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: AIM This paper reports a study to examine the effectiveness of a 6-month dementia care programme for Chinese families living with and caring for a relative with dementia , compared with routine family support services in Hong Kong . BACKGROUND Recognizing the adverse psychosocial health effects inherent in dementia care , different psychosocial interventions provided preliminary evidence of their effectiveness in improving family members ' knowledge and skills in caregiving and delaying dementia sufferers ' illness deterioration and institutionalization . Little is known about the effects of such interventions for family caregivers ' psychosocial health conditions , particularly in non-Western population s. METHODS A r and omized controlled trial was conducted with 92 Chinese families of a relative with dementia in two dementia care centres in Hong Kong . They were r and omly selected from a dementia client list and then r and omly assigned to receive either the dementia family care programme ( n=46 ) , or routine care only ( n=46 ) . Clients ' symptoms and institutionalization , and caregivers ' quality of life , burden and social support at recruitment , 1 week , and 12 and 18 months following intervention were measured and compared between the study groups using repeated measures MANOVAS followed by Helmert 's contrast tests . Data was collected over a period of 24 months , between September 2007 and August 2009 . RESULTS Results of the MANOVAS and contrast tests indicated that at 18-month follow-up , participants in the family programme reported significantly greater improvements in clients ' symptoms and institutionalization rates , and caregivers ' quality of life and burden , when compared with their counterparts in the routine care group . CONCLUSION These findings provide evidence that the dementia care family programme can improve the psychosocial functioning of both clients with dementia and their family caregivers in a Chinese population . Further research is recommended to investigate whether this intervention can also apply to families with different socio-economic background s and across cultures 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 Objective To assess the efficacy at 12 months of an early psychosocial counselling and support programme for out patients with mild Alzheimer ’s disease and their primary care givers . Design Multicentre , r and omised , controlled , rater blinded trial . Setting Primary care and memory clinics in five Danish districts . Participants 330 out patients with mild Alzheimer ’s disease and their 330 primary care givers . Interventions Participating dyads ( patient and primary care giver ) were r and omised to control support during follow-up or to control support plus DAISY intervention ( multifaceted and semi-tailored counselling , education , and support ) . Main outcome measures Primary outcomes at 12 months for patients were change from baseline in mini mental state examination ( MMSE ) score , Cornell depression scale score , and proxy rated European quality of life visual analogue scale ( EQ-VAS ) score . For care givers , outcomes were change from baseline in geriatric depression scale ( GDS 30 items ) score and EQ-VAS score . Results Because of multiple testing , statistical significance was set at an adjusted P limit of < 0.0005 . At 12 months there were no significant differences between the two allocation groups in changes from baseline in the primary and secondary outcomes . However , although non-significant with the adjusted P limit , a small difference was observed for one of the primary patient outcomes ( Cornell depression scale score ) in patients in favour of the DAISY intervention group before and after adjusting for attrition ( P=0.0146 and P=0.0103 respectively ) . Conclusions The multifaceted , semi-tailored intervention with counselling , education , and support for patients with mild Alzheimer ’s disease and their care givers did not have any significant effect beyond that with well structured follow-up support at 12 months after adjustment for multiple comparisons . The small positive effect found in the unadjusted primary outcome addressing depressive symptoms in patients may call for further research focusing on patients with Alzheimer ’s disease and comorbid depression . Trial registration IS RCT N74848736 PURPOSE Few empirical studies have compared the efficacy between psychoeducational ( skill-building ) approaches for reducing  caregivers ' psychological distress  and interventions modeled after typical community-based support groups . We compare the impact of two distinct interventions on Anglo and Latino caregivers of elderly relatives with dementia . DESIGN AND METHODS The change from pre assessment to post assessment ( baseline to 3 months ) for 213 female caregivers ( 122 Anglo and 91 Latino ) is presented . They were seen weekly for 10 weeks in either the Coping With Caregiving psychoeducational program ( instruction and practice in small groups to learn specific cognitive and behavioral skills ) or in the Enhanced Support Group condition ( guided discussion and empathic listening to develop reciprocal support within the group ) . Both programs were tailored to be sensitive to the cultural concerns of Anglo and Latino caregivers , and they were delivered in either English or Spanish by trained interventionists . RESULTS Overall , participants in the Coping With Caregiving condition reported a significant reduction in depressive symptoms , increased use of adaptive coping strategies , and a trend toward decreased use of negative coping strategies when compared with those in the Enhanced Support Group condition . Results were similar for both ethnic groups : there were no main effects for ethnicity , and no significant ethnicity by treatment interaction effects . IMPLICATION S This study provides empirical support that female caregivers benefit more from a skill-building approach to managing their distress than from support group membership alone . We find it very encouraging that the Latino caregivers responded well on key outcome variables , suggesting that Latinos will participate in clinical research and will benefit from their involvement when services are provided to meet their specific needs Although the literature is replete with studies examining the psychological concomitants and interventions for Alzheimer 's disease ( AD ) family caregivers , a surprisingly small amount of research exists on anxiety . Given prevalence rates suggesting that anxiety significantly impacts one in three family caregivers , brief group cognitive-behavioral therapy ( CBT ) interventions may offer assistance . To assess CBT 's effectiveness , 38 anxious AD family caregivers were recruited and r and omly assigned to a nine-week group CBT intervention or to a waitlist control . Caregivers r and omized to CBT demonstrated less anxiety on self-report and clinician-administered question naires than waitlist group participants at posttreatment and six-week follow-up assessment s. A sub sample of caregivers also demonstrated improved sleep , as assessed through actigraph measurements . Additional study is recommended with diverse anxious family caregiving groups to further investigate the effectiveness of brief CBT group interventions OBJECTIVES Dementia is a rapidly growing public health problem in low and middle income countries . There is an urgent need , in the absence of formal services , to develop interventions design ed to improve the lives of people with dementia , and their families . This study tests the effectiveness of the 10/66 caregiver intervention among people with dementia , and their carers . DESIGN A single blind parallel group r and omized controlled trial ( IS RCT N41039907 ) . SETTING Moscow . PARTICIPANTS Sixty family caregivers of people aged 65 and over with dementia were r and omized to receive the intervention and medical care as usual ( n = 30 ) or medical care as usual only ( n = 30 ) . Caregiver and person with dementia outcomes were assessed at baseline and after 6 months . INTERVENTION The caregiver education and training intervention was delivered over five , weekly , half-hour sessions and was made up of three modules : ( i ) assessment ( one session ) ; ( ii ) basic education about dementia ( two sessions ) ; and ( iii ) training regarding specific problem behaviors ( two sessions ) . MEASUREMENTS Dementia was diagnosed using DSM-IV criteria . Caregiver : Zarit Carer Burden Interview ; carer psychological distress ( SRQ 20 ) ; and carer Quality of Life ( WHOQOL-BREF ) . Person with dementia : Behavioural and Psychological symptoms ( NPI-Q ) ; quality of life ( DEMQOL ) . RESULTS Caregivers in the intervention group reported large and statistically significant net improvements at 6-month follow-up in burden compared to controls . No group differences were found on caregiver psychological distress and patient and caregiver quality of life . CONCLUSIONS The low-level intervention seems to be as , if not more , effective than similar interventions applied in high income countries Objective : To determine the effectiveness of a counseling and support intervention for spouse caregivers in delaying time to nursing home placement of patients with Alzheimer disease ( AD ) , and identify the mechanisms through which the intervention accomplished this goal . Methods : We conducted a r and omized controlled trial of an enhanced counseling and support intervention compared to usual care . Participants were a referred volunteer sample of 406 spouse caregivers of community-dwelling patients who had enrolled in the study over a 9.5-year period . The intervention consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad hoc telephone counseling . Structured question naires were administered at baseline and at regular follow-up intervals , every 4 months for the first year and every 6 months thereafter . Cox proportional hazard models were used to test the effects of the intervention on the time to nursing home placement for the patients after controlling for multiple time-invariant and time-dependent predictors of placement . Results : Patients whose spouses received the intervention experienced a 28.3 % reduction in the rate of nursing home placement compared with usual care controls ( hazard ratio = 0.717 after covariate adjustment , p = 0.025 ) . The difference in model-predicted median time to placement was 557 days . Improvements in caregivers ’ satisfaction with social support , response to patient behavior problems , and symptoms of depression collectively accounted for 61.2 % of the intervention ’s beneficial impact on placement . Conclusion : Greater access to effective programs of counseling and support could yield considerable benefits for caregivers , patients with Alzheimer disease , and society Objectives To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden , promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia . Methodology and Principal Findings This was a r and omised controlled trial in which the person with dementia-caregiver dyad was r and omly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months . It was carried out in communities based in two talukas ( administrative blocks ) in Goa , India . Mild to moderate cases with dementia ( diagnosed using the DSM IV criteria and grade d using the Clinical Dementia Rating scale ) and their caregivers were included in the trial . Community based intervention provided by a team consisting of Home Care Advisors who were supervised by a counselor and a psychiatrist , focusing on supporting the caregiver through information on dementia , guidance on behaviour management , a single psychiatric assessment and psychotropic medication if needed . We measured caregiver mental health ( General Health Question naire ) , caregiver burden ( Zarit Burden Score ) , distress due to behavioural disturbances ( NPI-D ) , behavioural problems in the subject ( NPI-S ) and activities of daily living in the elder with dementia ( EASI ) . Outcome evaluations were masked to the allocation status . We analysed each outcome with a mixed effects model . 81 families enrolled in the trial ; 41 were r and omly allocated to the intervention . 59 completed the trial and 18 died during the trial . The intervention led to a significant reduction of GHQ ( −1.12 , 95 % CI −2.07 to −0.17 ) and NPI-D scores ( −1.96 , 95%CI −3.51 to −0.41 ) and non-significant reductions in the ZBS , EASI and NPI-S scores . We also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm ( OR 0.34 , 95 % CI 0.01 to 1.03 ) . Conclusion Home based support for caregivers of persons with dementia , which emphasizes the use of locally available , low-cost human re sources , is feasible , acceptable and leads to significant improvements in caregiver mental health and burden of caring . Clinical Trials.gov Among the diverse group of interventions developed to help dementia family caregivers  cognitive-behavioural approaches show especially promising results . Objectives : This study describes a cognitive-behavioural group intervention aim ed principally at the modification of dysfunctional thoughts associated with caregiving ( MDTC ) . The efficacy of the MDTC intervention in reducing caregivers ’ depressive symptomatology , together with the frequency and appraisal of problem behaviours , is compared to that of a waiting-list control group ( WL ) . Furthermore , the potential mediating role of the dysfunctional thoughts in the relationship between this intervention and caregivers ’ depressive symptomatology is analyzed . Of the 74 dementia caregivers who were r and omized to one of two conditions ( MDTC and WL ) , 39 completed the post- 
    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: AIM This paper reports a study to examine the effectiveness of a 6-month dementia care programme for Chinese families living with and caring for a relative with dementia , compared with routine family support services in Hong Kong . BACKGROUND Recognizing the adverse psychosocial health effects inherent in dementia care , different psychosocial interventions provided preliminary evidence of their effectiveness in improving family members ' knowledge and skills in caregiving and delaying dementia sufferers ' illness deterioration and institutionalization . Little is known about the effects of such interventions for family caregivers ' psychosocial health conditions , particularly in non-Western population s. METHODS A r and omized controlled trial was conducted with 92 Chinese families of a relative with dementia in two dementia care centres in Hong Kong . They were r and omly selected from a dementia client list and then r and omly assigned to receive either the dementia family care programme ( n=46 ) , or routine care only ( n=46 ) . Clients ' symptoms and institutionalization , and caregivers ' quality of life , burden and social support at recruitment , 1 week , and 12 and 18 months following intervention were measured and compared between the study groups using repeated measures MANOVAS followed by Helmert 's contrast tests . Data was collected over a period of 24 months , between September 2007 and August 2009 . RESULTS Results of the MANOVAS and contrast tests indicated that at 18-month follow-up , participants in the family programme reported significantly greater improvements in clients ' symptoms and institutionalization rates , and caregivers ' quality of life and burden , when compared with their counterparts in the routine care group . CONCLUSION These findings provide evidence that the dementia care family programme can improve the psychosocial functioning of both clients with dementia and their family caregivers in a Chinese population . Further research is recommended to investigate whether this intervention can also apply to families with different socio-economic background s and across cultures 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 Objective To assess the efficacy at 12 months of an early psychosocial counselling and support programme for out patients with mild Alzheimer ’s disease and their primary care givers . Design Multicentre , r and omised , controlled , rater blinded trial . Setting Primary care and memory clinics in five Danish districts . Participants 330 out patients with mild Alzheimer ’s disease and their 330 primary care givers . Interventions Participating dyads ( patient and primary care giver ) were r and omised to control support during follow-up or to control support plus DAISY intervention ( multifaceted and semi-tailored counselling , education , and support ) . Main outcome measures Primary outcomes at 12 months for patients were change from baseline in mini mental state examination ( MMSE ) score , Cornell depression scale score , and proxy rated European quality of life visual analogue scale ( EQ-VAS ) score . For care givers , outcomes were change from baseline in geriatric depression scale ( GDS 30 items ) score and EQ-VAS score . Results Because of multiple testing , statistical significance was set at an adjusted P limit of < 0.0005 . At 12 months there were no significant differences between the two allocation groups in changes from baseline in the primary and secondary outcomes . However , although non-significant with the adjusted P limit , a small difference was observed for one of the primary patient outcomes ( Cornell depression scale score ) in patients in favour of the DAISY intervention group before and after adjusting for attrition ( P=0.0146 and P=0.0103 respectively ) . Conclusions The multifaceted , semi-tailored intervention with counselling , education , and support for patients with mild Alzheimer ’s disease and their care givers did not have any significant effect beyond that with well structured follow-up support at 12 months after adjustment for multiple comparisons . The small positive effect found in the unadjusted primary outcome addressing depressive symptoms in patients may call for further research focusing on patients with Alzheimer ’s disease and comorbid depression . Trial registration IS RCT N74848736 PURPOSE Few empirical studies have compared the efficacy between psychoeducational ( skill-building ) approaches for reducing  caregivers ' psychological distress  and interventions modeled after typical community-based support groups . We compare the impact of two distinct interventions on Anglo and Latino caregivers of elderly relatives with dementia . DESIGN AND METHODS The change from pre assessment to post assessment ( baseline to 3 months ) for 213 female caregivers ( 122 Anglo and 91 Latino ) is presented . They were seen weekly for 10 weeks in either the Coping With Caregiving psychoeducational program ( instruction and practice in small groups to learn specific cognitive and behavioral skills ) or in the Enhanced Support Group condition ( guided discussion and empathic listening to develop reciprocal support within the group ) . Both programs were tailored to be sensitive to the cultural concerns of Anglo and Latino caregivers , and they were delivered in either English or Spanish by trained interventionists . RESULTS Overall , participants in the Coping With Caregiving condition reported a significant reduction in depressive symptoms , increased use of adaptive coping strategies , and a trend toward decreased use of negative coping strategies when compared with those in the Enhanced Support Group condition . Results were similar for both ethnic groups : there were no main effects for ethnicity , and no significant ethnicity by treatment interaction effects . IMPLICATION S This study provides empirical support that female caregivers benefit more from a skill-building approach to managing their distress than from support group membership alone . We find it very encouraging that the Latino caregivers responded well on key outcome variables , suggesting that Latinos will participate in clinical research and will benefit from their involvement when services are provided to meet their specific needs Although the literature is replete with studies examining the psychological concomitants and interventions for Alzheimer 's disease ( AD ) family caregivers , a surprisingly small amount of research exists on anxiety . Given prevalence rates suggesting that anxiety significantly impacts one in three family caregivers , brief group cognitive-behavioral therapy ( CBT ) interventions may offer assistance . To assess CBT 's effectiveness , 38 anxious AD family caregivers were recruited and r and omly assigned to a nine-week group CBT intervention or to a waitlist control . Caregivers r and omized to CBT demonstrated less anxiety on self-report and clinician-administered question naires than waitlist group participants at posttreatment and six-week follow-up assessment s. A sub sample of caregivers also demonstrated improved sleep , as assessed through actigraph measurements . Additional study is recommended with diverse anxious family caregiving groups to further investigate the effectiveness of brief CBT group interventions OBJECTIVES Dementia is a rapidly growing public health problem in low and middle income countries . There is an urgent need , in the absence of formal services , to develop interventions design ed to improve the lives of people with dementia , and their families . This study tests the effectiveness of the 10/66 caregiver intervention among people with dementia , and their carers . DESIGN A single blind parallel group r and omized controlled trial ( IS RCT N41039907 ) . SETTING Moscow . PARTICIPANTS Sixty family caregivers of people aged 65 and over with dementia were r and omized to receive the intervention and medical care as usual ( n = 30 ) or medical care as usual only ( n = 30 ) . Caregiver and person with dementia outcomes were assessed at baseline and after 6 months . INTERVENTION The caregiver education and training intervention was delivered over five , weekly , half-hour sessions and was made up of three modules : ( i ) assessment ( one session ) ; ( ii ) basic education about dementia ( two sessions ) ; and ( iii ) training regarding specific problem behaviors ( two sessions ) . MEASUREMENTS Dementia was diagnosed using DSM-IV criteria . Caregiver : Zarit Carer Burden Interview ; carer psychological distress ( SRQ 20 ) ; and carer Quality of Life ( WHOQOL-BREF ) . Person with dementia : Behavioural and Psychological symptoms ( NPI-Q ) ; quality of life ( DEMQOL ) . RESULTS Caregivers in the intervention group reported large and statistically significant net improvements at 6-month follow-up in burden compared to controls . No group differences were found on caregiver psychological distress and patient and caregiver quality of life . CONCLUSIONS The low-level intervention seems to be as , if not more , effective than similar interventions applied in high income countries Objective : To determine the effectiveness of a counseling and support intervention for spouse caregivers in delaying time to nursing home placement of patients with Alzheimer disease ( AD ) , and identify the mechanisms through which the intervention accomplished this goal . Methods : We conducted a r and omized controlled trial of an enhanced counseling and support intervention compared to usual care . Participants were a referred volunteer sample of 406 spouse caregivers of community-dwelling patients who had enrolled in the study over a 9.5-year period . The intervention consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad hoc telephone counseling . Structured question naires were administered at baseline and at regular follow-up intervals , every 4 months for the first year and every 6 months thereafter . Cox proportional hazard models were used to test the effects of the intervention on the time to nursing home placement for the patients after controlling for multiple time-invariant and time-dependent predictors of placement . Results : Patients whose spouses received the intervention experienced a 28.3 % reduction in the rate of nursing home placement compared with usual care controls ( hazard ratio = 0.717 after covariate adjustment , p = 0.025 ) . The difference in model-predicted median time to placement was 557 days . Improvements in caregivers ’ satisfaction with social support , response to patient behavior problems , and symptoms of depression collectively accounted for 61.2 % of the intervention ’s beneficial impact on placement . Conclusion : Greater access to effective programs of counseling and support could yield considerable benefits for caregivers , patients with Alzheimer disease , and society Objectives To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden , promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia . Methodology and Principal Findings This was a r and omised controlled trial in which the person with dementia-caregiver dyad was r and omly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months . It was carried out in communities based in two talukas ( administrative blocks ) in Goa , India . Mild to moderate cases with dementia ( diagnosed using the DSM IV criteria and grade d using the Clinical Dementia Rating scale ) and their caregivers were included in the trial . Community based intervention provided by a team consisting of Home Care Advisors who were supervised by a counselor and a psychiatrist , focusing on supporting the caregiver through information on dementia , guidance on behaviour management , a single psychiatric assessment and psychotropic medication if needed . We measured caregiver mental health ( General Health Question naire ) , caregiver burden ( Zarit Burden Score ) , distress due to behavioural disturbances ( NPI-D ) , behavioural problems in the subject ( NPI-S ) and activities of daily living in the elder with dementia ( EASI ) . Outcome evaluations were masked to the allocation status . We analysed each outcome with a mixed effects model . 81 families enrolled in the trial ; 41 were r and omly allocated to the intervention . 59 completed the trial and 18 died during the trial . The intervention led to a significant reduction of GHQ ( −1.12 , 95 % CI −2.07 to −0.17 ) and NPI-D scores ( −1.96 , 95%CI −3.51 to −0.41 ) and non-significant reductions in the ZBS , EASI and NPI-S scores . We also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm ( OR 0.34 , 95 % CI 0.01 to 1.03 ) . Conclusion Home based support for caregivers of persons with dementia , which emphasizes the use of locally available , low-cost human re sources , is feasible , acceptable and leads to significant improvements in caregiver mental health and burden of caring . Clinical Trials.gov Among the diverse group of interventions developed to help dementia family caregivers  cognitive-behavioural approaches show especially promising results . Objectives : This study describes a cognitive-behavioural group intervention aim ed principally at the modification of dysfunctional thoughts associated with caregiving ( MDTC ) . The efficacy of the MDTC intervention in reducing caregivers ’ depressive symptomatology , together with the frequency and appraisal of problem behaviours , is compared to that of a waiting-list control group ( WL ) . Furthermore , the potential mediating role of the dysfunctional thoughts in the relationship between this intervention and caregivers ’ depressive symptomatology is analyzed . Of the 74 dementia caregivers who were r and omized to one of two conditions ( MDTC and WL ) , 39 completed the post- 
    Output:
    