Comparison of staff and resident health status ratings in care homes

BackgroundMany care home residents cannot self-report their own health status. Previous studies have shown differences between staff and resident ratings. In 2012, we collected 10 168 pairs of health status ratings using the howRu health status measure. This paper examines differences between staff and resident ratings.MethodHowRu is a short generic person-reported outcome measure with four items: pain or discomfort (discomfort), feeling low or worried (distress), limited in what you can do (disability) and require help from others (dependence). A summary score (howRu score) is also calculated. Mean scores are shown on a 0–100 scale. High scores are better than low scores. Differences between resident and staff reports (bias) were analysed at the item and summary level by comparing distributions, analysing correlations and a modification of the Bland-Altman method.Results and conclusionsDistributions are similar superficially but differ statistically. Spearman correlations are between 0.55 and 0.67. For items, more than 92.9% of paired responses are within one class; for the howRu summary score, 66% are within one class. Mean differences (resident score minus staff score) on 0–100 scale are pain and discomfort (−1.11), distress (0.67), discomfort (1.56), dependence (3.92) and howRu summary score (1.26). The variation is not the same for different severities. At higher levels of pain and discomfort, staff rated their discomfort and distress as better than residents. On the other hand, staff rated disability and dependence as worse than did residents. This probably reflects differences in perspectives. Red amber green (RAG) thresholds of 10 and 5 points are suggested for monitoring changes in care home mean scores.

Health status of care home residents: practicality and construct validity of data collection by staff at scale

BackgroundMedical diagnoses and assessed need for care are the prerequisites for planning and delivery of care to residents of care homes. Assessing the effectiveness of care is difficult. The aim of this study was to test the practicality and construct validity of the howRu health status measure using secondary analysis of a large data set.MethodThe data came from a Bupa Care Homes Census in 2012, which covered 24 506 residents in 395 homes internationally (UK, Australia and New Zealand). Staff completed optical mark readable forms about each resident using a short generic health status measure, howRu. Response rates were used to assess practicality and expected relationships between health status and independent variables were used to assess the construct validity.Results and discussion19,438 forms were returned (79.3%) in 360 care homes (91.1%); complete health status data were recorded for 18 617 residents (95.8% of those returned). Missing values for any health status items mostly came from a small number of homes. The relationships between howRu and independent variables support construct validity. Factor analysis suggests three latent variables (discomfort, distress and disability/dependence).ConclusionsHowRu proved easy to use and practical at scale. The howRu health status measure shows good construct validity.

Simbiosis Zooxanthellae dan Karang Sebagai Indikator Kualitas Ekosistem Terumbu Karang

TINJAUAN TEORITIS SIMBIOSIS ZOOXANTHELLAE DAN KARANG SEBAGAI INDIKATOR KUALITAS EKOSISTEM TERUMBU KARANG Unstain NWJ Rembet1 ABSTRACT A symbiotic process between zooxanthellae and corals can support the adaptative factors in terms of natural vulnerability criteria. The proposed consideration are 1) the symbiosis between zooxanthellae and corals provides phenomenal contributions to coral evolutionary process and 2) the criteria used by Gomez and Yap have been merely based on live coral cover that is still becoming key tools for the evaluation of coral reef health status measure. These criteria have been weaker and weaker due to neglecting the feature of intra- and interspesific relationship in coral biota itself. Therefore, the use of zooxanthellae and coral symbiotic relationship is thought of being able to complete the coral reef quality evaluation since its information could address this relationship feature beside on the basis of response to environmental pressures. Keywords : symbiotic, zooxanthellae, coral. ABSTRAK Proses simbiosis antara zooxanthellae dengan karang dapat memberikan suatu support terhadap faktor penyesuai dalam hal ini dari segi kriteria kerentanan alami. Pertimbangan yang diajukan adalah (1) simbiosis antara karang dengan zooxanthellae memberikan konstribusi fenomenal dalam proses evolusi karang dan (2) kriteria yang dipergunakan saat ini dari analisis Gomez dan Yap hanya didasarkan atas tutupan karang hidup yang sampai sekarang menjadi acuan bagi evaluasi tingkat status kesehatan terumbu. Kriteria tersebut dipandang mengalami kelemahan karena mengabaikan sifat hubungan intra dan ekstraspesifik dari biota karang itu sendiri. Atas dasar hal tersebut, maka penggunaan hubungan simbiosis zoxanthellae dan karang dipandang dapat melengkapi evaluasi kualitas terumbu karang karena informasinya dapat menjelaskan sifat hubungan intra dan ekstra spesifik, disamping atas dasar respon terhadap tekanan lingkungan. Kata kunci : simbiosis, zooxanthellae, karang. 1 Laboratorium Pengelolaan Wilayah Pesisir Terpadu, FPIK UNSRAT