A multi-stage intervention assessing, advising and customising sports bras for elite female British athletes.

Appropriate breast support is recommended in sport; however, what constitutes appropriate support is complex, individual and often sports specific, particularly in elite sport given the wear duration. This intervention educated, assessed and advised elite British female athletes on breasts and bras; those with unresolved issues engaged in bespoke bra interventions. Following educational workshops (n = 80), breast/bra surveys (n = 60), individual bra assessments (n = 37); a rower, shooter, and hockey player participated in the bespoke bra intervention. Eighty-three per cent of athletes rated their breast/bra knowledge as ≤average. Fifty-one per cent experienced breast pain, affecting performance for 29%; seven used medication and one surgery to relieve symptoms. In individual bra assessments most wore ill-fitting, unsupportive bras and wanted bra advice. Bespoke bra interventions eliminated breast pain: for the rower, improved breast position and spine rotation; for the shooter, repositioned tissue and improved performance; and for the hockey player, accommodated smart devices. Whilst bespoke bra development is challenging, most elite athlete breast/bra issues are resolved via education, advice and fitting.

Can we predict the neutral breast position using the gravity-loaded breast position, age, anthropometrics and breast composition data?

BACKGROUND: This study aimed to identify the predictor variables which account for neutral breast position variance using a full independent variable dataset (the gravity-loaded breast position, age and anthropometrics, and magnetic resonance imaging breast composition data), and a simplified independent variable dataset (magnetic resonance imaging breast composition data excluded). METHODS: Breast position (three-dimensional neutral and static gravity-loaded), age, anthropometrics and magnetic resonance imaging breast composition data were collected for 80 females (bra size 32A to 38D). Correlations between the neutral breast position and the gravity-loaded breast position, age, anthropometrics, and magnetic resonance imaging breast composition data were assessed. Multiple linear and multivariate multiple regression models were utilised to predict neutral breast positions, with mean absolute differences and root mean square error comparing observed and predicted neutral breast positions. FINDINGS: Breast volume was the only breast composition variable to contribute as a predictor of the neutral breast position. While ≥69% of the variance in the anteroposterior and mediolateral neutral breast positions were accounted for utilising the gravity-loaded breast position, multivariate multiple regression modelling resulted in mean absolute differences >5 mm. INTERPRETATION: Due to the marginal contribution of breast composition data, a full independent variable dataset may be unnecessary for this application. Additionally, the gravity-loaded breast position, age, anthropometrics, and breast composition data do not successfully predict the neutral breast position. Incorporation of the neutral breast position into breast support garments may enhance bra development. However, further identification of variables which predict the neutral breast position is required.

A multi-phase intervention study of sports bra prescription for elite UK female athletes preparing for the Tokyo Olympics and Paralympics.

Athletes report poor breast/bra knowledge, breast pain, sports bras causing lacerations and chafing, negatively affecting sports performance. No bra interventions to address these issues are reported. Working with 142 UK female athletes preparing for Tokyo Olympics/Paralympics (27 sports), this multi-phase intervention assessed breast/bra knowledge, preferences, issues via surveys and breast/bra assessments. Data were used to develop two sports bras. A total of 112 athletes were prescribed one of the new bras through individual assessments. After four weeks, wear athletes completed evaluations. Pre-intervention breast/bra knowledge was low (83% ≤average), multiple breast/bra issues were reported and most athletes wore ill-fitting, loose bras, offering limited support. Post-intervention, 63% reported improved knowledge and 97% reported their prescribed bra as better than their original bra. Eighty-seven per cent reported benefitting from this intervention, with 17% reporting improved performance. This intervention effectively assessed sports bra needs, developed and implemented solutions, which improved knowledge and potentially performance for some UK athletes.

There are two sides to every story: implications of asymmetry on breast support requirements for sports bra manufacturers.

This study aimed to investigate: (1) the prevalence and magnitude of breast movement asymmetry, (2) the interaction between static and dynamic breast asymmetry and (3) the influence of sports bras on breast asymmetry during running. Position data were collected from 167 females whilst treadmill running and then a sub-group of 12 participants in different bra conditions. Breast movement asymmetry existed in 89% of participants, with resultant static breast position asymmetry larger in participants displaying dynamic asymmetry. Asymmetry was most commonly caused (60% to 75%) by greater movement of the left breast. No significant relationships were found between asymmetry and bra size or breast pain. Sports bras reduced asymmetry prevalence from 75% to 33% of participants in the antero-posterior direction but only from 75% to 67% of participants in the infero-superior direction. The magnitude of range-of-motion asymmetry reduced from 67 mm with no bra to between 6 and 64 mm in-bra in the infero-superior direction, with the best performing bra incorporating encapsulating cups and adjustable straps and underband. It is recommended that sports bras allow underband and strap adjustment to facilitate individual breast support and that asymmetry is considered when designing and fitting bras, which could utilise resultant asymmetry measured statically.

Emotional Empathy in the Social Regulation of Distress: A Dyadic Approach.

Although research suggests distressed individuals benefit from others' empathy, it is unclear how an individual's level of empathy influences dyadic responses during emotional situations. In the current study, female participants (N = 140; 70 dyads) were paired with a stranger. One member of each dyad (the experiencer) was randomly assigned to undergo a stressful task and disclose negative personal experiences to their partner (the listener). Experiencers paired with listeners higher in dispositional emotional empathy had less negative affect during emotional disclosure and lower sympathetic nervous system reactivity during the stressful task and disclosure. Listeners higher in emotional empathy reported more negative affect in response to their partner's distress. Furthermore, for listeners higher in emotional empathy, those who more accurately rated their partner's emotions were more physiologically influenced by their partners. Findings shed light on interpersonal functions of empathy and suggest a stranger's level of emotional empathy regulates distressed partner's emotions and physiology.

Development of a brief online intervention to address aggression in the context of emotion-related impulsivity: Evidence from a wait-list controlled trial.

Trait-like tendencies to respond impulsively to emotion, labelled emotion-related impulsivity, are robustly related to aggression. We developed and tested an online intervention to address emotion-related impulsivity and aggression. The 6-session intervention focused on behavioral techniques shown to decrease arousal and aggression, supplemented with implementation intentions and smartphone prompts to facilitate skills transfer into daily life. First, we piloted the intervention in-person with 4 people. Then, 235 participants were randomly assigned to take the online intervention immediately or after a wait-list period; those in the waitlist were then invited to take part in the intervention. Participants completed the self-rated Feelings Trigger Action Scale to assess emotion-related impulsivity, the interview-based Modified Overt Aggression Scale and the self-rated Buss Perry Aggression Questionnaire. Participants who took part in the treatment completed daily anger logs. Attrition, as with other online programs, was high; however, treatment completers reported high satisfaction, and outcomes changed more rapidly during treatment than waitlist across all key outcome indices. In analyses including all participants who took part in the treatment (immediate or delayed), we observed moderate-to-large treatment gains, which were maintained as of the 3-month follow-up assessment. This work supports the usefulness of an intervention for addressing emotion-related impulsivity and aggression.

Do static and dynamic activities induce potentially damaging breast skin strain?

BACKGROUND/AIM: This study aimed to quantify breast skin strain and strain rate and the effect of support garments at reducing strain and to determine characteristics that correlate with strain during static and dynamic activity. METHODS: 39 women (UK size 32C to 36G) had electromagnetic sensors applied to their breast skin. Sensor coordinates were recorded while standing, walking, running, in no, low and high breast support conditions, plus bare-breasted in the estimated neutral position to calculate strain. Relative breast coordinates and 35 inter-sensor distances identified peak breast skin strain (%) and strain rate (%·s-1), which were then correlated with nipple kinematics, breast pain and participant characteristics. RESULTS: Mean peak breast skin strain was generally <60% during standing, walking and running; however, some individuals exhibited 93% strain in bare-breasted running. Compared with low support, high support did not further reduce strain during standing and walking. Peak breast skin strain/strain rate location was longitudinal, in lateral and medial breast regions and displayed strong correlations with breast volume, body mass index and bust circumference. CONCLUSION: Static and dynamic activity did not result in excessive breast skin strain, suggesting low risk of skin damage. However, during running, some individuals experienced excessive skin strains (up to 93%) and strain rates (up to 1258%·s-1). Breast skin strain/strain rate location suggests lift is required in the lateral and medial bra cup to reduce strain, particularly in larger breast volumes due to increased skin strain risk.

A brief online intervention to address aggression in the context of emotion-related impulsivity for those treated for bipolar disorder: Feasibility, acceptability and pilot outcome data.

Although aggression is related to manic symptoms among those with bipolar disorder, new work suggests that some continue to experience elevations of aggression after remission. This aggression post-remission appears related to a more general tendency to respond impulsively to states of emotion, labelled emotion-related impulsivity. We recently developed the first intervention designed to address aggression in the context of emotion-related impulsivity. Here, we describe feasibility, acceptability, and pilot data on outcomes for 21 persons who received treatment for bipolar disorder and endorsed high levels of aggression and emotion-related impulsivity. As with other interventions for aggression or bipolar disorder, attrition levels were high. Those who completed the intervention showed large changes in aggression using the interview-based Modified Overt Aggression Scale that were sustained through three months and not observed during wait list control. Although they also showed declines in the self-rated Buss-Perry Aggression Questionnaire and in self-rated emotion-related impulsivity as assessed with the Feelings Trigger Action Scale, these self-ratings also declined during the waitlist control. t Despite the limitations, the findings provide the first evidence that a brief, easily disseminated intervention could have promise for reducing aggression among those with bipolar disorder.

Improved Breastfeeding Outcomes Following an On-site Support Intervention in an Academic Family Medicine Center.

BACKGROUND AND OBJECTIVES: Despite the importance of breastfeeding, most US women do not meet recommendations for length of any or exclusive breastfeeding. Support in primary care settings is recommended (US Preventive Services Task Force, 2016), but optimal implementation strategies are not established. We evaluated the effect on breastfeeding rates of on-site breastfeeding support within an academic family medicine center with a diverse patient population. METHODS: We conducted a retrospective chart review 10 months before and 10 months following the implementation of integrated breastfeeding support provided by an International Board Certified Lactation Consultant (IBCLC) or MD-IBCLC. Two hundred eighty-one infants were identified, 140 before implementation and 141 after. A research assistant extracted data from the electronic medical record. We performed bivariate and multiple logistic regression analyses using STATA. RESULTS: There were no significant demographic differences before and after the intervention. The proportion of infants with any breastfeeding at 2, 4, and 6 months was greater in the postimplementation group (71.7% vs 86.7% at 2 months, P=.05; 61.5% vs 77.1% at 4 months, P=.08; and 50.7% vs 64.4%, P=.09 at 6 months). The proportion of infants exclusively breastfed was also greater in the postimplementation group (58.7% vs 77.8% at 2 months, P=.04; 50.5% vs. 54.2% at 4 months, P=.06; and 44.0% vs 49.3% at 6 months, P=.12). CONCLUSIONS: Providing on-site IBCLC breastfeeding support services within an academic family medicine clinic is associated with significant increases in breastfeeding, supporting the provision of lactation services on-site where mothers and children receive primary care.

Defeatist performance beliefs in college students: Transdiagnostic associations with symptoms and daily goal-directed behavior.

Defeatist performance beliefs are prevalent and linked to decreased motivation in people with psychological disorders. In this study, we investigated whether defeatist performance beliefs were associated with transdiagnostic psychopathology risk in people with no history of formal diagnosis and whether defeatist performance beliefs impacted engagement in daily goal-directed behavior. One hundred and two college students completed self-report measures of defeatist performance beliefs and risk for depression, mania, and psychosis. Sixty-one of these participants were randomly selected to identify a goal and complete daily surveys about their actual and expected goal progress, effort expenditure, experienced pleasure, and difficulty of goal pursuit. We found that greater defeatist performance beliefs were associated with higher risk for depression, mania, and psychosis. Using multilevel modeling, we found that greater defeatist performance beliefs predicted less goal progress, effort expenditure, and pleasure from goal pursuit. Together, these findings suggest that defeatist performance beliefs may impact goal-directed behavior in healthy people with no reported psychiatric history. Interventions targeting defeatist performance beliefs may have utility for actual goal-directed behavior in many people, regardless of psychiatric status.

Quantification of gravity-induced skin strain across the breast surface.

BACKGROUND: Quantification of the magnitude of skin strain in different regions of the breast may help to estimate possible gravity-induced damage whilst also being able to inform the selection of incision locations during breast surgery. The aim of this study was to quantify static skin strain over the breast surface and to estimate the risk of skin damage caused by gravitational loading. METHODS: Fourteen participants had 21 markers applied to their torso and left breast. The non-gravity breast position was estimated as the mid-point of the breast positions in water and soybean oil (higher and lower density than breast respectively). The static gravity-loaded breast position was also measured. Skin strain was calculated as the percentage extension between adjacent breast markers in the gravity and non-gravity loaded conditions. FINDINGS: Gravity induced breast deformation caused peak strains ranging from 14 to 75% across participants, with potentially damaging skin strain (>60%) in one participant and skin strains above 30% (skin resistance zone) in a further four participants. These peak strain values all occurred in the longitudinal direction in the upper region of the breast skin. In the latitudinal direction, smaller-breasted participants experienced greater strain on the outer (lateral) breast regions and less strain on the inner (medial) breast regions, a trend which was reversed in the larger breasted participants (above size 34D). INTERPRETATION: To reduce tension on surgical incisions it is suggested that preference should be given to medial latitudinal locations for smaller breasted women and lateral latitudinal locations for larger breasted women.

Positive urgency and emotional reactivity: Evidence for altered responding to positive stimuli.

Positive urgency, defined as a tendency to become impulsive during positive affective states, has gained support as a form of impulsivity that is particularly important for understanding psychopathology. Despite this, little is known about the emotional mechanisms and correlates of this form of impulsivity. We hypothesized that positive urgency would be related to greater emotional reactivity in response to a positive film clip. Seventy-five undergraduates watched a positive film clip, and a multimodal assessment of emotion was conducted, including subjective emotional experience, physiological activation (i.e., heart rate, respiratory sinus arrhythmia, skin conductance), and facial emotional behavior (i.e., objectively coded using the Facial Action Coding System). Positive urgency was not significantly related to greater positive emotional reactivity but rather a more complex array of emotions expressed in facial behavior, as indexed by similar levels of positive yet greater levels of negative behavior. These findings show that positive urgency may be linked to altered emotionality, but does not appear related to heightened positive emotional reactivity. Potential implications for functional outcomes are discussed. (PsycINFO Database Record

Estimating the gravity induced three dimensional deformation of the breast.

As human breast tissue is continuously deformed by gravity, it is difficult to identify the non-loaded neutral breast position from which to take measurements. To estimate the neutral nipple position, this study proposed a simple novel method to counteract the three dimensional effect of gravity on the breast using the buoyant forces from water and soybean oil (ρWATER = 994kgm-3; ρOIL = 909kgm-3). Fourteen female participants with breast sizes ranging from 30 to 34in. under band and B to E cup size took part in this study. Each participant had their static gravity-loaded nipple position measured and their neutral nipple position estimated (as the midpoint between the nipple position during water and soybean oil immersion). Participants were asked to sit in each fluid and fully submerge their torso and breasts. The mean gravity-induced nipple displacements from the neutral nipple position were 15.3mm in the posterior direction, 7.4mm in the lateral direction, and 25.7mm in the inferior direction. Gravity had a significant (p < 0.05, r > 0.82) measurable effect on the static nipple position, particularly in the inferior and posterior directions. Furthermore the density difference between water and soybean oil produced a significant difference (p < 0.05, r = 0.72) in superior-inferior nipple position (5.6mm). These findings suggest that neglect of gravity-induced breast deformations may lead to errors when assessing breast position and its relationship to possible breast pain, and that water alone may not be sufficient to estimate the neutral nipple position.

Positive urgency is related to difficulty inhibiting prepotent responses.

Positive urgency, the tendency to respond impulsively to positive affective states, has been linked to many psychopathologies, but little is known about mechanisms underpinning this form of impulsivity. We examined whether the Positive Urgency Measure (PUM) related to higher scores on performance-based measures of impulsivity and cognitive control that were administered after a positive mood induction. Undergraduates (n = 112) completed the self-report PUM, several positive mood inductions, and behavioral measures of impulsivity and cognitive control. PUM scores were significantly related to poor performance on the antisaccade task, a measure of prepotent response inhibition, but not to other performance measures. Together with existing literature, findings implicate deficits in response inhibition as one mechanism involved in emotion-related impulsivity. (PsycINFO Database Record

Negative symptoms in psychometrically defined schizotypy: The role of depressive symptoms.

People high in schizotypy, a risk factor for schizophrenia-spectrum disorders, can have negative symptoms, including diminished experience of motivation/pleasure (MAP) and emotional expressivity (EXP). Additionally, people high in schizotypy often report elevated depressive symptoms, which are also associated with diminished MAP and EXP. In this study, we examined whether negative symptoms were related to schizotypy above and beyond the presence of depressive symptoms. Thirty-one people high in schizotypy and 24 people low in schizotypy were administered the Clinical Assessment Interview for Negative Symptoms (CAINS), an interview-based measure of MAP and EXP negative symptoms and completed a self-report measure of cognitive and somatic-affective depressive symptoms. People high in schizotypy had more MAP negative symptoms than people low in schizotypy, but we found no group differences in EXP negative symptoms. Importantly, the relationship between MAP negative symptoms and schizotypy was fully mediated by cognitive depressive symptoms. These findings suggest that depressive symptoms, specifically cognitive depressive symptoms, may be a pathway for motivation and pleasure impairment, in people at elevated risk for developing schizophrenia-spectrum disorders.

Defeatist Performance Beliefs, Negative Symptoms, and Functional Outcome in Schizophrenia: A Meta-analytic Review.

Negative symptoms are a strong predictor of poor functional outcome in people with schizophrenia. Unfortunately there are few effective interventions for either negative symptoms or functional outcome, despite the identification of potential mechanisms. Recent research, however, has elucidated a new potential mechanism for negative symptoms and poor functional outcome: defeatist performance beliefs (DPB), or negative thoughts about one's ability to successfully perform goal-directed behavior that can prevent behavior initiation and engagement. We conducted 2 meta-analyses examining the relationship between DPB and both negative symptoms (n = 10 studies) and functional outcome (n = 8 studies) in people with schizophrenia. We found a small effect size for the relationship between DPB and negative symptoms, regardless of how negative symptoms were measured. We also found a small effect size for the relationship between DPB and functional outcome, which was significantly moderated by the method of assessing DPB and moderated by the sex composition of the study at a trend level. These findings highlight the potential of targeting DPB in psychosocial interventions for both negative symptoms and functional outcome.

Do people with schizophrenia have difficulty anticipating pleasure, engaging in effortful behavior, or both?

Motivation deficits are common in schizophrenia, but little is known about underlying mechanisms, or the specific goals that people with schizophrenia set in daily life. Using neurobiological heuristics of pleasure anticipation and effort assessment, we examined the quality of activities and goals of 47 people with and 41 people without schizophrenia, utilizing ecological momentary assessment. Participants were provided cell phones and called 4 times a day for 7 days, and were asked about their current activities and anticipation of upcoming goals. Activities and goals were later coded by independent raters on pleasure and effort. In line with recent laboratory findings on effort computation deficits in schizophrenia, relative to healthy participants, people with schizophrenia reported engaging in less effortful activities and setting less effortful goals, which were related to patient functioning. In addition, patients showed some inaccuracy in estimating how difficult an effortful goal would be, which in turn was associated with lower neurocognition. In contrast to previous research, people with schizophrenia engaged in activities and set goals that were more pleasure-based, and anticipated goals as being more pleasurable than controls. Thus, this study provided evidence for difficulty with effortful behavior and not anticipation of pleasure. These findings may have psychosocial treatment implications, focusing on effort assessment or effort expenditure. For example, to help people with schizophrenia engage in more meaningful goal pursuits, treatment providers may leverage low-effort pleasurable goals by helping patients to break down larger, more complex goals into smaller, lower-effort steps that are associated with specific pleasurable rewards.

Daily life evidence of environment-incongruent emotion in schizophrenia.

Researchers have recently hypothesized that negative emotion in positive situations may be one mechanism for understanding emotion dysfunction in schizophrenia. Using ecological momentary assessment, we examined the relationship between emotion experience and environmental context in the daily lives of participants with and without schizophrenia. Participants with (n=47) and without schizophrenia (n=41) were provided a cellular telephone and called four times a day for one week. During each call participants rated their emotion experiences, described their current activities, and rated enjoyment from those activities. In line with previous research, participants with schizophrenia reported higher negative emotion overall relative to participants without schizophrenia, but equivalent levels of positive emotion and activity enjoyment. In line with the environment-incongruent negative emotion hypothesis, participants with schizophrenia evidenced a weaker relationship between reported enjoyment of current activities and current negative emotion compared to participants without schizophrenia. In addition, lower neurocognition predicted this weak relationship between negative emotion and context in the schizophrenia group. These findings provide ecologically valid support for environment-incongruent negative emotion in schizophrenia, and suggest that people with schizophrenia with more impaired neurocognition may have more difficulties regulating negative emotion.

Using self-determination theory to understand motivation deficits in schizophrenia: the 'why' of motivated behavior.

Self-determination theory (SDT) provides a model for understanding motivation deficits in schizophrenia, and recent research has focused on problems with intrinsic motivation. However, SDT emphasizes that motivated behavior results from three different factors: intrinsic motivators (facilitated by needs for autonomy, competency, and relatedness), extrinsic motivators (towards reward or away from punishment), or when intrinsic and extrinsic motivators are absent or thwarted a disconnect-disengagement occurs resulting in behavior driven by boredom or 'passing time'. Using a novel approach to Ecological Momentary Assessment, we assessed the degree to which people with schizophrenia were motivated by these factors relative to healthy control participants. Forty-seven people with and 41 people without schizophrenia were provided with cell phones and were called four times a day for one week. On each call participants were asked about their goals, and about the most important reason motivating each goal. All responses were coded by independent raters (blind to group and hypotheses) on all SDT motivating factors, and ratings were correlated to patient functioning and symptoms. We found that, relative to healthy participants, people with schizophrenia reported goals that were: (1) less motivated by filling autonomy and competency needs, but equivalently motivated by relatedness; (2) less extrinsically rewarding, but equivalently motivated by punishment; (3) more disconnected-disengaged. Higher disconnected-disengaged goals were significantly associated with higher negative symptoms and lower functioning. These findings indicate several important leverage points for behavioral treatments and suggest the need for vigorous psychosocial intervention focusing on autonomy, competence, and reward early in the course of illness.