BACKGROUND: A high burden of unintentional fatal drowning has been reported in low- and middle-income countries. However, little is known about unintentional drowning in Indonesia.
METHODS: This population-based retrospective cohort study analysed unintentional drowning data for Indonesia sourced from The Global Burden of Disease Study 2019. Estimates of trends, mortality rates, incidence rates, years lived with disability (YLDs) and disability adjusted life years were generated.
RESULTS: A decline in unintentional drowning mortality rates was observed, with an average annual mortality rate of 2.58/100 000. Males were 1.81 (95% CI 1.79 to 1.84) times more likely than females to unintentionally drown. Average annual mortality rates were highest among the under-5 age group (9.67/100 000) and 70 and over (5.71/100 000 for males; 5.14/100 000 for females). Distributions of drowning deaths vary depending on region, with mortality rates higher in Papua, Kalimantan, Sulawesi, Maluku, Sumatra and Nusa Tenggara regions.
CONCLUSIONS: While a decline in drowning mortality rates in Indonesia was identified between 2005 and 2019, mortality rates for unintentional drowning remained high among children under 5 years, the elderly population and those residing in Papua, Kalimantan, Sulawesi, Maluku, Sumatra and Nusa Tenggara, warranting further focused attention.
CONCLUSIONS: A downward trend in the rate of unintentional drowning deaths in Indonesia is observed from 2005 onwards, with risk variation based on age, gender and region. The findings highlight the importance of addressing drowning as a cause of premature mortality and health system burden in Indonesia, including through enhancing drowning data collection systems and identifying drowning risk factors.

UNASSIGNED: \"Complex suicide\" refers to suicides in which more than one suicide method is applied. The victim can either plan different and simultaneous ways of death, to prevent any failures, or change the method because the first one fails or turns out to be too painful.
UNASSIGNED: A Middle-age-man was found dead inside a car, in a field, near the seaside. Clothes were intact, wet, and smeared with mud and gravel. His shirt had dried whitish biological material on the thoracic area, referable to oedema fluid, his trousers were down to his ankles exposing external genitalia. Inside the car, a kitchen-serrated blade knife and scissors were found, both smeared with dried blood material. Cadaveric inspection showed: multiple superficial stab/cut injuries; nasal cavities leaking aqueous-like fluid; triangular and linear stab lesions all over the body; hesitation marks on both latero-cervical regions and both wrists; no defensive injuries referrable to third parties; maceration over both palmar and plantar surfaces. Autopsy showed: hemorrhagic infiltration for thoracic muscles; expanded and heavily congested lungs.
UNASSIGNED: This is the first Italian case, and one of the few cases reported in major literature (third case worldwide), of unplanned complex suicide achieved through stabbing and drowning by a man with no psychiatric or substances abuse history. Therefore, analyzing any evidence to distinguish this kind of sudden/unnatural death from accidental or homicidal ones is mandatory. Such cases require a flawless approach to judicial inspection, autopsy, and toxicological exams. Moreover, a multidisciplinary perspective including psychiatric criminological investigation is needed.

UNASSIGNED: Homicide by drowning in adults is rare. Usually, marks of violence are found on both the victim and the perpetrator, unless the victim was under the influence of alcohol, drugs, or was unexpectedly forced or dragged into the water. Indeed, many cases of drowning in adults are believed to be accidental, but they may be the result of drunken fights or attempts to make the death appear ac-cidental. In order to define the manner of death, cooperation between the forensic pathologist and the investigators is mandatory. Indeed, the autopsy is important to distinguish homicide by drowning from other kinds of drowning. The purpose of this study is to highlight the features of homicide by drowning.
UNASSIGNED: Literature search was conducted using PubMed databases, using the following keywords: \"(homicide) and (drowning)\". 3 articles were included in the systematic review, in addition to 3 cases observed in our institute.
UNASSIGNED: Both external examination and autopsy findings and the results of the investigation are essential to differentiate a homicide by drowning from accidental ones. The low specificity and variability of external and internal findings, the possibility of atypical asphyctic and nonasphyctic pathophysiological mechanisms, whose nature is not detectable at postmortem examinations, makes the diagnosis of cause of death difficult and often based on exclusion criteria only. In complex cases only using a strict forensic method allows to use the essential tools to identify the real manner of death.

An additional microscopic diagnostic sign has been identified for verification of asphyxial type of drowning. In white non-linear male rats (age 2 months) subjected to free drowning, significant hyperplasia of argyrophilic and morphofunctional activity of serotonin-containing APUD-cells of the laryngeal mucosa were revealed under conditions of acute anoxia in comparison with the intact control. These changes promote the development of laryngospasm, which prevents water penetration into the airways and lungs in asphyxial type of drowning. The presence of statistically significant hyperplasia of argyrophilic and morphofunctional activity of serotonin-containing APUD-cells of the laryngeal mucosa under conditions of acute anoxia can be used as an additional diagnostic criterion for asphyxial type of drowning in experimental studies.

Purpose: Drownings are a societal phenomenon occurring worldwide, hence the importance of rescue skills, including directly towing a victim to a safe place. The purpose of this study was to evaluate the most effective towing techniques based on kinematic parameters, considering different types of drowning cases, for their recommendation for widespread use in water rescue. Methods: The research involved 18 water lifeguards aged 18-25 years. The evaluation included speed tests in towing a mannequin over a distance of 50 m using the Extended Arm Tow (EAT), Double Armpit Tow (DAT), \"Sailor\" Technique Tow (STT) and with a rescue tube (RT), accompanied by video recording to measure in the designated measurement area the number of cyclic paddling movements by the lower limbs, angles of the body attack, towing velocity, and its decrease during towing. Results: Number of cyclic paddling movements by the lower limbs, towing with a RT was considered the most beneficial, and least beneficial was the DAT. In the DAT, the lifeguard swam with the smallest body angle, in contrast to the STT, where this angle was the largest. The effect of the number of cyclic paddling movements and the body angle by the lifeguard was the velocity, with the highest value recorded in towing using a RT; in other techniques, velocity were similar. Conclusions: Institutions associated with water rescue should recommend towing using a RT for direct rescue actions in the water, as its use shortens the time, while simultaneously increasing safety for both the rescuer and the victim.

Adolescents aged 15 to 19 years have the second highest fatal drowning rate of any age group, second only to toddlers aged 12 to 36 months. This risk is amplified in black, indigenous, and people of color (BIPOC), and those of low socioeconomic status. Worcester, MA is a diverse city with over 40% of residents identifying as BIPOC and 20% living below the poverty line. The city has multiple natural bodies of water available for recreation, putting Worcester residents, particularly adolescents, at high risk of drowning. It is known that swimming lessons provided to adolescents significantly improve their swimming skills, however many programs are tailored to young children and are not appropriate for adolescents. Students from the University of Massachusetts T.H. Chan Medical School (UMass Chan), in collaboration with community partners, developed a water safety and swim education program tailored to Worcester adolescents as a means for an age-appropriate swim experience and education, community engagement, and injury prevention. Water Safe Worcester (WSW) was established as a city-wide injury prevention program that included swim lessons offered by medical students at the Central Community Branch YMCA in Worcester, MA. Instructors included UMass Chan medical students, graduate students, and staff. Adolescent YMCA members were invited to participate in lessons free of charge. Lessons were 90 min and emphasized a 3-fold approach: (1) expand knowledge of water safety and what to do in an emergency, (2) increase swimming skills, and (3) reduce fear of water. The overall attendance for the 2023 spring and summer sessions offered was 73 students, including multiple swimmers who attended more than one session. A total of 12 volunteers participated, which included 9 first-year medical students, one PhD student, one research assistant, and one surgery resident from UMass Chan. WSW demonstrated promising outcomes during its swim education classes, suggesting that WSW is a successful model to promote water safety, reduce the risk of drowning, and expand access to life-saving skills to Worcester\'s at-risk adolescents. This program serves as a critical step toward health equity while also providing an avenue for public health and injury prevention exposure for medical students.

BACKGROUND: Drowning is the leading cause of death among children in rural Bangladesh. While survival swimming for children ages 6 years and above is recommended in low-income and middle-income countries, research into the long-term retention of survival swimming skills is absent.
METHODS: The retention of four survival swimming skills, including swimming for 25 m, floating/treading for 30 s, reach rescue skills and throw rescue skills, was observed among those trained under the SwimSafe programme more than 10 years ago. Information about the practice of survival swimming skills among SwimSafe graduates and whether they recommended such lessons for others was also collected through surveys. A multistage sampling strategy was used. Descriptive statistics on the retention of survival swimming skills and other variables and ORs from logistic regression analysis were reported.
RESULTS: A total of 3603 SwimSafe graduates were observed. The retention of swimming and floating/treading skills was 88.4% and 89.7%, respectively, and that of swimming and floating/treading skills combined was 84.2%. While 87.7% of the graduates retained reach rescue skills, the retention of throw rescue skills was lower (71.9%). Approximately 60.6% of the graduates retained all four survival swimming skills. The majority of the graduates (70.3%) rarely practised swimming following graduation. Overall, 61.7% of the graduates recommended other children to learn survival swimming skills.
CONCLUSIONS: The majority of the SwimSafe graduates retained swimming and floating/treading skills for over 10 years despite minimal practice. Retention of throw rescue skills was lower. Therefore, refresher training and awareness campaigns focused on survival swimming skills are recommended.

UNASSIGNED: The role of forensic pathologists is pivotal in definitively diagnosing drowning cases. Further differentiation becomes essential for distinguishing between freshwater drowning (FWD) and saltwater drowning (SWD). Aquaporins are small integral membrane proteins that serve as major water transport pathways in various cell types. AQP4 appears to be involved in mechanisms related to cerebral volume regulation. Our study aims to examine the expression of AQP4 in the brain as a potential marker for differentiating between FWD and SWD relating to autopsy-performing timing.
UNASSIGNED: A total of 23 cases were classified into three groups: FWD, SWD, and controls. All samples were classified upon autopsy-performing timing into two subgroups: within and after 72 hours of death. The samples were then processed for histological and immunohistochemical investigations.
UNASSIGNED: For autopsies performed within 72 hours of death, we found a significantly higher value of AQP4-positive astrocytes in cases of FWD compared to SWD and control groups. We also found a significantly lower AQP4 expression in SWD cases compared to the control group. For autopsies conducted after 72 hours, the immunohistochemical staining does not reveal the peripheral terminations of astrocytes, which appear blurred and only recognizable as halos. In conclusion, the data aligns with existing literature about autopsies performed within 72 hours. However, in autopsies conducted after 72 hours, uncertain and even opposed results are observed. The difference can be ascribed to the post-mortem transformative processes that take place upon the cessation of vital functions.

BACKGROUND: Drowning is a leading cause of death for young children and knowing what puts a child at risk helps efforts across the spectrum of prevention. The purpose of this study was to identify risk and protective factors associated with hospital admission and mortality following paediatric drowning from a large level-1 paediatric trauma centre.
METHODS: Children (ages 0-17) who presented at an emergency department or were admitted for a drowning event between 2017 and 2023 were included in this retrospective cohort study (n=698). This study examined differences between patients who were admitted compared with not admitted, and those who survived compared with those who did not survive.
RESULTS: Participants who had adult supervision at the time of their drowning were significantly less likely to be admitted (OR=0.31, 95% CI 0.22 to 0.43, p<0.001) and significantly more likely to survive (OR=6.9, 95% CI 3.2 to 15.4, p<0.001). The environment also played a significant role in drowning outcomes. Children who drowned in a pool compared with other bodies of water were significantly more likely to survive (OR=3.0, 95% CI 1.6 to 5.5, p<0.001). Children from communities with higher child opportunity compared with those from very low opportunity were both simultaneously more likely to be admitted (IRR=1.7-2.4, 95% CI 1.3 to 3.3, p<0.001) and more often survived (IRR=1.7-3.0, 95% CI 1.3 to 3.5, p<0.001).
CONCLUSIONS: Our analysis revealed significant differences in drowning risk related to adult supervision, location of drowning and where a child lives. These findings can help drowning prevention strategies mitigate the severity of drowning by enhancing educational messages, resources and policy.

Objective: To understand the epidemiological characteristics of fatal drowning in children in Zhejiang Province in 2022, analyze factors such as the swimming ability of children, the caregiver behavior at drowning site, types of first aid personnel and methods of first aid of unintentional fatal drowning and provide evidence for targeted intervention. Methods: Using the \"Survey Form of Fatal Drowning Case in Children\" designed by National Center for Chronic and Non-communicable Disease Control and Prevention of the China CDC, we collected case information of children aged 0-17 years who died due to drowning in Zhejiang in 2022 from medical history/death investigation records, telephone interviews, and home visits. Results: A total of 341 fatal drowning cases in children occurred in Zhejiang in 2022 and 330 cases were investigated (96.77%). The male to female of the cases was 2.33∶1, most cases were aged 15-17 years and 0-4 years, and 54.24% of fatal drowning cases occurred in children from other provinces. In the drowning cases, 83.33% were unintentional ones, and the proportion of intentional fatal drowning cases in children increased with age. Fatal drowning cases mainly occurred in open natural water bodies and public water storage facilities. More fatal drowning cases occurred in open natural water bodies in older children, while more fatal drowning cases occurred in public water storage facilities in younger children. In 275 children who died due to unintentional drowning, 73.09% could not swim, and only 1.09% were fully supervised by adults within an arm\'s length. First aid personnel, mainly medical staffs, bystanders and adult caregivers, were present for 47.63% fatal drowning cases. The proportion of the cases who had cardiopulmonary resuscitation as the first aid within 5 minutes was 2.18%. Conclusions: Drowning poses a serious threat to children\'s lives and there are differences in reasons and locations of fatal drowning in children in different age groups in Zhejiang Province in 2022. It is necessary to conduct to interventions to improve children\'s swimming skills, strengthen effective adult care and conduct health education about field first aid of drowning to reduce the incidence of drowning and related deaths in children.
目的： 了解浙江省2022年儿童致死性溺水流行特征，为开展针对性干预提供依据。 方法： 采用中国CDC慢性非传染性疾病预防控制中心设计的《儿童溺水死亡调查表》，通过病史/死亡调查记录查询、电话调查、入户调查等方式收集2022年浙江省因溺水死亡的0~17岁儿童个案信息。 结果： 2022年浙江省共发生儿童致死性溺水341名，完成调查330名，完成率为96.77%，男女性别比为2.33∶1，年龄以15~17岁和0~4岁为主，外省户籍儿童占54.24%。83.33%儿童致死性溺水为非故意溺水，随着年龄增长，儿童自己故意溺水死亡比例呈上升趋势。低年龄组儿童溺水死亡主要发生在公共蓄水设施，高年龄组儿童主要发生在开放自然水域。275名儿童非故意致死性溺水中，73.09%不会游泳；现场有成年人看护且看护距离在一臂之内、看护时不间断且未做其他事情的比例仅为1.09%。溺水现场明确有第一急救人员在场者占47.63%，以医务人员、成年看护人和路人为主，第一时间获得急救措施为心肺复苏且发生溺水到获得心肺复苏间隔时间≤5 min者占2.18%。 结论： 浙江省2022年不同年龄组溺水死亡儿童的溺水意图、溺水发生场所等存在差异。应将提高儿童游泳技能、重视成年人有效看护、提高现场急救技术普及率等作为干预重点，不断降低儿童溺水的发生及所致死亡。.