human
***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: INTRODUCTION AND OBJECTIVES The aim of this work is to compare the effectiveness of two psychoeducational interventions for dementia caregivers : a cognitive behavioral one ( PCC ) , aim ed at the modification of dysfunctional thoughts about caregiving , and another one consisting in problem solving skills training ( PSP ) for caregivers , with the aim of modifying the behavioral problems of their relative . SUBJECTS AND METHODS Seventy five caregivers were asked to participate in an intervention program , of whom 31 finally completed the study . Both group interventions are compared with a control group ( CG ) . The caregiver groups were r and omly assigned to each experimental condition . Pre , post intervention , and follow up assessment s of the following variables have been made : depression , perceived stress , frequency of behavioral problems , perceived stress associated with the behavioral problems and dysfunctional thoughts about caregiving . RESULTS Following the intervention , caregivers in the PCC program show significantly less perceived stress than the other two groups . In the same direction , a trend exists to a significant reduction of the stress associated with the behavioral problems . In the follow up assessment , caregivers of the PCC program significantly report less relative 's behavioral problems than the other two groups . Caregivers of the PCC program have less dysfunctional thoughts than the other two groups , differences almost reaching significance . CONCLUSIONS Benefits of a psychoeducational intervention vary as a function of the contents it includes . The importance of intervening on the caregiver dysfunctional thoughts for an adequate coping with caregiving is highlighted ABSTRACT Objectives : Evaluation of long-term effects of an individualized short-term telephone intervention ( seven sessions ) , based on a comprehensive cognitive behavioral therapy ( CBT ) approach . The study goal was to evaluate the maintenance of intervention effects regarding well-being , quality of life , and health at two years post treatment . Method : Participants ( n = 105 ) were ( partly ) r and omized after baseline assessment in a two-arm study ( intervention , control group/usual care ) .  Depressive symptoms were assessed with the German version of the Center for Epidemiologic Studies Depression Scale ( CES-D ) . Caregivers ’ physical complaints were measured with the Gießener Beschwerdebogen ( GBB-24 ) , and quality of life with the World Health Organization quality of life -BREF ( WHOQOL-BREF ) . Emotional well-being and perceived health status were assessed using thermometer scaling . Data were analyzed by intention-to-treat analyses , including for those who terminated the intervention prematurely but still delivered data , using ANCOVAs . Results : Long-term intervention effects were found for emotional well-being ( p = 0.019 ) . For the subgroup of caregivers who were still caring at home at follow-up , the intervention led to an increased health status ( p = 0.023 ) , fewer bodily complaints ( global measure p= 0.014 , rheumatic pain p = 0.027 , heart trouble p = 0.042 ) , and a higher quality of life ( overall p = 0.044 and subscale environment p = 0.030 ) . Conclusion : The short-term CBT intervention via telephone showed long-term effects two years after treatment on emotional well-being , health status , bodily complaints , and quality of life A multicomponent intervention targeting grief symptoms in spouse caregivers of individuals with dementia was pilot tested in this feasibility study . Twenty spouse caregivers completed the study within the 5-month protocol . The five-component intervention , deduced from Meuser , Marwit , and S and ers ' Dementia Caregiver Grief Model and tailored to participants ' grief , mental health , and learning needs , included supportive grief counseling , emotional support , education , skill building , and referral to community re sources . Significant changes were found from baseline to intervention completion for the measures of grief , depression , anxiety , positive states of mind , and self-efficacy , result ing in a moderate effect size of -0.43 for grief to a large effect size of -2.40 for anxiety . Increases in quality of life and decreases in grief persisted at the 8-month follow up for caregivers who continued to provide care in the home . The Easing the Way intervention protocol is a promising caregiver program that warrants further testing in a r and omized controlled study 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 PURPOSE Few studies have addressed the effects of  caregiver interventions  on the costs of care for the care recipient . This study evaluated the effects of a caregiver education and support group delivered via the telephone on care recipient health care utilization and cost . DESIGN AND METHODS The Telehealth Education Program ( TEP ) is a manualized program of education and support design ed for caregivers of veterans with moderate-to-severe dementia . One hundred fifty-eight spousal caregivers were r and omly assigned to either the ten 1-hr sessions of TEP or the usual care ( UC ) .  Health care utilization and cost data were extracted from veterans Information System Technology Architecture data bases and included outpatient , inpatient , and nursing home data within the VA . RESULTS Total health care cost data showed a significant ( p = .039 ) average cost savings of $ 2,768 per patient at 6 months for TEP as compared with UC , but these were not maintained at 1 year . All costs included in the total costs measure contributed to this difference . Inpatient , outpatient , and nursing home costs were all assessed separately , but only nursing home costs reached significance ( p = .009 ) , with a savings of $ 1,057 per patient at 6 months . IMPLICATION S The TEP caregiver intervention result ed in short-term cost savings for veteran care recipients . Future studies of caregiver interventions should examine their effects on costs of care for the care recipients in addition to their effects on caregiver outcomes Objectives : This study sought to explore the effect of the family involvement in care ( FIC ) intervention on  family and staff well-being over a nine-month period in a long-term care ( LTC ) facility providing dementia care . Method : A quasi-experimental design with r and omised allocation of two LTC sites but not the participants was employed . Family caregivers ( n = 57 ) of residents with dementia and staff ( n = 59 ) from two LTC facilities in Queensl and , Australia , were recruited . Participants were assessed once pre-intervention and three times post-intervention for knowledge , stress and satisfaction outcomes . Between-group and within-group effects were analysed using ANOVAs at < 0.05 level of significance . Pre- and post-intervention interviews from a purposive sample of family caregivers were also conducted to enhance underst and ing of FIC benefits . Results : Beneficial intervention effects associated with family caregivers ’ knowledge of dementia were found ( p < 0.001 ) . Negative intervention effects were also found for family satisfaction outcomes in relation to staff consideration of their relatives and management effectiveness ( p < 0.05 ) . In addition , staff well-being and job satisfaction were found to be negatively affected by their perceived inappropriate behaviour of residents with dementia ( p < 0.05 ) . Conclusion : Participation in the FIC intervention improved family caregiver knowledge . The major barrier to the success of the partnership intervention in achieving beneficial long-term psychosocial effects for family and staff caregivers was lack of re sources and leadership required to support collaboration between family and staff , mainly due to environment and structural changes . This study contributes to our underst and ing of the importance of partnerships in promoting family involvement in dementia care & NA ; Aging baby boomers , longer life spans , and rising levels of Alzheimer 's disease and related dementias ( ADRD ) will result in a caregiver crisis in the near future . The ways in which caregivers deal with stresses related to caregiving will be critical to both their own well‐being and their ability to care for others . The purpose of this article is to describe the Stress‐Busting Program ( SBP ) for family caregivers and its effectiveness . The essential components of the SBP are education , stress management , problem solving , and support delivered in a group setting for 9 weeks . Results of the SBP indicate that throughout the program , caregivers experienced significant improvements in general health , vitality , social function , and mental health scores and decreases in anxiety , anger/hostility , depression , perceived stress , and caregiver burden . The SBP is a cost‐effective health‐promotion strategy for caregivers who have substantial ongoing stress OBJECTIVE The objective of this study was to determine the effects of counseling and support on the physical health of caregivers of spouses of people with Alzheimer disease . METHODS A r and omized controlled trial , conducted between 1987 and 2006 at an outpatient research clinic in the New York City metropolitan area compared outcomes of psychosocial intervention to usual care . Structured question naires were administered at baseline and regular follow-ups . A referred volunteer sample of 406 spouse caregivers of community dwelling patients with Alzheimer disease enrolled over a 9.5-year period .  Enhanced counseling and support consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad-hoc telephone counseling . Indicators of physical health included self-rated health ( SRH ) of caregivers and the number of reported illnesses . RESULTS Controlling for baseline SRH ( mean : 7.24 ) , intervention group caregivers had significantly better SRH than control group caregivers based upon model predicted mean scores four months after baseline ( 6.87 versus 7.21 ) , and this significant difference was maintained for two years ( 6.70 versus 7.01 ) . The effect of the intervention on SRH remained significant after controlling for the effects of patient death , nursing home placement , caregiver depressive symptoms and social support satisfaction . Similar benefits of intervention were found for number of illnesses .  CONCLUSION Counseling and support preserved SRH in vulnerable caregivers . Enhancing caregivers ' social support , fostering more benign appraisal s of stressors , and reducing depressive symptoms may yield indirect health benefits . Psychosocial intervention studies with biological measures of physical health outcomes are warranted Purpose : The 
    Output:
    
agent
***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: INTRODUCTION AND OBJECTIVES The aim of this work is to compare the effectiveness of two psychoeducational interventions for dementia caregivers : a cognitive behavioral one ( PCC ) , aim ed at the modification of dysfunctional thoughts about caregiving , and another one consisting in problem solving skills training ( PSP ) for caregivers , with the aim of modifying the behavioral problems of their relative . SUBJECTS AND METHODS Seventy five caregivers were asked to participate in an intervention program , of whom 31 finally completed the study . Both group interventions are compared with a control group ( CG ) . The caregiver groups were r and omly assigned to each experimental condition . Pre , post intervention , and follow up assessment s of the following variables have been made : depression , perceived stress , frequency of behavioral problems , perceived stress associated with the behavioral problems and dysfunctional thoughts about caregiving . RESULTS Following the intervention , caregivers in the PCC program show significantly less perceived stress than the other two groups . In the same direction , a trend exists to a significant reduction of the stress associated with the behavioral problems . In the follow up assessment , caregivers of the PCC program significantly report less relative 's behavioral problems than the other two groups . Caregivers of the PCC program have less dysfunctional thoughts than the other two groups , differences almost reaching significance . CONCLUSIONS Benefits of a psychoeducational intervention vary as a function of the contents it includes . The importance of intervening on the caregiver dysfunctional thoughts for an adequate coping with caregiving is highlighted ABSTRACT Objectives : Evaluation of long-term effects of an individualized short-term telephone intervention ( seven sessions ) , based on a comprehensive cognitive behavioral therapy ( CBT ) approach . The study goal was to evaluate the maintenance of intervention effects regarding well-being , quality of life , and health at two years post treatment . Method : Participants ( n = 105 ) were ( partly ) r and omized after baseline assessment in a two-arm study ( intervention , control group/usual care ) .  Depressive symptoms were assessed with the German version of the Center for Epidemiologic Studies Depression Scale ( CES-D ) . Caregivers ’ physical complaints were measured with the Gießener Beschwerdebogen ( GBB-24 ) , and quality of life with the World Health Organization quality of life -BREF ( WHOQOL-BREF ) . Emotional well-being and perceived health status were assessed using thermometer scaling . Data were analyzed by intention-to-treat analyses , including for those who terminated the intervention prematurely but still delivered data , using ANCOVAs . Results : Long-term intervention effects were found for emotional well-being ( p = 0.019 ) . For the subgroup of caregivers who were still caring at home at follow-up , the intervention led to an increased health status ( p = 0.023 ) , fewer bodily complaints ( global measure p= 0.014 , rheumatic pain p = 0.027 , heart trouble p = 0.042 ) , and a higher quality of life ( overall p = 0.044 and subscale environment p = 0.030 ) . Conclusion : The short-term CBT intervention via telephone showed long-term effects two years after treatment on emotional well-being , health status , bodily complaints , and quality of life A multicomponent intervention targeting grief symptoms in spouse caregivers of individuals with dementia was pilot tested in this feasibility study . Twenty spouse caregivers completed the study within the 5-month protocol . The five-component intervention , deduced from Meuser , Marwit , and S and ers ' Dementia Caregiver Grief Model and tailored to participants ' grief , mental health , and learning needs , included supportive grief counseling , emotional support , education , skill building , and referral to community re sources . Significant changes were found from baseline to intervention completion for the measures of grief , depression , anxiety , positive states of mind , and self-efficacy , result ing in a moderate effect size of -0.43 for grief to a large effect size of -2.40 for anxiety . Increases in quality of life and decreases in grief persisted at the 8-month follow up for caregivers who continued to provide care in the home . The Easing the Way intervention protocol is a promising caregiver program that warrants further testing in a r and omized controlled study 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 PURPOSE Few studies have addressed the effects of  caregiver interventions  on the costs of care for the care recipient . This study evaluated the effects of a caregiver education and support group delivered via the telephone on care recipient health care utilization and cost . DESIGN AND METHODS The Telehealth Education Program ( TEP ) is a manualized program of education and support design ed for caregivers of veterans with moderate-to-severe dementia . One hundred fifty-eight spousal caregivers were r and omly assigned to either the ten 1-hr sessions of TEP or the usual care ( UC ) .  Health care utilization and cost data were extracted from veterans Information System Technology Architecture data bases and included outpatient , inpatient , and nursing home data within the VA . RESULTS Total health care cost data showed a significant ( p = .039 ) average cost savings of $ 2,768 per patient at 6 months for TEP as compared with UC , but these were not maintained at 1 year . All costs included in the total costs measure contributed to this difference . Inpatient , outpatient , and nursing home costs were all assessed separately , but only nursing home costs reached significance ( p = .009 ) , with a savings of $ 1,057 per patient at 6 months . IMPLICATION S The TEP caregiver intervention result ed in short-term cost savings for veteran care recipients . Future studies of caregiver interventions should examine their effects on costs of care for the care recipients in addition to their effects on caregiver outcomes Objectives : This study sought to explore the effect of the family involvement in care ( FIC ) intervention on  family and staff well-being over a nine-month period in a long-term care ( LTC ) facility providing dementia care . Method : A quasi-experimental design with r and omised allocation of two LTC sites but not the participants was employed . Family caregivers ( n = 57 ) of residents with dementia and staff ( n = 59 ) from two LTC facilities in Queensl and , Australia , were recruited . Participants were assessed once pre-intervention and three times post-intervention for knowledge , stress and satisfaction outcomes . Between-group and within-group effects were analysed using ANOVAs at < 0.05 level of significance . Pre- and post-intervention interviews from a purposive sample of family caregivers were also conducted to enhance underst and ing of FIC benefits . Results : Beneficial intervention effects associated with family caregivers ’ knowledge of dementia were found ( p < 0.001 ) . Negative intervention effects were also found for family satisfaction outcomes in relation to staff consideration of their relatives and management effectiveness ( p < 0.05 ) . In addition , staff well-being and job satisfaction were found to be negatively affected by their perceived inappropriate behaviour of residents with dementia ( p < 0.05 ) . Conclusion : Participation in the FIC intervention improved family caregiver knowledge . The major barrier to the success of the partnership intervention in achieving beneficial long-term psychosocial effects for family and staff caregivers was lack of re sources and leadership required to support collaboration between family and staff , mainly due to environment and structural changes . This study contributes to our underst and ing of the importance of partnerships in promoting family involvement in dementia care & NA ; Aging baby boomers , longer life spans , and rising levels of Alzheimer 's disease and related dementias ( ADRD ) will result in a caregiver crisis in the near future . The ways in which caregivers deal with stresses related to caregiving will be critical to both their own well‐being and their ability to care for others . The purpose of this article is to describe the Stress‐Busting Program ( SBP ) for family caregivers and its effectiveness . The essential components of the SBP are education , stress management , problem solving , and support delivered in a group setting for 9 weeks . Results of the SBP indicate that throughout the program , caregivers experienced significant improvements in general health , vitality , social function , and mental health scores and decreases in anxiety , anger/hostility , depression , perceived stress , and caregiver burden . The SBP is a cost‐effective health‐promotion strategy for caregivers who have substantial ongoing stress OBJECTIVE The objective of this study was to determine the effects of counseling and support on the physical health of caregivers of spouses of people with Alzheimer disease . METHODS A r and omized controlled trial , conducted between 1987 and 2006 at an outpatient research clinic in the New York City metropolitan area compared outcomes of psychosocial intervention to usual care . Structured question naires were administered at baseline and regular follow-ups . A referred volunteer sample of 406 spouse caregivers of community dwelling patients with Alzheimer disease enrolled over a 9.5-year period .  Enhanced counseling and support consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad-hoc telephone counseling . Indicators of physical health included self-rated health ( SRH ) of caregivers and the number of reported illnesses . RESULTS Controlling for baseline SRH ( mean : 7.24 ) , intervention group caregivers had significantly better SRH than control group caregivers based upon model predicted mean scores four months after baseline ( 6.87 versus 7.21 ) , and this significant difference was maintained for two years ( 6.70 versus 7.01 ) . The effect of the intervention on SRH remained significant after controlling for the effects of patient death , nursing home placement , caregiver depressive symptoms and social support satisfaction . Similar benefits of intervention were found for number of illnesses .  CONCLUSION Counseling and support preserved SRH in vulnerable caregivers . Enhancing caregivers ' social support , fostering more benign appraisal s of stressors , and reducing depressive symptoms may yield indirect health benefits . Psychosocial intervention studies with biological measures of physical health outcomes are warranted Purpose : The 
    Output:
    