Swimming and water safety delivery for newly arrived Australians.

In Victoria, Australia, culturally and linguistically diverse communities are more than twice as likely to drown than their Australian-born counterparts. One explanation is the lack of feasible, community-led approaches to water safety and swimming education. A community engagement framework was used to develop and implement a 5-day pool program to teach swimming and water safety to newly arrived migrant children attending an English language school in Victoria. Socio-cultural needs of the predominantly Afghan cohort were incorporated through in-language consultation with parents who requested males and females be educated separately. Participants were assessed against Victorian aquatic competency benchmark standards at pre- and post-program, however, there was no expectation to achieve these competencies within the 5 days due to a lack of prior aquatic exposure. Independent and paired samples t-tests determined changes in skills, including by sex and number of lessons attended. Forty-one participants completed all assessments. Excluding lifesaving skills, there was a significant increase in total competency attainment overall from pre- to post-program (p < 0.001), and for each competency (p's ≤ 0.002)-predominantly knowledge and rescue skills. Improvements were mostly recorded among males, demonstrating that females may require more specialized support to achieve similar outcomes. Improvements in rescue skills and knowledge indicate the program's effectiveness in increasing newly arrived migrant children's awareness of, and exposure to, foundations of safe aquatic behaviours. Future programs tailored to newly arrived migrant communities should consider implementing water familiarization activities as a stepping stone to engagement with structured swimming and water safety education.

Hospital-admitted drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic.

OBJECTIVES: To examine trends in hospitalisation following drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic. DESIGN: Retrospective analysis of administrative hospital admission records. SETTING: Hospital admissions recorded in the Victorian Admitted Episodes Dataset. PARTICIPANTS: Hospital-admitted patients with ≥1 drowning-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis code. MAIN OUTCOME MEASURES: Incidence and incidence rate ratios (IRR; 95% CIs) of hospital-admitted drowning that occurred before (July 2017 to June 2019), during (July 2019 to June 2021) and after (July 2021 to June 2022) the onset of the COVID-19 pandemic. RESULTS: There were 736 hospital admissions related to drowning in the study period; the incidence was 2.6 per 100 000 population pre-COVID-19 and dropped to 2.0 per 100 000 during (2019/2020-2020/2021) and after (2021/2022) the onset of the pandemic. Among Victorian residents, drowning was positively associated with younger age, male sex and regional/remote residence. Drowning was negatively associated with the onset of COVID-19 (IRR 0.76 (0.64, 0.90)) as well as the post-COVID-19 period (0.78 (0.64, 0.97)), compared with pre-COVID-19. Natural water drowning rates were consistently higher than pool or bathtub drowning rates. Pool or bathtub drowning rates decreased with the onset of COVID-19; no significant change was observed in the natural water drowning rate. CONCLUSIONS: Pool and bathtub drowning rates declined since the onset of the COVID-19 pandemic, despite more time spent at home, while natural water drowning rates remained consistently high. Hospital admissions provide a valuable data source for monitoring of drowning, which is crucial to ensure a targeted, evidence-based approach to mitigate drowning risk.

A systematic review of demographic and background factors associated with the development of children's aquatic competence.

BACKGROUND: Globally, drowning is a leading cause of unintentional injury and death among children. Teaching aquatic competencies (swimming skills and water safety knowledge) to children has been proposed as a prevention strategy. In Australia, however, many children are not meeting standard aquatic competency benchmarks. Exploration of the connection between demographic and background factors and aquatic competencies could provide insight into why differences in acquisition of aquatic knowledge and skills occur. MAIN BODY: A systematic literature review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed to identify studies that reported on the association between demographic and background factors and aquatic competencies. Nine databases were searched for English language peer-reviewed studies published since 2000. Fourteen studies fulfilled all inclusion criteria. Studies were quasi-experimental or cross-sectional in design, which is considered quality level III-2 or IV, respectively, on the National Health and Medical Research Council Evidence Hierarchy. Study quality was moderate, and risk of bias was high. While aquatic competencies can be taught, this review found that factors including age, gender, geographic residence, medical conditions/disabilities, socioeconomic status, and swimming frequency were significantly associated with the demonstration and/or acquisition of aquatic competencies. CONCLUSION: This review provides insight into demographic and background factors that are significantly associated with the development of aquatic competence. Whilst further investigation is required to increase the evidence base, these findings may assist in tailoring swimming and water safety programs to accommodate those at-risk of not achieving age-appropriate aquatic competencies.

Awareness without learning: A preliminary study exploring the effects of beachgoer's experiences on risk taking behaviours.

Most drowning deaths on Australian beaches occur in locations not patrolled by lifeguards. At patrolled locations, where lifeguards supervise flagged areas in which beachgoers are encouraged to swim between, the incidence of drowning is reduced. To date, risk prevention practices on coasts focus on patrolled beaches, deploying warning signs at unpatrolled locations with the aim of raising public awareness of risk. What remains unexplored is the potential for learning and behaviour change that can transfer from patrolled to unpatrolled beaches through beachgoer's experiences and interactions with lifeguards. The aim of this preliminary study is to explore the risk perceptions of beachgoers at a patrolled beach to establish if and how their experiences of beach risk and interactions with lifeguards affect their behaviours. Data was collected in Gerroa, Australia by engaging 49 beachgoers using a mixed survey-interview methodology. Results show that beachgoers are aware that they should 'swim between the flags', but many did not know the basis for the positioning of safety flags. A key finding is that beachgoer's express a clear desire for a skills-based model of community engagement that enables learning with lifeguards. This demonstrates a reflective public that desires skill-development, which may transfer from patrolled to unpatrolled beaches to affect broader risk reduction on the Australian coast. Learning how to avoid site-specific rip hazards with lifeguards at the beach presents a promising, and previously unexplored model for beach drowning risk prevention that has the potential to affect behaviour at unpatrolled beaches, providing an empirically-supported alternative to prevailing deficit-based awareness raising methods.

Rock fisher behaviours and perceptions regarding drowning risk assessed by direct observation and self-report: A public awareness campaign evaluation.

ISSUE ADDRESSED: Participants engaged in rock fishing are at risk of drowning. Following coronial investigation of fatalities, a 3-year safety campaign targeting rock fishers was developed in Victoria, Australia. Key campaign messages were wearing lifejackets, not fishing alone, and checking sea and weather conditions. The reported study provides results from a campaign evaluation. METHODS: Evaluation by self-report and direct observation of safety attitudes and behaviours was undertaken pre- and during campaign. Data collections were as follows: (a) online survey of rock fishers recruited from panels, social media and rock fishing networks (n = 350) and (b) rock fisher direct observation and self-report at selected Victorian rock fishing platforms (n = 282; n = 58, respectively). RESULTS: Safety message recall was reported by 51.7% of rock fishers surveyed online though far fewer recalled campaign key messages. No effect on key safety behaviours or attitudes were detected for fishers on platforms during campaign. Never wearing a lifejacket was reported by 31.8% online, 60.3% at platforms and observed for 97.4%. From direct observation, most participants did not fish alone and checked conditions on arrival. CONCLUSION: Campaign evaluation measures showed mixed outcomes. Irrespective, most rock fishers carry high drowning risk through failure to wear lifejackets. Legal mandating of lifejackets for identified high-risk platform is being introduced for Victoria, although careful evaluation is required to detect unanticipated outcomes. Informing future campaign evaluation, complementary methods highlight likely bias in self-reporting through faulty recall or social desirability. SO WHAT?: Future campaigns require innovative or novel design, over longer duration, to capture attention and change rock fisher behaviours.

Bush Nippers: Evaluating the effectiveness of the Nipper education program in regional inland Victoria, Australia.

ISSUE ADDRESSED: Internationally, inland waterways are identified as leading locations for drowning. 'Nippers' programs provide coastal lifesaving and water safety knowledge and skills to children aged 5-14 years in Australia. However, a 49% increase in Victorian inland waterway drowning compared with the 10-year average, necessitated adapting the Nippers water safety program to inland regions: Bush Nippers. METHODS: Overall, 105 participants from two age groups (under 9 and under 12) were involved across three Bush Nippers programs delivered at river and/or pool locations in regional Victoria, Australia. Surveys and observations assessed participants' water safety knowledge and competencies, and used alongside interviews to obtain program feedback from parents, instructors and communities. Costs were compared to other aquatic programs to determine feasibility of replicating the program. RESULTS: Significant increases in knowledge from pre to immediate posttest were recorded (P < .05) and water competencies were high posttest. Communities were grateful for the regional program delivery and understood the necessity of learning lifesaving skills, particularly in open water environments. Costs were akin to other similar programs indicating program replicability and enhancing likelihood of uptake. CONCLUSIONS: Bush Nippers increased water safety knowledge in children and was well received by the community. Wider uptake of the program is encouraged to diversify aquatic education for regional Victorian children. SO WHAT?: Given the high regard and demand for the program, and importance of learning lifesaving skills, provision of a scalable lifesaving program in inland regions may address the drowning trend and improve aquatic participation.

Influence of a Survival Swimming Training Programme on Water Safety Knowledge, Attitudes and Skills: A Randomized Controlled Trial among Young Adults in Sri Lanka.

Drowning among young adults is high in Sri Lanka. Water safety education is a recommended strategy for drowning prevention but is often overlooked for young adults. This study aimed to evaluate the effectiveness of an adapted educational intervention, "Swim for Safety" on improving water safety knowledge, attitudes and survival swimming skills among undergraduates (19-28 years) in Sri Lanka. This study employed a parallel-group, two-arm randomized controlled trial design. The intervention group (n = 78) received a face-to-face, 12-lesson education programme, and the control group (n = 78) received a brochure and weekly mobile phone messages for six consecutive weeks. Baseline, post-intervention and three-month follow-up knowledge, attitudes and skills were evaluated. Knowledge and attitudes were assessed using a self-administered questionnaire and skills were evaluated following a skills assessment protocol. In total 116 participants, 60 intervention group and 56 control group, completed the study. At baseline there were no differences between groups in median scores of water safety knowledge, attitudes and survival swimming skills. The intervention group demonstrated statistically significant increases in median water safety knowledge, attitudes and survival swimming skill scores compared with the control group, following the intervention and maintained at three-month follow-up (p < 0.05). The adapted Swim for Safety programme significantly improved water safety knowledge, attitudes, and survival swimming skills among young adults in Sri Lanka. Therefore, it is recommended that the SfS programme be implemented widely to prevent drowning in young adults.

Examination of a pilot intervention program to change parent supervision behaviour at Australian public swimming pools.

ISSUE ADDRESSED: Drowning is one of the leading causes of unintentional death in children worldwide. There is limited evidence about the effectiveness of programs targeting child drowning prevention at public swimming pools. We examined the effectiveness of a public education program (Keep Watch @ Public Pools) for improving child supervision levels by parents at public swimming pools. METHODS: The program was evaluated via an observational study of parent supervision behaviour with children aged 0-14 years. Measures included domains of attention, proximity and preparedness. A rating scale from 0 = least effective to 4 = most effective was used, based upon the supervision domains. Seven public swimming pools in Melbourne, Victoria, Australia were randomised to either intervention or control pool. The intervention occurred over six weeks, and observations were taken over a one-week period both pre- and postintervention. Observations of a total of 10 186 children and 6930 parents/carers were recorded and analysed. RESULTS: A significant improvement in attention, proximity and preparedness was observed in parents of children aged 6-10 years at intervention pools. However, similar results were not observed in parents of children aged 0-5 years and 11-14 years. CONCLUSIONS: Supervision behaviour of parents can be modified, and the implications of these results for the community through to practice and policy are discussed. SO WHAT?: Targeted public education programs provide an effective way of improving parental supervision of children at public swimming pools. Such education programs should be widely implemented throughout public swimming pools, as one part of a comprehensive approach to drowning prevention.

Epidemiology of fatal and non-fatal drowning patients attended by paramedics in Victoria, Australia.

Drowning is a major cause of injury and death worldwide. This study aims to expand the evidence in fatal and non-fatal drowning. A retrospective study was conducted to investigate fatal and non-fatal drowning incidents attended by ambulance paramedics in Victoria (Australia) from 2007 to 2012. A total of 509 drowning incidents were identified, 339 (66.6%) were non-fatal, with 170 (33.4%) resulting in death. Children aged 0-4 years had the highest crude drowning rate (7.95 per 100,000 persons). Non-fatal incidents were more likely to be witnessed by a bystander when compared with fatal incidents (43.7% vs. 20.0%, p < 0.001). Spatial analysis indicated that 35 (43.8%) local government areas (LGAs) were considered at 'excess risk' of a drowning event occurring. This study is the first to apply spatial analysis to determine relative risk ratios for fatal and non-fatal drowning. These findings will enable geographically targeted and age-specific drowning prevention activities.

Drowning related out-of-hospital cardiac arrests: characteristics and outcomes.

AIM: There are few studies on drowning-related out-of-hospital cardiac arrest (OHCA) in which patients are followed from the scene through to hospital discharge. This study aims to describe this population and their outcomes in the state of Victoria (Australia). METHODS: The Victorian Ambulance Cardiac Arrest Registry was searched for all cases of OHCA with a precipitating event of drowning attended by emergency medical services (EMS) between October 1999 and December 2011. RESULTS: EMS attended 336 drowning-related OHCA during the study period. Cases frequently occurred in summer (45%) and the majority of patients were male (70%) and adult (77%). EMS resuscitation was attempted on 154 (46%) patients. Of these patients, 41 (27%) survived to hospital arrival and 12 (8%) survived to hospital discharge (5 adults [6%] and 7 [12%] children). Few patients were found in a shockable rhythm (6%), with the majority presenting in asystole (79%) or pulse-less electrical activity (13%). An initial shockable rhythm was found to positively predict survival (AOR 48.70, 95% CI: 3.80-624.86) while increased EMS response time (AOR 0.73, 95% CI: 0.54-0.98) and salt water drowning (AOR 0.69, 95% CI: 0.01-0.84) were found to negatively predict survival. CONCLUSIONS: Rates of survival in OHCA caused by drowning are comparable to other OHCA causes. Patients were more likely to survive if they did not drown in salt water, had a quick EMS response and they were found in a shockable rhythm. Prevention efforts and reducing EMS response time are likely to improve survival of drowning patients.

Effects of exercise on bone density and falls risk factors in post-menopausal women with osteopenia: a randomised controlled trial.

OBJECTIVES: This study aimed to determine the efficacy of an exercise program for post-menopausal women with osteopenia undertaken in community exercise facilities. DESIGN: Randomised, single-blind controlled trial. METHODS: Thirty-nine community volunteers with hip osteopenia and not taking bone-enhancing medication were randomly allocated to an exercise (EX) or control (CON) group. EX participants attended an exercise facility in Melbourne, Australia, three times/week for 52 weeks (with a 2 week break) for partially supervised exercises targeting hip bone strength, muscle strength and balance. They also performed daily jumping exercises at home. CON participants continued with their usual care. All participants were given calcium supplementation. Assessment at baseline and 52 weeks measured bone mineral density (BMD) at the proximal femur and lumbar spine. Health-related quality of life (QOL) and objective measures of strength and balance were also collected. RESULTS: ANCOVA adjusting for baseline values revealed a small benefit of exercise in mean total hip BMD (the primary outcome) with a significant mean difference in change between groups of -0.012 g/cm(2) (95% CI -0.022 to -0.002 g/cm(2)). EX participants improved 0.5% compared with a 0.9% loss for CON participants. The only other between-group differences were in QOL and a test of trunk and upper limb endurance, which both favoured the EX group. CONCLUSIONS: This exercise program appears to have modest benefits for post-menopausal women with osteopenia who are not taking bone-enhancing medication. This mode of exercise delivery has adherence and progression limitations but may be appropriate to recommend for some people.

Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial.

BACKGROUND: This randomised, single-blind controlled pilot trial aimed to determine the effectiveness of a physiotherapy program, including exercise and manual therapy, in reducing impairments and improving physical function and health-related quality of life in people with a history of painful osteoporotic vertebral fracture. METHODS: 20 participants were randomly allocated to an intervention (n = 11) or control (n = 9) group. The intervention group attended individual sessions with an experienced clinician once a week for 10 weeks and performed daily home exercises with adherence monitored by a self-report diary. The control group received no treatment. Blinded assessment was conducted at baseline and 11 weeks. Questionnaires assessed self-reported changes in back pain, physical function, and health-related quality of life. Objective measures of thoracic kyphosis, back and shoulder muscle endurance (Timed Loaded Standing Test), and function (Timed Up and Go test) were also taken. RESULTS: Compared with the control group, the intervention group showed significant reductions in pain during movement (mean difference (95% CI) -1.8 (-3.5 to -0.1)) and at rest (-2.0 (-3.8 to -0.2)) and significantly greater improvements in Qualeffo physical function (-4.8 (-9.2 to -0.5)) and the Timed Loaded Standing test (46.7 (16.1 to 77.3) secs). For the perceived change in back pain over the 10 weeks, 9/11 (82%) participants in the intervention group rated their pain as 'much better' compared with only 1/9 (11%) participants in the control group. CONCLUSION: Despite the modest sample size, these results support the benefits of exercise and manual therapy in the clinical management of patients with osteoporotic vertebral fractures, but need to be confirmed in a larger sample. TRIAL REGISTRATION: NCT00638768.

The influence of dance training on growth and maturation of young females: a mixed longitudinal study.

BACKGROUND: The effects of systematic sports training during childhood and adolescence on subsequent growth and sexual maturation remains in dispute. AIM: The study aimed to determine whether moderate-high volumes of dance training adversely influence linear growth and sexual maturation of young girls progressing through puberty. SUBJECTS AND METHODS: This 3-year mixed longitudinal study comprised 82 novice dancers and 61 controls, aged 8-11 years at baseline, who were assessed bi-annually for 3 consecutive years. A biological maturational age was determined by estimating attainment of age at peak height velocity (PHV). Body dimensions were measured by anthropometry, and exercise levels, nutritional intake and age at menarche by questionnaires. RESULTS: Controls had significantly greater unadjusted height velocity than dancers 1 year before PHV, however there was no difference between groups in age of attainment of PHV. When controlling for maturation, lean mass, fat mass and extracurricular sport (excluding dancing), there were no group differences in absolute growth or velocity of growth in height, sitting height or leg length. Within the dancers there were no effects of years of dancing (>6.5 years) or weekly dance hours (>7 h per week) on growth velocities. No association was found between age at menarche and years or hours of dance training. CONCLUSION: Results suggest that moderate-high levels of dance training do not affect linear growth and maturation. Thus, girls should not be discouraged from dance participation on the basis of potential growth delays.