Childhood unintentional injury: The impact of family income, education level, occupation status, and other measures of socioeconomic status. A systematic review

Introduction

Unintentional injuries represent a substantial public health burden among children and adolescents, and previous evidence suggests that there are disparities in injury by socioeconomic status (SES). This paper reports on a systematic review of literature on injury rates among children and adolescents by measures of SES.

Methods

A systematic literature search was conducted using six electronic databases: MEDLINE, PsycINFO, CINAHL, HealthSTAR, EMBASE, and SportsDiscus. This review considered children ages 19 years and under and publications between 1997 and 2017-representing an update since the last systematic review examined this specific question. Fifty-four articles were summarized based on study and participant descriptions, outcome and exposure, statistical tests used, effect estimates, and overall significance.

Results

Most articles addressed risk factors across all injury mechanisms; however, some focused particularly on burns/scalds, road traffic injuries, falls/drowning cases, and playground/sports injuries. Other studies reported on specific injury types including traumatic dental injuries, traumatic brain injuries, and fractures. The studies were of moderate quality, with a median of 15.5 (95% confidence interval [CI]: 15.34 to 15.66) out of 19. Thirty-two studies found an inverse association between SES and childhood unintentional injury, three found a positive association while twenty were not significant or failed to report effect measures.

Conclusion

Given the variability in definition of the exposure (SES) and outcome (injury), the results of this review were mixed; however, the majority of studies supported a relationship between low SES and increased injury risk. Public health practice must consider SES, and other measures of health equity, in childhood injury prevention programming, and policy.

Ramp abuse. A novel form of patient noncompliance to administration of nasal continuous positive airway pressure for treatment of obstructive sleep apnea

Administration of nasal continuous positive airway pressure (NCPAP) is the treatment of choice for most patients with obstructive sleep apnea. Many patients experience side effects with NCPAP use, and the compliance rate is reported to vary between 46-89%. The ramp is a device found on many NCPAP machines that resets the pressure to 3 cm H2O and then slowly increases the pressure to the prescribed pressure over a period of up to 45 min. The ramp allows patients time to fall asleep before the higher and likely more uncomfortable prescribed pressure is administered. We present a case in which a patient's repeated remote-controlled activation of this ramping feature severely limited effective therapy even when the NCPAP mask was properly in place, the machine was on, and the patient was breathing nasally.