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MMWR. Morbidity and Mortality Weekly... May 2024Drowning is the cause of approximately 4,000 U.S. deaths each year and disproportionately affects some age, racial, and ethnic groups. Infrastructure disruptions during...
INTRODUCTION
Drowning is the cause of approximately 4,000 U.S. deaths each year and disproportionately affects some age, racial, and ethnic groups. Infrastructure disruptions during the COVID-19 pandemic, including limited access to supervised swimming settings, might have affected drowning rates and risk. Data on factors that contribute to drowning risk are limited. To assess the potential impact of the pandemic on drowning death rates, pre- and post-COVID-19 pandemic rates were compared.
METHODS
National Vital Statistics System data were used to compare unintentional drowning death rates in 2019 (pre-COVID-19 pandemic onset) with those in 2020, 2021, and 2022 (post-pandemic onset) by age, sex, and race and ethnicity. National probability-based online panel survey (National Center for Health Statistics Rapid Surveys System) data from October-November 2023 were used to describe adults' self-reported swimming skill, swimming lesson participation, and exposure to recreational water.
RESULTS
Unintentional drowning death rates were significantly higher during 2020, 2021, and 2022 compared with those in 2019. In all years, rates were highest among children aged 1-4 years; significant increases occurred in most age groups. The highest drowning rates were among non-Hispanic American Indian or Alaska Native and non-Hispanic Black or African American persons. Approximately one half (54.7%) of U.S. adults reported never having taken a swimming lesson. Swimming skill and swimming lesson participation differed by age, sex, and race and ethnicity.
CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE
Recent increases in drowning rates, including those among populations already at high risk, have increased the urgency of implementing prevention strategies. Basic swimming and water safety skills training can reduce the risk for drowning. Addressing social and structural barriers that limit access to this training might reduce drowning deaths and inequities. The U.S. National Water Safety Action Plan provides recommendations and tools for communities and organizations to enhance basic swimming and water safety skills training.
Topics: Humans; Drowning; Swimming; United States; Male; Adult; Female; Young Adult; Child, Preschool; Adolescent; Child; Middle Aged; Infant; COVID-19; Aged; Self Report; Recreation
PubMed: 38781109
DOI: 10.15585/mmwr.mm7320e1 -
Public Health Reports (Washington, D.C.... May 2024To improve national drowning surveillance efforts, we developed and evaluated a definition for unintentional drowning for use in the National Syndromic Surveillance...
OBJECTIVES
To improve national drowning surveillance efforts, we developed and evaluated a definition for unintentional drowning for use in the National Syndromic Surveillance Program's ESSENCE platform (Electronic Surveillance System for the Early Notification of Community-Based Epidemics) and described drowning-related emergency department (ED) visits from 2019 through 2022 using the new definition.
METHODS
We adapted an unintentional drowning definition from a previous version, which included all drowning-related ED visits regardless of intent (including drowning related to assault and suicide, as well as unintentional drowning). We reviewed a random sample of 1000 visits captured by the new definition of unintentional drowning and categorized visits as likely, possibly, and unlikely to be related to unintentional drowning. We compared monthly drowning-related ED visits from 2020, 2021, and 2022 with monthly drowning ED visits from 2019, overall and by sex and age group.
RESULTS
A total of 35 431 ED visits related to unintentional drowning (10.71 per 100 000 ED visits) occurred from 2019 through 2022. Most visits (86%) captured by the new definition and manually reviewed were likely related to unintentional drowning. Rates were highest among males (14.04 per 100 000 ED visits) and children aged <1 to 4 years (65.61 per 100 000 ED visits). The number of drowning-related ED visits was higher in May and August 2020, May and June 2021, and May 2022 as compared with the same months in 2019 among people aged 18 to 44 years.
CONCLUSIONS
The definition for unintentional drowning is available in the National Syndromic Surveillance Program's ESSENCE platform for state and local jurisdictions to use to monitor unintentional drowning-related ED visits in near-real time to inform prevention strategies.
PubMed: 38780017
DOI: 10.1177/00333549241249675 -
PloS One 2024Drowning is an overlooked public health concern and drowning risk is dependent on environmental risk factors. The preponderance of drowning deaths occurs in low- and...
Drowning is an overlooked public health concern and drowning risk is dependent on environmental risk factors. The preponderance of drowning deaths occurs in low- and middle-income countries. Small-scale fishers face high occupational risk of drowning. Climate change increases the frequency and intensity of storms, thereby exacerbating fishers' risks and creating a need to examine the contribution of storms to fisher drowning deaths for the development of mitigation strategies. We examined this relationship between weather and fisher drowning deaths in Lake Victoria, which is Africa's largest lake, a site of high fishing pressure, and where climate change is predicted to increase thunderstorms. We conducted a verbal autopsy with people knowledgeable about recent fatal fisher drowning incidents to collect information about the deceased fishers and circumstances surrounding the incidents across 43 landing sites in the Kenyan shore of Lake Victoria. Semi-structured interviews with stakeholders also elucidated community perspectives on drowning risks. Fatal drownings were often attributed to bad weather (41.8%). Other risk factors, such as non-use of life jacket and navigation equipment, co-occurred with bad weather at high rates (69.5% and 67.8%, respectively) to jointly contribute to fatal drowning incidents. Such co-occurrence of risk factors indicates that actions across multiple risk factors can help mitigate the issue. Stakeholder analysis revealed a range of opportunities for improved communication of risks and action to mitigate risks across boat operators and manufacturers, as well as multiple levels of management. Across global small-scale fisheries, limited use of safety equipment and intensive fishing pressure may coincide with increases in extreme weather events, necessitating action to address current and mitigate future drowning risks to small-scale fishers.
Topics: Humans; Drowning; Climate Change; Male; Adult; Risk Factors; Female; Middle Aged; Fisheries; Kenya; Young Adult; Lakes; Adolescent; Weather; Aged; Accidents, Occupational
PubMed: 38776265
DOI: 10.1371/journal.pone.0302397 -
BMJ Open May 2024This study aimed to determine whether the association between conventional bystander cardiopulmonary resuscitation (BCPR) and better outcomes in drowning-associated... (Observational Study)
Observational Study
Advantages of bystander-performed conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest presumably caused by drowning in Japan: a propensity score-matching analysis using an extended nationwide database.
OBJECTIVES
This study aimed to determine whether the association between conventional bystander cardiopulmonary resuscitation (BCPR) and better outcomes in drowning-associated out-of-hospital cardiac arrest (OHCA) differs between young and older people or between non-medical and medical drowning in Japan.
DESIGN
Observational study.
SETTING
This study used data from the Japanese Fire and Disaster Management Agency databases.
PARTICIPANT
Of the 504 561 OHCA cases recorded in the nationwide database between 2016 and 2019, 16 376 (3.2%) were presumably caused by drowning.
MAIN OUTCOME MEASURE
The main outcomes were a 1-month neurological prognosis defined as cerebral performance category 1 or 2 and 1-month survival as measures.
RESULT
The incidence of drowning as a presumed cause of OHCA was high in the winter and the middle-aged and older generations in Japan. However, OHCA caused by drowning in the younger generation frequently occurs in the summer. Furthermore, younger patients had higher incidences of bystander-witnessed cardiac arrest (22.0%), BCPR provision (59.3%) and arrest in outdoor settings (54.0%) than middle-aged and older generations (5.9%, 46.1% and 18.7% respectively). If the patient was younger or the arrest was accidental, the conventional BCPR group had better neurological outcomes than the compression-only BCPR group (95% CI of adjusted OR, 1.22 to 12.2 and 1.80 to 5.57, respectively). However, in the case of middle-aged and older generations and medical categories, there was no significant difference in outcomes between the two types of BCPR. This conventional group's advantage was maintained even after matching.
CONCLUSION
Conventional bystander CPR yielded a higher neurologically favourable survival rate than compression-only BCPR for OHCA caused by drowning if the patient was younger or the arrest was non-medical. Conventional CPR education for citizens who have the chance to witness drownings should be maintained.
Topics: Humans; Out-of-Hospital Cardiac Arrest; Japan; Male; Female; Middle Aged; Cardiopulmonary Resuscitation; Aged; Drowning; Adult; Propensity Score; Databases, Factual; Aged, 80 and over; Young Adult; Incidence
PubMed: 38772590
DOI: 10.1136/bmjopen-2023-080579 -
Cureus Apr 2024Hypercalcemia is generally treated conservatively, including massive fluid administration. However, in cases of acute respiratory distress syndrome (ARDS) associated...
Hypercalcemia is generally treated conservatively, including massive fluid administration. However, in cases of acute respiratory distress syndrome (ARDS) associated with drowning, excessive fluid administration may worsen respiratory status. An 81-year-old female was found drowned in a hot spring at an accommodation facility and urgently transported to our hospital. On arrival, the patient exhibited severe respiratory failure, impaired consciousness, and bilateral lung infiltrates on computed tomography (CT), suggesting ARDS. Blood biochemical tests showed calcium (Ca) of 17.4 mg/dL, with altered consciousness attributed to hypercalcemia. Because of concerns about further deterioration of respiratory status, hemodialysis was performed to avoid massive fluid administration. Post-hemodialysis, blood calcium levels quickly decreased, leading to improved consciousness and respiration; the patient was extubated 48 hours post-admission. Subsequent examinations identified hot spring water aspiration as the cause of hypercalcemia. For hypercalcemia from hot spring drowning with acute respiratory distress syndrome, consider early hemodialysis initiation without excessive fluid administration.
PubMed: 38765426
DOI: 10.7759/cureus.58431 -
Indian Journal of Critical Care... May 2024Kumar V. VeXUS: Do Not Drown in the ExCESS. Indian J Crit Care Med 2024;28(5):419-421.
Kumar V. VeXUS: Do Not Drown in the ExCESS. Indian J Crit Care Med 2024;28(5):419-421.
PubMed: 38738201
DOI: 10.5005/jp-journals-10071-24711 -
BMJ Open May 2024To assess the feasibility and change in clinical outcomes associated with continuous glucose monitoring (CGM) use among a rural population in Malawi living with type 1... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To assess the feasibility and change in clinical outcomes associated with continuous glucose monitoring (CGM) use among a rural population in Malawi living with type 1 diabetes.
DESIGN
A 2:1 open randomised controlled feasibility trial.
SETTING
Two Partners In Health-supported Ministry of Health-run first-level district hospitals in Neno, Malawi.
PARTICIPANTS
45 people living with type 1 diabetes (PLWT1D).
INTERVENTIONS
Participants were randomly assigned to Dexcom G6 CGM (n=30) use or usual care (UC) (n=15) consisting of Safe-Accu glucose monitors and strips. Both arms received diabetes education.
OUTCOMES
Primary outcomes included fidelity, appropriateness and severe adverse events. Secondary outcomes included change in haemoglobin A1c (HbA1c), acceptability, time in range (CGM arm only) SD of HbA1c and quality of life.
RESULTS
Participants tolerated CGM well but were unable to change their own sensors which resulted in increased clinic visits in the CGM arm. Despite the hot climate, skin rashes were uncommon but cut-out tape overpatches were needed to secure the sensors in place. Participants in the CGM arm had greater numbers of dose adjustments and lifestyle change suggestions than those in the UC arm. Participants in the CGM arm wore their CGM on average 63.8% of the time. Participants in the UC arm brought logbooks to clinic 75% of the time. There were three hospitalisations all in the CGM arm, but none were related to the intervention.
CONCLUSIONS
This is the first randomised controlled trial conducted on CGM in a rural region of a low-income country. CGM was feasible and appropriate among PLWT1D and providers, but inability of participants to change their own sensors is a challenge.
TRIAL REGISTRATION NUMBER
PACTR202102832069874.
Topics: Humans; Malawi; Diabetes Mellitus, Type 1; Female; Male; Feasibility Studies; Blood Glucose Self-Monitoring; Adult; Glycated Hemoglobin; Hospitals, District; Blood Glucose; Middle Aged; Quality of Life; Rural Population; Continuous Glucose Monitoring
PubMed: 38719319
DOI: 10.1136/bmjopen-2023-075554 -
BMJ Open May 2024The purpose of this qualitative study is to describe the acceptability and appropriateness of continuous glucose monitoring (CGM) in people living with type 1 diabetes... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
The purpose of this qualitative study is to describe the acceptability and appropriateness of continuous glucose monitoring (CGM) in people living with type 1 diabetes (PLWT1D) at first-level (district) hospitals in Malawi.
DESIGN
We conducted semistructured qualitative interviews among PLWT1D and healthcare providers participating in the study. Standardised interview guides elicited perspectives on the appropriateness and acceptability of CGM use for PLWT1D and their providers, and provider perspectives on the effectiveness of CGM use in Malawi. Data were coded using Dedoose software and analysed using a thematic approach.
SETTING
First-level hospitals in Neno district, Malawi.
PARTICIPANTS
Participants were part of a randomised controlled trial focused on CGM at first-level hospitals in Neno district, Malawi. Pretrial and post-trial interviews were conducted for participants in the CGM and usual care arms, and one set of interviews was conducted with providers.
RESULTS
Eleven PLWT1D recruited for the CGM randomised controlled trial and five healthcare providers who provided care to participants with T1D were included. Nine PLWT1D were interviewed twice, two were interviewed once. Of the 11 participants with T1D, six were from the CGM arm and five were in usual care arm. Key themes emerged regarding the appropriateness and effectiveness of CGM use in lower resource setting. The four main themes were (a) patient provider relationship, (b) stigma and psychosocial support, (c) device usage and (d) clinical management.
CONCLUSIONS
Participants and healthcare providers reported that CGM use was appropriate and acceptable in the study setting, although the need to support it with health education sessions was highlighted. This research supports the use of CGM as a component of personalised diabetes treatment for PLWT1D in resource constraint settings.
TRIAL REGISTRATION NUMBER
PACTR202102832069874; Post-results.
Topics: Humans; Malawi; Diabetes Mellitus, Type 1; Male; Qualitative Research; Female; Adult; Blood Glucose Self-Monitoring; Patient Acceptance of Health Care; Middle Aged; Blood Glucose; Interviews as Topic; Hospitals, Rural; Hospitals, District; Continuous Glucose Monitoring
PubMed: 38719287
DOI: 10.1136/bmjopen-2023-075559 -
Clinical Nephrology. Case Studies 2024A 19-year-old woman with a history of asthma presented with acute confusion following a near-drowning event 2 weeks prior to admission. She was found to have severe...
A 19-year-old woman with a history of asthma presented with acute confusion following a near-drowning event 2 weeks prior to admission. She was found to have severe thrombocytopenia and microangiopathic hemolytic anemia (MAHA). The treatment for thrombotic thrombocytopenic purpura (TTP) was started on the day of admission due to high clinical suspicion. Subsequent workup confirmed a diagnosis of TTP with no clear etiology except the near-drowning incident. TTP following a near-drowning event has never been reported in the literature. Furthermore, she developed refractory TTP that required reinitiation of therapeutic plasma exchange and rituximab. After discharge, the patient had been doing well over a year of follow-up without remission.
PubMed: 38716112
DOI: 10.5414/CNCS111301 -
Aerospace Medicine and Human Performance May 2024Although an unintended aircraft landing on water (referred to as ditching) is a rare event, the potential for occupant injury/fatality increases immediately following...
Although an unintended aircraft landing on water (referred to as ditching) is a rare event, the potential for occupant injury/fatality increases immediately following the event due to adverse conditions. However, to date, few studies have addressed the subject. Herein, ditching events and post-ditching survival were investigated. Ditchings (1982-2022) in the United States were identified from the National Transportation Safety Board database. Occupant injury severity, aircraft type, pilot experience, flight conditions, and number of occupants were extracted. Poisson distribution, the Chi-squared test (2-tailed), Mann-Whitney U test, and Kruskal-Wallis one-way analysis of variance were employed. A total of 96 ditchings were identified. A systematic survey was hampered by the lack of a standardized reporting matrix in the reports. In total, 77 reports were included in the analysis. Across all ditchings, 128 of 169 (76%) occupants survived ditching and were rescued. Importantly, the initial ditching event was survived by 95% of all occupants. However, 32 (19%) occupants died post-ditching by drowning (21/32 cases) or for undetermined reasons. Considering probability per ditching event, in 26 (34%) of all ditchings, one or more occupants was/were fatally injured. Initial survival of the emergency ditching is high. Drowning was the leading cause of death after ditching and reduced the overall survival to 76%. Further investigation is needed to identify risk factors for fatal outcomes and/or improve probability of survival after ditching.
Topics: Humans; Accidents, Aviation; United States; Aircraft; Drowning; Male; Databases, Factual; Pilots
PubMed: 38715275
DOI: 10.3357/AMHP.6332.2024