A erosol-generating procedures pose a potential threat to health care workers, especially during this COVID-19 (coronavirus disease 2019) pandemic. Esophagogastroduodenoscopy (EGD) was assumed to be an aerosol-generating procedure and recommendations, therefore, reflect evidence generated from nongastrointestinal aerosol-generating procedures, such as bronchoscopy. However, there is no scientific evidence to support this claim. This study aims to provide scientific evidence on whether EGD is an aerosol-generating procedure and to examine ways of decreasing the amount of aerosol generated. Methods This study was a prospective observational trial to examine aerosol generation during EGD by applying a quantitative approach (see Supplementary Material for details). All patients undergoing EGD at the endoscopy center of the Prince of Wales Hospital from May 7, 2020 to June 1, 2020 were included. Procedures were performed with the patient in the left lateral position with a mouthguard, using a 9.9-mm flexible video gastrointestinal scope (GIF-H290; Olympus Hong Kong and China Limited, Kowloon, Hong Kong SAR). Measurements were taken using the portable GT-526S Handheld Particle Counter (Met One Instruments, Inc, Grants Pass, OR). The 6-channel particle sizes were programmed at 0.3 mm, 0.5 mm, 0.7 mm, 1 mm, 5 mm, and 10 mm. The particle counter was placed within 10 cm of the mouth of the patient once the patient entered the room and measured for at least 1 minute before the start of the procedure. The measurement was continued during the procedure until after the patient left the endoscopy suite.

Positive emotion regulation is important for enhancing psychological well‐being. Previous studies have adopted a cross‐sectional design to examine the relationships between positive emotion regulation strategies and psychological functioning. Relatively little is known about the role of positive emotion regulation strategies in positive and negative emotions in everyday life. This study examines associations between perceived capability of savoring and trait positive rumination and everyday emotions. Among 300 Hong Kong Chinese (age 18–77 years), perceived capability of savoring the moment and positive rumination predicted higher positive emotions during positive‐valenced events. Perceived capability of savoring the moment predicted lower negative emotions during positive‐valenced events and higher positive emotions during negative‐valenced events. Positive links between positive valence ratings of events and positive emotions were stronger among individuals who reported higher levels of perceived capability of savoring through reminiscence and greater trait emotion‐focused rumination. Positive links between negative valence ratings of events and negative emotions were significant only among individuals who reported low/medium levels of perceived capability of savoring through anticipation. These findings suggest that: (a) perceived capability of savoring and trait positive rumination are key mechanisms for increasing positive emotions and (b) perceived capability of savoring fosters adaptive adjustment to stress during negative events.

Multimorbid adults are more likely to have depression. However, existing data are mostly cross-sectional or retrospective with poor control of baseline depressive symptoms and a focus on long-term effects. This prospective study examined the short-term independent predictive association of multimorbidity with depressive symptoms. We collected baseline and three-month follow-up data from a population-based sample of 300 community-dwellers (aged 18–77) in Hong Kong. Multiple regression was used to examine the predictive association of baseline multimorbidity (two or more physical chronic conditions), relative to having one or zero conditions, with depressive symptoms in three months measured by the Center for Epidemiological Studies-Depression (CES-D, out of 60) scale. Multivariable adjustments were made for socio-demographics, baseline CES-D scores, and baseline self-perceived physical health status. A sub-analysis was conducted to compare multimorbid participants with monomorbid (one condition) ones. In our sample, 48 participants (16%) had multimorbidity. Adjusted analysis showed that on average, multimorbid participants had 2.71 (95% CI, 0.36–5.06, Cohen’s d = 0.128) more points in the CES-D scale at three-month follow-up than non-multimorbid participants (zero or one condition) did, which was independent of baseline CES-D scores, self-perceived physical health status, and socio-demographics. Compared with monomorbid participants, multimorbidity was associated with a similar difference of 2.92 (95% CI, 0.81–5.66, Cohen’s d = 0.220) points. Incremental R-square changes associated with the inclusion of multimorbidity were significant (P < 0.05). In conclusion, the effect of multimorbidity on depressive symptoms may take a shorter period to manifest than previously assumed. The mental health of adults with multimorbidity warrants more attention.

Objectives The COVID‐19 pandemic has raised concerns on whether colonoscopies (CS) carry a transmission risk. The aim was to determine whether CS are aerosol‐generating procedures. Methods This was a prospective observational trial including all patients undergoing CS at the Prince of Wales Hospital from 1 June to 31 July 2020. Three particle counters were placed 10 cm from each patient’s anus and near the mouth of endoscopists and nurses. The particle counter recorded the number of particles of size 0.3, 0.5, 0.7, 1, 5, and 10 μm. Patient demographics, seniority of endoscopists, use of CO2 and water immersion technique, and air particle count (particles/cubic foot, dCF) were recorded. Multilevel modeling was used to test all the hypotheses with a post‐hoc analysis. Results A total of 117 patients were recruited. During CS, the level of 5 μm and 10 μm were significantly higher than the baseline period (P = 0.002). Procedures performed by trainees had a higher level of aerosols when compared to specialists (0.3 μm, P < 0.001; 0.5 μm and 0.7 μm, P < 0.001). The use of CO2 and water immersion techniques had significantly lower aerosols generated when compared to air (CO2: 0.3, 0.5, and 0.7 μm: P < 0.001; water immersion: 0.3 μm: P = 0.048; 0.7 μm: P = 0.03). There were no significant increases in any particle sizes during the procedure at the endoscopists' and nurses' mouth. However, 8/117 (6.83%) particle count tracings showed a simultaneous surge of all particle sizes at the patient's anus and endoscopists' and nurses' level during rectal extubation. Conclusion Colonoscopy generates droplet nuclei especially during rectal extubation. The use of CO2 and water immersion techniques may mitigate these risks.