Background
Obesity is a global phenomenon and is associated with various types of cancer, including colon cancer. There is a growing interest for safe and effective bioactive compounds that suppress the risk for obesity-promoted colon cancer. Resveratrol (trans-3, 4', 5,-trihydroxystilbene), a stilbenoid found in the skin of red grapes and peanuts suppresses many types of cancers by regulating cell proliferation and apoptosis through a variety of mechanisms, however, resveratrol effects on obesity-promoted colon cancer are not clearly established.

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Resveratrol suppresses IGF-1 induced human colon cancer cell proliferation and elevates apoptosis via suppression of IGF-1R/Wnt and activation of p53 signaling pathways

Objective The aim of this study was to develop a measure of social care outcome, an equivalent to the quality-adjusted life year (QALY) in health, which could be used in a range of circumstances. Design The project drew on previous and parallel work developing the Adult Social Care Outcome Toolkit and the national Adult Social Care Survey. We developed and tested an instrument designed to reflect service users' social care-related quality of life (SCRQoL) and tested it with 30 service users from a variety of user groups and 300 older home care service users. In parallel, we explored discrete choice experiment (DCE) and best-worst scaling (BWS) approaches to preference elicitation with 300 members of the general population, and cognitively tested these with service users. We also cognitively tested a computer-aided time trade-off (TTO) exercise using SCRQoL attributes with members of the general population. In the second phase, using the finalised instruments, BWS interviews were conducted with 500 members of the general population, TTO interviews with a follow-up sample of 126 of these respondents, and BWS interviews with 458 people using equipment services. Main outcome measures The final measure had eight domains: personal cleanliness and comfort, accommodation cleanliness and comfort, food and drink, safety, social participation and involvement, occupation, control over daily life and dignity. In addition to measuring current SCRQoL, the instrument includes questions used to establish service users' views of their 'expected' SCRQoL in the absence of services. The difference between a person's current and 'expected' SCRQoL provides an indicator of service impact. Results There was good evidence for the validity of the descriptive system and the validity of the current, expected and SCRQoL gain scales. The DCE and BWS approaches yielded similar results and, once introductions made clear, were understood by service users. BWS was used for the main stages, as it had technical and cognitive advantages. The computer-aided approach to TTO worked well, and respondents found questions acceptable and understandable. There were no substantive differences in the preferences of service users and the general population. The key domain was control over daily life, with the lowest and highest levels strongly estimated in all models. After allowing for observable heterogeneity, service users' preferences appeared to be more closely associated with their own SCRQoL than with those of the general population. The consistency of the results with the results of a previous study allowed the final model to be based on the preferences of 1000 members of the general population. A formula based on the relationship between TTO and BWS values was estimated for a social care QALY, with '0' equivalent to 'being dead' and '1' being the 'ideal' SCRQoL state. Members of the population experienced significantly higher SCRQoL than service users. Conclusions Although further work is needed, particularly to develop an equivalent measure for informal carers and to explore the links with health QALYs, the measure has considerable potential. A number of methodological advances were achieved, including the first application of TTO in a social care context and use of BWS to establish service user preferences. Funding The National Institute for Health Research Health Technology Assessment programme.

/pdf/outcomes-of-social-care-for-adults-developing-a-preference-30bqtcakhy.pdf

Outcomes of social care for adults: developing a preference-weighted measure.

Individual budgets (IBs) were piloted as a new way of providing support for older and disabled adults and people with mental health problems eligible for publicly funded social care. 

The Department of Health set up IB pilot projects in 13 English local authorities, running from November 2005 to December 2007, and commissioned a national evaluation. 

This evaluation is the first robust UK study of the implementation and impact of personalisation approaches in social care.

/pdf/evaluation-of-the-individual-budgets-pilot-programme-final-7hlvuphoha.pdf

Evaluation of the Individual Budgets Pilot Programme: Final Report

The adult social care outcomes toolkit (ASCOT) includes a preference-weighted measure of social care-related quality of life for use in economic evaluations. ASCOT has eight attributes: personal cleanliness and comfort, food and drink, control over daily life, personal safety, accommodation cleanliness and comfort, social participation and involvement, occupation and dignity. This paper aims to demonstrate the construct validity of the ASCOT attributes. A survey of older people receiving publicly-funded home care services was conducted by face-to-face interview in several sites across England. Additional data on variables hypothesised to be related and unrelated to each of the attributes were also collected. Relationships between these variables and the attributes were analysed through chi-squared tests and analysis of variance, as appropriate, to test the construct validity of each attribute. 301 people were interviewed and approximately 10% of responses were given by a proxy respondent. Results suggest that each attribute captured the extent to which respondents exercised choice in how their outcomes were met. There was also evidence for the validity of the control over daily life, occupation, personal cleanliness and comfort, personal safety, accommodation cleanliness and comfort, and social participation and involvement attributes. There was less evidence regarding the validity of the food and drink and dignity attributes, but this may be a consequence of problems finding good data against which to validate these attributes, as well as problems with the distribution of the food and drink item. This study provides some evidence for the construct validity of the ASCOT attributes and therefore support for ASCOT's use in economic evaluation. It also demonstrated the feasibility of its use among older people, although the need for proxy respondents in some situations suggests that developing a version that is suitable for proxies would be a useful future direction for this work. Validation of the instrument on a sample of younger social care users would also be useful.

/pdf/an-assessment-of-the-construct-validity-of-the-ascot-measure-3phj36vihl.pdf

An assessment of the construct validity of the ASCOT measure of social care-related quality of life with older people

The first part of the paper argues that the care relationship is crucial to securing care quality, which has implications for the way in which quality is achieved and measured. However, for more than twenty years, governments have emphasised the part that increasing market competition and, more recently, user choice of services can play in driving up the quality of care. The second part of the paper analyses the development of social care services for older people, from the reform of 1990 to the changes following the general election of 2010. The paper goes on to examine whether competition and choice are in any case enough to result in ‘good care’, given the evidence of limitations both in the amount of choice available and in how far older people are able or willing to choose. It is argued that if ‘good care’ depends disproportionately on the quality of the care relationship, then more attention should be paid to the care workforce, which has received relatively little comment in recent government documents.

/pdf/re-shaping-social-care-services-for-older-people-in-england-1h1m68j6wm.pdf

Re-Shaping Social Care Services for Older People in England: Policy Development and the Problem of Achieving ‘Good Care’

Raising standards is one of the key objectives of the British government's Modernizing Agenda. The quality of life of vulnerable older people who are being maintained at home is fundamentally dependent on the quality of the home-care services they receive, so raising standards of home care is clearly central to this agenda. This paper draws on a small-scale study of service users and providers to examine the aspects of quality of home care of importance to older people, their experiences and barriers to improvement. Six key aspects of quality were investigated: reliability, continuity, flexibility, communication, staff attitudes and skills and knowledge. If performance indicators are to have the desired effect, more work needs to be done to ensure they reflect key aspects of quality from the user perspective. We identify potential areas for improvement in commissioning and organization but these all have resource implications that will need to be met if home care is to realize its full potential in maintaining and improving quality of life for older people.

Raising the Quality of Home Care: A Study of Service Users’ Views

Home care services play a fundamental role in England in supporting older and disabled people in their own homes. In order to identify and monitor the degree to which these services are providing good quality services, in 2003 the government required all councils with social services responsibilities (CSSR) to undertake user experience surveys among older service users. The questionnaire was required to include four questions, two of which were designed to be used as Best Value Performance Indicators (BVPI) reflecting the quality of home care of older people. Thirty-four local authorities participated in an extension study providing data from 21 350 home care users. The aim of the study was to answer three questions: (1) Do the performance indicators reflect home care quality? (2) Are the performance indicators using the most appropriate cut-off points? (3) What are the underlying constructs of home care quality? Evidence was found to support the use of two of the performance indicators and the current cut-off point being used for the satisfaction indicator. Factor analysis identified indicators of important dimensions of quality that were associated with overall satisfaction.

Using older home care user experiences in performance monitoring.

Reflecting and learning from the perspective of service users is an increasingly important aspect of government policy. In order to reflect this in performance indicators relating to the quality of services, all councils with social services responsibilities (CSSRs) are required to undertake user experience surveys (UES). In 2002-2003 the survey focused on older users of home care. This paper reports on the findings of an extension to that survey conducted as part of the PSSRU Costs, Quality and Outcomes programme. The principal aims of the UES extension study were:

 to add value to the User Experience Surveys for a sample of participating local authorities by enhancing comparability across dimensions not included in the four required items; to enable authorities to compare the quality of home care providers in their authorities and with providers used by other authorities; to assess the questions devised by ONS for their suitability as performance indicators; to facilitate the further development measurement of quality of homecare service. This report focuses on the evaluation of the conduct of the survey, the validity of the performance indicators, development of indicators of user experiences of quality and outcome and the factors associated with variations in these.

Performance and quality: user experiences of home care services. Final report

This paper reports on a small-scale study that investigated the careers, commitments, motivations and attitudes toward training of home care workers in Medway It also gathered information from home care providers to form a picture of Medway’s home care work force

Home care workers: careers, commitments and motivations

This paper reports on the findings of a small-scale study that investigated the meaning and delivery of quality in home care in four local authorities from the perspective of informal carers, users and providers and explored the views of users about proposed changes in the ethos of home care stipulated in the National Care Standards for Domiciliary Care (2003).

 We start by outlining the method used and then describe the characteristics of the consulted provider agencies and the characteristics and needs of the service users. Section 5 reports users’ experience of the home care service and section 6 the important aspects of quality from the perspective of users and providers. Finally, the report addresses the implications of our findings on the future development of home care provision.

/pdf/quality-in-home-care-client-and-provider-views-4iut13q2lv.pdf

Quality in home care: client and provider views

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