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Morgan ER, Sakamoto I, Ardelean A, Diaz-Rohena A, Falk A, Starnes C, Rivara FP, Vavilala M. Caregiver perspectives on a water safety toolkit for child supervision. Health Promot J Austr 2024; 35:345-354. [PMID: 37277112 DOI: 10.1002/hpja.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023] Open
Abstract
ISSUE ADDRESSED Drowning is one of the leading causes of unintentional deaths among children and adolescents globally. Adult supervision is one method to decrease the risk of drowning among youth. METHODS We sought to assess the acceptability of a Water Watcher toolkit among children's caregivers. The toolkit consists of a badge-to designate the adult(s) responsible for supervision during water activities-and a smartphone application. When activated, the application blocks incoming calls, text messages and other applications, for example, mobile games and social media, as well as providing a button to quickly dial 911 and information for guided cardiopulmonary resuscitation. We conducted online and in-person semi-structured interviews of 16 adults residing in Washington State, United States and providing supervision to a child under 18 years of age for at least 20 h per week. Interview guides were developed based on the Health Belief Model and we performed content analysis on interview transcripts using an inductive approach. RESULTS When asked about Water Watcher tools, respondents generally reacted favourably towards the intervention, citing benefits of formally delegating a responsible party during group activities and elimination of distractions. Primary challenges to using the toolkit were social acceptability, competence with technology, and the independence of older children (i.e., those 13- to 17-years-old). CONCLUSIONS Caregivers recognized the importance of minimizing distractions, and many liked the strategy to formally designate responsibility for child supervision during aquatic recreation. SO WHAT?: Interventions such as the Water Watcher toolkit are generally considered acceptable and expanding access to these resources could reduce the burden of unintentional drownings.
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Affiliation(s)
- Erin R Morgan
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- College of Medicine, Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | | | - Alan Ardelean
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Public Health, University of Rochester, Rochester, New York, USA
| | - Alejandra Diaz-Rohena
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- College of Natural Sciences, University of Puerto Rico, Rio Piedras, Puerto Rico
| | - Allison Falk
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Biological Sciences, University of Idaho, Moscow, Idaho, USA
| | - Cara Starnes
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Monica Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
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Jiang Z, Lin Z, Li Z, Yu M, He G, Hu J, Meng R, Hou Z, Zhu S, Zhou C, Xiao Y, Huang B, Xu X, Jin D, Qin M, Xu Y, Liu T, Ma W. Joint effects of heat-humidity compound events on drowning mortality in Southern China. Inj Prev 2024:ip-2023-045036. [PMID: 38443161 DOI: 10.1136/ip-2023-045036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Several previous studies have examined the association of ambient temperature with drowning. However, no study has investigated the effects of heat-humidity compound events on drowning mortality. METHODS The drowning mortality data and meteorological data during the five hottest months (May to September) were collected from 46 cities in Southern China (2013-2018 in Guangdong, Hunan and Zhejiang provinces). Distributed lag non-linear model was first conducted to examine the association between heat-humidity compound events and drowning mortality at city level. Then, meta-analysis was employed to pool the city-specific exposure-response associations. Finally, we analysed the additive interaction of heat and humidity on drowning mortality. RESULTS Compared with wet-non-hot days, dry-hot days had greater effects (excess rate (ER)=32.34%, 95% CI: 24.64 to 40.50) on drowning mortality than wet-hot days (ER=14.38%, 95%CI: 6.80 to 22.50). During dry-hot days, males (ER=42.40%, 95% CI: 31.92 to 53.72), adolescents aged 0-14 years (ER=45.00%, 95% CI: 21.98 to 72.35) and urban city (ER=36.91%, 95% CI: 23.87 to 51.32) showed higher drowning mortality risk than their counterparts. For wet-hot days, males, adolescents and urban city had higher ERs than their counterparts. Attributable fraction (AF) of drowning attributed to dry-hot days was 23.83% (95% CI: 21.67 to 26.99) which was significantly higher than that for wet-hot days (11.32%, 95% CI: 9.64 to 13.48%). We also observed that high temperature and low humidity had an additive interaction on drowning mortality. CONCLUSION We found that dry-hot days had greater drowning mortality risk and burden than wet-hot days, and high temperature and low humidity might have synergy on drowning mortality.
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Affiliation(s)
- Zhiying Jiang
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Ziqiang Lin
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Zhixing Li
- Department of Public Health, Jinan University, Guangzhou, China
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Min Yu
- Division of NCD Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Jianxiong Hu
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Ruilin Meng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Zhulin Hou
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Chunliang Zhou
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Yize Xiao
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Biao Huang
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Xiaojun Xu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Donghui Jin
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Mingfang Qin
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Yiqing Xu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Tao Liu
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
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Oporia F, Nuwaha F, Kobusingye O, Jagnoor J, Makumbi FE, Isunju JB, Kibira SPS. Development and validation of an intervention package to improve lifejacket wear for drowning prevention among occupational boaters on Lake Albert, Uganda. Inj Prev 2023; 29:493-499. [PMID: 37507211 DOI: 10.1136/ip-2022-044840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Occupational drowning is a growing public health concern globally. The human cost of fishing is highest in sub-Saharan Africa. Although lifejackets prevent drowning, the majority of boaters in Uganda do not wear them. We developed and validated a peer-to-peer training manual to improve lifejacket wear among occupational boaters on Lake Albert, Uganda. METHODS The intervention was developed in three stages. In stage one, we conducted baseline studies to explore and identify aspects of practices that need to change. In stage two, we held a stakeholder workshop to identify relevant interventions following the intervention functions of the behaviour change wheel (BCW). In stage three, we developed the content and identified its implementation strategies. We validated the intervention package using the Content Validity Index for each item (I-CVI) and scale (S-CVI/Ave). RESULTS Seven interventions were identified and proposed by stakeholders. Training and sensitisation by peers were unanimously preferred. The lowest I-CVI for the content was 86%, with an S-CVI/Ave of 98%. This indicates that the intervention package was highly relevant to the target community. CONCLUSION The stakeholder workshop enabled a participatory approach to identify the most appropriate intervention. All the proposed interventions fell under one of the intervention functions of the BCW. The intervention should be evaluated for its effectiveness in improving lifejacket wear among occupational boaters.
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Affiliation(s)
- Frederick Oporia
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Olive Kobusingye
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
- The George Institute for Global Health Injury Division, Camperdown, New South Wales, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, Camperdown, New South Wales, Australia
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
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Oporia F, Kibira SPS, Jagnoor J, Kobusingye O, Makumbi FE, Isunju JB, Nuwaha F. Peer-led training improves lifejacket wear among occupational boaters: Evidence from a cluster randomized controlled trial on Lake Albert, Uganda. PLoS One 2023; 18:e0292754. [PMID: 37862363 PMCID: PMC10588873 DOI: 10.1371/journal.pone.0292754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/21/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The burden of drowning among occupational boaters in low and middle-income countries is highest globally. In Uganda, over 95% of people who drowned from boating-related activities were not wearing lifejackets at the time of the incident. We implemented and evaluated a peer-led training program to improve lifejacket wear among occupational boaters on Lake Albert, Uganda. METHODS We conducted a two-arm cluster randomized controlled trial in which fourteen landing sites were randomized to the intervention and non-intervention arm with a 1:1 allocation ratio. In the intervention arm, a six-month peer-to-peer training program on lifejacket wear was implemented while the non-intervention arm continued to receive the routine Marine Police sensitizations on drowning prevention through its community policing program. The effect of the intervention was assessed on self-reported and observed lifejacket wear using a test of differences in proportions of wear following the intention to treat principle. The effect of contamination was assessed using mixed effect modified Poisson regression following the As Treated analysis principle at 95% CI. Results are reported according to the CONSORT statement-extension for cluster randomized trials. RESULTS Self-reported lifejacket wear increased markedly from 30.8% to 65.1% in the intervention arm compared to the non-intervention arm which rose from 29.9% to 43.2%. Observed wear increased from 1.0% to 26.8% in the intervention arm and from 0.6% to 8.8% in the non-intervention arm. The test of differences in proportions of self-reported lifejacket wear (65.1%- 43.2% = 21.9%, p-value <0.001) and observed wear (26.8%- 8.8% = 18%, p-value <0.001) showed statistically significant differences between the intervention and non-intervention arm. Self-reported lifejacket wear was higher among boaters who received peer training than those who did not (Adj. PR 1.78, 95% CI 1.38-2.30). CONCLUSION This study demonstrated that peer-led training significantly improves lifejacket wear among occupational boaters. The government of Uganda through the relevant ministries, and the Landing Site Management Committees should embrace and scale up peer-led training programs on lifejacket wear to reduce drowning deaths.
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Affiliation(s)
- Frederick Oporia
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Simon P. S. Kibira
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Olive Kobusingye
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Bierens J, Bray J, Abelairas-Gomez C, Barcala-Furelos R, Beerman S, Claesson A, Dunne C, Fukuda T, Jayashree M, T Lagina A, Li L, Mecrow T, Morgan P, Schmidt A, Seesink J, Sempsrott J, Szpilman D, Thom O, Tobin J, Webber J, Johnson S, Perkins GD. A systematic review of interventions for resuscitation following drowning. Resusc Plus 2023; 14:100406. [PMID: 37424769 PMCID: PMC10323217 DOI: 10.1016/j.resplu.2023.100406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 07/11/2023] Open
Abstract
Objectives The International Liaison Committee on Resuscitation, in collaboration with drowning researchers from around the world, aimed to review the evidence addressing seven key resuscitation interventions: 1) immediate versus delayed resuscitation; (2) compression first versus ventilation first strategy; (3) compression-only CPR versus standard CPR (compressions and ventilations); (4) ventilation with and without equipment; (5) oxygen administration prior to hospital arrival; (6) automated external defibrillation first versus cardiopulmonary resuscitation first strategy; (7) public access defibrillation programmes. Methods The review included studies relating to adults and children who had sustained a cardiac arrest following drowning with control groups and reported patient outcomes. Searches were run from database inception through to April 2023. The following databases were searched Ovid MEDLINE, Pre-Medline, Embase, Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the ROBINS-I tool and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The findings are reported as a narrative synthesis. Results Three studies were included for two of the seven interventions (2,451 patients). No randomised controlled trials were identified. A retrospective observational study reported in-water resuscitation with rescue breaths improved patient outcomes compared to delayed resuscitation on land (n = 46 patients, very low certainty of evidence). The two observational studies (n = 2,405 patients), comparing compression-only with standard resuscitation, reported no difference for most outcomes. A statistically higher rate of survival to hospital discharge was reported for the standard resuscitation group in one of these studies (29.7% versus 18.1%, adjusted odds ratio 1.54 (95% confidence interval 1.01-2.36) (very low certainty of evidence). Conclusion The key finding of this systematic review is the paucity of evidence, with control groups, to inform treatment guidelines for resuscitation in drowning.
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Affiliation(s)
- Joost Bierens
- Extreme Environments Laboratory, University of Portsmouth, Portsmouth, UK
| | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cristian Abelairas-Gomez
- CLINURSID Research Group and Faculty of Education Sciences, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo. Pontevedra, Spain
| | | | - Andreas Claesson
- Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Cody Dunne
- Department of Emergency Medicine, University of Calgary, Canada
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Toranomon Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Muralidharan Jayashree
- Department of Pediatrics. Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anthony T Lagina
- School of Emergency Medicine, Wayne State University, Detroit, USA
| | - Lei Li
- School of Emergency Medicine, Wayne State University, Detroit, USA
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tom Mecrow
- Royal National Lifeboat Institution, West Quay Road, Poole, Dorset, UK
| | - Patrick Morgan
- Extreme Environments Laboratory, University of Portsmouth, Portsmouth, UK
| | - Andrew Schmidt
- Department of Emergency Medicine, University of Florida-Jacksonville, Jacksonville, USA
| | - Jeroen Seesink
- Erasmus MC University Medical Center, Department of Anaesthesiology, Rotterdam, the Netherlands
| | | | - David Szpilman
- Brazilian Lifesaving Society, SOBRASA, Rio de Janeiro, Brazil
| | - Ogilvie Thom
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Joshua Tobin
- UT Health San Antonio, Dept of Anesthesiology, San Antonio, USA
| | - Jonathon Webber
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
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Davoudi-Kiakalayeh A, Barshan J, Emami Sigaroudi F, Mirak HM, Naseri Alavi SA. The application of the Haddon matrix in identifying drowning prevention solutions in the north of Iran. Heliyon 2023; 9:e16958. [PMID: 37484249 PMCID: PMC10361018 DOI: 10.1016/j.heliyon.2023.e16958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 07/25/2023] Open
Abstract
The application of the Haddon matrix in identifying drowning prevention solutions in the north of Iran is necessary. We dealt with drownings on three levels of prevention including before, during, and after the injury in northern Iran (Guilan province). This study aimed to investigate the use of Haddon's matrix in preventing three-level drowning cases before, during, and after the accident in the north of Iran. This qualitative study consisted of 9 focus groups with a sample size of 78 people including 48 nursing staff, 21 emergency medicine specialists, and 30 people from non-medical personnel (local community leaders, executive officials of relevant organizations, lifeguards, staff working in health centers, and families of victims). All group discussions were recorded and the questions were based on the focus group table. According to Haddon's table of results, the major risk group was the young and adolescent boys and more in the area of neglect in culture-building and education. In this study, the role of factors was investigated separately and the necessary solutions were presented that can be used as a scientific and practical basis to achieve the main goal of drowning prevention. These strategies require cross-sectoral collaboration, which seems to be a strong interaction with a greater focus on major risk groups to address deficiencies and prevent the recurrence of potential accidents. The study aimed to investigate the use of Haddon's matrix in the prevention of three-level drowning cases before the event, during the event, and after the event in northern Iran.
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Affiliation(s)
| | - Jalal Barshan
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Hamed Mousavi Mirak
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Apitz C, Tobias D, Helm P, Bauer UM, Niessner C, Siaplaouras J. Nationwide Survey Reveals High Prevalence of Non-Swimmers among Children with Congenital Heart Defects. CHILDREN (BASEL, SWITZERLAND) 2023; 10:988. [PMID: 37371220 DOI: 10.3390/children10060988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/23/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Physical activity is important for children with congenital heart defects (CHD), not only for somatic health, but also for neurologic, emotional, and psychosocial development. Swimming is a popular endurance sport which is in general suitable for most children with CHD. Since we have previously shown that children with CHD are less frequently physically active than their healthy peers, we hypothesized that the prevalence of non-swimmers is higher in CHD patients than in healthy children. METHODS To obtain representative data, we performed a nationwide survey in collaboration with the German National Register of Congenital Heart Defects (NRCHD) and the Institute for Sport Sciences of the Karlsruhe Institute for Technology (KIT). The questionnaire included questions capturing the prevalence of swimming skills and the timing of swim learning and was part of the "Motorik-Modul" (MoMo) from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A representative age-matched subset of 4569 participants of the MoMo wave two study served as a healthy control group. RESULTS From 894 CHD-patients (mean age of 12.5 ± 3.1 years), the proportion of non-swimmers in children with CHD was significantly higher (16% versus 4.3%; p < 0.001) compared to healthy children and was dependent on CHD severity: Children with complex CHD had an almost five-fold increased risk (20.4%) of being unable to swim, whereas in children with simple CHD, the ability to swim did not differ significantly from their healthy reference group (5.6% vs. 4.3% non-swimmers (p = not significant). CONCLUSIONS According to our results, one in five patients with complex CHD are non-swimmers, a situation that is concerning in regard of motoric development, inclusion and integration, as well as prevention of drowning accidents. Implementation of swim learning interventions for children with CHD would be a reasonable approach.
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Affiliation(s)
- Christian Apitz
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, 89075 Ulm, Germany
| | - Dominik Tobias
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, 89075 Ulm, Germany
| | - Paul Helm
- National Register for Congenital Heart Defects, 13353 Berlin, Germany
| | - Ulrike M Bauer
- National Register for Congenital Heart Defects, 13353 Berlin, Germany
| | - Claudia Niessner
- Institute for Sport and Sport Science, Karlsruhe Institute for Technology, 76131 Karlsruhe, Germany
| | - Jannos Siaplaouras
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, 89075 Ulm, Germany
- Praxis am Herz-Jesu-Krankenhaus, 36037 Fulda, Germany
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Santos C, Burnay C, Button C, Cordovil R. Effects of Exposure to Formal Aquatic Activities on Babies Younger Than 36 Months: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5610. [PMID: 37107892 PMCID: PMC10138400 DOI: 10.3390/ijerph20085610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
This systematic review investigated the possible effects of exposing infants to formal activities in aquatic environments. A literature search of eight databases was concluded on 12 December 2022. Studies were eligible if they: (i) focused on 0-36 months of age infants, (ii) addressed the exposure of infants to formal aquatic activities, and (iii) compared the 'same condition of aquatic exposure with the control' or 'before and after exposure'. The PRISMA protocol was used. Articles considered for inclusion (n = 18) were clustered in the health, development, and physiological outcome domains. The results show that research is focused on indoor activities, mainly in baby swimming programs and baby aquatic therapy interventions. Swimming and aquatic therapy practices are generally safe for babies' health, and there are benefits to preterm and newborns exposed to aquatic therapy once the physiological parameters are maintained in normal and safe patterns. A positive effect is also suggested in general gross and fine motor skills, visual motion perception, cognitive flexibility, and response selection accuracy for infants who participated in aquatic programs. Further investigation with high-quality experimental designs is required to establish the effect of exposure of infants to formal aquatic activities (Systematic Review Registration: CRD42021248054).
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Affiliation(s)
- Carlos Santos
- Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, 1499-002 Cruz Quebrada, Portugal
| | - Carolina Burnay
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, 1499-002 Cruz Quebrada, Portugal
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Chris Button
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Rita Cordovil
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, 1499-002 Cruz Quebrada, Portugal
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Leavy JE, Gray C, Della Bona M, D'Orazio N, Crawford G. A Review of Interventions for Drowning Prevention Among Adults. J Community Health 2023; 48:539-556. [PMID: 36653593 DOI: 10.1007/s10900-023-01189-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/20/2023]
Abstract
Adult drowning is a complex and multifactorial public health challenge requiring community, national and global efforts to mitigate impacts. This study updates the evidence base for public health interventions that address adult fatal and non-fatal drowning. A systematic review was undertaken of the peer-reviewed literature for English-language primary studies published between 2011 and 2021describing a drowning intervention with adults. Twenty-two studies were included. Most studies (n = 16) were conducted in high-income countries. Yearly trends in drowning prevention intervention publications were analysed with 2015 (n = 6) the peak publishing year. Over half of the study designs were pre-post (n = 15). Intervention duration ranged from 4 hours to 11 years. Ten studies described either behaviour change theory or formative evaluation to inform design. Thirteen studies targeted interventions at a population level, seven at a group level and two at individual level. Studies identified a range of prevention strategies, categorised as behavioural (n = 9) (e.g., swimming lessons), socio-ecological (n = 8) (e.g., mandatory personal flotation devices) and mixed (n = 5) (e.g., awareness campaign and barriers to prevent access to water). A range of outcomes were described including changes in awareness, water safety knowledge, attitudes, water safety behaviours and skills, environmental, policy and regulation changes and drowning rates. Findings indicate a small but important increase in the evaluation and publication of effective interventions to prevent adult drowning. The complexity of the issues surrounding drowning requires multi-strategy and context -specific adult focused prevention interventions. Contemporary evidence that identifies effective interventions that contribute to prevention efforts is an essential first step in addressing the challenge.
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Affiliation(s)
- Justine E Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia.
| | - Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Malena Della Bona
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Nicola D'Orazio
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
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10
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McAvoy C, Jagnoor J, Hoe C. Addressing a gap: a qualitative analysis of Scotland's Drowning and Incident Review process. Inj Prev 2022; 29:201-206. [PMID: 36564167 DOI: 10.1136/ip-2022-044785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/06/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Drowning is a leading cause of fatalities worldwide and Scotland carries a disproportionate number of drownings compared with its UK neighbours. Drowning data captured in Scotland are often incomplete and the Drowning and Incident Review (DIR) is a new process designed to help improve the capture of data and help inform future preventative measures. The aim of this study was to explore the perspectives and views of key stakeholders on the facilitators and barriers of implementing the DIR as well as areas for its future sustainability. METHODS A qualitative approach was used with in-depth interviews using key participants. Participants were identified using purposive sampling, through use of a stakeholder analysis. Participants watched a hypothetical DIR and then participated in a semistructured interview. Questions focused on DIR facilitators, barriers and areas for future sustainability. Qualitative data were then analysed using thematic analysis. RESULTS A total of 14 participants took part in the study. Results found: three facilitator themes (addresses a gap, design of DIR, safe space), four barrier themes (representation, resource, legal concerns, control concerns) and four areas for future sustainability (the voluntary nature, framework agreement, political prioritisation and the human element). These themes were then discussed within this paper in relation to findings from research on similar review processes. CONCLUSION The research was the first of its kind and the findings are therefore extremely important to provide a first exploration and insight into facilitators and barriers of the DIR as well as areas for its future sustainability.
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Affiliation(s)
- Carlene McAvoy
- Leisure Safety, The Royal Society for the Prevention of Accidents, Edinburgh, UK .,Honorary Fellow for the Injury program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Jagnoor Jagnoor
- Injury Prevention, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Connie Hoe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Heidelberg Institute for Global Health, Heidelberg University, Heidelberg, Germany
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Disparities in Adolescent Reported Drowning Prevention Strategies. J Adolesc Health 2022; 71:757-760. [PMID: 36088228 DOI: 10.1016/j.jadohealth.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Describe use of drowning prevention strategies among diverse adolescents. METHODS We analyzed 47,051 responses to 2012-2018 Washington statewide surveys of 8th-12th grade students, regarding formal swimming lessons, comfort in deep water (a measure of perceived water competency), and life jacket use in small watercraft. Using survey-weighted Poisson regression, we measured these strategies in relation to race/ethnicity, primary language, maternal education, and urbanicity. RESULTS 78.6% of students spoke English at home. Most students reported having had formal swimming lessons (62.2%), being comfortable in deep water (65.8%), and wearing life jackets (58.5%). Students primarily speaking Spanish (11.2%) reported formal swimming lessons (PR: 0.72; 95%CI: 0.67-0.78) and perceived water competency (PR: 0.75; 95%CI: 0.70-0.80) less often than primarily English-speaking. All prevention strategies were associated with higher maternal education. DISCUSSION Drowning prevention strategies, access to swimming lessons, life jackets, and water competency should be promoted among low-income children and those whose primary language is not English.
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Oporia F, Nuwaha F, Kibira SPS, Kobusingye O, Makumbi FE, Nakafeero M, Ssenyonga R, Isunju JB, Jagnoor J. Lifejacket wear and the associated factors among boaters involved in occupational boating activities on Lake Albert, Uganda: a cross-sectional survey. Inj Prev 2022; 28:513-520. [PMID: 35636933 PMCID: PMC9726957 DOI: 10.1136/injuryprev-2022-044608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Drowning death rates in lakeside fishing communities in Uganda are the highest recorded globally. Over 95% of people who drowned from a boating activity in Uganda were not wearing a lifejacket. This study describes the prevalence of lifejacket wear and associated factors among boaters involved in occupational boating activities on Lake Albert, Uganda. METHODS We conducted a cross-sectional survey, grounded on etic epistemology and a positivist ontological paradigm. We interviewed 1343 boaters across 18 landing sites on Lake Albert, Uganda. Lifejacket wear was assessed through observation as boaters disembarked from their boats and self-reported wear for those who 'always wore a life jacket while on the lake'. We used a mixed-effects multilevel Poisson regression, with landing site-specific random intercepts to elicit associations with lifejacket wear. We report adjusted prevalence ratios (PRs) at 95% confidence intervals. RESULTS The majority of respondents were male, 99.6% (1338/1343), and the largest proportion, 38.4% (516/1343) was aged 20-29 years. Observed lifejacket wear was 0.7% (10/1343). However, self-reported wear was 31.9% (428/1343). Tertiary-level education (adjusted PR 1.57, 95% CI 1.29- 1.91), boat occupancy of at least four people (adjusted PR 2.12, 95% CI 1.28 - 3.52), big boat size (adjusted PR 1.55, 95% CI 1.13 - 2.12) and attending a lifejacket-use training session (adjusted PR 1.25, 95% CI 1.01 - 1.56) were associated with higher prevalence of self-reported lifejacket wear. Self-reported wear was lower among the 30-39 year-olds compared to those who were aged less than 20 years (adjusted PR 0.66, 95% CI 0.45 - 0.99). CONCLUSION Lifejacket wear was low. Training on lifejacket use may improve wear among boaters involved in occupational boating activities on Lake Albert.
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Affiliation(s)
- Frederick Oporia
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Olive Kobusingye
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
- The George Institute for Global Health, Camperdown, New South Wales, Australia
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mary Nakafeero
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jagnoor Jagnoor
- George Institute for Global Health, Camperdown, New South Wales, Australia
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Varner JD, Liu A. Pediatric Drowning: In Deep Water. Pediatr Ann 2022; 51:e450-e455. [PMID: 36476198 DOI: 10.3928/19382359-20221006-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drowning is one of the most common causes of death globally. The current literature identifies risk factors associated with pediatric drowning and strategies to prevent its occurrence. This article seeks to equip pediatricians with the appropriate education and guidance to provide targeted counsel to parents with children of different age groups, as well as medical management, when faced with a drowning victim. [Pediatr Ann. 2022;51(12):e450-e455.].
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Scarr JP, Jagnoor J. Identifying opportunities for multisectoral action for drowning prevention: a scoping review. Inj Prev 2022; 28:585-594. [DOI: 10.1136/ip-2022-044712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
BackgroundDrowning is a complex health issue, where global agendas call for greater emphasis on multisectoral action, and engagement with sectors not yet involved in prevention efforts. Here, we explored the conceptual boundaries of drowning prevention in peer-review and grey literature, by reviewing the contexts, interventions, terminologies, concepts, planning models, and sector involvement, to identify opportunities for multisectoral action.MethodsWe applied scoping review method and have reported against Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist. We searched four electronic databases for peer-reviewed articles published on 1 January 2005 and 31 December 2020 and five databases for grey literature published on 1 January 2014 and 31 December 2020. We applied the search term “drowning,” and charted data addressing our research questions.ResultsWe included 737 peer-reviewed articles and 68 grey documents. Peer-publications reported situational assessments (n=478, 64.86%) and intervention research (n=259, 35.14%). Drowning was reported in the context of injury (n=157, 21.30%), commonly in childhood injury (n=72, 9.77%), mortality studies (n=60, 8.14%) and in grey documents addressing adolescent, child, environmental, occupational and urban health, refugee and migrant safety and disaster. Intervention research was mapped to World Health Organization recommended actions. The leading sectors in interventions were health, leisure, education and emergency services.ConclusionAlthough drowning is often described as a major health issue, the sectors and stakeholders involved are multifarious. The interventions are more often initiated by non-health sectors, meaning multisectoral action is critical. Framing drowning prevention to reinforce cobenefits for other health and development agendas could strengthen multisectoral action. Greater investment in partnerships with non-health sectors, encouraging joint planning and implementation, and creating systems for increased accountability should be a priority in future years.
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Salas Ballestín A, Frontera Juan G, Sharluyan Petrosyan A, Chocano González E, Figuerola Mulet J, De Carlos Vicente JC. Drowning Accidents in a Spanish Pediatric Intensive Care Unit: An Observational Study for 29 Years. Pediatr Emerg Care 2022; 38:e1631-e1636. [PMID: 36173436 DOI: 10.1097/pec.0000000000002583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Drowning is one of the most frequent accidents in children. We aimed to describe demographic and epidemiological characteristics of drowned children who required admission to a pediatric intensive care unit (PICU) to identify risk factors to guide possible preventive measures to avoid severe drowning. METHODS We conducted an observational study for 29 years (retrospective between 1991 and 2004; prospective between 2005 and 2019) that included all children (0-15 years old) requiring PICU admission after drowning. Data regarding patient characteristics, accident circumstances, and neurological outcomes at PICU discharge were analyzed. RESULTS A total of 160 patients were included, with no significant decrease over the study period. There was a predominance of males (75%), young age (60%; 1-5 years), summer months (91.1%; May-September), tourists (14.12 [95% confidence interval, 9.2-21.7] times higher risk of drowning than residents), swimming pool accidents (88.8%), and inadequate supervision (77.9%). The mortality was 18.7%, and 7.5% of admitted children had severe neurological sequelae. The initial resuscitation maneuvers by accident witnesses were incorrect in nearly half of the patients in whom these could be analyzed. CONCLUSIONS Emphasis should be placed on implementing preventive measures, focused on the described risk groups, and insisting on adequate supervision, swimming training programs, and training of the general population in safe rescue and cardiopulmonary resuscitation.
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Stehr P, Reifegerste D, Rossmann C, Caspar K, Schulze A, Lindemann AK. Effective communication with caregivers to prevent unintentional injuries in children under seven years. A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:2721-2730. [PMID: 35537900 DOI: 10.1016/j.pec.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This review systematically examines the theory base and effectiveness of communication strategies (i.e., message content, message attributes, communication channels, and communicators) of interventions for caregivers to prevent unintentional child injuries. METHODS Relevant articles were searched in the databases Communication and Mass Media Complete, PsycInfo, Pubmed, and Google Scholar, the journal Injury Prevention, and the literature of included studies. A total of 71 articles reporting 67 different studies were included and fully coded. Quality was assessed using the Mixed Methods Appraisal Tool. Coded categories and their frequencies are described, and the effectiveness of different communication strategies is explored with crosstabs. RESULTS Only 17 studies stated the use of a specific theory base; Precaution Adoption Process-Model, Theory of Planned Behavior, and Health Belief Model were most often used. The message content of most studies aimed at knowledge dissemination; however, addressing behavioral determinants, such as risk perception and self-efficacy, was more effective. About half of the studies did not elaborate on message attributes; calls to action, exemplars, and tailoring were most often used, the latter being most effective. Communication channels ranged from printed products to face-to-face communication and digital media. In addition, studies specifying interpersonal communicators were highly effective. CONCLUSION The results of the review suggest that the following aspects can contribute to effective communication in child injury prevention: theory-based communication, addressing broad knowledge and further behavioral determinants, digital tailoring, and health professionals as communicators. However, a conclusive statement on the effectiveness of different communication strategies is hampered by the fact that they are not specified and/or confounded in many studies. PRACTICE IMPLICATIONS Communication strategies should be theory based and address, in addition to knowledge, behavioral determinants such as risk perception and self-efficacy. Moreover, digital tailoring is an advanced way of enhancing effectiveness and health professionals, such as pediatricians and clinic staff, are important multipliers.
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Affiliation(s)
- Paula Stehr
- Department of Media and Communication, LMU Munich, Munich, Germany.
| | | | | | - Katja Caspar
- Department of Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Annett Schulze
- Department Risk Communication, Federal Institute for Risk Assessment, Berlin, Germany
| | - Ann-Kathrin Lindemann
- Department Risk Communication, Federal Institute for Risk Assessment, Berlin, Germany
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Irvine R, Doan T, Bosley E, Colbeck M, Bowles KA. Paediatric Out-of-Hospital Cardiac Arrests: An Epidemiological Study. PREHOSP EMERG CARE 2022:1-10. [PMID: 35771687 DOI: 10.1080/10903127.2022.2096159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To identify the epidemiological patterns of paediatric out-of-hospital cardiac arrests (OHCA) in Queensland, Australia and to investigate associations between patient variables and prehospital outcome.Methods: Included were paediatric (>4 days - 18 years) OHCA patients attended by paramedics in the state of Queensland (Australia) between January 2009 and December 2019. Patient and arrest characteristics were described. Factors associated with return of spontaneous circulation (ROSC) on hospital arrival were investigated.Results: A total of 1612 paediatric patients were included; 611 were deceased prior to paramedic arrival and 1001 received resuscitation attempts by paramedics. Approximately one quarter (26.8%) of resuscitation-attempted patients achieved ROSC on hospital arrival. Most arrests (49.7%) were due to medical causes. Arrests due to trauma had the lowest rate of ROSC on hospital arrival (9.6%), whereas those due to drug overdose had the highest rate (40%). Patients in rural areas had a lower rate of ROSC on hospital arrival than those in metropolitan areas (20.7% vs 32.5%, p < 0.001). The median response interval to all OHCA patients was 8 minutes. Trauma was considerably more prevalent in rural areas than in metropolitan areas, while all other aetiologies were comparable. Older paediatric age groups had higher rates of ROSC on hospital arrival than infants, particularly early adolescents (39.4% vs. 14.9%, p = 0.001). Aetiology, age, bystander witness, shockable initial rhythm, and geographic locality factors were independently associated with ROSC on hospital arrival.Conclusions: Approximately a quarter of paediatric prehospital OHCA achieved ROSC on hospital arrival. Prehospital outcome differs according to patient cohort and is associated with diverse patient demographic variables.
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Affiliation(s)
- Rachel Irvine
- Department of Paramedicine, Monash University, Victoria, Australia
| | - Tan Doan
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Marc Colbeck
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, Queensland, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Victoria, Australia
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Dunne CL, Sweet J, Clemens T. The link between medical conditions and fatal drownings in Canada: a 10-year cross-sectional analysis. CMAJ 2022; 194:E637-E644. [PMID: 35534027 PMCID: PMC9259405 DOI: 10.1503/cmaj.211739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Drowning accounts for hundreds of preventable deaths in Canada every year, but the impact of preexisting medical conditions on the likelihood of death from drowning is not known. We aimed to describe the prevalence of pre-existing medical conditions among people who fatally drowned in Canada and evaluate the risk of fatal drowning among people with common pre-existing medical conditions. METHODS We reviewed all Canadian unintentional fatal drownings (2007-2016) in the Drowning Prevention Research Centre Canada's database. For each fatal drowning we established whether the person had pre-existing medical conditions and whether those conditions contributed to the drowning. We calculated relative risk (RR) of fatal drowning stratified by age and sex for each pre-existing medical condition using data from the Canadian Chronic Disease Surveillance System. RESULTS During 2007-2016, 4288 people fatally drowned unintentially in Canada, of whom one-third had a pre-existing medical condition. A pre-existing medical condition contributed to drowning in 43.6% (n = 616) of cases. Fatal drowning occurred more frequently in people with ischemic heart disease (RR 2.7, 95% confidence interval [CI] 2.5-3.0) and seizure disorders (RR 6.3, 95% CI 5.4-7.3) but less frequently in people with respiratory disease (RR 0.12, 95% CI 0.10-0.15). Females aged 20-34 years with a seizure disorder had a 23 times greater risk than their age- and sex-matched cohort (RR 23, 95% CI 14-39). In general, fatal drowning occurred more often while people were bathing (RR 5.9, 95% CI 4.8-7.0) or alone (RR 1.99, 95% CI 1.32-2.97) and less often in males (RR 0.92, 95% CI 0.88-0.95) or in those who had used alcohol (RR 0.72, 95% CI 0.65-0.80), among those with pre-existing medical conditions. INTERPRETATION The risk of fatal drowning is increased in the presence of some preexisting medical conditions. Tailored interventions aimed at preventing drowning based on pre-existing medical conditions and age are needed. Initial prevention strategies should focus on seizure disorders and bathtub drownings.
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Affiliation(s)
- Cody L Dunne
- Department of Emergency Medicine (Dunne), University of Calgary, Calgary, Alta.; International Drowning Researchers' Alliance (Dunne, Clemens), Kuna, Idaho; Faculty of Medicine (Sweet), University of Ottawa, Ottawa, Ont.; Drowning Prevention Research Centre Canada (Clemens), Toronto, Ont.
| | - Julia Sweet
- Department of Emergency Medicine (Dunne), University of Calgary, Calgary, Alta.; International Drowning Researchers' Alliance (Dunne, Clemens), Kuna, Idaho; Faculty of Medicine (Sweet), University of Ottawa, Ottawa, Ont.; Drowning Prevention Research Centre Canada (Clemens), Toronto, Ont
| | - Tessa Clemens
- Department of Emergency Medicine (Dunne), University of Calgary, Calgary, Alta.; International Drowning Researchers' Alliance (Dunne, Clemens), Kuna, Idaho; Faculty of Medicine (Sweet), University of Ottawa, Ottawa, Ont.; Drowning Prevention Research Centre Canada (Clemens), Toronto, Ont
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Liu L, Villavicencio F, Yeung D, Perin J, Lopez G, Strong KL, Black RE. National, regional, and global causes of mortality in 5–19-year-olds from 2000 to 2019: a systematic analysis. Lancet Glob Health 2022; 10:e337-e347. [PMID: 35180417 PMCID: PMC8864304 DOI: 10.1016/s2214-109x(21)00566-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/04/2021] [Accepted: 11/29/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Li Liu
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Francisco Villavicencio
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Centre for Demographic Studies, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diana Yeung
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gerard Lopez
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Kathleen L Strong
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kienesberger B, Arneitz C, Wolfschluckner V, Flucher C, Spitzer P, Singer G, Castellani C, Till H, Schalamon J. Child safety programs for primary school children decrease the injury severity of dog bites. Eur J Pediatr 2022; 181:709-714. [PMID: 34535830 PMCID: PMC8821379 DOI: 10.1007/s00431-021-04256-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/06/2021] [Accepted: 09/01/2021] [Indexed: 11/08/2022]
Abstract
This study focuses on the impact of a prevention program regarding dog bites in children. As a consequence of our previous investigation in 2005, we have initiated a child safety program for primary school children starting January 2008 until present to teach children how to avoid dog attacks and how to behave in case of an attack. In our retrospective study, we analyzed all patients younger than 15 years presenting with dog-related injuries between 2014 and 2018. As the main indicator for success of the prevention measures taken, we have defined the severity of injury in comparison to our previous study. Out of 296 children with dog-related injuries, 212 (71.6%) had sustained a dog bite. In the vast majority (n = 195; 92%), these patients presented with minor injuries; the extremities were most commonly affected (n = 100; 47%). Injuries to the head (n = 95; 45%) and trunk (n = 18; 8%) were less frequent. The proportion of severe injuries (8%) was significantly lower compared to our previous study, where 26% of children presented with severe injuries necessitating surgical intervention, while the number of patients requiring in-hospital treatment declined from 27.5% in the period 1994-2003 to 9.0% in the period between 2014 and 2018 (p < 0.05).Conclusion: Teaching of primary school children may effectively reduce the injury severity of dog bites. What is Known: • Dog bites are a substantial healthcare problem especially in children. What is New: • This study shows that a broad-based prevention program for primary school children can effectively decrease the severity but not the frequency of dog bite injuries in children.
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Affiliation(s)
- Bernhard Kienesberger
- grid.11598.340000 0000 8988 2476Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria
| | - Christoph Arneitz
- grid.11598.340000 0000 8988 2476Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria
| | - Vanessa Wolfschluckner
- grid.11598.340000 0000 8988 2476Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria
| | - Christina Flucher
- grid.11598.340000 0000 8988 2476Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria
| | - Peter Spitzer
- Research Center for Childhood Accidents, Safe Kids Austria, Graz, Austria
| | - Georg Singer
- grid.11598.340000 0000 8988 2476Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria
| | - Christoph Castellani
- grid.11598.340000 0000 8988 2476Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria
| | - Holger Till
- grid.11598.340000 0000 8988 2476Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria
| | - Johannes Schalamon
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
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Influence of a Survival Swimming Training Programme on Water Safety Knowledge, Attitudes and Skills: A Randomized Controlled Trial among Young Adults in Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111428. [PMID: 34769944 PMCID: PMC8583420 DOI: 10.3390/ijerph182111428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022]
Abstract
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.
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van Duijn T, Ng JL, Burnay C, Anderson N, Uehara L, Cocker K, Button C. The Influence of Equipment and Environment on Children and Young Adults Learning Aquatic Skills. Front Psychol 2021; 12:733489. [PMID: 34690889 PMCID: PMC8531637 DOI: 10.3389/fpsyg.2021.733489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Learning aquatic skills is an important component of developing physical literacy in children. Aquatic skills such as floating, swimming and safe entry/exit promote engagement in different water environments and may help preserve lives in an emergency. This scoping review was conducted to evaluate the influence of task constraints (i.e., equipment) and environmental constraints (i.e., physical and social) on how children learn foundational aquatic skills. In developed countries, children are typically taught in swimming pools under direct supervision. It is also not uncommon to see children and infants learning to swim with assistive equipment (e.g., buoyancy aids). However, perhaps surprisingly, the evidence on how and where children learn aquatic skills does not uniformly promote such practices. For example, the use of flotation devices has not been proven to aid skill learning. Some researchers have advocated that children should learn aquatic skills whilst wearing outdoor clothing. One benefit of children wearing clothing is an increased capacity to practice in colder water (such as the ocean, rivers, or lakes). Overall, whilst practitioners often use equipment for various reasons it seems that not all equipment is equally useful in promoting the acquisition of aquatic skills. In less developed countries, with limited access to swimming pools and fewer resources for private instruction, a range of different open water aquatic environments and practices, such as swimming in temporarily flooded areas, have been reported. Such strategies are in urgent demand of further research given that drowning rates in less developed countries around the world exceed those in developed nations. It can be argued that learning in pools does not afford the opportunities to develop the whole range of adaptive skills that may be required in different open water environments such as navigating currents and waves, floating whilst clothed, or making life-saving decisions. Consequently, a shift toward teaching in open water environments has occurred in several countries. This review provides an evidence-base upon which practitioners can design more effective aquatic education programs for children.
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Affiliation(s)
- Tina van Duijn
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Jonathan Leo Ng
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Carolina Burnay
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Neil Anderson
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Luiz Uehara
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Kane Cocker
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Chris Button
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
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Theodorou CM, Rajasekar G, McFadden NR, Brown EG, Nuño M. Epidemiology of paediatric drowning hospitalisations in the USA: a population-based study. Inj Prev 2021; 28:148-155. [PMID: 34462333 DOI: 10.1136/injuryprev-2021-044257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/17/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Drowning is a leading cause of death in children ≤5 years old. Detailed data on the epidemiology of drowning in this high-risk population can inform preventative efforts. We aimed to study trends in incidence and case fatality rates (CFR) in the USA among young children hospitalised after drowning. METHODS Children ≤5 years old hospitalised in the USA after drowning were identified from the Kids Inpatient Database 2000-2016. Incidence and CFRs by calendar year, age, sex, race/ethnicity and hospital region were calculated. Trends over time were evaluated. Factors associated with fatal drowning were assessed. RESULTS Among 30 560 804 hospitalised children ≤5 years old, 9261 drowning cases were included. Patients were more commonly male (62.3%) and white (47.4%). Two years old had the highest incidence of hospitalisation after drowning, regardless of race/ethnicity, sex and region. Overall drowning hospitalisations decreased by 49% from 2000 to 2016 (8.38-4.25 cases per 100 000 children). The mortality rate was 11.4% (n=1060), and most occurred in children ≤3 years old (83.0%). Overall case fatality decreased between 2000 and 2016 (risk ratio (RR) 0.44, 95% CI 0.25 to 0.56). The lowest reduction in incidence and case fatality was observed among Black children (Incidence RR 0.92, 95% CI 0.75 to 1.13; case fatality RR 0.80, 95% CI 0.41 to 1.58). CONCLUSIONS Hospitalisations and CFRs for drowning among children ≤5 years old have decreased from 2000 to 2016. Two years old are at the highest risk of both fatal and non-fatal drowning. Disparities exist for Black children in both the relative reduction in drowning hospitalisation incidence and case fatality. Interventions should focus on providing equitable preventative care measures to this population.
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Affiliation(s)
- Christina M Theodorou
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Ganesh Rajasekar
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Nikia R McFadden
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Erin G Brown
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Miriam Nuño
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA.,Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento, CA, USA
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Guevarra JP, Peden AE, Franklin RC. Application of the PRECEDE-PROCEED model in the development of evidence-informed interventions for drowning prevention: a mixed-methods study protocol. BMJ Open 2021; 11:e050688. [PMID: 34301666 PMCID: PMC8311324 DOI: 10.1136/bmjopen-2021-050688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Drowning is a global public health threat, disproportionately impacting low-income and middle-income countries. In the Philippines, it is estimated that more than 5200 people die from drowning per annum. This number is likely to be higher than currently estimated with the inclusion of disaster-related and transportation-related drowning. Drowning is preventable if appropriate preventive interventions are put in place which redress known risk factors. METHODS AND ANALYSIS This study uses the PRECEDE-PROCEED model (PPM), an eight-step health promotion planning and evaluation model for building and improving intervention programmes. This mixed-methods study, which can be used in any location, will be implemented in Los Baňos, Laguna, Philippines, identified as an area of concern for drowning. Using the PPM, data on drowning will be collected from death records, community observation, key informant interviews, focus group discussions and community survey. A range of analytical methods will be used to explore drowning data including univariate and χ2 analyses, analysis of variance, relative risk and calculating rates using population data. The quantitative data and themes drawn from qualitative data will be used to populate the first four phases of the PPM. Following the data collection, the remaining stages of the PPM will be designed and implemented in the barangay (village) with the highest drowning rate. ETHICS AND DISSEMINATION This study has obtained ethical clearance from the University of the Philippines Manila Research Ethics Board (UPMREB 2017-425-01). Study findings will be disseminated through workshops and presentations to the local community as well as through peer-reviewed literature and conference presentations. The PPM has rarely been applied to drowning prevention and it is the aim that the study described in this protocol is expanded across other areas of the Philippines and to other countries with a high drowning burden to inform prevention efforts.
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Affiliation(s)
- Jonathan P Guevarra
- Department of Health Promotion and Education, University of the Philippines Manila, Manila, Philippines
| | - Amy E Peden
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia
| | - Richard Charles Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia
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Clemens T, Peden AE, Franklin RC. Exploring a Hidden Epidemic: Drowning Among Adults Aged 65 Years and Older. J Aging Health 2021; 33:828-837. [PMID: 33939560 DOI: 10.1177/08982643211014770] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To explore trends in unintentional fatal drowning among older adults (65 years and older). Methods: Total population retrospective analysis of unintentional fatal drowning among people aged 65 years and older in Australia, Canada and New Zealand (2005-2014) was conducted. Results: 1459 older adults died. Rates ranged from 1.69 (Canada) to 2.20 (New Zealand) per 100,000. Trends in crude drowning rates were variable from year to year. A downward trend was observed in New Zealand (y = -.507ln(x) + 2.9918), with upward trends in Australia (y = .1056ln(x) + 1.5948) and Canada (y = .1489ln(x) + 1.4571). Population projections suggest high annual drowning deaths by 2050 in Australia (range: 120-190; 1.69-2.76/100,000) and Canada (range: 209-430; 1.78-3.66/100,000). Significant locations and activities associated with older adult drowning differed by country and age band. Conclusions: Drowning among older adults is a hidden epidemic claiming increasing lives as the population ages. Targeted drowning prevention strategies are urgently needed in Australia, Canada, New Zealand and other similar countries.
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Affiliation(s)
- Tessa Clemens
- Drowning Prevention Research Centre Canada, Toronto, Canada
| | - Amy E Peden
- 10129Royal Life Saving Society - Australia, Broadway, Australia.,School of Population Health, Faculty of Medicine, 7800UNSW Sydney, Sydney, Australia.,College of Public Health, Medical and Veterinary Sciences, 8001James Cook University, Townsville, Australia
| | - Richard C Franklin
- 10129Royal Life Saving Society - Australia, Broadway, Australia.,College of Public Health, Medical and Veterinary Sciences, 8001James Cook University, Townsville, Australia
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De Buck E, Vanhove AC, O D, Veys K, Lang E, Vandekerckhove P. Day care as a strategy for drowning prevention in children under 6 years of age in low- and middle-income countries. Cochrane Database Syst Rev 2021; 4:CD014955. [PMID: 33884613 PMCID: PMC8406676 DOI: 10.1002/14651858.cd014955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Drowning is responsible for an estimated 320,000 deaths a year, and over 90% of drowning mortality occurs in low- to middle-income countries (LMICs), with peak drowning rates among children aged 1 to 4 years. In this age group, mortality due to drowning is particularly common in rural settings and about 75% of drowning accidents happen in natural bodies of water close to the home. Providing adequate child supervision can protect children from drowning, and organized formal day care programs could offer a way to achieve this. OBJECTIVES Primary objective • To assess the effects of day care programs for children under 6 years of age on drowning-related mortality or morbidity, or on total drowning accidents (fatal and non-fatal), in LMICs, compared to no day care programs or other drowning prevention interventions Secondary objectives • To assess the effects of day care programs in LMICs for children under 6 years of age on unsafe water exposure • To assess safety within these programs (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) • To assess the incidence of unintentional injury within these programs • To describe the cost-effectiveness of such programs, in relation to averted drowning-related mortality or morbidity SEARCH METHODS: On November 23, 2019, and for an update on August 18, 2020, we searched MEDLINE (PubMed), Embase, CENTRAL, ERIC, and CINAHL, as well as two trial registries. On December 16, 2019, and for an update on February 9, 2021, we searched 12 other resources, including websites of organizations that develop programs targeted to children. SELECTION CRITERIA We included randomized, quasi-randomized, and non-randomized controlled studies (with explicitly listed specific study design features) that implemented formal day care programs as a single program or combined with additional out-of-day care components (such as educational activities aimed at preventing injury or drowning or early childhood development activities) for children of preschool age (below 6 years of age) in LMICs for comparison with no such programs or with other drowning prevention interventions. Studies had to report at least one outcome related to drowning or injury prevention for the children enrolled. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection and data extraction, as well as risk of bias and GRADE assessment. MAIN RESULTS Two non-randomized observational studies, conducted in rural Bangladesh, involving a total of 252,631 participants, met the inclusion criteria for this review. One of these studies compared a formal day care program combined with parent education, playpens provided to parents, and community-based activities as additional out-of-day care components versus no such program. Overall we assessed this study to be at moderate risk of bias (moderate risk of bias due to confounding, low risk of bias for other domains). This study showed that implementation of a formal day care program combined with parent education, provision of playpens to parents, and community-based activities, in a rural area with a high drowning incidence, likely reduces the risk of death from drowning over the study period of 4 years and 8 months compared to no day care program (hazard ratio 0.18, 95% confidence interval [CI] 0.06 to 0.58; 1 study, 136,577 participants; moderate-certainty evidence). Drowning morbidity (non-fatal drowning resulting in complications), total drowning (fatal and non-fatal), unsafe water exposure, and program safety (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) were not reported, nor was the incidence of other unintentional injuries. Cost-effectiveness was reported as 812 USD (95% CI 589 to 1777) per disability-adjusted life-year averted as a consequence of drowning (moderate-certainty evidence). The second study compared day care programs with or without playpens provided to parents as an additional component versus only playpens provided to parents as an alternative drowning prevention intervention. Overall we assessed the study to be at critical risk of bias because we judged bias due to confounding to be at critical risk. As the certainty of evidence was very low, we are uncertain about the effects on drowning mortality rate of implementing a day care program compared to providing playpens (rate ratio 0.25, 95% CI 0.15 to 0.41; 1 study; 76,575 participants; very low-certainty evidence). Likewise, we are uncertain about the effects of a day care program with playpens provided as an additional component versus playpens provided alone (rate ratio 0.06, 95% CI 0.02 to 0.12; 1 study, 45,460 participants; very low-certainty evidence). The other outcomes of interest - drowning morbidity, total drowning, unsafe water exposure, program safety, incidence of other unintentional injuries, and cost-effectiveness - were not reported. AUTHORS' CONCLUSIONS This review provides evidence suggesting that a day care program with additional out-of-day care components such as community-based education, parent education, and playpens provided to parents likely reduces the drowning mortality risk in regions with a high burden of drowning compared to no intervention.
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Affiliation(s)
- Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Cochrane First Aid, Mechelen, Belgium
| | - Anne-Catherine Vanhove
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Belgian Centre for Evidence-Based Medicine - Cochrane Belgium, Leuven, Belgium
| | - Dorien O
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Koen Veys
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Belgian Red Cross, Mechelen, Belgium
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Preventing Child Drowning in the Philippines: The Need to Address the Determinants of Health. CHILDREN-BASEL 2021; 8:children8010029. [PMID: 33430273 PMCID: PMC7825742 DOI: 10.3390/children8010029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Abstract
Drowning is a public health issue in the Philippines, with children at significantly increased risk. Determinants of health (DoH) such as education, socio-economic status, ethnicity, and urbanization are factors that impact drowning risk. As drowning is a multisectoral issue, a national drowning prevention plan can drive collaboration with relevant stakeholders. This study reports trends in unintentional child (0-14 years) drowning in the Philippines (incidence, rates, and trends over time for fatal and non-fatal (years lived with a disability (YLDs) and disability adjusted life years (DALYs) from 2008-2017 and conducts an analysis of the Philippines' Multisector Action Plan (MSAP) on Drowning Prevention. From 2008-2017, 27,928 (95%UI [Uncertainty Interval]: 22,794-33,828) children aged 0-14 years died from drowning (52.7% aged 5-14 years old). Rates of drowning have declined among both age groups, with greater reductions seen among 0-4 year olds (y = -0.3368x + 13.035; R2 = 0.9588). The MSAP has 12 child drowning-specific activities and 20 activities were identified where DoH will need to be considered during development and implementation. The MSAP activities, and work done to prevent drowning more generally, must consider DoH such as education, urbanization, water and sanitation health, and safe water transportation. A national drowning surveillance system and investment in research in the Philippines are recommended.
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Irwin J, O'callaghan F, Glendon AI. Predicting Parental Intentions to Enrol Their Children in Swimming Lessons Using an Extended Theory of Planned Behaviour. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jenna Irwin
- School of Applied Psychology, Griffith University,
| | - Frances O'callaghan
- School of Applied Psychology, Griffith University,
- Menzies Health Institute Queensland,
| | - Aleck Ian Glendon
- Menzies Health Institute Queensland,
- Work and Organisational Wellbeing Research Centre, Griffith University,
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Abstract
Traumatic injury is a substantial burden for public health. Injury prevention can reduce the risk of injury by promoting healthy behaviors. It is unknown whether injury prevention education shared on social media is effective at promoting behavior change to reduce injuries. The purpose of this integrative review is to identify the influence of social media in providing injury prevention education to the public. An integrative literature review was conducted. The following databases were searched: CINAHL, PubMed, MEDLINE, and Applied Science & Technology Source. Studies were included if they were published between 2006 and 2018. Exclusion criteria included self-inflicted or intentional injuries, postinjury online interventions, support groups, online surveys, blogs, editorial content, YouTube videos, or studies of online surveillance tools.The initial search yielded 583 studies. Twelve studies met inclusion criteria. Two major themes were identified: social media content analysis and injury prevention through social media.The public is actively discussing injuries on social media, although unregulated online content may deliver inaccurate or false messages. Online conversation intensifies when major news stories are released, particularly when a celebrity or athlete is involved. Public health should use these patterns of major news stories to influence and shape online conversations about injury. Social media offers opportunity to understand, and trend, public perception of injuries. Additional research is needed to measure the effect of injury prevention delivered over social media.
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Willcox-Pidgeon SM, Franklin RC, Devine S, Leggat PA, Scarr J. Reducing inequities among adult female migrants at higher risk for drowning in Australia: The value of swimming and water safety programs. Health Promot J Austr 2020; 32 Suppl 1:49-60. [PMID: 32803829 DOI: 10.1002/hpja.407] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/12/2020] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Stacey M Willcox-Pidgeon
- Royal Life Saving Society - Australia, Broadway, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Richard C Franklin
- Royal Life Saving Society - Australia, Broadway, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Sue Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Justin Scarr
- Royal Life Saving Society - Australia, Broadway, NSW, Australia
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Abstract
Aquatic competencies have been proposed as a prevention strategy for children aged 2–4 years who are over-represented in drowning statistics. For this recommendation to be made, exploration of the connection between aquatic competencies and drowning is required. This review critically analyzed studies exploring aquatic competencies and their effect on drowning and/or injury severity in children 2–4 years. English language peer-reviewed literature up to 31 July 2019 was searched and the PRISMA process utilized. Data were extracted from twelve studies that fulfilled the inclusion criteria. Findings from this study included that aquatic competencies were not found to increase risk of drowning and demonstrated children aged 2–4 years are capable of developing age-appropriate aquatic competencies. Age-appropriate aquatic competencies extracted were propulsion/locomotion, flotation/buoyancy, water familiarization, submersion and water exits. The acquisition of these competencies holds benefit for the prevention of drowning. No evidence was found relating to injury severity. There was limited exploration of the relationship between aquatic competencies attainment and age-related developmental readiness. The review highlights the need for consistent measures of exposure, clarity around skills acquisition, better age-specific data (2 years vs. 3 years vs. 4 years), studies with larger sample sizes, further exploration of the dose–response relationship and consistent skill level testing across age groups. Further investigation is required to establish the efficacy of aquatic competencies as a drowning prevention intervention, as well as exploring the relationship between aquatic competencies and age-related developmental readiness. In conclusion, early evidence suggests aquatic competencies can help to reduce drowning.
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Willcox-Pidgeon SM, Franklin RC, Leggat PA, Devine S. Identifying a gap in drowning prevention: high-risk populations. Inj Prev 2020; 26:279-288. [PMID: 31907207 PMCID: PMC7279566 DOI: 10.1136/injuryprev-2019-043432] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/19/2019] [Accepted: 11/24/2019] [Indexed: 12/02/2022]
Abstract
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.
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Affiliation(s)
- Stacey M Willcox-Pidgeon
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Richard Charles Franklin
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Sue Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Peden AE, Franklin RC. Causes of distraction leading to supervision lapses in cases of fatal drowning of children 0-4 years in Australia: A 15-year review. J Paediatr Child Health 2020; 56:450-456. [PMID: 31667952 DOI: 10.1111/jpc.14668] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/18/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022]
Abstract
AIM Supervision is a strategy for preventing drowning among children. However, supervision lapses continue to be a contributory factor in child drowning. This study aims to identify, describe and analyse the causes of distraction leading to lapses in supervision in child drowning. METHODS A total population survey of all fatal unintentional drownings among children aged 0-4 years between 1 July 2002 and 30 June 2017 was undertaken using data from the Australian National Coronial Information System. Among closed coronial cases, causes of distraction leading to lapses in supervision were collected as free text from closed case documentation and subsequently thematically grouped into categories. Univariate and χ2 analysis was undertaken (P < 0.01). RESULTS A total of 447 children drowned during the study period (62.0% male; 66.9% aged 1-2 years; 53.3% swimming pools; 79.4% falls into water). Of the 426 (95.3%) closed cases, common supervision lapses were due to indoor household duties (27.6%), outdoor household duties (12.6%) and talking/socialising (11.9%). CONCLUSIONS This study has identified common scenarios for distractions leading to supervision lapses including the link between indoor household duties and bathtub drowning deaths and talking/socialising for deaths in swimming pools and at rivers. Challenges include medical issues impacting sole carers. The 7% of cases where a supervision lapse occurred due to miscommunication are opportunities to further reinforce the need for a designated supervisor, particularly with two or more adults present. Study findings on distraction causes, and strategies to minimise them, should be incorporated into national public awareness campaigns aimed at parents and care givers of this at-risk group.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society - Australia, Sydney, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard C Franklin
- Royal Life Saving Society - Australia, Sydney, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Franklin RC, Peden AE, Hamilton EB, Bisignano C, Castle CD, Dingels ZV, Hay SI, Liu Z, Mokdad AH, Roberts NLS, Sylte DO, Vos T, Abady GG, Abosetugn AE, Ahmed R, Alahdab F, Andrei CL, Antonio CAT, Arabloo J, Arba AAK, Badiye AD, Bakkannavar SM, Banach M, Banik PC, Banstola A, Barker-Collo SL, Barzegar A, Bayati M, Bhardwaj P, Bhaumik S, Bhutta ZA, Bijani A, Boloor A, Carvalho F, Chowdhury MAK, Chu DT, Colquhoun SM, Dagne H, Dagnew B, Dandona L, Dandona R, Daryani A, Dharmaratne SD, Dibaji Forooshani ZS, Do HT, Driscoll TR, Eagan AW, El-Khatib Z, Fernandes E, Filip I, Fischer F, Gebremichael B, Gupta G, Haagsma JA, Hassan S, Hendrie D, Hoang CL, Hole MK, Holla R, Hostiuc S, Househ M, Ilesanmi OS, Inbaraj LR, Irvani SSN, Islam MM, Ivers RQ, Jayatilleke AU, Joukar F, Kalhor R, Kanchan T, Kapoor N, Kasaeian A, Khan M, Khan EA, Khubchandani J, Krishan K, Kumar GA, Lauriola P, Lopez AD, Madadin M, Majdan M, Maled V, Manafi N, Manafi A, McKee M, Meles HG, Menezes RG, Meretoja TJ, Miller TR, Mithra P, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohebi F, Molokhia M, Mustafa G, Negoi I, Nguyen CT, Nguyen HLT, Olagunju AT, Olagunju TO, Padubidri JR, Pakshir K, Pathak A, Polinder S, Pribadi DRA, Rabiee N, Radfar A, Rana SM, Rickard J, Safari S, Salamati P, Samy AM, Sarker AR, Schwebel DC, Senthilkumaran S, Shaahmadi F, Shaikh MA, Shin JI, Singh PK, Soheili A, Stokes MA, Suleria HAR, Tarigan IU, Temsah MH, Tesfay BE, Valdez PR, Veisani Y, Ye P, Yonemoto N, Yu C, Yusefzadeh H, Zaman SB, Zhang ZJ, James SL. The burden of unintentional drowning: global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study. Inj Prev 2020; 26:i83-i95. [PMID: 32079663 PMCID: PMC7571364 DOI: 10.1136/injuryprev-2019-043484] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 12/21/2022]
Abstract
Background Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study’s objective is to describe unintentional drowning using GBD estimates from 1990 to 2017. Methods Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning. Results Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes. Conclusions There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries.
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Affiliation(s)
- Richard Charles Franklin
- College of Public Health, Medical and Veterinary Science, James Cook University, Douglas, Queensland, Australia.,Royal Life Saving Society, Sydney, New South Wales, Australia
| | - Amy E Peden
- Royal Life Saving Society, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Erin B Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Catherine Bisignano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Chris D Castle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Dillon O Sylte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Gdiom Gebreheat Abady
- College of Medicine and Health Sciences, Department of Nursing, Adigrat University, Adigrat, Ethiopia
| | | | - Rushdia Ahmed
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.,Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota, USA
| | | | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines.,Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ashish D Badiye
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | - Shankar M Bakkannavar
- Department of Forensic Medicine and Toxicology, Manipal Academy of Higher Education, Manipal, India
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland.,Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
| | - Palash Chandra Banik
- Department of Non-Communicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
| | - Amrit Banstola
- Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
| | | | - Akbar Barzegar
- Occupational Health Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India.,Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Deemed University, Wardha, India
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, University of Toronto, Toronto, Ontario, Canada.,Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Archith Boloor
- Department of Internal Medicine, Manipal Academy of Higher Education, Mangalore, India
| | - Félix Carvalho
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
| | - Samantha M Colquhoun
- Research School of Population Health, Australian National University, Action, Australian Capital Territory, Australia
| | - Henok Dagne
- Environmental and Occupational Health and Safety, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA.,Public Health Foundation of India, Gurugram, India
| | - Rakhi Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Public Health Foundation of India, Gurugram, India
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samath Dhamminda Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Hoa Thi Do
- Center of Excellence in Public Health Nutrition, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Tim Robert Driscoll
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Arielle Wilder Eagan
- Department of Global Health and Social Medicine, Harvard University, Boston, Massachusetts, USA.,Department of Social Services, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, Canada
| | | | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, California, USA.,School of Health Sciences, A.T. Still University, Arizona, Missouri, USA
| | - Florian Fischer
- Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
| | | | - Gaurav Gupta
- Non-Communicable Diseases (NCD), World Health Organization (WHO), New Delhi, India
| | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Shoaib Hassan
- Centre for International Health and Section for Ethics and Health Economics, University of Bergen, Bergen, Norway
| | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Michael K Hole
- Department of Pediatrics, Dell Medical School, University of Texas Austin, Austin, Texas, USA
| | - Ramesh Holla
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar.,Qatar Foundation for Education, Science, and Community Development, Doha, Qatar
| | | | | | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Mofizul Islam
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Achala Upendra Jayatilleke
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka.,Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
| | - Farahnaz Joukar
- Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Qazvin, Iran.,Health Services Management Department, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
| | - Neeti Kapoor
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maseer Khan
- Epidemiology Department, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Jagdish Khubchandani
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana, USA
| | - Kewal Krishan
- Department of Anthropology, Panjab University, Chandigarh, India
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Paolo Lauriola
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammed Madadin
- Pathology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marek Majdan
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Venkatesh Maled
- Health Education and Research Department, SDM College of Medical Sciences & Hospital, Dharwad, India.,Health University, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Navid Manafi
- Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran.,Ophthalmology Department, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ali Manafi
- Plastic Surgery Department, Iran University of Medical Sciences, Tehran, Iran
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ritesh G Menezes
- Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Ted R Miller
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Pacific Institute for Research & Evaluation, Calverton, Maryland, USA
| | - Prasanna Mithra
- Community Medicine, Manipal Academy of Higher Education, Mangalore, India
| | | | | | - Farnam Mohebi
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mariam Molokhia
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Ghulam Mustafa
- Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan.,Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
| | - Ionut Negoi
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | | | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Tinuke O Olagunju
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jagadish Rao Padubidri
- Department of Forensic Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Keyvan Pakshir
- Parasitology and Mycology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashish Pathak
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, RD Gardi Medical College, Ujjain, India
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Amir Radfar
- College of Medicine, University of Central Florida, Orlando, Florida, USA.,College of Graduate Health Sciences, A.T. Still University, Mesa, Arizona, USA
| | - Saleem Muhammad Rana
- University Institute of Public Health, University of Lahore, Lahore, Pakistan.,Public Health Department, University of Health Sciences, Lahore, Pakistan
| | - Jennifer Rickard
- Surgery Department, University of Minnesota, Minneapolis, Minnesota, USA.,Surgery Department, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Saeed Safari
- Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Abdur Razzaque Sarker
- Health Economics, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Faramarz Shaahmadi
- Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Jae Il Shin
- College of Medicine, Yonsei University, Seodaemun-gu, South Korea.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | | | - Amin Soheili
- Medical Surgical Nursing Department, Urmia University of Medical Science, Urmia, Iran.,Emergency Nursing Department, Semnan University of Medical Sciences, Semnan, Iran
| | - Mark A Stokes
- Department of Psychology, Deakin University, Burwood, Victoria, Australia
| | | | - Ingan Ukur Tarigan
- Center for Health Resource and Services Research and Development, National Institute of Health Research & Development, Jakarta, Indonesia
| | - Mohamad-Hani Temsah
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina.,Velez Sarsfield Hospital, Buenos Aires, Argentina
| | - Yousef Veisani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Pengpeng Ye
- Division of Injury Prevention and Mental Health Improvement, National Center for Chronic and Non-Communicable Disease Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Naohiro Yonemoto
- Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China.,Global Health Institute, Wuhan University, Wuhan, China
| | - Hasan Yusefzadeh
- Department of Health Economics and Management, Urmia University of Medical Science, Urmia, Iran
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Zhi-Jiang Zhang
- Department of Preventive Medicine, Wuhan University, Wuhan, China
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Chauvin M, Kosatsky T, Bilodeau-Bertrand M, Gamache P, Smargiassi A, Auger N. Hot weather and risk of drowning in children: Opportunity for prevention. Prev Med 2020; 130:105885. [PMID: 31705939 DOI: 10.1016/j.ypmed.2019.105885] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/13/2019] [Accepted: 11/05/2019] [Indexed: 01/02/2023]
Abstract
The link between outdoor temperature and risk of drowning in children is poorly understood. The objective of this study was to determine the association between elevated temperature and the chance of drowning in children and adolescents. We used a case-crossover study design to assess 807 fatal and nonfatal drowning-related hospitalisations among children aged 0 to 19 years in Quebec, Canada between 1989 and 2015. The primary exposure measure was maximum temperature the day of drowning. We estimated odds ratios and 95% confidence intervals (CI) for the association of temperature with drowning by age group (<2, 2-4, 5-9, 10-19 years), adjusted for precipitation, relative humidity, and holidays. Elevated temperature was associated with greater odds of drowning. Compared with 15 °C, a temperature of 30 °C was associated with 6 times the chance of drowning between 0 and 19 years of age (95% CI 4.40-8.16). The association was not modified by characteristics such as age or location of drowning. Relative to 15 °C, a temperature of 30 °C was associated with 3.75 times the odds of drowning in pools (95% CI 1.85-7.63) and 12.44 times the odds of drowning in other bodies of water (95% CI 3.53-43.81). Associations persisted even after implementation of a policy to restrict access to private pools in 2010. These findings suggest that hot weather is strongly associated with the risk of drowning in children aged 0 to 19 years. Interventions to prevent drowning in children should be enhanced during hot days, and not only around pools.
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Affiliation(s)
- Marine Chauvin
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, 2375, Côte-Ste-Catherine Road, Montreal, Quebec H3T 1A8, Canada; Institut national de santé publique du Québec, 190 Cremazie Blvd E., Montreal, Quebec H2P 1E2, Canada
| | - Tom Kosatsky
- National Collaborating Centre for Environmental Health, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | | | - Philippe Gamache
- Institut national de santé publique du Québec, 190 Cremazie Blvd E., Montreal, Quebec H2P 1E2, Canada
| | - Audrey Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, 2375, Côte-Ste-Catherine Road, Montreal, Quebec H3T 1A8, Canada; Institut national de santé publique du Québec, 190 Cremazie Blvd E., Montreal, Quebec H2P 1E2, Canada
| | - Nathalie Auger
- Institut national de santé publique du Québec, 190 Cremazie Blvd E., Montreal, Quebec H2P 1E2, Canada; University of Montreal Hospital Research Centre, Department of Social and Preventive Medicine, University of Montreal, 900 Saint Denis St, Montreal, Quebec H2X 0A9, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue W, Quebec H3A 1A2, Canada.
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36
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Peden AE, Franklin RC, Leggat PA. Developing drowning prevention strategies for rivers through the use of a modified Delphi process. Inj Prev 2019; 26:240-247. [PMID: 30928913 PMCID: PMC7279562 DOI: 10.1136/injuryprev-2019-043156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Richard C Franklin
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
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Della Bona M, Crawford G, Nimmo L, Leavy JE. What does 'Keep Watch' mean to migrant parents? Examining differences in supervision, cardiopulmonary resuscitation training and water familiarisation. Int J Public Health 2019; 64:755-762. [PMID: 30603940 DOI: 10.1007/s00038-018-1197-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/13/2018] [Accepted: 12/19/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Drowning is a public health challenge. Children of migrants may be at increased risk as parents may be unaware of local water safety issues. This study explores differences between Australian-born and migrant parents in Western Australia for: (1) swimming ability; (2) supervision; (3) water familiarisation; and (4) cardiopulmonary resuscitation (CPR) training. METHODS A cross-sectional survey of parents and carers of children aged under 5 years residing in WA (n = 1506) captured demographics, knowledge of appropriate supervision, water safety knowledge and skills. Logistic regression was conducted. RESULTS Migrants were significantly less likely to identify adequate supervision (p = 0.004); have participated in child water familiarisation programmes (p = 0.000); or perceived themselves as able swimmers (p = 0.000). Significantly less migrants had also undertaken CPR training (p = 0.000). CONCLUSIONS Findings add to the small but growing body of literature highlighting the importance of tailored drowning prevention strategies for migrants in countries such as Australia with a strong aquatic culture.
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Affiliation(s)
- Malena Della Bona
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Lauren Nimmo
- Health Promotion and Research, Royal Life Saving Society Western Australia Inc, PO Box 28, Floreat, WA, 6014, Australia
| | - Justine E Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
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38
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Peden AE, Mahony AJ, Barnsley PD, Scarr J. Understanding the full burden of drowning: a retrospective, cross-sectional analysis of fatal and non-fatal drowning in Australia. BMJ Open 2018; 8:e024868. [PMID: 30473541 PMCID: PMC6254411 DOI: 10.1136/bmjopen-2018-024868] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning. DESIGN A subset of data on fatal unintentional drowning from the Royal Life Saving National Fatal Drowning Database was compared on a like-for-like basis to data on hospital separations sourced from the Australian Institute of Health and Welfare's National Hospital Morbidity Database for the 13-year period 1 July 2002 to 30 June 2015. A restrictive definition was applied to the fatal drowning data to estimate the effect of the more narrow inclusion criteria for the non-fatal data (International Classification of Diseases (ICD) codes W65-74 and first reported cause only). Incidence and ratios of fatal to non-fatal drowning with univariate and Χ2 analysis are reported and used to calculate case-fatality rates. SETTING Australia, 1 July 2002 to 30 June 2015. PARTICIPANTS Unintentional fatal drowning cases and cases of non-fatal drowning resulting in hospital separation. RESULTS 2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0-4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65-74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal. CONCLUSIONS This study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society-Australia, Broadway, New South Wales, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Alison J Mahony
- Royal Life Saving Society-Australia, Broadway, New South Wales, Australia
| | - Paul D Barnsley
- Royal Life Saving Society-Australia, Broadway, New South Wales, Australia
| | - Justin Scarr
- Royal Life Saving Society-Australia, Broadway, New South Wales, Australia
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Gorsuch MM, Myers SL, Lai Y, Steward D, Motachwa R. Vanishing racial disparities in drowning in Florida. Inj Prev 2018; 25:487-493. [PMID: 30352797 DOI: 10.1136/injuryprev-2018-042872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the change in the racial disparity in drowning in Florida from 1970 to 2015 and to analyse the contextual factors associated with white, black and Hispanic drowning rates in Florida from 2007 to 2015. METHODS Our outcome variable is county-level annual drowning rates by race, ethnicity, sex and age group. We computed county-level contextual data, including emergency weather events, temperature, extreme weather, number of pools, quality of pools, coastline, swimming participation rates and prominent black competitive swim teams. RESULTS Between 1970 and 1990, the disparity in drowning rates between white and black males in Florida decreased dramatically. By 2005, the overall age-adjusted drowning rates converged. This convergence was most striking for those aged 10-34 and 35-64. While the gap has declined dramatically, there remains a racial disparity in drownings among those aged 10-34. CONCLUSIONS Overall, racial disparities in drowning have disappeared in Florida. However, some disparities remain. There is a persistent disparity in drownings among those aged 10-34.
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Affiliation(s)
- Marina Mileo Gorsuch
- Department of Economics and Political Science, St. Catherine University, St. Paul, Minnesota, USA
| | - Samuel L Myers
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yufeng Lai
- Department of Applied Economics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Devan Steward
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rachel Motachwa
- Department of Sociology, University of Minnesota, Minneapolis, Minnesota, USA
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40
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Dandona R, Kumar GA, George S, Kumar A, Dandona L. Risk profile for drowning deaths in children in the Indian state of Bihar: results from a population-based study. Inj Prev 2018; 25:364-371. [PMID: 29778993 PMCID: PMC6839727 DOI: 10.1136/injuryprev-2018-042743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND We report on incidence of drowning deaths and related contextual factors in children from a population-based study in the Indian state of Bihar which estimated the causes of death using verbal autopsy (VA). METHODS Interviews were conducted for deaths in 1-14 years population that occurred from January 2012 to March 2014 in 109 689 households (87.1% participation) in 1017 clusters representative of the state. The Population Health Metrics Research Consortium shortened VA questionnaire was used for interview and cause of death was assigned using the SmartVA automated algorithm. The annualised unintentional drowning death incidence, activity prior to drowning, the body of water where drowning death had occurred and contextual information are reported. FINDINGS The survey covered 224 077 children aged 1-14 years. Drowning deaths accounted for 7.2%, 12.5% and 5.8% of all deaths in 1-4, 5-9 and 10-14 years age groups, respectively. The adjusted incidence of drowning deaths was 14.3 (95% CI 14.0 to 14.7) per 100 000 children, with it being higher in urban (16.1, 95% CI 14.8 to 17.3) areas. Nearly half of the children drowned in a river (5.9, 95% CI 5.6 to 6.1) followed by in a pond (2.8, 95% CI 2.6 to 2.9). Drowning death incidence was the highest while playing (5.1, 95% CI 4.9 to 5.4) and bathing (4.0, 95% CI 3.8 to 4.2) with the former accounting for more deaths in 1-4 years age group. Sixty per cent of children were already dead when found. None of these deaths were reported to the civil registration system to obtain death certificate. INTERPRETATION The findings from this large representative sample of children document the magnitude of and variations in unintentional drowning deaths in Bihar. Urgent targeted drowning interventions are needed to address the risk in children. Gross under-reporting of drowning deaths in children in India needs attention.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, Gurugram, India.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Sibin George
- Public Health Foundation of India, Gurugram, India
| | - Amit Kumar
- Public Health Foundation of India, Gurugram, India
| | - Lalit Dandona
- Public Health Foundation of India, Gurugram, India.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Matthews BL, Franklin RC. Examination of a pilot intervention program to change parent supervision behaviour at Australian public swimming pools. Health Promot J Austr 2018; 29:153-159. [PMID: 30159992 DOI: 10.1002/hpja.37] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 01/21/2018] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
| | - Richard C Franklin
- Royal Life Saving Society - Australia, Broadway, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
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42
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McDonald EM, Mack K, Shields WC, Lee RP, Gielen AC. Primary Care Opportunities to Prevent Unintentional Home Injuries: A Focus on Children and Older Adults. Am J Lifestyle Med 2018; 12:96-106. [PMID: 27141210 PMCID: PMC4850836 DOI: 10.1177/1559827616629924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 01/17/2023] Open
Abstract
Unintentional injuries are a persistent public health problem in the United States. A new health care landscape has the potential to create a clinical environment that fosters greater involvement by health care providers in injury prevention. The aim of this article is to provide evidence supporting the need for engagement by primary care providers in unintentional home injury prevention along with examples of how this could be accomplished. We know a great deal about what population groups are at risk for certain types of injuries. We also know that many injuries can be prevented through policies, programs, and resources that ensure safe environments and promote safe behaviors. For example, the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative comprises clinical decision support tools and educational materials for health care providers. Two effective interventions that have demonstrated a reduction in falls among children are the redesign of baby walkers (engineering) and the mandated use of window guards (enforcement). Primary care clinicians can play a key role in promoting their patient's safety. Taken collectively, a focused attention on preventing unintentional home injuries by primary care providers can contribute to the reduction of injuries and result in optimal health for all.
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Affiliation(s)
- Eileen M. McDonald
- Eileen M. McDonald, MS, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 731, Baltimore, MD 21205; e-mail:
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Stanhope J, Weinstein P, Cook A. Do natural spring waters in Australia and New Zealand affect health? A systematic review. JOURNAL OF WATER AND HEALTH 2018; 16:1-13. [PMID: 29424713 DOI: 10.2166/wh.2017.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Therapeutic use of spring waters has a recorded history dating back to at least 1550 BC and includes both bathing in and drinking such waters for their healing properties. In Australia and New Zealand the use of therapeutic spring waters is a much more recent phenomenon, becoming a source of health tourism from the late 1800s. We conducted a systematic review aimed at determining the potential health outcomes relating to exposure to Australian or New Zealand natural spring water. We found only low-level evidence of adverse health outcomes relating to this spring water exposure, including fatalities from hydrogen sulphide poisoning, drowning and primary amoebic meningoencephalitis. We found no studies that investigated the therapeutic use of these waters, compared with similar treatment with other types of water. From the broader literature, recommendations have been made, including fencing potentially harmful spring water, and having signage and media messages to highlight the potential harms from spring water exposure and how to mitigate the risks (e.g. not putting your head under water from geothermal springs). Sound research into the potential health benefits of Australian and New Zealand spring waters could provide an evidence base for the growing wellness tourism industry.
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Affiliation(s)
- Jessica Stanhope
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, Australia, WA 6009
| | - Philip Weinstein
- School of Biological Sciences, The University of Adelaide, North Tce, Adelaide, Australia, SA 5001 and School of Pharmacy and Medical Sciences, University of South Australia, North Tce, Adelaide, Australia, SA 5001 E-mail:
| | - Angus Cook
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, Australia, WA 6009
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44
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Lukaszyk C, Ivers RQ, Jagnoor J. Systematic review of drowning in India: assessment of burden and risk. Inj Prev 2018; 24:451-458. [PMID: 29330198 DOI: 10.1136/injuryprev-2017-042622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/05/2017] [Accepted: 12/15/2017] [Indexed: 11/03/2022]
Abstract
AIM To examine the burden and risk factors for fatal and non-fatal drowning in India. METHODS Relevant literature was identified through a systematic search of 19 electronic databases and 19 national and global, institutional, organisational and government sources of injury data. Search terms used pertained to drowning, injury, trauma, morbidity and mortality in India. RESULTS A total of 16 research articles and five data sources were included in the review. Three national data sources provided counts of drowning deaths, reporting a range of 1348-62 569 drowning deaths per year. A further three national data sources provided information on drowning-related morbidity; however, each source presented different outcome measures making comparison difficult. Ten research studies investigated risk factors associated with drowning in India. Key risk factors reported were male gender, young age (0-5 years) and individuals residing in the North-Eastern part of the country who have high exposure to water sources within community settings. CONCLUSION Drowning-related morbidity and mortality have a significant impact on India, with risk factors identified for this setting similar to those within other low-income and middle-income countries. Regional data which look beyond routinely collected data are required to accurately investigate the burden and impact of drowning, to inform targeted, context-specific approaches for drowning reduction initiatives.
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Affiliation(s)
- Caroline Lukaszyk
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rebecca Q Ivers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Southgate Institute, Flinders University, Adelaide, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
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45
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Chan JSE, Ng MXR, Ng YY. Drowning in swimming pools: clinical features and safety recommendations based on a study of descriptive records by emergency medical services attending to 995 calls. Singapore Med J 2018; 59:44-49. [PMID: 28367581 PMCID: PMC5778258 DOI: 10.11622/smedj.2017021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study was a descriptive analysis of national ambulance case records and aimed to make practical safety recommendations in order to reduce the incidence of drowning in swimming pools. METHODS A search was performed of a national database of descriptive summaries by first-responder paramedics of all 995 calls made to the Singapore Civil Defence Force between 1 January 2012 and 31 December 2014. We included all cases of submersion in both public and private pools for which emergency medical services were activated. RESULTS The highest proportion of drowning cases occurred in the age group of 0-9 years. Males accounted for 57.0% (61/107) of cases. Bystander cardiopulmonary resuscitation (CPR) was performed in 91.3% (21/23) and 68.6% (48/70) of cases of cardiac/respiratory arrest from drowning in public and private pools, respectively; the rate of bystander CPR was higher when a lifeguard was present (88.5%, 23/26 vs. 68.7%, 46/67). The majority (72.0%, 77/107) of drowning incidents occurred in private pools, most of which had no lifeguards present. CONCLUSION To our knowledge, this study was the first in Singapore to examine data from emergency medical services. Since the majority of incidents occurred in private pools without lifeguards, it is recommended that a lifeguard be present at every pool. For pools that are too small to justify mandatory lifeguard presence, safety measures, such as guidelines for pool design and pool fencing with latched gates, may be considered. As strict enforcement may not be possible, public education and parental vigilance remain vital.
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Affiliation(s)
| | - Marie Xin Ru Ng
- Medical Department, HQ Singapore Civil Defence Force, Singapore
| | - Yih Yng Ng
- Medical Department, HQ Singapore Civil Defence Force, Singapore
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46
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Guan J, Li G. Characteristics of unintentional drowning deaths in children with autism spectrum disorder. Inj Epidemiol 2017; 4:32. [PMID: 29218603 PMCID: PMC5721095 DOI: 10.1186/s40621-017-0129-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/15/2017] [Indexed: 12/27/2022] Open
Abstract
Background The reported prevalence of autism spectrum disorder (ASD) has increased markedly in the past two decades. Recent research indicates that children with ASD are at a substantially increased risk of injury mortality, particularly from unintentional drowning. The purpose of this study was to explore the circumstances of fatal unintentional drowning incidents involving children with ASD under 15 years of age. Findings During January 2000 through May 2017, US newspapers reported a total of 23 fatal drowning incidents involving 18 boys and 5 girls with ASD. Age of victims ranged from 3 to 14 years (mean = 7.7 ± 2.9 years). These drowning incidents most commonly occurred in ponds (52.2%), followed by rivers (13.0%), and lakes (13.0%). For 11 incidents with location data available, the distance between victim residence and the water body where drowning occurred averaged 290.7 m (± 231.5 m). About three-quarters (73.3%) of the drowning incidents occurred in the afternoon hours from 12:00 to 18:59. Wandering was the most commonly reported activity that led to drowning, accounting for 73.9% of the incidents. Conclusions Fatal drowning in children with ASD typically occur in water bodies near the victims’ homes in the afternoon hours precipitated by wandering. Multifaceted intervention programs are urgently needed to reduce the excess risk of drowning in children with ASD.
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Affiliation(s)
- Joseph Guan
- Department of Epidemiology, Columbia University Mailman School of Public Health, DrPH; 622 West 168th St, New York, NY, PH5-505, USA
| | - Guohua Li
- Department of Epidemiology, Columbia University Mailman School of Public Health, DrPH; 622 West 168th St, New York, NY, PH5-505, USA. .,Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA. .,Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY, USA.
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Alsaif DM, Almadani OM, Ali Almoghannam S, Hamdi D, Al-Farayedhi MA, Kharosha MA. Child Fatalities in Dammam: A Call for Child Fatality Reviews in Arab Countries. J Forensic Sci 2017; 63:1171-1175. [PMID: 29098711 DOI: 10.1111/1556-4029.13685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Abstract
Identifying children's risk exposure is the first step toward mortality prevention. This retrospective study determined the causes of child fatalities in Dammam, Saudi Arabia. Death reports of children and adolescents from 1999 to 2015 (N = 157) were analyzed. Boys represented most cases (69%) and there were two age peaks (1-5 years and 16-18 years). Accidents (typically immersion) defined the main death circumstance (51%) followed by homicide (25%). Only 33% of cases underwent autopsy, and the most common cause of death was head injury (27%) followed by firearm injury. Only one immersion death underwent autopsy. This study revealed important data about the risk exposure of children in Dammam and emphasizes deficient investigative procedures. Child fatality reviews comprise systematic data collection by multidisciplinary teams to determine the true risks toward children in a community. Such teams do not exist in Arab countries; therefore, strategies should be implemented to initiate them.
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Affiliation(s)
- Dalia Mohammed Alsaif
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
| | - Osama M Almadani
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
| | - Salah Ali Almoghannam
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
| | - Dina Hamdi
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
| | - Maram A Al-Farayedhi
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
| | - Magdy A Kharosha
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
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Holland AJ, Soundappan SS. Trauma hazards in children: An update for the busy clinician. J Paediatr Child Health 2017; 53:1096-1100. [PMID: 28665528 DOI: 10.1111/jpc.13603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/17/2017] [Indexed: 12/29/2022]
Abstract
Trauma and injury continue to be common in children and remain an important cause of mortality and morbidity. Legislation mandating the use of helmets for all cyclists appears to have been effective in reducing the incidence and severity of head and facial injuries, with no clear evidence of a reduction in cycling usage or activity. Straddle injuries, whilst uncommon and generally minor, require careful clinical assessment as they may be associated with urethral trauma. Quad bikes remain highly dangerous with continuing reports of deaths in child riders due to their inherent lack of stability: a ban on their use by children would seem the most effective solution. The popularity of mobile devices and toys, coupled with the development of higher voltage, lithium button batteries have seen a surge in the number of cases and subsequent complications from ingestion. The problems seen in children following ingestion of high-powered, rare earth magnets in the late 1990s and 2000s has now receded due to legislation introduced in 2012. Inhaled, typically organic foreign bodies remain a diagnostic challenge with rigid bronchoscopy still the most effective diagnostic and therapeutic modality. Corrosive ingestion, now seen much less commonly, continues to be a potentially devastating injury when occurring as a result of caustic soda. Recent publicity concerning the problem of childhood drowning highlights the need for constant parental vigilance, the limitations of pool fencing and the importance of community cardiopulmonary resuscitation training, together with repeated education of the risk of rips when swimming in the sea.
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Affiliation(s)
- Andrew Ja Holland
- Douglas Cohen Department of Paediatric Surgery, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Soundappan Sv Soundappan
- Douglas Cohen Department of Paediatric Surgery, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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49
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Wu Y, Huang Y, Schwebel DC, Hu G. Unintentional Child and Adolescent Drowning Mortality from 2000 to 2013 in 21 Countries: Analysis of the WHO Mortality Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080875. [PMID: 28777318 PMCID: PMC5580579 DOI: 10.3390/ijerph14080875] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 12/05/2022]
Abstract
Limited research considers change over time for drowning mortality among individuals under 20 years of age, or the sub-cause (method) of those drownings. We assessed changes in under-20 drowning mortality from 2000 to 2013 among 21 countries. Age-standardized drowning mortality data were obtained through the World Health Organization (WHO) Mortality Database. Twenty of the 21 included countries experienced a reduction in under-20 drowning mortality rate between 2000 and 2013, with decreases ranging from −80 to −13%. Detailed analysis by drowning method presented large variations in the cause of drowning across countries. Data were missing due to unspecified methods in some countries but, when known, drowning in natural bodies of water was the primary cause of child and adolescent drowning in Poland (56–92%), Cuba (53–81%), Venezuela (43–56%), and Japan (39–60%), while drowning in swimming pools and bathtubs was common in the United States (26–37%) and Japan (28–39%), respectively. We recommend efforts to raise the quality of drowning death reporting systems and discuss prevention strategies that may reduce child and adolescent drowning risk, both in individual countries and globally.
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Affiliation(s)
- Yue Wu
- Department of Environmental and Occupational Health, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China.
| | - Yun Huang
- Department of Environmental and Occupational Health, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China.
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China.
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50
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Peden AE, Franklin RC, Queiroga AC. Epidemiology, risk factors and strategies for the prevention of global unintentional fatal drowning in people aged 50 years and older: a systematic review. Inj Prev 2017; 24:240-247. [PMID: 28774894 DOI: 10.1136/injuryprev-2017-042351] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/14/2017] [Accepted: 07/05/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE Drowning is a global public health issue and prevention poses an ongoing challenge for all countries. Many nations are experiencing ageing populations, and little is known about the epidemiology, risk factors and prevention of drowning deaths among older people. This paper reports on a systematic review of literature published on drowning among older people. METHODS A systematic literature review was undertaken using English-language, Portuguese-language and Spanish-language papers published between 1980 and 2015. The review explores gaps in the literature with a focus on the epidemiology, risk factors and strategies for the prevention of unintentional fatal drowning among people 50 years and over. RESULTS Thirty-eight papers were deemed relevant to the study design, including 18 (47%) on epidemiology, 19 (50%) on risk factors and 9 (24%) on strategies for prevention. Risk factors identified included male gender, ethnicity, rurality and increasing age. Prevention strategies commonly proposed were education and wearing life jackets. Gaps identified in the published literature include a lack of consistency around age groupings used for epidemiological studies; a lack of consensus on risk factors; a lack of total population, country-level analysis; and the need for older age-specific prevention strategies that have been implemented and their effectiveness evaluated. CONCLUSION This review identified drowning deaths among older people as a global issue. Further work is required to reduce drowning in this cohort. High-quality epidemiological studies identifying risk factors using standardised age groupings to allow for international comparisons are required, as are implementation and evaluation of older age-specific prevention strategies.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Richard C Franklin
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ana Catarina Queiroga
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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