Surgical trainee experiences from 2013 to 2023 within the United Kingdom as reported by the General Medical Council National Training Survey.

INTRODUCTION: The General Medical Council (GMC) issues annual surveys to all doctors within the United Kingdom (UK) in a formal postgraduate training scheme. This facilitates the monitoring of experiences for quality assurance purposes. Low job satisfaction has been associated with heightened levels of burnout and staff turnover, alongside deteriorating clinical care and productivity levels. METHODS: We gathered and extracted data from the publicly available online GMC reporting tool. Data ranged from 2013 to 2023 and spanned 12 postgraduate surgical training programmes across all 18 indicators available. In total, 198 individual metrics were recorded, in addition to burnout. We conducted trend analysis and yearly average mean scores for individual metrics, burnout and geographical differences for 141 individual training programmes within the 16 training regions. RESULTS: Of the 198 metrics analysed, 83 (42 â€‹%) were found to have statistically significant negative trends (P â€‹< â€‹0.05), in comparison to 24 (12 â€‹%) with positive trends. 5 specialities had over 50 â€‹% of metrics showing a significant negative trend. Overall satisfaction was negative in all 12 programmes, with eight reaching significance (P â€‹< â€‹0.05). Of 141 individual training programmes, 29 â€‹% showed a significantly negative trend in overall satisfaction, with 1 â€‹% demonstrating a significant positive trend (P â€‹< â€‹0.05). CONCLUSION: Our study is the first to explore long-term trends in trainee reported surgical training experiences within the UK. Our data have revealed widespread worsening trainee reported experiences and dissatisfaction across multiple specialities and geographical regions, especially in key areas of overall satisfaction, self-development, and clinical supervision.

Incidence and trends in workplace violence within emergency departments in the United Kingdom 2017-2022: an observational time series analysis.

Background: Workplace violence (WPV) is a notable issue facing healthcare services and workers globally. WPV impacts upon the well-being of staff and can put healthcare provision at risk with detrimental effects on patient care. This study aims to investigate and quantify, at national and regional levels, the incidence and trends of WPV within emergency departments (EDs). Methods: We requested data relating to WPV from all 152 trusts with an ED in the United Kingdom from January 2017-March 2022. We applied interrupted time series and trend analysis to check for significant differences in WPV across the COVID-19 pandemic. Results: We conducted time series analysis on 58 million attendances and detected statistically significant increases in WPV in March 2020-5.06/100,000 attendances (95% CI 1.59/100,000-8.53/100,000 p < 0.01) and May 2020-20.63/100,000 attendances (95% CI 9.39-31.87 p < 0.01). Rises in incidents of 0.37/100,000 attendances per month (95% CI 0.21-0.53 p < 0.0001) were found January 2017-March 2020. We analyzed 96 million attendances for yearly trends, which revealed statistically significant increasing trends of WPV in London and North-West England (p < 0.05), and physical WPV in the North West England (p < 0.05). Conclusion: There have been dramatic increases in incidents of WPV in United Kingdom EDs over the last 5 years with concerning rises during the COVID-19 period. Our findings highlight the potential to further demoralize a workforce already under significant strain, resulting in increased absences for physical or mental health and an exodus of staff. Therefore, trusts should ensure there are robust systems in place to protect and safeguard staff.

Descriptive Epidemiology of Cardiorespiratory Fitness in UK Adults: The Fenland Study.

INTRODUCTION: Cardiorespiratory fitness (CRF) is rarely measured in population studies. Most studies of CRF do not examine differences by population subgroups or seasonal trends. We examined how estimated CRF levels vary by anthropometric, sociodemographic, and behavioral characteristics in a population-based cohort of UK adults (the Fenland Study). METHODS: We used a validated submaximal exercise test to obtain CRF estimates (CRF estimated ) in 5976 women and 5316 men, residing in the East of England. CRF estimated was defined as estimated maximal oxygen consumption per kilogram total body mass (V̇O 2 max tbm ) and fat-free mass (V̇O 2 max ffm ). Descriptive statistics were computed across anthropometric and sociodemographic characteristics, and across the year. Progressive multivariable analyses were performed to examine associations with physical activity energy expenditure (PAEE) and body mass index (BMI). RESULTS: Mean ± SD V̇O 2 max tbm was lower in women (35.2 ± 7.5 mL·min -1 ·kg -1 ) than men (41.7 ± 7.3 mL·min -1 ·kg -1 ) but V̇O 2 max ffm was similar (women: 59.2 ± 11.6 mL·min -1 ·kg -1 ; men: 62.0 ± 10.3 mL·min -1 ·kg -1 ). CRF estimated was inversely associated with age but not after adjustment for PAEE. People in more physically demanding jobs were fitter compared with those in sedentary jobs, but this association was attenuated in women and reversed in men after adjustment for total PAEE. Physical activity energy expenditure and BMI were positively associated with CRF estimated at all levels of adjustment when expressed relative to fat-free mass. CRF estimated was 4% higher in summer than in winter among women, but did not differ by season among men. CONCLUSIONS: CRF estimated was inversely associated with age but less steeply than anticipated, suggesting older generations are comparatively fitter than younger generations. Physical activity energy expenditure and BMI were stronger determinants of the variance in CRF estimated than other characteristic including age. This emphasizes the importance of modifiable physical activity behaviors in public health interventions.

Physical Activity Behaviors of a Middle-Age South African Cohort as Determined by Integrated Hip and Thigh Accelerometry.

PURPOSE: Descriptive studies of objectively measured physical activity behaviors in African populations are rare. We developed a method of combining hip and thigh accelerometery signals to quantify and describe physical behaviors in middle-age South African men and women. METHODS: We integrated signals from two triaxial accelerometers worn simultaneously during free-living, in a subsample of the Middle-age Soweto Cohort ( n = 794; mean (SD) age, 53.7 (6.3) yr). Acceleration time series from the accelerometers were combined and movement-related acceleration was derived using Euclidean Norm Minus One (in milligrams), to determine total movement volume (mean Euclidean Norm Minus One) and nonmovement time (<28 m g ), light-intensity physical activity (LPA; 28-85 m g ), and moderate- to vigorous-intensity physical activity (MVPA; >85 m g ); thigh pitch angle and a sleep diary were used to divide nonmovement time (in minutes per day) into sleep, awake sitting/lying, and standing. Sociodemographic factors were self-reported, and weight and height were measured. RESULTS: Mean (SD) wear time was 128 (48) h. Movement volume was 15.0 (6.5) m g for men and 12.2 (3.4) m g for women. Men spent more time in MVPA and sitting/lying, whereas women spent more time standing. Age was inversely associated with movement volume, MVPA, and LPA. When compared with their normal-weight counterparts, men who were overweight or obese spent less time in MVPA, whereas women who were overweight or obese spent less time in LPA and more time sitting/lying. Socioeconomic status was inversely associated with total movement volume, MVPA, and time spent sleeping, and positively associated with time spent sitting/lying, in both men and women. CONCLUSIONS: Integrating signals from hip and thigh accelerometers enables characterization of physical behaviors that can be applied in an African population.

Physical activity intensity profiles associated with cardiometabolic risk in middle-aged to older men and women.

Accelerometers provide detailed data about physical activity (PA) across the full intensity spectrum. However, when examining associations with health, results are often aggregated to only a few summary measures [e.g. time spent "sedentary" or "moderate-to-vigorous" intensity PA]. Using multivariate pattern analysis, which can handle collinear exposure variables, we examined associations between the full PA intensity spectrum and cardiometabolic risk (CMR) in a population-based sample of middle-aged to older adults. Participants (n = 3660; mean ± SD age = 69 ± 8y and BMI = 26.7 ± 4.2 kg/m2; 55% female) from the EPIC-Norfolk study (UK) with valid accelerometry (ActiGraph-GT1M) data were included. We used multivariate pattern analysis with partial least squares regression to examine cross-sectional multivariate associations (r) across the full PA intensity spectrum [minutes/day at 0-5000 counts-per-minute (cpm); 5 s epoch] with a continuous CMR score (reflecting waist, blood pressure, lipid, and glucose metabolism). Models were sex-stratified and adjusted for potential confounders. There was a positive (detrimental) association between PA and CMR at 0-12 cpm (maximally-adjusted r = 0.08 (95%CI 0.06-0.10). PA was negatively (favourably) associated with CMR at all intensities above 13 cpm ranging between r = -0.09 (0.07-0.12) at 800-999 cpm and r = -0.14 (0.11-0.16) at 75-99 and 4000-4999 cpm. The strongest favourable associations were from 50 to 800 cpm (r = 0.10-0.12) in men, but from ≥2500 cpm (r = 0.18-0.20) in women; with higher proportions of model explained variance for women (R2 = 7.4% vs. 2.3%). Most of the PA intensity spectrum was beneficially associated with CMR in middle-aged to older adults, even at intensities lower than what has traditionally been considered "sedentary" or "light-intensity" activity. This supports encouragement of PA at almost any intensity in this age-group.

Joint associations between objectively measured physical activity volume and intensity with body fatness: the Fenland study.

BACKGROUND/OBJECTIVES: Physical activity energy expenditure (PAEE) represents the total volume of all physical activity. This can be accumulated as different underlying intensity profiles. Although volume and intensity have been studied in isolation, less is known about their joint association with health. We examined this association with body fatness in a population-based sample of middle-aged British adults. METHODS: In total, 6148 women and 5320 men from the Fenland study with objectively measured physical activity from individually calibrated combined heart rate and movement sensing and DXA-derived body fat percentage (BF%) were included in the analyses. We used linear and compositional isocaloric substitution analysis to examine associations of PAEE and its intensity composition with body fatness. Sex-stratified models were adjusted for socio-economic and dietary covariates. RESULTS: PAEE was inversely associated with body fatness in women (beta = -0.16 (95% CI: -0.17; -0.15) BF% per kJ day-1 kg-1) and men (beta = -0.09 (95% CI: -0.10; -0.08) BF% per kJ day-1 kg-1). Intensity composition was significantly associated with body fatness, beyond that of PAEE; the reallocation of energy to vigorous physical activity (>6 METs) from other intensities was associated with less body fatness, whereas light activity (1.5-3 METs) was positively associated. However, light activity was the main driver of overall PAEE volume, and the relative importance of intensity was marginal compared to that of volume; the difference between PAEE in tertile 1 and 2 in women was associated with 3 percentage-point lower BF%. Higher vigorous physical activity in the same group to the maximum observed value was associated with 1 percentage-point lower BF%. CONCLUSIONS: In this large, population-based cohort study with objective measures, PAEE was inversely associated with body fatness. Beyond the PAEE association, greater levels of intense activity were also associated with lower body fatness. This contribution was marginal relative to PAEE. These findings support current guidelines for physical activity which emphasise that any movement is beneficial, rather than specific activity intensity or duration targets.

Ligamentization and Remnant Integration: Review and Analysis of Current Evidence and Implications for Scapholunate Reconstruction.

Background Scapholunate interosseous ligament injuries are common but remain a therapeutic challenge. Current treatment modalities prioritize restoration of normal anatomy with reconstruction where appropriate. To date no reconstructive technique has been described that discusses the potential benefit of preservation of the scapholunate ligament remnant. Little is known about the "ligamentization" of grafts within the wrist. However, a growing body of knee literature suggests that remnant sparing may confer some benefit. In the absence of wrist specific studies, this literature must guide areas for potential augmentation of current surgical practices. Objective The purpose of this study was to perform a review of the process of ligamentization and a systematic review of the current literature on the possible role of ligament sparring and its effect on ligamentization. Methods A systematic search of the literature was performed to identify all the studies related to remnant sparing and the ligamentization of reconstructed tendons, regardless of graft type or joint involved from MEDLINE, EMBASE, and PubMed until February 1, 2016 using the following keywords: ligamentization, graft, remodelling, reconstruction, biomechan*, histolo∗, scapholunate ligament. Each selected study was evaluated for methodological quality and risk of bias according to a modified Systematic Review Center for Laboratory Animal Experimentation criteria. Conclusions The available literature suggests that ligament sparring demonstrated a trend toward improvements in vascularity, mechanoreceptors, and biomechanics that lessens in significance over time. Clinical Relevance This review suggests that remnant sparing may be one way to improve outcomes of scapholunate ligament reconstructive surgery. Level of Evidence This is a level I/II, review study.

Wearable-device-measured physical activity and future health risk.

Use of wearable devices that monitor physical activity is projected to increase more than fivefold per half-decade1. We investigated how device-based physical activity energy expenditure (PAEE) and different intensity profiles were associated with all-cause mortality. We used a network harmonization approach to map dominant-wrist acceleration to PAEE in 96,476 UK Biobank participants (mean age 62 years, 56% female). We also calculated the fraction of PAEE accumulated from moderate-to-vigorous-intensity physical activity (MVPA). Over the median 3.1-year follow-up period (302,526 person-years), 732 deaths were recorded. Higher PAEE was associated with a lower hazard of all-cause mortality for a constant fraction of MVPA (for example, 21% (95% confidence interval 4-35%) lower hazard for 20 versus 15 kJ kg-1 d-1 PAEE with 10% from MVPA). Similarly, a higher MVPA fraction was associated with a lower hazard when PAEE remained constant (for example, 30% (8-47%) lower hazard when 20% versus 10% of a fixed 15 kJ kg-1 d-1 PAEE volume was from MVPA). Our results show that higher volumes of PAEE are associated with reduced mortality rates, and achieving the same volume through higher-intensity activity is associated with greater reductions than through lower-intensity activity. The linkage of device-measured activity to energy expenditure creates a framework for using wearables for personalized prevention.

Descriptive epidemiology of energy expenditure in the UK: findings from the National Diet and Nutrition Survey 2008-15.

BACKGROUND: Little is known about population levels of energy expenditure, as national surveillance systems typically employ only crude measures. The National Diet and Nutrition Survey (NDNS) in the UK measured energy expenditure in a 10% subsample by gold-standard doubly labelled water (DLW). METHODS: DLW-subsample participants from the NDNS (383 males, 387 females) aged 4-91 years were recruited between 2008 and 2015 (rolling programme). Height and weight were measured and body-fat percentage estimated by deuterium dilution. RESULTS: Absolute total energy expenditure (TEE) increased steadily throughout childhood, ranging from 6.2 and 7.2 MJ/day in 4- to 7-year-olds to 9.7 and 11.7 MJ/day for 14- to 16-year-old girls and boys, respectively. TEE peaked in 17- to 27-year-old women (10.7 MJ/day) and 28- to 43-year-old men (14.4 MJ/day), before decreasing gradually in old age. Physical-activity energy expenditure (PAEE) declined steadily with age from childhood (87 kJ/day/kg in 4- to 7-year-olds) through to old age (38 kJ/day/kg in 71- to 91-year-olds). No differences were observed by time, region and macronutrient composition. Body-fat percentage was strongly inversely associated with PAEE throughout life, irrespective of expressing PAEE relative to body mass or fat-free mass. Compared with females with <30% body fat, females with >40% recorded 29 kJ/day/kg body mass and 18 kJ/day/kg fat-free mass less PAEE in analyses adjusted for age, geographical region and time of assessment. Similarly, compared with males with <25% body fat, males with >35% recorded 26 kJ/day/kg body mass and 10 kJ/day/kg fat-free mass less PAEE. CONCLUSIONS: This first nationally representative study reports levels of human-energy expenditure as measured by gold-standard methodology; values may serve as a reference for other population studies. Age, sex and body composition are the main determinants of energy expenditure. Key Messages This is the first nationally representative study of human energy expenditure, covering the UK in the period 2008-2015. Total energy expenditure (MJ/day) increases steadily with age throughout childhood and adolescence, peaks in the 3rd decade of life in women and 4th decade of life in men, before decreasing gradually in old age. Physical activity energy expenditure (kJ/day/kg or kJ/day/kg fat-free mass) declines steadily with age from childhood to old age, more steeply so in males. Body-fat percentage is strongly inversely associated with physical activity energy expenditure. We found little evidence that energy expenditure varied by geographical region, over time, or by dietary macronutrient composition.

Descriptive epidemiology of physical activity energy expenditure in UK adults (The Fenland study).

BACKGROUND: Physical activity (PA) plays a role in the prevention of a range of diseases including obesity and cardiometabolic disorders. Large population-based descriptive studies of PA, incorporating precise measurement, are needed to understand the relative burden of insufficient PA levels and to inform the tailoring of interventions. Combined heart and movement sensing enables the study of physical activity energy expenditure (PAEE) and intensity distribution. We aimed to describe the sociodemographic correlates of PAEE and moderate-to-vigorous physical activity (MVPA) in UK adults. METHODS: The Fenland study is a population-based cohort study of 12,435 adults aged 29-64 years-old in Cambridgeshire, UK. Following individual calibration (treadmill), participants wore a combined heart rate and movement sensor continuously for 6 days in free-living, from which we derived PAEE (kJ•day- 1•kg- 1) and time in MVPA (> 3 & > 4 METs) in bouts greater than 1 min and 10 min. Socio-demographic information was self-reported. Stratum-specific summary statistics and multivariable analyses were performed. RESULTS: Women accumulated a mean (sd) 50(20) kJ•day- 1•kg- 1 of PAEE, and 83(67) and 33(39) minutes•day- 1 of 1-min bouted and 10-min bouted MVPA respectively. By contrast, men recorded 59(23) kJ•day- 1•kg- 1, 124(84) and 60(58) minutes•day- 1. Age and BMI were also important correlates of PA. Association with age was inverse in both sexes, more strongly so for PAEE than MVPA. Obese individuals accumulated less PA than their normal-weight counterparts, whether considering PAEE or allometrically-scaled PAEE (- 10 kJ•day- 1•kg- 1 or - 15 kJ•day- 1•kg-2/3 in men). Higher income and manual work were associated with higher PA; manual workers recorded 13-16 kJ•kg- 1•day- 1 more PAEE than sedentary counterparts. Overall, 86% of women and 96% of men accumulated a daily average of MVPA (> 3 METs) corresponding to 150 min per week. These values were 49 and 74% if only considering bouts > 10 min (15 and 31% for > 4 METs). CONCLUSIONS: PA varied by age, sex and BMI, and was higher in manual workers and those with higher incomes. Light physical activity was the main driver of PAEE; a component of PA that is currently not quantified as a target in UK guidelines.