Search Results (86)

Awake Bruxism (AB) is defined as masticatory muscle activity during wakefulness, characterized by repetitive or sustained tooth contact and/or the bracing or thrusting of the mandible. AB remains less understood than Sleep Bruxism (SB), and its identification remains a methodological challenge. The aim of this study was to introduce the Awake Bruxism Identification Tool (ABIT), developed for children and adolescents aged 8 to 12 years, to facilitate the identification of AB. The tool integrates data from self-reports, clinical examinations, and the Ecological Momentary Assessment (EMA). It comprises questionnaires using a five-point Likert scale, an analog EMA component involving color-based responses, and a clinical inspection. The tool adopts the concept of an “AB Spectrum”, as it generates individualized scores based on the combined outcomes of these multiple assessment components. The ABIT was piloted with ten families to evaluate its comprehensibility, applicability, and reliability. The results demonstrated that the participants found the questions understandable, that the tool had a minimal impact on daily family routines, and that it required approximately 5–10 min to complete. Additionally, the test–retest reliability indicated temporal stability. In terms of identification, four children were classified within the “AB identified by report and self-report,” while three were identified through the “report, self-report, and EMA.” Based on participant feedback, adjustments were made to the instrument, including the addition of an item addressing Sleep Bruxism. Although the ABIT is being applied for the first time in a research setting, it presents a promising, clinically relevant approach grounded in the self-perception of children and their caregivers. Full article

Background: Borderline Personality Disorder (BPD) is a debilitating mental health condition characterized by emotional dysregulation and interpersonal dysfunction, with perceived social rejection exacerbating these issues. Emerging evidence suggests that a single session of transcranial direct current stimulation (tDCS) over the right ventrolateral prefrontal cortex (rVLPFC) may decrease the unique tendency of BPD patients to feel rejected even when socially included during a laboratory task. Objectives: This protocol outlines a double-blind, sham-controlled study evaluating the longitudinal effects of repeated anodal tDCS over the right ventrolateral prefrontal cortex (rVLPFC) on rejection-related emotions (RRE) during real-life social interactions in individuals with BPD. Methods: Sixty BPD patients will be randomized to receive real or sham tDCS across 10 daily sessions, coupled with an ecological momentary assessment (EMA) protocol capturing emotional and behavioral responses to real-life social interactions over four timepoints: baseline, during treatment, ten days post-treatment, and three months post-treatment. Primary outcomes include changes in RRE, with exploratory analyses examining feelings of social connection, aggressive tendencies, trust toward others, and interpersonal and affective dynamics. Multilevel modeling will assess temporal and group-level effects. Expected Results and Impact: This study aims to establish the efficacy of tDCS in reducing BPD patients’ negative emotional response in real-life social situations and to determine whether such effects are maintained in time. The findings could advance the clinical application of tDCS as an adjunctive intervention to alleviate social–emotional impairments in BPD, addressing gaps in current treatment approaches and guiding future research into the neural mechanisms of social emotion regulation. Full article

Tinnitus is defined as the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes tinnitus disorder when the phantom sound is associated with suffering and/or disability. There is only limited knowledge about the time course of tinnitus disorder. Bereavement science has identified four different trajectories: resilience, recovery, chronic, and delayed. The question arises whether these four trajectories exist in tinnitus as well if one considers tinnitus as the loss of silence (at will). To verify whether these four trajectories exist, short-term tinnitus progression was analyzed retrospectively using an Ecological Momentary Assessment (EMA) approach, extracting the data from patients who started using the TrackYourTinnitus (TYT) app (version 1, Ulm University, 2013) from the start of their tinnitus perception. Four patients were identified retrospectively via the TYT app with acute tinnitus, and the bereavement trajectories were reconstructed based on EMA. In conclusion, this perspective suggests that the four known bereavement trajectories may exist in tinnitus, and prospective evaluations of larger samples are warranted to confirm or disprove this analogy between bereavement and tinnitus, in which tinnitus is conceived as the loss of (controllable) silence. Full article

Background/Objectives: Over 5 million youth under the age of 19 provide daily, hands-on care to an ill or injured family member across the United States. Yet how these young carers perceive the care they deliver in the moment, and how these perceptions relate to well-being, is unexplored, particularly in complex neurological conditions. This paper presents initial data on young carers for a family member with amyotrophic lateral sclerosis (ALS). Methods: Ecological momentary assessment (EMA) was used to measure perceptions of care in the moments of care and the cognitive and emotional states of the young carers during those moments. Young carers (n = 15) aged 10–19 were followed for seven days, completing assessments three times per day, which provided 260 total measurements. Young carers reported frequently engaging in caregiving (~39% of assessments). Results: The results indicated that it was not simply performing a caregiving task that related to outcomes, but rather how caregiving moments were perceived that mattered. Caregiving moments perceived as more fulfilling resulted in young carers feeling less discontent and more focused, whereas caregiving moments perceived as lacking resources predicted more discontent and distress. Exploratory analyses highlighted the potential for burden for young carers. They reported high levels of worry when they were not around the care recipient, with this worry predicting feeling more discontent and distressed. Conclusions: Young carers are deeply involved in care and perceive care differently across moments, both positive and negative. These initial data can be used to develop targeting support programs in the moment of care, potentially lessening the negative impacts of care. Full article

Physical activity (PA) is essential for healthy aging, but its accurate assessment in older adults remains challenging due to the limitations and biases of traditional clinical assessment. Mobile technologies and wearable sensors offer a more ecological, less biased alternative for evaluating PA in this population. This study aimed to optimize digital phenotyping strategies for assessing PA patterns in older adults, by integrating ecological momentary assessment (EMA) and continuous wearable sensor data collection. Over two weeks, 108 community-dwelling older adults provided real-time EMA responses while their PA was continuously monitored using Garmin Vivo 5 sensors. The combined approach proved feasible, with 67.2% adherence to EMA prompts, consistent across time points (morning: 68.1%; evening: 65.4%). PA predominantly occurred at low (51.4%) and moderate (46.2%) intensities, with midday activity peaks. Motivation and self-efficacy were significantly associated with low-intensity PA (R = 0.20 and 0.14 respectively), particularly in the morning. However, discrepancies between objective step counts and self-reported PA measures, which showed no correlation (R = −0.026, p = 0.65), highlight the complementary value of subjective and objective data sources. These findings support integrating EMA, wearable sensors, and temporal frameworks to enhance PA assessment, offering precise insights for personalized, time-sensitive interventions to promote PA. Full article

Background/Objectives: Excess adiposity, affecting 43% of the global adult population, is a major contributor to cardiometabolic diseases. Lifestyle behaviours, specifically dietary habits, play a key role in weight management. Real-time assessment methods such as Ecological Momentary Assessment (EMA) provide context-rich data that reduce recall bias and offer insights into dietary triggers and lapses. This study examines dietary triggers among adults with excess adiposity in Singapore using EMA, focusing on factors influencing dietary adherence and lapses. Methods: A total of 250 participants with a BMI ≥ 23 kg/m² were recruited to track dietary habits for one week, at least three times a day, using the Eating Behaviour Lapse Inventory Survey Singapore (eBLISS) embedded within the Eating Trigger Response Inhibition Program (eTRIP© V.1) smartphone app. Logistic regression analysis was used to identify predictors of dietary adherence. Results: Of the 4708 responses, 76.4% of the responses were indicative of adherence to dietary plans. Non-adherence was primarily associated with food accessibility and negative emotions (stress, nervousness, and sadness). Factors such as meals prepared by domestic helpers and self-preparation were significantly associated with adherence. Negative emotions and premenstrual syndrome were identified as significant predictors of dietary lapses. Conclusions: EMA offers valuable insights into dietary behaviours by identifying real-time triggers for dietary lapses. Future interventions can utilise technology-driven approaches to predict and prevent lapses, potentially improving adherence and weight management outcomes. Full article

Our study presents an innovative variational Bayesian parameter estimation method for the Quantile Nonlinear Dynamic Latent Variable Model (QNDLVM), particularly when dealing with missing data and nonparametric priors. This method addresses the computational inefficiencies associated with the traditional Markov chain Monte Carlo (MCMC) approach, which struggles with large datasets and high-dimensional parameters due to its prolonged computation times, slow convergence, and substantial memory consumption. By harnessing the deterministic variational Bayesian framework, we convert the complex parameter estimation into a more manageable deterministic optimization problem. This is achieved by leveraging the hierarchical structure of the QNDLVM and the principle of efficiently optimizing approximate posterior distributions within the variational Bayesian framework. We further optimize the evidence lower bound using the coordinate ascent algorithm. To specify propensity scores for missing data manifestations and covariates, we adopt logistic and probit models, respectively, with conditionally conjugate mean field variational Bayes for logistic models. Additionally, we utilize Bayesian local influence to analyze the Ecological Momentary Assessment (EMA) dataset. Our results highlight the variational Bayesian approach’s notable accuracy and its ability to significantly alleviate computational demands, as demonstrated through simulation studies and practical applications. Full article

Using Ecological Momentary Assessment (EMA), this study examined associations between momentary availability of physical activity (PA) space and accessibility of PA opportunities among 608 elementary and middle school students who were participating in an obesity prevention trial in one mid-Atlantic state in the U.S. Smartphones prompted EMA surveys at random times to assess children’s perceived availability of PA space and accessibility of PA opportunities during out-of-school time, three to seven times each day over seven days. Multilevel logistic regression, which accounted for multiple responses per student, examined within- and between-person relations as well as the moderating effects of locale. The participants (M age = 10.88 years) lived in suburban (64%), rural (23%), and urban locales (13%). PA space availability was associated with greater PA opportunity accessibility (within-person OR = 9.82, p < 0.001; between-person OR = 22.61, p < 0.001). Locale moderated within-person relationships (p < 0.001), indicating that urban students with space were unable to use it or could be active but were without space. These findings advance our knowledge of temporal and environmental aspects related to childhood PA across diverse locales and can be used by policymakers to make informed decisions to ensure the use of age-appropriate, high quality, and safe spaces, particularly for children in urban areas. Full article

Suicidal behavior and Non-Suicidal Self-Injuries (NSSIs) are a major health problem in the adolescent population. New technologies can contribute to the development of innovative interventions in suicide prevention. Here, we present the SmartCrisis-Teen study protocol. The study consists of a randomized clinical trial which aims to evaluate the effectiveness of a digital safety plan to prevent suicidal behavior and NSSIs in adolescents. This is a multicentric study which will be conducted among the adolescent population, both in clinical and student settings, with a target sample of 1080 participants. The intervention group will receive an Ecological Momentary Intervention (EMI) consisting of a digital safety plan on their mobile phone. All participants will receive their Treatment As Usual (TAU). Participants will be followed for six months, with weekly and monthly telephone visits and face-to-face visits at three and six months. Participants will be assessed using traditional questionnaires as well as Ecological Momentary Assessment (EMA) and Implicit Association Tests (IATs). With this intervention, we expect a reduction in NSSIs through the acquisition of coping strategies and a decrease in suicidal behavior over the course of follow-up. This study provides a novel, scalable digital intervention for preventing suicidal behavior and NSSIs in adolescents, which could contribute to improving adolescent mental health outcomes globally. Full article

Healthcare professionals are known to suffer from workplace stress and burnout, which can negatively affect their empathy for patients and quality of care. While existing research has identified factors associated with wellbeing and empathy in healthcare professionals, these efforts are typically focused on the group level, ignoring potentially important individual differences and implications for individualized intervention approaches. In the current study, we implemented N-of-1 personalized machine learning (PML) to predict wellbeing and empathy in healthcare professionals at the individual level, leveraging ecological momentary assessments (EMAs) and smartwatch wearable data. A total of 47 mood and lifestyle feature variables (relating to sleep, diet, exercise, and social connections) were collected daily for up to three months followed by applying eight supervised machine learning (ML) models in a PML pipeline to predict wellbeing and empathy separately. Predictive insight into the model architecture was obtained using Shapley statistics for each of the best-fit personalized models, ranking the importance of each feature for each participant. The best-fit model and top features varied across participants, with anxious mood (13/19) and depressed mood (10/19) being the top predictors in most models. Social connection was a top predictor for wellbeing in 9/12 participants but not for empathy models (1/7). Additionally, empathy and wellbeing were the top predictors of each other in 64% of cases. These findings highlight shared and individual features of wellbeing and empathy in healthcare professionals and suggest that a one-size-fits-all approach to addressing modifiable factors to improve wellbeing and empathy will likely be suboptimal. In the future, such personalized models may serve as actionable insights for healthcare professionals that lead to increased wellness and quality of patient care. Full article

Background and Objectives: Although there is strong evidence of the positive effects of physical exercise on health, adherence to face-to-face exercise programs in the adult population is low, identifying several barriers that hinder their practice. There is research that demonstrates the viability of physical exercise programs with the use of Mobile Health in Ecological Momentary Assessment (EMA) mode, which contributes to overcoming many reported barriers. To synthesize the methodological characteristics and health effects of physical exercise programs based on mobile health in EMA modality in adults in developing countries. Materials and Methods: This systematic review was conducted according to guidelines established by the PRISMA statement in APA PsycArticles and CINAHL databases by EBSCOhost, Cochrane Library, PubMed, and Web of Science for articles published between 2008 and March 2024. Results: Telephone counseling on clinical–behavioral factors is believed to reduce morbidity and mortality in developed countries, but this aspect is not explored in developing countries. We included nine randomized controlled trials with a total of 4394 male and female participants aged 18 to 60 years. The interventions were mainly carried out by text messages, lasting between 20 to 80 min per session, 3 to 5 days per week, and most were carried out over 12 months. The interventions on the variables of physical activity, nutrition, and medical assessments showed significant effects, and variables such as quality of life and anthropometric measurements were not significant in most studies. Conclusions: This systematic review included studies from different developing countries, the most common diseases being diabetes, overweight, obesity, and hypertension. All the studies used mobile devices as the technology, finding a profile of the adults studied, as well as the characteristics of exercise programs based on mobile health in EMA modality. Full article

We examined whether perceived stress, anhedonia, and food insecurity were associated with dietary adherence during a 6-week intervention. Sixty participants (23 m; 53 ± 14 y) completed psychosocial measures and were provided with full meals. Individuals with obesity were randomized to a weight-maintaining energy needs (WMENs) (n = 18; BMI 33 ± 4) or a 35% calorie-reduced diet (n = 19; BMI 38 ± 9); normal-weight individuals (n = 23; BMI 23 ± 2) were assigned to a WMENs diet. Adherence scores were determined via weekly assessments and daily ecological momentary assessments (EMAs) of real-time behavior in a natural environment. Perceived stress and anhedonia were associated with % body fat (all r-values > 0.25, all p-values < 0.05), but food insecurity and adherence were not. Higher perceived stress (r = −0.31, p = 0.02), anhedonia (r = −0.34, p = 0.01), and food insecurity (r = −0.27, p = 0.04) were associated with lower adherence scores, even after adjusting for age, sex, and % body fat. In all adjusted models, % body fat was not associated with adherence. Higher measures of stress, anhedonia, and food insecurity predicted lower adherence independently of body fat, indicating that psychosocial factors are important targets for successful adherence to dietary interventions, regardless of body size. Full article

Accelerometers have been used to objectively quantify physical activity, but they can pose a high burden. This study was conducted to determine the feasibility of using a single-item smartphone-based ecological momentary assessment (EMA) in lieu of accelerometers in long-term assessment of daily exercise. Data were collected from a randomized controlled trial of intermittently exercising, otherwise healthy adults (N = 79; 57% female, mean age: 31.9 ± 9.5 years) over 365 days. Smartphone-based EMA self-reports of exercise entailed daily end-of-day responses about physical activity; the participants also wore a Fitbit device to measure physical activity. The Kappa statistic was used to quantify the agreement between accelerometer-determined (24 min of moderate-to-vigorous physical activity [MVPA] within 30 min) and self-reported exercise. Possible demographic predictors of agreement were assessed. Participants provided an average of 164 ± 87 days of complete data. The average within-person Kappa was κ = 0.30 ± 0.22 (range: −0.15–0.73). Mean Kappa ranged from 0.16 to 0.30 when the accelerometer-based definition of an exercise bout varied in duration from 15 to 30 min of MVPA within any 30 min period. Among the correlates examined, sex was significantly associated with agreement; mean agreement was higher among women (κ = 0.37) than men (κ = 0.20). Agreement between EMA self-reported and accelerometer-measured exercise was fair, suggesting that long-term exercise monitoring through a single-item EMA may be acceptable. Full article

Lifestyle factors—such as diet, physical activity (PA), smoking, and alcohol consumption—have a significant impact on mortality as well as healthcare costs. Moreover, they play a crucial role in the development of type 2 diabetes mellitus (DM2). There also seems to be a link between lifestyle behaviours and insulin resistance, which is often a precursor of DM2. This study uses an enhanced Healthy Living Index (HLI) integrating accelerometric data and an Ecological Momentary Assessment (EMA) to explore differences in lifestyle between insulin-sensitive (IS) and insulin-resistant (IR) individuals. Moreover, it explores the association between lifestyle behaviours and inflammation. Analysing data from 99 participants of the mPRIME study (57 women and 42 men; mean age 49.8 years), we calculated HLI scores—ranging from 0 to 4— based on adherence to specific low-risk lifestyle behaviours, including non-smoking, adhering to a healthy diet, maximally moderate alcohol consumption, and meeting World Health Organization (WHO) PA guidelines. Insulin sensitivity was assessed using a Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and C-reactive protein (CRP) levels were used as a proxy for inflammation. Lifestyle behaviours, represented by HLI scores, were significantly different between IS and IR individuals (U = 1529.0; p = 0.023). The difference in the HLI score between IR and IS individuals was mainly driven by lower adherence to PA recommendations in the IR group. Moreover, reduced PA was linked to increased CRP levels in the IR group (r = −0.368, p = 0.014). Our findings suggest that enhancing PA, especially among individuals with impaired insulin resistance, holds significant promise as a preventive strategy. Full article

As mobile devices have become a central part of our daily lives, they are also becoming increasingly important in research. In the medical context, for example, smartphones are used to collect ecologically valid and longitudinal data using Ecological Momentary Assessment (EMA), which is mostly implemented through questionnaires delivered via smart notifications. This type of data collection is intended to capture a patient’s condition on a moment-to-moment and longer-term basis. To collect more objective and contextual data and to understand patients even better, researchers can not only use patients’ input via EMA, but also use sensors as part of the Mobile Crowdsensing (MCS) approach. In this paper, we examine how researchers have embraced the topic of MCS in the context of EMA through a systematic literature review. This PRISMA-guided review is based on the databases PubMed, Web of Science, and EBSCOhost. It is shown through the results that both EMA research in general and the use of sensors in EMA research are steadily increasing. In addition, most of the studies reviewed used mobile apps to deliver EMA to participants, used a fixed-time prompting strategy, and used signal-contingent or interval-contingent self-assessment as sampling/assessment strategies. The most commonly used sensors in EMA studies are the accelerometer and GPS. In most studies, these sensors are used for simple data collection, but sensor data are also commonly used to verify study participant responses and, less commonly, to trigger EMA prompts. Security and privacy aspects are addressed in only a subset of mHealth EMA publications. Moreover, we found that EMA adherence was negatively correlated with the total number of prompts and was higher in studies using a microinteraction-based EMA ($\mu$EMA) approach as well as in studies utilizing sensors. Overall, we envision that the potential of the technological capabilities of smartphones and sensors could be better exploited in future, more automated approaches. Full article