Submersion injuries in children younger than 5 years in urban Utah.

Submersion injuries of children younger than 5 years in 4 urban Utah counties from 1984 through 1988 were studied retrospectively to identify associated risk factors. Infants younger than 1 year had the highest rates of both submersion injuries and deaths. The incidence of bathtub drownings was 2 to 3 times higher than reported national rates. All bathtub drownings occurred while the victim was bathing with a young sibling (10 months to 7 years of age) without adult supervision. All drownings in pools and moving bodies of water (rivers, irrigation ditches) resulted from unintentional falls into the water rather than from swimming and wading activities. Drowning prevention strategies should focus on educating parents about the risk of young children bathing with siblings in the absence of adult supervision and fencing regulations for pools and open bodies of moving water.     

Drowning risks to epileptic children: a study from Hawaii.

The role of epileptiform seizures in causing drowning and near-drowning among children was studied by examining the case reports of all 140 childhood immersion accidents that occurred in an area of Hawaii over five years. Four of the 140 immersion accidents were caused partly by epileptiform seizures, but none were fatal. The combined results of the Hawaiian and Brisbane studies (total population studied over five years 1 600 000) showed that no epileptic children died from accidents in the sea or in swimming pools; and the 2.9% incidence of immersion accidents due to seizures in the Hawaiian study compares well with the incidence found in other series. If an epileptic child is mentally normal, well controlled with anticonvulsants, and supervised in the water then the risk of drowning is very small.     

Content Analysis of Printed News Media Related to Drowning Incidents in Turkey

Drowning is a major public health problem in Turkey as it is for other countries. According to the latest statistics, the annual average number of people who drowned in the rivers, lakes, or seas of Turkey is 642. An examination of the language and the presentation style that the media use while covering the news about drowning cases may help us to determine the risk factors of the drowning cases and reduce the number. This study aims to show the awareness level of the Turkish print media on preventing drowning incidents and to discuss the steps to be taken in the Turkish media in order to prevent drowning. To this end, attitudes and presentations of three best-selling newspapers in Turkey—Zaman, Posta, and Hürriyet—and a less-selling one, Cumhuriyet, were studied in accordance with the content analysis method. The results show that the awareness of the Turkish media to prevent drowning incidents is inadequate. The number of drowning cases covered by these newspapers are very few, and they emphasis the forensic aspect of the incidents by using dramatic language without background information.     

Identification of Naegleria fowleri in domestic water sources by nested PCR

The free-living amoeboflagellate Naegleria fowleri is the causative agent of primary amoebic meningoencephalitis (PAM), a rapidly fatal disease of the central nervous system. In the United States, the disease is generally acquired while swimming and diving in freshwater lakes and ponds. In addition to swimming, exposure to N. fowleri and the associated disease can occur by total submersion in bathwater or small backyard wading pools. In the present study, swipe samples and residual pipe water from homes in Arizona were examined for N. fowleri by nested PCR due to the death of two previously healthy children from PAM. Since neither child had a history of swimming in a freshwater lake or pond prior to the onset of disease symptoms, the domestic water supply was the suspected source of infection. Of 19 samples collected from bathroom and kitchen pipes and sink traps, 17 samples were positive for N. fowleri by PCR. A sample from a Micro-Wynd II filter was obtained by passing water from bathtubs through the filter. Organisms attached to the filter also tested positive by PCR. The two samples that tested negative for N. fowleri were one that was obtained from a kitchen sink trap and a swipe sample from the garbage disposal of one home.     

Causes of fatal childhood accidents involving head injury in northern region, 1979-86.

OBJECTIVE--To examine the causes and circumstances surrounding fatal accidents involving head injuries in children in the Northern region. DESIGN--Retrospective review of the hospital case notes, necropsy reports, and records of the coroners'' inquests. SETTING--Northern Regional Health Authority. PATIENTS--All 255 children aged less than 16 years who died with a head injury during 1979-86. MAIN OUTCOME MEASURES--Cause of injury and circumstances of accident according to reports of inquests; injury severity score; number of fatal accidents and mortality per 100,000 children in 10 groups of local authority wards ranked according to their score on the overall deprivation index; and distance of site of accident from child''s home. RESULTS--Of the 255 children who died after a head injury, 136 (53%) children were playing at the time of the accident. 195 (76%) children sustained the head injury in road traffic accidents, 135 as pedestrians, 35 as cyclists, and 25 as passengers in a vehicle. In 120 accidents in child pedestrians the primary cause of accident was the unsafe behaviour of the child. 172 (67%) accidents occurred within one to two km of the child''s home and 153 (63%) between 3 pm and 9 pm. The mortality was significantly related to social deprivation; excluding eight children injured while on holiday in the region, 15-fold decrease in mortality was recorded between the local authority wards that ranked highest on the overall deprivation index and those that ranked lowest (14.0/100,000 children, group 10 v 0.9/100,000, group 1 respectively, p less than 0.00001). CONCLUSIONS--The finding that most accidents occurred in children living in deprived areas who were playing unsupervised near their home suggests that childhood mortality might be appreciably reduced if children at play were protected from traffic, particularly in socially deprived areas.     

Insulin dependent diabetes in children under 5: incidence and ascertainment validation for 1992.

OBJECTIVE--To establish the incidence of insulin dependent diabetes diagnosed in children under 5 years of age in the British Isles during 1992, comparing the national and regional results with those of our 1988 national study, and estimating the 1992 study''s level of case ascertainment. DESIGN--Active monthly reporting of cases by consultant paediatricians through the framework of the British Paediatric Surveillance Unit, with additional reports from specialist diabetes nurses and regional health authorities. SUBJECTS--All children diagnosed under the age of 5 years with primary insulin dependent diabetes from 1 January to 31 December 1992 (inclusive) and resident in the British Isles at diagnosis. RESULTS--387 children (208 boys and 179 girls) were confirmed to have insulin dependent diabetes, giving a national incidence of 9.3/100,000/year. This is similar to the 9.9/100,000/year found in 1988. Three sample capture-recapture analysis, which could only be applied across the 12 (out of 18) regions supplying regional information to the study, suggested ascertainment rates of 78% for the British Paediatric Surveillance Unit, 67% for specialist nurses, 69% for regional health authorities, and 99% for the aggregated registry. CONCLUSIONS--The national incidence of diabetes in the under 5s in the British Isles did not differ between 1988 and 1992. Nearly complete (99%) ascertainment of cases was possible only for regions for which three data sources were available. Capture-recapture analysis highlighted both the need for more than one data source and for each data source to be complete for the whole study area.     

Identification of Naegleria fowleri in Domestic Water Sources by Nested PCR

The free-living amoeboflagellate Naegleria fowleri is the causative agent of primary amoebic meningoencephalitis (PAM), a rapidly fatal disease of the central nervous system. In the United States, the disease is generally acquired while swimming and diving in freshwater lakes and ponds. In addition to swimming, exposure to N. fowleri and the associated disease can occur by total submersion in bathwater or small backyard wading pools. In the present study, swipe samples and residual pipe water from homes in Arizona were examined for N. fowleri by nested PCR due to the death of two previously healthy children from PAM. Since neither child had a history of swimming in a freshwater lake or pond prior to the onset of disease symptoms, the domestic water supply was the suspected source of infection. Of 19 samples collected from bathroom and kitchen pipes and sink traps, 17 samples were positive for N. fowleri by PCR. A sample from a Micro-Wynd II filter was obtained by passing water from bathtubs through the filter. Organisms attached to the filter also tested positive by PCR. The two samples that tested negative for N. fowleri were one that was obtained from a kitchen sink trap and a swipe sample from the garbage disposal of one home.     

Acute Spinal-Cord Lesions from Diving—Epidemiological and Clinical Features

The aquatic activity that produces the greatest number of spinal-cord lesions is diving. Persons in the general population at greatest risk are males aged 15 to 19 years. Of the cases identified, 45 percent resulted from diving into a river or stream, 27 percent into swimming pools and 28 percent into lakes, reservoirs or the ocean. Distribution by age differed for the major groups of bodies of water. The incidence of spinal-cord injuries was related to season (spring-summer) and day of the week (weekends). The incidence of injuries was highest in those county areas with the least opportunity for exposure to swimming pools or rivers. Of the injured persons, 60 percent were tetraplegic at hospital admission. The most frequent radiologic finding was wedge fracture. This finding, in the absence of objective evidence that most divers struck the bottom of the water reservoir or a hard object, suggests that hyperventroflexion was the mechanism responsible for injury in most of the cases. Physicians and others should be aware of strategy options for preventing or reducing such injuries.     

Distribution, movements, and mortality of anadromous arctic char, Salvelinus alpinus L., in the Cumberland Sound area of Baffin Island

During 1972 the downstream movement of anadromous artic char, Salvelinus alpinus L., from two rivers flowing into Cumberland Sound, Baffin Island, began during the middle of May and was completed within 2 weeks. This movement took place during both the day and night. Upon reaching saltwater, many char older than 9 years (longer than 20 cm) began to migrate along the shore of the Sound at a rate of 0–6–0-9 km/day with the result that the average maximum distance travelled from the natal river was 40–50 km. Char 6–9 years old, 10–20 cm in length, remained much closer to the rivers while those younger than 5 years never entered saltwater. During the period of saltwater residence, the fish frequently moved into the intertidal zone and freshwater. Maturing fish of both sexes were occasionally found in saltwater. The upstream migration to the lakes began during the second week of August and was completed within 5–6 weeks. Females tended to ascend the rivers before males, although fish of all different size and age migrated upstream simultaneously. Migration occurred during both the day and night. The maximum distance anadromous char moved from saltwater was 40 km. The char were found only in freshwater between May and September and were normally located near the bottom of lakes at a depth of 15–40 m. During this period, large scale movements were probably very limited. Average annual mortality was estimated at 16.0% per year with the highest rates (25–30%) occurring at ages 10 and 15–17 years. Many fish probably died of old age but physical deterioration during and after spawning was also an important cause of death.     

Viruses in recreational water‐borne disease outbreaks: a review

Viruses are believed to be a significant cause of recreationally associated water‐borne disease. However, they have been difficult to document because of the wide variety of illnesses that they cause and the limitations in previous detection methods. Noroviruses are believed to be the single largest cause of outbreaks, which have been documented in the published literature 45% (n = 25), followed by adenovirus (24%), echovirus (18%), hepatitis A virus (7%) and coxsackieviruses (5%). Just under half of the outbreaks occurred in swimming pools (49%), while the second largest outbreak occurred in lakes or ponds (40%). The number of reported outbreaks associated with noroviruses has increased significantly in recent years probably because of better methods for virus detection. Inadequate disinfection was related to 69% (n = 18) of swimming pool outbreaks. A lack of required reporting and nonuniform water quality and chlorination/disinfection standards continues to contribute to water‐borne recreational disease outbreaks.     

SURVIVAL OF HELICOVERPA PUNCTIGERA (WALLENGREN) AND H. ARMIGERA (HÜBNER) (LEPIDOPTERA: NOCTUIDAE) PUPAE SUBMERGED IN WATER

The effect of varying periods of submersion in water on survival of non-diapausing pupae of Helicoverpa punctigera (Wallengren) and H. armigera (Hübner) was investigated. At 25°C the submersion time to kill 50% of pupae was 49 h for H. punctigera and 35 h for H. armigera . Since pupae survive relatively long periods under water, drowning may not be an important mortality factor in the field except when prolonged waterlogging occurs.     

The link between medical conditions and fatal drownings in Canada: a 10-year cross-sectional analysis

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.

Drowning is an important cause of death in Canada and some aspects of its epidemiology have been characterized.^1,2 Identifying and addressing risk factors for fatal drowning can save lives. For example, after research showed a considerable proportion of child drownings occurred in unsecured household pools and the effectiveness of pool fencing at reducing these deaths, legislative changes were introduced in Quebec.^3–5Although studies evaluating risk factors frequently focus on modifiable environmental or behavioural factors (e.g., infant bath seats, supervision status or alcohol and drug use),^6–11 limited research has evaluated the relation between pre-existing medical conditions and the risk of drowning.Studies that have evaluated the association between pre-existing medical conditions and drowning are limited by small sample sizes and narrow focus on certain conditions (e.g., autism spectrum disorder, epilepsy), or are age-specific (e.g., children).^12–17 The association between various pre-existing medical conditions and drowning in different age groups is not well understood. This information could assist with the development of targeted drowning prevention strategies and prioritizing of resources spent on prevention.Forty-four percent of Canadian adults have at least 1 chronic disease, which suggests that millions of Canadians with conditions that potentially impair their heart, lungs or brain participate in water activities.¹⁸ Furthermore, swimming and aquatic fitness is often encouraged for those with chronic illness to promote health.^19,20 However, the public and physicians should be aware of pre-existing medical conditions that might place people at a higher risk of drowning, so that appropriate precautions can be taken to ensure safety while participating in aquatic activities.We sought to describe pre-existing medical conditions by age group among people who fatally drowned in Canada and to evaluate the risk of fatal drowning among people with common conditions to inform future public health interventions.     

Drowning Mortality and Morbidity Rates in Children and Adolescents 0-19yrs: A Population-Based Study in Queensland,Australia

ObjectiveTo redress the lack of Queensland population incidence mortality and morbidity data associated with drowning in those aged 0-19yrs, and to understand survival and patient care.ResultsDrowning death to survival ratio was 1:10, and two out of three of those who survived were admitted to hospital. Incidence rates for fatal and non-fatal drowning increased over time, primarily due to an increase in non-fatal drowning. There were non-significant reductions in fatal and admission rates. Rates for non-fatal drowning that did not result in hospitalisation more than doubled over the seven years. Children aged 5-9yrs and 10-14yrs incurred the lowest incidence rates 6.38 and 4.62 (expressed as per 100,000), and the highest rates were among children aged 0-4yrs (all drowning events 43.90; fatal 4.04; non-fatal 39.85–comprising admission 26.69 and non-admission 13.16). Males were over-represented in all age groups except 10-14yrs. Total male drowning events increased 44% over the seven years (P<0.001).ConclusionThis state-wide data collection has revealed previously unknown incidence and survival ratios. Increased trends in drowning survival rates may be viewed as both positive and challenging for drowning prevention and the health system. Males are over-represented, and although infants and toddlers did not have increased fatality rates, they had the greatest drowning burden demonstrating the need for continued drowning prevention efforts.     

Insulin dependent diabetes in childhood and material deprivation in northern England, 1977-86.

OBJECTIVE--To determine the incidence of insulin dependent diabetes in the Northern region of England in children less than 16 years old in the period 1977 to 1986 and to relate the incidence data to an index of deprivation. DESIGN--Retrospective analysis of hospital case records identified from the regional health authority''s computer; validation of the primary source with hospital clinic registers and community paediatric registers. SETTING--Northern region, excluding South Cumbria District Health Authority (659,300 children under 16 in 1981). PATIENTS--All children diagnosed with insulin dependent diabetes before the age of 16 and resident in the region at time of diagnosis. MAIN OUTCOME MEASURES--Incidence rates for the 10 year period and analysis of incidence rates within categories of deprivation. RESULTS--919 incident cases were identified. The validation procedure covered 54% of all cases identified and gave 95% completeness of ascertainment. The average annual incidence over the 10 year period was 14.8/100,000 for girls and 13.4/100,000 for boys. The annual incidence for the most and least deprived areas of the region was 18.7/100,000 (95% confidence interval 16.2 to 21.5) for boys and 7/100,000 (5.6 to 8.8) for girls. There was a highly significant trend (p less than 0.001) of decreasing incidence with decreasing level of deprivation. CONCLUSIONS--In the north of England the incidence of childhood diabetes is related to material deprivation.     

Benefits of swimming pools in two remote Aboriginal communities in Western Australia: intervention study

Objective To determine the health impact of swimming pools built with the aim of improving quality of life and reducing high rates of pyoderma and otitis media.Design Intervention study assessing prevalence of ear disease and skin infections before and at six monthly intervals after opening of swimming pools.Setting Two remote Aboriginal communities in Western Australia.Participants 84 boys and 78 girls aged < 17 years.Main outcome measures Changes in prevalence and severity of pyoderma and perforation of tympanic membranes with or without otorrhoea over 18 months after opening of pools.Results In community A, 61 children were seen before the pool was opened, and 41, 46, and 33 children were seen at the second, third, and fourth surveys. Equivalent figures for community B were 60, 35, 39, and 45. Prevalence of pyoderma declined significantly from 62% to 18% in community A and from 70% to 20% in community B during the 18 months after the pools opened. Over the same period, prevalence of severe pyoderma fell from 30% to 15% in community A and from 48% to 0% in community B. Prevalence of perforations of the tympanic membrane fell from 32% in both communities to 13% in community A and 18% in community B. School attendance improved in community A.Conclusion Swimming pools in remote communities were associated with reduction in prevalence of pyoderma and tympanic membrane perforations, which could result in long term benefits through reduction in chronic disease burden and improved educational and social outcomes.     

Structure and dynamics of the trophic spectrum of the American mink (<Emphasis Type="Italic">Neovison vison</Emphasis>) in the Southern Urals

The peculiarities of feeding of the American mink (Neovison vison) near lakes and mountain rivers of the Southern Urals are studied. Significant differences are shown between structure and dynamics of the mink diet near lakes and mountain rivers. The diet of minks near mountain rivers depends on the abundance of small-sized mammals inhabited at the banks, which is determined by properties of the hydrological regime in each season.     

Cryptococcosis in Colombian children and literature review

Cryptococcosis is reported in adults and is often acquired immune deficiency syndrome (AIDS)-associated; however, its frequency in children is low. Based on the National Survey on Cryptococcosis conducted in Colombia, an epidemiological and clinical analysis was performed on cases of the disease observed in children less than 16 years old between 1993-2010. We found 41 affected children (2.6% prevalence) from the 1,578 surveys received. The country mean annual incidence rate was 0.017 cases/100,000 children under 16 years, while in Norte de Santander the incidence rate was 0.122 cases/100,000 (p < 0.0001). The average age of infected children was 8.4 and 58.5% were male. In 46.3% of cases, a risk factor was not identified, while 24.4% had AIDS. The most frequent clinical manifestations were headache (78.1%), fever (68.8%), nausea and vomiting (65.6%), confusion (50%) and meningeal signs (37.5%). Meningitis was the most frequent clinical presentation (87.8%). Amphotericin B was given to 93.5% of patients as an initial treatment. Positive microbiological identification was accomplished by India ink (94.7%), latex in cerebrospinal fluid (100%) and culture (89.5%). Out of 34 isolates studied, Cryptococcus neoformans var. grubii (VNI 85.3%, VNII 8.8%) was isolated in 94.1% of cases and Cryptococcus gattii (VGII) was isolated in 5.9% of cases. These data are complemented by a literature review, which overall suggests that cryptococcosis in children is an unusual event worldwide.     

Progressive drowning of carbonate platform in the Moravo-Silesian Basin (Czech Republic) before the Frasnian/Famennian event: facies,compositional variations and gamma-ray spectrometry

The Moravo-Silesian Basin (MSB; eastern Czech Republic and southern Poland) hosted an extensive shallow-water carbonate platform in the Middle Devonian to Frasnian interval. The platform drowned in a stepwise fashion from the Palmatolepis hassi to the Pa. linguiformis zone. Three types of drowning successions were revealed from conodont biostratigraphy, facies, microfacies and gamma-ray spectrometry data: (A) drowning to periplatform turbidite setting; (B) drowning to (hemi)pelagic seamount setting and (C) drowning associated with the stratigraphical gap. In the lower Pa. hassi zone, rapid subsidence caused the platform to drown locally along the N–S to NW–SE trending faults (type A drowning). In the upper Pa. rhenana to the Pa. linguiformis zone, the drowning accelerated in the western part of the MSB due to locally higher subsidence rates combined with the Late Frasnian biotic crisis (type B). In the southern part of the basin, the platform emerged shortly before the Frasnian/Famennian (F/F) boundary and drowned in the Early to Late Famennian (type C). The primary cause of drowning was differential subsidence at the Laurussian passive margin. Eustatic sea-level fluctuations, if any, contributed only to a minor extent to the Late Frasnian drowning, but were effective in type C drowning during the Famennian. The drowning boundaries are associated with increased contents of K and Th, reflecting the deceleration of carbonate production. Uranium contents display isolated peaks that roughly correlate with the drowning boundaries or the stratigraphic gaps associated with the F/F boundary. The uranium contents are considered to reflect local depositional conditions and are not suitable for stratigraphic correlation. On the other hand, from the K and Th contents, we can infer Late Frasnian sea-level fluctuations with duration on the order of 1 Myr. These cyclic variations in K and Th contents proved to be useful in platform-to-basin stratigraphic correlation.     

Interacting Factors Associated with Adult Male Drowning in New Zealand

Objectives

i) to identify factors that contribute to the global trend of the higher incidence of male drowning relative to females, and; ii) to explore relationships between such factors from mortality data in New Zealand.

Methods

Drownings from 1983 to 2012 were examined for: Age, Ethnicity, Site, Activity, Buoyancy and Alcohol. Conditional frequency tables presented as mosaic plots were used to assess the interactions of these factors.

Results

Alcohol was involved in a high proportion of Accidental Immersion drownings (61%) and was highest for males aged 20-24 years. When alcohol was involved there were proportionally more incidences where a life jacket was Available But Not Worn and less incidences where a life jacket was Worn. Many 30-39 year old males drowned during underwater activities (e.g., snorkeling, diving). Older men (aged +55 years old) had a high incidence of drowning while boating. Different ethnicities were over-represented in different age groups (Asian men aged 25-29, and European men aged 65-74) and when involved in different activities.

Conclusions

Numerous interacting factors are responsible for male drownings. In New Zealand, drowning locations and activities differ by age and ethnicity which require targeted intervention strategies.