Understanding Canadians' knowledge, attitudes and practices related to antimicrobial resistance and antibiotic use: Results from public opinion research.

Background: Antimicrobial resistance is a current and pressing issue in Canada. Population-level antibiotic consumption is a key driver. The Public Health Agency of Canada undertook a comprehensive assessment of the Canadian public's knowledge, attitudes and practices in relation to antimicrobial resistance and antibiotic use, to help inform the implementation of public awareness and knowledge mobilization. Methods: Data were collected in three phases: 1) six in-person focus groups (53 participants) to help frame the survey; 2) nationwide survey administration to 1,515 Canadians 18 years and older via cell phone and landline; and 3) 12 online focus groups to analyze survey responses. Survey data is descriptive. Results: A third (33.9%) of survey respondents reported using antibiotics at least once in the previous 12 months, 15.8% more than twice and 4.6% more than five times. Antibiotic use was reported more among 1) those with a household income below $60,000, 2) those with a medical condition, 3) those without a university education and 4) among the youngest adults (18-24 years of age) and (25-34 years of age). Misinformation about antibiotics was common: 32.5% said antibiotics "can kill viruses"; 27.9% said they are "effective against colds and flu"; and 45.8% said they are "effective in treating fungal infections". Inaccurate information was reported more often by those 1) aged 18-24 years, 2) with a high school degree or less and 3) with a household income below $60,000. In focus groups, the time/money trade-offs involved in accessing medical care were reported to contribute to pushing for a prescription or using unprescribed antibiotics, particularly in more remote contexts, while the cost of a prescription contributed to sharing and using old antibiotics. A large majority, across all demographic groups, followed the advice of medical professionals in making health decisions. Conclusion: High trust in medical professionals presents an important opportunity for knowledge mobilization. Delayed prescriptions may alleviate concerns about the time/money constraints of accessing future care. Consideration should be given to prioritizing access to appropriate diagnostic and other technology for northern and/or remote communities and/or medical settings serving many young children to alleviate concerns of needing a prescription or of needing to return later.

Prevalence of antimicrobial-resistant organisms in smaller Canadian hospitals: Community, Rural, and Northern Acute Care Point Prevalence (CNAPP-19) Survey, 2019.

Background: The availability of national data on the prevalence of antimicrobial resistant infections in smaller, community, northern and rural acute care hospitals is limited. The objective of this article is to determine the prevalence of infections caused by selected antimicrobial-resistant organisms (AROs) in these smaller hospitals. Methods: A point prevalence survey was conducted by 55 hospitals between February and May 2019 and included representation from all 10 Canadian provinces. Eligible hospitals were those with 350 or fewer beds. Data were collected on hospital characteristics. De-identified patient data were collected on selected infections (pneumonia, urinary tract infections, bloodstream infections, skin/soft tissue infections, surgical site infections, and Clostridioides difficile infections) for selected AROs (methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, extended-spectrum ß-lactamase-producing organisms and carbapenemase-producing organisms). Data on antimicrobial prescribing and infection prevention and control precautions were also collected. Results: A total of 3,640 patients were included in the survey. Median patient age was 73 years, and 52.8% (n=1,925) were female. Selected infections were reported in 14.4% (n=524) of patients, of which 6.9% (n=36) were associated with an ARO infection. Infection prevention and control additional precautions were in place for 13.7% (n=500) of patients, of which half (51.0%, n=255) were due to an ARO. Approximately one third (35.2%, n=1,281) of patients had at least one antimicrobial prescribed. Conclusion: Antimicrobial-resistant organisms remain a serious threat to public health in Canada. The results of this survey warrant further investigation into AROs in smaller Canadian hospitals as a potential reservoir of antimicrobial resistance.

Prevalence of Positive Mental Health and Associated Factors Among Postpartum Women in Canada: Findings from a National Cross-Sectional Survey.

OBJECTIVES: The objectives of this study were to compare the prevalence of three positive mental health (PMH) outcomes (self-rated mental health, life satisfaction, sense of community belonging) in postpartum women to the general population, and to examine the relationship between protective factors and the three PMH outcomes among postpartum women. METHODS: The national cross-sectional Survey on Maternal Health (n = 6558) was analyzed. Analyses were weighted and 95% confidence intervals were calculated. Three adjusted logistic regression models were generated. To compare this sample to the general population of women, estimates from the Canadian Community Health Survey-Annual Component (2018) were used. RESULTS: Compared to the general population of women, a larger proportion of postpartum women reported a strong sense of community belonging. The odds of postpartum women with high self-rated physical health having high self-rated mental health were approximately seven times greater (aOR 6.9, 95% confidence interval [CI] 5.9, 8.1) than postpartum women with lower self-rated physical health. The absence of symptoms of postpartum depression (PPD) or generalized anxiety disorder (GAD) and high self-rated physical health were significantly associated with all three PMH outcomes. Frequent availability of maternal support was associated with greater odds of high life satisfaction (aOR 1.6, 95% CI 1.4, 1.9) and sense of community belonging (aOR 1.4, 95% CI 1.2, 1.6). CONCLUSIONS: Our study demonstrated that availability of maternal support, self-rated physical health and absence of symptoms of PPD or GAD were associated with PMH among postpartum women. As physical health had the strongest association with mental health, we encourage further examination of this relationship.

Thoughts of self-harm and associated risk factors among postpartum women in Canada.

BACKGROUND: The prevalence of thoughts of self-harm during the postpartum period is not well documented in Canada. To estimate the prevalence of thoughts of self-harm among postpartum women in Canada, this study explored prevalence by socio-demographic characteristics and examined the associations between thoughts of self-harm and aspects of maternal mental health. METHODS: This study used data from the 2018/2019 Survey on Maternal Health which surveyed women living in the 10 provinces anywhere between 6-13 months postpartum. Participants were asked to report experiencing thoughts of self-harm, rate their mental health, and participate in the abbreviated Edinburgh Postpartum Depression Scale and Generalized Anxiety Disorder (GAD) scale. Adjusted logistic regression analyses were performed to examine associations. RESULTS: Of the 6,558 respondents who agreed to share their data, 10.4% reported thoughts of self-harm since the birth of their child. Of these women, 37.0% reported low mental health, 54.2% had moderate levels of symptoms of postpartum depression (PPD) and 37.1% had symptoms of GAD. Women who experienced low mental health, moderate levels of symptoms of PPD and/or GAD were more likely to report thoughts of self-harm. LIMITATIONS: As thoughts of self-harm and aspects of mental health are self-reported, there is the potential for social desirability bias and underreporting. The cross-sectional survey design did not allow the reporting of thoughts of self-harm at different time points. DISCUSSION: The high proportion of postpartum women in Canada reporting thoughts of self-harm and strong associations with aspects of maternal mental health highlight the need for effective supports during postpartum.

An update on positive mental health among youth in Canada. / Mise à jour sur la santé mentale positive chez les jeunes au Canada.

The Positive Mental Health Surveillance Indicator Framework (PMHSIF) provides estimates of positive mental health outcomes and associated risk and protective factors for youth aged 12 to 17 years in Canada. This study explored the relationship between sociodemographic factors and psychological and social well-being among youth in Canada using data from the Canadian Student Tobacco, Alcohol and Drugs Survey 2016-2017. Grade and province were significantly associated with psychological and social well-being.

The Quick Stats table presents recent estimates of positive mental health outcomes and determinants among youth in Canada. Over three-quarters of youth have high relatedness (81.8%), a high level of happiness (79.3%), high competence (78.4%) and high self-rated mental health (75.9%). The majority of youth reported high autonomy (73.0%) and life satisfaction (61.0%). Students in middle school (Grades 7­8) were more likely to have higher psychological and social well-being compared to students in high school (Grades 9­12).

Le tableau Statistiques rapides pré- sente des estimations récentes des résultats et des déterminants de la santé mentale positive chez les jeunes au Canada. Plus des trois quarts des jeunes indiquent avoir un niveau élevé d'appartenance (81,8 %), de bonheur (79,3 %), de compétence (78,4 %) et de santé mentale auto- évaluée (75,9 %). La majorité des jeunes ont déclaré jouir d'une grande autonomie (73,0 %) et d'une grande satisfaction à l'égard de leur vie (61,0 %). Les élèves du niveau intermédiaire (de 7e et 8e années) étaient davantage susceptibles de ressentir un bien-être psychologique et social plus élevé que les élèves du secondaire (de la 9e à la 12e année).

An update on positive mental health among adults in Canada. / Mise à jour sur la santé mentale positive chez les adultes au Canada.

This At-a-glance presents updated estimates for the Positive Mental Health Surveillance Indicator Framework for adults aged 18 years and older. Using data from the 2015 and 2017 Canadian Community Health Survey, we calculated the prevalence of positive mental health and associated determinants. Estimates for positive mental health outcomes for adults ranged from 68.1% to 87.1%. We also explored the associations between sociodemographic factors and positive mental health among adults in Canada. Our findings suggest sociodemographic differences in odds of self-rated mental health, happiness, life satisfaction, and psychological and social well-being.

The Quick Stats table presents recent estimates of positive mental health outcomes and associated risk and protective factors among adults in Canada. The majority of adults in Canada have high positive mental health. Out of the five positive mental health outcomes, life satisfaction had the highest prevalence (87.1%) and social well-being the lowest (68.1%). Sociodemographic factors including sex, age group, income quintile, education level, province, urban/rural status and immigration status were significantly associated with positive mental health outcomes.

Le tableau Statistiques rapides présente les estimations les plus récentes en matière de santé mentale positive et de facteurs de risque et de protection connexes chez les adultes au Canada. La majorité des adultes au Canada ont une santé mentale positive élevée. Parmi les cinq résultats en matière de santé mentale positive, la satisfaction à l'égard de la vie a la prévalence la plus élevée (87,1 %), et le sentiment de bien-être social la prévalence la plus faible (68,1 %). Plusieurs facteurs sociodémographiques, à savoir le sexe, le groupe d'âge, le quintile de revenu, le niveau de scolarité, la province, le milieu de résidence (urbain/rural) et le statut vis-à-vis de l'immigration sont associés de manière statistiquement significative aux résultats en matière de santé mentale positive.

At-a-glance - The Child Maltreatment Surveillance Indicator Framework. / Aperçu - Cadre des indicateurs de surveillance de la maltraitance envers les enfants.

The federal health portfolio has conducted surveillance on child maltreatment as a public health issue since the 1990s. The Public Health Agency of Canada (PHAC) is now releasing the Child Maltreatment Indicator Framework, to take its place alongside other PHAC frameworks, such as the Suicide Surveillance Indicator Framework. Based on a scoping review of existing reviews and meta-analyses, this Framework, along with the online interactive data tool, presents child maltreatment outcome indicators and risk and protective factors at the individual, family, community and societal levels, disaggregated by sex, age and other sociodemographic variables. This Framework will function as a valuable resource pertaining to an issue that affects at least one in three Canadian adults.

The Child Maltreatment Surveillance Indicator Framework complements other indicator frameworks released by the Public Health Agency of Canada and presents available data on child maltreatment outcomes and risk and protective factors at the individual, family, community and societal level. One-third (34.1%) of the Canadian population aged 15 years and older have experienced at least one type of childhood maltreatment. Physical abuse was experienced most often (27.4%), followed by exposure to intimate partner violence (10.6%) and sexual abuse (8.1%). Factors such as parental mental illness, substance use and past experience of family violence can put children at higher risk of child maltreatment.

Le Cadre d'indicateurs de la maltraitance envers les enfants vient compléter d'autres cadres d'indicateurs publiés par l'Agence de la santé publique du Canada et présente des données sur les résultats et les facteurs de risque et de protection de la violence envers les enfants, aux échelles individuelle, familiale, communautaire et sociétale. Le tiers (34,1 %) de la population canadienne âgée de 15 ans et plus a été victime d'au moins un type de maltraitance durant l'enfance. La violence physique est le type de maltraitance le plus répandu (27,4 %), suivie de l'exposition à la violence entre partenaires intimes (10,6 %) et de l'abus sexuel (8,1 %). Des facteurs présents chez les parents tels que la maladie mentale, la consommation de substances et le fait d'avoir été victime de violence familiale peut exposer les enfants à un risque plus élevé de maltraitance.

Canadian Chronic Disease Indicators, 2019 - Updating the data and taking into account mental health. / Indicateurs des maladies chroniques au Canada, 2019 ­ Mise à jour des données et prise en compte de la santé mentale.

The 2019 edition of the Canadian Chronic Disease Indicators (CCDI) provides recent estimates of the burden of chronic conditions and measures of general health and associated determinants in Canada. Using data from the CCDI and 2017 Canadian Community Health Survey, we explored the relationship between sociodemographic factors and selfreported mental health. Our findings suggest that sex (males vs females: adjusted odds ratio [aOR] = 1.22); age (65-79 vs 35-49 year age group: aOR = 1.48); education (postsecondary graduate vs less than high school: aOR = 1.68); household income adequacy (highest quintile [Q5] vs lowest [Q1]: aOR = 2.25); and immigrant status (recent immigrants vs nonimmigrants: aOR= 2.29) were significantly associated with higher self-reported mental health.

The Canadian Chronic Disease Indicators Quick Statistics table shows estimates of the burden of chronic conditions, measures of general health and associated determinants of health. In 2017, more than two-thirds (70.3%) of the population in Canada reported having "excellent" or "very good" mental health. Age, sex, province of residence, income quintile, education level and immigration status were sociodemographic factors significantly associated with self-reported mental health.

Le tableau Statistiques rapides sur les Indicateurs des maladies chroniques au Canada présente les estimations du fardeau des maladies chroniques ainsi que les mesures de la santé générale et des déterminants connexes de la santé. En 2017, plus des deux tiers (70,3 %) de la population du Canada ont déclaré avoir une « excellente ¼ ou une « très bonne ¼ santé mentale. L'âge, le sexe, la province de résidence, le quintile de revenu, le niveau d'études et le statut vis-à-vis de l'immigration étaient des facteurs sociodémographiques corrélés de façon significative à la santé mentale auto-déclarée.