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Annals of Intensive Care Apr 2024Drowning-associated pneumonia (DAP) is frequent in drowned patients, and possibly increases mortality. A better understanding of the microorganisms causing DAP could... (Review)
Review
BACKGROUND
Drowning-associated pneumonia (DAP) is frequent in drowned patients, and possibly increases mortality. A better understanding of the microorganisms causing DAP could improve the adequacy of empirical antimicrobial therapy. We aimed to describe the pooled prevalence of DAP, the microorganisms involved, and the impact of DAP on drowned patients.
METHODS
Systematic review and meta-analysis of studies published between 01/2000 and 07/2023 reporting on DAP occurrence and microorganisms involved.
RESULTS
Of 309 unique articles screened, 6 were included, involving 688 patients. All were retrospective cohort studies, with a number of patients ranging from 37 to 270. Studies were conducted in Europe (France N = 3 and Netherland N = 1), United States of America (N = 1) and French West Indies (N = 1). Mortality ranged between 18 to 81%. The pooled prevalence of DAP was 39% (95%CI 29-48), similarly following freshwater (pooled prevalence 44%, 95%CI 36-52) or seawater drowning (pooled prevalence 42%, 95%CI 32-53). DAP did not significantly impact mortality (pooled odds ratio 1.43, 95%CI 0.56-3.67) but this estimation was based on two studies only. Respiratory samplings isolated 171 microorganisms, mostly Gram negative (98/171, 57%) and mainly Aeromonas sp. (20/171, 12%). Gram positive microorganisms represented 38/171 (22%) isolates, mainly Staphylococcus aureus (21/171, 12%). Water salinity levels had a limited impact on the distribution of microorganisms, except for Aeromonas sp. who were exclusively found following freshwater drowning (19/106, 18%) and never following seawater drowning (0%) (p = 0.001). No studies reported multidrug-resistant organisms but nearly 30% of the isolated microorganisms were resistant to amoxicillin-clavulanate, the drug that was the most commonly prescribed empirically for DAP.
CONCLUSIONS
DAP are commonly caused by Gram-negative bacteria, especially Aeromonas sp. which is exclusively isolated following freshwater drowning. Empirical antimicrobial therapy should consider covering them, noting than amoxicillin-clavulanate may be inadequate in about one-third of the cases. The impact of DAP on patients' outcome is still unclear.
PubMed: 38641650
DOI: 10.1186/s13613-024-01287-1 -
International Journal of Molecular... Feb 2024The study of aquaporins (AQPs) in various forensic fields has offered a promising horizon in response to the need to have reliable elements for the identification of the... (Review)
Review
The study of aquaporins (AQPs) in various forensic fields has offered a promising horizon in response to the need to have reliable elements for the identification of the manner of death and for the individuation of forensic markers for the timing of lesions and vitality of injury. In the literature, various tissues have been studied; the most investigated are the lungs, brain, kidneys, skin, and blood vessels. A systematic literature review on PubMed following PRISMA 2020 guidelines enabled the identification of 96 articles. In all, 34 of these were enrolled to identify Aquaporin-like (AQP-like) forensic markers. The analysis of the literature demonstrated that the most significant markers among the AQPs are as follows: for the brain, AQP4, which is very important in brain trauma and hypoxic damage; AQP3 in the skin lesions caused by various mechanisms; and AQP5 in the diagnosis of drowning. Other applications are in organ damage due to drug abuse and thrombus dating. The focus of this review is to collect all the data present in the literature about the forensic application of AQPs as forensic markers in the most important fields of application. In the current use, the individuation, validation, and application of markers in forensic investigation are very useful in real forensic applications in cases evaluated in court.
Topics: Humans; Aquaporins; Lung; Hypoxia; Brain; Skin
PubMed: 38473914
DOI: 10.3390/ijms25052664 -
BMC Public Health Feb 2024Drowning is a public health problem in Türkiye, as in the rest of the world. This study aims to systematically review the literature on drowning in Türkiye with a...
INTRODUCTION
Drowning is a public health problem in Türkiye, as in the rest of the world. This study aims to systematically review the literature on drowning in Türkiye with a focus on data sources, epidemiology, risk factors and prevention strategies.
METHODS
Literature searches were conducted using PubMed, SPORTSDiscus, Scopus, Web of Science, Turk MEDLINE, Google Scholar and Google Akademik (Turkish language). Studies (limited to original research written in English and Turkish) reporting drowning (unintentional and intentional; fatal and non-fatal) of residents and tourists in Türkiye were independently dual screened at the title and abstract and full text stages. Study quality was assessed using JBI checklists and evidence level assessed based on study design.
RESULTS
From a total of 917 studies, 49 met the inclusion criteria. Most (51%) focused on unintentional fatal drowning. Included studies were most commonly analytical cross-sectional studies (n = 23) and case series (n = 20) meaning the evidence level was low or very low for 48 (98%) studies. Fifteen studies examined drowning at the national level, while sub-national studies (n = 30) focused on urban areas across three provinces: Antalya (n = 6), Istanbul (n = 6), Izmir (n = 4). There was little consensus on risk factors beyond male drowning risk, and no data reported on implemented or evaluated drowning prevention interventions.
DISCUSSION
There is a need for more national-level studies to identify the causes of drowning and to guide intervention implementation and evaluation to inform policy makers and donors. Currently official data is limited in its detail, providing age and gender data only, hampering efforts to identify, and thus address, causal factors for drowning.
PRACTICAL APPLICATIONS
There is currently very little evidence to inform investment in effective drowning prevention interventions in Türkiye. To improve this, data collection systems on drowning in Türkiye need to be strengthened via the development a national drowning registry.
TRIAL REGISTRATION
#CRD42022382615.
Topics: Humans; Male; Drowning; Cross-Sectional Studies; Turkey; Risk Factors; Public Health
PubMed: 38378496
DOI: 10.1186/s12889-024-18032-9 -
Heliyon Jan 2024Identifying risk factors would help consider suicide prevention in any specific population. We aimed to assess suicidal behaviour among university students in the UK.
INTRODUCTION
Identifying risk factors would help consider suicide prevention in any specific population. We aimed to assess suicidal behaviour among university students in the UK.
METHODS
An extensive keyword search was conducted through PubMed, Cochrane, CINHAL Plus, PubMed Central, Web of Science, Trip database, and Science Direct, following the PRISMA guidelines to identify different publications. The search strategy for the literature review was based on the Population Exposure Outcome framework. Critical appraisal utilised the CASP tool for cohort studies and the AXIS tool for cross-sectional studies, resulting in 14 included studies. A narrative synthesis was performed.
RESULTS
Postgraduate and undergraduate students used different suicidal methods such as poisoning, jumping, hanging, drowning, and suffocating, with jumping most preferred by male students. The predisposing factors of suicide among university students included: mental health problems (depression, psychological stress, psychosis, mania, neuroticism, financial anxiety, imperfect parents' connection with students), sexual orientation with risk of suicide among non-heterosexual students due to lowered self-esteem from feeling disregarded, disrespected and insufficient attention from the surrounding. Suicidal behaviour was high among unmarried students, male and unemployed female students, and students with childhood experiences such as physical abuse, family violence, emotional abuse, neglect, and physical punishment-gender, with females seeking more services from general hospitals with more suicide attempts in older females. High risk was also noted in males, with increased risk in white students compared to black students.
CONCLUSION
The review highlighted that students with previous mental health problems, a history of experiencing sexual abuse in childhood, bad relationships with their mother, disrespect and disregard in the community due to sexual identity are the major contributing factors for suicide among university students in the UK.
PubMed: 38293523
DOI: 10.1016/j.heliyon.2024.e24069 -
International Journal of Environmental... Dec 2023This systematic review identifies and describes the use of the Expert Recommendation for Implementing Change (ERIC) concepts and strategies using public health... (Review)
Review
This systematic review identifies and describes the use of the Expert Recommendation for Implementing Change (ERIC) concepts and strategies using public health approaches to drowning prevention interventions as a case study. International calls for action have identified the need to better understand the implementation of drowning prevention interventions so that intervention design and implementation is improved. In high-income countries (HICs), interventions are sophisticated but still little is known or written about their implementation. The review was registered on PROSPERO (number CRD42022347789) and followed the PRISMA guidelines. Eight databases were searched. Articles were assessed using the Public Health Ontario Meta-tool for quality appraisal of public health evidence. Forty-nine articles were included. Where ERIC strategies were reported, the focus was on evaluative and iterative strategies, developing partnerships and engaging the target group. The review identified few articles that discussed intervention development and implementation sufficiently for strategies to be replicated. Findings will inform further research into the use and measurement of implementation strategies by practitioners and researchers undertaking work in drowning prevention in HICs and supports a call to action for better documentation of implementation in public health interventions.
Topics: Humans; Implementation Science; Developed Countries; Drowning; Databases, Factual; Documentation
PubMed: 38248510
DOI: 10.3390/ijerph21010045 -
Journal of Thermal Biology Jan 2024Cold water immersion (CWI) evokes the life-threatening reflex cold shock response (CSR), inducing hyperventilation, increasing cardiac arrhythmias, and increasing... (Meta-Analysis)
Meta-Analysis Review
Cold water immersion (CWI) evokes the life-threatening reflex cold shock response (CSR), inducing hyperventilation, increasing cardiac arrhythmias, and increasing drowning risk by impairing safety behaviour. Repeated CWI induces CSR habituation (i.e., diminishing response with same stimulus magnitude) after ∼4 immersions, with variation between studies. We quantified the magnitude and coefficient of variation (CoV) in the CSR in a systematic review and meta-analysis with search terms entered to Medline, SportDiscus, PsychINFO, Pubmed, and Cochrane Central Register. Random effects meta-analyses, including effect sizes (Cohen's d) from 17 eligible groups (k), were conducted for heart rate (HR, n = 145, k = 17), respiratory frequency (f, n = 73, k = 12), minute ventilation (V, n = 106, k = 10) and tidal volume (V, n = 46, k=6). All CSR variables habituated (p < 0.001) with large or moderate pooled effect sizes: ΔHR -14 (10) bt. min (d: -1.19); Δf -8 (7) br. min (d: -0.78); ΔV, -21.3 (9.8) L. min (d: -1.64); ΔV -0.4 (0.3) L . Variation was greatest in V (control vs comparator immersion: 32.5&24.7%) compared to V (11.8&12.1%). Repeated CWI induces CSR habituation potentially reducing drowning risk. We consider the neurophysiological and behavioural consequences.
Topics: Humans; Cold-Shock Response; Habituation, Psychophysiologic; Drowning; Water; Respiratory Rate; Cold Temperature; Immersion
PubMed: 38211547
DOI: 10.1016/j.jtherbio.2023.103775 -
BMC Sports Science, Medicine &... Jan 2024The study aims to update the specific classification of mechanisms of death in swimming and to demonstrate these categories are reasonable, by analyzing more...
BACKGROUND
The study aims to update the specific classification of mechanisms of death in swimming and to demonstrate these categories are reasonable, by analyzing more characteristics of death cases, evaluating the available evidence and determining their quality.
METHODS
Original articles were queried from PubMed, Web of Science, Embase databases, Cochrane Library, and Scopus. Included studies, which were evaluated as level 4 evidence or higher according to the Oxford Centre for Evidence-Based Medicine, discussed hypothesized mechanisms of death in swimming. Parameters analyzed in this study included decedents' characteristics, outcome measures, findings, methodological index for non-randomized studies (MINORS), and critical evaluation of each study classified by death mechanism.
RESULTS
A total of twenty-five studies were included for further analysis: fourteen were associated with cardiovascular diseases, two were about cerebrovascular diseases, two contained respiratory diseases, seven were about hazardous conditions and three contained other drownings, which provided evidence for mechanisms of death.
CONCLUSIONS
It is found that cardiovascular disease is the main cause or contributing factor of death in swimming. Respiratory diseases and cerebrovascular diseases are difficult to be definitive mechanism categories due to insufficient evidence. Hazardous conditions appear to be one of the possible risk factors because there are more cases of deaths from unsafe environments in swimming, but further statistics and research are still needed to support this view. Our study may have important implications for developing potential prevention strategies for sports and exercise medicine.
TRIAL REGISTRATION
PROSPERO ID (CRD42021267330). Registered Aug 13th 2021.
PubMed: 38167168
DOI: 10.1186/s13102-023-00799-w -
Health Promotion International Oct 2023Little is known about unintentional drowning deaths in Indonesia, the world's fourth most populous and largest archipelagic country. This study aimed to describe the... (Review)
Review
Little is known about unintentional drowning deaths in Indonesia, the world's fourth most populous and largest archipelagic country. This study aimed to describe the epidemiology and risk factors of unintentional drowning in Indonesia and explore existing health promotion and drowning prevention approaches in Indonesia within a socio-ecological health promotion framework. A scoping review, guided by PRISMA-ScR, was conducted to locate peer-reviewed studies and government reports/policy documents published until May 2023, in English or Indonesian language, using MEDLINE (Ovid), CINAHL, Informit, PsycINFO (ProQuest), Scopus, SafetyLit, BioMed Central and Google Scholar, Indonesian journal databases (Sinta, Garuda) and government agencies websites around the terms: drown, swim, flood, hurricane, cyclone, disaster, water rescue and maritime/boat safety. This review identified 32 papers. However, a paucity of information on unintentional drowning rates, risk factors and prevention in Indonesia was noted. The unavailability of a coordinated national drowning data collection system in Indonesia, from which national and subnational subcategory data can be collected, underlines the possibility of under-representation of drowning mortality. The association between various exposures and drowning incidents has not been fully investigated. An over-reliance on individual-focused, behaviour-based, preventive measures was observed. These findings highlight the need for improving drowning surveillance to ensure the availability and reliability of drowning data; and strengthening research to understand the risk factors for drowning and delivery of drowning prevention programs. Further policy development and research focusing on health promotion approaches that reflect a socio-ecological approach to drowning prevention in Indonesia is imperative.
Topics: Humans; Drowning; Indonesia; Reproducibility of Results; Risk Factors; Health Promotion
PubMed: 37851464
DOI: 10.1093/heapro/daad130 -
Children (Basel, Switzerland) Aug 2023Swimming is the only sport providing lifesaving skills, reducing the risk of death by drowning, a top cause of deaths in children aged 1-14 years. Research shows... (Review)
Review
Swimming is the only sport providing lifesaving skills, reducing the risk of death by drowning, a top cause of deaths in children aged 1-14 years. Research shows swimming amongst other sports can aid fundamental movement skill (FMS) development. Therefore, this review investigated the following: (1) how swimming impacts FMS development in children aged 3-11 years, (2) successful tools assessing swimming and FMS, and (3) recommendations appropriate to the UK curriculum based on findings of this study. A systematic literature review using Google Scholar, PubMed, and SPORTDiscuss was conducted to investigate the effects of swimming on FMS development. Methods included database searching, finalising articles appropriate to the inclusion and exclusion criteria, and identifying relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Mixed Methods Appraisal Tool assessed data quality and bias risk, whilst thematic analysis synthesised data alongside descriptive results. Ten papers were synthesised, identifying significant positive impacts of swimming on FMS, including significant pre-post testing ( < 0.01), significant improvements compared to other sports ( < 0.001), and significant improvements in specific motor skills (Balance; = 0.0004). Future research specifically addressing swimming and FMS is essential to improving the curriculum.
PubMed: 37628410
DOI: 10.3390/children10081411 -
Injury Epidemiology Aug 2023Globally, drowning is a leading cause of unintentional injury and death among children. Teaching aquatic competencies (swimming skills and water safety knowledge) to... (Review)
Review
BACKGROUND
Globally, drowning is a leading cause of unintentional injury and death among children. Teaching aquatic competencies (swimming skills and water safety knowledge) to children has been proposed as a prevention strategy. In Australia, however, many children are not meeting standard aquatic competency benchmarks. Exploration of the connection between demographic and background factors and aquatic competencies could provide insight into why differences in acquisition of aquatic knowledge and skills occur.
MAIN BODY
A systematic literature review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed to identify studies that reported on the association between demographic and background factors and aquatic competencies. Nine databases were searched for English language peer-reviewed studies published since 2000. Fourteen studies fulfilled all inclusion criteria. Studies were quasi-experimental or cross-sectional in design, which is considered quality level III-2 or IV, respectively, on the National Health and Medical Research Council Evidence Hierarchy. Study quality was moderate, and risk of bias was high. While aquatic competencies can be taught, this review found that factors including age, gender, geographic residence, medical conditions/disabilities, socioeconomic status, and swimming frequency were significantly associated with the demonstration and/or acquisition of aquatic competencies.
CONCLUSION
This review provides insight into demographic and background factors that are significantly associated with the development of aquatic competence. Whilst further investigation is required to increase the evidence base, these findings may assist in tailoring swimming and water safety programs to accommodate those at-risk of not achieving age-appropriate aquatic competencies.
PubMed: 37553586
DOI: 10.1186/s40621-023-00447-4