Less Than Full-time Training in surgical specialities: Consensus recommendations for flexible training by the Association of Surgeons in Training

AbstractChanges in lifestyle, career expectations, and working environments, alongside the feminisation of the workforce have resulted in an increased demand for Less Than Full-time Training (LTFT) within surgery. However, provision of and adequacy of flexible training remain variable. It is important that LTFT options are provided to ensure surgery is an attractive and viable career option, and can compete with other specialties to attract and retain the best candidates to maintain high standards of patient care. LTFT options should be readily available to both genders within surgical specialities. Furthermore, improved information for those considering LTFT should be available, locally, regionally and nationally. Training within LTFT posts should be tailored to the training requirements of the individual, in order to achieve the competencies necessary for completion of training. The recommendations set out in this consensus statement should inform the trainee's position and help guide discussions with respect to the provision of LTFT within surgery

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Mental health and wellbeing of jockeys

Despite receiving much public attention in recent years, the mental health status of jockeys has not been established. This study investigated the incidence of common mental health disorders in jockeys. Amateur (n=74) and professional (n=42) jockeys completed an online anonymous questionnaire incorporating validated self-reported measurement tools to assess the prevalence of psychological distress, depression, anxiety, social phobia, perceived stress and self-esteem. Personal and lifestyle characteristics were also reported. Fifty four percent of jockeys were experiencing symptoms of at least one of general psychological distress, depression, general anxiety disorder or social anxiety. Professional jockeys displayed significantly greater mean scores on measures of psychological distress (p<0.01), depression (p<0.05), anxiety (p<0.05) and perceived stress (p<0.01). No difference was present in measures between professional flat and jump jockeys. Professional jockeys were classified as displaying symptoms of depression (mean score 20.29; 57.1% at or above threshold of 16) and perceived stress (mean score 20.24; 52.4% at or above threshold of 20). Current injury, social anxiety or high levels of perceived stress increased the likelihood of displaying depressive symptoms in the jockey sample. With a high prevalence of depression and perceived stress evident in professional jockeys, mental health support strategies should be implemented with specific focus on stress management and dealing with injury. Future research should further investigate factors that increase the susceptibility of jockeys to mental health disorders

Mental health difficulties among professional jockeys: a narrative review

Introduction Emerging academic literature and high profile disclosures of mental health difficulties and mental illness from current and former professional jockeys suggest that further exploration of the mental health of jockeys is required. To date, a comprehensive review of jockeys’ mental health has yet to be conducted. Objectives To examine the existing literature related to jockeys’ mental health, including the prevalence of symptoms associated with mental health difficulties and help-seeking. Design A narrative review of the literature was conducted with articles screened from inception until January 2021. Results Sixteen studies were included in the narrative review. Studies covered a range of mental health difficulties which included mood (depression), anxiety, distress, disordered eating and substance misuse. Rates of help-seeking among jockeys were also explored. Results indicated that jockeys reported higher levels of depressive and anxiety symptoms compared with other elite athletes. Substance misuse, in particular adverse alcohol use, also appears greater among jockeys than other elite athletes. Distress symptoms appear comparable with other elite athletes. Risk factors for mental health difficulties included injury, perceived stress, athlete burnout, career dissatisfaction and the contemplation of retirement. Weight-making negatively impacts jockeys’ mood and attitudes towards eating, with lower competitive riding weights associated with more disordered eating attitudes. Moreover, help-seeking from mental health professionals appears low. Conclusion The review identifies a high prevalence of symptoms of mental health difficulties among professional jockeys. Applied recommendations and future research considerations are proposed throughout the review articl

The behavioural determinants of weight-making in weight-category sports: A narrative review

Weight-category athletes (e.g. boxers, wrestlers, jockeys etc.) who engage in weight-making practices to compete are at risk of encountering negative physiological and psychological consequences. There is evidence to support safer weight-making strategies for these athletes; however, there appears to be poor adherence to these evidence-based methods. The aim of this review article is to identify the behavioural determinants which lead to athletes’ engagement and adherence in various weight-making practices amongst weight-category sports. A narrative review was conducted with articles screened for inclusion until February 2023. Twenty-three articles met the criteria for inclusion within this review. This review highlights the broad socio-cultural influences on athletes being introduced to weight-making from a young age and the continued engagement with these practices due to their wide cultural acceptance. Psychological factors such as perceived competence and confidence influence positive beliefs related to weight-making practices, further engraining them within the cultural sphere of weight-category sports. Recommendations related to future research and for practitioners within these sports are proposed throughout the article. Recommendations relate to such areas as further identification of barriers and facilitators to safer weight-making with weight-category athletes, education on the impact of weight-making for athlete support personnel, and psychological skills training to overcome periods of self-regulatory fatigue.</p

Common mental disorders among Irish jockeys: prevalence and risk factors

Objective Jockeys compete in a sport, horseracing, renowned for its physical and psychological demands. Previous research has identified that common mental disorders (CMDs) may be prevalent among this unique population of athletes. The aim of the present study was to further explore the prevalence of CMDs among jockeys and to test for associations with potential risk factors. Methods An anonymous survey was distributed to professional jockey online. Self-report screening tools for four CMDs (psychological distress, depression, generalized anxiety, and adverse alcohol use) were included alongside predictor variables from questionnaires assessing for burnout, career satisfaction, social support, and the contemplation of retirement. Binary logistic regression was used to explore associations between CMDs (present versus not present) and risk factors. Eighty-four professional jockeys completed the questionnaire (response rate = 52%). Results In total, 79% of jockeys met the threshold for at least one CMD. Prevalence (%) of CMD varied as follows: adverse alcohol (61%), depression (35%), generalized anxiety (27%), and psychological distress (19%). Burnout, career (dis)satisfaction, lower levels of social support, and the contemplation of retirement increased the odds of meeting the criteria for CMDs. Conclusion The findings indicate that jockeys report CMD symptoms at comparable rates to athletes in other sports. The study was the first to highlight potential risk factors as predictors of CMDs among jockeys, including burnout, career satisfaction, and the current contemplation of retirement. Screening tools for the risk factors demonstrated may, therefore, provide useful in the early identification of CMDs among jockeys. The development of jockey-specific assessment tools, education programmes, and interventions may help better understand and support the mental health of jockey