Psychological Resilience in Post-acute Care: A Cross-Sectional Study of Health Care Workers in Singapore Community Hospitals.

OBJECTIVES: Psychological resilience is a crucial component of mental health and well-being for health care workers. It is positively linked to compassion satisfaction and inversely associated with burnout. The current literature on health care worker resilience has mainly focused on primary care and tertiary hospitals, but there is a lack of studies in post-acute and transitional care settings. Our study aims to address this knowledge gap and evaluate the factors associated with psychological resilience among health care professionals working in community hospitals. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Physicians, nurses, rehabilitation therapists (consisting of physiotherapists, occupational therapists, and speech therapists), pharmacists, dietitians, and social workers in 2 community hospitals in Singapore. METHODS: Eligible health care workers were invited to fill in anonymous, self-reported questionnaires consisting of sociodemographic, lifestyle, and work-related factors together with the Connor-Davidson Resilience Scale (CD-RISC-10). Univariate analysis and multiple linear regression were conducted to study the relationship between each factor and resilience scores. RESULTS: A total of 574 responses were received, giving a response rate of 81.1%. The mean CD-RISC-10 score reported was 28.4. Multiple linear regression revealed that male gender (B = 1.49, P = .003), Chinese (B = -3.18, P < .001), active smokers (B = -3.82, P = .01), having perceived work crisis support (B = 2.95, P < .001), work purpose (B = 1.84, P = .002), job satisfaction (B = 1.01, P = .04), and work control (B = 2.53, P < .001) were significantly associated with psychological resilience scores among these health care workers. CONCLUSION AND IMPLICATIONS: Our study highlights the importance of certain individual and organizational factors that are associated with psychological resilience. These findings provide valuable insight into developing tailored interventions to foster resilience, such as strengthening work purpose and providing effective work crisis support, thus reducing burnout among health care workers in the post-acute care setting.

Evaluating the association of COVID-19 restrictions on discharge planning and post-discharge outcomes in the community hospital and Singapore regional health system.

Objectives: The COVID-19 is a global health issue with widespread impact around the world, and many countries initiated lockdowns as part of their preventive measures. We aim to quantify the duration of delay in discharge to community from Community Hospitals, as well as quantify adverse patient outcomes post discharge pre and during lockdown period. Design and methods: We conducted a before-after study comparing the length of stay in Community Hospitals, unscheduled readmissions or Emergency Department attendance, patients' quality of life using EQ5D-5l, number and severity of falls, in patients admitted and discharged before and during lockdown period. Results: The average length of stay in the lockdown group (27.77 days) were significantly longer than that of the pre-lockdown group (23.76 days), p = 0.003. There were similar proportions of patients with self-reported falls post discharge between both groups. Patients in the pre-lockdown group had slightly better EQ-5D-5l Index score at 0.55, compared to the lockdown study group at 0.49. Half of the patients in both groups were referred to Community Care Services on discharge. Conclusion: Our study would help in developing a future systematic preparedness guideline and contingency plans in times of disease outbreak and other similar public health emergencies.

COVID-19-Related Vaccine Hesitancy among Community Hospitals' Healthcare Workers in Singapore.

COVID-19 has culminated in widespread infections and increased deaths over the last 3 years. In addition, it has also resulted in collateral economic and geopolitical tensions. Vaccination remains one of the cornerstones in the fight against COVID-19. Vaccine hesitancy must be critically evaluated in individual countries to promote vaccine uptake. We describe a survey conducted in three Singapore community hospitals looking at healthcare workers' vaccine hesitancy and the barriers for its uptake. The online anonymous survey was conducted from March to July 2021 on all staff across three community hospital sites in SingHealth Singapore. The questionnaire was developed following a scoping review and was pilot tested and finalized into a 58-item instrument capturing data on demographics, contextual features, knowledge, attitudes, perceptions, and other vaccine-related factors in the vaccine hesitancy matrix. Logistic regression analysis was employed for all co-variates that are significant in univariate analysis. The response rate was 23.9%, and the vaccine hesitancy prevalence was 48.5% in the initial phase of the pandemic. On logistic regression analysis, only being female, a younger age, not having had a loved one or friend infected with COVID-19 and obtaining information from newspapers were associated with vaccine hesitancy in healthcare workers in Singapore community hospitals.

COVID-19 Vaccine Hesitancy-A Scoping Review of Literature in High-Income Countries.

Vaccine hesitancy forms a critical barrier to the uptake of COVID-19 vaccine in high-income countries or regions. This review aims to summarize rates of COVID-19 hesitancy and its determinants in high-income countries or regions. A scoping review was conducted in Medline®, Embase®, CINAHL®, and Scopus® and was reported in accordance with the PRISMA-SCr checklist. The search was current as of March 2021. Studies which evaluated COVID-19 vaccine hesitancy and its determinants in high-income countries (US$12,536 or more GNI per capita in 2019) were included. Studies conducted in low, lower-middle, and upper-middle income countries or regions were excluded. Factors associated with vaccine hesitancy were grouped into four themes (vaccine specific, individual, group, or contextual related factors). Of 2237 articles retrieved, 97 articles were included in this review. Most studies were conducted in U.S. (n = 39) and Italy (n = 9). The rates of vaccine hesitancy across high-income countries or regions ranged from 7-77.9%. 46 studies (47.4%) had rates of 30% and more. Younger age, females, not being of white ethnicity and lower education were common contextual factors associated with increased vaccine hesitancy. Lack of recent history of influenza vaccination, lower self-perceived risk of contracting COVID-19, lesser fear of COVID-19, believing that COVID-19 is not severe and not having chronic medical conditions were most frequently studied individual/group factors associated with increased vaccine hesitancy. Common vaccine-specific factors associated with increased vaccine hesitancy included beliefs that vaccine are not safe/effective and increased concerns about rapid development of COVID-19 vaccines. Given the heterogeneity in vaccine hesitancy definitions used across studies, there is a need for standardization in its assessment. This review has summarized COVID-19 vaccine hesitancy determinants that national policymakers can use when formulating health policies related to COVID-19 vaccination.

The effect of coffee consumption on insulin sensitivity and other biological risk factors for type 2 diabetes: a randomized placebo-controlled trial.

BACKGROUND: In observational studies, coffee consumption has been consistently associated with a lower risk of type 2 diabetes mellitus. Trials examining the effect of coffee consumption on glucose metabolism have been limited by the use of surrogate insulin sensitivity indices, small sample sizes, lack of blinding, and short follow-up duration. OBJECTIVES: We aimed to overcome limitations of previously conducted coffee trials in a randomized placebo-controlled trial of the effect of coffee consumption on insulin sensitivity. METHODS: We conducted a 24-wk randomized placebo-controlled trial in 126 overweight, non-insulin sensitive (HOMA-IR ≥1.30), Chinese, Malay, and Asian-Indian males and females aged 35-69 y. Participants were randomly assigned to receive 4 cups of instant regular coffee (n = 62) or 4 cups of a coffee-like placebo beverage (n = 64) per day. The primary outcome was the amount of glucose metabolized per kilogram of body weight per minute (Mbw) assessed during steady-state conditions with a hyperinsulinemic euglycemic clamp. Secondary outcomes included other clamp-based insulin sensitivity measures, biological mediators of insulin sensitivity, and measures of fasting glucose metabolism. RESULTS: Coffee consumption did not significantly change insulin sensitivity compared with placebo (percentage mean difference in Mbw = 4.0%; 95% CI: -8.3, 18.0%; P = 0.53). Furthermore, no significant differences in fasting plasma glucose (2.9%; 95% CI: -0.4, 6.3%; P = 0.09) or biological mediators of insulin resistance, such as plasma adiponectin (2.3%; 95% CI: -1.4, 6.2%; P = 0.22), were observed between coffee and placebo groups over 24 wk of intervention. Participants in the coffee arm experienced a loss of fat mass (FM) (-3.7%; 95% CI: -6.3, -1.1%; P = 0.006) and reduction in urinary creatinine concentrations (-21.2%; 95% CI: -31.4, -9.5%; P = 0.001) compared with participants in the placebo arm over 24 wk of intervention. CONCLUSIONS: Consuming 4 cups/d of caffeinated coffee for 24 wk had no significant effect on insulin sensitivity or biological mediators of insulin resistance but was associated with a modest loss of FM and reduction in urinary creatinine concentrations.This trial was registered at clinicaltrials.gov as NCT01738399. Registered on November 28, 2012. Trial sponsor: Nestlé Research, Lausanne, Switzerland. Trial site: National University of Singapore.

Impact of tax and subsidy framed messages on high- and lower-sugar beverages sold in vending machines: a randomized crossover trial.

OBJECTIVE: Framing of fiscal incentives has been suggested to be important in influencing purchase decisions. We aimed to examine the effect of framing a modest price difference between high- and lower-sugar beverages as a tax or a subsidy respectively, using messages placed on vending machines to influence beverage purchases. DESIGN/SETTING: This is an 11-week randomized crossover trial conducted between August and November 2015, with a two-week run-in period before intervention, targeted at students, staff and faculty of a university campus in Singapore. Twenty-one beverage vending machines were used to implement the intervention involving 'tax message', 'subsidy message' and 'no message (control)'. The former two messages suggest 'a tax for high sugar beverages' or 'a subsidy for lower sugar beverages' respectively. Prices of the beverages offered were fixed at baseline and remained the same in all three experimental conditions: lower-sugar beverage options were priced ~ 10% lower than the corresponding high-sugar option. The machines were randomized to one of the 6 sequences of intervention. Each message intervention period was 3 weeks. The effect of messages was assessed by comparing average weekly units of beverages sold between interventions using mixed effects model. RESULTS: The average weekly units of high and lower-sugar beverages sold per vending machine were 115 and 98 respectively in the control condition. The percentage of high-sugar beverages sold was 54% in the control, 53% in the tax, and 54% in the subsidy message condition. There was no difference in the weekly units of high-sugar beverages sold for the tax message (- 2, 95% CI -8 to 5, p = 0.61) or the subsidy message (0, 95% CI -10 to 10, p = 0.96) conditions as compared with the control condition. Similarly, there was no difference in the weekly units of lower-sugar beverages sold for the tax message (4, 95% CI -4 to 13, p = 0.32) or the subsidy message (7, 95% CI -4 to 18, p = 0.18) conditions as compared with the control condition. CONCLUSIONS: The use of tax and subsidy messages to highlight modest price differences did not substantially reduce high-sugar beverage sales in vending machines on an Asian university campus.

Development of a Semi-Quantitative Food Frequency Questionnaire to Assess the Dietary Intake of a Multi-Ethnic Urban Asian Population.

Assessing habitual food consumption is challenging in multi-ethnic cosmopolitan settings. We systematically developed a semi-quantitative food frequency questionnaire (FFQ) in a multi-ethnic population in Singapore, using data from two 24-h dietary recalls from a nationally representative sample of 805 Singapore residents of Chinese, Malay and Indian ethnicity aged 18-79 years. Key steps included combining reported items on 24-h recalls into standardized food groups, developing a food list for the FFQ, pilot testing of different question formats, and cognitive interviews. Percentage contribution analysis and stepwise regression analysis were used to identify foods contributing cumulatively ≥90% to intakes and individually ≥1% to intake variance of key nutrients, for the total study population and for each ethnic group separately. Differences between ethnic groups were observed in proportions of consumers of certain foods (e.g., lentil stews, 1%-47%; and pork dishes, 0%-50%). The number of foods needed to explain variability in nutrient intakes differed substantially by ethnic groups and was substantially larger for the total population than for separate ethnic groups. A 163-item FFQ covered >95% of total population intake for all key nutrients. The methodological insights provided in this paper may be useful in developing similar FFQs in other multi-ethnic settings.

A randomized placebo-controlled trial of the effect of coffee consumption on insulin sensitivity: Design and baseline characteristics of the Coffee for METabolic Health (COMETH) study.

BACKGROUND: Coffee consumption has been consistently associated with a lower risk of type 2 diabetes mellitus in cohort studies. In addition, coffee components increased insulin sensitivity in animal models. However, data from intervention studies on the effect of coffee consumption on glucose metabolism have been limited by small sample sizes, lack of blinding, short follow-up duration and the use of surrogate indices of insulin sensitivity. We designed the Coffee for Metabolic Health (COMETH) study to evaluate the effect of coffee consumption on insulin sensitivity. METHODOLOGY: The COMETH study is a double-blind randomized placebo-controlled 24-week trial. Participants were overweight, male and female habitual coffee consumers who were of Chinese, Malay and Asian-Indian ethnicity. We excluded smokers, persons with diabetes, and persons with low insulin resistance (HOMA-IR < 1.30). Participants were randomly assigned to receive daily 4 cups of instant regular coffee or 4 cups of a coffee-like placebo beverage. The hyperinsulinemic euglycemic clamp was performed at baseline and at the end of 24 weeks to determine changes in the bodyweight standardized M-value. Secondary outcomes included changes in fasting glucose and insulin sensitivity mediators such as adiponectin, markers of inflammation, liver function, and oxidative stress.We enrolled 128 participants, 126 (57.1% males; aged 35-67 years) of whom completed baseline assessments. DISCUSSION: If improvement in insulin sensitivity in the coffee group is significantly greater than that of the placebo group, this would support the hypothesis that coffee consumption reduced risk of type 2 diabetes through biological pathways involving insulin sensitivity. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01738399. Registered on 28 November 2012. Trial Sponsor: Nestlé Research Center, Lausanne, Switzerland. Trial Site: National University of Singapore.