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BACKGROUND: Antimicrobial resistance (AMR) of infectious agents is a growing concern for public health organizations. Given the complexity of this issue and how widespread the problem has become, resources are often insufficient to address all concerns, thus prioritization of AMR pathogens is essential for the optimal allocation of risk management attention. Since the epidemiology of AMR pathogens differs between countries, country-specific assessments are important for the determination of national priorities. OBJECTIVE: To develop a systematic and transparent approach to AMR risk prioritization in Canada. METHODS: Relevant AMR pathogens in Canada were selected through a transparent multi-step consensus process (n=32). Each pathogen was assessed using ten criteria: incidence, mortality, case-fatality, communicability, treatability, clinical impact, public/political attention, ten-year projection of incidence, economic impact, and preventability. For each pathogen, each criterion was assigned a numerical score of 0, 1, or 2, and multiplied by criteria-specific weighting determined through researcher consensus of importance. The scores for each AMR pathogen were summed and ranked by total score, where a higher score indicated greater importance. A sensitivity analysis was conducted to determine the effects of changing the criteria-specific weights. RESULTS: The AMR pathogen with the highest total weighted score was extended spectrum B-lactamase-producing (ESBL) Enterobacteriaceae (score=77). When grouped by percentile, ESBL Enterobacteriaceae, Clostridium difficile, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus were in the 80-100th percentile. CONCLUSION: This assessment provides useful information for prioritising public health strategies regarding AMR resistance at the national level in Canada. As the AMR environment and challenges change over time and space, this systematic and transparent approach can be adapted for use by other stakeholders domestically and internationally. Given the complexity of influences, resource availability and multiple stakeholders, regular consideration of AMR activities in the public health realm is essential for appropriate and responsible prioritisation of risk management that optimises the health and security of the population.

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A medical record review of patients hospitalized for medical conditions in Winnipeg, Canada during 1998/99 was completed using InterQual utilization review instruments. On admission, 95% of patients required the services provided in an acute care facility. Fifty-eight percent of days in hospital following the day of admission required an acute care setting, and 42% required an alternate level of care. Our results suggest there is room for treating more acute patients within the existing system.

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This study examined the reliability and validity of the three-day estimated record provided by parents and caregivers of preschoolers. Subjects included a random sample of 146 preschoolers (24-47 months) in dual-earner families. Parents and caregivers completed a three-day estimated record for each child. Six weeks later they were randomly assigned into either a group completing a second estimated record (Group1) as a test of reliability, or a group completing a weighed record (Group 2) as a test of validity. For Group 1, significant differences (P<0.05) in group mean intakes of energy and four of 10 nutrients were found; however, the magnitude of the differences was considered small. Similar results were found for Group 2. Intra-person variation in energy and nutrient intakes exceeded inter-person variation (60-90% versus 10-40% of the total variation). The three-day estimated record provided by parents and caregivers of preschool children is reliable and valid at the group level, however, intra-person variation affects its use at the individual level. These results have implications for the design of future studies of preschool children with employed parents where food intake must be recorded by multiple caregivers. Researchers and practitioners are challenged to design new, simpler methods to measure food intake that lend themselves to the varied eating situations of many preschool children today.