Understanding a population: A methodology for a population-based coastal safety survey.

Drowning is a global public health problem, but accurately estimating drowning risk remains a challenge. Coastal drowning comprises a significant proportion of the drowning burden in Australia and is influenced by a range of behavioural factors (e.g. risk perception, knowledge, attitudes and behaviours) that are poorly understood. These factors, along with those that impact exposure (e.g. coastal visitation and activity participation) all impact on drowning risk. While excellent mortality and morbidity data exists in Australia, a lack of coastal participation data presents challenges to identifying high-risk groups or activities and prioritising prevention efforts. This methods paper describes the development and evolution of an ongoing, annual, nationally representative online survey as an effective tool used to capture valuable data about the Australian population's relationship with the coast. This paper explores how the survey is structured (12-14 sections spanning multiple topics and themes), the different question types used (including open text, 4-digit responses and categorical questions), the sample size (1400-1600 respondents), sampling strategy (using demographic quota sampling which can then be post-weighted to the population if required) and how topics and themes have changed over time to enhance the quality of data collected (i.e., wording changes to enhance participant comprehension or data usability and changing issue-specific 'feature' topics of interest such as campaign evaluation). How the survey is implemented online is described, both practically through to third-party recruitment processes and ethically to maximise anonymity of respondents and ensure data quality. Interim analyses indicate the impact of considering exposure when calculating fatal drowning rates, especially by activity (e.g., crude boating drowning rate 0.12 per 100,000 population vs 0.95 per 100,000 exposed population [relative risk = 8.01; 95% confidence interval: 4.55-14.10]). This study highlights lessons learned in the process of conducting a nationally representative coastal participation survey as well as the strengths and limitations of adopting this approach. Data collected will provide more detailed information on the skills, behaviours, knowledge and attitudes of coastal activity participants. Analyses of this unique dataset will inform research that will underpin development and evaluation of coastal drowning prevention initiatives prioritising those most at risk. It is hoped that the methods detailed within this study may be useful for other countries to develop similar approaches to understanding their own population.

Opportunities for gender transformative approaches in a community-based drowning reduction program in Bangladesh.

BACKGROUND: Community-based programs in rural low-and middle-income country settings are well-placed to conduct gender transformative activities that aid program sustainability and catalyse wider social change, such as reducing gender inequities that in turn improve health outcomes. The Anchal program is a drowning prevention intervention for children aged 1-5 years old in rural Bangladesh. It provides community crèche-based supervision delivered by local trained paid-female volunteers. We aimed to identify the influence of the Anchal program on gender norms and behaviours in the community context, and the effects these had on program delivery and men and women's outcomes. METHODS: Qualitative in-depth interviews, focus group discussions and observations were conducted with program beneficiaries and providers. Gender outcomes were analysed using FHI 360's Gender Integration Framework. RESULTS: The Anchal program was found to be a gender accommodating program as it catered for communities' gender-based roles and constraints but did not actively seek to change underlying beliefs, perceptions and norms that led to these. The program in some cases enhanced the independence and status of female community staff. This changed perceptions of communities towards acceptable levels of physical mobility and community involvement for women. Conversely, gender affected program delivery by reducing the ability of female supervisory staff to engage with male community leaders. The double burden of wage and household labour carried by local female staff also limited performance and progression. Gender-based constraints on staff performance, attrition and community engagement affected efficiency of program delivery and sustainability. CONCLUSIONS: The Anchal program both adapted to and shaped community gender norms and roles. The program has well-established relationships in the community and can be leveraged to implement gender transformative activities to improve gender-based equity. Health programs can broaden their impacts and target social determinants of health like gender equity to increase program sustainability and promote equitable health outcomes.

Terrible twos.

Presents a brief story about the drowning death of a two year old child, the grief of the parents, and subsequent organ donation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Parental Perceptions of Surviving Sibling Grief Responses to an Adolescent's Violent and Sudden Death by the Sewol Ferry Disaster in South Korea.

The aim of this study was to provide empirical descriptions of responses to the death of a sibling to the sinking of the Sewol ferry in South Korea. 16 bereaved parents are interviewed regarding their surviving children's grief responses at approximately 2 years after the death. The surviving siblings described by the bereaved parents are 14 in total, including 8 teens in their 10s and 4 young adults in their 20s. Interviews were transcribed verbatim and analyzed using a qualitative content analysis method. The following themes emerged: (a) negative behavioral changes, (b) expressions of grief, (c) change in relationship with parents, (d) school adjustment problems, and (e) social changes. Unique aspects of the grief responses among the surviving siblings in this study are noted. Discussions and implications are provided based on the results.

Factors associated with health-related quality of life (HRQOL) in students who survived the Sewol ferry disaster in South Korea.

BACKGROUND: The purpose of this study was to analyze the mental health status of Danwon students who survived the Sewol ferry disaster. The study also evaluated the mental health effects of the disaster on the survivors. METHODS: Questionnaires were used to collect data from selected respondents. It was found that high family function and adolescent's strengths influence the quality of life of the survivors significantly. RESULTS: Higher scores on the Family Adaptability and Cohesion Evaluation Scales (p < 0.001) or the strengths domain of Strengths and Difficulties Questionnaire (p = 0.027) were significantly associated with higher KIDSCREEN-27 scores. LIMITATION: It is difficult to explain the causal relationship and generalize due to cross-sectionals study with small sample size. CONCLUSIONS: Family function and adolescent's strengths had the significant relationship with higher quality of life of survivors. This finding offers important insight into understanding the effects of such accident, and suggest the importance the family and mental health to survivors of disasters.

What does 'Keep Watch' mean to migrant parents? Examining differences in supervision, cardiopulmonary resuscitation training and water familiarisation.

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.

Filicide-suicide: An unusual variant of dyadic death.

Dyadic suicides may be committed simultaneously or one after another by two or more people who may or may not have made a prior pact. The perpetrator is usually male and their victims female, and generally their intimate partners, with children less commonly involved. Another distinct type of homicide-suicide is the killing of children by a parent (filicide-suicide). The terms 'maternal filicide' or 'paternal filicide' are used respectively when the perpetrator is the mother or the father of the victim. We report a rare case of maternal filicide, where the mother drowned her three children and then herself in the same water tank. The case highlights the extreme stress put on a mother of girls in a patriarchal society where there is an overriding expectation and wish for sons. The resulting pressure on this mother for her 'failure' caused her to take her own and her children's lives.

The lived experience of rescuing people who have driven into floodwater: Understanding challenges and identifying areas for providing support.

BACKGROUND: Drowning is a major public health issue, with risk increasing during times of flood. Driving into floodwater is a major risk factor for flood-related drowning and injury, and despite widespread public health campaigns, many people continue to undertake this risky behaviour and require rescue. PURPOSE: We aimed to identify key challenges faced by emergency services personnel when rescuing those who have driven into floodwater, and to identify strategies for supporting rescuers in this important role. METHODS: Australian flood rescue operators (N = 8) who had previously rescued a driver who had driven into floodwater participated in semi-structured interviews. Data were analysed using thematic analysis. RESULTS: Four challenges emerged from their experiences: involvement of untrained personnel; varying information provided by emergency telephone operators; behaviour of drivers complicating the rescue; people sightseeing floods or flood rescues or ignoring closed roads providing rescuers with sources of distraction and frustration. CONCLUSIONS: We propose five strategies for translating these results into practice, including: training and protocol development for (i) emergency personnel and (ii) telephone operators; (iii) training for rescuers regarding non-compliant rescuees; (iv) educating the public and (v) increasing compliance with closed roads. Current findings provide valuable insights into how rescuers can be supported in performing their roles, and implementation of these strategies has the potential to reduce fatalities occurring due to attempting to drive through floodwater. SO WHAT?: The strategies presented have the potential to reduce the frequency and improve the outcomes of floodwater rescues, aiding in the prevention of injury and death.

Breathalysing and surveying river users in Australia to understand alcohol consumption and attitudes toward drowning risk.

BACKGROUND: Little is known about people's river usage, a leading drowning location. This study examines alcohol consumption patterns of river users and their attitudes to drowning risk. METHODS: A convenience sample of adult (18+ years) river users were surveyed at four river locations. The survey covered eight domains: demographics; river attendance frequency; frequency of engaging in water activities; drinking patterns; alcohol and water safety knowledge; alcohol and water safety attitudes; alcohol consumption; and Blood Alcohol Concentration (BAC). For BAC, participants were asked to record time since their last alcoholic drink and were then breathalysed to record an estimate of their BAC. BAC was examined by BAC reading (negative, positive, ≥0.050%). Hazardous lifetime drinking levels were calculated and their impact on drowning risk evaluated. Univariate and chi square analysis (95% confidence interval) was conducted. RESULTS: Six hundred eighty four people participated (51.6% female; 49.0% aged 18-34 years). Sixteen percent (15.9%) had a positive BAC (Mean + BAC = 0.068%; SD ± 0.08; Range = 0.001-0.334%), with 7.2% ≥0.050% (Mean BAC ≥0.050% =0.132%; SD ± 0.06). Those significantly more likely to record a BAC ≥0.050% at the river were: aged 18-34 years, resided in inner regional and low socio-economic areas, visited the river in the afternoon, with friends, on days with higher maximum air temperatures, frequent river users (11+ times in the last 30 days) and those who spend longer in the water (301+ minutes). River users who recorded a BAC ≥0.050% were more likely to self-report engaging in risky activities (i.e. diving into water of unknown depth and jumping into the river from height). River users on Australia day (a national public holiday) were significantly more likely to drink heavily (Mean BAC ≥0.05% = 0.175%; SD ± 0.09). CONCLUSIONS: Despite males accounting for 85% of alcohol-related river drowning deaths, similar numbers of males and females were consuming alcohol at the river. This study has addressed a gap in knowledge by identifying river usage and alcohol consumption patterns among those at increased drowning risk. Implications for prevention include delivering alcohol-related river drowning prevention strategies to both males and females; at peak times including during hot weather, afternoons, public holidays and to river users who swim.

[Analysis of 124 Suicide Cases in Wuhua District in Kunming].

OBJECTIVES: To analyze the relationship between the suicide method and the sex, age, education background and cause of suicide to provide reference for the forensic identification of suicide. METHODS: After scene investigation, external body examination, autopsy and case investigation, 124 identified suicide cases which happened in recent three years in Wuhua district in Kunming were collected. Analytical methods as chi-square test and descriptive statistics were performed by SPSS 22.0. RESULTS: In all the suicide cases, male to female ratio was 1.53∶1. The suicide methods were mainly fatal fall, hanging and drowning. The ratio of local to non-native residents was 1∶1. The suicide rate in the people with primary school or junior middle school education level was highest. The group of >10-50 years tended to choose fatal fall suicide and people over 60 years were more likely to choose hanging. People with different academic background tended to choose fatal fall suicide. The suicide methods as fatal fall and hanging were chosen because of mental and physical diseases and economic problems, while the suicides with emotional problems were more likely to choose fatal fall and poisoning. CONCLUSIONS: Suicide belongs to a kind of complex cases. For the cases of suspected suicide, complete exploration and overall consideration should be done to determine the nature of cases based on comprehensive analysis of all the influence factors.

Perceptions of the risk of drowning at surf beaches among New Zealand youth.

In many countries, beaches are a high-risk location for drowning. In New Zealand, youth and young adults are particularly at risk of drowning at beaches, accounting for 17.4% of drowning deaths and 18.4% of rescues at surf beaches between 2008 and 2013, over 90% of fatalities were male. This study explored New Zealand youth risk perceptions of drowning and their coping appraisal processes at a surf beach. A cross-sectional survey of high school students (n = 599) was conducted between February and April 2014. Females and non-New Zealand European students reported higher levels of perceived vulnerability and severity of drowning risk, and New Zealand European students reported higher levels of self-efficacy of preventive actions. By addressing the underlying causes of underestimation of risk and overestimation of ability, these findings can be utilized to increase awareness and to enhance water safety risk strategies for youth, especially males, in the surf beach setting.

Cognitive performance in transient global hypoxic brain injury due to moderate drowning.

INTRODUCTION: Drowning is a serious and frequently neglected public health threat. Primary respiratory impairment after submersion often leads to brain dysfunction. Depending on the period of global hypoxia (respiratory failure), clinical aspects of neurological dysfunction are evident on the first evaluation after the water rescue. Nowadays, many neuropsychological assessments after drowning are inconclusive, with some studies reporting only minor neurological or cognitive impairments. The aim of this study is to identify measures in neuropsychological tests that most contribute to classify volunteers as moderate drowning subjects or healthy controls. To the best of our knowledge, this study is the first neuropsychological prospective case-control study of moderate drowning in a country with large coastal cities. METHOD: Fifteen moderate drowning patients (DP), who met the inclusion criteria, were compared with 18 healthy controls (HC). All subjects were assessed on memory, learning, visual spatial ability, executive function, attention, and general intellectual functioning and underwent structural magnetic resonance (MR) imaging of the brain at 3.0 T, in order to exclude subjects with anatomic abnormalities. RESULTS: Neuropsychological tests assessing learning, execution function, and verbal fluency-Rey Auditory Verbal Learning Test (RAVLT) general learning ability, Digit Span total, Phonological Verbal Fluency (total FAS correct), and Brief Visuospatial Memory Test Revised (BVMT) correct recognition-have the strongest discriminating ability, using predictive models via the partial least squares (PLS) approach for data classification, while the other tests have shown similar predictive values between groups. CONCLUSIONS: Learning, execution function, and verbal fluency domains were the most critically affected domains. Serious impairments in the same domains have already been reported in severe drowning cases, and we hypothesize that subtle alterations found in moderate drowning cases, although not sufficient to be detected in daily routine, may possibly have a negative impact on cognitive reserve.

Analysis of 124 Suicide Cases in Wuhua District in Kunming / 法医学杂志

OBJECTIVES@#To analyze the relationship between the suicide method and the sex, age, education background and cause of suicide to provide reference for the forensic identification of suicide.@*METHODS@#After scene investigation, external body examination, autopsy and case investigation, 124 identified suicide cases which happened in recent three years in Wuhua district in Kunming were collected. Analytical methods as chi-square test and descriptive statistics were performed by SPSS 22.0.@*RESULTS@#In all the suicide cases, male to female ratio was 1.53∶1. The suicide methods were mainly fatal fall, hanging and drowning. The ratio of local to non-native residents was 1∶1. The suicide rate in the people with primary school or junior middle school education level was highest. The group of >10-50 years tended to choose fatal fall suicide and people over 60 years were more likely to choose hanging. People with different academic background tended to choose fatal fall suicide. The suicide methods as fatal fall and hanging were chosen because of mental and physical diseases and economic problems, while the suicides with emotional problems were more likely to choose fatal fall and poisoning.@*CONCLUSIONS@#Suicide belongs to a kind of complex cases. For the cases of suspected suicide, complete exploration and overall consideration should be done to determine the nature of cases based on comprehensive analysis of all the influence factors.

Dry Drowning: Myths and Misconceptions.

Drowning is a leading cause of death in children and is highly preventable. More than 10 people die of drowning in the United States each day, most of them adults. Rates of drowning are highest in children given their developmental vulnerabilities. Drowning incidents that result in cardiopulmonary arrest have a straightforward emergency clinical response, but the management approaches to the more common scenario of brief, nonfatal submersion is less clear. Clinicians must make clinical-care decisions based on evidence to provide safe and effective care in a timely manner and to help families avoid unnecessary anxiety. Such anxiety has been heightened by reports of unanticipated "dry drowning" appearing in the media. This article discusses this concept and provides guidance for clinicians. [Pediatr Ann. 2017;46(10):e354-e357.].

The Effectiveness of Aquatic Group Therapy for Improving Water Safety and Social Interactions in Children with Autism Spectrum Disorder: A Pilot Program.

Drowning is the number one cause of accidental death in children with Autism Spectrum Disorder (ASD). Few studies have examined the effectiveness of swim instruction for improving water safety skills in children with moderate to severe ASD. This study examines the feasibility and effectiveness of an aquatic therapy program on water safety and social skills in children with mild to severe ASD (n = 7). Water safety skills were evaluated using the Aquatics Skills Checklist and social skills were measured using the Social Skills Improvement Scale. We provide preliminary evidence that children with ASD can improve water safety skills (p = 0.0002), which are important for drowning prevention after only 8 h of intervention. However, social skills did not respond to intervention (p = 0.6409).

Effects of Mental Health Support on the Grief of Bereaved People Caused by Sewol Ferry Accident.

Few studies have assessed the overall effects of multi-centered, complicated mental health support on the grief process. This study investigated the broader influence of mental health support provided practically to the bereaved family on the severity of complicated grief. Ninety-three bereaved family members of the Sewol ferry accident were recruited. Severity of complicated grief, post-traumatic stress disorder (PTSD) and depressive disorder was assessed through self-reporting questionnaire, inventory of complicated grief (ICG), PTSD Check List-5 (PCL-5) and Patient Health Questionnaire-9 (PHQ-9). We also included demographic, socioeconomic, health-related variables, and Functional Social Support Questionnaire (FSSQ), which affect the ICG score. Participants were divided into 4 groups based on the experience of psychotherapy or psychiatry clinic service before the accident and mental health support after the disaster. In univariate analysis, these 4 groups showed a significant difference in the mean ICG score (P = 0.020). Participants who received mental health support only after the Sewol ferry accident (group 2) showed a lower mean ICG score than those who received neither psychotherapy or psychiatry clinic service before the disaster nor mental health support after the accident (group 4). There was no significant correlation between the ICG score and other variables except for subjective health status measured 1 month after the disaster (P = 0.005). There was no significant difference in PCL-5 (P = 0.140) and PHQ-9 scores (P = 0.603) among groups, respectively. In conclusion, mental health support significantly reduced the severity of grief only in those participants who had not received any psychotherapy or psychiatry clinic service before the accident.

Understanding hikers who approached a hazardous river in Yosemite National Park.

OBJECTIVES: To understand the perceptions and motivations of hikers who approached a swift river at locations that have been associated with drowning in the past. METHODS: A survey was completed by 399 adults who had been observed getting 'too close' to the Merced River. The questionnaire covered trail familiarity, information sources, timing and motivation of their decision, perceived safety, knowledge and opinion of park rules. RESULTS: Sixty-eight per cent of invited hikers agreed to participate. Almost all had received advance information about their hike, but most often that did not include a river warning. Most respondents were observed in the risk zone by the footbridge, and their most frequent motivation was to 'cool off'. Ninety-two per cent of hikers reported feeling very or somewhat safe by the river. Their risk perceptions did not correlate with expert ratings of danger. Males, younger subjects and those who had hiked the trail before were more likely to enter the most hazardous parts of the risk zone. Eleven per cent of people at the footbridge and 43% at the top of the waterfall thought that the park should not allow visitors to go where they had been. The most common reason they gave for this view was that the location was unsafe. CONCLUSIONS: While this needs assessment identified channels for informing hikers of drowning risk, there are indications that they might not personalise such warnings. Another option would be to explore cooling alternatives that could compete with the swift water that runs along many hiking trails.

Suicidal drownings with psychiatric disorders in Shanghai: a retrospective study from 2010.1 to 2014.6.

Psychiatric disorders exhibited in 13% suicidal drownings in Southwestern Croatia and 63% in Milan, but in China is unknown. This study is committed to outline the feature of a suicidal drowning with psychiatric disorder, show mental status and reveal key factor to high incidence in China. Immersed corpses were handled by SPSBMPH in its jurisdiction range. Half of immersed corpses were suicidal, and nearly half of suicides had psychiatric disorders. 104 suicidal drownings with psychiatric disorders cases from 2010.1 to 2014.6 were reviewed (21.5% of all immersed corpses, 42.1% of suicides). Most victims clothed normally, and only 2 fastened attached weights. Male victims were more and younger than female. Psycho were prone to commit suicidal drowning in warm and hot season. Psycho were prone to choose familiar area to commit suicide, 45 decedents were found in their familiar areas. Suicidal drowings were occult without suicide attempts, suicide note or abnormal clothing, but showed abnormal mental or behavior changes prior to suicide. The three leading psychiatric disorders were depression (33.7%), depression status (30.8%) and schizophrenia (20.2%). Only 44.2% decedents had visited psychiatric disorder specialist, and merely less than 10% patients could adhere to regular medication. No regular medication on psychiatric disorder was the key factor contributing to high incidence of suicide in psycho. Professional psychiatric and psychological intervention should be taken as soon as possible when they had psychiatric symptoms or suffered misfortune. Guardians should be alert to patients' abnormality to detect their suicidal ideation and intervene, especially in warm season.

[A retrospective analysis of 105 drowning victims with psychiatric disorders].

OBJECTIVE: To analyze the features of drowning victims with psychiatric disorders to support further investigation on such cases. METHODS: One hundred and five archives of drowning victims with psychiatric disorders from January 2010 to June 2014 in Harbor Public Security Subbureau, Shanghai Public Security Bureau were reviewed. The decedents' general information, autopsy findings, case investigation data and disease histories were statistically analyzed. RESULTS: Of the 105 cases, 104 were suicides. Most decedents were poorly educated. Most suicides occurred in warm climate, and the corpses were usually found within 2 days. Most decedents had no suicide history and notes, but had abnormal mental or behavior changes before suicide. Depression, depression status and schizophrenia were the main types of psychiatric disorders, and only 9 decedents had received regular therapies before their deaths. CONCLUSION: Mental disorder is a high risk factor in the drowning victims. Guardians should be aware of psychotic abnormal behaviors, especially during warm climate seasons.

A retrospective analysis of 105 drowning victims with psychiatric disorders / 法医学杂志

OBJECTIVE@#To analyze the features of drowning victims with psychiatric disorders to support further investigation on such cases.@*METHODS@#One hundred and five archives of drowning victims with psychiatric disorders from January 2010 to June 2014 in Harbor Public Security Subbureau, Shanghai Public Security Bureau were reviewed. The decedents' general information, autopsy findings, case investigation data and disease histories were statistically analyzed.@*RESULTS@#Of the 105 cases, 104 were suicides. Most decedents were poorly educated. Most suicides occurred in warm climate, and the corpses were usually found within 2 days. Most decedents had no suicide history and notes, but had abnormal mental or behavior changes before suicide. Depression, depression status and schizophrenia were the main types of psychiatric disorders, and only 9 decedents had received regular therapies before their deaths.@*CONCLUSION@#Mental disorder is a high risk factor in the drowning victims. Guardians should be aware of psychotic abnormal behaviors, especially during warm climate seasons.