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Forensic Science, Medicine, and... Dec 2023This study summarized the available evidence on the differences in volume, density, electrolyte concentration, and total proteins in paranasal sinus fluid between...
Differences in volume, density, electrolyte concentration, and total proteins in the fluid of the paranasal sinuses of freshwater and saltwater drowning victims: a systematic review and meta-analysis.
This study summarized the available evidence on the differences in volume, density, electrolyte concentration, and total proteins in paranasal sinus fluid between freshwater and saltwater drowning victims. A systematic search was conducted in electronic databases and gray literature, resulting in the inclusion of five studies with 234 drowning victims (92 saltwater incidents and 142 freshwater incidents). Meta-analyses using the inverse-of-variance method and a random-effects model were performed, reporting effect sizes as standardized mean differences (SMD) with 95% confidence intervals (CI). The findings showed a significantly higher sinus density in saltwater drowning cases compared to freshwater drowning cases (SMD 0.91, 95% CI 0.50 to 1.32). However, no significant differences were observed in sinus fluid volume. Saltwater drowning victims exhibited higher electrolyte concentrations (sodium: SMD 3.77, 95% CI 3.07 to 4.48; potassium: SMD 0.78, 95% CI 0.07 to 1.49; chloride: SMD 3.48, 95% CI 2.65 to 4.31; magnesium: SMD 4.01, 95% CI 3.00 to 5.03) and lower total protein concentrations (SMD - 1.20, 95% CI - 1.82 to - 0.58) in sinus fluid compared to freshwater drowning victims. This meta-analysis highlights the importance of analyzing the characteristics and composition of sinus fluid in forensic investigations of drowning cases. While no differences were found in sinus fluid volume, saltwater drowning victims exhibited higher sinus density, elevated electrolyte concentrations, and lower total protein concentrations compared to freshwater drowning victims.
PubMed: 38148467
DOI: 10.1007/s12024-023-00761-9 -
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 -
Journal of Forensic and Legal Medicine Oct 2023Drowning is a significant global cause of unintentional injury fatalities, and accurate forensic diagnosis of drowning remains a challenge due to the nonspecific nature... (Meta-Analysis)
Meta-Analysis Review
Drowning is a significant global cause of unintentional injury fatalities, and accurate forensic diagnosis of drowning remains a challenge due to the nonspecific nature of post-mortem findings obtained through classical autopsy methods. Our manuscript addresses this issue by focusing on the emerging use of paranasal sinus fluid as a valuable tool in determining the cause of death, specifically in distinguishing drowning from non-drowning cases. The study provided a comprehensive summary of available evidence from observational studies that compared findings in the paranasal sinuses between drowning and non-drowning victims, analyzing parameters such as the presence of fluid, fluid volume, and density. The study encompassed a total of 14 selected studies involving 1044 subjects and utilized rigorous risk of bias assessment and data synthesis techniques. The meta-analysis demonstrated a strong association between the presence of fluid in the paranasal sinuses and drowning (OR = 17.1; 95% CI 7.2 to 40.5; p < 0.001). In addition, drowning victims had a significantly greater volume of fluid (SMD = 0.8; 95% CI 0.5 to 1.2; p < 0.001) and lower fluid density (SMD = -1.4; 95% -2.5 to -0.4; p = 0.008) compared to non-drowning cases. The results support the utility of paranasal sinus fluid analysis as a valuable diagnostic method in cases where drowning is suspected but cannot be definitively confirmed through traditional approaches.
Topics: Humans; Drowning; Cause of Death; Tomography, X-Ray Computed; Paranasal Sinuses; Autopsy
PubMed: 37717366
DOI: 10.1016/j.jflm.2023.102591 -
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 -
Seizure Aug 2023To document epilepsy-related mortality in sub-Saharan Africa (SSA) and investigate possible associations with onchocerciasis endemicity. (Meta-Analysis)
Meta-Analysis
PURPOSE
To document epilepsy-related mortality in sub-Saharan Africa (SSA) and investigate possible associations with onchocerciasis endemicity.
METHODS
Systematic review with meta-analysis. Searches were performed in PubMed and Google Scholar (search terms: 'epilepsy'; 'mortality/death'; 'sub-Saharan Africa'). Included studies were classified as high-risk or low-risk for onchocerciasis based on documented endemicity data. Pooled mortality rates and annual case fatality rates (CFR) were calculated, and risk factors for mortality among persons with epilepsy (PWE) were investigated using meta-regression analysis.
RESULTS
The 28 eligible studies reported 30 epilepsy surveys, of which 9 (30.0%) were conducted in onchocerciasis high-risk sites. The pooled epilepsy mortality rate was 20.9 (95% CI: 5.9-74.4) per 100,000 person-years, and the pooled CFR was 36.2 (95% CI: 23.9-54.4) per 1,000 PWE per year, albeit with substantial between-study heterogeneity. Compared to onchocerciasis low-risk sites, high-risk sites had higher pooled mortality (342.9 versus 10.0 per 100,000 PY; p<0.001) and CFR (57.0 versus 26.6 per 1,000 PWE per year; p = 0.001). Mortality of PWE was almost five-fold that of people without epilepsy (mortality risk ratio: 4.9; 95% CI: 3.5-6.8). Studies in onchocerciasis high-risk sites and the study which recruited only PWE with nodding syndrome were associated with higher CFR (p = 0.044 and p = 0.002, respectively). The leading causes of epilepsy-related death were status epilepticus (58.5%), drowning (15.7%), and sudden unexpected death in epilepsy (10.1%).
CONCLUSION
Epilepsy mortality remains high in SSA. Most reported causes of death among PWE might be averted by improving seizure control. Better epilepsy prevention and care are urgently needed, particularly in onchocerciasis-endemic settings.
Topics: Humans; Onchocerciasis; Epilepsy; Seizures; Status Epilepticus; Africa South of the Sahara; Prevalence
PubMed: 37451075
DOI: 10.1016/j.seizure.2023.07.006 -
Resuscitation Plus Jun 2023The International Liaison Committee on Resuscitation, in collaboration with drowning researchers from around the world, aimed to review the evidence addressing seven key... (Review)
Review
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 ( = 46 patients, very low certainty of evidence). The two observational studies ( = 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.
PubMed: 37424769
DOI: 10.1016/j.resplu.2023.100406 -
Journal of Safety Research Jun 2023Globally, injuries are a leading cause of mortality and morbidity for adolescents, which disproportionately affect the disadvantaged. To build an investment case for...
INTRODUCTION
Globally, injuries are a leading cause of mortality and morbidity for adolescents, which disproportionately affect the disadvantaged. To build an investment case for adolescent injury prevention, evidence is needed as to effective interventions.
METHODS
A systematic review of peer-reviewed original research published between 2010-2022 was conducted. CINAHL, Cochrane Central, Embase, Medline and PsycINFO databases were searched for studies reporting the effectiveness of unintentional injury prevention interventions for adolescents (10-24 years), with assessment of study quality and equity (e.g., age, gender, ethnicity, socio-economic status).
RESULTS
Sixty-two studies were included; 59 (95.2%) from high-income countries (HIC). Thirty-eight studies (61.3%) reported no aspect of equity. Thirty-six studies (58.1%) reported prevention of sports injuries (commonly neuromuscular training often focused on soccer-related injuries, rule changes and protective equipment). Twenty-one studies (33.9%) reported prevention of road traffic injury, with legislative approaches, commonly graduated driver licensing schemes, found to be effective in reducing fatal and nonfatal road traffic injury. Seven studies reported interventions for other unintentional injuries (e.g., falls).
DISCUSSION
Interventions were strongly biased towards HIC, which does not reflect the global distribution of adolescent injury burden. Low consideration of equity in included studies indicates current evidence largely excludes adolescent populations at increased risk of injury. A large proportion of studies evaluated interventions to prevent sports injury, a prevalent yet low severity injury mechanism. Findings highlight the importance of education and enforcement alongside legislative approaches for preventing adolescent transport injuries. Despite drowning being a leading cause of injury-related harm among adolescents, no interventions were identified.
CONCLUSION
This review provides evidence to support investment in effective adolescent injury prevention interventions. Further evidence of effectiveness is needed, especially for low- and middle-income countries, populations at increased risk of injury who would benefit from greater consideration of equity and for high lethality injury mechanisms like drowning.
Topics: Adolescent; Humans; Drowning; Automobile Driving; Licensure; Accidental Injuries; Athletic Injuries
PubMed: 37330882
DOI: 10.1016/j.jsr.2023.03.005 -
Healthcare (Basel, Switzerland) May 2023The aim of this study was to assess the association between the presence of a right-to-left shunt (RLS) and neurological decompression sickness (NDCS) and asymptomatic... (Review)
Review
OBJECTIVE
The aim of this study was to assess the association between the presence of a right-to-left shunt (RLS) and neurological decompression sickness (NDCS) and asymptomatic brain lesions among otherwise healthy divers.
BACKGROUND
Next to drowning, NDCS is the most severe phenotype of diving-related disease and may cause permanent damage to the brain and spinal cord. Several observational reports have described the presence of an RLS as a significant risk factor for neurological complications in divers, ranging from asymptomatic brain lesions to NDCS.
METHODS
We systematically reviewed the MEDLINE, Embase, and CENTRAL databases from inception until November 2021. A random-effects model was used to compute odds ratios.
RESULTS
Nine observational studies consisting of 1830 divers (neurological DCS: 954; healthy divers: 876) were included. RLS was significantly more prevalent in divers with NDCS compared to those without (62.6% vs. 27.3%; odds ratio (OR): 3.83; 95% CI: 2.79-5.27). Regarding RLS size, high-grade RLS was more prevalent in the NDCS group than the no NDCS group (57.8% versus 18.4%; OR: 4.98; 95% CI: 2.86-8.67). Further subgroup analysis revealed a stronger association with the inner ear (OR: 12.13; 95% CI: 8.10-18.17) compared to cerebral (OR: 4.96; 95% CI: 2.43-10.12) and spinal cord (OR: 2.47; 95% CI: 2.74-7.42) DCS. RLS was more prevalent in divers with asymptomatic ischemic brain lesions than those without any lesions (46.0% vs. 38.0%); however, this was not statistically significant (OR: 1.53; 95% CI: 0.80-2.91).
CONCLUSIONS
RLS, particularly high-grade RLS, is associated with greater risk of NDCS. No statistically significant association between RLS and asymptomatic brain lesions was found.
PubMed: 37239692
DOI: 10.3390/healthcare11101407 -
SAGE Open Medicine 2023Virtual autopsy is a non-invasive/minimally invasive method for conducting an autopsy, with the assistance of imaging techniques. We aim to review the benefits of... (Review)
Review
OBJECTIVE
Virtual autopsy is a non-invasive/minimally invasive method for conducting an autopsy, with the assistance of imaging techniques. We aim to review the benefits of virtual autopsy in detecting pathologies in the paediatric population.
METHOD
The procedure adhered to Institute of Medicine and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Seven databases including MEDLINE and SCOPUS were searched for articles published 2010-2020 worldwide in English. A narrative synthesis of the findings of included studies was carried out to discuss and summarize the results of the review.
RESULTS
From 686 studies on paediatric deaths, 23 met selection/quality criteria. Virtual autopsy was better than conventional autopsy in detecting skeletal lesions and bullet trajectory, thus a crucial tool in the investigation of traumatic and firearm deaths. Virtual autopsy was superior to conventional autopsy in identifying the point of bleeding in postoperative deaths and objectively quantifying air/fluid in body cavities. Virtual autopsy was a useful adjunct for detecting pulmonary thrombo-embolism, foreign body aspiration, drowning and metastatic malignancies. The use of non-contrast imaging in investigating natural paediatric deaths did not offer more information than conventional autopsy. Misinterpretation of normal post-mortem changes as pathological findings was another disadvantage of virtual autopsy leading to erroneous conclusions. But accuracy may be improved with contrast enhancement and post-mortem magnetic resonance imaging.
CONCLUSION
Virtual autopsy is a crucial tool in the investigation of traumatic and firearm deaths in the paediatric population. Virtual autopsy will be useful as an adjunct to conventional autopsy in asphyxial deaths, stillbirths and decomposed bodies. Virtual autopsy has limited value in differentiating antemortem and post-mortem changes with the added risk of misinterpretations, therefore should be used with caution in natural deaths.
PubMed: 37197019
DOI: 10.1177/20503121231172002