INTRODUCTIONEmerging infectious disease outbreaks, such as the present coronavirus disease 2019 pandemic, often have a psychological impact on the well-being of the general population, including survivors and caregivers. Our study aimed to synthesise extant literature regarding the combined psychological responses and coping methods used by the general population in past outbreaks. METHODSWe conducted a narrative synthesis of the published literature over the last two decades with a quality appraisal of included articles that reported both psychological responses and coping strategies within infectious disease outbreaks. RESULTSA total of 144 papers were identified from the search, 24 of which were included in the review. Overall, 18 studies examined the psychosocial responses of the general population towards the severe acute respiratory syndrome epidemic, four studies focused on the Ebola epidemic and two studies covered the H1N1 outbreak. Common themes in psychological responses included anxiety/fears, depression, anger, guilt, grief and loss, post-traumatic stress and stigmatisation, but also a greater sense of empowerment and compassion towards others. Coping strategies adopted included problem-focused coping (seeking alternatives, self-and other-preservation), seeking social support, avoidance, and positive appraisal of the situation.CONCLUSION Amid the range of psychosocial responses seen in past infectious disease outbreaks, practical considerations for the current COVID-19 pandemic need to focus on the individual in the context of the larger social environment, with an emphasis on raising awareness of the range of possible psychosocial responses, access to psychological help, selfcare, empowering self-support groups and sustained engagement with updated, reliable information about the outbreak.

These findings could potentially inform the development of practical community mental health programs for future infectious disease outbreaks.

BackgroundMultimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern. The aim of the current study was to estimate the economic burden of multimorbidity among older adults in Singapore by investigating its association with the healthcare and societal resource use and cost.MethodsThe Well-being of the Singapore Elderly (WiSE) study was a single phase, cross sectional survey among a nationally representative sample of Singapore residents (N = 2565) aged 60 years and above. Multimorbidity was defined in this study as having two or more chronic conditions, from a list of 10 conditions. Care was classified into healthcare which included direct medical care, intermediate and long-term care, indirect care, and social care, provided by paid caregivers and family members or friends. Costs were calculated from the societal perspective, including healthcare and social care costs, by multiplying each service unit with the relevant unit cost. Generalized linear models were used to investigate the relationship between total annual costs and various socio-demographic factors.ResultsThe prevalence of multimorbidity was 51.5 %. Multimorbid respondents utilised more healthcare and social care resources than those with one or no chronic conditions. The total societal cost of multimorbidity equated to SGD$15,148 per person, annually, while for those with one or no chronic conditions the total annual societal costs per person were SGD$5,610 and SGD$2,806, respectively. Each additional chronic condition was associated with increased healthcare (SGD$2,265) and social care costs (SGD$3,177). Older age (i.e. 75–84 years old, and especially over 85 years), Indian ethnicity and being retired were significantly associated with higher total costs from the societal perspective, while older age (75 years and above) and ‘Other’ ethnicity were significantly associated with higher total healthcare costs.ConclusionMultimorbidity was associated with substantially higher healthcare utilisation and social care costs among older adults in Singapore. With the prevalence of multimorbidity increasing, especially as the population ages, we need healthcare systems that are evolving to address the emerging challenges associated with multimorbidity and the respective healthcare and societal costs.

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In this study, cabbage [Brassica rapa L. subsp. chinensis (L.) Hanelt cv. Xinza No 1], mung bean [Vigna radiata (L.) R. Wilczek var. radiata cv. VC-3762], and wheat (Triticum aestivum L. cv. Altas 66) were grown in Pb-contaminated soils. Application of ethylenediaminetetraacetic acid (EDTA) (3.0 mmol of EDTA/kg soil) to the soil significantly increased the concentrations of Pb in the shoots and roots of all the plants. Lead concentrations in the cabbage shoots reached 5010 and 4620 mg/kg dry matter on Days 7 and 14 after EDTA application, respectively. EDTA was the best in solubilizing soil-bound Pb and enhancing Pb accumulation in the cabbage shoots among various chelates (EDTA, diethylenetriaminepentaacetic acid [DTPA], hydroxyethylenediaminetriacetic acid [HEDTA], nitrilotriacetic acid [NTA], and citric acid). Results of the sequential chemical extraction of soil samples showed that the Pb concentrations in the carbonate-specifically adsorbed and Fe-Mn oxide phases were significantly decreased after EDTA treatment. The results indicated that EDTA solubilized Pb mainly from these two phases in the soil. The relative efficiency of EDTA enhancing Pb accumulation in shoots (defined as the ratio of shoot Pb concentration to EDTA concentration applied) was highest when 1.5 or 3.0 mmol EDTA/kg soil was used. Application of EDTA in three separate doses was most effective in enhancing the accumulation of Pb in cabbage shoots and decreased mobility of Pb in soil compared with one- and two-dose application methods. This approach could help to minimize the amount of chelate applied in the field and to reduce the potential risk of soluble Pb movement into ground water.