output (b = -0.19, p = .04), such that the less parental warmth individuals received during childhood, the more cortisol they secreted on days that they experienced more severe stress. CONCLUSIONS: The childhood psychosocial environment may have long-term effects on biological responses to daily stress, creating vulnerability to disease in individuals from difficult childhoods.

Hasler BP, Troxel WM (Oct 2010). Couples’ nighttime sleep efficiency and concordance: evidence for bidirectional associations with daytime relationship functioning. Psychosom Med, 72(8), 794-801.

Objective: To examine prospectively the directionality of the association between daily relationship functioning and nightly sleep quality and the association between couples’ relationship functioning and concordance in sleep-wake rhythms. Emerging evidence suggests the existence of bidirectional links between sleep and relational processes in dyads, but to date, this research has been primarily cross sectional. Methods: Sleep was measured via both diaries and wrist actigraphy for 7 days in 29 heterosexual cosleeping couples. Ecological momentary assessment methods were used to characterize daily relationship functioning. Dyadic, multilevel analyses were used to examine the degree to which nightly sleep efficiency or within-couple concordance in sleep timing predicted the next day’s relational functioning and vice versa. Results: In the first set of analyses, for men, higher diary-based sleep efficiency predicted less negative partner interaction the following day. For women, less negative partner interaction during the day predicted greater actigraphy-based sleep efficiency that night. Furthermore, if women reported more positive and less negative daytime partner interaction during the day, this also predicted higher diary-based sleep efficiency for their male partners that night. In the second set of analyses, among females only, lower diary- or actigraphy-based sleep onset concordance respectively predicted less positive and more negative partner interactions the next day. Conclusions: Bidirectional associations seem to exist between sleep parameters and interpersonal interaction and may represent a novel pathway linking close relationships with physical and mental health.

Havermans R, Nicolson NA, Berkhof J, deVries MW. (Aug 2010). Mood reactivity to daily events in patients with remitted bipolar disorder. Psychiatry Res. 2010 , 179(1), 47-52.

Information about mood reactions to naturally occurring stress in remitted bipolar patients may help elucidate the mechanism by which stressors influence the propensity to manic or depressive relapse in these patients. Using the experience sampling method (ESM), we therefore investigated negative and positive mood states and their reactivity to daily hassles and uplifts in 38 outpatients with remitted bipolar disorder and 38 healthy volunteers. Multilevel regression analyses confirmed that mean levels of negative affect (NA) were higher and positive affect (PA) lower in bipolar patients. Reactivity of NA and PA to hassles and uplifts in bipolar patients was similar to controls and was unrelated to the number of previous episodes. Bipolar patients with subsyndromal depressive symptoms, however, showed particularly large NA responses to daily hassles, which they also rated as more stressful. Subsyndromal depressive symptoms in patients with remitted bipolar disorder thus appear to increase sensitivity to everyday stressors.

Havermans R, Nicolson NA, Berkhof J, Devries MW. (Aug 2010). Patterns of salivary cortisol secretion and responses to daily events in patients with remitted bipolar disorder. Psychoneuroendocrinology [Epub ahead of print].

Previous studies on bipolar disorder revealed abnormalities in the function of the HPA axis, including disturbed patterns of cortisol secretion, during depressive and manic episodes. It is less clear whether these abnormalities persist after symptomatic recovery. In the present study we used the experience sampling method with intensive salivary cortisol sampling to study patterns of cortisol secretion in relation to negative and positive daily events during the normal daily life of a group of 36 patients with remitted bipolar disorder and 38 healthy controls. Results of multilevel regression analysis indicated that daytime cortisol levels and reactivity to daily events were similar in remitted bipolar patients and healthy controls, but bipolar patients showed flatter diurnal slopes and larger cortisol fluctuations over successive measures. Patients with many previous episodes had higher overall cortisol levels, reduced cortisol reactivity to negative daily events, and flatter diurnal slopes than patients with fewer episodes. These results provide additional evidence of subtle HPA axis dysregulation in remitted bipolar patients, especially in those with many recurrent episodes.

Heo J, Lee Y, Pedersen PM, McCormick BP. (Sep 2010). Flow Experience in the Daily Lives of Older Adults: An Analysis of the Interaction between Flow, Individual Differences, Serious Leisure, Location, and Social Context. Can J Aging, 29(3), 411-23.

This study examined how serious leisure, individual differences, social context, and location contribute to older adults’ experiences of flow - an intense psychological state - in their daily lives. The Experience Sampling Method was used with 19 older adults in a Midwestern city in the United States. Experience of flow was the outcome measure, and the data were analyzed using hierarchical linear modeling. Results indicated that location and employment status influenced the subjects’ flow experience. Furthermore, the findings revealed that retirement was negatively related to experiencing flow, and there was a significant association between home and the flow experience. The results of this study enhance the understanding of flow experiences in the everyday lives of older adults.

Hinkley T, Salmon J, Okely AD, Trost SG (Sep 2010). Correlates of sedentary behaviours in preschool children: a review. Int J Behav Nutr Phys Act, 7, 66.

BACKGROUND: Sedentary behaviour has been linked with a number of health outcomes. Preschool-aged children spend significant proportions of their day engaged in sedentary behaviours. Research into the correlates of sedentary behaviours in the preschool population is an emerging field, with most research being published since 2002. Reviews on correlates of sedentary behaviours which include preschool children have previously been published; however, none have reported results specific to the preschool population. This paper reviews articles reporting on correlates of sedentary behaviour in preschool children published between 1993 and 2009. METHODS: A literature search was undertaken to identify articles which examined correlates of sedentary behaviours in preschool children. Articles were retrieved and evaluated in 2008 and 2009. RESULTS: Twenty-nine studies were identified which met the inclusion criteria. From those studies, 63 potential correlates were identified. Television viewing was the most commonly examined sedentary behaviour. Findings from the review suggest that child’s sex was not associated with television viewing and had an indeterminate association with sedentary behaviour as measured by accelerometry. Age, body mass index, parental education and race had an indeterminate association with television viewing, and outdoor playtime had no association with television viewing. The remaining 57 potential correlates had been investigated too infrequently to be able to draw robust conclusions about associations. CONCLUSIONS: The correlates of preschool children’s sedentary behaviours are multi-dimensional and not well established. Further research is required to provide a more comprehensive understanding of the influences on preschool children’s sedentary behaviours to better inform the development of interventions.

Hintzen A, Delespaul P, van Os J, Myin-Germeys I (Aug 2010). Social needs in daily life in adults with Pervasive Developmental Disorders. Psychiatry Res, 179(1), 75-80.

Although social deficits remain a persistent component of the behavioural phenotype of Pervasive Developmental Disorders (PDD) in adulthood, it remains unclear whether these represent diminished social needs, as is seen in social anhedonia, or rather thwarted social needs, as is seen in social anxiety. This study used the Experience Sampling Method (ESM)-a structured diary technique-to examine social interaction in daily life of 8 adults with PDD, compared to 14 healthy controls. Multilevel linear regression analyses showed that PDD subjects a) did not spend more time alone, b) had no increased preference to be alone when in company, and c) spent more time with familiar people, compared to control subjects. Patients experienced more negative affect and anxiety when in the company of less familiar people compared to when they are alone, whereas no difference in affect could be found between being alone or being with familiar people. All these lines of evidence suggest that PDD subjects do have a desire to interact. However, this may be thwarted as is seen in social anxiety. Therapeutic interventions should aim at decreasing negative affect and anxiety in social interactions possibly by improving social skills to fulfil the existing social needs in adults with PDD.

Huijnen IP, Verbunt JA, Peters ML, Delespaul P, Kindermans HP, Roelofs J, Goossens M, Seelen HA (Jul 2010). Do depression and pain intensity interfere with physical activity in daily life in patients with Chronic Low Back Pain? Pain, 150(1), 161-6.

Patients with chronic pain may have difficulties estimating their own physical activity level in daily life. Pain-related factors such as depression and pain intensity may affect a patients’ ability to estimate their own daily life activity level. This study evaluates whether patients with Chronic Low Back Pain (CLBP) who are more depressed and/or report more pain indeed have a lower objectively assessed daily life activity level or whether they only perceive their activity level as lower. Patients with CLBP were included in a cross-sectional study. During 14days physical activity in daily life was measured, with both an electronic diary and an accelerometer. Multilevel analyses were performed to evaluate whether a higher level of depression and/or pain intensity was associated with a lower objectively assessed activity level or the discrepancy between the self-reported and objectively assessed daily life activity levels. Results, based on 66 patients with CLBP (mean RDQ score 11.8), showed that the objectively assessed daily life activity level is not associated with depression or pain intensity. There was a moderate association between the self-reported and objectively assessed activity levels (beta=0.39, p<0.01). The discrepancy between the two was significantly and negatively related to depression (beta=-0.19, p=0.01), indicating that patients who had higher levels of depression judged their own activity level to be relatively low compared to their objectively assessed activity level. Pain intensity was not associated with the perception of a patient’s activity level (beta=0.12, ns).

Husky MM, Gindre C, Mazure CM, Brebant C, Nolen-Hoeksema S, Sanacora G, Swendsen J (Jul 2010). Computerized ambulatory monitoring in mood disorders: feasibility, compliance, and reactivity. Psychiatry Res, 178(2), 440-2.

Patients with depression (n=20) or bipolar disorder (n=21) completed computerized ambulatory monitoring for three consecutive days. Results indicate satisfactory rates of acceptance and compliance, with no salient fatigue effects. However, some evidence for reactive effects was found. The findings provide support for this approach in the study of mood disorders.

Inoue S, Ohya Y, Odagiri Y, Takamiya T, Kamada M, Okada S, Tudor-Locke C, Shimomitsu T (Sep 2010). Characteristics of Accelerometry Respondents to a Mail-Based Surveillance Study. J Epidemiol [Epub ahead of print].

Background: Differences in the characteristics of respondents and nonrespondents to a survey can be a cause of selection bias. The aim of this study was to determine the sociodemographic and lifestyle characteristics of respondents to a field-based accelerometry survey.Methods: A cross-sectional mail survey was sent to 4000 adults (50% male; age 20 to 69 years) who were randomly selected from the registries of residential addresses of 4 cities in Japan. There were 1508 respondents (responding subsample) to the initial questionnaire. A total of 786 participants from the responding subsample also agreed to wear an accelerometer for 7 days (accelerometer subsample). Age, sex, and city of residence were compared between the accelerometer subsample and all 3214 nonrespondents, including those who did not respond to the initial questionnaire. In addition, multiple logistic regression analyses were used to compare the sociodemographic and lifestyle characteristics of the accelerometer subsample and the 722 respondents who participated in the questionnaire survey but not the accelerometry (questionnaire-only subsample).Results: As compared with all nonrespondents, the accelerometer subsample included significantly more women, middle-aged and older adults, and residents of specific cities. Multiple logistic regression analyses comparing the accelerometer and questionnaire-only subsamples revealed that participation in the accelerometry survey was greater among nonsmokers (odds ratio, 1.35; 95% confidence interval, 1.02-1.79) and persons who reported a habit of leisure walking (1.56, 1.21-2.01).Conclusions: Sex, age, city of residence, smoking status, and leisure walking were associated with participation in accelerometry. This response pattern reveals potential selection bias in mail-based accelerometry studies.

Jern P, Gunst A, Sandqvist F, Sandnabba NK, Santtila P (Oct 2010). Using Ecological Momentary Assessment to Investigate Associations between Ejaculatory Latency and Control in Partnered and Non-Partnered Sexual Activities. J Sex Res, 5, 1-9.

Ecological Momentary Assessment (EMA) was used to investigate associations between, and variations in, ejaculatory control and ejaculation latency time (ELT) over repeated measurements of sexual activities. Differences between measures recorded in partnered or non-partnered settings were also investigated. The sample consisted of 21 male Finns aged 18 years or above, contributing a total of 158 reports of partnered and non-partnered sexual activities over a six-week period. In the context of non-partnered sexual activities, after controlling for within-subjects dependence, ELTs between events were predictive of one another, but ELT did not predict ejaculatory control when measured simultaneously, nor at subsequent events. Also, ejaculatory control could not predict simultaneously measured ELT or ejaculatory control at subsequent events. During partnered sexual activities, both ejaculatory control and ELT could be accurately predicted by observing ejaculatory control at prior events. In this context, ejaculatory control could also reliably predict simultaneously measured ELT. ELT or ejaculatory control during partnered sexual activity could not be predicted by observing ELT at prior events. Between-event correlations were generally low, indicating considerable variation in ejaculatory functioning over time. EMA is a thrifty assessment method for studying variations in ejaculatory function, and is likely suitable for studying sexual dysfunctions in general.

Kanno A, Metoki H, Kikuya M, Terawaki H, Hara A, Hashimoto T, Asayama K, Inoue R, Shishido Y, Nakayama M, Totsune K, Ohkubo T, Imai Y (Aug 2010). Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study. Hypertens Res [Epub ahead of print].

Masked hypertension (MHT) is considered to be associated with organ damage, whereas the association of white-coat hypertension (WCHT) with organ damage remains controversial. Using home blood pressure measurements, we have previously reported that MHT is associated with a risk of chronic kidney disease (CKD) compared with sustained normal blood pressure (SNBP), although WCHT was not significantly related to CKD in a general Japanese population. The objective of this study was to examine CKD risk associated with WCHT and MHT as determined by ambulatory blood pressure (ABP) monitoring. Among 1023 residents in the general Japanese population of Ohasama, ABP and casual blood pressure (CBP) levels were recorded and blood and urine samples were collected. CKD was defined as a positive proteinuria and/or estimated glomerular filtration rate <60 ml min(-1) per 1.73 m(2). Participants were categorized into four groups using daytime ABP of 140/85 mm Hg and CBP of 140/90 mm Hg as cutoff points: SNBP, 60.0%; WCHT, 15.4%; MHT, 15.0%; and sustained hypertension (SHT), 9.6%. Odds ratios (ORs) for prevalence of CKD were calculated using a multiple logistic regression model. Compared with SNBP, risk of CKD was significantly higher in SHT (OR, 2.81; 95% confidence interval (CI), 1.66-4.75; P=0.0001), MHT (OR, 2.29; 95% CI, 1.45-3.63; P=0.0004) and WCHT (OR, 1.67; 95% CI, 1.03-2.71; P=0.0368). CKD was significantly associated with MHT and WCHT on the basis of ABP monitoring compared with SNBP in the general Japanese population.

Kaputa D, Price D, Enderle JD (Jul 2010). A portable, inexpensive, wireless vital signs monitoring system. Biomed Instrum Technol, 44(4), 350-3.

The University of Connecticut, Department of Biomedical Engineering has developed a device to be used by patients to collect physiological data outside of a medical facility. This device facilitates modes of data collection that would be expensive, inconvenient, or impossible to obtain by traditional means within the medical facility. Data can be collected on specific days, at specific times, during specific activities, or while traveling. The device uses biosensors to obtain information such as pulse oximetry (SpO2), heart rate, electrocardiogram (ECG), non-invasive blood pressure (NIBP), and weight which are sent via Bluetooth to an interactive monitoring device. The data can then be downloaded to an electronic storage device or transmitted to a company server, physician’s office, or hospital. The data collection software is usable on any computer device with Bluetooth capability, thereby removing the need for special hardware for the monitoring device and reducing the total cost of the system. The modular biosensors can be added or removed as needed without changing the monitoring device software. The user is prompted by easy-to-follow instructions written in non-technical language. Additional features, such as screens with large buttons and large text, allow for use by those with limited vision or limited motor skills.

Kashdan TB, Ferssizidis P, Collins RL, Muraven M (Sep 2010). Emotion differentiation as resilience against excessive alcohol use: an ecological momentary assessment in underage social drinkers. Psychol Sci, 21(9), 1341-7.

Some people are adept at using discrete emotion categories (anxious, angry, sad) to capture their felt experience; other people merely communicate how good or bad they feel. We theorized that people who are better at describing their emotions might be less likely to self-medicate with alcohol. During a 3-week period, 106 underage social drinkers used handheld computers to self-monitor alcohol intake. From participants’ reported experiences during random prompts, we created an individual difference measure of emotion differentiation. Results from a 30-day timeline follow-back revealed that people with intense negative emotions consumed less alcohol if they were better at describing emotions and less reliant on global descriptions. Results from ecological momentary assessment procedures revealed that people with intense negative emotions prior to drinking episodes consumed less alcohol if they were better at describing emotions. These findings provide support for a novel methodology and dimension for understanding the influence of emotions on substance-use patterns.

Kendal RL, Galef BG, van Schaik CP (Aug 2010). Social learning research outside the laboratory: How and why? Learning & Behavior, 38(3), 187-194.

Abstract: This special issue of Learning & Behavior has two inextricably linked foci: first, identification of social learning in natural contexts, and second, consideration of the implications of current findings from the study of social learning in natural contexts for understanding the evolution of cultural capacities in the animal kingdom, of which humans are an integral part. Although there are well- established, sophisticated methods for documenting social learning in the laboratory, they often have limited ecological validity and are frequently not practicable. A variety of methods have emerged for identifying social learning in natural contexts. These methods will be a focus throughout this special issue, and include (1) intensive field observation; (2) theoretical/statistical methods for assessing the likelihood of asocial learning being responsible for an observed pattern of behavior; (3) fitting mathematical models to phylogenetic data; and (4) use of novel field and naturalistic experiments. Thus, identification of social learning in free-living populations of animals is a necessary first step in our quest for knowledge.

Kuppens P, Allen NB, Sheeber LB (Jul 2010). Emotional inertia and psychological maladjustment. Psychological Science, 21(7), 984-991.

In this article, we examine the concept of emotional inertia as a fundamental property of the emotion dynamics that characterize psychological maladjustment. Emotional inertia refers to the degree to which emotional states are resistant to change. Because psychological maladjustment has been associated with both emotional underreactivity and ineffective emotion-regulation skills, we hypothesized that its overall emotion dynamics would be characterized by high levels of inertia. We provide evidence from two naturalistic studies that, using different methods, showed that the emotional fluctuations of individuals who exhibited low self-esteem (Study 1) and depression (Study 2) were characterized by higher levels of inertia in both positive and negative emotions than the emotional fluctuations of people who did not exhibit low self-esteem and depression. We also discuss the usefulness of the concept of emotional inertia as a hallmark of maladaptive emotion dynamics.

Lacy BE, Weiser K, Chertoff J, Fass R, Pandolfino JE, Richter JE, Rothstein RI, Spangler C, Vaezi MF (Jul 2010). The diagnosis of gastroesophageal reflux disease. Am J Med, 123(7), 583-92.

BACKGROUND: Gastroesophageal reflux disease is a highly prevalent condition that imposes a significant economic impact on the US health care system. The utility of commonly used tests for the diagnosis of gastroesophageal reflux disease has not been adequately reviewed. METHODS: A comprehensive review of the literature was undertaken to provide an evidence-based approach to the diagnosis of gastroesophageal reflux disease. EMBASE (1980-December 2008), OVID MEDLINE, and PubMed, (1966-December 2008) were searched using “gastroesophageal reflux” and “adults” with other terms, including medications, diagnostic tests, symptoms, and epidemiologic terms. Studies were limited to human trials, English language, and full articles. RESULTS: Heartburn is a reasonably sensitive symptom for the diagnosis of gastroesophageal reflux disease, although it does not reliably predict esophagitis. Standardized questionnaires have limited specificity, whereas the double-contrast barium swallow has a low sensitivity to diagnose gastroesophageal reflux. The role of esophageal manometry is limited to accurate placement of a pH-measuring device. pH testing has reasonable sensitivity and specificity for the diagnosis of gastroesophageal reflux disease. The sensitivity of upper endoscopy to diagnose gastroesophageal reflux is lower than that of pH tests. CONCLUSION: The diagnosis of gastroesophageal reflux disease remains difficult. In the absence of alarm symptoms, empiric treatment with acid suppression is warranted. pH testing provides valuable information in many patients, although the clinical utility of newer tests needs to be determined. Endoscopy should not be the first test used to diagnose gastroesophageal reflux.

Lardinois M, Lataster T, Mengelers R, van Os J, Myin-Germeys I (Aug 2010). Childhood trauma and increased stress sensitivity in psychosis. Acta Psychiatr Scand [Epub ahead of print].

Objective: The notion that traumatic experiences in childhood may predict later psychotic outcomes would be strengthened if a plausible mechanism could be demonstrated. Because increased stress sensitivity is part of the behavioural expression of psychosis liability, the possible mediating role of childhood trauma was investigated. Method: Fifty patients with psychosis were studied with the experience sampling method to assess stress reactivity in daily life, defined as emotional and psychotic reactivity to stress. Traumatic experiences in childhood were assessed with the Childhood Trauma Questionnaire. Results: A significant interaction was found between stress and CT on both negative affect (event stress: beta = 0.04, P < 0.04; activity stress: beta = 0.12, P < 0.001) and psychotic intensity (event stress: beta = 0.06, P < 0.001; activity stress: beta = 0.11, P < 0.001), showing that a history of CT is associated with increased sensitivity to stress. Conclusion: A history of childhood trauma in patients with psychosis is associated with increased stress reactivity later in life, suggestive for an underlying process of behavioural sensitization.

Leahey TM, Crane MM, Pinto AM, Weinberg B, Kumar R, Wing RR (Jul 2010). Effect of teammates on changes in physical activity in a statewide campaign. Prev Med, 51(1), 45-9.

OBJECTIVE: Most Americans do not meet physical activity recommendations. Statewide campaigns can effectively increase activity levels. Reported herein are physical activity outcomes from Shape Up Rhode Island (SURI) 2007, a statewide campaign to increase steps through team-based competition. Given the importance of social networks in behavior change, this paper focused on the effects of team and team characteristics on activity outcomes. METHOD: For 16weeks, 5333 adults comprising 652 teams wore pedometers and reported their steps online. RESULTS: Participants’ daily steps increased from 7029(3915) at baseline to 9393(5976) at SURI end (p<0.001). There was a significant intraclass correlation for step change among team members (ICC=0.09); thus, an individual’s change in steps was influenced by what team they were on. Moreover, baseline team characteristics predicted individual step change; being on a more active team was associated with greater increases in activity for individual members (p<0.001), whereas being on a team with a broad range of steps was associated with smaller changes in activity for individual members (p=0.02). CONCLUSION: These findings are the first to suggest that team members influence individual activity outcomes in team-based statewide campaigns. Future research should explore ways to use social network factors to enhance team-based physical activity programs.

Lo S, Lin L, Hwang J, Chang Y, Liau C, Wang J (Aug 2010). Working the night shift causes increased vascular stress and delayed recovery in young women. Chronobiology International, 27(7), 1454-1468.

Shiftwork has been associated with elevated blood pressure (BP) and decreased heartrate variability (HRV), factors that may increase the long-term risk of cardiovascular-related mortality and morbidity. This study explored the effect of shiftwork on dynamic changes in autonomic control of HRV (cardiac stress), systolic BP and diastolic BP, i.e., SBP and DBP (vascular stress), and recovery in the same subjects working different shifts. By studying the same subjects, the authors could reduce the effect of possible contribution of between-subject variation from genetic predisposition and environmental factors. The authors recruited 16 young female nurses working rotating shifts—day (08:00–16:00 h), evening (16:00–00:00 h), and night (00:00–08:00 h)—and 6 others working the regular day shift. Each nurse received simultaneous and repeated 48-h ambulatory electrocardiography and BP monitoring during their work day and the following off-duty day. Using a linear mixed-effect model to adjust for day shift, the results of the repeated-measurements and self-comparisons found significant shift differences in vascular stress. While working the night shift, the nurses showed significant increases in vascular stress, with increased SBP of 9.7 mm Hg. The changes of SBP and DBP seemed to peak during waking time at the same time on the day off as they did on the working day. Whereas HRV profiles usually returned to baseline level after each shift, the SBP and DBP of nightshift workers did not completely return to baseline levels the following off-duty day (p < .001). The authors concluded that although the nurses may recover from cardiac stress the first day off following a night shift, they do not completely recover from increases in vascular stress on that day.

Maddison R, Jiang Y, Vander Hoorn S, Exeter D, Mhurchu CN, Dorey E (Aug 2010). Describing patterns of physical activity in adolescents using global positioning systems and accelerometry. Pediatr Exerc Sci, 22(3), 392-407.

This study aimed to describe the location and intensity of free-living physical activity in New Zealand adolescents during weekdays and weekend days using Global Positioning Systems (GPS), accelerometry, and Geographical Information Systems (GIS). Participants (n = 79) aged 12-17 years (M = 14.5, SD 1.6) recruited from two large metropolitan high schools each wore a GPS watch and an accelerometer for four consecutive days. GPS and accelerometer data were integrated with GIS software to map the main locations of each participant’s episodes of moderate-vigorous physical activity. On average participants performed 74 (SD 36) minutes of moderate and 7.5 (SD 8) minutes of vigorous activity per day, which on weekdays was most likely to occur within a 1 km radius of their school or 150 meters of their home environment. On weekends physical activity patterns were more disparate and took place outside of the home environment. Example maps were generated to display the location of moderate to vigorous activity for weekdays and weekends.

Maina G, Bovenzi M, Palmas A, Prodi A, Filon FL (Sep 2010). Job strain, effort-reward imbalance and ambulatory blood pressure: results of a cross-sectional study in call handler operators. Int Arch Occup Environ Health [Epub ahead of print].

OBJECTIVES: To examine the association between two job stress models-the job strain (JDC) and the effort-reward imbalance (ERI) model-and ambulatory blood pressure monitoring in call handler operators. METHODS: Participants included 74 women (age, 34.9 ± 9.9 years) and 26 men (age 36.0 ± 10.8 years) who were monitored on 2 workdays for ambulatory blood pressure. Measures of both job stress models were related to blood pressure by the generalized estimating equations (GEE) method while adjusting for potential confounders (gender, age, cigarette smoking, alcohol consumption, educational level, marital status, time of day, and work schedule). RESULTS: Workshifts were associated with an increase of 3-4 and 14 mmHg in mean arterial pressure (MAP) compared with diurnal activities out of work and sleeping period, respectively (P < 0.001). Ambulatory blood pressure was also significantly related with work schedule preference: unpleasant work schedule was associated with an increase of 2 mmHg in MAP compared with pleasant work schedule (P = 0.013). In the ERI model, subjects scoring high in work stress have higher ambulatory blood pressure at work, at home, and during sleep. Work stress by time interaction was not longer significant when controlling for potential confounders: generalized estimating equations revealed that MAP was influenced by BMI (>25 vs. <25: 0.7 (0.2-1.1) mmHg), workshift preference (unpleasant vs. pleasant: 2 (0.4-3.6) mmHg), and time of day. Weak not significant relation was found between ABP and psychosocial factors evaluated by the JDC and ERI models. CONCLUSION: These results do not support work stress as a significant factor influencing ABP in a homogeneous group of call-handlers. Complementary information independently obtained from the two work stress models could provide more exhaustive explanations on the stress-related effects on blood pressure.

Marceau LD, Link CL, Smith LD, Carolan SJ, Jamison RN (Sep 2010). In-clinic use of electronic pain diaries: barriers of implementation among pain physicians. J Pain Symptom Manage, 40(3), 391-404.

OBJECTIVES: The aim of this study was to examine barriers to the use of electronic diaries within the clinic setting and determine outcome differences between patients who used electronic diaries to monitor their progress with summary data feedback and patients who monitored their progress with paper diaries without summary data feedback. METHODS: One hundred thirty-four (n=134) chronic pain patients were asked to monitor their pain, mood, activity interference, medication use, and pain location on either a paper or electronic diary immediately before each monthly clinic visit for 10 months. Patients and their treating physicians in the electronic diary group (n=67) were able to observe changes in their ratings whereas patients using the paper diaries (n=67) had no feedback about their data entry. RESULTS: Most participants believed that completing pain diaries was beneficial; yet, only 23% of patients in the experimental condition felt that the data from the electronic diaries improved their care and less than 15% believed that their doctor made a change in their treatment based on the summary diary information. CONCLUSION: In general, treating physicians were positive about the use of electronic diaries, although they admitted that they did not regularly incorporate the summary data in their treatment decision making because either they forgot or they were too busy. Future studies in understanding barriers to physicians’ and patients’ use of diary data to impact treatment outcome are needed to improve care for persons with chronic pain.

Motl RW, Sosnoff JJ, Dlugonski D, Suh Y, Goldman M (Sep 2010). Does a waist-worn accelerometer capture intra- and inter-person variation in walking behavior among persons with multiple sclerosis? Med Eng Phys [Epub ahead of print]

The valid application of accelerometry and interpretation of its output (i.e., counts per unit time) for the measurement of walking behavior in persons with multiple sclerosis (MS) rests upon multiple untested assumptions. This study tested the assumption that a waist-worn accelerometer should capture the intra- and inter-person variation in walking behavior. Twenty-four participants with a neurologist-confirmed diagnosis of MS and who were ambulatory with minimal assistance undertook three 6-min periods of over-ground walking that involved comfortable (CWS) and then slower (SWS) and faster (FWS) walking speeds while wearing ActiGraph, model 7164, accelerometers around the waist and ankle. The experimental manipulation of walking was successful such that the CWS was 76.7±13.0m/min (range=55.6-105.14), whereas the SWS and FWS were 64.3±12.3m/min (range=44.5-90.1) and 89.1±13.8m/min (range=60.9-116.4), respectively. Movement counts from the waist and ankle-worn accelerometer were strongly associated with the manipulation of speed, but the association was stronger for the waist than ankle based on both eta-squared estimates (?(2) values=.78 and .46) and the average squared multiple correlations from individual regression analyses (R(2) values=.97±.04 and .88±.21). The bivariate correlation between movement counts from the waist-worn accelerometer and speed of walking (r=.823, p=.001) was large in magnitude and significantly different (z=3.22, p=.001) from that between movement counts from the ankle-worn unit and walking speed (r=.549, p=.001). This study provides novel evidence that an accelerometer worn around the waist captures intra- and inter-person variation in over-ground walking behavior in those with MS.

Moullec G, Maïano C, Morin AJ, Monthuy-Blanc J, Rosello L, Ninot G (Jul 2010). A very short visual analog form of the Center for Epidemiologic Studies Depression Scale (CES-D) for the idiographic measurement of depression. J Affect Disord [Epub ahead of print]

BACKGROUND: The experience sampling method, also referred to as ecological momentary assessment (ESM-EMA) has recently gained popularity in the study of depression. However, no psychometrically sound multidimensional depression questionnaires specifically designed for the ESM-EMA context are currently available. AIMS: The main objective of the present study was to develop and validate a very short visual analog scale of the Center for Epidemiologic Studies Depression Scales (CES-D-VAS-VS) specifically designed for the ESM-EMA context. To this end, the full French version of the CES-D was adapted for the ESM-EMA context. From this full-length adapted version a very short version was then extracted from this longer instrument and validated. STUDY DESIGN: A sample comprising 163 patients with a major depressive episode (MDE) and 306 participants without mental disorders was involved in this study. RESULTS: The obtained results provided support for the factor validity, strong measurement invariance (invariance of the loadings and intercepts of the measurement model) across sex and clinical status groups, reliability and convergent validity of the CES-D-VAS-VS. This instrument comprises 4 items measuring positive affect, depressive affect, somatic complaints and disturbed interpersonal relationships. CONCLUSION: The present results provide preliminary evidence regarding the construct validity of the CES-D-VAS-VS among patients and community adults sample but also underline the need to rely on latent variables methods in the use of this instrument to account for the differential levels of measurement errors (uniquenessess) that were observed across groups.

Napolitano Napolitano MA, Borradaile KE, Lewis BA, Whiteley JA, Longval JL, Parisi AF, Albrecht AE, Sciamanna CN, Jakicic JM, Papandonatos GD, Marcus BH (Sep 2010). Accelerometer use in a physical activity intervention trial. Contemp Clin Trials [Epub ahead of print].

This paper describes the application of best practice recommendations for using accelerometers in a physical activity (PA) intervention trial, and the concordance of different methods for measuring PA. A subsample (n=63; 26%) of the 239 healthy, sedentary adults participating in a PA trial (mean age=47.5; 82% women) wore the ActiGraph monitor at all 3 assessment time points. ActiGraph data were compared with self-report (i.e., PA weekly recall and monthly log) and fitness variables. Correlations between the PA recall and ActiGraph for moderate intensity activity ranged from 0.16-0.48 and from 0.28-0.42 for vigorous intensity activity. ActiGraph and fitness [estimated VO(2)(ml/kg/min)] had correlations of 0.15-0.45. The ActiGraph and weekly self-report were significantly correlated at all time points (correlations ranged from 0.23 to 0.44). In terms of detecting intervention effects, intervention groups recorded more minutes of at least moderate-intensity PA on the ActiGraph than the control group at 6months (min=46.47, 95% CI=14.36-78.58), but not at 12months. Limitations of the study include a small sample size and only 3days of ActiGraph monitoring. To obtain optimal results with accelerometers in clinical trials, the authors recommend following best practice recommendations: detailed protocols for monitor use, calibration of monitors and validation of data quality, and use of validated equations for analysis. The ActiGraph has modest concordance with other assessment tools and is sensitive to change over time. However, until more information validating the use of accelerometry in clinical trials becomes available, properly administered self-report measures of PA should remain part of the assessment battery.

Nicolaï SP, Teijink JA, Prins MH (Aug 2010). Multicenter randomized clinical trial of supervised exercise therapy with or without feedback versus walking advice for intermittent claudication. J Vasc Surg, 52(2), 348-55.

OBJECTIVE: The initial treatment for intermittent claudication is supervised exercise therapy (SET). Owing to limited capacity and patient transports costs of clinic-based SET, a concept of SET provided by local physiotherapists was developed. We hypothesized that provision of daily feedback with an accelerometer in addition to SET would further increase walking distance. METHODS: This multicenter randomized trial was set in vascular surgery outpatient clinics and included 304 patients with intermittent claudication. Patients were randomized to exercise therapy in the form of “go home and walk” advice (WA), SET, or SET with feedback. Local physiotherapists provided SET. The primary outcome measure was the change in absolute claudication distance. Secondary outcomes were the change in functional claudication distance and results on the Walking Impairment Questionnaire (WIQ) and Short-Form 36 (SF-36) Health Survey after 12 months. RESULTS: In 11 centers, 102, 109, and 93 patients were included, respectively, in the WA, SET, and SET with feedback groups, and data for 83, 93, and 76, respectively, could be analyzed. The median (interquartile range) change in walking distance between 12 months and baseline in meters was 110 (0-300) in the WA group, 310 (145-995) in the SET group, and 360 (173-697) in the SET with feedback group (P < .001 WA vs SET). WIQ scores and relevant domains of the SF-36 improved statistically significantly in the SET groups. CONCLUSIONS: SET is more effective than WA in improving walking distance, WIQ scores, and quality of life for patients with intermittent claudication. Additional feedback with an accelerometer did not result in further improvement. SET programs should be made available for all patients with intermittent claudication.

Nielsen G, Taylor R, Williams S, Mann J (Jul 2010). Permanent play facilities in school playgrounds as a determinant of children’s activity. J Phys Act Health, 7(4), 490-6.

BACKGROUND: To investigate whether the number of permanent playground facilities in schools influences objectively measured physical activity. METHODS: Physical activity was measured using Actical accelerometers over 2 to 5 days in 417 children (5-12 years) from 7 schools. The number of permanent play facilities likely to encourage physical activity in individuals or groups of children (eg, adventure playgrounds, swings, trees, playground markings, courts, sandpits) were counted on 2 occasions in each school. The surface area of each playground (m(2)) was also measured. RESULTS: The number of permanent play facilities in schools ranged from 14 to 35 and was positively associated with all measures of activity. For each additional play facility, average accelerometry counts were 3.8% (P < .001) higher at school and 2.7% (P < .001) higher overall. Each additional play facility was also associated with 2.3% (P = .001) or 4 minutes more moderate/vigorous activity during school hours and 3.4% (P < .001) more (9 minutes) over the course of the day. School playground area did not affect activity independent of the number of permanent play facilities. Findings were consistent across age and sex groups. CONCLUSION: Increasing the number of permanent play facilities at schools may offer a cost-effective and sustainable option for increasing physical activity in young children.

Nijsen TM, Aarts RM, Cluitmans PJ, Griep PA. (Sep 2010). Time-frequency analysis of accelerometry data for detection of myoclonic seizures. IEEE Trans Inf Technol Biomed, 14(5), 1197-203.

Four time-frequency and time-scale methods are studied for their ability of detecting myoclonic seizures from accelerometric data. Methods that are used are: the short-time Fourier transform (STFT), the Wigner distribution (WD), the continuous wavelet transform (CWT) using a Daubechies wavelet, and a newly introduced model-based matched wavelet transform (MOD). Real patient data are analyzed using these four time-frequency and time-scale methods. To obtain quantitative results, all four methods are evaluated in a linear classification setup. Data from 15 patients are used for training and data from 21 patients for testing. Using features based on the CWT and MOD, the success rate of the classifier was 80%. Using STFT or WD-based features, the classification success is reduced. Analysis of the false positives revealed that they were either clonic seizures, the onset of tonic seizures, or sharp peaks in “normal” movements indicating that the patient was making a jerky movement. All these movements are considered clinically important to detect. Thus, the results show that both CWT and MOD are useful for the detection of myoclonic seizures. On top of that, MOD has the advantage that it consists of parameters that are related to seizure duration and intensity that are physiologically meaningful. Furthermore, in future work, the model can also be useful for the detection of other motor seizure types.

Palmier-Claus JE, Myin-Germeys I, Barkus E, Bentley L, Udachina A, Delespaul PA, Lewis SW, Dunn G (Aug 2010). Experience sampling research in individuals with mental illness: reflections and guidance Acta Psychiatr Scand [Epub ahead of print].

Objective: The experience sampling method (ESM) represents a valuable way of assessing clinical phenomena in real world settings and across time. Despite its theoretical advantages, using this methodology in psychiatric populations is challenging. This paper acts as a guide to researchers wishing to employ this approach when investigating mental illness. Method: The contents represent the opinions of researchers around the United Kingdom and the Netherlands who are experienced at using the ESM. Results: In ESM studies, participants are required to fill in questions about their current thoughts, feelings and experiences when prompted by an electronic device (e.g. a wristwatch, PDA). Entries are typically made at fixed or random intervals over 6 days. This article outlines how to design and validate an ESM diary. We then discuss which sampling procedure to use and how to increase compliance through effective briefing and telephone sessions. Debriefing, data management and analytical issues are considered, before suggestions for future clinical uses of the ESM are made. Conclusion: The last decade has seen an increase in the number of studies employing the ESM in clinical research. Further research is needed to examine the optimal equipment and procedure for different clinical groups.

Parati G, Schumacher H, Bilo G, Mancia G. (Sep 2010). Evaluating 24-h antihypertensive efficacy by the smoothness index: a meta-analysis of an ambulatory blood pressure monitoring database. J Hypertens [Epub ahead of print].

OBJECTIVE: The aim of this meta-analysis was to compare the 24-h antihypertensive efficacy of different treatments using the smoothness index. METHODS: Data were taken from the telmisartan ambulatory blood pressure monitoring (ABPM) clinical programme. Eleven clinical trials that randomized mild-to-moderate hypertensive patients to treatment with telmisartan 40/80 mg, losartan 50 mg, valsartan 80/160 mg, ramipril 10 mg, amlodipine 5 mg monotherapy, or with an angiotensin receptor blocker (ARB) and hydrochlorothiazide (HCTZ) 12.5/25 mg, were included. Treatment duration ranged from 4 to 14 weeks. The smoothness index was calculated according to the published formula. RESULTS: Altogether, 5188 patients were included (65% men; 52% were using telmisartan as monotherapy or in combination with HCTZ). Telmisartan 80 mg had a higher smoothness index than losartan, valsartan or ramipril (P < 0.05), and was comparable with amlodipine. All combination therapies had a higher smoothness index than monotherapy; the largest value was observed with telmisartan 80 mg and HCTZ 12.5 mg. Overall, the smoothness index was lower in men, older patients, black patients, smokers and in those with lower baseline blood pressure (P < 0.05). CONCLUSION: The smoothness index was affected by age, race, sex, behavioural and haemodynamic factors. It was also able to differentiate the 24-h blood pressure effects of antihypertensive drugs, with telmisartan and amlodipine achieving the highest values, possibly because of their long plasma half-lives. All combination therapies had a higher smoothness index than monotherapy. An understanding of the relative effects of different antihypertensives on the smoothness index may help to differentiate their effectiveness in reducing blood pressure-related cardiovascular risk.

Pfaltz MC, Michael T, Grossman P, Margraf J, Wilhelm FH (Oct 2010). Instability of physical anxiety symptoms in daily life of patients with panic disorder and patients with posttraumatic stress disorder. J Anxiety Disord, 24(7), 792-8.

The present study examined severity as well as degree and temporal pattern of instability of DSM-IV-based bodily symptoms of anxiety (BSA) in daily life of 26 panic disorder (PD) patients, 17 posttraumatic stress disorder (PTSD) patients, and 28 healthy controls (HC) during 1 week, using electronic diaries. The ecological momentary assessment around every 3h during wake times was accepted well by patients. Compared to HC, patient groups exhibited elevated instability of BSA. BSA instability was more pronounced in PTSD than PD (p<0.005), even after controlling for mean symptom level. Numbers of symptomatic episodes were comparable in PTSD and PD, but the duration of symptom-free episodes was shorter in PTSD than PD. Results indicate that PTSD patients are particularly burdened by fluctuations in somatic symptoms of anxiety, implying perceived unpredictability and uncontrollability. Electronic diaries can be applied in innovative ways to provide novel insights into the phenomenology of anxiety disorders that may not be captured well by retrospective interviews and questionnaires.

Pfaltz MC, Grossman P, Michael T, Margraf J, Wilhelm FH (Oct 2010). Physical activity and respiratory behavior in daily life of patients with panic disorder and healthy controls. Int J Psychophysiol, 78(1), 42-9.

Panic disorder (PD) has been linked in laboratory investigations to respiratory alterations, particularly persistent respiratory variability. However, studies of PD respiratory pattern outside the laboratory are rare, have not controlled for the confounding influence of varying levels of physical activity, and have not addressed whether abnormalities in respiratory pattern vary depending on the intensity of physical activity. Cognitive and biological theories of PD, in fact, predict that respiratory alterations may be particularly pronounced when patients are physically active. This study assessed physical activity and respiratory pattern of 26 PD patients and 26 healthy controls (HC) during two waking periods of daily life (9:00-21:00) one week apart. Respiratory data were stratified for predefined levels of physical activity (inactivity, minimal movement, slow/moderate/fast walking, and running) and analyzed using linear mixed models. Groups did not generally differ in respiratory measures, although PD patients did show elevated variability of absolute levels of tidal volume during minimal movement and slow walking (root mean squared successive differences). Other ways of analyzing tidal volume variability based on relative levels, percentage of sighing, or pooled activity levels did not substantiate this finding. Amount of time spent at different activity levels did not differ between groups, which is at variance with studies linking anticipatory anxiety with motoric agitation, and PD with self-reported avoidance of exercise. In conclusion, results provided little evidence for respiratory abnormalities or central respiratory dysregulation in PD at varying levels of activity, although instability of tidal volume regulation during low activity remains a possibility. Our research approach indicates the usefulness of stratification of real life data on the basis of levels of activity, as well as how ambulatory assessment strategies, complementarily to laboratory studies, may improve understanding of biological and psychological factors contributing to development and maintenance of PD and other anxiety disorders.

Picard RW (Jul 2010). Emotion research by the people, for the people. Emotion Review, 2(3), 250-254.

Emotion research will leap forward when its focus changes from comparing averaged statistics of self-report data across people experiencing emotion in laboratories to characterizing patterns of data from individuals and clusters of similar individuals experiencing emotion in real life. Such an advance will come about through engineers and psychologists collaborating to create new ways for people to measure, share, analyze, and learn from objective emotional responses in situations that truly matter to people. This approach has the power to greatly advance the science of emotion while also providing personalized help to participants in the research.

Pierdomenico SD, Cuccurullo F (Sep 2010). Prognostic Value of White-Coat and Masked Hypertension Diagnosed by Ambulatory Monitoring in Initially Untreated Subjects: An Updated Meta Analysis. Am J Hypertens [Epub ahead of print].

The prognostic relevance of white-coat hypertension (WCH) and masked hypertension (MH) is controversial. The aim of this study was to perform an updated meta-analysis on the prognostic value of WCH and MH diagnosed by ambulatory monitoring in initially untreated subjects.MethodsWe searched for articles evaluating cardiovascular outcome in WCH or MH or sustained hypertension (SH) in comparison with normotension, investigating untreated subjects at baseline or performing separate analysis for untreated or treated subjects, and reporting adjusted hazard ratio (HR) and 95% confidence interval (CI).ResultsEight studies were identified. Five whole studies and untreated groups of three others were included in the meta-analysis. The pooled population consisted of 7,961 subjects who experienced 696 events. When compared with normotension, the overall adjusted HR was 0.96 (95% CI 0.65-1.42) for WCH (P = 0.85), 2.09 (1.55-2.81) for MH (P = 0.0001), and 2.59 (2.0-3.35) for SH (P = 0.0001). There was no significant difference between WCH and normotension according to normotensive subjects source (same or different study population) and follow-up length. Where reported, prevalence of drug therapy was higher in subjects with WCH than in those with normotension at follow-up.ConclusionsCardiovascular risk is not significantly different between WCH and normotension, regardless of normotensive population type and follow-up length. However, at follow-up drug therapy was more frequent in WCH than in normotension and its possible impact on outcome should be evaluated in future studies. MH shows significantly higher risk than normotension, although the best way for its detection and treatment remains to be established.

Reis HT, Gosling SD (2010). Social psychological methods outside the laboratory. In: Handbook of social psychology, Vol 1 (5th ed.). Fiske, Susan T. (Ed.); Gilbert, Daniel T. (Ed.); Lindzey, Gardner (Ed.); Hoboken, NJ, US: John Wiley & Sons Inc, 2010. pp. 82-114.

(from the chapter) This chapter reviews some of the more important, popular, and timely methods for conducting social psychological research outside of the laboratory. The chapter begins with a review of the purpose of non-laboratory methods, emphasizing how they have been used in social psychology, as well as the kinds of insights that they can and cannot provide. Included in this section is a review of how laboratory and non-laboratory methods complement each other in a research program. We then describe in some detail five methods that have become influential tools in social psychology and give every indication of continued value: field experiments, Internet methods, diary methods, ambulatory monitoring, and trace measures. The chapter concludes with a brief commentary on the future of non-laboratory methods in social psychology. We do not review two broad and common classes of non-laboratory methods, survey research and observational methods.

Rietberg MB, van Wegen EE, Uitdehaag BM, de Vet HC, Kwakkel G (Oct 2010). How reproducible is home-based 24-hour ambulatory monitoring of motor activity in patients with multiple sclerosis? Arch Phys Med Rehabil, 91(10), 1537-41.

OBJECTIVE: To determine the reproducibility of 24-hour monitoring of motor activity in patients with multiple sclerosis (MS). DESIGN: Test-retest design; 6 research assistants visited the participants twice within 1 week in the home situation. SETTING: General community. PARTICIPANTS: A convenience sample of ambulatory patients (N=43; mean age ± SD, 48.7±7.0y; 30 women; median Expanded Disability Status Scale scores, 3.5; interquartile range, 2.5) were recruited from the outpatient clinic of a university medical center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dynamic activity and static activity parameters were recorded by using a portable data logger and classified continuously for 24 hours. Reproducibility was determined by calculating intraclass correlation coefficients (ICCs) for test-retest reliability and by applying the Bland-Altman method for agreement between the 2 measurements. The smallest detectable change (SDC) was calculated based on the standard error of measurement. RESULTS: Test-retest reliability expressed by the ICC(agreement) was .72 for dynamic activity, .74 for transitions, .77 for walking, .71 for static activity, .67 for sitting, .62 for standing, and .55 for lying. Bland and Altman analysis indicated no systematic differences between the first and second assessment for dynamic and static activity. Measurement error expressed by the SDC was 1.23 for dynamic activity, 66 for transitions, .99 for walking, 1.52 for static activity, 4.68 for lying, 3.95 for sitting, and 3.34 for standing. CONCLUSIONS: The current study shows that with 24-hour monitoring, a reproducible estimate of physical activity can be obtained in ambulatory patients with MS..

Ritz T, Rosenfield D, Steptoe A (Oct 2010). Physical activity, lung function, and shortness of breath in the daily life of individuals with asthma. Chest, 138(4), 913-8.

BACKGROUND: The effects of physical activity on asthma have been explored extensively. Exercise can trigger later bronchoconstriction in many patients, and deconditioning due to a sedentary lifestyle may be the consequence. However, the immediate effect of physical activity in asthma and health is bronchodilation. To date, little is known about the association between physical activity and lung function in the daily life of asthma patients. METHODS: We studied 20 individuals with asthma and 20 control subjects using an electronic diary of activities and spirometry (peak expiratory flow [PEF], FEV(1)). Participants rated their shortness of breath and their intensity of physical and social activity for the preceding 30 min. Assessments were made over the course of 3 weeks, tid (morning, afternoon, evening/night). RESULTS: Stronger physical activity was concurrently associated with significantly higher lung function. In contrast, it also showed a positive concurrent association with shortness of breath. In prospective cross-lag analyses, lower PEF and FEV(1) earlier in the day predicted lower physical and social activity levels later in the day, but shortness of breath did not. CONCLUSION: The findings show that detrimental effects observed in exercise-induced bronchoconstriction cannot be generalized to physical activity in daily lives of individuals with asthma. Nevertheless, people with asthma still feel more shortness of breath when being more physically active. They adjust their activity levels throughout the day according to their earlier lung function, but this does not fully explain the concurrent positive association of physical activity and lung function.

Rofail LM, Wong KK, Unger G, Marks GB, Grunstein RR (Aug 2010). The utility of single-channel nasal airflow pressure transducer in the diagnosis of OSA at home. Sleep, 33(8), 1097-105.

RATIONALE: Given the high prevalence of obstructive sleep apnea (OSA) and the demand on polysomnography (PSG), there is a need for low cost accurate simple diagnostic modalities that can be easily deployed in primary care to improve access to diagnosis. STUDY OBJECTIVES: The aim was to examine the utility of single-channel nasal airflow monitoring using a pressure transducer at home in patients with suspected OSA. DESIGN: Cross-sectional study. SETTING: Laboratory and home. PARTICIPANTS: The study was conducted in two populations. Consecutive patients with suspected OSA were recruited from the sleep disorders clinic at a tertiary referral center and from 6 local metropolitan primary care centers. INTERVENTIONS: All patients answered questionnaires and had laboratory PSG. Nasal airflow was monitored for 3 consecutive nights at home in random order either before or after PSG. RESULTS: Atotal of 193 patients participated (105 sleep clinic patients and 88 from primary care). The mean bias PSG apnea hypopnea index (AHI) minus nasal flow respiratory disturbance index (NF RDI) was -4.9 events per hour with limits of agreement (2 SD) of 27.8. NF RDI monitored over 3 nights had high accuracy for diagnosing both severe OSA (defined as PSG AHI > 30 events per hour) with area under the receiver operating characteristic curve (AUC) 0.92 (95% confidence interval (CI) 0.88-0.96) and any OSA (PSG AHI > 5), AUC 0.87 (95% CI 0.80-0.94). CONCLUSIONS: Single-channel nasal airflow can be implemented as an accurate diagnostic tool for OSA at home in both primary care and sleep clinic populations.

Rouhani H, Favre J, Crevoisier X, Aminian K (Jul 2010). Ambulatory assessment of 3D ground reaction force using plantar pressure distribution. Gait Posture, 32(3), 311-6.

This study aimed to use the plantar pressure insole for estimating the three-dimensional ground reaction force (GRF) as well as the frictional torque (T(F)) during walking. Eleven subjects, six healthy and five patients with ankle disease participated in the study while wearing pressure insoles during several walking trials on a force-plate. The plantar pressure distribution was analyzed and 10 principal components of 24 regional pressure values with the stance time percentage (STP) were considered for GRF and T(F) estimation. Both linear and non-linear approximators were used for estimating the GRF and T(F) based on two learning strategies using intra-subject and inter-subjects data. The RMS error and the correlation coefficient between the approximators and the actual patterns obtained from force-plate were calculated. Our results showed better performance for non-linear approximation especially when the STP was considered as input. The least errors were observed for vertical force (4%) and anterior-posterior force (7.3%), while the medial-lateral force (11.3%) and frictional torque (14.7%) had higher errors. The result obtained for the patients showed higher error; nevertheless, when the data of the same patient were used for learning, the results were improved and in general slight differences with healthy subjects were observed. In conclusion, this study showed that ambulatory pressure insole with data normalization, an optimal choice of inputs and a well-trained nonlinear mapping function can estimate efficiently the three-dimensional ground reaction force and frictional torque in consecutive gait cycle without requiring a force-plate.

Sanbonmatsu DM, Uchino BN, Birmingham W (Sep 2010). On the Importance of Knowing Your Partner’s Views: Attitude Familiarity is Associated with Better Interpersonal Functioning and Lower Ambulatory Blood Pressure in Daily Life. Ann Behav Med [Epub ahead of print].

BACKGROUND: Relationships have been linked to significant physical health outcomes. However, little is known about the more specific processes that might be responsible for such links. PURPOSE: The main aim of this study was to examine a previously unexplored and potentially important form of partner knowledge (i.e., attitude familiarity) on relationship processes and cardiovascular function. METHODS: In this study, 47 married couples completed an attitude familiarity questionnaire and ambulatory assessments of daily spousal interactions and blood pressure. RESULTS: Attitude familiarity was associated with better interpersonal functioning between spouses in daily life (e.g., greater partner responsiveness). Importantly, attitude familiarity was also related to lower overall ambulatory systolic blood pressure and diastolic blood pressure. CONCLUSIONS: These data suggest that familiarity with a spouse’s attitudes may be an important factor linking relationships to better interpersonal and physical health outcomes.

Schoenthaler AM, Schwartz J, Cassells A, Tobin JN, Brondolo E (Oct 2010). Daily interpersonal conflict predicts masked hypertension in an urban sample. Am J Hypertens, 23(10), 1082-8.

BACKGROUND: Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH. METHODS: Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (≤120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: ≥135 mm Hg or DiaABP: ≥85 mm Hg. Logistic regression was used to examine whether daily interpersonal conflict is an independent predictor of MMH. RESULTS: This form of MMH (i.e., optimal office BP plus elevated ABP) was present in 21% of participants (n = 50). Those with MMH (vs. without) were significantly more likely to be men (P < 0.001). Daily harassment and unfair treatment scores were significant predictors of MMH group status (P < 0.05). Participants with harassment scores >30 were significantly more likely to be in the MMH group. CONCLUSION: MH may be a concern, even for patients with optimal office BP. Evaluating exposure to psychosocial stressors, including routine levels of interpersonal conflict may help to identify those patients who might benefit from further clinical follow-up.

Sejdic E, Falk TH, Steele CM, Chau T (Jul 2010). Vocalization removal for improved automatic segmentation of dual-axis swallowing accelerometry signals. Med Eng Phys, 32(6), 668-72.

Automatic segmentation of dual-axis swallowing accelerometry signals can be severely affected by strong vocalizations. In this paper, a method based on periodicity detection is proposed to detect and remove such vocalizations. Periodic signal components are detected using conventional speech processing techniques and information from both axes are combined to improve vocalization detection accuracy. Experiments with 408 healthy subjects performing dry, wet, and wet chin tuck swallows show that the proposed method attains an average 95.3% sensitivity and 96.3% specificity. When applied in conjunction with an automatic segmentation algorithm, it is observed that segmentation accuracy improves by approximately 55%. These results encourage further development of medical devices for the detection of swallowing difficulties.

Sevick MA, Stone RA, Zickmund S, Wang Y, Korytkowski M, Burke LE (Jun 2010). Factors associated with probability of personal digital assistant-based dietary self-monitoring in those with type 2 diabetes. Journal of Behavioral Medicine, 33(4), 315-325.

Knowledge of factors associated with the use of technology could inform the design of technology-based behavioral interventions. This study examined modifiable and nonmodifiable factors associated with technology-based self-monitoring. 123 participants with type 2 diabetes self-monitored diet using a personal digital assistant in a 6-month behavioral intervention. Multinomial logistic regression was used to examine probability of nonadherent and suboptimally adherent behavior relative to adherent behavior. Sociodemographic characteristics were not associated with probability of self-monitoring. Probability of adherence generally was greater in the weeks preceding no group session, and lower in the weeks following no group session or following skipped sessions. Non-modifiable factors suggested by the literature to be associated with poorer access to technology (lower income, older age, minority race, and lower education) were not associated with probability of self-monitoring in this population.

Sheftell F, Almas M, Weeks R, Mathew NT, Pitman V, Lipton RB (Jul 2010). Quantifying the return of headache in triptan-treated migraineurs: An observational study. Cephalalgia, Vol 30(7), Jul, 2010. pp. 838-846.

To improve understanding of secondary treatment failure in migraine patients, we evaluated ‘headache return’ as a novel endpoint to assess returning headaches according to their severity, expanding on current standard assessments of overall recurrence or relapse rates, in a six-month observational study of triptan-treated migraineurs. A total of 359 patients (91% female; mean age, 42.5 years) recorded data for 2168 headaches in electronic diaries. Two-thirds of headaches responded to triptan treatment (improved-to-mild or no pain two hours post-dose); 34% of headaches had a pain-free response. By 48 hours post-dose, 19% of all responding headaches returned; 24% of headaches achieving a pain-free response returned, predominantly to mild pain. More severe baseline headache, short duration since diagnosis of migraine, and female gender were associated with increased likelihood of headache return. Treatment satisfaction declined with increasing severity of headache return, demonstrating the value of assessing headache return by severity to fully evaluate its impact.

Shetty V, Zigler C, Robles TF, Elashoff D, Yamaguchi M (Aug 2010). Developmental validation of a point-of-care, salivary alpha-amylase biosensor. Psychoneuroendocrinology [Epub ahead of print].

The translation of salivary alpha-amylase (sAA) to the ambulatory assessment of stress hinges on the development of technologies capable of speedy and accurate reporting of sAA levels. Here, we describe the developmental validation and usability testing of a point-of-care, colorimetric, sAA biosensor. A disposable test strip allows for streamlined sample collection and a corresponding hand-held reader with integrated analytic capabilities permits rapid analysis and reporting of sAA levels. Bioanalytical validation utilizing saliva samples from 20 normal subjects indicates that, within the biosensor’s linear range (10-230U/ml), its accuracy (R(2)=0.989), precision (CV<9%), and measurement repeatability (range -3.1% to +3.1%) approach more elaborate laboratory-based, clinical analyzers. The truncated sampling-reporting cycle (<1min) and the excellent performance characteristics of the biosensor has the potential to take sAA analysis out of the realm of dedicated, centralized laboratories and facilitate future sAA biomarker qualification studies.

Slootmaker SM, Chinapaw MJ, Seidell JC, van Mechelen W, Schuit AJ (Jul 2010). Accelerometers and Internet for physical activity promotion in youth? Feasibility and effectiveness of a minimal intervention [ISRCTN93896459]. Prev Med, 51(1), 31-6.

OBJECTIVE: To evaluate the feasibility and effectiveness of a 3-month minimal physical activity (PA) intervention in adolescents. METHODS: A randomised controlled trial, including five secondary schools (n=87). In the 3-month intervention (Amsterdam, The Netherlands, 2005) adolescents were provided with a PAM accelerometer, coupled to a web-based tailored PA advice (PAM COACH). Measurements (i.e., PA, determinants of PA, aerobic fitness and anthropometrics) took place at baseline and at 3- and 8-month follow-up. RESULTS: Sixty-five percent of the participants in the intervention group reported to have worn the PAM frequently and 56% of the PAM users uploaded their PAM scores to the PAM COACH at least once. We found significant differences between groups in favour of the intervention group in moderate intensity PA (MPA) for girls after 3 months (411 min/week; 95% CI: 1; 824; P=0.04) and in sedentary time for boys after 8 months (-1801 min/week; 95% CI: -3545; -57; P=0.04). CONCLUSIONS: Although the process evaluation suggests that a substantial proportion of the participants did not regularly wear the PAM and did not upload information to the PAM COACH website, our findings suggest promising intervention effects on MPA among girls and sedentary time among boys.

Smart-Richman L, Pek J, Pascoe E, Bauer DJ (Jul 2010). The effects of perceived discrimination on ambulatory blood pressure and affective responses to interpersonal stress modeled over 24 hours. Health Psychol, 29(4), 403-11.

OBJECTIVE: This research examined the impact of perceived discrimination on ambulatory blood pressure (ABP) and daily level affect during social interaction. DESIGN: For 24 hrs, adult Black and White participants wore an ABP monitor and completed palm pilot diary entries about their social interactions. MAIN OUTCOME MEASURES: Mean level and time-trend trajectories of blood pressure and heart rate were examined as well as mean level measures of positive and negative affect after stressful and nonstressful social interactions. RESULTS: Analyses showed that, after controlling for important covariates, perceived discrimination predicted the slopes of both wake and nocturnal ABP responses, with those who reported more discrimination having steeper daytime trajectories for systolic and diastolic blood pressure and less nighttime dipping in heart rate over time as compared to those who had reported relatively infrequent discrimination. High levels of perceived discrimination were also related to positive and negative affective responses after stressful encounters. CONCLUSIONS: These results suggest that, regardless of race, perceived discrimination is related to cardiovascular and affective responses that may increase vulnerability to pathogenic processes.

Smith JA, Decalmer S, Kelsall A, McGuinness K, Jones H, Galloway S, Woodcock A, Houghton LA (Sep 2010). Acoustic cough-reflux associations in chronic cough: potential triggers and mechanisms. Gastroenterology, 139(3), 754-62.

BACKGROUND & AIMS: Central sensitization is thought to play a role in chronic cough and might explain the temporal association between cough and gastroesophageal reflux (GOR) in patients in whom non-GOR causes have been excluded. Using our novel simultaneous acoustic cough recording and impedance/pH monitoring technique, we aimed to explore this further by assessing such temporal associations and their relationship to the acidity, duration, and proximal extent of reflux and the presence of erosive disease and cough reflex sensitivity in unselected patients (ie, including non-GOR causes) with chronic cough. METHODS: Twenty-four hour ambulatory acoustic cough monitoring with simultaneous impedance/pH recording was carried out in 71 unselected patients with chronic cough, aged 51-64 years (47 female). In addition, all patients underwent cough reflex sensitivity testing to citric acid, and 66 patients underwent gastroscopy. Temporal associations between cough and reflux were expressed using the symptom association probability. RESULTS: Seventy percent of patients exhibited temporal associations, with 48% having a positive symptom association probability (SAP(R-C)) for cough preceded by reflux (mainly distal), 56% a positive symptom association probability (SAP(C-R (2 min))) for reflux preceded by cough, and 32% both. Moreover, SAP(R-C) positive patients had a more sensitive cough reflex (P = .03) but similar esophageal reflux exposure and erosive disease, together with similar prevalence of extraesophageal causes of cough compared with SAP(R-C) negative patients. Reflux immediately following cough was rare. CONCLUSIONS: Cough temporally associates with reflux irrespective of proposed diagnoses, may be self-perpetuating in some patients, and is likely to be driven by central processes.

Sosnoff JJ, Goldman MD, Motl RW (Jul 2010). Real-life walking impairment in multiple sclerosis: preliminary comparison of four methods for processing accelerometry data. Mult Scler, 16(7), 868-77.

This study further validates accelerometers as a measure of walking impairment in persons with multiple sclerosis. We examined total movement counts and three novel methods of processing accelerometer data (i.e. standard deviation, approximate entropy and detrended fluctuation analysis) for quantifying real-life walking impairment in this population. A total of 70 individuals with a definite diagnosis of multiple sclerosis completed a battery of patient-rated measures of walking impairment and then wore an ActiGraph accelerometer for 7 days. The data were analyzed using multivariate analysis of variance and bivariate correlation analysis. The results indicated that total daily movement counts and standard deviation of daily movement counts differed between groups of persons with mild, moderate, and severe self-reported disability status and who were independently ambulatory or ambulatory with assistance. Those two metrics for the accelerometer data further demonstrated strong correlations with patient-rated measures of walking impairment. By comparison, there were smaller and often non-significant differences in approximate entropy and detrended fluctuation analysis metrics for the accelerometer data as a function of disability and ambulatory status, and only moderate correlations with patient-rated measures of walking impairment. The results confirm that the metric of total daily movement counts correlates with level of disability, ambulatory status, and patient reports of walking impairment in persons with multiple sclerosis. We further demonstrate that variability, indexed by the standard deviation of daily movement counts, correlates with multiple sclerosis-related disability, ambulatory status, and self-reported walking impairment. Such results provide preliminary evidence that variability in accelerometer counts is not simply noise and may provide important information about multiple sclerosis-related walking impairment.

Sterling M, Chadwick BJ (Sep 2010). Psychologic processes in daily life with chronic whiplash: relations of posttraumatic stress symptoms and fear-of-pain to hourly pain and uptime. Clin J Pain, 26(7), 573-82.

OBJECTIVES: Recent models of the relationship between posttraumatic stress and whiplash pain suggest that psychological stress relating to a motor vehicle crash may influence pain perception. The mechanisms of this relationship may be through more direct, psychological pathways, or through factors proposed by the fear-avoidance models of chronic pain. This study sought to investigate the relative contribution of fear-of-pain and trauma symptomatology to daily pain and time spent in an upright posture (uptime) in chronic whiplash-associated disorder (WAD). METHODS: Hourly electronic-diary reports were used to explore the within-day relationship of psychological trauma symptoms and fear-of-pain to same-hour and next-hour pain reports and next-hour uptime (measured by accelerometers) in 32 individuals with a chronic WAD. Within-person effects were analyzed for 329 diary entries using multilevel modeling with fixed slopes and random intercepts. RESULTS: Reports of trauma-related hyperarousal were associated with greater same-hour pain, and this relationship was mediated by fear-of-pain. Fear-of-pain and uptime were independently associated with reports of increased next-hour pain (controlling for first-order serial autocorrelation). Fear-of-pain was unrelated to next-hour uptime, but trauma-related avoidance symptoms were associated with reduced uptime. This study supports the relationship between psychological trauma responses and pain, suggesting behavioral (avoidance) pathways and effects on pain perception through fear-of-pain. These findings reinforce the need to evaluate traumatic stress as a factor in recovery from WAD.

Turner JE, Markovitch D, Betts JA, Thompson D (Sep 2010). Nonprescribed physical activity energy expenditure is maintained with structured exercise and implicates a compensatory increase in energy intake. Am J Clin Nutr [Epub ahead of print].

BACKGROUND: Exercise interventions elicit only modest weight loss, which might reflect a compensatory reduction in nonprescribed physical activity energy expenditure (PAEE). OBJECTIVE: The objective was to investigate whether there is a reduction in nonprescribed PAEE as a result of participation in a 6-mo structured exercise intervention in middle-aged men. DESIGN: Sedentary male participants [age: 54 ± 5 y; body mass index (in kg/m(2)): 28 ± 3] were randomly assigned to a 6-mo progressive exercise (EX) or control (CON) group. Energy expenditure during structured exercise (prescribed PAEE) and nonprescribed PAEE were determined with the use of synchronized accelerometry and heart rate before the intervention, during the intervention (2, 9, and 18 wk), and within a 2-wk period of detraining after the intervention. RESULTS: Structured prescribed exercise increased total PAEE and had no detrimental effect on nonprescribed PAEE. Indeed, there was a trend for greater nonprescribed PAEE in the EX group (P = 0.09). Weight loss in the EX group (-1.8 ± 2.2 kg compared with +0.2 ± 2.2 kg in the CON group, P < 0.02) reflected only ?40% of the 300-373 kcal/kg body mass potential energy deficit from prescribed exercise. Serum leptin concentration decreased by 24% in the EX group (compared with 3% in the CON group, P < 0.03), and we estimate that this was accompanied by a compensatory increase in energy intake of ?100 kcal/d. CONCLUSIONS: The adoption of regular structured exercise in previously sedentary, middle-aged, and overweight men does not result in a negative compensatory reduction in nonprescribed physical activity. The less-than-predicted weight loss is likely to reflect a compensatory increase in energy intake in response to a perceived state of relative energy insufficiency.

Wang N, Redmond SJ, Ambikairajah E, Celler BG, Lovell NH (Oct 2010). Can triaxial accelerometry accurately recognize inclined walking terrains? IEEE Trans Biomed Eng, 57(10), 2506-16.

The standard method for the analysis of body accelerations cannot accurately estimate the energy expenditure (EE) of uphill or downhill walking. The ability to recognize the grade of the walking surface will most likely improve upon the accuracy of the EE estimates for daily physical activities. This paper investigates the benefits of automatic gait analysis approaches including step-by-step gait segmentation and heel-strike recognition of the accelerometry signal in classifying various gradients. Triaxial accelerometry signals were collected from 12 subjects, performing walking on seven different gradient surfaces: 1) 92 m of 0(°) flat ground; 2) 85 m of ±2.70(°) inclined ramp; 3) 24 m of ±9.86(°) inclined ramp; and 4) 6-m pitch line of ±28.03(°) rake of stairway. Validity studies performed on a group of randomly selected healthy subjects showed high agreement scores between the automated heel-strike recognition markers, manual gait annotation markers, and video-based gait-segmentation markers. Thirteen subset features were found using a subset-selection search procedure from 57 extracted features which maximize the classification accuracy, performed with a Gaussian mixture model classifier, as estimated using sixfold cross-validation. An overall walking pattern-recognition accuracy of 82.46% was achieved on seven different inclined terrains using the 13 selected features. This system should, therefore, improve the accuracy of daily EE estimates with accurate measures on terrain inclinations.

Wannag E, Eriksson AS, Larsson PG (Aug 2010). Attention-deficit hyperactivity disorder and nocturnal epileptiform activity in children with epilepsy admitted to a national epilepsy center. Epilepsy & Behavior, 18(4), 445-449.

The aim of this study was to determine if there exists a relationship between attention-deficit hyperactivity disorder (ADHD) and the quantity of focal nocturnal epileptiform activity on the EEG (FNEA) measured as the percentage of epileptiform activity during non-REM sleep (spike index). This was accomplished with a prospective study of children aged 6–14 years consecutively admitted to our center. Of 362 patients, 44 (12.2%) had previously been diagnosed with ADHD. Twenty-four-hour ambulatory EEG recording and assessment of ADHD according to DSM-IV were performed in 46 children suspected of having ADHD. ADHD was diagnosed in 30. We could not find any correlation between the spike index in 8 children with FNEA and the severity of their ADHD symptoms. This study is underpowered and should be considered a pilot study. There is a need for further investigation of a possible causal effect of FNEA on ADHD symptoms in larger cohorts of patients with FNEA.

Warren RE, Marshall T, Padfield PL, Chrubasik S (Sep 2010). Variability of office, 24-hour ambulatory, and self-monitored blood pressure measurements. Br J Gen Pract, 60(578), 675-80.

BACKGROUND: The diagnosis of hypertension is difficult when faced with several different blood pressure measurements in an individual. Using the average of several office measurements is recommended, although considerable uncertainty remains. Twenty-four-hour ambulatory monitoring is often considered the gold standard, but self-monitoring of blood pressure has been proposed as a superior method. AIM: Determination of within-individual variability of blood pressure measured in the office, by ambulatory monitoring, and by a week of self-monitoring. DESIGN OF STUDY: Retrospective analysis of a clinical trial of 163 subjects. METHOD: Within-patient variability of office and ambulatory blood pressure was determined from measurements at 0 and 6 weeks. Subjects had performed self-monitoring of blood pressure twice each morning and evening, for at least 6 weeks; variability was determined from the means of week 1 and week 6. RESULTS: The within-individual coefficients of variation (CVs) for systolic blood pressure were: office, 8.6%; ambulatory, 5.5%; self, 4.2%. Equivalent values for diastolic blood pressure were 8.6%, 4.9%, and 3.9%. CVs tended to be lower with longer self-monitoring duration, and higher with longer intervals between self-monitoring. CONCLUSION: Office blood pressure is impractical for precise assessment, as 10-13 measurements are required to give the accuracy required for rational titration of antihypertensive drugs. Twenty-four-hour ambulatory monitoring is better than a single office measurement, but considerable uncertainty remains around the estimate. A week of self-monitoring appears to be the most accurate method of measuring blood pressure, but remains imperfect. Further research may identify superior self-monitoring schedules. Given the inherent accuracy in blood pressure measurement, the importance of considering overall cardiovascular risk is emphasised.

Wenze SJ, Miller IW (Aug 2010). Use of ecological momentary assessment in mood disorders research Clin Psychol Rev, 30(6), 794-804.

Ecological momentary assessment (EMA) entails repeated, intensive sampling of respondents’ current experiences while they are engaged in their typical daily routines, in their natural environments. In this article we discuss benefits of using EMA techniques in mood disorders research, provide an overview of the various specific EMA techniques that have been used with mood-disordered populations to date, and summarize the diverse range of research questions that EMA has been used to explore in this field. In addition, we evaluate the feasibility and acceptability of using EMA techniques with this population and suggest additional areas that might be fruitful to investigate, with a focus on the extension of EMA techniques into treatment research. Overall, data suggest that using EMA techniques in mood disorders research is feasible, generally acceptable, and highly promising. We conclude with a discussion of caveats, limitations, and ethical considerations.

Wichers M, Peeters F, Geschwind N, Jacobs N, Simons CJP, Derom C, Thiery E, Delespaul PH, van Os J (Jul 2010). Unveiling patterns of affective responses in daily life may improve outcome prediction in depression: A momentary assessment study. Journal of Affective Disorders, 124(1-2), 191-195.

Daily life affective responses are closely linked to vulnerability and resilience in depression. Prediction of future clinical course may be improved if information on daily life emotional response patterns is taken into account. Method: Female subjects with a history of major depression (n=83), recruited from a population twin register, participated in a longitudinal study using momentary assessment technology with 4 follow-up measurements. The effect of baseline daily life emotional response patterns (affect variability, stress-sensitivity and reward experience) on follow-up depressive symptomatology was examined. Results: Both reward experience (B=−0.30, p=0.001) and negative affect variability (B=0.46, p=0.001) predicted future negative affective symptoms independent of all other dynamic emotional patterns and conventional predictors. Conclusion: Daily life information on dynamic emotional patterns adds to the prediction of future clinical course, independent of severity of symptoms and neuroticism score. Better prediction of course may improve decision-making regarding quantitative and qualitative aspects of treatment.

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