Equipping soldiers to benefit from goal-focused leadership: The moderating effects of non-discriminatory leader behaviors and workgroup cohesion.

We apply the Job Demands-Resources model to explicate how two contextual factors (nondiscriminatory leadership behavior and cohesion) may equip subordinates to benefit from the leadership style of goal-focused leadership (GFL), a predominant leadership style in the military context. We predict that only when GFL is delivered in conjunction with nondiscriminatory leadership behaviors in a cohesive workgroup (which, we theorize, combine to create a resource-rich environment), subordinates may experience the lowest levels of exhaustion. We tested our hypothesis in two independent samples of uniformed United States Department of Defense personnel deployed in non-combat zones, and results are fully supportive. We add to recent efforts to expand the nomological network of GFL, pinpointing situational factors that may equip subordinates to experience lower (rather than higher) exhaustion when working with a goal-focused leader. In doing so, we also contribute to theory on diversity and stress, and we suggest practical applications for leadership across a range of hierarchical contexts, including the military and other large organizations. In all, our work may help inform the proper balance of leadership and workgroup factors, which determine the optimal context in which individuals can be equipped to benefit from GFL.

Unhealthy lifestyles do not mediate the relationship between socioeconomic status and incident depressive symptoms: the Health ABC study.

BACKGROUND: The relationship between low socioeconomic status (SES) and depressive symptoms is well described, also in older persons. Although studies have found associations between low SES and unhealthy lifestyle factors, and between unhealthy lifestyle factors and depressive symptoms, not much is known about unhealthy lifestyles as a potential explanation of socioeconomic differences in depressive symptoms in older persons. METHODS: To study the independent pathways between SES (education, income, perceived income, and financial assets), lifestyle factors (smoking, alcohol use, body mass index, and physical activity), and incident depressive symptoms (Center for Epidemiologic Studies-Depression [CES-D 10] and reported use of antidepressant medication), we used 9 years of follow-up data (1997-2007) from 2,694 American black and white participants aged 70-79 years from the Health, Aging, and Body Composition (Health ABC) study. At baseline, 12.1% of the study population showed prevalent depressive symptoms, use of antidepressant medication, or treatment of depression in the 5 years prior to baseline. These persons were excluded from the analyses. RESULTS: Over a period of 9 years time, 860 participants (31.9%) developed depressive symptoms. Adjusted hazard ratios for incident depressive symptoms were higher in participants from lower SES groups compared with the highest SES group. The strongest relationships were found for black men. Although unhealthy lifestyle factors were consistently associated with low SES, they were weakly related to incident depressive symptoms. Lifestyle factors did not significantly reduce hazard ratios for depressive symptoms by SES. CONCLUSION: In generally healthy persons aged 70-79 years, lifestyle factors do not explain the relationship between SES and depressive symptoms.

Interruptions in Remote Work: a Resource-based Model of Work and Family Stress.

We use the conservation of resources (COR) theory to propose a work-family model of stress in remote work. We propose that interruptions from family are a unique hindrance stressor, detrimental for the employee's challenge and hindrance stress responses in remote work, which, in turn, have distinct effects on resource-oriented attitudes and states of both the employee and spouse. Namely, we expect that both partners' satisfaction with the work arrangement, employee engagement, and spouse family overload will be associated with the way the employee experiences stress in remote work (stress response). We also integrate the effort-recovery model to examine whether two types of breaks taken by employees while working remotely replenish resources lost through interruptions. Using a sample of 391 couples, we find support for all hypotheses that pertain to the employee. Findings involving the spouse support the primacy of the resource loss tenet in COR theory, in that these detrimental effects are significant in crossing over to the spouse via hindrance but are not significant via challenge stress. We discuss the implications of these findings, emphasizing that interruptions are harmful for both types of stress experienced by remote employees (i.e., lower "good" and higher "bad" stress responses), and interruptions appear to have far-reaching effects on both partners. However, choosing to use breaks for both nonwork goals and self-care can buffer these otherwise detrimental effects.

A longitudinal assessment of occupation, respiratory symptoms, and blood lead levels among latino day laborers in a non-agricultural setting.

BACKGROUND: The reliance on Latino migrant day labor in the U.S. is increasing. Prospective data on day laborers' work and health experience in non-agriculture settings are lacking and outcomes are generally restricted to injury rates. METHODS: An ambidirectional study was conducted to quantify the number of job and job task changes held over 12 months in a cohort of 73 migrant day laborers and assessed the relation between work type, health symptoms, and blood lead level. RESULTS: On average, participants worked 2.4 different jobs over the past year averaging 41.5 hr per week. Construction work was associated with a twofold increase in sino-nasal and respiratory symptoms in both adjusted and unadjusted models and was associated with increased blood lead levels. CONCLUSIONS: Despite day labor status, workers had relatively stable employment. Respiratory symptoms were common and often improved when away from work suggesting that workplace irritant exposure is likely. Migrant day laborers working construction are vulnerable to adverse health effects associated with irritant and lead exposure.

How do stressors lead to burnout? The mediating role of motivation.

We extend existing stressor-strain theoretical models by including intrinsic motivation as a mediator between well-established job stressors and burnout. Though the link between situational stressors and burnout is well established, little is known about mechanisms behind this relationship. With a sample of 284 self-employed individuals, we examined motivation as a mediator to explain why situational factors impact 3 dimensions of burnout: emotional exhaustion, cynicism, and inefficacy. Motivation is an explanatory mechanism that drives human behavior and thought, and thus may have an impact on important well-being outcomes. As expected, intrinsic motivation was a full mediator for the effect of perceived fit on the inefficacy dimension of burnout. Unexpectedly, neither perceived fit nor motivation was related to the other 2 dimensions of burnout, and role ambiguity had only a direct effect on the inefficacy dimension; it was also unrelated to exhaustion and cynicism. We discuss implications of these findings for researchers as well as for practitioners.

Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, and body composition study.

BACKGROUND: Cross-sectional studies find an elevated prevalence of depression among subjects with diabetes mellitus (DM). The causal mechanisms and temporal sequence of this association have not been clearly delineated. This study investigated the prospective relationship between DM and depressive symptoms. METHODS: The Health, Aging, and Body Composition Study was a cohort study conducted in the metropolitan areas of Memphis, Tenn, and Pittsburgh, Pa. The analysis included 2522 community-dwelling subjects, aged 70 to 79 years, without baseline depressive symptoms. Incident depressed mood was defined as use of antidepressants at follow-up visits or presence of depressive symptoms (score >or=10 on the 10-item Center for Epidemiological Studies Depression scale). Presence of incident depressed mood at 2 consecutive annual clinic visits defined the incidence of recurrent depressed mood. Diabetes mellitus status, glycosylated hemoglobin (HbA1c) level, and DM-related comorbidities were assessed at baseline. Diabetes mellitus status was further characterized as absent, controlled (HbA1c level <7%), or uncontrolled (HbA1c level >or=7%). Discrete time survival analysis was used to estimate depressive events risk. RESULTS: During a mean follow-up of 5.9 years, participants with DM had a higher age-, sex-, race-, and site-adjusted incidence of depressed mood (23.5% vs 19.0%) (P = .02) and recurrent depressed mood (8.8% vs 4.3%) (P<.001) than those without DM. Diabetes mellitus was associated with a 30% increased risk of incident depressed mood (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.07-1.61), which was attenuated after adjustment for DM-related comorbidities (OR, 1.20; CI, 0.97-1.48). A stronger relationship was observed between DM and recurrent depressed mood (OR, 1.91; CI, 1.32-2.76), particularly among participants with poor glycemic control. CONCLUSION: Among well-functioning older adults, DM is associated with increased risk of depressive symptoms.

The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study.

OBJECTIVE: To explore antecedents and outcomes of nurse self-reported job satisfaction and dissatisfaction-based turnover cognitions, theorizing (using Self-Determination Theory) that leaders can foster work conditions that help fulfill innate needs, thereby fostering satisfaction of nurses and patients, and reducing adverse events. DATA SOURCES/STUDY SETTING: Primary and secondary data were collected within a 4-month period in 2015, from 2,596 nurses in 110 Army treatment facilities (hospitals and clinics) across 35 health care systems. DATA COLLECTION/EXTRACTION: We collected individual nurse responses to the Practice Environment Scale-Nursing Work Index, in addition to aggregated archival data from the same timeframe, including both facility-level patient satisfaction records (the Army Provider Level Satisfaction Survey) and health care system-level adverse events records (provided by the Army Programming, Analysis, and Evaluation office). PRINCIPAL FINDINGS: Five predictors of nurse satisfaction and turnover cognitions emerged-supportive leadership, staffing levels, nurse-physician teamwork, adoption of nursing care practice, and advancement opportunities. Aggregated nurse satisfaction was the most consistent predictor of both patient satisfaction and adverse events. CONCLUSION: These findings provide evidence of the importance of nurse attitudes in improving perceived and actual performance across facilities and health care systems; in addition to practical steps, managers can take to improve satisfaction and retention.

Expression of the CUB domain containing protein 1 (CDCP1) gene in colorectal tumour cells.

Expression of CUB domain containing protein 1 (CDCP1) is upregulated in carcinoma cells. We quantitated CDCP1 gene expression in matched normal colon and tumour tissue and compared the level of expression to other genes upregulated in colorectal tumourigenesis. Furthermore, we show that the CDCP1 gene generates two transcripts which are co-expressed in normal and matched tumour tissue as well as in the majority of cell lines analysed. However, intracellular localisation studies revealed that only one of these transcripts encodes a protein that is localised to the cell surface.

Effect of selenium supplementation on biochemical markers and outcome in critically ill patients.

BACKGROUND & AIMS: This study aimed to assess the effect of high dose selenium (Se) supplementation on Se status in blood, oxidative stress, thyroid function and possible effects on requirement for renal replacement therapy (RRT) in severely septic patients admitted to the intensive care unit (ICU). METHODS: This prospective single-centre study was carried out in 40 septic ICU patients who were randomized to high dose Se (Se+ group, N=18 (474, 316, 158 microg/day), each for 3 consecutive days followed by a standard dose of 31.6 microg/day of Se given as sodium selenite whereas the control group (Se-, N=22) received only the standard dose of Se. Plasma Se, glutathione peroxidase (GSH-Px), F2 isoprostanes, thyroid function tests (total T4 and total T3), C-reactive protein (CRP) and red blood cell (RBC) GSH-Px were estimated on day 0, 3, 7, 14. RESULTS: In the Se+ group, plasma Se increased by day 3 and 7 (P<0.0001) and day 14 (P=0.02), plasma GSH-Px increased by day 3 and 7 (P=0.01) as compared to Se- group. There was a significant negative correlation between plasma Se and SOFA (sepsis related organ failure assessment) (r=-0.36, P=0.03) along with low plasma Se and high CRP at the time of admission. Requirement for renal replacement therapy was not significantly different between the groups. CONCLUSION: Although high dose Se supplementation increased plasma Se and GSH-Px activity, it did not reduce oxidative damage or the requirement for RRT. Se levels in blood are influenced by redistribution and severity of illness and therefore should be interpreted with caution.

Low plasma granulocyte-macrophage colony stimulating factor is an indicator of poor prognosis in sepsis.

OBJECTIVE: Monocyte dysfunction has been shown to be associated with adverse consequences in septic patients. The cytokine growth factor granulocyte-macrophage colony stimulating factor (GM-CSF) may be required for optimal monocyte function in these patients. The current study investigates whether plasma GM-CSF levels were significantly different in septic patients and whether there was an association with prognosis. DESIGN: Plasma samples were collected from all septic patients from day 1 of the diagnosis of sepsis for 3 days. Healthy volunteer plasma served as control samples. A novel enzyme-linked immuno-adsorbent assay was developed with suitable sensitivity for detection of GM-CSF in patient and normal plasma. APACHE II score, age, sex and outcome were determined for all patients. SETTING: A single centre study at the Royal Liverpool University Hospital in a medico-surgical 13 bed intensive care unit. PATIENTS: All septic patients (n = 53) fulfilling the criteria of the APCC for the diagnosis of sepsis, were recruited for the study with informed consent from day 1 of the diagnosis of sepsis and plasma GM-CSF measured on three consecutive days. Patients were excluded from the study if on immunosuppressive therapy. Normal healthy volunteers (n = 33) were included in the study to serve as controls. RESULTS: Plasma GM-CSF levels were statistically significantly depressed in patients who died compared with those who survived, who had levels comparable with healthy controls. CONCLUSIONS: The results indicate that low plasma GM-CSF is associated with adverse consequences for septic patients. The measurement of GM-CSF in the plasma of septic patients merits further study for use as a prognostic marker and also to identify the type of immunotherapy the patient may benefit from.

Is low monocyte HLA-DR expression helpful to predict outcome in severe sepsis?

OBJECTIVE: Low monocyte human leukocyte antigen-DR (HLA-DR) expression has been reported to be an indicator of poor survival in critically ill septic patients. We assessed its usefulness as a prognostic indicator in order to identify possible interventions to normalise HLA-DR expression in those patients with lowered monocyte HLA-DR. DESIGN: HLA-DR expression was measured on separated monocytes of septic patients, using flow cytometry, and HLA-DR upregulation was measured by the same techniques after ex vivo stimulation with granulocyte macrophage colony stimulating factor (GM-CSF). APACHE II score, age, sex and outcome were determined for all patients. SETTING: A single-centre study at the Royal Liverpool University Hospital in a medico-surgical 13-bed intensive care unit. PATIENTS AND PARTICIPANTS: All septic patients ( n=70) fulfilling the criteria of the ACCP for the diagnosis of sepsis were recruited for the study with informed consent from day 1 of diagnosis of sepsis and monocyte HLA-DR expression measured on 3 consecutive days. Patients were excluded from the study if they were on immunosuppressive therapy. Normal healthy volunteers ( n=45) were included. RESULTS: Low monocyte surface expression and median fluorescence density HLA-DR expression was not associated with a high mortality. High APACHE II scores were not correlated with low HLA-DR expression. However, in those patients where HLA-DR expression was lowered, this could be restored ex vivo by GM-CSF. CONCLUSIONS: In the group of septic patients under study, HLA-DR was not a useful prognostic marker of outcome. We did not find a higher mortality in the group of patients who had low expression. These findings are contradictory to some previously reported findings, and the possible reasons are discussed.

HLA-DR regulation and the influence of GM-CSF on transcription, surface expression and shedding.

Low surface HLA-DR expression is a feature in sepsis. However, the mechanisms that regulate HLA-DR expression have not been elucidated. The current study investigates regulation of HLA-DR gene transcription, post transcriptional events and shedding of surface HLA-DR, as well as the regulation of HLA-DR by GM-CSF and an immunomodulatory cytokine. Plasma and PBMC were collected from septic patients and healthy volunteers. An ELISA was developed to measure soluble HLA. PCR techniques were used to determine HLA-DR mRNA levels, and flow cytometry and fluorescent microscopy were used for measurement of surface expressed and intracellular HLA-DR. Septic patients fulfilling the criteria of the American College of Chest Physicians (ACCP) for sepsis were recruited for the study (n=70). HLA-DR was measured on three consecutive days, days seven and fourteen. Patients were excluded from the study if on immunosuppressive therapy. Results: Higher levels of shed HLA-DR were found in the plasma of septic patients compared to healthy controls. The level of HLA-DR mRNA was significantly lower in septic patients compared to healthy controls, however an increased intracellular HLA-DR expression was observed. When HL-60 cells were treated with GM-CSF, gene transcription, surface expression and shedding of HLA-DR were all up-regulated. These results indicate that the mechanisms involved in the regulation of HLA-DR in sepsis include shedding of HLA-DR from the cell surface and regulation of HLA-DR gene transcription. Post-translational processing of HLA-DR was also seen to be compromised. GM-CSF was shown to regulate HLA-DR at all these levels.

Environmental lead after Hurricane Katrina: implications for future populations.

BACKGROUND: As a result of Hurricane Katrina, > 100,000 homes were destroyed or damaged and a significant amount of sediment was deposited throughout the city of New Orleans, Louisiana. Researchers have identified the potential for increased lead hazards from environmental lead contamination of soils. OBJECTIVES: We assessed the distribution of residential soil and dust lead 2 years poststorm and compared soil lead before and after the storm. METHODS: We conducted a cross-sectional study in New Orleans in which households were selected by stratified random sampling. A standard residential questionnaire was administered, and lead testing was performed for both the interior and exterior of homes. Logistic regression was used to identify significant predictors of interior and exterior lead levels in excess of allowable levels. RESULTS: One hundred nine households were enrolled; 61% had at least one lead measurement above federal standards. Of homes with bare soil, 47% had elevated lead and 27% had levels exceeding 1,200 ppm. Housing age was associated with soil lead, and housing age and soil lead were associated with interior lead. Race, income, and ownership status were not significantly associated with either interior or exterior lead levels. The median soil lead level of 560 ppm was significantly higher than the median level of samples collected before Hurricane Katrina. CONCLUSIONS: The high prevalence (61%) of lead above recommended levels in soil and dust samples in and around residences raises concern about potential health risks to the New Orleans population, most notably children. Steps should be taken to mitigate the risk of exposure to lead-contaminated soil and dust. Further research is needed to quantify the possible contribution of reconstruction activities to environmental lead levels.

Demand-control-person: integrating the demand-control and conservation of resources models to test an expanded stressor-strain model.

We propose an expanded stressor-strain model that explicitly incorporates person characteristics, the Demand-Control-Person model. This model integrates Karasek's traditional Demand-Control model with Hobfoll's (1989) Conservation of Resources theory. With participants from two organizations, we tested the moderating role of emotional stability in conjunction with two job demands (i.e., uncertainty and time pressure) and control (i.e., decision latitude) in predicting two forms of strain (i.e., job dissatisfaction and disengagement). Our findings support the expanded Demand-Control-Person model, such that a significant three-way interaction emerged for uncertainty and time pressure. As predicted, the traditional Demand-Control model only held among individuals high in emotional stability, such that low-emotional stability individuals did either not benefit as readily from decision latitude or were more susceptible to job demands when they had decision latitude. Thus, the Demand-Control-Person model may provide a more comprehensive model and consistent prediction of the effect of stressors on strain as determined by individual characteristics.

General job performance of first-line supervisors: the role of conscientiousness in determining its effects on subordinate exhaustion.

In an integrated test of the job demands-resources model and trait activation theory, we predicted that the general job performance of employees who also hold supervisory roles may act as a demand to subordinates, depending on levels of subordinate conscientiousness. In a sample of 313 customer service call centre employees, we found that high-conscientiousness individuals were more likely to experience emotional exhaustion, and low-conscientiousness individuals were less likely as the general job performance of their supervisor improved. The results were curvilinear, such that high-conscientiousness individuals' exhaustion levelled off with very high supervisor performance (two standard deviations above the mean), and low-conscientiousness individuals' exhaustion levelled off as supervisor performance improved from moderate to high. These findings suggest high-conscientiousness employees may efficiently handle demands presented by a low-performing coworker who is their boss, but when performance expectations are high (i.e. high-performing boss), these achievement-oriented employees may direct their resources (i.e. energy and time) towards performance-related efforts at the expense of their well-being. Conversely, low-conscientiousness employees suffer when paired with a low-performing boss, but benefit from a supervisor who demonstrates at least moderate job performance.

Service employees give as they get: internal service as a moderator of the service climate-service outcomes link.

We lend theoretical insight to the service climate literature by exploring the joint effects of branch service climate and the internal service provided to the branch (the service received from corporate units to support external service delivery) on customer-rated service quality. We hypothesized that service climate is related to service quality most strongly when the internal service quality received is high, providing front-line employees with the capability to deliver what the service climate motivates them to do. We studied 619 employees and 1,973 customers in 36 retail branches of a bank. We aggregated employee perceptions of the internal service quality received from corporate units and the local service climate and external customer perceptions of service quality to the branch level of analysis. Findings were consistent with the hypothesis that high-quality internal service is necessary for branch service climate to yield superior external customer service quality.

Race, socioeconomic resources, and late-life mobility and decline: findings from the Health, Aging, and Body Composition study.

BACKGROUND: This study examines the relationship between race and mobility over 5 years in initially well-functioning older adults and evaluates how a broad set of socioeconomic status indicators affect this relationship. METHODS: Data were from 2,969 black and white participants aged 70-79 from the Health, Aging, and Body Composition study. Mobility parameters included self-reported capacity to walk a quarter mile and climb 10 steps and usual gait speed. Incident mobility limitation was defined as reported difficulty walking a quarter mile or climbing 10 steps at two consecutive semiannual assessments. Gait speed decline was defined as a 4% reduction in speed per year. RESULTS: At baseline, even though all participants were free of mobility limitation, blacks had slower walking speed than their white counterparts, which was not explained by poverty, education, reading level, or income adequacy. After 5 years, accounting for age, site, and baseline mobility, blacks were more likely to develop mobility limitation than whites. Adjusting for prevalent conditions at baseline eliminated this difference in women; controlling for education eliminated this difference in men. No differences in gait speed decline were identified. CONCLUSIONS: Higher rates of mobility loss observed in older blacks relative to older whites appear to be a function of both poorer initial mobility status and existing health conditions particularly for women. Education may also play a role especially for men.

Dietary patterns and survival of older adults.

BACKGROUND: Recent research has linked overall dietary patterns to survival in older adults. OBJECTIVES: The objective of this study was to determine the dietary patterns of a cohort of older adults, and to explore associations of these dietary patterns with survival over a 10-year period. A secondary goal was to evaluate participants' quality of life and nutritional status according to their dietary patterns. DESIGN: The Health, Aging, and Body Composition Study is a prospective cohort study of 3,075 older adults. In this study, all-cause mortality was assessed from baseline through Year 10. Food intake was estimated with a modified Block food frequency questionnaire, and dietary patterns of 2,582 participants with complete data were derived by cluster analysis. RESULTS: Six dietary pattern clusters were identified, including a Healthy Foods cluster, characterized by higher intake of low-fat dairy products, fruit, whole grains, poultry, fish, and vegetables. Both the High-Fat Dairy Products and Sweets and Desserts clusters had a 1.4-fold higher risk of mortality than the Healthy Foods cluster after adjusting for potential confounders. The Healthy Foods cluster also had significantly more years of healthy life and more favorable levels of selected nutritional biomarkers than the other clusters. CONCLUSIONS: A dietary pattern consistent with current guidelines to consume relatively high amounts of vegetables, fruit, whole grains, poultry, fish, and low-fat dairy products may be associated with superior nutritional status, quality of life and survival in older adults.

The downside of goal-focused leadership: the role of personality in subordinate exhaustion.

Exhaustion has a significant impact on employees and organizations, and leader behavior may affect it. We applied conservation of resources theory to test propositions regarding the joint effects of goal-focused leadership (GFL) and personality on employee exhaustion. We proposed that the relationship between GFL and exhaustion depends on employees' standing on both conscientiousness and emotional stability. Specifically, we expected that high-conscientiousness subordinates experience greater compatibility with a goal-focused leader because of their predisposition to direct resources toward achievement and goal setting, resulting in lower exhaustion under such a leader than among low-conscientiousness employees. Furthermore, high emotional stability may compensate for GFL incompatibility among low-conscientiousness employees by providing additional resources to manage GFL. In contrast, employees low on both traits likely experience greater exhaustion under a goal-focused leader compared with other employees. Results revealed a 3-way interaction in 2 independent samples and were generally supportive of our predictions. GFL was associated with heightened exhaustion among individuals in the low-emotional-stability, low-conscientiousness group but not among workers having any other trait combination.

The Relationship between Mold Exposure and Allergic Response in Post-Katrina New Orleans.

Objectives. The study's objective was to examine the relation between mold/dampness exposure and mold sensitization among residents of Greater New Orleans following Hurricane Katrina. Methods. Patients were recruited from the Allergy Clinic of a major medical facility. Any patient receiving a skin prick test for one of 24 molds between December 1, 2005 and December 31, 2008 was eligible for the study. Exposure was assessed using standardized questionnaires. Positive mold reactivity was defined as a wheal diameter >3 mm to any mold genera. Results. Approximately 57% of participants tested positive to any indoor allergen, 10% to any mold. Over half of respondents had significant home damage, 34% reported dampness/mold in their home, half engaged in renovation, and one-third lived in a home undergoing renovation. Despite extensive exposure, and multiple measures of exposure, we found no relationship between mold/dampness exposure and sensitivity to mold allergens. Conclusions. These results along with results of earlier research indicate no excess risk of adverse respiratory effects for residents living in New Orleans after the devastation of Hurricane Katrina.