Understanding the barriers to identifying carers of people with advanced illness in primary care:triangulating three data sources

BACKGROUND: Approximately 10% of the UK population have an unpaid caring role for a family member or friend. Many of these carers make a significant contribution to supporting patients at the end of life. Carers can experience poor physical and psychosocial wellbeing, yet they remain largely unsupported by health and social care services. Despite initiatives for general practices to identify carers and their needs, many remain unidentified. Neither are carers self-identifying and requesting support. This study set out to explore the barriers to, and consider strategies for, identifying carers in primary care. METHODS: We integrated findings from three data sources – a review of the caregiving literature; a workshop with researchers who have undertaken research with those caring at the end of life, and focus groups with carers and health professionals. RESULTS: Three categories of barrier emerged. 1) Taking on the care of another person is often a gradual process, carers did not immediately identify with being a ‘carer’ – preferring to think of themselves in relational terms to the patient e.g. spouse, sibling, son or daughter. Often it was health and social care professionals who encouraged carers to consider themselves as an unpaid carer. 2) As the cared-for person’s condition deteriorated, the caring role often became all-encompassing so that carers were managing competing demands, and felt unable to look after their own needs as well as those of the cared-for person. 3) There was ambiguity about the legitimacy of carer needs and about the role of the primary health care team in supporting carers, from both the perspective of the carers and the health professionals. GPs were thought to be reactive rather than proactive which discouraged carers from asking for help. CONCLUSIONS: The needs of carers have to be legitimised to ensure primary care staff are proactive in their approach and carers are empowered to utilise the support available. Strategies to identify carers have to be sensitive to the complex dynamics of a caring relationship as well as the primary care context. Identification is a key factor in improving support for carers themselves and to enable them to support the patient

Inconsistent relationships between area, heterogeneity and plant species richness in temperate farmed landscapes

Relationships between area, heterogeneity and species richness are fundamental concepts in ecology yet questions remain about how area and heterogeneity trade-off (AHTO) to constrain biodiversity. Although there is growing evidence for unimodal heterogeneity diversity relationships (HDR’s) and an AHTO, tests of the concept and consequences for species richness across a landscape-scale gradient of human-modified ecosystems are rare. Using data from a national (Wales) field survey we analysed relationships between environmental heterogeneity and plant species richness (α and γ). We used ordination to produce a composite metric of heterogeneity and compared this to commonly used metrics. We used niche hypervolumes to categorise the breadth of plant species’ ecological preferences and analysed relationships between species richness, niche width and heterogeneity. The HDR was unimodal with α diversity at the smallest scale and positive with α and γ diversity (non-linear) at the 1 km scale although in low intensity landscapes the HDR with γ diversity was unimodal. There was a unimodal relationship between habitat diversity and γ diversity. Land use intensity was unimodally related to diversity. There were significant interactions between niche width and heterogeneity. Richness of broad niche species increased with heterogeneity with flattening of the curve at higher levels. Narrow niche species were rare and mostly unresponsive. The expected decline in narrow niche species with increasing heterogeneity was not found although they did decline with land-use intensity. Using a unique dataset, an analysis of a large-scale mosaic of ecosystems found that the shape of the HDR varies with land use intensity, the heterogeneity metric, spatial scale, diversity type and niche width. Although heterogeneity can increase species richness, there may be trade-offs at higher heterogeneity. A fundamental constraint on realising the benefit of heterogeneity is the low availability of narrower niche species in local species pools in modified landscapes

Interface of the Environment and Occurrence of Botrytis cinerea in Pre-symptomatic Tomato Crops

Botrytis cinerea (Grey mould) is a necrotrophic fungus infecting over 230 plant species worldwide. It can cause major pre- and post-harvest diseases of many agronomic and horticultural crops. Botrytis cinerea causes annual economic losses of 10–100 billion US dollars worldwide and instability in the food supply (Jin and Wu, 2015). Grey mould losses, either at the farm gate or later in the food chain, could be reduced with improved knowledge of inoculum availability during production. In this paper, we report on the ability to monitor Botrytis spore concentration in glasshouse tomato production ahead of symptom development on plants. Using a light weight and portable air sampler (microtitre immunospore trap) it was possible to quantify inoculum availability within hours. Also, this study investigated the spatial aspect of the pathogen with an increase of B. cinerea concentration in bio-aerosols collected in the lower part of the glasshouse (0.5 m) and adjacent to the trained stems of the tomato plants. No obvious relationship was observed between B. cinerea concentration and the internal glasshouse environmental parameters of temperature and relative humidity. However the occurrence of higher outside wind speeds did increase the prevalence of B. cinerea conidia in the cropping environment of a vented glasshouse. Knowledge of inoculum availability at time periods when the environmental risk of pathogen infection is high should improve the targeted use and effectiveness of control inputs

Hepatitis E virus (HEV) in Scotland:evidence of recent increase in viral circulation in humans

Background: Previous studies showed low levels of circulating hepatitis E virus (HEV) in Scotland. We aimed to reassess current Scottish HEV epidemiology. Methods: Blood donor samples from five Scottish blood centres, the minipools for routine HEV screening and liver transplant recipients were tested for HEV antibodies and RNA to determine seroprevalence and viraemia. Blood donor data were compared with results from previous studies covering 2004-08. Notified laboratory-confirmed hepatitis E cases (2009-16) were extracted from national surveillance data. Viraemic samples from blood donors (2016) and chronic hepatitis E transplant patients (2014-16) were sequenced. Results: Anti-HEV IgG seroprevalence varied geographically and was highest in Edinburgh where it increased from 4.5% in 2004-08) to 9.3% in 2014-15 (p = 0.001). It was most marked in donors < 35 years. HEV RNA was found in 1:2,481 donors, compared with 1:14,520 in 2011. Notified laboratory-confirmed cases increased by a factor of 15 between 2011 and 2016, from 13 to 206. In 2011-13, 1 of 329 transplant recipients tested positive for acute HEV, compared with six cases of chronic infection during 2014-16. Of 10 sequenced viraemic donors eight and all six patients were infected with genotype 3 clade 1 virus, common in European pigs. Conclusions: The seroprevalence, number of viraemic donors and numbers of notified laboratory-confirmed cases of HEV in Scotland have all recently increased. The causes of this change are unknown, but need further investigation. Clinicians in Scotland, particularly those caring for immunocompromised patients, should have a low threshold for testing for HEV