Re-visiting the six-item Stanford presenteeism scale (SPS-6) and its psychometric properties.

Presenteeism has often been considered as the correlate of absenteeism and associated to productivity loss. This study sought to re-examine the psychometric properties of the 6-item Stanford Presenteeism Scale (SPS-6), a popular measure which has been translated in a number of languages. The study adopted a cross-sectional design with 268 participants aged 18 - 65 working in a multinational IT company with headquarters based in Poland. The respondents participated willingly in an online questionnaire on a presenteeism health-related productivity measure (SPS-6), job resources (peer support), job demands (work-to-family conflict), engagement and burnout. Their responses were subjected to statistical analyses. Confirmatory Factor Analysis revealed that the SPS-6 is better represented by two singular and independent components, namely completing work and avoiding distractions, rather than an aggregated measure of health-related productivity. In fact, the aggregated measure had convergent and discriminant validity issues. We also assessed, via Structural Equation Modeling (SEM), the explanatory role of the SPS-6 within the wider well-being discourse by subjecting its' factors as outcomes using the JD-R framework. Here, burnout was better at explaining its relationship to avoiding distractions and completing work compared to engagement, while avoiding distractions was more dominant than completing work in explaining indirect pathways. Given the convergent and discriminant validity of its two-dimensional measures, we argue that the SPS-6 is a better assessment of health-related productivity in the light of presenteeism when keeping both components separate rather than adding the scores from both dimensions to provide a global score as has been the practice so far. In addition, the SEM findings suggest that both SPS-6 components may require different theoretical explanations. This study supports a growing chorus of scholars who argue the need to look deeper into the presenteeism phenomenon, not least its measures.

Post-surgery length of stay using multi-criteria decision-making tool.

Purpose Length of stay (LOS) in hospital after surgery varies for each patient depending on surgeon's decision that considers criticality of the surgery, patient's conditions before and after surgery, expected time to recovery and experience of the surgeon involved. Decision on patients' LOS at hospital post-surgery affects overall healthcare performance as it affects both cost and quality of care. The purpose of this paper is to develop a model for deriving the most appropriate LOS after surgical interventions. Design/methodology/approach The study adopts an action research involving multiple stakeholders (surgeon, patients/patients' relatives, hospital management and other medics). First, a conceptual model is developed using literature and experts' opinion. Second, the model is applied in three surgical interventions in a public hospital in Malta to demonstrate the effectiveness of the model. Third, the policy alternatives developed are compared to a selection of current international standards for each surgical intervention. The proposed model analyses three LOS threshold policies for three procedures using efficiency and responsiveness criteria. The entire analysis is carried out using 325 randomly selected patient files along with structured interactions with more than 50 stakeholders (surgeon, patients/patients' relatives, hospital management and other medics). A multiple criteria decision-making method is deployed for model building and data analysis. The method involves combining the analytic hierarchy process (AHP) for verbal subjective judgements on prioritizing the four predictors of surgical LOS-medical, financial, social and risk, with pairwise comparisons of the sub-criteria under each criterion in line with the concerned interventions-the objective data of which are obtained from the patients' files. Findings The proposed model was successfully applied to decide on the best policy alternative for LOS for the three interventions. The best policy alternatives compared well to current international benchmarks. Research limitations/implications The proposed method needs to be tested for other interventions across various healthcare settings. Practical implications Multi-criteria decision-making tools enable resource optimization and overall improvement of patient care through the application of a scientific management technique that involves all relevant stakeholders while utilizing both subjective judgements as well as objective data. Originality/value Traditionally, the duration of post-surgery LOS is mainly based on the surgeons' clinical but also arbitrary decisions, with, as a result, having insufficiently explicable variations in LOS amongst peers for similar interventions. According to the authors' knowledge, this is the first attempt to derive post-surgery LOS using the AHP, a multiple criteria decision-making method.

Impact of School Air Quality on Children's Respiratory Health.

BACKGROUND: Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. AIMS: This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children. SETTINGS AND DESIGN: Five primary schools were selected with 9- to 11-year-old students participating. MATERIALS AND METHODS: Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out. STATISTICAL ANALYSIS USED: SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used. RESULTS: The mean indoor PM 2.5 level of 17.78 µg/m3 and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 µg/m3. High exposure to formaldehyde, NO2, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing (P < 0.001) but not nocturnal cough (P = 0.34). CONCLUSIONS: School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation.

Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis.

The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state's health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta.