Cervical spine injuries occurring at the beach: epidemiology, mechanism of injury and risk factors.

OBJECTIVE: Surf zone injuries include cervical spine injuries (CSI). Risk factors for CSI have not been extensively investigated. The objective was to examine risk factors associated with diagnosed CSI that occurred in a beach setting. METHODS: This retrospective case series used manually linked data from Sunshine Coast Hospital and Health Service Emergency Departments, Queensland Ambulance Service, Surf Life Saving Queensland (SLSQ), and Bureau of Meteorology data from 01/01/2015-21/04/2021. Variables included victim demographics, mechanism of injury, scene information, and patient course. RESULTS: Seventy-nine of the 574 (13.8%) confirmed CSI occurred at the beach. Local residents and visitors were injured equally. Females represented a minority (12.7%) of those diagnosed with CSI but were a higher proportion of suspected spinal incidents reported to SLSQ (45%). Surfers were more likely to be injured through shallow water diving than swimmers (27.6% vs 2.2%). Females were more likely to be injured by shallow water diving than males (30.0% vs 8.7%). Visitors were more likely to be injured swimming and local residents surfing (68.2% vs 77.8% respectively). CSI occurred most commonly (40.0%) with a below average ocean wave height (0.75-1.25 m) and were most likely (45.3%) to occur in the second half of the outgoing tide. One beach had a statistically significant greater incidence of spinal incidents (OR 3.9, 95% CI: 2.1-7.2) and of CSI (OR 10.7, 95% CI: 1.5-79.5). CONCLUSIONS: Risk factors for CSI at the beach include male sex, smaller wave height and an outgoing tide. Shallow water diving among surfers and females should be addressed urgently.

Challenges in the delivery of sex education for people with intellectual disabilities: A Chinese cultural-contextual analysis.

BACKGROUND: Staff members' views can have a significant impact on sexuality issues of people with intellectual disabilities. Research on the impact of sociocultural factors in this area in the Chinese context is sparse. METHODS: Semi-structured interviews were conducted with seven professionals (social worker, nurse, life skills trainer and manager) to explore their experiences of and attitudes towards the sexual needs of people with intellectual disabilities by applying interpretative phenomenological analysis. RESULTS: The study identified two major themes, each with two sub-themes: 1. Professional handling of the sexual needs of people with intellectual disabilities (sex education and intervention); 2. Barriers (incompatible approaches and parental resistance). Participants also experienced feelings of resignation facing the barriers they encountered. Collectivism and cultural view about sex are potentially the influencing factors. CONCLUSION: This study highlights the need to adopt an evidence-based sex education programme whose content and delivery should take account of cultural factors.

Road traffic fatalities in rural and remote Australia from 2006 to 2017: The need for targeted action.

OBJECTIVE: To explore rural motor vehicle collision (MVC) fatalities by trends over time, mode of transport, age, state, sex, and Aboriginal and Torres Strait Islander status. DESIGN: A retrospective total population-based time series was conducted using the Australian Bureau of Statistics (ABS) death registration data. SETTING: All statistical local area (SLA) within Australia from 2006 to 2017. PARTICIPANTS: Australian residents whose deaths were registered with the ABS between 01 January 2006 and 31 December 2017 where the underlying cause of death was related to unintentional transport accidents. MAIN OUTCOME MEASURES: Fatality rates were determined using population data collected from the 2006, 2011 and 2016 census. Trends over time by rurality were analysed by financial year. Rates of transport deaths by vehicle type were determined by rurality. Risk ratios were calculated to compare demographic groups based on sex, Aboriginal and Torres Strait Islander status and age. A 3-year scorecard was organised by state and rurality using 99.7% confidence intervals. RESULTS: Motor vehicle collision fatalities increase with increasing remoteness. Females, children from 0 to 14 years, pedestrians, and Aboriginal and Torres Strait Islander peoples are at a significantly higher risk of fatal MVCs than their respective metropolitan counterparts. The 3-year scorecard indicates that road fatality rates in the NT, WA, and all rural and remote areas required immediate attention and targeted action. CONCLUSIONS: There is a need for investment in MVC fatality prevention in rural Australia from inner regional to remote areas in order to meet the road safety targets established by the National Road Safety Strategy.

Cardiac rehabilitation in rural and remote areas of North Queensland: How well are we doing?

OBJECTIVE: To address access to cardiac rehabilitation (CR) for people in R&R areas, this research aimed to investigate: (1) post discharge systems and support for people returning home from hospital following treatment for heart disease (HD). (2) propose changes to improve access to CR in R&R areas of NQ. SETTING: Four focus communities in R&R areas of NQ. PARTICIPANTS: Focus communities' health staff (resident/visiting) (57), community leaders (10) and community residents (44), discharged from hospital in past 5 years following treatment for heart disease (purposeful sampling). DESIGN: A qualitative descriptive case study, with data collection via semi-structured interviews. Inductive/deductive thematic analysis was used to identify primary and secondary themes. Health service audit of selected communities. RESULTS: Health services in the focus communities included multipurpose health services, and primary health care centres staffed by resident and visiting staff that included nurses, Aboriginal and Torres Strait Islander Health Workers, medical officers, and allied health professionals. Post-discharge health care for people with HD was predominantly clinical. Barriers to CR included low referrals to community-based health professions by discharging hospitals; poorly defined referral pathways; lack of guidelines; inadequate understanding of holistic, multidisciplinary CR by health staff, community participants and leaders; limited centre-based CR services; lack of awareness, or acceptance of telephone support services. CONCLUSION: To address barriers identified for CR in R&R areas, health care systems' revision, including development of referral pathways to local health professionals, CR guidelines and in-service education, is required to developing a model of care that focuses on self-management and education: Heart: Road to Health.

Comparing rural traffic safety in Canada and Australia: a scoping review of the literature.

INTRODUCTION: The reduction of road fatalities is a priority established by the WHO and ratified by the UN. Rates of road fatalities are disproportionately high in rural areas in both Australia and Canada, two Commonwealth countries with comparable healthcare systems and rural health challenges. The purpose of this review was to compare and contrast the epidemiology, risk factors and prevention strategies of rural road fatalities in both countries to inform the next steps for prevention. METHODS: A scoping literature review was undertaken systematically to search for peer-reviewed literature published from January 2000 to June 2021. Articles were reviewed from five databases (EMCARE, Medline, CINAHL, Scopus and Informit). Search terms were adapted to suit each database and included combinations of keywords such as 'traffic accident', 'fatality', 'rural/remote', 'Australia' and 'Canada'. Themes and data associated with the research outcomes were extracted and tabulated. RESULTS: Forty-three papers were identified as relevant: 14 exploring epidemiology, 25 investigating risk factors and 37 proposing prevention strategies. People living in rural locations were 3.2 (95% confidence interval: 3.0-3.5) times more likely than urban dwellers to die in road-related incidents, with rates of motor vehicle fatalities universally higher. Common risk factors included drugs and alcohol, speed, driver error and biological sex. Key prevention strategies included improved infrastructure, vehicle design, impaired driving prevention and education. CONCLUSION: Further research regarding preventative measures and significant investment in rural road safety in both Australia and Canada are needed to prevent future incidents.

Treatment of the lung injury of drowning: a systematic review.

BACKGROUND: Drowning is a cause of significant global mortality. The mechanism of injury involves inhalation of water, lung injury and hypoxia. This systematic review addressed the following question: In drowning patients with lung injury, what is the evidence from primary studies regarding treatment strategies and subsequent patient outcomes? METHODS: The search strategy utilised PRISMA guidelines. Databases searched were MEDLINE, EMBASE, CINAHL, Web of Science and SCOPUS. There were no restrictions on publication date or age of participants. Quality of evidence was evaluated using GRADE methodology. RESULTS: Forty-one papers were included. The quality of evidence was very low. Seventeen papers addressed the lung injury of drowning in their research question and 24 had less specific research questions, however included relevant outcome data. There were 21 studies regarding extra-corporeal life support, 14 papers covering the theme of ventilation strategies, 14 addressed antibiotic use, seven papers addressed steroid use and five studies investigating diuretic use. There were no clinical trials. One retrospective comparison of therapeutic strategies was found. There was insufficient evidence to make recommendations as to best practice when supplemental oxygen alone is insufficient. Mechanical ventilation is associated with barotrauma in drowning patients, but the evidence predates the practice of lung protective ventilation. There was insufficient evidence to make recommendations regarding adjuvant therapies. CONCLUSIONS: Treating the lung injury of drowning has a limited evidentiary basis. There is an urgent need for comparative studies of therapeutic strategies in drowning.

A scoping review of female drowning: an underexplored issue in five high-income countries.

BACKGROUND: Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. METHODS: A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. RESULTS: The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). CONCLUSION: Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

Reducing inequities among adult female migrants at higher risk for drowning in Australia: The value of swimming and water safety programs.

ISSUE ADDRESSED: Drowning is a global public health challenge with a need to ensure equity to drowning prevention information and interventions. In Australia, people born overseas are identified as being at greater risk of drowning. This paper presents findings from a community-based qualitative evaluation of swimming and water safety (SWS) programs delivered to adults from migrant backgrounds in Sydney, Australia. METHODS: A qualitative study was conducted in November-December 2019 among 35 female participants of SWS programs targeted to adult migrants. While offered to all SWS program participants, no males took part in the study. Focus groups and interviews were recorded, transcribed and thematically analysed using a deductive approach. The domains of enquiry were guided by the health belief model and the theory of planned behaviour. RESULTS: Study participants were ≥25 years, first generation and most had lived in Australia for ≥10 years. Most were nonswimmers and were fearful of water prior to the program. Key themes were: direct SWS program outcomes, health and well-being; enablers and barriers to participation including: motivation, a program coordinator, fear and settlement priorities. CONCLUSION: Findings suggest that in order to increase SWS participation among migrant communities, the broader determinants of health need to be considered. Culturally appropriate strategies are required to enable both men and women equal opportunities to access SWS programs. SO WHAT: SWS programs provide multiple benefits for adult migrants; however, the impact on reducing inequities is limited, with broader multi-strategic health promotion approaches and policies required for inclusion and sustainability.

Identifying a gap in drowning prevention: high-risk populations.

INTRODUCTION: Some populations have been less susceptible to reductions in drowning than others. It has been hypothesised that this is due to prevention strategies failing to account for the influence of social determinants (such as ethnicity, socioeconomic status). Populations such as ethnic minorities have been over-represented in injury statistics, however this is not well explored in drowning. This study aims to identify high-risk populations for drowning, risk factors and prevention strategies. METHODS: A literature review undertaken systematically using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was conducted of peer-reviewed literature in English, published between 1990 and 2018 from high-income countries. Search terms included drowning, water safety, ethnic minority, migrant, and culturally diverse. RESULTS: In total, 35 articles were included. High-risk populations identified were: ethnic minorities, First Nations/Aboriginal people, migrants and rural residents. Over half (51%) focused on children (0-18 years). Risk factors included social determinants, swimming ability and knowledge, attitudes and behaviour. Four intervention studies were found; two focused on upskilling adults from high-risk populations to increase employment opportunities within the aquatic industry; an evaluation of a 10-year rock fishing safety education project and a learn-to-swim programme for minority children. Proposed prevention strategies included education, practical skills, research, policy and engagement. DISCUSSION: Limited literature exists pertaining to drowning among adults from high-risk populations. There is a need to increase the sophistication of drowning prevention strategies addressing the disparities in drowning from a culturally appropriate perspective. Acknowledging the role of the social determinants of health in drowning prevention is essential in order to improve drowning outcomes for high-risk populations globally.

Developing drowning prevention strategies for rivers through the use of a modified Delphi process.

INTRODUCTION: Internationally, rivers are a leading drowning location, yet little evidence exists evaluating river drowning prevention strategies. This study aims to use expert opinion to identify strategies more likely to be effective. METHODS: Using a modified Delphi process, a virtual panel of 30 experts from 12 countries considered, grouped and prioritised strategies for river drowning prevention. Proposed strategies were assessed against known evidence and suitability in high-income countries (HICs) as well as low-income and middle-income countries (LMICs) using expert opinion. The final phase consolidated a list of strategies whose effectiveness was assessed against 10 evidence-based river drowning scenarios. RESULTS: An initial list of 424 prevention strategies was refined to 22. After being assessed against the 10 scenarios, a final list of 13 strategies was derived. Strategies addressed alcohol consumption around rivers, flood mitigation, improving child supervision, learning to swim, increased lifejacket wear and achieving community-wide resuscitation skills. DISCUSSION: While all 13 strategies were assessed as being effective in both LMICs and HICs by at least 60% of the respondents, further work is required to define river drowning at a country level and therefore allow for effective solutions to be developed, particularly in LMICs. No strategy will be effective in isolation and must be implemented alongside policy and behaviour change, public awareness and education. Evaluation should be incorporated as part of any future implementation of strategies. CONCLUSION: This Delphi process identified 13 drowning prevention strategies for rivers. Further research is required to validate the efficacy of these findings through implementation and evaluation.

Exploring Australian residents cycling engagement - Differences in self-reported cycling behaviour between urban and rural dwelling Queenslanders.

ISSUE ADDRESSED: Cycling participation rates in Australia and Queensland remain low. Rural residents typically do not have distinct cycling infrastructure available for use. Investigating current cycling participation and barriers to cycling engagement will inform future work to promote cycling engagement. METHODS: Data were collected through the inclusion of cycling-related questions in the 2012 Queensland Social Survey. RESULTS: The majority of the sample had not cycled in the previous 12 months (66%; n = 831). Significantly more rural residents reported not cycling due to environmental concerns (P < 0.05) and preferring other modes of transport or exercise (P < 0.01). Rural cyclists (31.4%; n = 113) had higher levels of cycling engagement in the previous week (41.6% to 32.6% urban; χ2  = 7.83; n = 420; P < 0.05) but lower cycling durations than urban cyclists (41.6% rural residents cycling for 30+ minutes vs 57.4% urban residents; χ2  = 8.25; n = 418; P < 0.01). Rural cycling engagement was independently associated with being male (OR = 2.34; 95% CI = 1.40-3.91); sufficient physical activity engagement (OR = 1.86; 95% CI = 1.10-3.15); and having children at place of residence (1-2 children: OR = 3.21; 95% CI = 1.88-5.49; 3+ children: OR = 3.01; 95% CI = 1.17-7.75). CONCLUSIONS: One-third of all adults cycled in the previous 12 months irrespective of location; however reasons for not cycling varied by urban/rural location. Results indicate that environmental factors appear to be inhibiting cycling participation in rural areas. Advocating for government commitment for infrastructure development to support safe cycling across Queensland including outside of metropolitan areas is required. SO WHAT?: This research explores self-reported cycling engagement amongst a sample of urban and rural dwelling Queenslanders. Differences in cycling exposure and reasons for lack of engagement offer insights into what may encourage greater cycling participation.

Exploring visitation at rivers to understand drowning risk.

INTRODUCTION: Globally, rivers are a common drowning location. In Australia, rivers are the leading location for fatal drowning. Limited information exists on exposure and impact on river drowning risk. METHODS: Australian unintentional fatal river drowning data (sourced from coronial records) and nationally representative survey data on river visitation were used to estimate river drowning risk based on exposure for adults (18 years and older). Differences in river drowning rates per 100 000 (population and exposed population) were examined by sex, age group, activity prior to drowning, alcohol presence and watercraft usage. RESULTS: Between 1 January 2014 and 31 December 2016, 151 people drowned in Australian rivers; 86% male and 40% aged 18-34 years. Of survey respondents, 73% had visited a river within the last 12 months. After adjusting for exposure: males were 7.6 times more likely to drown at rivers; female drowning rate increased by 50% (0.06-0.09 per 100 000); males aged 75+ years and females aged 55-74 years were at highest risk of river drowning; and swimming and recreating pose a high risk to both males and females. After adjusting for exposure, males were more likely to drown with alcohol present (RR=8.5; 95% CI 2.6 to 27.4) and in a watercraft-related incident (RR=25.5; 95% CI 3.5 to 186.9). CONCLUSIONS: Calculating exposure for river drowning is challenging due to diverse usage, time spent and number of visits. While males were more likely to drown, the differences between males and females narrow after adjusting for exposure. This is an important factor to consider when designing and implementing drowning prevention strategies to effectively target those at risk.

Cardiopulmonary resuscitation and first-aid training of river users in Australia: A strategy for reducing drowning.

ISSUE ADDRESSED: Rivers are a leading location for fatal drowning worldwide, often geographically isolated from timely medical assistance. Cardiopulmonary resuscitation (CPR) benefits drowning victims and those who suffer cardiac arrests. This study explored CPR and first-aid training of river users in Australia. METHODS: Adult river users (18+ years) were surveyed at four high-risk river drowning sites. Respondents were asked the last time they undertook CPR (responses converted into: "CPR ever undertaken"-yes/no; and "CPR training current"-yes/no (training undertaken ≤12 months ago). Responses were explored by demographics and social determinants of health. RESULTS: Of those surveyed (N = 688), 98.4% responded regarding CPR. Seventy-five percent (74.9%) had undertaken CPR training previously. Females and 35- to 44-year-olds were more likely to have undertaken training (P < 0.05). Males and older people (65+ years) were less likely to hold a current qualification (P < 0.05). Major city residents reported a longer mean time (5.4 years) since last trained than remote and very remote locations (2.0 years). People in low socio-economic areas had a shorter time since qualification current (5.8 years) than those in areas deemed high (7.2 years). CONCLUSION: Current CPR qualifications are important, particularly among those visiting high-risk river drowning locations. System-level, upstream strategies that should be explored include compulsory CPR training in secondary schools and linking CPR updates to motor vehicle licence renewals. SO WHAT?: Cardiopulmonary resuscitation is a vital component of multifaceted river drowning prevention. Social determinants of health, such as socio-economic disadvantage and geographical isolation, were not barriers to participation or currency of qualification.

Breathalysing and surveying river users in Australia to understand alcohol consumption and attitudes toward drowning risk.

BACKGROUND: Little is known about people's river usage, a leading drowning location. This study examines alcohol consumption patterns of river users and their attitudes to drowning risk. METHODS: A convenience sample of adult (18+ years) river users were surveyed at four river locations. The survey covered eight domains: demographics; river attendance frequency; frequency of engaging in water activities; drinking patterns; alcohol and water safety knowledge; alcohol and water safety attitudes; alcohol consumption; and Blood Alcohol Concentration (BAC). For BAC, participants were asked to record time since their last alcoholic drink and were then breathalysed to record an estimate of their BAC. BAC was examined by BAC reading (negative, positive, ≥0.050%). Hazardous lifetime drinking levels were calculated and their impact on drowning risk evaluated. Univariate and chi square analysis (95% confidence interval) was conducted. RESULTS: Six hundred eighty four people participated (51.6% female; 49.0% aged 18-34 years). Sixteen percent (15.9%) had a positive BAC (Mean + BAC = 0.068%; SD ± 0.08; Range = 0.001-0.334%), with 7.2% ≥0.050% (Mean BAC ≥0.050% =0.132%; SD ± 0.06). Those significantly more likely to record a BAC ≥0.050% at the river were: aged 18-34 years, resided in inner regional and low socio-economic areas, visited the river in the afternoon, with friends, on days with higher maximum air temperatures, frequent river users (11+ times in the last 30 days) and those who spend longer in the water (301+ minutes). River users who recorded a BAC ≥0.050% were more likely to self-report engaging in risky activities (i.e. diving into water of unknown depth and jumping into the river from height). River users on Australia day (a national public holiday) were significantly more likely to drink heavily (Mean BAC ≥0.05% = 0.175%; SD ± 0.09). CONCLUSIONS: Despite males accounting for 85% of alcohol-related river drowning deaths, similar numbers of males and females were consuming alcohol at the river. This study has addressed a gap in knowledge by identifying river usage and alcohol consumption patterns among those at increased drowning risk. Implications for prevention include delivering alcohol-related river drowning prevention strategies to both males and females; at peak times including during hot weather, afternoons, public holidays and to river users who swim.

Cardiac rehabilitation services for people in rural and remote areas: an integrative literature review.

INTRODUCTION: Morbidity and mortality from heart disease continues to be high in Australia with cardiac rehabilitation (CR) recognised as best practice for people with heart disease. CR is known to reduce mortality, reoccurrence of heart disease, hospital readmissions and costs, and to improve quality of life. Australian Aboriginal and Torres Strait Islanders (Australian First Peoples or Indigenous peoples) have a greater need for CR due to their higher burden of disease. However, CR referral, access and attendance remain low for all people who live in rural and remote areas. The aim of this integrative review was to identify barriers, enablers and pathways to CR for adults living independently in rural and remote areas of high-income countries, including Australia. METHODS: Studies were identified through five online data bases, plus reference lists of the selected studies. The studies focused on barriers and enablers of CR for adults in rural and remote areas of Australia and other high-income countries, in English peer-reviewed journals (2007-2016). A mix of qualitative, quantitative and mixed method studies were reviewed through a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), followed by a critical review and thematic analysis. RESULTS: Sixteen studies were selected: seven qualitative, four quantitative and five mixed method. Five themes that influence CR attendance were identified: referral, health services pathways and planning; cultural and geographic factors necessitating alternative and flexible programs; professional roles and influence; knowing, valuing, and psychosocial factors; and financial costs - personal and health services. Factors identified that impact on referral and access to CR were hospital inpatient education programs on heart disease and risk factors; discharge processes including CR eligibility criteria and referral to ensure continuum and transition of care; need for improved accessibility of services, both geographically and through alternative programs, including home based with IT and/or telephone support. Also, the need to ensure that health professionals understand, value and support CR; the impact of mental health, coping with change and competing priorities; costs including travel, medications and health professional consultations; as well as low levels of involvement of Australian First Peoples in their own care and poor cultural understanding by non-Australian First Peoples staff all negatively impact on CR access and attendance. CONCLUSION: This study found weak systems with low referral rates and poor access to CR in rural and remote areas. Underlying factors include lack of health professional and public support, often based on poor perception of benefits of CR, compounded by scarce and inflexible services. Low levels of involvement of Australian First Peoples, as well as a lack of cultural understanding by non-Australian First Peoples staff, is evident. Overall, the findings demonstrate the need for improved models of referral and access, greater flexibility of programs and professional roles, with management support. Further, increased education and involvement of Australian First Peoples, including Indigenous health workers taking a lead in their own people's care, supported by improved education and greater cultural awareness of non-Australian First Peoples staff, is required.

Fatal river drowning: the identification of research gaps through a systematic literature review.

INTRODUCTION: Drowning is a leading cause of unintentional death. Rivers are a common location for drowning. Unlike other location-specific prevention efforts (home swimming pools and beaches), little is known about prevention targeting river drowning deaths. METHODS: A systematic literature review was undertaken using English language papers published between 1980 and 2014, exploring gaps in the literature, with a focus on epidemiology, risk factors and prevention strategies for river drowning. RESULTS: Twenty-nine papers were deemed relevant to the study design including 21 (72.4%) on epidemiology, 18 (62.1%) on risk factors and 10 (34.5%) that proposed strategies for prevention. Risk factors identified included age, falls into water, swimming, using watercraft, sex and alcohol. DISCUSSION: Gaps were identified in the published literature. These included a lack of an agreed definition for rivers, rates for fatal river drowning (however, crude rates were calculated for 12 papers, ranging from 0.20 to 1.89 per 100 000 people per annum), and consensus around risk factors, especially age. There was only one paper that explored a prevention programme; the remaining nine outlined proposed prevention activities. There is a need for studies into exposure patterns for rivers and an agreed definition (with consistent coding). CONCLUSIONS: This systematic review has identified that river drowning deaths are an issue in many regions and countries around the world. Further work to address gaps in the published research to date would benefit prevention efforts.

Impact of lifeguard oxygen therapy on the resuscitation of drowning victims: Results from an Utstein Style for Drowning Study.

INTRODUCTION: No published evidence was identified regarding the use of oxygen in the treatment of drowning in two recent systematic reviews. The aim of our study was to investigate the impact of on scene, pre-Emergency Medical Services (EMS) oxygen therapy by lifeguards in the resuscitation of drowning victims. METHOD: We conducted a retrospective case match analysis of drowning patients presenting to the EDs of Sunshine Coast Hospital and Health Service. Patients were matched for age, sex and severity of drowning injury. The primary outcome was in-hospital mortality. Secondary outcomes included positive pressure ventilation (PPV) by EMS and the ED, as well as admission to the Intensive Care Unit. RESULTS: There were 108 patients in each group. Median (IQR) age was 22 (15-43) in the oxygen group and 23 (15-44) years in the non-oxygen group. There were 45 females in the oxygen group and 41 females in the non-oxygen group. Sixteen patients had suffered cardiac arrest and three patients respiratory arrest in each group. There were five deaths in each group. Initial oxygen saturation on arrival of EMS was identical in both groups 89.2% (±19.9) in the oxygen group versus 89.3% (±21.1) (P = 0.294) in the non-oxygen group. The oxygen group required PPV more frequently with EMS (19 vs 11, P < 0.01) and in the ED (19 vs 15, P < 0.01). CONCLUSION: On scene treatment with oxygen by lifeguards did not improve oxygenation or outcomes in drowning patients.

COVID-19: Current Status and Future Prospects.

This second Special Issue in a series of Special Issues in Tropical Medicine and Infectious Disease looks at recent global research on the current Coronavirus (COVID-19) Pandemic [...].

Travel vaccines-priorities determined by incidence and impact.

BACKGROUND: Infectious disease epidemiology is continuously shifting. While travel has been disrupted by the COVID-19 pandemic and travel-related epidemiological research experienced a pause, further shifts in vaccine-preventable diseases (VPDs) relevant for travellers have occurred. METHODS: We conducted a literature search on the epidemiology of travel-related VPD and synthesized data for each disease with a focus on symptomatic cases and on the impact of the respective infection among travellers, considering the hospitalization rate, disease sequela and case fatality rate. We present new data and revised best estimates on the burden of VPD relevant for decisions on priorities in travel vaccines. RESULTS: COVID-19 has emerged to be a top travel-related risk and influenza remains high in the ranking with an estimated incidence at 1% per month of travel. Dengue is another commonly encountered infection among international travellers with estimated monthly incidence of 0.5-0.8% among non-immune exposed travellers; the hospitalized proportion was 10 and 22%, respectively, according to two recent publications. With recent yellow fever outbreaks particularly in Brazil, its estimated monthly incidence has risen to >0.1%. Meanwhile, improvements in hygiene and sanitation have led to some decrease in foodborne illnesses; however, hepatitis A monthly incidence remains substantial in most developing regions (0.001-0.01%) and typhoid remains particularly high in South Asia (>0.01%). Mpox, a newly emerged disease that demonstrated worldwide spread through mass gathering and travel, cannot be quantified regarding its travel-related risk. CONCLUSION: The data summarized may provide a tool for travel health professionals to prioritize preventive strategies for their clients against VPD. Updated assessments on incidence and impact are ever more important since new vaccines with travel indications (e.g. dengue) have been licensed or are undergoing regulatory review.

Feasibility study of the Utstein Style For Drowning to aid data collection on the resuscitation of drowning victims.

Aim: The revised Utstein Style For Drowning (USFD) was published in 2015. Core data were considered feasible to be reported in most health systems worldwide. We aimed to determine the suitability of the USFD as a template for reporting data from drowning research. Method: Clinical records of 437 consecutive drowning presentations to the Sunshine Coast Hospital and Health Service Emergency Departments (ED) between 1/1/2015 and 31/12/2021 were examined for data availability to complete the USFD. The proportions of patients with each variable documented is reported. Time taken to record core and supplementary variables was recorded for 120 consecutive patients with severity of drowning Grade 1 or higher. Results: There were 437 patients, including 227 (51.9%) aged less than 16 years. There were 253 (57.9%) males and 184 (42.1%) females. Sixty-one patients (13.9%) received cardiopulmonary resuscitation (CPR). There were nine (2.1%) deaths after presentation to the ED. Median time for data entry was 17 minutes for core variables and 6 min for supplementary. This increased to 29 + 6 minutes for patients in cardiac arrest. Sixteen (32.7%) of 49 core variables and four (13.3%) of 30 supplementary variables were documented 100% of the time. One (2.0%) core and seven (23.3%) supplementary variables were never documented. Duration of submersion was documented in 100 (22.9%) patients. Conclusion: USFD is time consuming to complete. Data availability to enable completion of the USFD varies widely, even in a resource rich health system. These results should be considered in future revisions of the USFD.