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Introduction: To curb transmission of COVID-19, Singapore has experienced multiple, ongoing community restrictions. Gaining the ability to adapt and thrive under pressure will be key to addressing effects of these restrictions on mental health. To inform this, we examine the following research questions, (1) What typifies adversity related to living with on-off COVID-19 restrictions? (2) Who are the resilient? (3) How are negative effects of adversity attenuated? Methods: Participants were a part of the Strengthening Our Community's Resilience Against Threats from Emerging Infections (SOCRATES) cohort, invited to participate in this survey either via email or text message. Using the community survey data (N = 1,364), analyses including Wilcoxon rank sum test and logistic regression were conducted. Results: Adversities are identified as circumstances associated with a significant increase in Hospital Anxiety and Depression Scale (HADS) scores. These are typified by having financial worries; experiencing heightened emotions and frequent crying; having "out of body" experiences; having to move frequently or not being able to settle into accommodation; and regularly feeling mistreated by someone close to you. Being resilient in the face of adversity was determined by HADS scores for depression and anxiety (dichotomized at the median) and characterized by overall better social relationships such as having harmonious living situations and solution-driven coping strategies, especially the ability to harness the belief that difficult situations can lead to growth. Discussion: In accordance with the Loads-Levers-Lifts model, results indicate that initiatives that increase access to identified protection, while minimizing exposure to known adversities where possible, will promote resilience under COVID-19 restrictions. [ABSTRACT FROM AUTHOR]

Background: Dengue results in high morbidity and mortality globally. The knowledge, attitude and practices (KAP) of dengue management, including diagnosis, among primary care physicians (PCPs) are important to reduce dengue transmission and burden. However, there is a lack of understanding on the impact of dengue epidemic on dengue management. Hence, the aim of this study is to examine the changes in KAP on dengue management among PCPs before and after the largest dengue epidemic in 2013 in Singapore.Methods: Surveys were mailed to 2000 and 1514 PCPs registered under the Singapore Medical Council in March of year 2011 and 2014, respectively. Survey data were then collected between April and June of that year. Chi-square or Fisher's exact test was used for comparing categorical variables. A multivariate logistic regression model was implemented to determine independent factors for frequent use of dengue diagnostic tests (DDTs). All tests were conducted at 5% level of significance. Adjusted odds ratio and corresponding 95% confidence intervals were reported, where applicable. Qualitative data were descriptively coded for themes and analysis.Results: Among PCPs surveyed in 2011 and 2014, 89.9% and 86% had good knowledge on dengue management respectively. The usage of DDTs had increased significantly in 2014 (N = 164;56%) as compared to 2011 (N = 107;29.5%) in both private and public clinics (p < 0.001). Dengue Duo point-of-care test (POCT) kits was independently associated with frequent use of DDTs (adjusted odds ratio = 2.15; 95% confidence interval = 1.25-3.69). There was a significant reduction in referral of dengue patients to hospital (31.4% in 2011; 13.3% in 2014; p < 0.001), and a significant increase in frequency of clinic follow-ups (18.4% in 2011; 28.5% in 2014; p = 0.003). One key theme highlighted was that dengue management can be improved with availability of POCT kit, better awareness of the disease and any revised clinical guidelines.Conclusion: The knowledge on dengue management remained high, while the attitude and practices, particularly on the usage of DDTs improved significantly after a large epidemic. Furthermore, PCPs had more confident in managing dengue patients in primary care settings and in educating patients on the importance of vector control and dengue warning signs to reduce dengue transmission and burden. [ABSTRACT FROM AUTHOR]

Objectives: Understanding factors influencing inappropriate antibiotic use can guide the design of interventions to improve antibiotic practices and reduce antimicrobial resistance (AMR). Methods: A nationally representative cross-sectional survey (N = 2004) was conducted between November 2020 and January 2021. Knowledge of antibiotic use and AMR using the World Health Organization's Multi-Country AMR Survey questionnaire, and antibiotic practices were examined. Multivariable logistic regression was performed to identify factors associated with inappropriate antibiotic use and examine effect measure modifications. Results: After adjusting for potential confounding, poor knowledge of antibiotic use was associated with a 3x increased odds of inappropriate antibiotic use in adults aged ≥50 years (aOR 3.11, 95% CI [2.24–4.32]), 5× increased odds in those aged 35–49 years (aOR 4.88, 95% CI [3.32–7.16]), and 7× increased odds in those aged 21–34 years (aOR 6.58, 95% CI [4.19–10.33]). While there was no statistically significant association in adults aged ≥50 years, poor knowledge of AMR increased the odds of inappropriate antibiotic use by 4 times in adults aged 35–49 years (aOR 3.73, 95% CI [1.53–9.11]) and 5 times in those aged 21–34 years (aOR 4.90, 95% CI [1.84–13.02]). Conclusions: Targeted educational interventions for specific age groups are needed in conjunction with empowering the public with knowledge of antibiotic use and AMR. [ABSTRACT FROM AUTHOR]