BackgroundEffective influenza pandemic management requires understanding of the factors influencing behavioral changes. We aim to determine the differences in knowledge, attitudes and practices in various different cohorts and explore the pertinent factors that influenced behavior in tropical Singapore.MethodsWe performed a cross-sectional knowledge, attitudes and practices survey in the Singapore military from mid-August to early-October 2009, among 3054 personnel in four exposure groups - laboratory-confirmed H1N1-2009 cases, close contacts of cases, healthcare workers, and general personnel.Results1063 (34.8%) participants responded. The mean age was 21.4 (SE 0.2) years old. Close contacts had the highest knowledge score (71.7%, p = 0.004) while cases had the highest practice scores (58.8%, p < 0.001). There was a strong correlation between knowledge and practice scores (r = 0.27, p < 0.01) and knowledge and attitudes scores (r = 0.21, p < 0.01). The significant predictors of higher practice scores were higher knowledge scores (p < 0.001), Malay ethnicity (p < 0.001), exposure group (p < 0.05) and lower education level (p < 0.05). The significant predictors for higher attitudes scores were Malay ethnicity (p = 0.014) and higher knowledge scores (p < 0.001). The significant predictor for higher knowledge score was being a contact (p = 0.007).ConclusionKnowledge is a significant influence on attitudes and practices in a pandemic, and personal experience influences practice behaviors. Efforts should be targeted at educating the general population to improve practices in the current pandemic, as well as for future epidemics.

BP compared with UBP RUL ECT was slightly more efficacious in treating depression and required fewer treatment sessions, but led to greater cognitive side effects. The decision of whether to use BP or UBP RUL ECT should be made on an individual patient basis and should be based on a careful weighing of the relative priorities of efficacy versus minimization of cognitive impairment.

Background: In order to improve the quality of courses in simulation, it is necessary to get to know the educational environment. The objective of this study was to adapt the DREEM scale and to present a new questionnaire called QuESST, that allows to de ne medical simulation environment as a speci c type of educational environment. Methods: The DREEM scale was translated and adapted into Polish conditions. A new tool-QuESST questionnaire was developed to complete the data with medical simulation environment aspects. Reliability, t-test, Component Analysis as well as correlation between the two methods were assessed in a sample of medical science students (N=312). Results: Statistical analysis presented a good reliability of the Polish translation of the DREEM scale (Cronbach's Alpha = 0,95). The t-test for the DREEM questionnaire was stable and reliable relevant (t=-,584, p=,562). Signi cant strong correlation was reported with the DREEM and QuESST tool (r=0,559, p£ 0.001). Also, moderate and high correlations were found with the overall result of QuESST and the results of individual DREEM subscales. Conclusions: The QuESST scale may be considered helpful in determining the medical simulation environment conditions and can be used to supplement the DREEM scale to create an effective educational environment with medical simulation.

BackgroundChina confirmed person to person transmission of a novel coronavirus (now named SARS-CoV-2) on 21 st Jan 2020 1 with more than 200 cases and 4 deaths. The World Health Organization (WHO) declared the COVID-19 outbreak as one of international concern on 30 th Jan 2020 2 . By 11 th Mar 2020 the WHO Director-General declared the COVID-19 outbreak a pandemic with 118,00 cases in 114 countries and 4291 deaths 3 . COVID-19 is currently understood as a droplet spread illness with a reproduction number of approximately 2.2 4 , transmitted via respiratory droplets, contact, fomites and fecal-oral routes 5,6 and with high lethality (3.4%) 7 . Many more patients with COVID-19 than SARS (Severe Acute Respiratory Syndrome) 8 have mild symptoms that contribute to spread as these patients are not picked up by current screening mechanisms 9 . The current outbreak is expected to last at least till the end of 2020 10 with the possibility of a second deadlier wave several months after the current outbreak like the 1918 Spanish Flu 11 . There is no known specific treatment or vaccine. Challenges Facing ECT during COVID-19This situation poses significant challenges for ECT services around the world. ECT is an essential psychiatric service that provides lifesaving treatment for severe mental illnesses like depression and catatonia if given in a timely fashion 12,13 and for which there is no viable alternative. However, ECT service is often not prioritized in hospitals 14 and may be stopped if anaesthesia resources are limited. This occurred at the beginning of the COVID-19 situation in a general hospital in Singapore, resulting in an acute ECT course stopping halfway for a patient