Researchers Seek to Improve Employee Injury Reporting and Predict Injury Risk

The healthcare industry has one of the highest rates of non-fatal workplace injuries and illnesses. And healthcare workers are sometimes reluctant to report injuries due to time constraints, peer pressure, the ‘normalcy’ of injury, or the fear of retaliation.

A team of researchers at Cincinnati Children’s is working on a new approach to reporting workplace injuries they hope will improve injury reporting rates by making it easier for employees to do so, reduce healthcare workplace injuries, and better predict the risk of injury.

The team plans to study their new approach over the next four years using a $2.5 million grant from the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (NIOSH).

How It Will Work

The research team—led by Nancy Daraiseh, PhD, associate professor, and Maurizio Macaluso, MD, DPH, director of the Division of Biostatistics and Epidemiology—will supplement Cincinnati Children’s existing 803-SAFE system with their new injury reporting method. A randomly sampled group of direct patient providers who choose to participate in the study will use a mobile phone app to report injuries, near-misses, and individual health complaints over a two-week period. Staggering data collection will occur throughout the next two years. Meanwhile, 803-SAFE call handlers will code audio injury reports transferred from the app. The study team will then use machine learning and data visualization to predict workplace risk by comparing this newly collected mobile app data with routinely collected hospital data.

This study is the next phase of an earlier NIOSH-funded study that used handheld digital voice recorders. It showed that enhancing injury reporting was possible and led to detecting more injuries and near misses than more common methods. To date, there are no studies in a real work environment using injury data monitoring in this way. The results of this project will have a direct and immediate impact on employee safety operations. Some other benefits of reducing stress levels and the risk of injury for employees include improved patient care and outcomes, increased employee productivity, and reduced risk of errors, employee turnover, and hospital operating costs.

Macaluso and Daraiseh hope that the methods and results of their research study will be helpful for organizations like the Solutions for Patient Safety (SPS) network, which is a group of more than 180 children’s hospitals—including Cincinnati Children’s—that work together to eliminate serious harm to both patients and employees. As part of their quality improvement initiatives for safety, SPS may adopt their methods on a national scale. Other investigators on this study include Cole Brokamp, PhD, and William Vidonish, MBA.

How Childhood Risk Factors Affect Adult Cardiovascular Events

Cardiovascular disease affects more than 126 million people a year worldwide and continues to be the leading cause of death in the United States. It is well known that risk factors in adults, such as high cholesterol, lead to heart attacks and other cardiovascular illnesses.

A new international study published in the New England Journal of Medicine on April 4, 2022, finds, for the first time, that risk factors present in childhood also are directly related to the onset of heart disease in adults. Joint first authors Jessica Woo, MHSA, PhD, from the Division of Biostatistics and Epidemiology at Cincinnati Children’s, and David Jacobs, PhD, and Alan Sinaiko, MD, from the University of Minnesota led the study. Data for the study stems from research started 40-50 years ago in Finland, Australia, and five centers in the United States. These centers formed the International Childhood Cardiovascular Cohorts (i3C) consortium, consisting of close to 40,000 individuals followed from childhood (age 3-19 years) into early adulthood.

Key Findings

Findings from this study show a link between childhood cardiovascular risk factors—such as body mass index, blood pressure, blood lipids, and cigarette smoking—and the development of cardiovascular events in adults, with 75% of events occurring before age 53. It also demonstrates that many of the individuals who had adult cardiovascular events were children with cardiovascular risk factors measuring on the high end of the average category. The findings suggest even slightly high levels of risk factors at a young age can lead to cardiovascular problems relatively early in life, and researchers emphasize that while modern medicine has many advances for treating heart disease, it is best to stop it before it starts.

The current medical emphasis focusing on reducing the influence of cardiovascular risk factors in adults remains an important component of prevention of premature heart disease in early adulthood. While the present study does not permit the precise identification of children destined to develop heart disease, it strongly suggests the positive value of public health preventive strategies that can lower risk levels during childhood, such as promoting healthy eating and physical activity at home and school. It also points to a need for further research to more precisely identify at-risk children who go on to develop early clinical cardiovascular disease.

About the Study

This international study included researchers from Cincinnati Children’s, the University of Minnesota, the University of Cincinnati, the University of Colorado, Children’s Hospital Colorado, the University of Turku and Turku University Hospital in Finland, Tampere University in Finland, the University of Tasmania in Australia, Tulane University, the University of Iowa, Wake Forest School of Medicine, Murdoch Children’s Research Institute in Australia, and the University of Oxford in the United Kingdom.

Asthma and the Legacy of Racism Extends Beyond Poor Neighborhoods

JAMA Pediatrics published data online May 23, 2022 from a long-running birth cohort study shows that children from poorer or more densely populated neighborhoods were more likely to develop asthma, as were Black and Hispanic children even in more affluent neighborhoods, compared to White children. Antonella Zanobetti, PhD, Harvard T.H Chan School of Public Health, Department of Environmental Health, and Patrick Ryan, PhD, MS, Cincinnati Children’s Hospital Medical Center led the study. This research receives support from a grant from the National Institutes of Health (5UG3OD023282).

The study analyzed data from 5,809 children born over a span of four decades near 10 study sites throughout the United States. Each study site used questionnaires and interviews to collect information such as wheezing and asthma occurrence, medical history, and demographics from children and their parents over many years. Using U.S. Census tract data for the decade closest to the birth year to match each child's home address, and then using survival analysis, they examined how children’s race/ethnicity (reported by parental questionnaire), their mother’s education level and smoking habits, and their neighborhood conditions, related to incidence of asthma and wheeze.

Wheezing and asthma were common. Of the 5,809 children, 46% experienced wheezing in their first year of life, and 26% continued to experience wheezing through age 11. One in four children received a diagnosis of asthma by age 11. Children in neighborhoods with higher population density and more families below the poverty level experienced more asthma and early and persistent wheezing. Black and Hispanic children remained at higher risk for asthma than White children, even in neighborhoods with more resources.

This study is the first in a series of three planned research phases. It examined large data sets from 10 of 12 groups of people born at a similar time, or birth cohorts, within the Childhood Respiratory and Environmental Workgroup (CREW). The cohorts are in diverse urban, suburban, and rural areas across eight states in the Northeast, Midwest, and Southwest. The data collection includes 8,997 children starting in 1980. Adding new enrollees to new cohorts occurred over the decades until 2013.

Previous birth cohort studies include identification of some risk factors that leave children more vulnerable to developing asthma, but the impact of these risk factors is small and at times limited by specific population characteristics. James Gern, MD, University of Wisconsin-Madison, directs the CREW initiative, established in 2016 and created to overcome the statistical limitations of smaller studies. CREW is part of a seven-year initiative from the National Institutes of Health: the Environmental Influences on Child Health Outcomes (ECHO) program.

Trauma-Informed Home Visits Support Mothers and Children

Home visiting began as a strategy to help prevent child abuse and neglect by supporting pregnant moms and new parents with learned skills and behaviors that promote nurturing, sensitivity, and stimulating early environments. From pregnancy until children are 2 or 3 years old, trained preventionists visit families to offer regular education, modeling, screenings and links to community resources.

Research shows many of the mothers participating in these programs likely experienced trauma, violence, abuse or neglect during their own childhood. In the Cincinnati region, 70% of mothers enrolled in home visiting programs have a history of childhood trauma, according to Every Child Succeeds, which serves nearly 2,500 at-risk families annually. Childhood trauma contributes to later problems in psychological adjustment, interpersonal relationships, physical health, and parenting. The adverse experiences of the mothers also have a strong association with developmental risk factors for their children.

As a preventive strategy, it is important for home visiting programs to provide opportunities for mothers to heal and build the skills they need to support their children’s social-emotional development. To help guide trauma-responsive professional development and interventions, researchers at Cincinnati Children’s documented current trauma-related knowledge and practices in the field. With funding from the Home Visiting Applied Research Collaborative, they surveyed 128 home visiting programs throughout the United States.

The results, coupled with in-depth interviews of home visitors, led to the development of five modules that can be readily incorporated into home visiting practices to address clinical issues common to mothers with trauma histories, depression, and low social support. These are the five modules: behavioral activation, deep breathing, identifying social supports, building social skills and future aspirations. Co-principal investigators Alonzo “Ted” Folger, PhD, MS, from the Division of Biostatistics and Epidemiology and director of Evaluation and Epidemiologic Research for Every Child Succeeds, and Robert Ammerman, PhD, from the Division of Behavioral Medicine and Clinical Psychology and scientific director for Every Child Succeeds, anticipate that the development of these new trauma modules will improve home visiting services locally and nationally.

First-Ever National Survey of Home Visiting Programs

Several key themes emerged from the survey. While home visiting agencies are moving towards embracing new trauma-informed approaches, one-third of programs do not ask about trauma. Approximately half of the programs surveyed found it challenging to support mothers who have trauma histories and related intense emotions, shame, and guilt. While 75% of programs have training in trauma-informed approaches, there is a need for more work to evaluate their skills and provide further training. Most home visiting programs also indicated on the survey that their programs could be more effective in addressing maternal depression and social isolation. In fact, home visitors recognized the strong relationship between trauma, inadequate social support and depression. They identified social anxiety as significant impediments to accessing social support resources and growing supportive social networks.

Next Steps

The findings from this research are already stimulating new investments in trauma training for more than 80 home visitors in the Cincinnati region. The research team hopes to further develop strategies that home visitors can use directly when working with parents who experienced trauma, including strategies that help mothers manage their mood and prevent depression as well as build strong social networks and support systems.

Funding

This study receives support from a grant from the Home Visiting Applied Research Collaborative (HARC), a national home visiting research and development platform. Based at Johns Hopkins University, the goal of HARC is to advance innovative methods in home visiting research and the translation of findings into policy and practice. This was the very first grant awarded by HARC to advance the paradigm of precision home visiting.

About the Study

Study contributors from Cincinnati Children’s included Nichole Nidey, PhD, from the Division of Biostatistics & Epidemiology, and Jennifer Frey, PhD, Judith Van Ginkel, PhD, Jennifer Berndsen, Margaret Clark, MPA, Lacy Dickerson, Stephanie Marston, and Beth Heeter from Every Child Succeeds).

Perinatal Depression May Triple the Risk of ADHD in Children

Children born to mothers with perinatal depression face a higher risk for attention deficit hyperactivity disorder (ADHD), according to a study led by experts at Cincinnati Children’s. The population-based study, published online in the Journal Annals of Epidemiology, is among the first to examine this association across the perinatal time period—from prenatal to postpartum. The findings further support the idea that improving a mother’s health can influence a child’s health long after pregnancy and delivery.

Although previous studies had identified perinatal depression as a risk factor for ADHD, many based on self-report of maternal depression or diagnosis of ADHD among children. In this study, researchers examined insurance claims data from a population-based sample of privately insured mother-child pairs, reducing the self-report and selection bias of prior studies. Among the 5,635 mother-child pairs, 484 mothers received a diagnosis of depression during the perinatal period, and 269 children received a diagnosis of ADHD. Overall, researchers found that children born to mothers with perinatal depression were over three times more likely to receive a diagnosis of ADHD.

Insights from the study can not only help identify these high-risk groups—they can also help personalize the care they receive. Next, researchers aim to examine how depression treatment modalities can influence health outcomes for mothers and children throughout their life course.

Study contributors from Cincinnati Children’s included Nichole Nidey, PhD, of the Divisions of Developmental and Behavioral Pediatrics and Biostatistics and Epidemiology and Tanya Froehlich, MD, MS, director of research, Division of Developmental and Behavioral Pediatrics.

Cincinnati Childrens Supporting Price Hill Air Quality Study

U.S. Environmental Protection Deputy Administrator Janet McCabe and Cincinnati Mayor Aftab Pureval announced on March 29, 2022, that the EPA awarded a $75,000 environmental justice grant to Groundwork Ohio River Valley. The non-profit organization will use the EPA funding to monitor air quality in Lower Price Hill and to build up a program that trains and certifies young people for green jobs. Patrick Ryan, PhD, MS, in the Division of Biostatistics and Epidemiology at Cincinnati Children’s, will work on the air quality monitoring project.

Compared to the rest of Cincinnati, Lower Price Hill residents suffer disproportionately higher rates of cancer and asthma, upper respiratory ailments, seizures, learning disabilities, lead poisoning and other health outcomes. The new monitors will measure fine particulate matter (PM2.5) both indoors and outdoors. Exposure to PM2.5 causes multiple short- and long-term health effects, and something extensively studied by scientists at Cincinnati Children’s and the University of Cincinnati.

In response to community concerns regarding environmental exposures, Groundwork Ohio River Valley, an environmental justice non-profit organization, is working closely with residents to improve health outcomes and climate resiliency through the Climate Safe Neighborhoods Partnership, a network run through Groundwork USA.

Data to Support Planning

One goal for the project is to create yearly air quality reports, which would be available to incorporate into neighborhood resilience plans as the City Council adopts them. The new EPA grant comes in addition to a Translation and Community Engagement Award from the University of Cincinnati’s Center for Environmental Genetics. The funding will support epidemiologists at Cincinnati Children’s as they assist Groundwork with a pilot community and personal air sampling study in Lower Price Hill.

The University of Cincinnati College of Medicine houses the Center for Environmental Genetics with funding from the National Institute for Environmental Health Sciences (NIEHS).

The air monitor project includes installing a dozen PurpleAir Sensors throughout the neighborhood. In addition, several Lower Price Hill residents will carry mobile Airbeam monitors with them for week-long periods.