Surgical Performance Anxiety and Wellbeing Among Surgeons: A Cross-sectional Study in the United Kingdom.

OBJECTIVE: This national cross-sectional study aims to establish the prevalence and potential impact of performance anxiety among surgeons and investigate its association with psychological traits and wellbeing. SUMMARY AND BACKGROUND DATA: Despite a growing awareness that human factors, non-technical skills and wellbeing in healthcare affect patient outcomes, an area that has remained unexplored is surgical performance anxiety (SPA). METHODS: A prospectively registered, cross-sectional study using mixed methods was conducted across the United Kingdom. Data captured included demographics, surgical specialty, trait anxiety, trait perfectionism, SPA, and surgical perfectionism scores. Wellbeing was assessed using The Short Warwick-Edinburgh Mental Wellbeing Scale, whereas qualitative data were collected regarding surgeons' experiences of SPA. RESULTS: A total of 631 responses were collected. Mean age was 41·2 years and mean surgical experience 15·3 years. A total of 62% were male and 52% of consultant/attending grade. A total of 100% felt that SPA affected surgeons, with 87% having experienced it themselves. A total of 65% reported SPA negatively impacted surgical performance and 96% felt SPA negatively impacted surgeons' wellbeing. Male surgeons reported significantly better wellbeing than female surgeons. Surgeons with SPA reported significantly worse wellbeing compared with surgeons who did not experience SPA. Surgeons in general experienced significantly lower mental wellbeing compared with population norms. Thematic analysis highlighted a reticence to share SPA openly and need for cultural change. CONCLUSIONS: Surgical performance anxiety is a very common and significant challenge among surgeons across all specialties at all levels of experience in the United Kingdom. It is perceived by surgeons to affect surgical performance adversely and is associated with worse psychological wellbeing. A more open culture of sharing and acknowledgment has been identified to be beneficial.

Arts engagement supports social connectedness in adulthood: findings from the HEartS Survey.

BACKGROUND: Loneliness is a public health challenge, associated with premature mortality and poorer health outcomes. Social connections can mitigate against loneliness, and there is evidence that the arts can support social connectedness. However, existing research on the arts and social connectedness is limited by focus on particular age groups and arts activities, as well as a reliance on typically small-scale studies. METHODS: This study reports survey data from 5892 adults in the United Kingdom, closely matched to the national profile in terms of sociodemographic and economic characteristics. It investigates the extent to which arts engagement is perceived to be linked with feelings of social connectedness, which forms of arts engagement are reported as most connecting, and how. Data were collected via the HEartS Survey, a newly designed tool to capture arts engagement in the United Kingdom and its associations with social and mental health outcomes. Demographic and quantitative data, pertaining to the extent to which arts engagement is perceived to be linked with social connectedness, were analysed descriptively. Qualitative data pertaining to respondents' perceptions of how arts engagement is linked with feelings of social connectedness were analysed using inductive thematic analysis. RESULTS: Results demonstrated that the majority of respondents (82%) perceive their arts engagement to be linked with feelings of social connectedness at least some of the time. The forms of arts engagement most linked with feelings of social connectedness were attending a live music performance, watching a live theatre performance, and watching a film or drama at the cinema or other venue. Four overarching themes characterise how arts engagement is perceived to facilitate feelings of social connectedness: social opportunities, sharing, commonality and belonging, and collective understanding. CONCLUSIONS: The findings suggest that arts engagement can support social connectedness among adults in the UK through multiple pathways, providing large-scale evidence of the important role that the arts can play in supporting social public health.

Socio-economic inequalities in arts engagement and depression among older adults in the United Kingdom: evidence from the English Longitudinal Study of Ageing.

OBJECTIVES: Arts engagement has been positively linked with mental health and well-being; however, socio-economic inequalities may be prevalent in access to and uptake of arts engagement reflecting on inequalities in mental health. This study estimated socio-economic inequality and horizontal inequity (unfair inequality) in arts engagement and depression symptoms of older adults in England. Trends in inequality and inequity were measured over a period of ten years. STUDY DESIGN: This is a repeated cross-sectional study. METHODS: In this analysis, we used data from six waves (waves 2 to 7) of the nationally representative English Longitudinal Study of Ageing. We estimated socio-economic inequality using concentration curves that plot the distribution of arts engagement and depression symptoms against the distribution of wealth. A concentration index was used to measure the magnitude of the inequality. Unfair inequality was then calculated for need-standardised arts engagement using a horizontal inequity index (HII). RESULTS: The study sample included adults aged 50 years and older from waves 2 (2004/2005, n = 6620) to 7 (2014/2015, n = 3329). Engagement with cinema, galleries and theatre was pro-rich unequal, i.e. concentrated among the wealthier, but inequality in depression was pro-poor unequal, i.e. concentrated more among the less wealthy. While pro-rich inequality in arts engagement decreased from wave 2 (conc. index: 0·291, 95% confidence interval 0·27 to 0·31) to wave 7 (conc. index: 0·275, 95% confidence interval 0·24 to 0·30), pro-poor inequality in depression increased from wave 2 (conc. index: -0·164, 95% confidence interval -0·18 to -0·14) to wave 7 (conc. index: -0·189, 95% confidence interval -0·21 to -0·16). Depression-standardised arts engagement showed horizontal inequity that increased from wave 2 (HII: 0·455, 95% confidence interval 0·42 to 0·48) to wave 7 (HII: 0·464, 95% confidence interval 0·42 to 0·50). CONCLUSIONS: Our findings suggest that while socio-economic inequality in arts engagement might appear to have reduced over time, once arts engagement is standardised for need, inequality has actually worsened over time and can be interpreted as inequitable (unfair). Relying on need-unstandardised estimates of inequality might thus provide a false sense of achievement to policy makers and lead to improper social prescribing interventions being emplaced.

Cross-sectional and longitudinal associations between receptive arts engagement and loneliness among older adults.

PURPOSE: Loneliness in older adulthood is a societal and public health challenge warranting identification of sustainable and community-based protective factors. This study investigated whether frequency of receptive arts engagement is associated with lower odds of loneliness in older adults. METHODS: We used data of respondents from waves 2 (2004-2005) and 7 (2014-2015) of the English Longitudinal Study of Ageing (ELSA) and examined cross-sectional (n = 6222) and longitudinal (n = 3127) associations between frequency of receptive arts engagement (including visits to the cinema, museums/galleries/exhibitions, theatre/concerts/opera) and odds of loneliness (cut-off ≥ 6 on three-item short form of the Revised UCLA Loneliness Scale). We fitted logistic regression models adjusted for a range of sociodemographic, economic, health and social, community and civic engagement factors. RESULTS: Cross-sectionally, we found dose-response negative associations between engagement with all receptive arts activities and odds of loneliness. Prospectively, in the fully-adjusted models we found most robust evidence for the negative association between engagement with museums/galleries/exhibitions and odds of loneliness (OR = 0.68, 95% CI 0.48-0.95) for those who engaged every few months or more often compared with those who never engaged. We found weaker evidence for lower odds of loneliness for more frequent engagement with theatre/concerts/opera. CONCLUSIONS: Frequent engagement with certain receptive arts activities and venues, particularly museums, galleries and exhibitions, may be a protective factor against loneliness in older adults. Future research is needed to identify the mechanisms through which this process may occur, leading to better understanding of how arts activities and venues can reduce loneliness among older adults.

How Participatory Music Engagement Supports Mental Well-being: A Meta-Ethnography.

Participatory music engagement has the capacity to support well-being. Yet, there is little research that has scrutinized the processes through which music has an effect. In this meta-ethnography [PROSPERO CRD42019130164], we conducted a systematic search of 19 electronic databases and a critical appraisal to identify 46 qualitative studies reporting on participants' subjective views of how participatory music engagement supports their mental well-being. Synthesis of first-order and second-order interpretations using thematic coding resulted in four third-order pathways that account for how participatory music engagement supports mental well-being: managing and expressing emotions, facilitating self-development, providing respite, and facilitating connections. Our interpretation suggests that people benefit from participatory music engagement by engaging with specific and multiple processes that meet their individual needs and circumstances. These findings inform research directions within the field of music and well-being, as well as guiding the development and delivery of future music interventions.

Profiling the Location and Extent of Musicians' Pain Using Digital Pain Drawings.

BACKGROUND AND AIMS: According to existing literature, musicians are at risk of experiencing a range of painful musculoskeletal conditions. Recently, a novel digital technology was developed to investigate pain location and pain extent. The aim of this study was to describe pain location and pain extent in musicians using a digital method for pain drawing (PD) analysis. Additionally, the association between PD variables and clinical features were explored in musicians with pain. METHODS: One hundred and fifty-eight musicians (90 women and 68 men; aged 22.4 ± 3.6 years) were recruited from Swiss and U.K. conservatories. Participants were asked to complete a survey including both background musical information and clinical features, the QuickDASH (QD) questionnaire, and the digital PDs. RESULTS: Of the 158 participants, 126 musicians (79.7%) reported having pain, with higher prevalence in the areas of the neck and shoulders, the lower back, and the right arm. The mean percentage of pain extent was 3.1% ± 6.5%. The mean QD score was higher for musicians with pain than for those without pain. Additionally, the results indicated a positive correlation between the QD score and pain extent, and there were significant correlations between age and pain intensity, as well as between pain extent and pain intensity. CONCLUSIONS: The high prevalence of pain among musicians has been confirmed using a digital technique for PD acquisition and analysis. In addition, positive correlations between pain extent and upper limb disability have been demonstrated. Our findings highlight the need for effective prevention and treatment strategies for musicians.

The razor's edge: Australian rock music impairs men's performance when pretending to be a surgeon.

OBJECTIVE: Over the past few decades there has been interest in the role of music in the operating theatre. However, despite many reported benefits, a number of potentially harmful effects of music have been identified. This study aimed to explore the effects of rock and classical music on surgical speed, accuracy and perceived distraction when performing multiorgan resection in the board game Operation. DESIGN: Single-blind, three-arm, randomised controlled trial. SETTING: Imperial Festival, London, May 2016. PARTICIPANTS: Members of the public (n = 352) aged ≥ 16 years with no previous formal surgical training or hearing impairments. METHODS: Participants were randomised to listen through noise-cancelling headphones to either the sound of an operating theatre, rock music or classical music. Participants were then invited to remove three organs from the board game patient, Cavity Sam, using surgical tweezers. MAIN OUTCOME MEASURES: Time taken (seconds) to remove three organs from Cavity Sam; the number of mistakes made in performing the surgery; and perceived distraction, rated on a five-point Likert-type scale from 1 (not at all distracting) to 5 (very distracting). RESULTS: Rock music impairs the performance of men but not women when undertaking complex surgical procedures in the board game Operation, increasing the time taken to operate and showing a trend towards more surgical mistakes. In addition, classical music was associated with lower perceived distraction during the game, but this effect was attenuated when factoring in how much people liked the music, with suggestions that only people who particularly liked the music of Mozart found it beneficial. CONCLUSIONS: Rock music (specifically Australian rock music) appears to have detrimental effects on surgical performance. Men are advised not to listen to rock music when either operating or playing board games.

The Impact of Culture-, Health- and Nature-Based Engagement on Mitigating the Adverse Effects of Public Health Restrictions on Wellbeing, Social Connectedness and Loneliness during COVID-19: Quantitative Evidence from a Smaller- and Larger-Scale UK Survey.

Numerous UK surveys conducted during COVID-19 examined the pandemic's detrimental effects on health, and the consequences of lockdown and other public health restrictions on mental health. Some surveys considered specific populations and social inequities exacerbated during COVID-19. Fewer surveys examined the ways in which the adverse effects of public health restrictions, such as lockdown, shielding and social distancing, might be alleviated. Drawing upon self-determination theory, the purpose of the current study was to assess whether culture-, health- and nature-based engagement would mitigate the effects of these restrictions on psychological wellbeing, social connectedness and loneliness. Quantitative data from a smaller-scale survey (n = 312) and a subset of questions embedded in a larger-scale survey (n = 3647) were analyzed using univariate and multivariate methods. Frequency of engagement, whether participation was online or offline and with or without other people, and the extent to which type of participation was associated with psychological wellbeing, social connectedness and loneliness were examined. Sports and fitness, gardening and reading occurred frequently in both surveys. For the smaller-scale survey, increases in connectedness and frequency of participation and decreases in loneliness were significantly associated with improved wellbeing, whereas the type of participation and age range were not significant predictors. Outcomes from the smaller-scale survey approximated the larger-scale survey for measures of loneliness, type and frequency of participation and proportion of respondents in each age range. As the frequency of participation was a significant predictor of wellbeing, but the type of participation was not significant, the findings implied that any type of participation in a sufficient quantity would be likely to boost wellbeing.

Modelling arts professionals' wellbeing and career intentions within the context of COVID-19.

The COVID-19 pandemic had a substantial effect on the creative and cultural industries in the United Kingdom (UK), as seen in our first snapshot of the HEartS Professional Survey (April-June 2020, Phase 1, N = 358). By analysing data collected one year later (April-May 2021, Phase 2, N = 685), the aims of the current study are to trace the contributors to (1) arts professionals' mental and social wellbeing and (2) their expectations of staying in the arts. Findings show that artists continued to experience challenges in terms of finances, and mental and social wellbeing. Over half of the respondents reported financial hardship (59%), and over two thirds reported being lonelier (64%) and having increased anxiety (71%) than before the pandemic. Hierarchical multiple linear regression models, using the Mental Health Continuum-Short Form, Center for Epidemiologic Studies Depression Scale, Social Connectedness Scale, and Three-Item Loneliness Scale as outcome variables, indicate that perceived financial hardship continued to be associated with higher depression and loneliness scores. As in our first study, more physical activity before lockdown was associated with higher wellbeing and social connectedness scores, and higher self-rated health scores were associated with higher wellbeing and lower depression scores. Similarly, increases in physical activity during lockdown, as well as older age, were still associated with higher wellbeing and social connectedness scores and with lower depression and loneliness scores. An ordinal logistic regression model indicated three contributors to artists' professional expectations of remaining in the arts: greater proportion of income from the arts pre-pandemic, continued maintenance of skills, and greater proportion of freelance work. The results suggest that the wellbeing patterns observed at the start of the pandemic remained consistent a year on. They point to possible strategies to support wellbeing and underline the importance of finances for expectations of remaining in arts professions.

Building community through higher music education: a training program for facilitating musical engagement among older adults.

Preparing music students to design and carry out community-based initiatives can be an effective way to enhance their employability and their wellbeing. With a large body of evidence now pointing to the benefits of musical engagement for older adults, both for individuals and for society as a whole, there is considerable opportunity and value in training aspiring professional musicians to work with and on behalf of those in their third and fourth age. This article describes a seminar designed by a Swiss conservatoire in collaboration with local nursing homes involving residents and music university students in a 10-week group music making program. On the basis of the positive results to emerge in terms of health, wellbeing and career preparation, we aim to provide information relevant for colleagues to replicate this seminar in other higher music education institutions. Moreover, this paper aims to shed light on the complexity of designing music students' training so that they acquire the competences needed to deliver meaningful, community-based initiatives alongside their other professional training commitments, and to provide directions for future research. The development and implementation of these points could foster the increase and sustainability of innovative programs beneficial for older adults, musicians and local communities.

Effects of choir singing on physiological stress in Japanese older adults: its relationship with cognitive functioning and subjective well-being.

BACKGROUND: Leisure activities are believed to contribute to healthy ageing. We compared the effects of choir singing and go playing on cortisol levels in Japanese older adults. We also examined its relevance to the older adults' emotional affect and cognitive performance. METHODS: Thirty-six older adults participated either in choir or go playing, within a 2 (groups)×2 (time points) design. Dependent measures included levels of salivary cortisol, as well as key psychological, cognitive, and neuropsychological measures. RESULTS: A significant two-way interaction was observed, showing that levels of salivary cortisol decreased for the choir but increased for the go groups. The decrease in salivary cortisol for the choir group correlated with the participant's negative affect and their degree of cognitive impairment. CONCLUSION: Choir singing has the potential to reduce Japanese older adults' physiological stress. The decreases can be seen more prominently for people with stronger negative affect and cognitive impairment. Further research is required to replicate these effects.

Music in the life of nursing home residents.

BACKGROUND: Making and listening to music can be beneficial for older adults. However, little is known about how and to what extent those who live in nursing homes have access to music and the functions that music plays in their lives. METHODS: This study involved 20 residents who volunteered from six nursing homes in Switzerland. Each resident was interviewed, and the data were analysed using thematic analysis. RESULTS: For many residents, their access to music decreased after moving into their nursing home, and many of them wanted more musical experiences in their daily lives, both with music from their pasts and with unfamiliar repertoire. Music was strongly connected to their sense of identity and elicited positive emotions. Musical activities offered by the nursing homes also stimulated social interactions. CONCLUSIONS: Music plays a central role in facilitating positive wellbeing and quality of life in nursing homes.

The future of the cultural workforce: Perspectives from early career arts professionals on the challenges and future of the cultural industries in the context of COVID-19.

The COVID-19 pandemic has had a profound impact on the arts sector, disrupting livelihoods and professional networks and accentuating the instability that is common for creative workers. Gaps in support for grassroots organisations and freelance workers have highlighted structural inequalities within the industry, and the significant challenges for individual workers in the early stages of their career. Yet, the pandemic has also emphasised the importance of the arts as a community resource and its role in supporting wellbeing and togetherness. This qualitative study explored the experiences of the pandemic for early career arts workers, focusing on its impacts upon their livelihoods and how it has shaped their future career directions. Sixteen arts and cultural workers across a variety of sectors including theatre, film, circus, music, and literature participated in solo, semi-structured interviews during April-June 2021. Thematic analysis identified three overarching themes: (i) 'Pandemic precarity and creative practice', (ii) 'PostCOVID I: Inclusivity and diversifying audiences', and (iii) 'PostCOVID II: Adapting, developing, and disrupting cultural practices'. Overall, the experiences capture an early career workforce that, while committed and engaged with their creative practice, also seeks a more equitable, fairer, and diverse industry that protects artists and engages more flexibly with broader audiences.

Arts engagement trends in the United Kingdom and their mental and social wellbeing implications: HEartS Survey.

Evidence on the role of the arts in promoting health and wellbeing has grown over the last two decades. In the United Kingdom, studies using secondary data sources have documented temporal variations in levels of arts engagement in the population, its determinants and its mental wellbeing implications. However, arts engagement is often characterized by prioritizing "high-brow" art forms. In this article, we introduce the HEartS Survey, a tool that aims to increase the balance between inclusivity and brevity of existing arts engagement measures and to focus specifically on the connection between arts engagement and social wellbeing. We explore trends in participatory and receptive engagement with literary, visual, performing, crafts and decorative arts among 5,338 adults in the UK in 2018-2019 using summative engagement scores and cluster analysis. Regression models, adjusted for demographic, socioeconomic, health, and social covariates, examine correlations between arts engagement and psychological and social wellbeing measures. Over 97% of respondents reported engagement in one or more arts activities at least once during 2018-2019, with reading and listening to music being the most popular activities. Arts engagement grouped into three distinct clusters: 19.8% constituted "low engagers" whose main source of engagement was occasional reading; 44.4% constituted "receptive consumers" who read and listened to music frequently and engaged with popular receptive arts activities such as cinema, live music, theater, exhibitions, and museums; and 35.8% constituted "omnivores" who frequently engaged in almost all arts activities. In agreement with existing studies, more arts engagement was associated with higher levels of wellbeing, social connectedness, and lower odds of intense social loneliness. In contrast, we found a positive association between more arts engagement, depression, and intense emotional loneliness for the most highly engaged omnivores. We conclude that arts engagement in the population forms specific profiles with distinct characteristics and consider implications for mental and social wellbeing.

Regaining motor control in musician's dystonia by restoring sensorimotor organization.

Professional musicians are an excellent model of long-term motor learning effects on structure and function of the sensorimotor system. However, intensive motor skill training has been associated with task-specific deficiency in hand motor control, which has a higher prevalence among musicians (musician's dystonia) than in the general population. Using a transcranial magnetic stimulation paradigm, we previously found an expanded spatial integration of proprioceptive input into the hand motor cortex [sensorimotor organization (SMO)] in healthy musicians. In musician's dystonia, however, this expansion was even larger. Whereas motor skills of musicians are likely to be supported by a spatially expanded SMO, we hypothesized that in musician's dystonia this might have developed too far and now disrupts rather than assists task-specific motor control. If so, motor control should be regained by reversing the excessive reorganization in musician's dystonia. Here, we test this hypothesis and show that a 15 min intervention with proprioceptive input (proprioceptive training) restored SMO in pianists with musician's dystonia to the pattern seen in healthy pianists. Crucially, task-specific motor control improved significantly and objectively as measured with a MIDI (musical instrument digital interface) piano, and the amount of behavioral improvement was significantly correlated to the degree of sensorimotor reorganization. In healthy pianists and nonmusicians, the SMO and motor performance remained essentially unchanged. These findings suggest that the differentiation of SMO in the hand motor cortex and the degree of motor control of intensively practiced tasks are significantly linked and finely balanced. Proprioceptive training restored this balance in musician's dystonia to the behaviorally beneficial level of healthy musicians.

Music Teachers' Perspectives and Experiences of Ensemble and Learning Skills.

In this article, we report data from two survey studies administered to expert music teachers. Both questionnaires aimed to explore teachers' pedagogical and performative practice and included open questions elucidating musical skills emerging in groups. The first study focuses on collective teaching settings offered to amateurs, jazz musicians, and university students with various levels of musical expertise. The second reports data from teachers based at the Royal College of Music, London, where the main emphasis is on Western classical repertoire. We integrate both studies and discuss overlapping findings. Despite intrinsic differences concerning the general goals of their teaching and the educational systems in which they operate, our data indicate the ability to "listen and respond to others" as the most important ensemble skill, whereas "time management," "comparing yourself to the class," and the "development of responsible ways of learning" emerged as main learning skills. We discuss results and suggestions for future research in teaching and learning music in different contexts in the light of recent theoretical research in the cognitive sciences, considering implications for educators interested in diverse skill levels.

Art for Ages: The Effects of Group Music Making on the Wellbeing of Nursing Home Residents.

In many countries, life expectancy has increased considerably in past years, and the importance of finding ways to ensure good levels of wellbeing through aging has become more important than ever. Arts based interventions are promising in this respect, and the literature suggests that musical activities can reduce isolation and anxiety and foster feelings of achievement and self-confidence. The present study examined the effects of group music making programs on the health and wellbeing of nursing home residents in Southern Switzerland. A team of professional and student musicians delivered 10 weekly music sessions in four nursing homes, focusing on singing, rhythm-based activities with percussion instruments, and listening to short, live performances. 22 participants (16 women and 6 men, aged 72-95 years, mean 83.6, SD ± 6.9) were recruited to take part in the study and were interviewed after the last music session. The data were analyzed with thematic analysis to investigate how residents experienced group music making and its effects. The findings show that the music programs were beneficial for residents' wellbeing. Music plays an important role in their lives, both in their pasts and presently, and being involved in musical activities offers engagement and novelty in daily life, providing learning opportunities and facilitating interpersonal relationships. Moreover, these results were due to interactions with the musicians involved. Residents particularly appreciated the opportunity to listen to live performances as part of the sessions. This study suggests that nursing home residents value music and that music based interventions play an important and direct role in enhancing their wellbeing.

Longitudinal Associations Between Short-Term, Repeated, and Sustained Arts Engagement and Well-Being Outcomes in Older Adults.

OBJECTIVES: This study investigated whether frequency of receptive arts engagement over 10 years contributes to experienced, evaluative, and eudaimonic well-being in older adults. METHODS: We used repeated data of 3,188 respondents from Waves 2-7 (2004/2005-2014/2015) of the English Longitudinal Study of Ageing. We examined longitudinal associations between short-term (frequent engagement at one wave), repeated (frequent engagement at 2-3 waves), and sustained (frequent engagement at 4-6 waves) arts engagement and experienced, evaluative and eudaimonic well-being. We fitted linear and logistic regression models adjusted for baseline well-being and a number of sociodemographic, economic, health, and social engagement factors. RESULTS: In the fully adjusted models, short-term engagement was not longitudinally associated with well-being, but repeated engagement with the theater/concerts/opera and museums/galleries/exhibitions was associated with enhanced eudaimonic well-being, and sustained engagement with these activities was associated with greater experienced, evaluative, and eudaimonic well-being. DISCUSSION: Long-term frequent engagement with certain arts activities is associated with higher levels of happiness, life satisfaction, self-realization, and control/autonomy in older adults. These findings suggest that policies that facilitate older adults' access to arts venues and activities, and support their continued engagement with them, may help to promote happy, fulfilling lives of an increasing segment of the population.