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      Mortalidad por ahogamientos en Cataluña (2019-2022) Translated title: Drowning mortality in Catalonia (2019-2022)

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          RESUMEN

          Fundamentos:

          Los datos sobre ahogamientos tienden a subestimar la mortalidad por esta causa. El objetivo de este estudio fue describir los ahogamientos mortales registrados en Cataluña entre 2019 y 2022 a través de fuentes forenses, mostrar sus características y valorar la utilidad de esta información para monitorizar la mortalidad por ahogamientos.

          Métodos:

          Se realizó un estudio observacional retrospectivo basado en el registro de muertes judiciales del Instituto de Medicina Legal y Ciencias Forenses de Cataluña. Se analizaron la etiología médico-legal, entorno acuático, edad, sexo, fecha de defunción y municipio de procedencia. El análisis estadístico se basó en la prueba de comparación de proporciones basada en Chi cuadrado para las variables categóricas y la prueba U de Mann Whitney para la comparación de variables numéricas.

          Resultados:

          Se registraron 310 ahogamientos mortales, con una edad media de 57,2 años y predominio masculino (77,1%). La mayoría fueron no intencionales (71,3%), seguidos por suicidios (15,5%) y casos de intencionalidad indeterminada (12,6%). Comparados con los ahogamientos intencionales, los no intencionales y de intencionalidad indeterminada incluyeron más hombres que mujeres (81,2% frente a 56%, p<0,001), y menos casos con nacionalidad española que extranjera o indeterminada (60% frente a 92%, p<0,001). Las personas de mediana y avanzada edad aportaron la mayoría de las defunciones pero, entre los ahogamientos no intencionales, los registrados en piscinas incluyeron más niños y adolescentes de cero-catorce años que los que tuvieron lugar en aguas naturales.

          Conclusiones:

          Los resultados prueban la importancia de los ahogamientos mortales en Cataluña y la necesidad de fortalecer las actividades preventivas, especialmente en la infancia y durante episodios de calor intenso. Las fuentes médico-forenses son útiles para monitorizar la mortalidad por ahogamientos, pero convendría que incorporaran variables como el lugar de residencia y la nacionalidad.

          ABSTRACT

          Background:

          Data on drownings tend to underestimate mortality from this cause. The objective of this study was to describe fatal drownings recorded in Catalonia between 2019 and 2022 through forensic sources, present their characteristics, and assess the utility of this information for monitoring drowning mortality.

          Methods:

          A retrospective observational study based on the register of judicial deaths from the Institute of Legal Medicine and Forensic Sciences of Catalonia was carried out. Data on medicolegal aetiology, aquatic environment, age, gender, date of death, and municipality of origin were analysed. Statistical analysis was based on the comparison of proportions test based on Chi-square for categorical variables and the Mann Whitney U test for the comparison of numerical variables.

          Results:

          A total of 310 drownings were recorded, with a mean age of 57.2 years and a male predominance (77.1%). The majority of drownings were unintentional (71.3%), followed by suicides (15.5%), and cases of undetermined intent (12.6%). Compared to intentional drownings, unintentional and undetermined intent drownings had a higher percentage of males than females (81.2% vs. 56%, p<0.001), and fewer cases with Spanish nationality than foreign or undetermined nationality (60% vs. 92%, p<0.001). Middle-aged and older individuals accounted for the majority of deaths, but among unintentional drownings, those recorded in pools included significantly higher percentages of children and adolescents aged zero-fourteen years than those occurring in natural waters.

          Conclusions:

          The results highlight the importance of drowning mortality in Catalonia and the need to strengthen preventive activities, especially for children and during episodes of intense heat. Medicolegal sources are useful for monitoring drowning mortality, but it would be beneficial if they incorporated information on variables such as place of residence and nationality.

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          Drowning risk and climate change: a state-of-the-art review

          Drowning and climate change are both significant global health threats, yet little research links climate change to drowning risk. Research into the epidemiology, risk factors and preventive strategies for unintentional drowning in high-income and in low-income and middle-income countries has expanded understanding, but understanding of disaster and extreme weather-related drowning needs research focus. As nation states and researchers call for action on climate change, its impact on drowning has been largely ignored. This state-of-the-art review considers existing literature on climate change as a contributor to changes in drowning risks globally. Using selected climate change-related risks identified by the World Meteorological Organization and key risks to the Sustainable Development Goals as a framework, we consider the drowning risks associated with heat waves, hydrometeorological hazards, drought and water scarcity, damaged infrastructure, marine ecosystem collapse, displacement, and rising poverty and inequality. Although the degree of atmospheric warming remains uncertain, the impact of climate change on drowning risk is already taking place and can no longer be ignored. Greater evidence characterising the links between drowning and climate change across both high-income and low-income and middle-income contexts is required, and the implementation and evaluation of drowning interventions must reflect climate change risks at a local level, accounting for both geographical variation and the consequences of inequality. Furthermore, collaboration between the injury prevention, disaster risk reduction and climate change mitigation sectors is crucial to both prevent climate change from stalling progress on preventing drowning and further advocate for climate change mitigation as a drowning risk reduction mechanism.
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            Unintentional drowning: Role of medicinal drugs and alcohol

            Background Alcohol is a well-known risk factor in unintentional drownings. Whereas psychotropic drugs, like alcohol, may cause psychomotor impairment and affect cognition, no detailed studies have focused on their association with drowning. Finland provides extensive post-mortem toxicological data for studies on drowning because of its high medico-legal autopsy rates. Methods Drowning cases, 2000 through 2009, for which post-mortem toxicological analysis was performed, came from the database of the Toxicological Laboratory, Department of Forensic Medicine, University of Helsinki, using the ICD-10 nature-of-injury code T75.1. The data were narrowed to unintentional drowning, using the ICD-10 external-injury codes V90, V92, and W65–74. Each drowning case had its blood alcohol concentration (BAC) and concentrations of other drugs recorded. Evaluation of the contribution of psychotropic drugs to drowning was based on their blood concentration by means of a 6-grade scale. Results Among victims ≥15 years old, unintentional drownings numbered 1697, of which, 303 (17.9%) were boating-related and 1394 (82.1%) non-boating-related. Among these, 65.0% of boating-related and 61.8% of non-boating-related victims were alcohol-positive (=BAC ≥ 50 mg/dL). The male-to-female ratio in alcohol-positive drownings was 7.3. At least one psychotropic drug appeared in 453 (26.7%) drowning cases, with some victims’ bodies showing up to 7 different drugs. Overall 70 different psychotropic drugs were detectable, with 134 (7.9%) cases both alcohol-negative and psychotropic-drug-positive, of these, 59 (3.5%) were graded 4 to 6, indicating a possible to very probable contribution to drowning. Our findings suggest that psychotropic drugs may play a significant role in drowning, in up to 14.5% of cases, independently or in association with alcohol. Conclusions Psychotropic drugs alone or in association with alcohol may be an overlooked risk factor in drowning, due to their effects on psychomotor function and cognition. Future studies should also address other mechanisms—for instance drug-induced long-QT syndrome—by which drugs may contribute to drowning. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4306-8) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Rev Esp Salud Publica
                Rev Esp Salud Publica
                resp
                Revista Española de Salud Pública
                Ministerio de Sanidad
                1135-5727
                2173-9110
                05 June 2024
                Jan-Dec 2024
                : 98
                : e202406039
                Affiliations
                [1 ] originalAgencia de Salud Pública de Cataluña; Departamento de Salud de la Generalitat de Catalunya normalizedDepartamento de Salud de la Generalitat de Catalunya orgnameDepartamento de Salud de la Generalitat de Catalunya orgdiv1Agencia de Salud Pública de Cataluña Barcelona, Spain
                [2 ] originalInstituto de Medicina Legal y Ciencias Forenses de Cataluña; Departamento de Justicia, Derechos y Memoria de la Generalitat de Catalunya normalizedGeneralitat de Catalunya orgnameGeneralitat de Catalunya orgdiv1Instituto de Medicina Legal y Ciencias Forenses de Cataluña; Departamento de Justicia, Derechos y Memoria Barcelona, Spain
                [3 ] originalUniversitat Oberta de Catalunya (UOC) normalizedUniversitat Oberta de Catalunya (UOC) orgnameUniversitat Oberta de Catalunya (UOC) Barcelona, Spain
                [4 ] originalUniversitat Rovira i Virgili normalizedUniversitat Rovira i Virgili orgnameUniversitat Rovira i Virgili Reus, Spain
                [5 ] originalDepartament de Ciències Mèdiques; Universitat de Girona normalizedUniversitat de Girona orgnameUniversitat de Girona orgdiv1Departament de Ciències Mèdiques Girona, Spain
                [6 ] originalUniversitat Autònoma de Barcelona normalizedUniversitat Autònoma de Barcelona orgnameUniversitat Autònoma de Barcelona Barcelona, Spain
                [7 ] originalDepartament de Medicina, Universitat de Barcelona normalizedUniversitat de Barcelona orgnameUniversitat de Barcelona orgdiv1Departament de Medicina Barcelona, Spain
                Author notes
                Correspondencia: Josep M. Suelves Joanxich Agència de Salut Pública de Catalunya. C/ Roc Boronat, 81-95. CP 08005. Barcelona. España. josepmaria.suelves@ 123456gencat.cat

                Los autores declaran que no existe ningún conflicto de intereses.

                Article
                e202406039
                11571907
                38899691
                353575ea-8f54-4c30-8a66-f1d7b48a5640

                This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. You are free to Share (copy and redistribute the material in any medium or format) under the following terms: Attribution (You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use); NonCommercial (You may not use the material for commercial purposes); NoDerivatives (If you remix, transform, or build upon the material, you may not distribute the modified material); No additional restrictions (You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits).

                History
                : 19 December 2023
                : 30 April 2024
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 32
                Categories
                Original Breve

                ahogamiento,mortalidad,piscinas,playas,calor,prevención de accidentes,prevención del suicidio,género,drowning,mortality,swimming pools,bathing beaches,heat,accident prevention,suicide prevention,gender

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