Overview of guidance for endoscopy during the coronavirus disease 2019 pandemic.

From its beginning in December 2019, the coronavirus disease 2019 outbreak has spread globally from Wuhan and is now declared a pandemic by the World Health Organization. The sheer scale and severity of this pandemic is unprecedented in the modern era. Although primarily a respiratory tract infection transmitted by direct contact and droplets, during aerosol-generating procedures, there is a possibility of airborne transmission. In addition, emerging evidence suggests possible fecal-oral spread of the virus. Clinical departments that perform endoscopy are faced with daunting challenges during this pandemic. To date, multiple position statements and guidelines have been issued by various professional organizations to recommend practices in endoscopic procedures. This article aims to summarize and discuss available evidence for these practices, to provide guidance for endoscopy to enhance patient safety, avoid nosocomial outbreaks, protect healthcare personnel, and ensure rational use of personal protective equipment. Responses adapted to national recommendations and local infection control guidelines and tailored to the availability of medical resources are imminently needed to fight the coronavirus disease 2019 pandemic.

Depression Outcome Expectancy in Primary Care in Singapore: Symptom Severity as a Mediating Determinant.

BACKGROUND: Depression has been identified as the most common mental illness in Singapore. To address this growing concern, the current study focused on the population within the primary care setting since depression has been demonstrated to be highly prevalent in these patients. This study examined the possible predictors of outcome expectancy based on illness perception and depression severity. METHODS: One hundred and one adult patients with depressive symptoms in primary care were recruited for a cross-sectional study. Positive outcome expectancy was measured using the Depression Change Expectancy Scale, and illness perception was measured using the Illness Perception Questionnaire Mental Health. Depression severity was derived from the Patient Health Questionnaire-9 scores extracted from the participants' medical records. Regression and mediation analyses were applied to explore possible predictors of positive outcome expectancy. RESULTS: Regression analysis demonstrated that symptom severity, and specific dimensions under illness perception (i.e., perception of chronicity, perception of personal control, and perception of treatment control) were the most significant predictors of positive outcome expectancy. Mediation analysis found that symptom severity partially mediated the relationship between perception of chronicity and positive outcome expectancy. CONCLUSIONS: Pharmacotherapy, interventions from allied health professionals, and psychotherapeutic interventions (e.g., strategies from positive psychology, solution-focused therapy, and strengths-based cognitive behavioral therapy) that aim to directly alleviate depressive symptoms as well as improve the perceptions of chronicity, personal control, and treatment control could potentially enhance treatment benefits in primary care patients with depression.

The characteristics of household food waste in Hong Kong and their implications for sewage quality and energy recovery.

Food waste (FW) is a worldwide environmental issue due to its huge production amount. FW separation from municipal solid waste followed by different treatment strategies has been widely accepted. Food waste disposer (FWD) is a promising approach to separate and collect household food waste (HFW), which has been widely applied in many countries. However, the feasibility of FWD application in many countries is still being debated due to the major concerns over the impact of FWD on the wastewater treatment plants. In order to investigate the feasibility of FWD application, FW characterization is a key work to be conducted in advance. Since the FW characteristics largely vary by region, reliable and representative FW characteristics in different countries should be investigated. To provide such information for further studies on FW management for Hong Kong, HFW was collected from Hong Kong typical households over one year and analyzed systemically in this study. The FW composition varied little from place to place or season to season, and the values observed were comparable with results reported from other countries and regions. Based on the reliable HFW characteristics obtained from one-year survey coupled with statistical analysis, simulated HFW for Hong Kong consisting of 50% fruits, 20% vegetables, 20% starchy food and 10% meat was proposed for future studies. On the other hand, the FWD treatment caused more than 50% of the biodegradable organic content in HFW to dissolve. With a ratio of 1 g food waste to 1 L sewage, total solids in the wastewater stream were predicted to increase by 73%, total chemical oxygen demand by 61%, soluble chemical oxygen demand by 110%, nitrogen by 6% and phosphorus by 16%. Theoretically, 22 million m3/year of additional methane could be generated if 50% of Hong Kong residential buildings equipped with FWD. That would certainly increase pollutant loading on the wastewater treatment plants, but also energy recovery potential.

Effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy.

AIM: To determine the effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. METHODS: Consecutive patients who underwent capsule endoscopy during the 16-mo study period were either given 250 mg oral erythromycin, 1 h prior to swallowing the capsule endoscope or nothing. The gastric and small bowel transit time, and the small bowel image quality were compared. RESULTS: Twenty-four patients received oral erythromycin whereas 14 patients were not given any prokinetic agent. Patients who received erythromycin had a significantly lower gastric transit time than control (16 min vs 70 min, P = 0.005), whereas the small bowel transit time was comparable between the two groups (227 min vs 183 min, P = 0.18). Incomplete small bowel examination was found in three patients of the control group and in one patient of the erythromycin group. There was no significant difference in the overall quality of small bowel images between the two groups. A marked reduction in gastric transit time was noted in two patients who had repeat capsule endoscopy after oral erythromycin. CONCLUSION: Use of oral erythromycin significantly reduces the gastric transit time of capsule endoscopy.