***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — A large proportion of disabled stroke survivors live at home and are supported by informal caregivers . Identification of determinants of caregiver burden will help to target caregiver interventions . Methods — Data on patient , caregiver , and health and social support characteristics were collected prospect ively over 1 year in 232 stroke survivors in a r and omized trial of caregiver training .  The contribution of these variables to caregiver burden score ( CBS ) and quality of life ( QOL ) measures at 3 months and 1 year was analyzed using regression models . Results — Stroke patients had a mean age of 74±11 years , and 120 ( 52 % ) were men . The mean age of caregivers was 65.7±12.5 years , 149 ( 64 % ) were females , and 116 ( 50 % ) had received caregiver training .  The mean CBS was 48±13 and 38±11 ( score range of bad to good 88 to 22 ) and QOL score was 75±16 and 75±15 ( score range of bad to good 0 to 100 ) at 3 months and 1 year , respectively . CBS and QOL correlated with each other and with patient ( age , dependency , and mood ) , caregiver ( age , gender , mood , and training ) , and support ( social services and family networks ) variables . Of these , only patient and caregiver emotional status , caregiver age and gender , and participation in caregiver training  were independent predictors of either outcome at 3 months . Patient dependency and family support were additional independent predictors at 1 year . Social services support predicted institutionalization but not caregiver outcomes . Conclusion — Advancing age and anxiety in patients and caregivers , high dependency , and poor family support identify caregivers at risk of adverse outcomes , which may be reduced by caregiver training OBJECTIVE The objective of this study was to evaluate the strengths and weaknesses of a group support program and a home visiting program for family caregivers of stroke patients . It also examined the best fit between intervention variant and family caregiver and patient characteristics . van den Heuvel 's previous effect study showed positive effects of the same intervention program , but unlike our present study differences between the two support variants could not be measured . METHODS Of 257 family caregivers who were included and r and omly assigned to an intervention variant or a control group , 127 family caregivers completed the intervention in either the group program or the home visiting program . RESULTS Evaluation data showed that both intervention variants had been helpful and feasible , but home visit participants missed peer contact and follow-up contacts were missed in both intervention programs . In comparison to the home visiting program , the group program participants showed more benefit especially with respect to informational and emotional components . Caregivers ' preference for type of intervention revealed that both types of intervention had its supporters . Those that preferred the group program could be clearly characterised : they were burdened , lived with a more psychologically h and icapped relative , were using active coping strategies more frequently or lived in a region which is considered to be more sociable . CONCLUSION The present study adds extensively to van den Heuvel 's effect study with respect to discriminative aspects of group and home intervention programs and their respective benefits for specific family caregiver groups . PRACTICE IMPLICATION S In order to suitably match an intervention type with specific caregiver characteristics the intervention provider should utilize caregiver self- selection or undertake professional screening of caregiver burden . Telephone contacts should be offered in addition to the interventions BACKGROUND : Few studies have examined the factors associated with depression in informal caregivers of HIV-infected persons . OBJECTIVE : To investigate the relationship between depression and caregiver burden among informal caregivers of HIV-infected individuals . DESIGN : Cross-sectional study using baseline data from an ongoing r and omized trial of a supportive telephone intervention . PARTICIPANTS : One hundred seventy-six dyads of HIV patients and their informal caregiver . MEASUREMENTS : Depression was defined as a Beck Depression Inventory > 10 . A Caregiver Strain Index > 6 identified informal caregivers with a high caregiver burden . We used logistic regression to identify characteristics that were associated with depression in the informal caregiver . RESULTS : Informal caregivers were 42 years old ( SD , 13 ) , 53 % female , 59 % nonwhite , and 30 % had education beyond high school . Forty-seven percent of informal caregivers were the patient ’s partner , 18 % a friend , and 35 % a family member . Twenty-seven percent of informal caregivers had a high caregiver burden , and 50 % were depressed . We found significantly greater odds of informal caregiver depression with high caregiver burden ( OR , 6.08 ; 95 % CI , 2.40 to 15.4 ) , informal caregiver medical comorbidity besides HIV ( OR , 2.32 ; 95 % CI , 1.09 to 4.92 ) , spending all day together ( OR , 3.92 ; 95 % CI , 1.59 to 9.69 ) , having to help others besides the HIV patient ( OR , 2.55 ; 95 % CI , 1.14 to 5.74 ) , and duration of the HIV patient ’s diagnosis ( OR , 1.01 per month ; 95 % CI , 1.00 to 1.01 ) . CONCLUSIONS : High caregiver burden was strongly associated with depression  among HIV-infected individuals ’ informal caregivers , who themselves had difficult life circumstances . Informal caregivers of HIV patients may be in need of both mental health services and assistance in caregiving Purpose : To evaluate the feasibility and effectiveness of early supported discharge ( ESD ) following acute stroke . Method : An ESD scheme was compared to conventional rehabilitation in a r and omized controlled trial . All patients admitted with acute stroke were considered for inclusion . Eighty-eight ( 20.2 % ) were found to be eligible and 82 were r and omized either to early supported discharge ( n=42 ) or conventional rehabilitation ( n=40 ) . The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale . The General Health Question naire , the Montgomery Aasberg Depression Rating Scale , mortality , placement and patient and carer satisfaction served as secondary outcome measures . Results : Median length of stay was reduced from 31 days in the conventional hospital rehabilitation group to 22 days in the early supported discharge group ( p=0.09 ) . No differences were found regarding primary outcome . The General Health Question naire score showed a significant difference in favour of the early supported discharge group at three months ( 19.5/24 , p = 0.02 ) , but not at six . At six months , the proportion of patients being dead or in institution showed a trend of being higher in the conventional rehabilitation group ( OR 3.8 , 95 % CI 0.8 - 23 ) . Conclusions : Early supported discharge after stroke is feasible and it is possible that it has benefits compared with conventional rehabilitation Family caregivers , the “ second victims ” or hidden patients in dementia care , are at risk for social isolation , stress , depression , and mortality . Telephone-based support ( telesupport groups ) represents a practical , low-burden , low-cost source of emotional support . The present study evaluated the feasibility and effectiveness of professionally led telephone-based support groups for female family caregivers of community-dwelling dementia patients . Recruited through various community sources , 103 female caregivers were r and omized to the telesupport group treatment or a control condition . Effects on caregiver burden , depression , and personal gains were evaluated at 6 months , the main end point . Older care-givers ( ≥65 ) in telesupport  reported lower depression than control group caregivers did The present research describes the association between objective and subjective  caregiver burden experienced by families and friends of individuals with chronic mental illness . Although there has been a significant quantity of research conducted about burden and mental illness , the findings have been equivocal because of varying definitions of burden and varying sampling procedures . The present research utilizes a st and ardized interview instrument for caregivers . Caregivers were named by a stratified r and om sample of clients who have been certified as severely mentally disabled and have received publicly-funded community mental health services in the state of Ohio during the 1990 fiscal year . Data were collected by the first author and a research assistant during telephone interviews between August 1991 and May 1992 . One hundred and eighty-nine caregivers were interviewed . Findings showed that the majority of caregivers are female , white , and aged 50 years or more . Parents comprise the largest group of caregivers and slightly more than one third of clients live with the caregiver . The relationship between caregiver and client is generally described as positive ; however , the interviews were conducted during a period when the clients ' symptomatology was more under control than previously in the relationship . Caregivers state that the clients need help much more often than they ask for it in all categories of possible help . Considering caregiver burden in relation to caregiver behaviors , time management is a somewhat frequent problem that is very troublesome to the caregiver . Considering client behaviors in relation to caregiver burden , embarrassing behaviors are most troublesome and occur with moderate frequency . The surprise element of these behaviors seems to be the most problematic Purpose : This paper explores the perceived health and reported level of strain in the primary carers of severely brain injured individuals , 15 - 18 months after discharge from inpatient rehabilitation . Method : Seventy carers took part in a prospect i ve descriptive study utilizing a semistructured interview and st and ardized measures including the SF36 , The Carer Strain Index and the Relative Question naire .  Functional consequences for the injured person were also assessed . Results : The SF36 demonstrated a trend towards lower perceived health for carers than that reported in the general population . Neither perceived health status nor level of strain differed significantly according to the type of injury sustained ( haemorrhagic or traumatic ) nor initial severity of injury . Factors that contributed to carers having worse health status included the injured person 's level of disability and interpersonal factors such as the nature of the relationship , with spouses having lower perceived health status than parents . Conclusions : Irrespective of cause of injury , generalised health consequences result for the carers of those with disabling consequences of brain injury . Factors independent of the injured individual themselves ( such as the nature of the relationship to the carer ) need to be taken into consideration when exploring wellbeing of carers and planning services This investigation evaluates the moderating influence of social support on the negative effects of stress for family caregivers and vali date s the Perceived Stress Scale as a st and ard of measurement . Seventy-five family caregivers to older adults with heart failure were interviewed in their homes about  perceived stress  ,  depressive symptoms , and social support after hospital discharge . The Perceived Stress Scale demonstrated internal consistency . Social support did not moderate the effects of stress on depressive symptoms . Lack of a significant association between salivary cortisol and the Perceived Stress Scale did not support testing of construct validity . Stress levels , however , frequently vary due to caregiving dem and s and additional influencing factors ABSTRACT Objective : Despite response variability , cholinesterase inhibitors are recommended in mild to moderate Alzheimer 's disease . Dose titration is common ; however r and omized controlled trials ( RCTs ) have mainly investigated fixed-dose regimens . We examined practice patterns and outcomes of 6 ± 1.5-month rivastigmine therapy . Methods : Prospect i ve , pharmacoepidemiologic , naturalistic study of 175 evaluable patients with mild to moderate Alzheimer 's disease ( + 151 caregivers ) from 52 centers in Belgium on 6 ± 1.5 month ( titrated ) rivastigmine treatment . Main outcome measures : Measured at baseline ( enrollment ) and follow-up ( 6 ± 1.5 months ) . For patients : Mini-Mental State Exam ( MMSE ) , Activities of Daily Living ( ADL ) , Neuropsychiatric Inventory ( NPI ) , Global Deterioration Scale ( GDS ) scores ; treatment response ( improvement , maintenance , or decline less than normative slope ) . For caregivers : hours/week spent caring ; Zarit Caregiver Burden Scale ( ZCBS ) , 12‐item version of General Health Question naire ( GHQ‐12 ) , Instrumental Activities of Daily Living ( IADL ) scores . Results : Patients ’ MMSE and NPI scores ( p < 0.001 ) improved from baseline to follow-up , but not ADL and GDS scores . Treatment response was 89.1 % of patients for MMSE ( including 60.6 % with improvement ) and 77.7 % for NPI ( including 57.1 % with improvement ) . Quadratic curves were fitted for the average daily dose and the MMSE and NPI scores ; with a trend towards average daily dose of 6.0 ± 3.0 mg/day . Caregivers ’ ZCBS ( p = 0.036 ) and GHQ‐12 ( p = 0.029 ) scores improved , but not IADL scores and time spent caring . Conclusions :  Patients ’ MMSE and ADL scores confirmed the meta-analyses of rivastigmine efficacy trials , while NPI scores exceeded efficacy results . Proportionately more patients responded to ( titrated ) treatment than in fixed-dose RCTs . Caregivers reported less burden ( similar to meta- analysis ) and better general health over the study period . Where efficacy and effectiveness results diverge , the benefit is in ‘ real-world ’ effectiveness . Large sample , multi-country replications , less sensitive to censoring secondary to missing data and powered to permit advanced modeling , as well as RCTs with adaptive design s to accommo 
    Output:
    
RESULTS The construct of  caregiver burden  is not st and ardized , and many terms are used to describe burden .