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Background: Limited space and resources are potential obstacles to infection prevention and control (IPAC) measures in in-centre hemodialysis units. We aimed to assess IPAC measures implemented in Quebec's hemodialysis units during the spring of 2020, describe the characteristics of these units and document the cumulative infection rates during the first year of the COVID-19 pandemic., Methods: For this cross-sectional survey, we invited leaders from 54 hemodialysis units in Quebec to report information on the physical characteristics of the unit and their perceptions of crowdedness, which IPAC measures were implemented from Mar. 1 to June 30, 2020, and adherence to and feasibility of appropriate IPAC measures. Participating units were contacted again in March 2021 to collect information on the number of COVID-19 cases in order to derive the cumulative infection rate of each unit., Results: Data were obtained from 38 of the 54 units contacted (70% response rate), which provided care to 4485 patients at the time of survey completion. Fourteen units (37%) had implemented appropriate IPAC measures by 3 weeks after Mar. 1, and all 38 units had implemented them by 6 weeks after. One-third of units were perceived as crowded. General measures, masks and screening questionnaires were used in more than 80% of units, and various distancing measures in 55%-71%; reduction in dialysis frequency was rare. Data on cumulative infection rates were obtained from 27 units providing care to 4227 patients. The cumulative infection rate varied from 0% to 50% (median 11.3%, interquartile range 5.2%-20.2%) and was higher than the reported cumulative infection rate in the corresponding region in 23 (85%) of the 27 units., Interpretation: Rates of COVID-19 infection among hemodialysis recipients in Quebec were elevated compared to the general population during the first year of the pandemic, and although hemodialysis units throughout the province implemented appropriate IPAC measures rapidly in the spring of 2020, many units were crowded and could not maintain physical distancing. Future hemodialysis units should be designed to minimize airborne and droplet transmission of infection., Competing Interests: Competing interests: None declared., (© 2021 CMA Joule Inc. or its licensors.)

Objective: To identify physicians' perceptions of breast cancer prevention in order to generate strategies to increase women's participation in the Quebec breast cancer screening program (QBCSP)., Design: Qualitative study using archival data and in-depth interviews., Setting: Laval, Que, a suburban city north of Montreal., Participants: Twenty family physicians and 1 gynecologist practising in Laval who had received at least 1 screening mammography report in 2004 or 2005., Methods: Archival data were obtained in order to refine our understanding of the QBCSP. In-depth individual interviews were conducted with participating physicians until data saturation was reached in order to determine physicians' knowledge of, beliefs and attitudes about, and behaviour toward preventive breast cancer practices, as well as their suggestions for enhancing patient compliance. The interviews were recorded, transcribed, and coded, and the content was analyzed., Main Findings: Respondents indicated that the screening age groups, the age for beginning clinical breast examination, and the instructions to patients about breast self-examination should be harmonized. Letters to patients should be shortened, simplified, and endorsed by physicians. Screening mammography reports should include more details and be clearer about patient follow-up. The need for patients to sign authorization forms for transmission of information related to their participation in the QBCSP should be reinforced by their physicians. Following abnormal mammogram results, services and procedures should be simplified and delays in appointments decreased. Referral for "orphan patients" (ie, patients without family physicians) should be supervised by nurse practitioners, with physician consultations when needed., Conclusion: This study provides a qualitative understanding of improvements or modifications needed in order to reach a screening mammography participation rate sufficient to reduce breast cancer mortality in women.

As part of the Canadian Federal-Provincial Initiative in Heart Health, the goal of the Fabreville Heart Health Program was to sensitize a district of Laval, Quebec's second most populous city, to heart-healthy behaviours. The program was planned and implemented by a committee composed of Fabreville community leaders and professionals from the Public Health Department. Between 1992 and 1994, intervention objectives were defined by the department in terms of changing individual behaviours associated with cardiovascular risk factors, namely diet, sedentariness and smoking, as well as adapting physical and social environments to facilitate these changes. However, from 1994 to its conclusion in 1997, the program was re-oriented to engage the population in mobilizing their own community and taking charge of interventions themselves. Actions then became dependent on the interests and motivation of Fabreville residents to transform their lifestyles and aspects of their physical environment. The initial evaluation process, based on the positivist paradigm, was designed to measure changes in individual behaviours and certain physical environments, such as an increase in designated non-smoking areas. However, following the re-orientation towards community mobilization, it was decided that evaluation should go beyond the professional production of data to include a process of the collective construction of knowledge. Evaluation methodology then became based on the constructivist paradigm. Yet field constraints such as lack of community involvement in both leadership and process evaluation, and the need to ensure evaluation standards and fulfil sponsor obligations, compelled the Public Health Department to return to using a certain number of positivist methods. The ensuing inter-paradigm dialogue helped broaden the scope of evaluation and contributed to gaining a more in-depth understanding of the processes and outcomes of community mobilization.

The theory of planned behavior and the stages-of-change model were used to gain a clearer understanding of the factors associated with regular exercise in order to plan more effective programs in heart disease prevention. The study was conducted using a self-administered postal questionnaire sent to a sample of 2,269 men 30 to 60 years of age. Nearly a quarter (23.3%) of respondents were physically inactive, of whom 10.5% were in the precontemplation and 12.8% in the contemplation stages; 42.1% exercised less than twice a week, of whom 22.4% were in the preparation I and 19.7% in the preparation II stages. Only 34.6% were in the action stage, exercising regularly for at least 20 minutes twice a week or more with the intention of continuing to do so. Logistic regression indicated that the variables derived from the theory of planned behavior, namely attitude, subjective norm and perceived behavioral control, were differently associated with the stages of behavior. Perceived behavioral control was strongly significant in all stages. Attitude was related with stages in which individuals have intention of exercising (contemplation and preparation II). In contrast, subjective norm seemed to be associated with stages in which individuals have no intention of doing so (precontemplation and preparation I). By identifying the specific needs of sub-groups, the results can help define programs most likely to accelerate men to the stage of regular exercise, part of an effective strategy for heart health promotion in this high-risk population.

Purpose: The purpose of the study was to identify the determinants of intention to have a low-fat diet in 30- to 60-year-old men., Design: The survey design was cross-sectional and consisted of a self-administered questionnaire. The dependent variable was the intention to have a low-fat diet within the next 4 months, and the independent variables were those suggested by the theory of planned behavior., Setting: The study population was drawn from three districts representing a modal sample of Laval, the second most populous city (N = 314,398) in the province of Quebec., Subjects: The sample comprised 3200 people. Of the 3200 questionnaires sent out, 2583 were received and 2269 were eligible (i.e., were answered by 30- to 60-year-old men), giving a response rate of 70.9%. Of the 2269 questionnaires, 430 were incomplete, resulted in 1839 being usable for analysis., Measures: Multiple regression analysis was conducted to determine the influence of the independent variables on the dependent variable, the intention to have a low-fat diet. The independent variables were (1) direct and indirect determinants of intention as suggested in the theory of planned behavior and (2) sociodemographic and concomitant variables and their interactions. Discriminant analysis was used on the significant variables obtained in the regression to establish the cognitive profile of respondents' intention, strong or weak., Results: In the final model, five variables 51% of the total variance. Respondents who had a stronger intention perceived that their important referents would approve them having a low-fat diet. They scored higher in seeing the advantages of adopting the target behavior and had a more positive attitude toward the behavior. They also perceived themselves as having control over the target behavior, and scored higher in terms of recognizing the perceived power of this control factor., Conclusions: The results suggests that the theory of planned behavior can be an effective tool in the planning of heart health promotion. They indicate that low-fat diet programs for men should target the work site and peer-group organizations, and place emphasis on adapting usual recipes. Though accenting the health and nutritional benefits of a low-fat diet, messages should appeal to emotion as well as reason.