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: BACKGROUND Based on the National Institute on Aging/National Institute of Nursing Research Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) r and omized controlled trial ( REACH II ) , REACH VA ( Department of Veterans Affairs ) was the first national clinical translation of a proven behavioral intervention for dementia caregivers , running from September 2007 through August 2009 . This article describes the population and outcomes of the REACH VA translation of REACH II into the VA . METHODS Clinical staff members from 24 VA Medical Center Home-Based Primary Care programs in 15 states delivered the intervention to stressed caregivers of patients with dementia . Like REACH II , the 6-month REACH VA intervention , structured through a protocol and individualized through a risk assessment , targeted education , support , and skills training to address caregiving risk areas of safety , social support , problem behaviors , depression , and health through 12 individual in-home and telephone sessions and 5 telephone support group sessions . Staff members of the Memphis VA Medical Center , Memphis , Tennessee , collected data on burden , depression , health and healthy behaviors , caregiving frustrations , social support , dementia-related behaviors , and time spent providing care and on duty . RESULTS From baseline to 6 months , caregivers reported significantly decreased burden , depression , impact of depression on daily life , caregiving frustrations , and number of troubling dementia-related behaviors . A 2-hour decrease in hours per day on duty approached significance . Caregivers ( 96 % ) believed that the program should be provided by the VA to caregivers . CONCLUSIONS This clinical translation achieved outcomes similar to the REACH II r and omized controlled trial , providing clinical ly significant benefits for caregivers of a veteran with a progressive dementing disease . This model of caregiver support can inform public policy in providing assistance to caregivers PURPOSE To assess , in the context of Primary Health Care ( PHC ) , the effect of a psychological intervention in mental health among caregivers ( CGs ) of dependent relatives . DESIGN AND METHODS R and omized multicenter , controlled clinical trial . The 125 CGs included in the trial were receiving health care in PHC . INCLUSION CRITERIA Identifying oneself as principal CG of a dependent relative with dementia or any other disability , and having performed this task for at least 6 months . CGs were r and omized to an intervention group ( cognitive-behavioral treatment for managing dysfunctional thoughts about caregiving and training in self-help techniques ) or to a control group ( care as usual ) . CG mental health ( General Health Question naire [ GHQ-12 ] ) , dysfunctional thoughts about caregiving , quality of life , and burden were measured . RESULTS The intervention group showed improvement in mental health : A mean reduction in GHQ-12 score of -3.33 points was recorded in the intervention group vs. the control group ( 95 % CI : -5.95 to -0.70 ; p = .01 ; Cohen d = 0.55 ) . Improvement was also recorded in dysfunctional thoughts about caregiving : ( -5.84 ; 95 % CI : -10.60 to -1.09 ; p = .01 ; Cohen d = 0.62 ) . Among the CGs that completed the initial and final assessment s , a mean of 4.77 ( SD 2.68 ) attended a maximum of 8 sessions . Men attended more often ( 5.00 sessions with SD 2.68 ) than women ( 4.70 sessions with SD 2.45 ; p < .001 ) . IMPLICATION S Psychological group intervention in the context of PHC , aim ed at the CGs of dependent persons with dementia and other disabilities , has improved mental health condition in CGs Context Providing care for patients with dementia can pose enormous burdens that may be eased with assistance and support . Needs may differ by race or ethnicity . Contributions The investigators r and omly assigned Hispanic , black , and white dementia caregivers to receive written educational material s or an intensive intervention to improve caregiver quality of life .  The specific interventions were determined by caregivers , were delivered via trained personnel and telephone support groups , and targeted several dimensions of need . The study found that quality of life improved for Hispanic and white caregivers and for black spousal caregivers in the intervention group but not in the control group . The intervention had no detectable effect on the number of care recipients who were institutionalized . Caution s The study used only a single 6-month follow-up assessment , combined heterogeneous cultures and ethnicities into 3 groups , and excluded some ethnicities . Implication s An intensive intervention targeting several dimensions of caregiver need improved caregiver quality of life without an apparent effect on care recipient institutionalization . The effect did not differ by caregiver race or ethnicity . The Editors Caring for a family member with dementia is extremely stressful , contributes to psychiatric and physical illness , and increases the risk for death ( 1 , 2 ) . The accumulating evidence on the personal , social , and health effects of dementia caregiving has generated a broad range of intervention studies , including r and omized trials aim ed at decreasing the burden and stress of caregiving . Several studies have demonstrated statistically significant effects in reducing caregiver burden , lowering caregiver depression , and delaying institutionalization of care recipients ( 1 , 3 , 4 ) through either targeted interventions that treat a specific caregiver problem , such as depression , or broad-based multicomponent interventions that include counseling , case management , and telephone support . Persistent limitations of caregiver intervention research are the paucity of well-controlled r and omized trials , the limited range of outcomes examined , small sample sizes and insufficient power , geographic limitations , inadequate racial or ethnic variation , and a scarcity of comprehensive multicomponent interventions ( 4 ) . Indeed , none of the 41 r and omized clinical trials published in the last 5 years met Consoli date d St and ards of Reporting Trials ( CONSORT ) recommendations for reporting r and omized trials ( 5 ) , and many have serious method ologic problems that call into question the reported findings ( 4 ) . To address these limitations , the National Institute on Aging and the National Institute of Nursing Research funded a multisite research program design ed to develop and test an effective caregiver intervention : the Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) study . We performed the study in 2 phases . In the first phase ( REACH I ) , we tested several different interventions at 6 U.S. sites to identify the most promising approaches to decreasing  caregiver burden and depression ( 6 ) . Results from the study showed that active treatments were superior to control conditions in reducing caregiver burden and that active engagement in skills training statistically significantly reduced  caregiver depression ( 7 , 8) . The existing literature and findings from REACH I helped guide the design of the REACH II intervention ( 7 , 8) . We based the REACH II study on the premise that caregivers can have problems in several areas at varying levels of intensity , and thus , interventions must be responsive to variations in needs among caregivers . The findings from REACH I also suggest that interventions that use active techniques , such as role-playing and interactive practice , are more effective at improving outcomes , such as depression symptoms , compared with more passive methods , such as providing information ( 7 ) . We based the REACH II intervention on these assumptions and design ed the intervention to maximize outcomes by systematic ally targeting several problem areas , tailored the intervention to respond to the needs of each individual , and actively engaged the caregiver in the intervention process . We hypothesized that participants assigned to the intervention would do better than those in the control group on several indicators of caregiver quality of life , including depression , burden , self-care , and social support and care recipient problem behaviors , and that these differences would be largest among Hispanic or Latino persons because they have lower access to support services ( 8) . In additional analyses , we assessed the effects of treatment on rates of caregiver clinical depression and care recipient institutional placement , as well as the benefits derived from study participation . Methods Caregivers Eligibility criteria for caregivers included the following : Hispanic or Latino , white or Caucasian , or black or African-American race or ethnicity ; age 21 years or older ; living with or sharing cooking facilities with the care recipient ; providing care for a relative with diagnosed Alzheimer disease or related disorders for at least 4 hours per day for at least the past 6 months ; and reported distress associated with caregiving ( reported at least 2 of the following 6 items at baseline assessment : felt overwhelmed , felt like they often needed to cry , were angry or frustrated , felt they were cut off from family or friends , reported  moderate to high levels of general stress , or felt their health had declined ) . We excluded caregivers who were involved in another caregiver intervention study , who had participated in REACH I , or who had an illness that would prevent 6 months of study participation . Other requirements were logistic , including having a telephone , planning to remain in the geographic area for at least 6 months , and competency in either English or Spanish ( see Appendix Table 1 for a detailed list of exclusions ) . Appendix Table 1 . Reasons for In eligibility Care Recipients To be eligible for the study , caregivers had to confirm that their relative had diagnosed Alzheimer disease or related disorders . In addition , we screened care recipients for a history of severe mental illness , head injury , Parkinson disease , or stroke , and we administered the  MiniMental State Examination ( MMSE )  ( 9 ) . We excluded patients who were bedbound with MMSE scores of 0 because we felt that our intervention had little to offer caregivers who were caring for such patients . Moreover , being bedbound is a risk factor for institutional placement or death , and we sought to exclude caregivers who were likely to transition out of the caregiving role within the 6-month study . For patients who scored more than 23 on the MMSE or had other conditions , such as head injury , we required a physician 's diagnosis of Alzheimer disease or related disorders . Procedures We recruited caregiver and care recipient dyads at 5 sites : Birmingham , Alabama ; Memphis , Tennessee ; Miami , Florida ; Palo Alto , California ; and Philadelphia , Pennsylvania . Enrollment began in June 2002 , and follow-up ended in August 2004 . Recruitment occurred in memory disorder clinics , primary care clinics , social service agencies , physician offices , churches , and community centers and by using professionally design ed brochures , public service announcements on radio stations , newspaper articles , television , targeted newsletters , and community presentations . We translated all intervention material s and assessment instruments into Spanish for the Hispanic or Latino participants by using established techniques for forward- and -back translation and allowing for regional variation in language expression . We used bilingual and bicultural staff at the 3 sites that recruited Hispanic or Latino participants : Palo Alto , Philadelphia , and Miami . At all sites , assessors and interventionists received cultural sensitivity training and were certified before entering the field . Certified assessors were blinded to group assignment of study participants . The institutional review boards of all 5 site institutions and the coordinating center in Pittsburgh , Pennsylvania , approved the study . We obtained written informed consent from all caregivers and from care recipients whenever possible . Caregivers provided consent on behalf of care recipients who could not do so on their own . After telephone screening ( n= 995 ) and baseline assessment ( n= 670 ) , we r and omly assigned participants ( n= 642 ) to the intervention or control group ( Figure ) . We stratified r and omization by using a block size of 2 or 4 within strata defined by the 5 intervention sites , 3 racial or ethnic groups ( Hispanic or Latino , white or Caucasian , and black or African American ) , and 2 caregivercare recipient relationships ( spouse or nonspouse ) . We performed r and omization at the coordinating center by using a computer-generated algorithm and a st and ard protocol for transmitting r and omization information between the coordinating center and the study sites . We administered 1 of 3 follow-up batteries , on the basis of care recipient status at follow-up ( full follow-up , bereavement battery , or placement battery ) , to study participants 6 months after r and omization when the intervention was completed . To maximize the number of individuals who could be included in the outcome analyses , we ensured that the 3 batteries were as similar as possible . We did not ask caregivers about caregiver burden and care recipient functional status if their care recipients had died ; thus , we could not include these caregivers in the primary outcome analysis ( 10 ) . Figure . Study flow diagram . * See Appendix Table 1 for reasons for in eligibility . See Appendix Table 2 ( for reasons for unavailable end points and types of 6-month follow-up . Appendix Table 2 . Reasons for Unavailable End Points and Types of 6-Month Follow-up Trial Groups Intervention The intervention involved a range of strategies : provision of Objective : The primary objective is to report on the efficacy of an individualized dementia care consultation intervention for family caregivers of patients with diagnosed dementia living in the community . The secondary objective is to present evidence on the intervention process to inform the feasibility and sustainability of the model featuring collaboration between primary care physicians and a voluntary sector organization . Method : R and omization was based on primary care physician practice site . In the intervention group , dementia care consultants located at an Alzheimer 's association chapter  provided individualized counseling and support over a 12-month period , and sent copies of care plans developed with family caregivers to referring primary care physicians . In the control group , family caregivers received educational and community re source information but no care consultation . Nursing home admission of patients during the 12-month study period was the primary outcome ; secondary outcomes included measures of caregiver self-efficacy 
    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: BACKGROUND Based on the National Institute on Aging/National Institute of Nursing Research Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) r and omized controlled trial ( REACH II ) , REACH VA ( Department of Veterans Affairs ) was the first national clinical translation of a proven behavioral intervention for dementia caregivers , running from September 2007 through August 2009 . This article describes the population and outcomes of the REACH VA translation of REACH II into the VA . METHODS Clinical staff members from 24 VA Medical Center Home-Based Primary Care programs in 15 states delivered the intervention to stressed caregivers of patients with dementia . Like REACH II , the 6-month REACH VA intervention , structured through a protocol and individualized through a risk assessment , targeted education , support , and skills training to address caregiving risk areas of safety , social support , problem behaviors , depression , and health through 12 individual in-home and telephone sessions and 5 telephone support group sessions . Staff members of the Memphis VA Medical Center , Memphis , Tennessee , collected data on burden , depression , health and healthy behaviors , caregiving frustrations , social support , dementia-related behaviors , and time spent providing care and on duty . RESULTS From baseline to 6 months , caregivers reported significantly decreased burden , depression , impact of depression on daily life , caregiving frustrations , and number of troubling dementia-related behaviors . A 2-hour decrease in hours per day on duty approached significance . Caregivers ( 96 % ) believed that the program should be provided by the VA to caregivers . CONCLUSIONS This clinical translation achieved outcomes similar to the REACH II r and omized controlled trial , providing clinical ly significant benefits for caregivers of a veteran with a progressive dementing disease . This model of caregiver support can inform public policy in providing assistance to caregivers PURPOSE To assess , in the context of Primary Health Care ( PHC ) , the effect of a psychological intervention in mental health among caregivers ( CGs ) of dependent relatives . DESIGN AND METHODS R and omized multicenter , controlled clinical trial . The 125 CGs included in the trial were receiving health care in PHC . INCLUSION CRITERIA Identifying oneself as principal CG of a dependent relative with dementia or any other disability , and having performed this task for at least 6 months . CGs were r and omized to an intervention group ( cognitive-behavioral treatment for managing dysfunctional thoughts about caregiving and training in self-help techniques ) or to a control group ( care as usual ) . CG mental health ( General Health Question naire [ GHQ-12 ] ) , dysfunctional thoughts about caregiving , quality of life , and burden were measured . RESULTS The intervention group showed improvement in mental health : A mean reduction in GHQ-12 score of -3.33 points was recorded in the intervention group vs. the control group ( 95 % CI : -5.95 to -0.70 ; p = .01 ; Cohen d = 0.55 ) . Improvement was also recorded in dysfunctional thoughts about caregiving : ( -5.84 ; 95 % CI : -10.60 to -1.09 ; p = .01 ; Cohen d = 0.62 ) . Among the CGs that completed the initial and final assessment s , a mean of 4.77 ( SD 2.68 ) attended a maximum of 8 sessions . Men attended more often ( 5.00 sessions with SD 2.68 ) than women ( 4.70 sessions with SD 2.45 ; p < .001 ) . IMPLICATION S Psychological group intervention in the context of PHC , aim ed at the CGs of dependent persons with dementia and other disabilities , has improved mental health condition in CGs Context Providing care for patients with dementia can pose enormous burdens that may be eased with assistance and support . Needs may differ by race or ethnicity . Contributions The investigators r and omly assigned Hispanic , black , and white dementia caregivers to receive written educational material s or an intensive intervention to improve caregiver quality of life .  The specific interventions were determined by caregivers , were delivered via trained personnel and telephone support groups , and targeted several dimensions of need . The study found that quality of life improved for Hispanic and white caregivers and for black spousal caregivers in the intervention group but not in the control group . The intervention had no detectable effect on the number of care recipients who were institutionalized . Caution s The study used only a single 6-month follow-up assessment , combined heterogeneous cultures and ethnicities into 3 groups , and excluded some ethnicities . Implication s An intensive intervention targeting several dimensions of caregiver need improved caregiver quality of life without an apparent effect on care recipient institutionalization . The effect did not differ by caregiver race or ethnicity . The Editors Caring for a family member with dementia is extremely stressful , contributes to psychiatric and physical illness , and increases the risk for death ( 1 , 2 ) . The accumulating evidence on the personal , social , and health effects of dementia caregiving has generated a broad range of intervention studies , including r and omized trials aim ed at decreasing the burden and stress of caregiving . Several studies have demonstrated statistically significant effects in reducing caregiver burden , lowering caregiver depression , and delaying institutionalization of care recipients ( 1 , 3 , 4 ) through either targeted interventions that treat a specific caregiver problem , such as depression , or broad-based multicomponent interventions that include counseling , case management , and telephone support . Persistent limitations of caregiver intervention research are the paucity of well-controlled r and omized trials , the limited range of outcomes examined , small sample sizes and insufficient power , geographic limitations , inadequate racial or ethnic variation , and a scarcity of comprehensive multicomponent interventions ( 4 ) . Indeed , none of the 41 r and omized clinical trials published in the last 5 years met Consoli date d St and ards of Reporting Trials ( CONSORT ) recommendations for reporting r and omized trials ( 5 ) , and many have serious method ologic problems that call into question the reported findings ( 4 ) . To address these limitations , the National Institute on Aging and the National Institute of Nursing Research funded a multisite research program design ed to develop and test an effective caregiver intervention : the Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) study . We performed the study in 2 phases . In the first phase ( REACH I ) , we tested several different interventions at 6 U.S. sites to identify the most promising approaches to decreasing  caregiver burden and depression ( 6 ) . Results from the study showed that active treatments were superior to control conditions in reducing caregiver burden and that active engagement in skills training statistically significantly reduced  caregiver depression ( 7 , 8) . The existing literature and findings from REACH I helped guide the design of the REACH II intervention ( 7 , 8) . We based the REACH II study on the premise that caregivers can have problems in several areas at varying levels of intensity , and thus , interventions must be responsive to variations in needs among caregivers . The findings from REACH I also suggest that interventions that use active techniques , such as role-playing and interactive practice , are more effective at improving outcomes , such as depression symptoms , compared with more passive methods , such as providing information ( 7 ) . We based the REACH II intervention on these assumptions and design ed the intervention to maximize outcomes by systematic ally targeting several problem areas , tailored the intervention to respond to the needs of each individual , and actively engaged the caregiver in the intervention process . We hypothesized that participants assigned to the intervention would do better than those in the control group on several indicators of caregiver quality of life , including depression , burden , self-care , and social support and care recipient problem behaviors , and that these differences would be largest among Hispanic or Latino persons because they have lower access to support services ( 8) . In additional analyses , we assessed the effects of treatment on rates of caregiver clinical depression and care recipient institutional placement , as well as the benefits derived from study participation . Methods Caregivers Eligibility criteria for caregivers included the following : Hispanic or Latino , white or Caucasian , or black or African-American race or ethnicity ; age 21 years or older ; living with or sharing cooking facilities with the care recipient ; providing care for a relative with diagnosed Alzheimer disease or related disorders for at least 4 hours per day for at least the past 6 months ; and reported distress associated with caregiving ( reported at least 2 of the following 6 items at baseline assessment : felt overwhelmed , felt like they often needed to cry , were angry or frustrated , felt they were cut off from family or friends , reported  moderate to high levels of general stress , or felt their health had declined ) . We excluded caregivers who were involved in another caregiver intervention study , who had participated in REACH I , or who had an illness that would prevent 6 months of study participation . Other requirements were logistic , including having a telephone , planning to remain in the geographic area for at least 6 months , and competency in either English or Spanish ( see Appendix Table 1 for a detailed list of exclusions ) . Appendix Table 1 . Reasons for In eligibility Care Recipients To be eligible for the study , caregivers had to confirm that their relative had diagnosed Alzheimer disease or related disorders . In addition , we screened care recipients for a history of severe mental illness , head injury , Parkinson disease , or stroke , and we administered the  MiniMental State Examination ( MMSE )  ( 9 ) . We excluded patients who were bedbound with MMSE scores of 0 because we felt that our intervention had little to offer caregivers who were caring for such patients . Moreover , being bedbound is a risk factor for institutional placement or death , and we sought to exclude caregivers who were likely to transition out of the caregiving role within the 6-month study . For patients who scored more than 23 on the MMSE or had other conditions , such as head injury , we required a physician 's diagnosis of Alzheimer disease or related disorders . Procedures We recruited caregiver and care recipient dyads at 5 sites : Birmingham , Alabama ; Memphis , Tennessee ; Miami , Florida ; Palo Alto , California ; and Philadelphia , Pennsylvania . Enrollment began in June 2002 , and follow-up ended in August 2004 . Recruitment occurred in memory disorder clinics , primary care clinics , social service agencies , physician offices , churches , and community centers and by using professionally design ed brochures , public service announcements on radio stations , newspaper articles , television , targeted newsletters , and community presentations . We translated all intervention material s and assessment instruments into Spanish for the Hispanic or Latino participants by using established techniques for forward- and -back translation and allowing for regional variation in language expression . We used bilingual and bicultural staff at the 3 sites that recruited Hispanic or Latino participants : Palo Alto , Philadelphia , and Miami . At all sites , assessors and interventionists received cultural sensitivity training and were certified before entering the field . Certified assessors were blinded to group assignment of study participants . The institutional review boards of all 5 site institutions and the coordinating center in Pittsburgh , Pennsylvania , approved the study . We obtained written informed consent from all caregivers and from care recipients whenever possible . Caregivers provided consent on behalf of care recipients who could not do so on their own . After telephone screening ( n= 995 ) and baseline assessment ( n= 670 ) , we r and omly assigned participants ( n= 642 ) to the intervention or control group ( Figure ) . We stratified r and omization by using a block size of 2 or 4 within strata defined by the 5 intervention sites , 3 racial or ethnic groups ( Hispanic or Latino , white or Caucasian , and black or African American ) , and 2 caregivercare recipient relationships ( spouse or nonspouse ) . We performed r and omization at the coordinating center by using a computer-generated algorithm and a st and ard protocol for transmitting r and omization information between the coordinating center and the study sites . We administered 1 of 3 follow-up batteries , on the basis of care recipient status at follow-up ( full follow-up , bereavement battery , or placement battery ) , to study participants 6 months after r and omization when the intervention was completed . To maximize the number of individuals who could be included in the outcome analyses , we ensured that the 3 batteries were as similar as possible . We did not ask caregivers about caregiver burden and care recipient functional status if their care recipients had died ; thus , we could not include these caregivers in the primary outcome analysis ( 10 ) . Figure . Study flow diagram . * See Appendix Table 1 for reasons for in eligibility . See Appendix Table 2 ( for reasons for unavailable end points and types of 6-month follow-up . Appendix Table 2 . Reasons for Unavailable End Points and Types of 6-Month Follow-up Trial Groups Intervention The intervention involved a range of strategies : provision of Objective : The primary objective is to report on the efficacy of an individualized dementia care consultation intervention for family caregivers of patients with diagnosed dementia living in the community . The secondary objective is to present evidence on the intervention process to inform the feasibility and sustainability of the model featuring collaboration between primary care physicians and a voluntary sector organization . Method : R and omization was based on primary care physician practice site . In the intervention group , dementia care consultants located at an Alzheimer 's association chapter  provided individualized counseling and support over a 12-month period , and sent copies of care plans developed with family caregivers to referring primary care physicians . In the control group , family caregivers received educational and community re source information but no care consultation . Nursing home admission of patients during the 12-month study period was the primary outcome ; secondary outcomes included measures of caregiver self-efficacy 
    Output:
    