***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 : Caregivers of people with chronic conditions are more likely than non-caregivers to have depression and emotional problems .  Few studies have examined the effectiveness of mindfulness-based stress reduction ( MBSR ) in improving their mental well-being . Methods : Caregivers of persons with chronic conditions who scored 7 or above in the Caregiver Strain Index were r and omly assigned to the 8-week MBSR group ( n = 70 ) or the self-help control group ( n = 71 ) . Vali date d instruments were used to assess the changes in depressive and anxiety symptoms , quality of life , self-efficacy , self-compassion and mindfulness . Assessment s were conducted at baseline , post-intervention and at the 3-month follow-up . Results : Compared to the participants in the control group , participants in the MBSR group had a significantly greater decrease in depressive symptoms at post-intervention and at 3 months post-intervention ( p < 0.01 ) . The improvement in state anxiety symptoms was significantly greater among participants in the MBSR group than those of the control group at post-intervention ( p = 0.007 ) , although this difference was not statistically significant at 3 months post-intervention ( p = 0.084 ) . There was also a statistically significant larger increase in self-efficacy ( controlling negative thoughts ; p = 0.041 ) and mindfulness ( p = 0.001 ) among participants in the MBSR group at the 3-month follow-up compared to the participants in the control group . No statistically significant group effects ( MBSR vs. control ) were found in perceived stress , quality of life or self-compassion . Conclusions : MBSR appears to be a feasible and acceptable intervention to improve mental health among family caregivers with significant care burden , although further studies that include an active control group are needed to make the findings more conclusive BACKGROUND : Compared with other parents , mothers of children with autism spectrum disorder or other neurodevelopmental disabilities experience more stress , illness , and psychiatric problems . Although the cumulative stress and disease burden of these mothers is exceptionally high , and associated with poorer outcomes in children , policies and practice s primarily serve the identified child with disabilities . METHODS : A total of 243 mothers of children with disabilities were consented and r and omized into either Mindfulness-Based Stress Reduction ( mindfulness practice ) or Positive Adult Development ( positive psychology practice ) . Well-trained , supervised peer mentors led 6 weeks of group treatments in 1.5-hour weekly sessions , assessing mothers 6 times before , during , and up to 6 months after treatment . Mothers had children with autism ( 65 % ) or other disabilities ( 35 % ) . At baseline , 85 % of this community sample had significantly elevated stress , 48 % were clinical ly depressed , and 41 % had anxiety disorders . RESULTS : Using slopes-as- outcomes , mixed r and om effects models , both treatments led to significant reductions in stress , depression , and anxiety , and improved sleep and life satisfaction , with large effects in depression and anxiety . Mothers in Mindfulness-Based Stress Reduction versus Positive Adult Development had greater improvements in anxiety , depression , sleep , and well-being .  Mothers of children with autism spectrum disorder improved less in anxiety , but did not otherwise differ from their counterparts . CONCLUSIONS : Future studies are warranted on how trained mentors and professionals can address the unmet mental health needs of mothers of children with developmental disabilities . Doing so improves maternal well-being and furthers their long-term caregiving of children with complex developmental , physical , and behavioral needs Objectives Research suggests that an 8-week Mindfulness-Based Stress Reduction ( MBSR ) program ( a structured form of meditation ) might be effective in the treatment of various health problems including chronic pain . Our objective was to compare the clinical effectiveness of the MBSR program with a multidisciplinary pain intervention ( MPI ) program in terms of pain intensity , pain-related distress , quality of life , and mood in patients with chronic pain . Methods A r and omized , comparative clinical trial was conducted , including 6-month posttreatment follow-up . Ninety-nine participants , aged 24 to 64 years , with pain for a minimum of 3 months , were recruited from community-based clinics , hospitals , and community service centers . Participants were r and omly allocated to either the MBSR program ( 51 participants ) or a MPI program ( 48 participants ) . The study used vali date d Chinese versions of self-reported question naires measuring pain , mood symptoms , and health-related quality of life . Results Thirty-nine participants ( 77 % ) completed the MBSR  program and 44 ( 90 % ) completed the MPI program . Patients in both the groups were comparable with regard to demographical characteristics , pain intensity , mood symptoms , and health-related quality -of-life measures before intervention . In both the groups , patients who completed the trial demonstrated statistically significant improvements in pain intensity and pain-related distress . However , no statistically significant differences were observed in overall results between the MBSR and MPI groups . Conclusions This r and omized , clinical trial showed that both MBSR and MPI programs reduced pain intensity and pain-related distress although no statistically significant differences were observed between the 2 groups and the improvements were small CONTEXT The decision to institutionalize a patient with dementia is complex and is based on patient and caregiver characteristics and the sociocultural context of patients and caregivers . Most studies have determined predictors of nursing home placement primarily according to patient or caregiver characteristics alone . OBJECTIVE To develop and vali date a prognostic model to determine the comprehensive predictors of placement among an ethnically diverse population of patients with dementia . DESIGN , SETTING , AND PARTICIPANTS The Medicare Alzheimer 's Disease Demonstration and Evaluation study , a prospect i ve study at 8 sites in the United States , with enrollment between December 1989 and December 1994 of 5788 community-living persons with advanced dementia . MAIN OUTCOME MEASURES Time to nursing home placement throughout a 36-month follow-up period , assessed by interview and review of Medicare records , and its association with patient and caregiver characteristics , obtained by interview at enrollment . RESULTS Patients were divided into a development ( n = 3859 ) and validation ( n = 1929 ) cohort . In the development cohort , the Kaplan-Meier estimates of nursing home placement throughout 1 , 2 , and 3 years were 22 % , 40 % , and 52 % , respectively . After multivariate adjustment , patient characteristics that were associated with nursing home placement were as follows : black ethnicity ( hazard ratio , 0.60 ; 95 % confidence interval [ CI ] , 0.48 - 0.74 ) , Hispanic ethnicity ( HR , 0.40 ; 95 % CI , 0.28 - 0.56 ) ( both ethnicities were inversely associated with placement ) , living alone ( HR , 1.74 ; 95 % CI , 1.49 - 2.02 ) , 1 or more dependencies in activities of daily living ( HR , 1.38 ; 95 % CI , 1.20 - 1.60 ) , high cognitive impairment ( for Mini-Mental Status Examination score < or = 20 : HR , 1.52 ; 95 % CI , 1.33 - 1.73 ) , and 1 or more difficult behaviors ( HR , 1.30 ; 95 % CI , 1.11 - 1.52 ) . Caregiver characteristics associated with patient placement were age 65 to 74 years ( HR , 1.17 ; 95 % CI , 1.01 - 1.37 ) , age 75 years or older ( HR , 1.55 ; 95 % CI , 1.31 - 1.84 ) , and high Zarit Burden Scale score ( for highest quartile : HR , 1.73 ; 95 % CI , 1.49 - 2.00 ) . Patients were assigned to quartiles of risk based on this model . In the development cohort , patients in the first , second , third , and fourth quartile had a 25 % , 42 % , 64 % , and 91 % rate of nursing home placement at 3 years , respectively . In the validation cohort , the respective rates were 21 % , 50 % , 64 % , and 89 % . The C statistic for 3-year nursing home placement was 0.66 in the development cohort and 0.63 in the validation cohort . CONCLUSIONS Patient and caregiver characteristics are both important determinants of long-term care placement for patients with dementia . Interventions directed at delaying placement , such as reduction of caregiver burden  or  difficult patient behaviors  , need to take into account the patient and caregiver as a unit OBJECTIVES The purpose of this study was to investigate the predictors of  caregiver burden and depression  , including objective stressors and mediation forces influencing caregiving outcomes . METHODS This investigation is based on the 1994 Canadian Study of Health and Aging ( CSHA ) data base . Participants were 613 individuals with dementia , living in either the community or an institution , and their informal caregivers . Participants for the CSHA were identified by screening a large r and om sample of elderly persons across Canada .  Structural equation models representing four alternative pathways from caregiving stressors ( e.g. , functional limitations , disturbing behaviors , patient residence , assistance given to caregiver ) to caregiver burden and depression were compared . RESULTS The data provided the best fit to a model whereby the effects on the caregiver 's well-being are mediated by appraisal s of burden . A higher frequency of disturbing behavior , caring for a community-dwelling patient , and low informal support were related to higher burden , which in turn led to more depressive symptomatology .  Caregivers of patients exhibiting more disturbing behaviors and functional limitations received less help from family and friends , whereas those whose care recipients resided in an institution received more informal support . DISCUSSION Our findings add to the preexisting literature because we tested alternative models of caregiver burden using an unusually large sample size of participants and after overcoming method ological limitations of past research . Results highlight the importance of the effective management of disturbing behaviors , the provision of formal services for caregivers with highly impaired patients and no informal support , and the improvement of coping skills in burdened caregivers OBJECTIVES The purpose of this study was to examine the effects of a structured , 8-week , Mindfulness-Based Stress Reduction ( MBSR ) program on perceived stress , mood , endocrine function , immunity , and functional health outcomes in individuals infected with the human immunodeficiency virus ( HIV ) . DESIGN This study used a quasiexperimental , nonr and omized design . METHODS Subjects were specifically recruited ( nonr and om ) for intervention ( MBSR ) or comparison group . Data were collected at pretest and post-test in the MBSR group and at matched times in the comparison group . t Tests where performed to determine within-group changes and between-group differences . RESULTS Natural killer cell activity and number increased significantly in the MBSR group compared to the comparison group . No significant changes or differences were found for psychological , endocrine , or functional health variables . CONCLUSIONS These results provide tentative evidence that MBSR may assist in improving immunity in individuals infected with HIV Behavioral interventions that support caregivers ' restful sleep may delay the onset or decrease the severity of debilitating depressive symptoms . This , in turn , may increase caregivers ' physical and psychological health and wellbeing . A repeated- measures experimental design was used to test the feasibility and effectiveness of a brief behavioral sleep intervention for family caregivers of persons with advanced stage cancer . The CAregiver Sleep Intervention ( CASI ) includes stimulus control , relaxation , cognitive therapy , and sleep hygiene elements . CASI is individualized and delivered to accommo date caregiver burden . Thirty adult caregivers participated . The Pittsburgh Sleep Quality Index ( PSQI ) , Center for Epidemiological Studies -Depression scale ( CES-D ) , and Caregiver Quality of Life-Cancer scale ( CQOLC ) were used to measure self-reported sleep quality , depressive symptoms , and quality of life . Actigraphs measured latency , duration , efficiency , and wake after sleep onset ( WASO ) scores . Data were collected at baseline , 3 and 5 weeks , 2 , 3 , and 4 months post baseline . Improvement was seen across groups ; however , intervention caregivers showed more improvement in PSQI and CES-D scores than control caregivers . The CASI appears to be effective in improving sleep quality and depressive symptoms in caregivers of persons with cancer . Improvements in quality of life scores were similar across groups . Sample size and homogeneity limit generalizeability This study aims to investigate the impact of caregiving on the health status and quality of life ( QOL ) of primary informal caregivers ( PCGs ) of elderly care recipients in Hong Kong . A total of 246 PCGs and 492 matched noncaregiver ( NCG ) controls were identified in a population -based cross-sectional study through r and om telephone dialing . Their health status and QOL were assessed based on structured question naires and Short Form 36 ( SF-36 ) Health Survey . Multiple conditional logistic regression analysis showed that compared with NCGs , PCGs had significantly increased risks for reporting worse health , more doctor visits , anxiety and depression , and weight loss . Female PCGs were more likely to report chronic diseases , symptoms , and insomnia . PCGs , particularly women , had significantly lower scores in all eight domains of 
    Output:
    
There were improvements in the self-rated psychological symptoms , such as stress , depression , anxiety and mindfulness .
To conclude , mindfulness-based stress reduction , as a safe and transportable approach , has potential to improve the psychological symptoms in the caregivers of patients with various conditions