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 Although several face-to-face programs are dedicated to informal caregivers of persons with dementia , they are not always accessible to overburdened or isolated caregivers . Based on a face-to-face intervention program , we adapted and design ed a Web-based fully automated psychoeducational program ( called Diapason ) inspired by a cognitive approach . Objective This study aim ed to evaluate through a pilot unblinded r and omized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer ’s disease ( PWAD ) based on a mixed methods research design . Methods We recruited and r and omized offline 49 informal caregivers of a PWAD in a day care center in Paris , France . They either received the Web-based intervention and usual care for 3 months ( experimental group , n=25 ) or only usual care ( control group , n=24 ) . Caregivers ’ perceived stress ( PSS-14 , primary outcome ) , self-efficacy , burden , perceived health status , and depression ( secondary outcomes ) were measured during 3 face-to-face on-site visits : at baseline , at the end of the program ( month 3 ) , and after follow-up ( month 6 ) . Additionally , semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis . Results Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups ( P=.98 ) . The experimental group significantly improved their knowledge of the illness ( d=.79 , P=.008 ) from baseline to month 3 . Of the 25 participants allocated to the experimental group , 17 ( 71 % ) finished the protocol and entirely viewed at least 10 of 12 online sessions . On average , participants used the website 19.72 times ( SD 12.88 ) and were connected for 262.20 minutes ( SD 270.74 ) . The results of the satisfaction question naire showed that most participants considered the program to be useful ( 95 % , 19/20 ) , clear ( 100 % , 20/20 ) , and comprehensive ( 85 % , 17/20 ) . Significant correlations were found between relationship and caregivers ’ program opinion ( P=.01 ) . Thus , positive opinions were provided by husb and s and sons ( 3/3 ) , whereas qualified opinions were primarily reported by daughters ( 8/11 ) . Female spouses expressed negative ( 2/3 ) or neutral opinions ( 1/3 ) . Caregivers expected more dynamic content and further interaction with staff and peers . Conclusions In this study , quantitative results were inconclusive owing to small sample size . Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers . Caregivers did not rule out their interest in this kind of intervention provided that it met their needs . More dynamic , personalized , and social interventions are desirable . Our recruitment issues pointed out the necessity of in-depth studies about caregivers ’ help-seeking behaviors and readiness factors . Trial Registration Clinical trials.gov NCT01430286 ; http:// clinical trials.gov/ct2/show/NCT01430286 ( Archived by WebCite at http://www.webcitation/6KxHaRspL ) Caregivers of persons with Alzheimer 's disease ( AD ) are confronted with novel decision-making tasks that leave them at risk for social isolation . Computer Link is a computer network providing information , communication , and decision-support functions for caregivers of persons with AD . One hundred two AD caregivers participated in a r and omized field experiment to evaluate the effects of ComputerLink on confidence in decision making , decision-making skill , and social isolation . During the 1-year study period , AD caregivers averaged two encounters per week with Computer Link for sessions lasting an average of 13 minutes . Access to Computer Link enhanced caregivers'decision-making confidence . Decision-making skill was unaffected . ComputerLink access did not lead to changes in social isolation as measured by st and ard instruments . The decision-support function was used least often . Postings to ComputerLink 's public bulletin board included both information-seeking and supportive messages . These findings are congruent with reports of other community-based interventions for caregivers and consistent with evaluations of computerized decision-support systems 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 PURPOSE Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia . DESIGN AND METHODS The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest r and omized clinical trial with a 30-day follow-up and a waitlist control condition . Vali date d instruments include the Center for Epidemiologic Studies -Depression scale , the State-Trait Anxiety Inventory , the Caregiver Strain scale from Benjamin Rose , and Positive Aspects of Caregiving used in the nationwide REACH study . RESULTS Those who viewed Caregiver 's Friend : Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression , anxiety , level and frequency of stress , caregiver strain , self-efficacy , and intention to seek help , as well as perceptions of positive aspects of caregiving . IMPLICATION S Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost , effective , convenient , individually tailored programs that present educational information , cognitive and behavioral skills , and affective learning opportunities . This makes Web-based multimedia a promising avenue for work-life balance programs , employee-assistance providers , and organizations interested in improving family caregiver health and well-being Background The World Health Organization stresses the importance of accessible and (cost)effective caregiver support , given the expected increase in the number of people with dementia and the detrimental impact on the mental health of family caregivers . Methods This study assessed the effectiveness of the Internet intervention ‘ Mastery over Dementia ’ . In a RCT , 251 caregivers , of whom six were lost at baseline , were r and omly assigned to two groups . Caregivers in the experimental group ( N = 149 ) were compared to caregivers who received a minimal intervention consisting of e-bulletins ( N = 96 ) . Outcomes were symptoms of depression ( Center for Epidemiologic Studies Depression Scale : CES-D ) and anxiety ( Hospital Anxiety and Depression Scale : HADS-A ) . All data were collected via the Internet , and an intention-to-treat analysis was carried out . Results Almost all caregivers were spouses or children ( in-law ) . They were predominantly female and lived with the care recipient in the same household . Age of the caregivers varied from 26 to 87 years . Level of education varied from primary school to university , with almost half of them holding a bachelor ’s degree or higher . Regression analyses showed that caregivers in the experimental group showed significantly lower symptoms of depression ( p = .034 ) and anxiety ( p = .007 ) post intervention after adjustment for baseline differences in the primary outcome scores and the functional status of the patients with dementia . Effect sizes were moderate for symptoms of anxiety ( .48 ) and small for depressive symptoms ( .26 ) . Conclusions The Internet course ‘ Mastery over Dementia ’ offers an effective treatment for family caregivers of people with dementia reducing symptoms of depression and anxiety . The results of this study justify further development of Internet interventions for family caregivers of people with dementia and suggest that such interventions are promising for keeping support for family caregivers accessible and affordable . The findings are even more promising because future generations of family caregivers will be more familiar with the Internet . Trial Registration Dutch Trial Register NTR-2051 www.trialregister.nl/trialreg/admin/ rct Objectives This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder . Outcomes examined were depressive symptoms , upset following disruptive behaviors , anxious and angry mood states , and caregiving self‐efficacy . Methods Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via r and om allocation to either of the following : ( 1 ) a 14‐week behavioral intervention using video instructional material s , workbook and telephone coaching in behavioral management , pleasant events scheduling , and relaxation or ( 2 ) a basic education guide and telephone support comparison condition . Telephone assessment s were conducted by interviewers blind to treatment condition at pre‐intervention , post‐intervention , and 6 months following intervention . Results For those providing in‐home care at post‐treatment , depressive symptoms , upset following disruptive behaviors , and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition . Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition . Caregiving self‐efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition . Effect sizes were moderate but not maintained at the 6‐month follow‐up . Conclusions This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support . Carers ' abilities to maintain strategy use during progressive disorders such as Alzheimer 's disease likely require longer intervention contact than provided in the current study . Dementia carers , including those living in rural areas , can benefit from accessible and empirically supported interventions that can be easily disseminated across distances at modest cost . © 2015 The Authors . International Journal of Geriatric Psychiatry Published by John Wiley & Sons , BACKGROUND Few personalized e- interventions are available for informal and professional caregivers of people with dementia . The DEMentia Digital Interactive Social Chart ( DEM-DISC ) is an ICT tool to support customized disease management in dementia . The aim of this study was to improve and evaluate DEM-DISC , its user-friendliness and usefulness and to investigate the future implementation . METHODS A cluster r and omized controlled trial ( RCT ) design was used with measurements at baseline , 6 and 12 months . A total of 73 informal caregivers of people with dementia , supported by 19 r and omized case managers participated in the study . In the intervention group , both carers ( n = 41 ) and case managers ( n = 13 ) could access DEM-DISC during twelve months . The control group , 32 carers and 14 case managers , had no access to DEM-DISC . Semi-structured interviews were conducted with ten stakeholders . RESULTS Informal caregivers who used DEM-DISC for twelve months reported an increased sense of competence than controls . A subgroup of users who frequently accessed DEM-DISC reported more met needs after six months than controls . Overall informal caregivers and case managers judged DEM-DISC as easy to learn and user-friendly . CONCLUSIONS This study demonstrates that using DEM-DISC had a positive effect on the sense of competence and experienced ( met ) needs of informal carers . This shows the importance of user-friendly ICT solutions to assist carers in finding appropriate care services tailored to their specific situation and needs . For further implementation of DEM-DISC methods to keep the information up date d is of great importance BACKGROUND / OBJECTIVES Available services and intervention programs for dementia caregivers are often underutilized because of issues such as cost , logistics , lack of knowledge about available services , or insufficient support from others . Information technologies offer the potential of removing these barriers and facilitating the ability of caregivers to access needed support . This project evaluated the feasibility and efficacy of technology-based psychosocial intervention among minority family caregivers of dementia patients . DESIGN A feasibility and efficacy trial . SETTING Participants ' homes in the Greater Miami Community . PARTICIPANTS One hundred ten ( 56 Hispanic American and 54 African American ) caregivers of patients with dementia . INTERVENTION A technology-based multi-component psychosocial intervention was delivered in-home and via videophone technology over 5 months . The intervention was modeled after the REACH II intervention and targeted known areas of caregiver risk . MEASUREMENT St and ardized measures of depression , caregiver burden , social support , and the caregivers ' perception of the caregiver 's experience were administered at baseline and 5 months post-r and omization . RESULTS Overall , caregivers who received the intervention reported a decrease in burden , an increase in perceived social support and positive perceptions of the caregiving experience . No effect was observed for depression . Most participants indicated that the intervention improved their caregiving skills and found the technology to be easy to use . CONCLUSIONS A technology-based format was feasible for delivering a multi-component intervention to minority family dementia caregivers . The intervention improved caregiver outcomes for both Hispanic and African American caregivers . The results suggest that technology may help eliminate disparities in access to caregiver intervention programs BACKGROUND The increasing prevalence of dementia , including among rural veterans , highlights the improved outcomes possible for caregivers who receive effective support . However , providing these complex interventions in rural areas presents challenges . Internet-based and telephone-based caregiver support can 
    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 Although several face-to-face programs are dedicated to informal caregivers of persons with dementia , they are not always accessible to overburdened or isolated caregivers . Based on a face-to-face intervention program , we adapted and design ed a Web-based fully automated psychoeducational program ( called Diapason ) inspired by a cognitive approach . Objective This study aim ed to evaluate through a pilot unblinded r and omized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer ’s disease ( PWAD ) based on a mixed methods research design . Methods We recruited and r and omized offline 49 informal caregivers of a PWAD in a day care center in Paris , France . They either received the Web-based intervention and usual care for 3 months ( experimental group , n=25 ) or only usual care ( control group , n=24 ) . Caregivers ’ perceived stress ( PSS-14 , primary outcome ) , self-efficacy , burden , perceived health status , and depression ( secondary outcomes ) were measured during 3 face-to-face on-site visits : at baseline , at the end of the program ( month 3 ) , and after follow-up ( month 6 ) . Additionally , semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis . Results Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups ( P=.98 ) . The experimental group significantly improved their knowledge of the illness ( d=.79 , P=.008 ) from baseline to month 3 . Of the 25 participants allocated to the experimental group , 17 ( 71 % ) finished the protocol and entirely viewed at least 10 of 12 online sessions . On average , participants used the website 19.72 times ( SD 12.88 ) and were connected for 262.20 minutes ( SD 270.74 ) . The results of the satisfaction question naire showed that most participants considered the program to be useful ( 95 % , 19/20 ) , clear ( 100 % , 20/20 ) , and comprehensive ( 85 % , 17/20 ) . Significant correlations were found between relationship and caregivers ’ program opinion ( P=.01 ) . Thus , positive opinions were provided by husb and s and sons ( 3/3 ) , whereas qualified opinions were primarily reported by daughters ( 8/11 ) . Female spouses expressed negative ( 2/3 ) or neutral opinions ( 1/3 ) . Caregivers expected more dynamic content and further interaction with staff and peers . Conclusions In this study , quantitative results were inconclusive owing to small sample size . Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers . Caregivers did not rule out their interest in this kind of intervention provided that it met their needs . More dynamic , personalized , and social interventions are desirable . Our recruitment issues pointed out the necessity of in-depth studies about caregivers ’ help-seeking behaviors and readiness factors . Trial Registration Clinical trials.gov NCT01430286 ; http:// clinical trials.gov/ct2/show/NCT01430286 ( Archived by WebCite at http://www.webcitation/6KxHaRspL ) Caregivers of persons with Alzheimer 's disease ( AD ) are confronted with novel decision-making tasks that leave them at risk for social isolation . Computer Link is a computer network providing information , communication , and decision-support functions for caregivers of persons with AD . One hundred two AD caregivers participated in a r and omized field experiment to evaluate the effects of ComputerLink on confidence in decision making , decision-making skill , and social isolation . During the 1-year study period , AD caregivers averaged two encounters per week with Computer Link for sessions lasting an average of 13 minutes . Access to Computer Link enhanced caregivers'decision-making confidence . Decision-making skill was unaffected . ComputerLink access did not lead to changes in social isolation as measured by st and ard instruments . The decision-support function was used least often . Postings to ComputerLink 's public bulletin board included both information-seeking and supportive messages . These findings are congruent with reports of other community-based interventions for caregivers and consistent with evaluations of computerized decision-support systems 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 PURPOSE Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia . DESIGN AND METHODS The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest r and omized clinical trial with a 30-day follow-up and a waitlist control condition . Vali date d instruments include the Center for Epidemiologic Studies -Depression scale , the State-Trait Anxiety Inventory , the Caregiver Strain scale from Benjamin Rose , and Positive Aspects of Caregiving used in the nationwide REACH study . RESULTS Those who viewed Caregiver 's Friend : Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression , anxiety , level and frequency of stress , caregiver strain , self-efficacy , and intention to seek help , as well as perceptions of positive aspects of caregiving . IMPLICATION S Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost , effective , convenient , individually tailored programs that present educational information , cognitive and behavioral skills , and affective learning opportunities . This makes Web-based multimedia a promising avenue for work-life balance programs , employee-assistance providers , and organizations interested in improving family caregiver health and well-being Background The World Health Organization stresses the importance of accessible and (cost)effective caregiver support , given the expected increase in the number of people with dementia and the detrimental impact on the mental health of family caregivers . Methods This study assessed the effectiveness of the Internet intervention ‘ Mastery over Dementia ’ . In a RCT , 251 caregivers , of whom six were lost at baseline , were r and omly assigned to two groups . Caregivers in the experimental group ( N = 149 ) were compared to caregivers who received a minimal intervention consisting of e-bulletins ( N = 96 ) . Outcomes were symptoms of depression ( Center for Epidemiologic Studies Depression Scale : CES-D ) and anxiety ( Hospital Anxiety and Depression Scale : HADS-A ) . All data were collected via the Internet , and an intention-to-treat analysis was carried out . Results Almost all caregivers were spouses or children ( in-law ) . They were predominantly female and lived with the care recipient in the same household . Age of the caregivers varied from 26 to 87 years . Level of education varied from primary school to university , with almost half of them holding a bachelor ’s degree or higher . Regression analyses showed that caregivers in the experimental group showed significantly lower symptoms of depression ( p = .034 ) and anxiety ( p = .007 ) post intervention after adjustment for baseline differences in the primary outcome scores and the functional status of the patients with dementia . Effect sizes were moderate for symptoms of anxiety ( .48 ) and small for depressive symptoms ( .26 ) . Conclusions The Internet course ‘ Mastery over Dementia ’ offers an effective treatment for family caregivers of people with dementia reducing symptoms of depression and anxiety . The results of this study justify further development of Internet interventions for family caregivers of people with dementia and suggest that such interventions are promising for keeping support for family caregivers accessible and affordable . The findings are even more promising because future generations of family caregivers will be more familiar with the Internet . Trial Registration Dutch Trial Register NTR-2051 www.trialregister.nl/trialreg/admin/ rct Objectives This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder . Outcomes examined were depressive symptoms , upset following disruptive behaviors , anxious and angry mood states , and caregiving self‐efficacy . Methods Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via r and om allocation to either of the following : ( 1 ) a 14‐week behavioral intervention using video instructional material s , workbook and telephone coaching in behavioral management , pleasant events scheduling , and relaxation or ( 2 ) a basic education guide and telephone support comparison condition . Telephone assessment s were conducted by interviewers blind to treatment condition at pre‐intervention , post‐intervention , and 6 months following intervention . Results For those providing in‐home care at post‐treatment , depressive symptoms , upset following disruptive behaviors , and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition . Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition . Caregiving self‐efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition . Effect sizes were moderate but not maintained at the 6‐month follow‐up . Conclusions This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support . Carers ' abilities to maintain strategy use during progressive disorders such as Alzheimer 's disease likely require longer intervention contact than provided in the current study . Dementia carers , including those living in rural areas , can benefit from accessible and empirically supported interventions that can be easily disseminated across distances at modest cost . © 2015 The Authors . International Journal of Geriatric Psychiatry Published by John Wiley & Sons , BACKGROUND Few personalized e- interventions are available for informal and professional caregivers of people with dementia . The DEMentia Digital Interactive Social Chart ( DEM-DISC ) is an ICT tool to support customized disease management in dementia . The aim of this study was to improve and evaluate DEM-DISC , its user-friendliness and usefulness and to investigate the future implementation . METHODS A cluster r and omized controlled trial ( RCT ) design was used with measurements at baseline , 6 and 12 months . A total of 73 informal caregivers of people with dementia , supported by 19 r and omized case managers participated in the study . In the intervention group , both carers ( n = 41 ) and case managers ( n = 13 ) could access DEM-DISC during twelve months . The control group , 32 carers and 14 case managers , had no access to DEM-DISC . Semi-structured interviews were conducted with ten stakeholders . RESULTS Informal caregivers who used DEM-DISC for twelve months reported an increased sense of competence than controls . A subgroup of users who frequently accessed DEM-DISC reported more met needs after six months than controls . Overall informal caregivers and case managers judged DEM-DISC as easy to learn and user-friendly . CONCLUSIONS This study demonstrates that using DEM-DISC had a positive effect on the sense of competence and experienced ( met ) needs of informal carers . This shows the importance of user-friendly ICT solutions to assist carers in finding appropriate care services tailored to their specific situation and needs . For further implementation of DEM-DISC methods to keep the information up date d is of great importance BACKGROUND / OBJECTIVES Available services and intervention programs for dementia caregivers are often underutilized because of issues such as cost , logistics , lack of knowledge about available services , or insufficient support from others . Information technologies offer the potential of removing these barriers and facilitating the ability of caregivers to access needed support . This project evaluated the feasibility and efficacy of technology-based psychosocial intervention among minority family caregivers of dementia patients . DESIGN A feasibility and efficacy trial . SETTING Participants ' homes in the Greater Miami Community . PARTICIPANTS One hundred ten ( 56 Hispanic American and 54 African American ) caregivers of patients with dementia . INTERVENTION A technology-based multi-component psychosocial intervention was delivered in-home and via videophone technology over 5 months . The intervention was modeled after the REACH II intervention and targeted known areas of caregiver risk . MEASUREMENT St and ardized measures of depression , caregiver burden , social support , and the caregivers ' perception of the caregiver 's experience were administered at baseline and 5 months post-r and omization . RESULTS Overall , caregivers who received the intervention reported a decrease in burden , an increase in perceived social support and positive perceptions of the caregiving experience . No effect was observed for depression . Most participants indicated that the intervention improved their caregiving skills and found the technology to be easy to use . CONCLUSIONS A technology-based format was feasible for delivering a multi-component intervention to minority family dementia caregivers . The intervention improved caregiver outcomes for both Hispanic and African American caregivers . The results suggest that technology may help eliminate disparities in access to caregiver intervention programs BACKGROUND The increasing prevalence of dementia , including among rural veterans , highlights the improved outcomes possible for caregivers who receive effective support . However , providing these complex interventions in rural areas presents challenges . Internet-based and telephone-based caregiver support can 
    Output:
    