Background Family carers are central in supporting patients nearing the end of life, but this often has an impact on their own mental health. Understanding what factors may affect carers’ mental health is important in developing strategies to maintain mental health, through identifying carers at risk who may need added monitoring and support or developing interventions to change modifiable factors. Reviews of the qualitative, observational and intervention literature were conducted to address this. Aims (1) to review trials of carer interventions to improve our understanding of factors related to carer mental health identified in earlier qualitative and observational reviews; (2) to synthesise the evidence from our qualitative, observational and intervention reviews on factors related to carers’ mental health during end-of-life caregiving. Method We carried out searches of MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO® (American Psychological Association, Washington, DC, USA), Social Sciences Citation Index, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Database of Abstracts of Reviews of Effects (DARE) from 1 January 2009 to 24 November 2019. We included studies into adult informal/family carers for adult patients at the end of life cared for at home that considered any factor related to carer mental health (anxiety, depression, distress, quality of life) pre bereavement. The quality appraisal used Critical Appraisal Skills Programme (CASP) checklists and the Newcastle–Ottawa Scale. The qualitative review analysis developed themes that then provided a framework for the quantitative review analyses. Findings from all three reviews were mapped onto a single framework, informed by a carer Review Advisory Panel. Results A total of 31 qualitative, 60 observational, 12 intervention and 3 mixed-methods studies were identified. Factors associated with carer mental health were as follows: (1) patient condition, particularly psychological symptoms and quality of life; (2) impact of caring responsibilities, particularly life changes, workload and carer burden; (3) relationships, particularly with the patient; (4) finances, whether sufficient or not; (5) internal processes, particularly self-efficacy; (6) support, particularly adequacy and quality of support; (7) contextual factors, particularly age and gender. The three types of literature were reflected in most themes and yielded similar or complementary results, adding validity to findings. Only observational studies investigated contextual factors. Intervention studies focused on modifiable factors, but added little evidence on the causal direction between factors and mental health owing to design and analysis limitations. Relationships and finance received little attention overall. There was limited research into ethnicity, race or culture. Quantitative research missed some factors highlighted by carers in qualitative studies (e.g. quality aspects of formal support), and focused more on ‘self-management’ within internal processes (emphasised less by carers). Limitations Findings are from Organisation for Economic Co-operation and Development (OECD) country English-language publications on adult carers and patients in the home setting and limited to these contexts. Literature heterogeneity (study focus, objectives, methods, variables, measures) hindered meta-synthesis. Conclusions Future work requires broad stakeholder engagement to address the diverse range of factors associated with carers’ mental health. Project findings will be disseminated accordingly. Future research needs more (1) work on defining and measuring concepts; (2) longitudinal design, repeated measurement and path analysis, to move beyond evidence of association towards an understanding of causal relationships; (3) focus on factors that matter to carers rather than what is easily measured or manipulated; and (4) investigation of relationships, finance, ethnicity, race and culture. Study registration This study is registered as PROSPERO CRD42019130279. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in Health and Social Care Delivery Research. See the NIHR Journals Library website for further project information.
No significant variation in mating activity was observed among eight laboratory strains of the Mediterranean fruit fly (medfly), Ceratitis capitata (Wiedemann) (Diptera: Tephritidae). Two methods were used to select strains showing high and low mating activity: a single pair technique (SP) assessing ‘time to mating’ and a mass technique (M) based on a ‘mating index’. Reciprocal pairings between fast and slow selected lines showed that the difference between the SP lines was female‐determined whereas the difference between the M lines depended on the behaviour of both sexes. M selection, irrespective of its direction, affected two courtship parameters, ‘vibration distance’ and ‘vibration duration’ both of which tended to be shorter. M selection was also associated with a reduction in ‘startle activity’ in females. Résumé Deux méthodes de sélection de la mouche méditerranéenne des fruits, Ceratitis capitata (Diptera: Tephritidae), en fonction de leur comportement sexuel: réponse à la sélection et influence de la méthode de sélection Aucune variation significative n'a été observée dans les activités sexuelles de huit souches de laboratoire de la mouche méditerranéenne du fruit, Ceratitis capitata (Wiedemann) (Diptera Tephritidae). Deux méthodes ont été utilisées pour sélectionner des souches manifestant une activité sexuelle basse ou élevée: une technique utilisant un seul couple (SP), basée sur la durée de la période avant copulation, et une technique de masse (M), basée sur un ‘index d'accouplement’. Des appariements réciproques entre les lignées rapides et lentes ont montré que la différence entre les lignées SP était déterminée par les femelles, tandis que la différence entre les lignées M résultait du comportement des deux sexes. La sélection M, quelle que soit sa direction, affects deux paramètres, la ‘distance entre partenaires lors de la vibration’ et la ‘durée de la vibration’ qui tous deux tendent à se raccourcir. La sélection M est aussi associée à une réduction de la réaction des femelles à un brusque stimulus lumineux ('Startle activity').
BACKGROUND Background: The COVID-19 pandemic has accelerated the shift towards digital provision of many services, including health and social care, public, financial and leisure services. COVID-19 services (test appointments and results, vaccination appointments etc.) were provided digital-first to the public. Many social, cultural, and economic activities, (appointments, ticket bookings, tax and utility payments, shopping etc.) have transitioned to online platforms. To use digitalised services individuals must be digitally included. This is influenced by three main factors: access, (whether individuals have access to internet); ability, (having requisite skills and confidence to participate online); and affordability, (ability to pay for infrastructure (equipment) and data packages). Many older adults, especially those aged 75+years, are still digitally excluded. OBJECTIVE To explore the views of adults aged 75+ on using digital technologies to access public services. METHODS We conducted semi-structured qualitative interviews with adults aged 75 years and above resident in Greater Manchester. Two distinct groups of older adults were recruited (1) those who were participating (to varying degrees) in digital activities and/or enrolled on a learning and support programme; (2) those who were not engaged digitally. We also interviewed community support workers. Thematic analysis was used to identify the key themes from the data. RESULTS Overall 24 older adults participated (mean age=81, 14 women, 23 White British, 18 digitally engaged) and 2 support workers. Six themes were identified as key in understanding issues around motivation, engagement, and participation; 1) ‘Initial motivation to participate digitally’; e.g. maintaining social connections and gaining skills to be able to connect with family and friends, 2) ‘Public services and freedom of choice’; in particular, little interaction with online public services apart from prescription ordering 3) ‘Narrow use and restriction of activity online’; undertaking limited tasks online and in a modified manner, e.g. checking but never transferring funds during online banking, 4) ‘Impact of digital participation on well-being’; choosing to go to the shops or GP surgery to get out of the house and get some exercise, 5) ‘The last generation?’, respondents feeling there were generational barriers to adapting to new technology and change 6) ‘Making digital accessible’; understanding the support needed to keep those engaged online. CONCLUSIONS The views of older people must be included as we move to greater digitalisation of services if we are not to exclude them from services for which they have great need.
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