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Background: The COVID-19 pandemic has changed the epidemiology of upper respiratory tract infections (URTI) and the disease profile of patients attending the emergency department (ED). Hence, we sought to explore the changes in ED physicians' attitudes and behaviours in four EDs in Singapore. Methods: We employed a sequential mixed-methods approach (quantitative survey followed by in-depth interviews). Principal component analysis was performed to derive latent factors, followed by multivariable logistic regression to explore the independent factors associated with high antibiotic prescribing. Interviews were analysed using the deductive-inductive-deductive framework. We derive five meta-inferences by integrating the quantitative and qualitative findings with an explanatory bidirectional framework. Results: We obtained 560 (65.9%) valid responses from the survey and interviewed 50 physicians from various work experiences. ED physicians were twice as likely to report high antibiotic prescribing rates pre-COVID-19 pandemic than during the pandemic (AOR = 2.12, 95% CI 1.32 to 3.41, p = 0.002). Five meta-inferences were made by integrating the data: (1) Less pressure to prescribe antibiotics due to reduced patient demand and more patient education opportunities; (2) A higher proportion of ED physicians self-reported lower antibiotic prescribing rates during the COVID-19 pandemic but their perception of the overall outlook on antibiotic prescribing rates varied; (3) Physicians who were high antibiotic prescribers during the COVID-19 pandemic made less effort for prudent antibiotic prescribing as they were less concerned about antimicrobial resistance; (4) the COVID-19 pandemic did not change the factors that lowered the threshold for antibiotic prescribing; (5) the COVID-19 pandemic did not change the perception that the public's knowledge of antibiotics is poor. Conclusions: Self-reported antibiotic prescribing rates decreased in the ED during the COVID-19 pandemic due to less pressure to prescribe antibiotics. The lessons and experiences learnt from the COVID-19 pandemic can be incorporated into public and medical education in the war against antimicrobial resistance going forward. Antibiotic use should also be monitored post-pandemic to assess if the changes are sustained. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic aggravated the global public health system, which is already overwhelmed by the increasing statistics of comorbidities and burden due to obesity. The number of individuals with obesity and obesity-associated diseases are rising in many regions that could attribute to the growing obesogenic environment and the lockdown implemented to curb COVID-19. This review focuses on the aspects of the obesity epidemic, chronic inflammatory effects of obesity, positive outcomes of obesity interventions and the worsening effects observed in obese COVID-19 patients. The chronic inflammatory effects of obesity are apparent by the increase of pro-inflammatory signals by immune cells in the adipose tissue and reactive species populations. The reduction of antioxidants exacerbates the effects of oxidative stress on genomic and tissue levels. The public must be made aware of the importance of practising a healthier lifestyle, even more now as we are fighting the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Antimicrobial Resistance & Infection Control (2023) 12:24 https://doi.org/10.1186/s13756-023-01230-2 The original article [[1]] contained an error in attribution and display of affiliation #8 which has since been corrected. The online version of the original article can be found at https://doi.org/10.1186/s13756-023-01230-2. [Extracted from the article]