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: In 3 studies , the authors investigated the functional role of psychological resilience and positive emotions in the stress process . Studies 1a and 1b explored naturally occurring daily stressors . Study 2 examined data from a sample of recently bereaved widows . Across studies , multilevel r and om coefficient modeling analyses revealed that the occurrence of daily positive emotions serves to moderate stress reactivity and mediate stress recovery . Findings also indicated that differences in psychological resilience accounted for meaningful variation in daily emotional responses to stress . Higher levels of trait resilience predicted a weaker association between positive and negative emotions , particularly on days characterized by heightened stress . Finally , findings indicated that over time , the experience of positive emotions functions to assist high-resilient individuals in their ability to recover effectively from daily stress . Implication s for research into protective factors that serve to inhibit the scope , severity , and diffusion of daily stressors in later adulthood are discussed STUDY OBJECTIVES The physical and psychological effects of caregiving have been examined in several population s. To date , no one has examined the effects of caregiving on caregivers of patients receiving long-term mechanical ventilation ( LTV ) [ patients who required > 4 days of continuous in-hospital mechanical ventilation ] who reside in a home or institutional setting after hospital discharge . The purpose of this study was to describe the characteristics and examine depression , burden , overload , and physical health in this caregiver population over a 6-month period after hospital discharge . DESIGN This was a prospect i ve longitudinal descriptive study of posthospital outcomes for patients receiving LTV and their caregivers . SETTING AND PARTICIPANTS Caregivers of 135 patients receiving LTV admitted to the ICUs of a university medical center , a Veterans Administration hospital , and small community hospital were enrolled . MEASUREMENTS AND RESULTS Interviews of caregivers were conducted at hospital discharge and 6 months later . Descriptive statistics , analysis of variance , and multiple regression analyses were used to analyze the data . Established tools were used to assess caregiver depression , burden , overload , and physical health . Caregivers reported a drop in physical health scores from hospital discharge to 6 months after discharge ( p = 0.0001 ) . Caregivers of patients residing in an institution reported higher depression ( p = 0.039 ) and overload scores ( p = 0.002 ) than did caregivers of patients residing at home 6 months after discharge ; 51.2 % of caregivers at discharge and 36.4 % at 6 months after discharge reported symptoms consistent with some degree of depression . In addition , 12.2 % of caregivers at hospital discharge and 15.6 % at 6 months after discharge were classified as having symptoms consistent with severe depression . Caregiver physical health ( p = 0.025 ) and overload ( p = 0.006 ) made statistically significant contributions to explaining caregiver depression . CONCLUSIONS Caregivers of patients receiving LTV in our sample have similar characteristics to other caregiving population s. However , our sample had higher depression scores than those reported for many other caregiver groups OBJECTIVE Few studies have examined prospect ively and longitudinally depressive symptoms of family caregivers who provide care to colorectal cancer patients , and fewer have addressed ethnic minorities in this regard . This study investigated the relations of social support and caregiving stress with caregivers '  depressive symptoms during the first year since the relative 's diagnosis , as well as the role of ethnicity in such relations . METHODS Seventy-nine caregivers provided complete data at 2 months ( T1 ) , 6 months ( T2 ) , and 12 months ( T3 ) after their relative 's cancer diagnosis .  Demographics and caregiving experiences were measured at T1 . Depressive symptoms were assessed at T1 through T3 . RESULTS Greater caregiving stress and lack of social support were significant predictors of greater depressive symptoms . The adverse effect of caregiving stress was more pronounced among African American caregivers , whereas the beneficial effect of social support was more pronounced among White caregivers . CONCLUSIONS The findings highlight the importance of both caregiving stress and lack of social support early in caregivership . Findings also suggest that caregivers may benefit from programs tailored for their ethnicity OBJECTIVES Few studies have examined the effects of caregiving on the caregivers of chronically critically ill ( CCI ) patients , and no one has examined the impact of a disease management program ( DMP ) on physical and psychological outcomes for the caregivers of CCI patients . The purpose s of this study of caregivers of CCI patients were as follows : ( 1 ) to describe the characteristics of CCI patients and caregivers and to examine the frequency of depression , subjective burden , and physical health ; ( 2 ) to examine factors related to depression after hospital discharge ; and ( 3 ) to examine the effects of a DMP on the physical health , depression , and burden of caregivers 2 months post-hospital discharge . DESIGN Prospect i ve experimental design . SETTING AND PARTICIPANTS Caregivers of 290 patients who had received > 3 days of mechanical ventilation while in the ICU of a university medical center . MEASUREMENTS Sociodemographics , caregiver burden , physical health status , and depression were measured using established tools . RESULTS Interviews of caregivers were conducted at hospital discharge and 2 months later . Seventy-three percent of patients survived , completed the study period , and required caregiving 2 months later . Caregivers of patients residing in an institution reported higher depression ( p = 0.0001 ) , higher burden ( ie , disrupted schedule , p = 0.0001 ; lack of family support , p = 0.036 ) , and greater health problem scores ( p = 0.0001 ) than did caregivers of patients residing at home . The DMP did not have a statistically significant impact on any of the outcome variables . However , by 2 months , 54 % of caregivers in the experimental group had no depression or mild depression compared with 34.5 % of the control group . CONCLUSION Two months after hospital discharge , approximately 25 % of caregivers were classified as depressed with 16.7 % of the depressed group classified as moderately or severely depressed . The caregivers of CCI patients are at risk for post-hospital discharge depression , and the caregivers of institutionalized CCI patients are at highest risk of long-term negative effects from caregiving BACKGROUND The outcomes of  informal caregivers of survivors of critical illness likely depend on patient characteristics , which may change over time . To date , few studies have examined patient-specific predictors of post-ICU informal caregiver burden , and none has tested whether predictors vary after hospital discharge . METHODS We design ed a prospect i ve , longitudinal observational study , enrolling 48 patient-caregiver dyads from four ICUs in a university hospital . Informal caregiver depression symptoms were measured with the Center for Epidemiologic Studies Depression scale . Lifestyle disruption  was measured with the Activity Restriction Scale . Linear regression models were built to test for patient- and caregiver-specific predictors of depression symptoms and lifestyle disruption 2 , 6 , and 12 months after ICU admission . RESULTS Patients had a mean ( SD ) age of 52.5 ( 19.7 ) years , 67 % were men , median ( interquartile range ) Acute Physiology and Chronic Health Evaluation score was 52 ( 38.5 , 65 ) . The caregivers had a mean ( SD ) age of 52.8 ( 12.8 ) years , 91.2 % were women , and 48 % were spouses . Predictors of caregiver depression symptoms were patient gender ( men ) at 2 and 12 months and tracheostomy at 12 months . Predictors of lifestyle disruption were patient education ( more common among high school graduates ) and patient gender ( men ) at 2 months , and tracheostomy , functional dependency , and patient gender ( men ) at 12 months . CONCLUSIONS The determinants of post-ICU informal caregiver burden likely depend on characteristics of the patient as well as the caregiver and may vary over time . Further research is necessary to better underst and the longitudinal determinants of burden in order to develop more effective caregiver interventions OBJECTIVES ( 1 ) To estimate caregiver support required by patients 2 months after prolonged ( at least 48 h ) mechanical ventilation ( MV ) in an ICU ; ( 2 ) to describe caregiver burden , caregiver depressive symptomatology , and caregiver limitations in activities ; and ( 3 ) to investigate factors related to depressive symptoms at 2 months in caregivers . DESIGN Prospect i ve cohort study . STUDY PARTICIPANTS Caregivers of 115 patients who received prolonged MV in an ICU . MEASUREMENTS Sociodemographics , employment status , hours spent providing care , help from paid caregiving sources , caregiver burden , and caregiver depressive symptoms . RESULTS The proportion of patients who survived at least 2 months and required caregiver support was 74.8 % . The average age of caregivers was 52.9 years ( SD , 14.2 ) , 76.5 % were women , and more than half were spouses ( 52.2 % ) . Only 33 of the caregivers ( 28.7 % ) were working , and 30.3 % had to reduce their time spent at work to provide care to the patient . The prevalence of risk of clinical depression ( defined as Center for Epidemiological Studies depression scale [ CES-D ] score > or = 16 ) among caregivers was 33.9 % . The mean caregiver CES-D score was 13.2 ( SD , 11 ; median , 10 ) . Multiple linear regression analysis showed that higher CES-D score was associated with more hours per day helping with patients ' activities of daily living and instrumental activities of daily living ( p = 0.003 ) . CONCLUSIONS Two months after being placed on MV for at least 48 h , a high proportion of patients need caregiver support . Approximately 34 % of caregivers are at risk of clinical depression . Many caregivers report lifestyle changes and burden when providing care for the patients BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . PURPOSE The study aim ed to describe characteristics of  caregivers of chronically critically ill ( CCI ) patients , describe key outcomes ( depression , employment , physical health ) , and examine race as one of several predictors of post-hospital depressive symptoms . MATERIAL S AND METHODS This was a prospect i ve study of caregivers of hospital survivors of prolonged ( > 72 hours ) mechanical ventilation . Caregivers  were interviewed at admission to the intensive care unit ( ICU ) and 2 months post-discharge . RESULTS Patients discharged to an institution had a high risk of post-hospital mortality ( odds ratio , 8.61 ; P = .01 ) . Caregivers of patients residing in an institution 2 months post-discharge had greater odds of being depressed than caregivers of patients residing at home ( odds ratio , 2.75 ; P = .001 ) . Nonwhite caregivers of patients residing in an institution had the least improvement in depression over time . Predictors of depression 2 months post-discharge were depression during hospitalization ( P = .001 ) , sex ( P = .019 ) , health status ( P = .009 ) , and residence of the patient ( P = .001 ) , with no change based on race . Almost 50 % of employed caregivers had a reduction in paid work . There was a significant reduction in physical health status over time ( P = .001 ) with no difference based on race . CONCLUSIONS Caregivers of CCI patients are at risk for depression post-hospital discharge . Nonwhite caregivers of patients residing in an institution 2 months post-discharge are at highest risk for depression RATIONALE Although caregiver burden is well described in chronic illness , few studies have examined burden among caregivers of survivors of critical illness . In existing studies , it is unclear whether the observed burden is a consequence of critical illness or of preexisting patient illness . OBJECTIVES 
    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: In 3 studies , the authors investigated the functional role of psychological resilience and positive emotions in the stress process . Studies 1a and 1b explored naturally occurring daily stressors . Study 2 examined data from a sample of recently bereaved widows . Across studies , multilevel r and om coefficient modeling analyses revealed that the occurrence of daily positive emotions serves to moderate stress reactivity and mediate stress recovery . Findings also indicated that differences in psychological resilience accounted for meaningful variation in daily emotional responses to stress . Higher levels of trait resilience predicted a weaker association between positive and negative emotions , particularly on days characterized by heightened stress . Finally , findings indicated that over time , the experience of positive emotions functions to assist high-resilient individuals in their ability to recover effectively from daily stress . Implication s for research into protective factors that serve to inhibit the scope , severity , and diffusion of daily stressors in later adulthood are discussed STUDY OBJECTIVES The physical and psychological effects of caregiving have been examined in several population s. To date , no one has examined the effects of caregiving on caregivers of patients receiving long-term mechanical ventilation ( LTV ) [ patients who required > 4 days of continuous in-hospital mechanical ventilation ] who reside in a home or institutional setting after hospital discharge . The purpose of this study was to describe the characteristics and examine depression , burden , overload , and physical health in this caregiver population over a 6-month period after hospital discharge . DESIGN This was a prospect i ve longitudinal descriptive study of posthospital outcomes for patients receiving LTV and their caregivers . SETTING AND PARTICIPANTS Caregivers of 135 patients receiving LTV admitted to the ICUs of a university medical center , a Veterans Administration hospital , and small community hospital were enrolled . MEASUREMENTS AND RESULTS Interviews of caregivers were conducted at hospital discharge and 6 months later . Descriptive statistics , analysis of variance , and multiple regression analyses were used to analyze the data . Established tools were used to assess caregiver depression , burden , overload , and physical health . Caregivers reported a drop in physical health scores from hospital discharge to 6 months after discharge ( p = 0.0001 ) . Caregivers of patients residing in an institution reported higher depression ( p = 0.039 ) and overload scores ( p = 0.002 ) than did caregivers of patients residing at home 6 months after discharge ; 51.2 % of caregivers at discharge and 36.4 % at 6 months after discharge reported symptoms consistent with some degree of depression . In addition , 12.2 % of caregivers at hospital discharge and 15.6 % at 6 months after discharge were classified as having symptoms consistent with severe depression . Caregiver physical health ( p = 0.025 ) and overload ( p = 0.006 ) made statistically significant contributions to explaining caregiver depression . CONCLUSIONS Caregivers of patients receiving LTV in our sample have similar characteristics to other caregiving population s. However , our sample had higher depression scores than those reported for many other caregiver groups OBJECTIVE Few studies have examined prospect ively and longitudinally depressive symptoms of family caregivers who provide care to colorectal cancer patients , and fewer have addressed ethnic minorities in this regard . This study investigated the relations of social support and caregiving stress with caregivers '  depressive symptoms during the first year since the relative 's diagnosis , as well as the role of ethnicity in such relations . METHODS Seventy-nine caregivers provided complete data at 2 months ( T1 ) , 6 months ( T2 ) , and 12 months ( T3 ) after their relative 's cancer diagnosis .  Demographics and caregiving experiences were measured at T1 . Depressive symptoms were assessed at T1 through T3 . RESULTS Greater caregiving stress and lack of social support were significant predictors of greater depressive symptoms . The adverse effect of caregiving stress was more pronounced among African American caregivers , whereas the beneficial effect of social support was more pronounced among White caregivers . CONCLUSIONS The findings highlight the importance of both caregiving stress and lack of social support early in caregivership . Findings also suggest that caregivers may benefit from programs tailored for their ethnicity OBJECTIVES Few studies have examined the effects of caregiving on the caregivers of chronically critically ill ( CCI ) patients , and no one has examined the impact of a disease management program ( DMP ) on physical and psychological outcomes for the caregivers of CCI patients . The purpose s of this study of caregivers of CCI patients were as follows : ( 1 ) to describe the characteristics of CCI patients and caregivers and to examine the frequency of depression , subjective burden , and physical health ; ( 2 ) to examine factors related to depression after hospital discharge ; and ( 3 ) to examine the effects of a DMP on the physical health , depression , and burden of caregivers 2 months post-hospital discharge . DESIGN Prospect i ve experimental design . SETTING AND PARTICIPANTS Caregivers of 290 patients who had received > 3 days of mechanical ventilation while in the ICU of a university medical center . MEASUREMENTS Sociodemographics , caregiver burden , physical health status , and depression were measured using established tools . RESULTS Interviews of caregivers were conducted at hospital discharge and 2 months later . Seventy-three percent of patients survived , completed the study period , and required caregiving 2 months later . Caregivers of patients residing in an institution reported higher depression ( p = 0.0001 ) , higher burden ( ie , disrupted schedule , p = 0.0001 ; lack of family support , p = 0.036 ) , and greater health problem scores ( p = 0.0001 ) than did caregivers of patients residing at home . The DMP did not have a statistically significant impact on any of the outcome variables . However , by 2 months , 54 % of caregivers in the experimental group had no depression or mild depression compared with 34.5 % of the control group . CONCLUSION Two months after hospital discharge , approximately 25 % of caregivers were classified as depressed with 16.7 % of the depressed group classified as moderately or severely depressed . The caregivers of CCI patients are at risk for post-hospital discharge depression , and the caregivers of institutionalized CCI patients are at highest risk of long-term negative effects from caregiving BACKGROUND The outcomes of  informal caregivers of survivors of critical illness likely depend on patient characteristics , which may change over time . To date , few studies have examined patient-specific predictors of post-ICU informal caregiver burden , and none has tested whether predictors vary after hospital discharge . METHODS We design ed a prospect i ve , longitudinal observational study , enrolling 48 patient-caregiver dyads from four ICUs in a university hospital . Informal caregiver depression symptoms were measured with the Center for Epidemiologic Studies Depression scale . Lifestyle disruption  was measured with the Activity Restriction Scale . Linear regression models were built to test for patient- and caregiver-specific predictors of depression symptoms and lifestyle disruption 2 , 6 , and 12 months after ICU admission . RESULTS Patients had a mean ( SD ) age of 52.5 ( 19.7 ) years , 67 % were men , median ( interquartile range ) Acute Physiology and Chronic Health Evaluation score was 52 ( 38.5 , 65 ) . The caregivers had a mean ( SD ) age of 52.8 ( 12.8 ) years , 91.2 % were women , and 48 % were spouses . Predictors of caregiver depression symptoms were patient gender ( men ) at 2 and 12 months and tracheostomy at 12 months . Predictors of lifestyle disruption were patient education ( more common among high school graduates ) and patient gender ( men ) at 2 months , and tracheostomy , functional dependency , and patient gender ( men ) at 12 months . CONCLUSIONS The determinants of post-ICU informal caregiver burden likely depend on characteristics of the patient as well as the caregiver and may vary over time . Further research is necessary to better underst and the longitudinal determinants of burden in order to develop more effective caregiver interventions OBJECTIVES ( 1 ) To estimate caregiver support required by patients 2 months after prolonged ( at least 48 h ) mechanical ventilation ( MV ) in an ICU ; ( 2 ) to describe caregiver burden , caregiver depressive symptomatology , and caregiver limitations in activities ; and ( 3 ) to investigate factors related to depressive symptoms at 2 months in caregivers . DESIGN Prospect i ve cohort study . STUDY PARTICIPANTS Caregivers of 115 patients who received prolonged MV in an ICU . MEASUREMENTS Sociodemographics , employment status , hours spent providing care , help from paid caregiving sources , caregiver burden , and caregiver depressive symptoms . RESULTS The proportion of patients who survived at least 2 months and required caregiver support was 74.8 % . The average age of caregivers was 52.9 years ( SD , 14.2 ) , 76.5 % were women , and more than half were spouses ( 52.2 % ) . Only 33 of the caregivers ( 28.7 % ) were working , and 30.3 % had to reduce their time spent at work to provide care to the patient . The prevalence of risk of clinical depression ( defined as Center for Epidemiological Studies depression scale [ CES-D ] score > or = 16 ) among caregivers was 33.9 % . The mean caregiver CES-D score was 13.2 ( SD , 11 ; median , 10 ) . Multiple linear regression analysis showed that higher CES-D score was associated with more hours per day helping with patients ' activities of daily living and instrumental activities of daily living ( p = 0.003 ) . CONCLUSIONS Two months after being placed on MV for at least 48 h , a high proportion of patients need caregiver support . Approximately 34 % of caregivers are at risk of clinical depression . Many caregivers report lifestyle changes and burden when providing care for the patients BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . PURPOSE The study aim ed to describe characteristics of  caregivers of chronically critically ill ( CCI ) patients , describe key outcomes ( depression , employment , physical health ) , and examine race as one of several predictors of post-hospital depressive symptoms . MATERIAL S AND METHODS This was a prospect i ve study of caregivers of hospital survivors of prolonged ( > 72 hours ) mechanical ventilation . Caregivers  were interviewed at admission to the intensive care unit ( ICU ) and 2 months post-discharge . RESULTS Patients discharged to an institution had a high risk of post-hospital mortality ( odds ratio , 8.61 ; P = .01 ) . Caregivers of patients residing in an institution 2 months post-discharge had greater odds of being depressed than caregivers of patients residing at home ( odds ratio , 2.75 ; P = .001 ) . Nonwhite caregivers of patients residing in an institution had the least improvement in depression over time . Predictors of depression 2 months post-discharge were depression during hospitalization ( P = .001 ) , sex ( P = .019 ) , health status ( P = .009 ) , and residence of the patient ( P = .001 ) , with no change based on race . Almost 50 % of employed caregivers had a reduction in paid work . There was a significant reduction in physical health status over time ( P = .001 ) with no difference based on race . CONCLUSIONS Caregivers of CCI patients are at risk for depression post-hospital discharge . Nonwhite caregivers of patients residing in an institution 2 months post-discharge are at highest risk for depression RATIONALE Although caregiver burden is well described in chronic illness , few studies have examined burden among caregivers of survivors of critical illness . In existing studies , it is unclear whether the observed burden is a consequence of critical illness or of preexisting patient illness . OBJECTIVES 
    Output:
    