Environmental Investigation during Legionellosis Outbreak, Montérégie, Quebec, Canada, 2021.

In August 2021, a legionellosis outbreak involving 7 persons occurred within a 500-meter radius in the Montérégie region of Québec, Canada. Near real-time modeling of wind direction along with epidemiologic and environmental investigations identified the possible source. Modeling wind direction could help identify likely Legionella pneumophila sources during legionellosis outbreaks.

Portrait of COVID-19 Outbreaks in the Workplaces of the Monteregie Region.

OBJECTIVES: The aims of the studies are to describe COVID-19 outbreaks in the workplaces of the Monteregie Region, Quebec, Canada, and to evaluate potential risk factors for identifying at least one COVID-19 outbreak in these workplaces. METHODS: An ecological retrospective cohort study was conducted using deidentified databases of COVID-19 outbreaks that occurred in workplaces from February 27, 2020, to June 30, 2021. RESULTS: Among 30,489 workplaces studied, 897 workplaces with at least one COVID-19 outbreak were identified. These outbreaks were associated with a sizeable number of workers in the workplace (adjusted odds ratio [aOR] = 6.78; 95% CI: 5.43-8.47), the presence of temporary foreign workers (aOR = 2.26; 95% CI: 1.53-3.33), contacts with clients (aOR = 1.93; 95% CI: 1.68-2.21), and being localized in the Montreal Metropolitan Area (aOR = 1.26; 95% CI: 1.09-1.45). CONCLUSIONS: These results enable the identification of potential risk factors for COVID-19 outbreaks in workplaces, with the aim of targeting workplaces where infection control and prevention measures might be enhanced or adapted to improve workers' health.

Breast cancer screening practices for women aged 35 to 49 and 70 and older.

OBJECTIVE: To describe physician practices with regard to opportunistic screening for breast cancer in women aged 35 to 49 years and 70 years of age and older, and to identify the determinants associated with the practice of prescribing screening mammography. DESIGN: Postal survey. SETTING: Quebec. PARTICIPANTS: Simple random sample of 1400 general practitioners practising in Quebec in 2009. MAIN OUTCOME MEASURES: Five cancer screening practices among 4 types of female clientele and the factors influencing physicians in their practice of prescribing screening mammography. RESULTS: The response rate was 36%. For women aged 35 to 49 years, more than 80% of physicians reported using practices judged adequate, except for the teaching of breast self-examination and referrals to genetic counseling (60% and 54%). For women 70 years of age and older with good life expectancy, only 50% of general practitioners prescribed screening mammography. For the 70 years of age and older age group without good life expectancy, for whom screening is not indicated, nearly half of physicians continued to do the clinical breast examination and more than one-third reviewed family history. The main determinants for the practice of prescribing mammography are a favourable attitude to screening, screening skills, peer support, belief in the efficacy of mammography, and sufficient knowledge of the issue and of recommendations. CONCLUSION: Improvements are needed in the practice of teaching breast self-examination to women aged 35 to 49 years and referring them to genetic counseling, as well as in prescribing mammography for women 70 years of age and older who are in good health. Public health actions to improve these practices should focus on physician attitudes and skills and on communicating clearer recommendations.

Severe pulmonary hypertension and chronic obstructive pulmonary disease.

RATIONALE: Severe pulmonary hypertension occurs occasionally in patients with chronic obstructive pulmonary disease (COPD), but no detailed description of these patients is available. OBJECTIVES: To identify and characterize patients with COPD and severe pulmonary hypertension. METHODS: Retrospective study of 27 patients with COPD with severe pulmonary hypertension (pulmonary artery mean pressure [Ppa], > or = 40 mm Hg) among 998 patients who underwent right heart catheterization between 1990 and 2002 as part of a workup for chronic respiratory failure during a period of disease stability. RESULTS: Of the 27 patients, 16 had another disease capable of causing pulmonary hypertension. The remaining 11 (11 of 998, 1.1%) patients had COPD as the only cause of pulmonary hypertension, with a median Ppa of 48 mm Hg (interquartile range, 46-50). They had an unusual pattern of cardiopulmonary abnormalities with mild to moderate airway obstruction, severe hypoxemia, hypocapnia, and a very low diffusing capacity for carbon monoxide (p < 0.01 compared with a control group of patients with COPD). Exertional dyspnea was more severe (p < 0.01) and survival was shorter (p = 0.0026) than in the control subjects. CONCLUSIONS: Severe pulmonary hypertension is uncommon in patients with COPD. When it occurs, another cause must be sought. COPD with severe pulmonary hypertension and no other possible cause shares features with pulmonary vascular diseases, such as idiopathic pulmonary hypertension.