Mental health of general practitioners in Chongqing, China during COVID-19: a cross-sectional study.

OBJECTIVES: In the context of the COVID-19 pandemic, general practitioners (GPs) continue to face unprecedented challenges that affect their mental health. However, few studies have assessed the mental health status of GPs. This study aimed to provide preliminary understanding of stress, job burn-out and well-being levels among GPs to train and manage them during public health emergencies. DESIGN: We conducted a cross-sectional online self-report survey. SETTING: The survey was conducted in Chongqing, China from July to August 2022. PARTICIPANTS: Data were collected from 2145 GPs, with an effective response rate of 91.0%. PRIMARY AND SECONDARY OUTCOME MEASURES: The main evaluation indicators were stress (Cohen's Perceived Stress Scale), job burn-out (Maslach Burnout Inventory-Human Services Survey Scale) and well-being (WHO-5 Well-Being Index). Multiple linear regression analysis was used to compare the effect of different demographic characteristics on the impact of stress, job burn-out and decreased well-being. RESULTS: Stress, job burn-out and decreased well-being were common among GPs. In this study, 59.7% experienced job burn-out, 76.1% experienced high levels of stress and 52.0% may have experienced depression. The main factors that influenced stress, burn-out and well-being were differences in age, working hours per week, title, part-time management work, work-life balance, sleep disorders, whether GPs received adequate recognition by patients and the work team and mental toughness (p<0.05). CONCLUSION: This survey is the first to investigate stress, job burn-out and well-being levels among local GPs in China during the COVID-19 pandemic. Curbing stress and job burn-out levels and ensuring well-being among GPs could be achieved by reducing paperwork, management work and working hours; promoting life and work balance; and increasing resilience among GPs. The findings provide a basis for policy-makers to formulate strategies for developing general practice.

The relationship between psychological capital, patient's contempt, and professional identity among general practitioners during COVID-19 in Chongqing, China.

General practitioners are crucial in the primary healthcare system as well as for epidemic prevention and control. However, few researchers have examined their professional identity. This study investigated the current status of the professional identity of general practitioners in Chongqing, China and explored the effects of psychological capital and patient's contempt on their professional identity. From December 2021 to January 2022, randomized cluster sampling was used to conduct a cross-sectional online self-assessment questionnaire survey among general practitioners in Chongqing. In total, 2,180 general practitioners working for more than one year were selected. General practitioners' sense of professional identity, mental health, and sense of patients' disrespect were measured using the Professional Identity Scale, Psychological Capital Questionnaire, and Patient's Contempt Questionnaire. Sociodemographic characteristics were also collected. A multiple linear regression model was used to analyze the association between professional identity, psychological capital, and patient's contempt. The average score for professional identity among general practitioners was 53.59 (SD = 6.42). The scores for self-efficacy, hope, resilience, and optimism (subscales of psychological capital) were 26.87 (SD = 5.70), 26.47 (SD = 5.74), 26.97 (SD = 5.55), and 26.86 (SD = 5.59), respectively. The score for perceived contempt was 34.19 (SD = 7.59). An average monthly income greater than CNY 8,000 (ß = 1.018, p < 0.001), work tenure of more than 15 years (ß = 0.440, p = 0.001), hope (ß = 0.249, p < 0.001) and a higher optimism score (ß = 0.333, p < 0.001) were positively correlated with professional identity. Having a bachelor's degree and above (ß = -0.720, p = 0.014), an administrative role (ß = -1.456, p < 0.001), self-efficacy (ß = -0.122, p < 0.001), and higher patient's contempt (ß = -0.103, p < 0.001) were negatively associated with professional identity. General practitioners in Chongqing demonstrated high professional identity and a strong psychological status during the COVID-19 pandemic. Psychological capital and patient's contempt were associated with professional identity. To improve general practitioners' professional identity, stakeholders should promote practitioners' mental health and physician-patient relationships in China.

Molecular mechanism of the response of Zygosaccharomyces rouxii to D-fructose stress by the glutathione metabolism pathway.

Zygosaccharomyces rouxii produces high levels of 4-hydroxy-2,5-dimethyl-3(2H)-furanone in YPD medium supplemented with 120 g/L D-fructose and 180 g/L NaCl after 5 d. D-fructose has a stress effect on Z. rouxii, and GSH-Px is a main enzyme involved in the defense of Z. rouxii against oxygen stress according to our previous report. In order to further explore the molecular mechanism of the glutathione metabolism pathway in Z. rouxii in response to D-fructose stress, changes in the expression of genes and proteins involved in the synthesis of glutathione precursor amino acids and enzymes were observed. In addition, changes in the intermediates related to glutathione synthesis in Z. rouxii were reported. The results indicated that some gene-encoding enzymes involved in the glutamate, cysteine and glycine biosynthesis pathways and key genes involved in glutathione synthesis were upregulated. The expression levels of other genes, except SHMT, were consistent with the qRT-PCR results. The contents of γ-glutamylcysteine and glutathione amide in the D-fructose group were higher than those in the control group. In the D-fructose stress groups, the metabolic flux towards glutathione synthesis was increased. These results might provide more in-depth and detailed theoretical support for the oxidative stress defense mechanism of Z. rouxii under D-fructose stress.

Molecular mechanisms of furanone production through the EMP and PP pathways in Zygosaccharomyces rouxii with D-fructose addition.

4-Hydroxy-2,5-dimethyl-3(2H)-furanone (HDMF) and 4-hydroxy-2(or 5)-ethyl-5(or 2)-methyl-3(2H)-furanone (HEMF) are important aroma chemicals in fermented foods. In this study, transcriptomics, qRT-PCR and enzymology methods were used to study the molecular mechanisms of furanone production through the Embden-Meyerhof-Parnas (EMP) and Pentose Phosphate (PP) pathways in Zygosaccharomyces rouxii based on the results of our previous study. The results indicated that D-fructose addition could significantly enhance Z. rouxii biomass production. In addition, HDMF and HEMF production was increased as a result of D-fructose addition based on HPLC analysis. The significant pathways for furanone synthesis were EMP (zro00010) and PP (zro00030) based on KEGG analysis. At the mRNA level, the differentially expressed genes involved in HDMF and HEMF biosynthesis were HK, PFK1, G6PI, FBA, TPI, 6GPL, TKT, and 6PGDH. Transient overexpression of FBA and 6PGDH in Z. rouxii was significantly increased during furanone production. FBA can regulate the accumulation of dihydroxyacetone phosphate (DHAP), which is one of the precursors of HDMF, while 6PGDH can regulate the accumulation of ribulose-5-phosphate, a precursor of HEMF. In addition, the activities of PFK1, FBA, and 6PGDH were significantly correlated with furanone production. LC-MS/MS results indicated that the primary metabolites for furanone synthesis in the EMP and PP pathways gradually increased with the consumption of D-fructose. These data demonstrate that D-fructose addition can be used to generate furanones through the EMP and PP pathways in Z. rouxii.

A new understanding: Gene expression, cell characteristic and antioxidant enzymes of Zygosaccharomyces rouxii under the D-fructose regulation.

Zygosaccharomyces rouxii is a well-known salt-tolerant yeast. In our previous study, it was interesting that Z. rouxii could produce higher levels of 4-hydroxy-2, 5-dimethyl-3(2 H)-furanone in 120 g/L D-fructose and 180 g/L NaCl involved YPD medium at 5 d. In order to explore the resistance and furanone production mechanisms of Z. rouxii under D-fructose regulation, a comparative transcriptomics method in Z. rouxii was to set to find differentially expressed genes, the physiological and biochemical indexes (growth and cell morphology, lipid peroxidation and relative electrical conductivity, the antioxidant enzymes activity), and the expression of oxidoreductase activity genes. The results indicated that a larger number of different expressed genes at transcriptome analysis, such as the series antioxidant enzymes were related to the resistance characteristics. Research had confirmed that the living cell numbers and cell areas of D-fructose regulation group were significantly lower than the controls at the initial stage, while those higher than of the controls at the late stage. During the fermentation period, the lipid peroxidation and the relative electrical conductivity of the yeast cell membrane were increased. And also the D-fructose regulation group present lower inhibition superoxide anion ability. The activity of CAT in the D-fructose regulation group was always higher than that of the control group. Only the activity of GSH-Px was found to be significantly increased at 1 d except for other enzymes activities. Most of the oxidoreductase activity genes, such as especially the GSH-Px gene under D-fructose regulation conditions were expressed at higher levels than those of control groups. Combining the levels of transcription and enzymes activity data, those could understand that exogenous D-fructose had a stress effect on Z. rouxii at the early stage of culture. With the fermentation time progress, it was no longer a stressor substance for the Z. rouxii, and changed the nutrient to promote growth of Z. rouxii in the later stages. During the whole process, GSH-Px was the main defense enzyme and CAT was the sustained defense enzyme. Therefore, the experimental results might provide effective mechanisms in Z. rouxii for practical application of furanone production in the industry under exogenous D-fructose regulation.