Rates of Burnout in Female Orthopaedic Surgeons Correlate with Barriers to Gender Equity.

BACKGROUND: The primary purpose of this study was to investigate the relationships between career burnout and the barriers to gender equity identified by Canadian female orthopaedic surgeons. A secondary purpose was to assess relationships between the demographic characteristics of the female surgeons and career burnout and job satisfaction. METHODS: An electronic survey was distributed to 330 Canadian female orthopaedic surgeons. Demographic variables including age, stage and years in practice, practice setting, and marital status were collated. The survey included the Gender Bias Scale (GBS) questionnaire and 2 questions each about career burnout and job satisfaction. The Pearson r correlation coefficient evaluated the relationships among the higher- and lower-order factors of the GBS, burnout, and job satisfaction. Spearman rank correlation coefficient assessed relationships among burnout, job satisfaction, and demographic variables. RESULTS: Survey responses were received from 218 (66.1%) of the 330 surgeons. A total of 110 surgeons (50.5%) agreed or strongly agreed that they felt career burnout (median score = 4). Burnout was positively correlated with the GBS higher-order factors of Male Privilege (r = 0.215, p < 0.01), Devaluation (r = 0.166, p < 0.05), and Disproportionate Constraints (r = 0.152, p < 0.05). Job satisfaction (median = 4) was reported by 168 surgeons (77.1%), and 66.1% were also satisfied or very satisfied with their role in the workplace (median = 4). Burnout was significantly negatively correlated with surgeon age and job satisfaction. CONCLUSIONS: Half of the female orthopaedic surgeons reported symptoms of career burnout. Significant relationships were evident between burnout and barriers to gender equity. Identification of the relationships between gender-equity barriers and burnout presents an opportunity to modify organizational systems to dismantle barriers and reduce this occupational syndrome. CLINICAL RELEVANCE: Given the relationships between gender inequity and career burnout in this study of female orthopaedic surgeons, actions to dismantle gender barriers and address systemic biases are necessary at all career stages to reduce burnout.

Female and Younger Orthopaedic Sport Medicine Patients Are More Negatively Affected by COVID-19-Related Health Care Closures.

PURPOSE: To determine whether sex or age influence whether coronavirus disease 2019 (COVID-19) health care closures affect the health, recovery, and access to resources of preoperative and postoperative orthopaedic sports medicine patients. METHODS: Electronic questionnaires assessing physical and emotional health, the value of virtual care, and access to resources were distributed to patients with postponed (PP) orthopaedic restorative surgeries and those within 3 months' postoperative (PO), at the time of the COVID-19 health care closures. The EQ-5D-3L was included as a standardized measure of general health. Chi-square tests compared responses between sexes and age groups. Unpaired t-tests compared the EQ visual analog scale (VAS) by sex, and a one-way analysis of variance (ANOVA) compared the EQ VAS by age. RESULTS: Females in the PO group were more likely to report that their recovery was delayed (49.5% vs 36%) and that closures had negatively affected their recovery (P = .013). Females in the PP group reported more symptoms of pain/discomfort on the EQ-5D-3L (P = .023). In the PP group, patients aged 25 to 44 years were most likely to identify pain as a concern (P = .54). In the PO group, patients younger than 45 years reported a significantly lower mean EQ VAS health state (P = .017). For the final analysis, there were 115 subjects in the PP group and 198 in the PO group. CONCLUSION: This study demonstrated significant sex- and age-specific differences in health and recovery among orthopaedic sports medicine patients as a result of the COVID-19 health care closures. Females reported significantly more pain, anxiety, and delay in their rehabilitation, while younger patients reported greater negative impacts and worse overall health state.

The Evaluation of a Health-Based Education and Behavioral Change Retreat on Quality of Life, Physical Activity and Psychosocial Health in Adult Cancer Survivors: An Exploratory Analysis.

Knights Cabin Cancer retreats may represent an ideal opportunity and environment to fill the gap in health education and behavioral change. It is unknown, however, whether the program improves quality of life, physical activity, and psychosocial health. Cancer survivors who enrolled in a retreat completed online questionnaires prior to and 3 months post to assess health-related quality of life, physical activity, and psychosocial variables; perceived stress, depression, and self-esteem. Paired t tests were utilized to compare changes pre and 3 months post the retreat. The majority of the 51 cancer survivors were female with a mean age of 53. The mental component summary of health-related quality of life (p < 0.016) and physical activity score (p = 0.048) was significantly improved at follow-up, while the physical component summary of health-related quality of life was not (p = 0.139). In addition, participants showed an improvement in psychosocial variables of self-esteem (p = 0.016) and depression (p = 0.016) after 3 months but did not show a significant improvement in perceived stress (p = 0.054). Improvements were seen following a Knights Cabin Cancer retreat in mental health-related quality of life and physical activity as well as some psychosocial variables. Further research is needed to evaluate the individual program components and the sustainability of the program in the community.

Identification of ABC transporters acting in vitamin B12 metabolism in Caenorhabditis elegans.

Vitamin B12 (cobalamin, Cbl) is a micronutrient essential to human health. Cbl is not utilized as is but must go through complex subcellular and metabolic processing to generate two cofactor forms: methyl-Cbl for methionine synthase, a cytosolic enzyme; and adenosyl-Cbl for methylmalonyl-CoA mutase, a mitochondrial enzyme. Some 10-12 human genes have been identified responsible for the intracellular conversion of Cbl to cofactor forms, including genes that code for ATP-binding cassette (ABC) transporters acting at the lysosomal and plasma membranes. However, the gene for mitochondrial uptake is not known. We hypothesized that ABC transporters should be candidates for other uptake and efflux functions, including mitochondrial transport, and set out to screen ABC transporter mutants for blocks in Cbl utilization using the nematode roundworm Caenorhabditis elegans. Thirty-seven mutant ABC transporters were screened for the excretion of methylmalonic acid (MMA), which should result from loss of Cbl transport into the mitochondria. One mutant, wht-6, showed elevated MMA excretion and reduced [14C]-propionate incorporation, pointing to a functional block in methylmalonyl-CoA mutase. In contrast, the wht-6 mutant appeared to have a normal cytosolic pathway based on analysis of cystathionine excretion, suggesting that cytosolic methionine synthase was functioning properly. Further, the MMA excretion in wht-6 could be partially reversed by including vitamin B12 in the assay medium. The human ortholog of wht-6 is a member of the G family of ABC transporters. We propose wht-6 as a candidate for the transport of Cbl into mitochondria and suggest that a member of the corresponding ABCG family of ABC transporters has this role in humans. Our ABC transporter screen also revealed that mrp-1 and mrp-2 mutants excreted lower MMA than wild type, suggesting they were concentrating intracellular Cbl, consistent with the cellular efflux defect proposed for the mammalian MRP1 ABC transporter.

PAT-12, a potential anti-nematode target, is a new spectraplakin partner essential for Caenorhabditis elegans hemidesmosome integrity and embryonic morphogenesis.

Caenorhabditis elegans embryonic elongation depends on both epidermal and muscle cells. The hemidesmosome-like junctions, commonly called fibrous organelles (FOs), that attach the epidermis to the extracellular matrix ensure muscle anchoring to the cuticular exoskeleton and play an essential role during elongation. To further define how hemidesmosomes might control elongation, we searched for factors interacting with the core hemidesmosome component, the spectraplakin homolog VAB-10. Using the VAB-10 plakin domain as bait in a yeast two-hybrid screen, we identified the novel protein T17H7.4. We also identified T17H7.4 in an independent bioinformatic search for essential nematode-specific proteins that could define novel anti-nematode drug or vaccine targets. Interestingly, T17H7.4 corresponds to the C. elegans equivalent of the parasitic OvB20 antigen, and has a characteristic hemidesmosome distribution. We identified two mutations in T17H7.4, one of which defines the uncharacterized gene pat-12, previously identified in screens for genes required for muscle assembly. Using isoform-specific GFP constructs, we showed that one pat-12 isoform with a hemidesmosome distribution can rescue a pat-12 null allele. We further found that lack of pat-12 affects hemidesmosome integrity, with marked defects at the apical membrane. PAT-12 defines a novel component of C. elegans hemidesmosomes, which is required for maintaining their integrity. We suggest that PAT-12 helps maintaining VAB-10 attachment with matrix receptors.

CUTI-1: A novel tetraspan protein involved in C. elegans CUTicle formation and epithelial integrity.

The nematode cuticle is a tough extracellular matrix composed primarily of cross-linked collagens and non-collagenous cuticulins. It is required for nematode motility and protection from the external environment. Little is known about how the complex process of cuticle formation has been adapted to the specialized requirements of the nematode cuticle, which is structurally and compositionally unique from other organisms. The C. elegans gene cuti-1 (CUTicle and epithelial Integrity) encodes a nematode-specific protein. We have shown that CUTI-1 is expressed in the epithelia and in seam cells. Within these tissues the expression of cuti-1 mRNA cycles throughout development in line with the molting cycle, a process that involves synthesis of a new cuticle. In addition, knockdown of cuti-1 by RNA interference (RNAi) results in worms that display post-embryonic phenotypes related to cuticle dysfunction and defects in epithelial integrity. This is one of the first reports of a nematode-specific protein involved in extracellular matrix formation. It provides further insight into how novel ways have evolved to regulate the formation of the cuticle, which is the primary protective barrier and skeletal component of nematodes.

A mutation in a chromosome condensin II subunit, kleisin beta, specifically disrupts T cell development.

Condensins are ubiquitously expressed multiprotein complexes that are important for chromosome condensation and epigenetic regulation of gene transcription, but whose specific roles in vertebrates are poorly understood. We describe a mouse strain, nessy, isolated during an ethylnitrosourea screen for recessive immunological mutations. The nessy mouse has a defect in T lymphocyte development that decreases circulating T cell numbers, increases their expression of the activation/memory marker CD44, and dramatically decreases the numbers of CD4(+)CD8(+) thymocytes and their immediate DN4 precursors. A missense mutation in an unusual alternatively spliced first exon of the kleisin beta gene, a member of the condensin II complex, was shown to be responsible and act in a T cell-autonomous manner. Despite the ubiquitous expression and role of condensins, kleisin beta(nes/nes) mice were viable, fertile, and showed no defects even in the parallel pathway of B cell lymphocyte differentiation. These data define a unique lineage-specific requirement for kleisin beta in mammalian T cell differentiation.