[Epidemiological characteristics of fatal drowning and related factors in children in Zhejiang Province, 2022].

Objective: To understand the epidemiological characteristics of fatal drowning in children in Zhejiang Province in 2022, analyze factors such as the swimming ability of children, the caregiver behavior at drowning site, types of first aid personnel and methods of first aid of unintentional fatal drowning and provide evidence for targeted intervention. Methods: Using the "Survey Form of Fatal Drowning Case in Children" designed by National Center for Chronic and Non-communicable Disease Control and Prevention of the China CDC, we collected case information of children aged 0-17 years who died due to drowning in Zhejiang in 2022 from medical history/death investigation records, telephone interviews, and home visits. Results: A total of 341 fatal drowning cases in children occurred in Zhejiang in 2022 and 330 cases were investigated (96.77%). The male to female of the cases was 2.33∶1, most cases were aged 15-17 years and 0-4 years, and 54.24% of fatal drowning cases occurred in children from other provinces. In the drowning cases, 83.33% were unintentional ones, and the proportion of intentional fatal drowning cases in children increased with age. Fatal drowning cases mainly occurred in open natural water bodies and public water storage facilities. More fatal drowning cases occurred in open natural water bodies in older children, while more fatal drowning cases occurred in public water storage facilities in younger children. In 275 children who died due to unintentional drowning, 73.09% could not swim, and only 1.09% were fully supervised by adults within an arm's length. First aid personnel, mainly medical staffs, bystanders and adult caregivers, were present for 47.63% fatal drowning cases. The proportion of the cases who had cardiopulmonary resuscitation as the first aid within 5 minutes was 2.18%. Conclusions: Drowning poses a serious threat to children's lives and there are differences in reasons and locations of fatal drowning in children in different age groups in Zhejiang Province in 2022. It is necessary to conduct to interventions to improve children's swimming skills, strengthen effective adult care and conduct health education about field first aid of drowning to reduce the incidence of drowning and related deaths in children.

Knowing how to swim and drowning prevention in children aged 10 to 14 years. Systematic review.

PURPOSE: Drowning is 1 of the 10 leading causes of death due to unintentional injuries in children and adolescents worldwide. Knowing how to swim has been traditionally associated with water safety. However, its conceptualization may vary across studies, leading to different measurements and effects on the risk of drowning. This review sought to understand the current state of scientific evidence associating both issues. OBJECTIVES: To identify conceptualizations of knowing how to swim and to analyze the evidence indicating whether "knowing how to swim" may be a protective or a risk factor for unintentional drowning in children aged 10 to 14 years. METHOD: A systematic review of observational etiology studies was conducted, considering original peer-reviewed research published up to the year 2020. Databases including PubMed, Cochrane Central, Tripdatabase, Science Direct, Epistemonikos, Bvs and Bireme were searched for studies associating swimming skills as a risk or a protective factor for drowning (10-14 years). Study quality was assessed, and quantitative data were synthesized (without performing a meta-analysis). RESULTS: A total of 6,508 results were identified, with only 6 studies meeting the criteria for inclusion in the final cohort. It was evidenced that the exclusive possession of swimming skills, without a concurrent understanding of water safety, is associated with increased exposure to aquatic environments. Consequently, this may increase the risk of drowning. CONCLUSIONS: Among children aged 10 to 14 years, there is insufficient evidence regarding whether knowing how to swim serves as a protective factor against drowning compared to not knowing how to swim. PRACTICAL APPLICATIONS: The insufficiency of evidence and a lack of consensus in the conceptualization of swimming as a form of knowledge underscores the need for further research. Such research is crucial for informing investments in drowning prevention interventions, particularly during early adolescence.

Child drowning mortality in Israel: Trends and measures for prevention.

INTRODUCTION: In this study, we use the media-based database of Beterem-Safe Kids Israel, to provide a 15-year review of unintentional fatal childhood drowning in Israel, between 2008 and 2022. METHOD: It total, we identified 257 cases of child mortality due to drowning during this period. RESULTS: Our results demonstrate a gradual rise in childhood mortality due to drowning, from 72 cases in 2008-2012, to 85 cases in 2013-2017, and to 100 cases in 2018-2022. Especially worth noting is the increase in childhood drowning in domestic swimming pools. We point to a link between low socioeconomic status and cases of drowning, showing that the risk of drowning extends beyond a mere matter of caregiver inattention. We recommend a series of regulatory and legislative steps to reduce fatal childhood drowning, including fencing built around domestic swimming pools, extending lifeguard activity hours, adding declared beaches, forming programs of safe behavior in water environments for adolescents, and establishing swimming lessons during the 2nd grade, for all populations. We further recommend that a special focus will be put in municipalities situated at the bottom of the socioeconomic index.

The dynamics of drowning: Clarifying terminologies and response strategies.

ABSTRACT: Drowning is the process of respiratory impairment from immersion or submersion in a liquid. Worldwide, approximately 360,000 deaths annually can be attributed to drowning. Morbidity and mortality are a result of hypoxia, so the focus during resuscitation should be on airway management and optimizing oxygenation. This article describes several drowning scenarios and discusses appropriate response and treatment algorithms.

Trends in injury-related mortality among residents of Jiangsu Province from 2012 to 2021: an age-period-cohort analysis.

Objective: We investigated the temporal trends and examined age-, period-, and cohort-specific effects of injury-related deaths among residents in Jiangsu to provide evidence for future injury prevention. Methods: This study included 406,936 injury deaths from the Jiangsu provincial population death registration system. The average annual percent change (AAPC) in age-standardized mortality rates (ASMRs) was analyzed using joinpoint regression. Age-period-cohort models were generated to explore the effects of age, period, and birth cohort effects on mortality risk. Results: ASMRs for all injuries (AAPC = -2.3%), road traffic accidents (AAPC = -5.3%), suicide (AAPC = -3.8%), and drowning (AAPC = -3.9%) showed a downward trend during 2012-2021(all p < 0.05), while unintentional falls showed an upward trend (AAPC = 5.1%, p < 0.05). From 2012 to 2021, the age-standardized mortality rates (ASMRs) for four primary types of injuries consistently exhibited higher among males compared to females, with rural regions displaying higher ASMRs than urban areas. Trends in ASMRs for road traffic accidents, drowning, and unintentional falls by sex and urban/rural areas were consistent with overall trends. Significant age, cohort, and period effects were identified in the trends of injury-related deaths for both sexes in Jiangsu. The age effect showed that the highest age effect for injury-related deaths was for the ages of 85 years and above, except for suicide, which was for the ages 80-84 years. Between 2012 and 2021, the period effect on road traffic accidents declined, while that on accidental falls increased. Initially, the period effect on suicide decreased but then rose, peaking in 2012 with a Relative Risk (RR) of 1.11 (95% CI: 1.04-1.19). Similarly, the period effect on drowning initially declined before rising, with the highest effect observed in 2013, at an RR of 1.12 (95% CI: 1.07-1.19). The highest cohort effects for road traffic accidents were observed in the 1957-1961 group, for accidental falls in the 1952-1956 group, and for both drowning and suicide in the 1927-1931 group. Conclusion: The mortality rate of unintentional falls has been increasing. Older adults are at high risk for the four leading injuries. The improvements in mortality rates can be attributed to advancements in education, urbanization, and the promulgation and implementation of laws and policies.

Drowning.

Drowning is responsible for considerable morbidity and mortality worldwide, and it is estimated that 90% of drownings are preventable. Drowning is defined as "the process of experiencing respiratory impairment from submersion/immersion in liquid." Emergency providers should focus on airway management and rapid delivery of oxygen to interrupt the drowning process and improve patient outcomes. Patients with minimal or no symptoms do not require any specific diagnostic workup, aside from physical examination and 4 to 6 hours of observation prior to discharge. Patients with more severe symptoms may present with rales and foamy secretions, and should be managed with high-concentration oxygen and positive airway pressure.

Scuba diving-related fatalities in the Philippines from 2008 to 2022 as reported in online news media.

The present study aims to investigate the demographics and characteristics of scuba diving fatalities in the Philippines which can help in the identification of local trends and ultimately in the development of appropriate preventive measures. Data on scuba diving-related fatalities in the Philippines from 2008 to 2022 were manually retrieved from online news media sources. Information on age, sex, nationality, certification, purpose, and causative factors, whenever possible were collected and analysed. A total of 39 fatalities were identified having a median age of 43.5 (range 20-80). Majority of victims were males (n = 30), and of foreign ethnicity (n = 26). Asphyxia was identified as the possible disabling injury in almost half of the cases (n = 17). The causes of death based on autopsies were determined only for few cases which included drowning (n = 2), heart attack (n = 1), and traumatic injuries from a dynamite blast (n = 1). Potential vulnerable groups were identified to be the ageing population and foreign tourist divers. In the absence of an existing database, this preliminary report provides the best available evidence at this time concerning scuba diving fatalities in the Philippines.

Drowning prevention challenges and opportunities: An exploratory study of perspectives of delegates from ASEAN nations.

The South East Asian region has the world's second highest fatal drowning burden. This study reports analysis of survey data from representatives from nations within the Association of South East Asian Nations regarding current efforts, challenges and future opportunities for drowning prevention. Twenty-two responses were received from respondents from all ASEAN nations excepting Cambodia and Myanmar. Drowning prevention initiatives varied across ASEAN nations, with most efforts focused on public education and raising awareness, including the provision of drowning data to the media. The lack of comprehensive, national level data collection was identified as a challenge, necessitating strengthened data collection capacity. Governmental involvement spanned one to six different ministries, highlighting the multi-sectoral nature of drowning prevention. However, a lead ministry could be identified in only two countries. Despite the challenges identified, there remain many opportunities to strengthen drowning prevention across ASEAN nations, addressing a significant regional public health threat.

[Drowning mortality in Catalonia (2019-2022)]. / Mortalidad por ahogamientos en Cataluña (2019-2022).

OBJECTIVE: Data on drownings tend to underestimate mortality from this cause. The objective of this study was to describe fatal drownings recorded in Catalonia between 2019 and 2022 through forensic sources, present their characteristics, and assess the utility of this information for monitoring drowning mortality. METHODS: A retrospective observational study based on the register of judicial deaths from the Institute of Legal Medicine and Forensic Sciences of Catalonia was carried out. Data on medicolegal aetiology, aquatic environment, age, gender, date of death, and municipality of origin were analysed. Statistical analysis was based on the comparison of proportions test based on Chi-square for categorical variables and the Mann Whitney U test for the comparison of numerical variables. RESULTS: A total of 310 drownings were recorded, with a mean age of 57.2 years and a male predominance (77.1%). The majority of drownings were unintentional (71.3%), followed by suicides (15.5%), and cases of undetermined intent (12.6%). Compared to intentional drownings, unintentional and undetermined intent drownings had a higher percentage of males than females (81.2% vs. 56%, p<0.001), and fewer cases with Spanish nationality than foreign or undetermined nationality (60% vs. 92%, p<0.001). Middle-aged and older individuals accounted for the majority of deaths, but among unintentional drownings, those recorded in pools included significantly higher percentages of children and adolescents aged zero-fourteen years than those occurring in natural waters. CONCLUSIONS: The results highlight the importance of drowning mortality in Catalonia and the need to strengthen preventive activities, especially for children and during episodes of intense heat. Medicolegal sources are useful for monitoring drowning mortality, but it would be beneficial if they incorporated information on variables such as place of residence and nationality.

OBJETIVO: Los datos sobre ahogamientos tienden a subestimar la mortalidad por esta causa. El objetivo de este estudio fue describir los ahogamientos mortales registrados en Cataluña entre 2019 y 2022 a través de fuentes forenses, mostrar sus características y valorar la utilidad de esta información para monitorizar la mortalidad por ahogamientos. METODOS: Se realizó un estudio observacional retrospectivo basado en el registro de muertes judiciales del Instituto de Medicina Legal y Ciencias Forenses de Cataluña. Se analizaron la etiología médico-legal, entorno acuático, edad, sexo, fecha de defunción y municipio de procedencia. El análisis estadístico se basó en la prueba de comparación de proporciones basada en Chi cuadrado para las variables categóricas y la prueba U de Mann Whitney para la comparación de variables numéricas. RESULTADOS: Se registraron 310 ahogamientos mortales, con una edad media de 57,2 años y predominio masculino (77,1%). La mayoría fueron no intencionales (71,3%), seguidos por suicidios (15,5%) y casos de intencionalidad indeterminada (12,6%). Comparados con los ahogamientos intencionales, los no intencionales y de intencionalidad indeterminada incluyeron más hombres que mujeres (81,2% frente a 56%, p<0,001), y menos casos con nacionalidad española que extranjera o indeterminada (60% frente a 92%, p<0,001). Las personas de mediana y avanzada edad aportaron la mayoría de las defunciones pero, entre los ahogamientos no intencionales, los registrados en piscinas incluyeron más niños y adolescentes de cero-catorce años que los que tuvieron lugar en aguas naturales. CONCLUSIONES: Los resultados prueban la importancia de los ahogamientos mortales en Cataluña y la necesidad de fortalecer las actividades preventivas, especialmente en la infancia y durante episodios de calor intenso. Las fuentes médico-forenses son útiles para monitorizar la mortalidad por ahogamientos, pero convendría que incorporaran variables como el lugar de residencia y la nacionalidad.

Advantages of bystander-performed conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest presumably caused by drowning in Japan: a propensity score-matching analysis using an extended nationwide database.

OBJECTIVES: This study aimed to determine whether the association between conventional bystander cardiopulmonary resuscitation (BCPR) and better outcomes in drowning-associated out-of-hospital cardiac arrest (OHCA) differs between young and older people or between non-medical and medical drowning in Japan. DESIGN: Observational study. SETTING: This study used data from the Japanese Fire and Disaster Management Agency databases. PARTICIPANT: Of the 504 561 OHCA cases recorded in the nationwide database between 2016 and 2019, 16 376 (3.2%) were presumably caused by drowning. MAIN OUTCOME MEASURE: The main outcomes were a 1-month neurological prognosis defined as cerebral performance category 1 or 2 and 1-month survival as measures. RESULT: The incidence of drowning as a presumed cause of OHCA was high in the winter and the middle-aged and older generations in Japan. However, OHCA caused by drowning in the younger generation frequently occurs in the summer. Furthermore, younger patients had higher incidences of bystander-witnessed cardiac arrest (22.0%), BCPR provision (59.3%) and arrest in outdoor settings (54.0%) than middle-aged and older generations (5.9%, 46.1% and 18.7% respectively). If the patient was younger or the arrest was accidental, the conventional BCPR group had better neurological outcomes than the compression-only BCPR group (95% CI of adjusted OR, 1.22 to 12.2 and 1.80 to 5.57, respectively). However, in the case of middle-aged and older generations and medical categories, there was no significant difference in outcomes between the two types of BCPR. This conventional group's advantage was maintained even after matching. CONCLUSION: Conventional bystander CPR yielded a higher neurologically favourable survival rate than compression-only BCPR for OHCA caused by drowning if the patient was younger or the arrest was non-medical. Conventional CPR education for citizens who have the chance to witness drownings should be maintained.

The influence of water safety knowledge on adolescents' drowning risk behaviors: a framework of risk-protect integrated and KAP theory.

Introduction: Although previous research has examined the risk factors for drowning behavior among adolescents, it is unclear whether this association is influenced by water safety knowledge. This study aimed to examine whether water safety knowledge is associated with adolescents' drowning risk behaviors and whether drowning risk perceptions and attitudes could have a chain mediating role in the association between water safety knowledge and adolescents' drowning risk behaviors. Methods: This study included 7,485 adolescents from five Chinese provinces and cities. We used the Drowning Risk Behaviors Scales (DRBS) to evaluate the risk of drowning behaviors. The Water Safety Knowledge Scale (WSKS) was used to evaluate the competence level of water safety knowledge. The Drowning Risk Perceptions Scale (DRPS) was used to evaluate the risk level of perceptions, and the Drowning Risk Attitudes Scale (DRAS) was used to evaluate the risk level of attitudes. Results: The results of the mediating effect test showed that water safety knowledge (WSK) affected drowning risk behaviors (DRB) through three indirect paths. Drowning risk perceptions (DRP) and attitudes (DRA) have significantly mediated the association between WSK and DRB. In conclusion, DRP and DRA can act as mediators between WSK and DRB, not only individually, but also as chain mediators, where the direct effect is-0.301, the total indirect effect is-0.214, and the total mediated indirect effect is 41.5%. Discussion: Water safety knowledge negatively predicts adolescents' drowning risk behaviors; water safety knowledge has an inhibitory effect on drowning risk perceptions. Water safety knowledge can directly influence adolescents' drowning risk perceptions and indirectly affect drowning risk behaviors through the mediation of drowning risk perceptions and attitudes comprising three paths: (1) the drowning risk perceptions mediation path, (2) the drowning risk attitudes mediation path, and (3) the drowning risk perceptions and attitudes mediation paths.

Evaluation of eye and serum findings in different waters in rabbits by drowning and submersion modeling.

Background/aim: This study investigated serum, vitreous, and anterior chamber fluid electrolyte changes, corneal thickness (CT), corneal volume (CV), anterior chamber volume (ACV), and anterior chamber depth (ACD) as an auxiliary diagnostic method in the identification of drowning in fresh or salt water. Materials and methods: The study used 35 healthy, adult, male, white New Zealand rabbits, seperated into five groups (control, saltwater drowning (SWD), saltwater immersion (SWI), freshwater drowning (FWD), freshwater immersion (FWI)). CT, CV, ACV, and ACD measurements were made with Pentacam topography at 0, 2, and 4 h in all groups. Magnesium (mg), sodium (Na), and chlorine (Cl) were measured in the blood at 0 and 2 h, and in blood, vitreous fluid, and humor aqueous at 4 h. Results: It was determined that CT, CV, ACV, and ACD are not of great value in drowning diagnosis and are affected by the fresh or salt water rather than drowning. Vitreous Na, Cl, and Mg levels are ineffective in determining drowning after one h. Anterior chamber fluid may provide valuable information in the differentiation freshwater - saltwater drownings at the 4th h in corpses retrieved from water. Conclusion: Anterior chamber fluid Na and Cl levels, especially in corpses removed from salt water, can be an easily used test that can help diagnose drowning.

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.

Vaporization of perfluorocarbon attenuates sea-water-drowning-induced acute lung injury by deactivating the NLRP3 inflammasomes in canines.

Seawater-drowning-induced acute lung injury (SD-ALI) is a life-threatening disorder characterized by increased alveolar-capillary permeability, an excessive inflammatory response, and refractory hypoxemia. Perfluorocarbons (PFCs) are biocompatible compounds that are chemically and biologically inert and lack toxicity as oxygen carriers, which could reduce lung injury in vitro and in vivo. The aim of our study was to explore whether the vaporization of PFCs could reduce the severity of SD-ALI in canines and investigate the underlying mechanisms. Eighteen beagle dogs were randomly divided into three groups: the seawater drowning (SW), perfluorocarbon (PFC), and control groups. The dogs in the SW group were intratracheally administered seawater to establish the animal model. The dogs in the PFC group were treated with vaporized PFCs. Probe-based confocal laser endomicroscopy (pCLE) was performed at 3 h. The blood gas, volume air index (VAI), pathological changes, and wet-to-dry (W/D) lung tissue ratios were assessed. The expression of heme oxygenase-1 (HO-1), nuclear respiratory factor-1 (NRF1), and NOD-like receptor family pyrin domain containing-3 (NLRP3) inflammasomes was determined by means of quantitative real-time polymerase chain reaction (qRT-PCR) and immunological histological chemistry. The SW group showed higher lung injury scores and W/D ratios, and lower VAI compared to the control group, and treatment with PFCs could reverse the change of lung injury score, W/D ratio and VAI. PFCs deactivated NLRP3 inflammasomes and reduced the release of caspase-1, interleukin-1ß (IL-1ß), and interleukin-18 (IL-18) by enhancing the expression of HO-1 and NRF1. Our results suggest that the vaporization of PFCs could attenuate SD-ALI by deactivating NLRP3 inflammasomes via the HO-1/NRF1 pathway.