OBJECTIVE Excessive dissatisfaction and stress among physicians can precipitate burnout, which results in diminished productivity, quality of care, and patient satisfaction and treatment adherence. Given the multiplicity of its harms and detriments to workforce retention and in light of the growing physician shortage, burnout has garnered much attention in recent years. Using a national survey, the authors formally evaluated burnout among neurosurgery trainees. METHODS An 86-item questionnaire was disseminated to residents in the American Association of Neurological Surgeons database between June and November 2015. Questions evaluated personal and workplace stressors, mentorship, career satisfaction, and burnout. Burnout was assessed using the previously validated Maslach Burnout Inventory. Factors associated with burnout were determined using univariate and multivariate logistic regression. RESULTS The response rate with completed surveys was 21% (346/1643). The majority of residents were male (78%), 26-35 years old (92%), in a stable relationship (70%), and without children (73%). Respondents were equally distributed across all residency years. Eighty-one percent of residents were satisfied with their career choice, although 41% had at some point given serious thought to quitting. The overall burnout rate was 67%. In the multivariate analysis, notable factors associated with burnout included inadequate operating room exposure (OR 7.57, p = 0.011), hostile faculty (OR 4.07, p = 0.008), and social stressors outside of work (OR 4.52, p = 0.008). Meaningful mentorship was protective against burnout in the multivariate regression models (OR 0.338, p = 0.031). CONCLUSIONS Rates of burnout and career satisfaction are paradoxically high among neurosurgery trainees. While several factors were predictive of burnout, including inadequate operative exposure and social stressors, meaningful mentorship proved to be protective against burnout. The documented negative effects of burnout on patient care and health care economics necessitate further studies for potential solutions to curb its rise.

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Hypercortisolemia is a potential mediator of bone loss and mood disturbance in these disorders.

Objective Anorexia nervosa is characterized by self-induced starvation and associated with severe bone and fat loss. Oxytocin is a peptide hormone involved in appetite and energy homeostasis. Recent data show that oxytocin has an anabolic effect on bone and stimulates osteoblast function. There is limited information about oxytocin levels or its relationship to decreased bone mineral density (BMD) in anorexia nervosa. Our objective was to investigate the relationship between oxytocin levels, BMD and body composition in women with anorexia nervosa. Method We studied 36 women, mean age 27.6±1.3 years: 17 with anorexia nervosa (AN) and 19 healthy controls (HC) in a cross-sectional study. Oxytocin levels were determined from pooled serum samples obtained every 20 minutes from 8pm to 8am. Fasting leptin levels were measured. BMD at the anterior-posterior (AP) and lateral spine and hip, and body composition were assessed by dual energy X-ray absorptiometry. Results Mean oxytocin levels (14.3±1.5 vs. 31.8±5.1 pg/mL, p=0.003), leptin levels (2.7±0.5 vs. 11.4±1.1 ng/mL, p<0.0001), BMD (AP spine: 0.83±0.02 vs. 1.04±0.03; lateral spine: 0.63±0.02 vs. 0.81±0.02; total hip: 0.79±0.03 vs. 0.97±0.03 g/cm2, <0.0001), and fat mass (8.8±0.6 vs. 19.7±0.9 kg, p<0.0001) were lower in AN vs. HC. Oxytocin levels were associated with BMD at the AP (r=0.40, p=0.02) and lateral (r=0.36, p=0.04) spine, fat mass (r=0.42, p=0.01), and leptin levels (r=0.55, p=0.001). Conclusion Overnight secretion of oxytocin in AN is decreased compared with healthy women. Low oxytocin levels are associated with decreased BMD and body fat and may contribute to anorexia nervosa-induced bone loss.