Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Effects of gender-affirming hormone therapy on insulin sensitivity and incretin responses in transgender people

OBJECTIVE: The long-term influences of sex hormone administration on insulin sensitivity and incretin hormones are controversial. We investigated these effects in 35 transgender men (TM) and 55 transgender women (TW) from the European Network for the Investigation of Gender Incongruence (ENIGI) study. RESEARCH DESIGN AND METHODS: Before and after 1 year of gender-affirming hormone therapy, body composition and oral glucose tolerance tests (OGTTs) were evaluated. RESULTS: In TM, body weight (2.8 +/- 1.0 kg; P < 0.01), fat-free mass (FFM) (3.1 +/- 0.9 kg; P < 0.01), and waist-to-hip ratio (-0.03 +/- 0.01; P < 0.01) increased. Fasting insulin (-1.4 +/- 0.8 mU/L; P = 0.08) and HOMA of insulin resistance (HOMA-IR) (2.2 +/- 0.3 vs. 1.8 +/- 0.2; P = 0.06) tended to decrease, whereas fasting glucose (-1.6 +/- 1.6 mg/dL), glucose-dependent insulinotropic polypeptide (GIP) (-1.8 +/- 1.0 pmol/L), and glucagon-like peptide 1 (GLP-1) (-0.2 +/- 1.1 pmol/L) were statistically unchanged. Post-OGTT areas under the curve (AUCs) for GIP (2,068 +/- 1,134 vs. 2,645 +/- 1,248 [pmol/L] x min; P < 0.01) and GLP-1 (2,352 +/- 796 vs. 2,712 +/- 1,015 [pmol/L] x min; P < 0.01) increased. In TW, body weight tended to increase (1.4 +/- 0.8 kg; P = 0.07) with decreasing FFM (-2.3 +/- 0.4 kg; P < 0.01) and waist-to-hip ratio (-0.03 +/- 0.01; P < 0.01). Insulin (3.4 +/- 0.8 mU/L; P < 0.01) and HOMA-IR (1.7 +/- 0.1 vs. 2.4 +/- 0.2; P < 0.01) rose, fasting GIP (-1.4 +/- 0.8 pmol/L; P < 0.01) and AUC GIP dropped (2,524 +/- 178 vs. 1,911 +/- 162 [pmol/L] x min; P < 0.01), but fasting glucose (-0.3 +/- 1.4 mg/dL), GLP-1 (1.3 +/- 0.8 pmol/L), and AUC GLP-1 (2,956 +/- 180 vs. 2,864 +/- 93 [pmol/L] x min) remained unchanged. CONCLUSIONS: In this cohort of transgender persons, insulin sensitivity but also post-OGTT incretin responses tend to increase with masculinization and to decrease with feminization