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Compared with their peers, young carers are at a higher risk of being not in education, employment or training. Using Arksey and O’Malley’s framework, this review aims to map out the literature on young carers’ experiences of caring while attending school and their future career perceptions. The key themes that emerge from the literature include: the impact of the caring role on education and future aspirations; school awareness and multiagency support; and the positives gained from caring. Greater support in secondary school, along with multiagency collaboration, are highlighted as key influences on the likelihood of young carers maximising their career opportunities.

Introduction: Family carers provide a wide range and significant amount of assistance to relatives, friends and neighbours who are ill or disabled. Statistical data from the Organisation for Economic Co-operation and Development (OECD) indicates that at least 1 in 10 adults is involved in informal, and most often unpaid care. About half of the proportion of those who participate in a caring role combine this with paid employment and balancing both roles can be a challenge. Consequently, there is increased demand for the introduction of measures to reconcile paid work and care-provision. Unfortunately, much remains unknown about the lives of family carers who balance work with care. Aim: The present work endeavours to illuminate this topic by scoping the extent, range and nature of available evidence on ‘family carers who are in paid employment’.Methods: Steps followed when carrying out the scoping review included: i) Clarifying the research purpose and question; ii) Identifying relevant research studies from various electronic databases, reference lists of identified studies, and grey or unpublished literature; iii) Selection of studies by two independent reviewers; iv) Collating data using an excel data sheet; and v) Analysing and summarising data using qualitative thematic analysis. Results: Two-hundred-and-sixty-three publications were incorporated, and these comprised a variety of research study designs, which were based in different countries. Six themes were emergent from the scoping review findings. The first was the compound carer’s experience who is a working family carer; subthemes relevant to this group were coping, health outcomes and employment outcomes. A subsequent theme was health outcomes for working family carers; health outcomes were subdivided into mental health, physical health, and health behaviour outcomes. The theme on the profile of characteristics for working family carers comprised of subthemes indicative that caring was largely a gendered activity, with age as another important variant — caring increasing at older ages. The economic impact of caring on working family carers was an eminent theme with a clear personal economic impact and national economic impact. A significant finding was the theme on conflicting priorities among working family carers; subthemes related to this were either work-to-family conflict or family-to-work conflict. The most important theme in the present work was that on employment outcomes among working family carers with subthemes characterised by employment participation, employment-related disadvantages, work-place provisions in place for this group and positive employment impacts. Finally, it was clear that there were support services for working family carers and thus this was an apparent theme; subthemes related to this were the formal services and social support services. Conclusions: Evidence on working family cares is vast and covers a wide range of topics such as compound caring, health, demographic profile, conflicting priorities, finances, employment, and support services. Working family carers face the difficult task of balancing work with care which could lead to negative outcomes related to employment, finances, and health. Implications for applicability: The pressures associated with the dual responsibility can be alleviated via the introduction of support services and policies to support working carers.

The objective of this review was to pool and rank the efficacy of lifestyle intervention strategies targeting weight, body mass index, waist circumference and waist-to-hip ratio in people with psychosis by comparing the effect size of these weight outcomes. Secondary to this, the objective was to stratify the lifestyle interventions according to their inclusion of dietary information that adheres to Australian Dietary Guidelines.People living with psychosis have a significantly increased risk of all-cause mortality, with cardiovascular disease a considerable contributor to this risk. Controlling lifestyle risk factors, which include smoking, poor diet and inadequate physical activity, leads to significant weight reduction and decreases cardiovascular disease risk. Previous reviews on this topic have not clearly identified essential components of lifestyle interventions in people with psychosis, mainly due to statistical limitations of analyses. This review employed a network meta-analysis, which compares more than two groups of interventions and ranks them according to efficacy, thus providing a global estimate of effect. Additionally, available reviews have not assessed compliance of dietary information offered in lifestyle interventions to established guidelines.This review considered randomized controlled trials that delivered lifestyle interventions to community-dwelling adults with psychotic disorders. Outcomes of interest included weight, body mass index, waist circumference and waist-to-hip ratio.The Cochrane Library, MEDLINE/PreMEDLINE, Embase, CINAHL, Scopus and PsycINFO were searched for studies published in English from 1985 to June 2018. Data were qualitatively summarized, during which lifestyle intervention subgroups were created (based on key similarities) and then compared in direct meta-analyses and network meta-analyses. Assessment of study adherence to Australian Dietary Guidelines was conducted in a narrative format.Thirty-two randomized controlled trials were included, and the overall quality of these studies ranged from what appeared to be low to moderate. Lifestyle intervention studies contained both a dietary and physical activity component, with the exception of two studies that focused solely on physical activity. Delivery of dietary and physical activity information was mainly through education; however, some studies provided additional structure to the intervention by offering tailored advice or helping participants to set goals, and providing regular review of progress for diet, physical activity or both. Results from network-meta-analyses showed that only studies with a structured approach for both diet and physical activity demonstrated significant decreases in weight (effect size = -4.12, 95% confidence interval = -7.772 to -2.760, P = 0.000) and body mass index (effect size = -2.94, 95% confidence interval = -1.78 to -0.357, P = 0.003). Waist circumference subgroup comparisons mainly comprised single studies; therefore, findings were inconclusive. Dietary information provided in studies generally complied with Australian Dietary Guidelines; however, none of the studies complied with all guidelines.Lifestyle interventions incorporating both dietary and physical activity components led to the greatest decreases in weight (4.1 kg) and body mass index (2.9 points) among people with psychosis. Important intervention strategies for both components are the personalization of education through tailored advice or goal setting, and a corresponding progress review. Dietary information in the included studies appeared to comply with the Australian Dietary Guidelines. However, these findings were weakened by an increased risk of bias, complex and multicomponent study designs, and lack of clarity in reporting of study methodology.

ISSUE ADDRESSED Lifestyle interventions use nutrition and physical activity behaviour modification techniques to decrease obesity and cardio-metabolic risk in people with psychosis. Evidence on the specific behaviour modification strategies applied to decrease obesity is weakened by inadequate methodology reporting of lifestyle interventions. A systematic review that we conducted earlier highlighted a possible deficiency in reporting; hence we aim to critically appraise lifestyle intervention studies that target weight outcomes for people with psychosis against the methods component of the CONSORT statement for randomised trials of nonpharmacologic treatments. METHODS COMPONENT We considered randomised controlled studies which delivered lifestyle interventions to community-dwelling adults with psychotic disorders, and included those with the following outcomes of interest: weight, body mass index, waist circumference and waist-to-hip ratio. The Cochrane Library, MEDLINE/PREMEDLINE, EMBASE, CINAHL, Scopus and PsycINFO were searched for English publications between 1985 and 2018. Methodology and reporting of studies were evaluated using the CONSORT statement for randomised trials of nonpharmacologic treatments. RESULTS Thirty-two studies met the inclusion criteria. Critical appraisals revealed that reporting of lifestyle intervention studies was generally incomplete. Fewer than 50% provided the recommended information on trial design, participant characteristics, detail of interventions, outcomes, sample size, randomisation, blinding and statistical methods. CONCLUSIONS Application of guidelines, like the CONSORT statement, in future publications of lifestyle interventions for people with psychosis will improve accuracy of reporting. SO WHAT?: Enhanced reporting in lifestyle intervention studies for people with psychosis will promote guideline creation and translation of research, which is likely to positively impact physical health outcomes.

REVIEW QUESTION/OBJECTIVE:: (i) To systematically review and rank the efficacy of different types of lifestyle intervention strategies on weight outcomes (weight, body mass index [BMI], waist circumference and waist-to-hip ratio) in people with psychosis. (The efficacy of different types of lifestyle intervention strategies will be ranked by comparing the effect size on weight outcomes in people with psychotic disorders.) (ii) To stratify lifestyle interventions that target weight outcomes (weight, BMI, waist circumference and waist-to-hip ratio) in people with psychosis, according to their inclusion of dietary information that adheres with Australian Dietary Guidelines (National Health and Medical Research Council. Eat for Health, Australian Dietary Guidelines Canberra National Health and Medical Research Council; 2013).Specifically, the review question is: What lifestyle intervention strategies targeting weight outcomes (weight, BMI, waist circumference and waist-to-hip ratio) in people with psychosis compared to no treatment or various control conditions have the best efficacy?

This analysis aimed to examine the association of social dysfunction with food security status, fruit intake, vegetable intake, meal frequency and breakfast consumption in people with psychosis from the Hunter New England (HNE) catchment site of the Survey of High Impact Psychosis (SHIP). Social dysfunction and dietary information were collected using standardised tools. Independent binary logistic regressions were used to examine the association between social dysfunction and food security status, fruit intake, vegetable intake, meal frequency and breakfast consumption. Although social dysfunction did not have a statistically significant association with most diet variables, participants with obvious to severe social dysfunction were 0.872 (95% CI (0.778, 0.976)) less likely to eat breakfast than those with no social dysfunction p < 0.05. Participants with social dysfunction were therefore, 13% less likely to have breakfast. This paper highlights high rates of social dysfunction, significant food insecurity, and intakes of fruits and vegetables below recommendations in people with psychosis. In light of this, a greater focus needs to be given to dietary behaviours and social dysfunction in lifestyle interventions delivered to people with psychosis. Well-designed observational research is also needed to further examine the relationship between social dysfunction and dietary behaviour in people with psychosis.