Full-Range Public Health Leadership, Part 2: Qualitative Analysis and Synthesis

Public health leadership is an important topic in the era of U.S. health reform, population health innovation, and health system transformation. This study utilized the full-range leadership model in order to examine the public health leadership. We sought to understand local public health leadership from the perspective of local health department leaders and those who work with and for them. Public health leadership was explored through interviews and focus groups with directors (n = 4) and staff (n = 33) from local health departments. Qualitative analytic methods included reflexive journals, code-recode procedures, and member checking, with analysis facilitated by Atlas.ti v.6.0. Qualitative results supported and expanded upon previously reported quantitative findings. Leading by example and providing individual consideration to followers were found to be more important than other leader factors, such as intellectual stimulation, inspirational motivation, or idealized attributes of leaders. Having a clear and competent vision of public health, being able to work collaboratively with other community agencies, and addressing the current challenges to public health with creativity and innovation were also important findings. Idealized leadership behaviors and individual consideration should be the focus of student and professional development. Models that incorporate contextual considerations, such as the situational leadership model, could be utilized to ensure that optimal individual consideration is given to followers

Full-Range Public Health Leadership, Part 1: Quantitative Analysis

BACKGROUND: Workforce and leadership development are central to the future of public health. However, public health has been slow to translate and apply leadership models from other professions and to incorporate local perspectives in understanding public health leadership. PURPOSE: This study utilized the full-range leadership model in order to examine public health leadership. Specifically, it sought to measure leadership styles among local health department directors and to understand the context of leadership in local health departments. METHODS: Leadership styles among local health department directors (n = 13) were examined using survey methodology. Quantitative analysis methods included descriptive statistics, boxplots, and Pearson bivariate correlations using SPSS v18.0. FINDINGS: Self-reported leadership styles were highly correlated to leadership outcomes at the organizational level. However, they were not related to county health rankings. Results suggest the preeminence of leader behaviors and providing individual consideration to staff as compared to idealized attributes of leaders, intellectual stimulation, or inspirational motivation. IMPLICATIONS: Holistic leadership assessment instruments such as the multifactor leadership questionnaire can be useful in assessing public health leaders\u27 approaches and outcomes. Comprehensive, 360-degree reviews may be especially helpful. Further research is needed to examine the effectiveness of public health leadership development models, as well as the extent that public health leadership impacts public health outcomes

The Impact of Emotional Intelligence on Conditions of Trust among Leaders at the Kentucky Department for Public Health

There has been limited leadership research on emotional intelligence and trust in governmental public health settings. The purpose of this study was to identify and seek to understand the relationship between trust and elements of emotional intelligence, including stress management, at the Kentucky Department for Public Health (KDPH). The KDPH serves as Kentucky’s state governmental health department. KDPH is led by a Commissioner and composed of seven primary divisions and 25 branches within those divisions. The study was a non-randomized cross-sectional study utilizing electronic surveys that evaluated conditions of trust among staff members and emotional intelligence among supervisors. Pearson correlation coefficients and corresponding p-values are presented to provide the association between emotional intelligence scales and the conditions of trust. Significant positive correlations were observed between supervisors’ stress management and the staff members’ trust or perception of supervisors’ loyalty (r = 0.6, p = 0.01), integrity (r = 0.5, p = 0.03), receptivity (r = 0.6, p = 0.02), promise fulfillment (r = 0.6, p = 0.02), and availability (r= 0.5, p = 0.07). This research lays the foundation for emotional intelligence and trust research and leadership training in other governmental public health settings, such as local, other state, national, or international organizations. This original research provides metrics to assess the public health workforce with attention to organizational management and leadership constructs. The survey tools could be used in other governmental public health settings in order to develop tailored training opportunities related to emotional intelligence and trust organizations

The Impact of Emotional Intelligence on Conditions of Trust among Leaders at the Kentucky Department for Public Health

There has been limited leadership research on emotional intelligence and trust in governmental public health settings. The purpose of this study was to identify and seek to understand the relationship between trust and elements of emotional intelligence, including stress management, at the Kentucky Department for Public Health (KDPH). The KDPH serves as Kentucky’s state governmental health department. KDPH is led by a Commissioner and composed of seven primary divisions and 25 branches within those divisions. The study was a non-randomized cross-sectional study utilizing electronic surveys that evaluated conditions of trust among staff members and emotional intelligence among supervisors. Pearson correlation coefficients and corresponding p-values are presented to provide the association between emotional intelligence scales and the conditions of trust. Significant positive correlations were observed between supervisors’ stress management and the staff members’ trust or perception of supervisors’ loyalty (r = 0.6, p = 0.01), integrity (r = 0.5, p = 0.03), receptivity (r = 0.6, p = 0.02), promise fulfillment (r = 0.6, p = 0.02), and availability (r = 0.5, p = 0.07). This research lays the foundation for emotional intelligence and trust research and leadership training in other governmental public health settings, such as local, other state, national, or international organizations. This original research provides metrics to assess the public health workforce with attention to organizational management and leadership constructs. The survey tools could be used in other governmental public health settings in order to develop tailored training opportunities related to emotional intelligence and trust organizations

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A search for loci contributing to acquisition of peak bone mass

Background: Low peak bone mass is an important risk factor for osteoporotic fracture. Despite heritability of 50-85%, genetic studies have failed to identify a significant susceptibility locus. With advances in genotyping technologies, a genome-wide association (GWA) approach now allows an unbiased search for genetic determinants. Aim: To perform a GWA study using pooled DNA samples (as the cost of individual genotyping is prohibitive) to identify genetic loci associated with bone accrual in a cohort where all known confounding factors could be accounted for Methods: The Young Hearts 2000 Project carried out an in-depth survey of 1700 Northern Irish secondary school children. PIXI DXA scans of wrist and heel were performed and blood was collected. 1318 subjects had complete data available within separate age/sex groups: 12yr boys and girls, 15yr old boys and girls. BMD measurements were ranked after adjustments for age, BMI and pubertal status. Within each group, 50 subjects with the highest (controls) and 50 subjects with the lowest (cases) corrected BMD scores were selected giving a total of 400. DNA was extracted manually from stored buffy coat and pooled DNA was analysed using Illumina's HumanHap550 Genotyping BeadChip. The raw data for each SNP was compared between high and low BMD pools. Results: Clusters of SNPs that showed the greatest differences between high and low BMD pools were at Chr7 - GRM8, Chr8 - SGCZ, Chr15 - TRPM7 and Chr16 - TRAP1. These differences were confirmed on individual genotyping with p-values<0.05 for the SNPs within GRM8, SGCZ and TRAP 1. The SGCZ region showed the strongest association with BMD across the age groups. The TRAP 1 region was confirmed in replication pools. These genes each have described activity in bone and therefore are reasonable candidates for association with bone accrual and warrant further replication studies.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Assessing hybrid vigor using the thermal sensitivity of physiological trade-offs in tiger salamanders

&lt;ol&gt; &lt;li&gt;Hybridization between species affects biodiversity and population sustainability in numerous ways, many of which depend on the fitness of the hybrid relative to the parental species. Hybrids can exhibit fitter phenotypes compared to the parental lineages, and this 'hybrid vigor' can then lead to the extinction of one or both parental lines.&lt;/li&gt; &lt;li&gt;In this study, we analyzed the relationship between water loss and gas exchange to compare physiological performance among three tiger salamander genotypes – the native California tiger salamander (CTS), the invasive barred tiger salamanders (BTS), and CTS x BTS hybrids across multiple temperatures (13.5°C, 20.5°C, and 23.5°C). We developed a new index of performance, the water-gas exchange ratio (WGER), which we define as the ratio of gas exchange to evaporative water loss (µL VO&lt;sub&gt;2&lt;/sub&gt;/µL H&lt;sub&gt;2&lt;/sub&gt;O). The ratio describes the ability of an organism to support energetically costly activities with high levels of gas exchange while simultaneously limiting water loss to lower desiccation risk. We used flow-through respirometry to measure the thermal sensitivity of metabolic rate and resistance to water loss of each salamander genotype to compare indices of physiological performance.&lt;/li&gt; &lt;li&gt;We found that temperature had a significant effect on metabolic rate and resistance to water loss, with both traits increasing as temperatures warmed. Across genotypes, we found that hybrids have a higher WGER than the native CTS, owing to a higher metabolic rate despite having a lower resistance to water loss.&lt;/li&gt; &lt;li&gt;These results provide greater insight into the physiological mechanisms driving hybrid vigor and offer a potential explanation for the rapid spread of salamander hybrids. More broadly, our introduction of the WGER may allow for species- or lineage-wide comparisons of physiological performance across changing environmental conditions, highlighting the insight that can be gleaned from multi-trait analysis of organism performance.&lt;/li&gt; &lt;/ol&gt;&lt;p&gt;Funding provided by: National Science Foundation&lt;br&gt;Crossref Funder Registry ID: http://dx.doi.org/10.13039/100000001&lt;br&gt;Award Number: &lt;/p&gt;&lt;p&gt;Funding provided by: University of Tennessee, Knoxville&lt;br&gt;Crossref Funder Registry ID: http://dx.doi.org/10.13039/100014455&lt;br&gt;Award Number: &lt;/p&gt