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: PURPOSE We assess the effects of racial or ethnic concordance between caregivers and interventionists on  caregiver attrition , change in depression , and change in burden in a multisite r and omized clinical trial . DESIGN AND METHODS Family caregivers of patients with Alzheimer 's disease were r and omized to intervention or control groups at six sites from 1996 to 2000 . Interventionists provided psychosocial interventions aim ed at decreasing caregiver depression and burden . This analysis included 694 caregivers who received face-to-face interventions from 36 interventionists at five sites . We modeled caregiver loss to follow-up at 12 months and changes in depression and burden from baseline by racial or ethnic concordance by using r and om effects logistic and linear regression models , controlling for caregiver age , gender , race or ethnicity , relation to care recipient , interventionist race or ethnicity , and care recipient activities of daily living . The loss to follow-up model also controlled for care recipient institutionalization and death . RESULTS Overall , there was no difference in caregiver loss to follow-up or change in depression or burden by racial or ethnic concordance . African-American caregivers with an interventionist of the same race or ethnicity had greater decreases in depression than did African-American caregivers with interventionists of a different race or ethnicity . However , this finding has to be interpreted cautiously because there were only two African-American interventionists . IMPLICATION S Although these initial findings do not provide conclusive evidence on whether racial or ethnic concordance is associated with intervention outcomes for caregivers of Alzheimer 's disease patients , these results , along with the paucity of research studies evaluating this issue , suggest that the effects of racial or ethnic concordance in research should be systematic ally examined in future studies Project ACT is a r and omized controlled trial design ed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia ( BPSD ) and caregiver distress . The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances . All participants are interviewed at baseline , 4-months ( main trial endpoint ) , and 6-months ( maintenance ) . The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers ( communication style , environmental clutter ) contributing to behaviors , and instruct in strategies to reduce caregiver stress and manage targeted behaviors . To rule out infection or other potential medical contributors to behaviors , a nurse obtains blood and urine sample s from the dementia patient , and conducts a medication review . Participants in the no-treatment control group are offered the nurse arm and one in-home session following trial completion at 6-months . This paper describes the research methods , theoretical and clinical aspects of this multi-component , targeted psycho-social treatment approach , and the measures used to evaluate quality of life improvements for persons with dementia and their families 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 OBJECTIVES To examine the relationships between changes from baseline to post-Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) intervention in caregiver ( CG ) self-reported health , burden , and bother . DESIGN R and omized , multisite clinical trial . SETTING CG and care recipient ( CR ) homes in five U.S. cities . PARTICIPANTS Four hundred ninety-five dementia CG and CR dyads ( 169 Hispanic , 160 white , and 166 African American ) receiving intervention and their controls . INTERVENTION CGs were assigned to the REACH intervention or a no-treatment control group . Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months . Control subjects received two brief " check-in " telephone calls during this 6-month period . MEASUREMENTS The primary outcome was change in CG health status from baseline to after the intervention . Secondary outcomes were CG burden and bother after the intervention . RESULTS After the intervention , CGs reported better self-rated health , sleep quality , physical health , and emotional health , which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention . Changes in depression appeared to mediate these relationships . Several racial and ethnic group differences existed in physical and emotional health , as well as in total frustration with caregiving , emotional burden , and CG-rated bother with CR 's activities of daily living and instrumental activities of daily living at baseline and at follow-up , although differences between baseline and posttest did not vary according to race . CONCLUSION A structured , multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas , improved self-reported health status , and decreased burden and bother in racially and ethnically diverse CGs of people with dementia CONTEXT Optimal treatment to postpone functional decline in patients with dementia is not established . OBJECTIVE To test a nonpharmacologic intervention realigning environmental dem and s with patient capabilities . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve 2-group r and omized trial ( Care of Persons with Dementia in their Environments [ COPE ] ) involving patients with dementia and family caregivers ( community-living dyads ) recruited from March 2006 through June 2008 in Pennsylvania . INTERVENTIONS Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits ; obtained blood and urine sample s ; and trained families in home safety , simplifying tasks , and stress reduction . Control group caregivers received 3 telephone calls and educational material s. MAIN OUTCOME MEASURES Functional dependence , quality of life , frequency of agitated behaviors , and engagement for patients and well-being , confidence using activities , and perceived benefits for caregivers at 4 months . RESULTS Of 284 dyads screened , 270 ( 95 % ) were eligible and 237 ( 88 % ) r and omized . Data were collected from 209 dyads ( 88 % ) at 4 months and 173 ( 73 % ) at 9 months . At 4 months , compared with controls , COPE patients had less functional dependence ( adjusted mean difference , 0.24 ; 95 % CI , 0.03 - 0.44 ; P = .02 ; Cohen d = 0.21 ) and less dependence in instrumental activities of daily living ( adjusted mean difference , 0.32 ; 95 % CI , 0.09 - 0.55 ; P = .007 ; Cohen d = 0.43 ) , measured by a 15-item scale modeled after the Functional Independence Measure ; COPE patients also had improved engagement ( adjusted mean difference , 0.12 ; 95 % CI , 0.07 - 0.22 ; P = .03 ; Cohen d = 0.26 ) , measured by a 5-item scale . COPE caregivers improved in their well-being ( adjusted mean difference in Perceived Change Index , 0.22 ; 95 % CI , 0.08 - 0.36 ; P = .002 ; Cohen d = 0.30 ) and confidence using activities ( adjusted mean difference , 0.81 ; 95 % CI , 0.30 - 1.32 ; P = .002 ; Cohen d = 0.54 ) , measured by a 5-item scale . By 4 months , 64 COPE dyads ( 62.7 % ) vs 48 control group dyads ( 44.9 % ) eliminated 1 or more caregiver-identified problems ( chi(2/1 ) = 6.72 , P = . 01 ) . CONCLUSION Among community-living dyads , a nonpharmacologic biobehavioral environmental intervention compared with control result ed in better outcomes for COPE dyads at 4 months . Although no group differences were observed at 9 months for patients , COPE caregivers perceived greater benefits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00259454 ABSTRACT Objectives : Evaluation of long-term effects of an individualized short-term telephone intervention ( seven sessions ) , based on a comprehensive cognitive behavioral therapy ( CBT ) approach . The study goal was to evaluate the maintenance of intervention effects regarding well-being , quality of life , and health at two years post treatment . Method : Participants ( n = 105 ) were ( partly ) r and omized after baseline assessment in a two-arm study ( intervention , control group/usual care ) .  Depressive symptoms were assessed with the German version of the Center for Epidemiologic Studies Depression Scale ( CES-D ) . Caregivers ’ physical complaints were measured with the Gießener Beschwerdebogen ( GBB-24 ) , and quality of life with the World Health Organization quality of life -BREF ( WHOQOL-BREF ) . Emotional well-being and perceived health status were assessed using thermometer scaling . Data were analyzed by intention-to-treat analyses , including for those who terminated the intervention prematurely but still delivered data , using ANCOVAs . Results : Long-term intervention effects were found for emotional well-being ( p = 0.019 ) . For the subgroup of caregivers who were still caring at home at follow-up , the intervention led to an increased health status ( p = 0.023 ) , fewer bodily complaints ( global measure p= 0.014 , rheumatic pain p = 0.027 , heart trouble p = 0.042 ) , and a higher quality of life ( overall p = 0.044 and subscale environment p = 0.030 ) . Conclusion : The short-term CBT intervention via telephone showed long-term effects two years after treatment on emotional well-being , health status , bodily complaints , and quality of life PURPOSE OF STUDY The authors determined short-term effects of a home environmental intervention on self-efficacy and upset in caregivers and daily function of dementia patients . They also determined if treatment effect varied by caregiver gender , race , and relationship to patient . DESIGN AND METHODS Families ( N = 171 ) of dementia patients were r and omized to intervention or usual care control group .  The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications . RESULTS Compared with controls , intervention caregivers reported fewer declines in patients ' instrumental activities of daily living ( p = .030 ) and less decline in self-care and fewer behavior problems in patients at 3 months post-test . Also , intervention spouses reported reduced upset ( p = .049 ) , women reported enhanced self-efficacy in managing behaviors ( p = .038 ) , and women ( p = .049 ) and minorities ( p = .037 ) reported enhanced self-efficacy in managing functional dependency . IMPLICATION S The environmental program appears to have a modest effect on dementia patients ' IADL dependence . Also , among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving The goal of this study was to evaluate a community-based psychoeducational-nursing intervention design ed to teach home caregivers  to manage behavioral problems of persons with Alzheimer 's disease and related dementias ( ADRD ) using the Progressively Lowered Stress Threshold ( PLST ) model , and to compare this intervention with routine information and referrals for case management , community-based services , and support groups . Previous caregiver studies have overwhelmingly pointed to the adverse effects of caregiving on the caregivers ' physical and mental health , and high prevalence rates of depression among caregivers of persons with ADRD have consistently been reported . Therefore , a primary aim was to evaluate the impact of the intervention on caregivers ' affect 
    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: PURPOSE We assess the effects of racial or ethnic concordance between caregivers and interventionists on  caregiver attrition , change in depression , and change in burden in a multisite r and omized clinical trial . DESIGN AND METHODS Family caregivers of patients with Alzheimer 's disease were r and omized to intervention or control groups at six sites from 1996 to 2000 . Interventionists provided psychosocial interventions aim ed at decreasing caregiver depression and burden . This analysis included 694 caregivers who received face-to-face interventions from 36 interventionists at five sites . We modeled caregiver loss to follow-up at 12 months and changes in depression and burden from baseline by racial or ethnic concordance by using r and om effects logistic and linear regression models , controlling for caregiver age , gender , race or ethnicity , relation to care recipient , interventionist race or ethnicity , and care recipient activities of daily living . The loss to follow-up model also controlled for care recipient institutionalization and death . RESULTS Overall , there was no difference in caregiver loss to follow-up or change in depression or burden by racial or ethnic concordance . African-American caregivers with an interventionist of the same race or ethnicity had greater decreases in depression than did African-American caregivers with interventionists of a different race or ethnicity . However , this finding has to be interpreted cautiously because there were only two African-American interventionists . IMPLICATION S Although these initial findings do not provide conclusive evidence on whether racial or ethnic concordance is associated with intervention outcomes for caregivers of Alzheimer 's disease patients , these results , along with the paucity of research studies evaluating this issue , suggest that the effects of racial or ethnic concordance in research should be systematic ally examined in future studies Project ACT is a r and omized controlled trial design ed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia ( BPSD ) and caregiver distress . The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances . All participants are interviewed at baseline , 4-months ( main trial endpoint ) , and 6-months ( maintenance ) . The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers ( communication style , environmental clutter ) contributing to behaviors , and instruct in strategies to reduce caregiver stress and manage targeted behaviors . To rule out infection or other potential medical contributors to behaviors , a nurse obtains blood and urine sample s from the dementia patient , and conducts a medication review . Participants in the no-treatment control group are offered the nurse arm and one in-home session following trial completion at 6-months . This paper describes the research methods , theoretical and clinical aspects of this multi-component , targeted psycho-social treatment approach , and the measures used to evaluate quality of life improvements for persons with dementia and their families 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 OBJECTIVES To examine the relationships between changes from baseline to post-Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) intervention in caregiver ( CG ) self-reported health , burden , and bother . DESIGN R and omized , multisite clinical trial . SETTING CG and care recipient ( CR ) homes in five U.S. cities . PARTICIPANTS Four hundred ninety-five dementia CG and CR dyads ( 169 Hispanic , 160 white , and 166 African American ) receiving intervention and their controls . INTERVENTION CGs were assigned to the REACH intervention or a no-treatment control group . Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months . Control subjects received two brief " check-in " telephone calls during this 6-month period . MEASUREMENTS The primary outcome was change in CG health status from baseline to after the intervention . Secondary outcomes were CG burden and bother after the intervention . RESULTS After the intervention , CGs reported better self-rated health , sleep quality , physical health , and emotional health , which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention . Changes in depression appeared to mediate these relationships . Several racial and ethnic group differences existed in physical and emotional health , as well as in total frustration with caregiving , emotional burden , and CG-rated bother with CR 's activities of daily living and instrumental activities of daily living at baseline and at follow-up , although differences between baseline and posttest did not vary according to race . CONCLUSION A structured , multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas , improved self-reported health status , and decreased burden and bother in racially and ethnically diverse CGs of people with dementia CONTEXT Optimal treatment to postpone functional decline in patients with dementia is not established . OBJECTIVE To test a nonpharmacologic intervention realigning environmental dem and s with patient capabilities . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve 2-group r and omized trial ( Care of Persons with Dementia in their Environments [ COPE ] ) involving patients with dementia and family caregivers ( community-living dyads ) recruited from March 2006 through June 2008 in Pennsylvania . INTERVENTIONS Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits ; obtained blood and urine sample s ; and trained families in home safety , simplifying tasks , and stress reduction . Control group caregivers received 3 telephone calls and educational material s. MAIN OUTCOME MEASURES Functional dependence , quality of life , frequency of agitated behaviors , and engagement for patients and well-being , confidence using activities , and perceived benefits for caregivers at 4 months . RESULTS Of 284 dyads screened , 270 ( 95 % ) were eligible and 237 ( 88 % ) r and omized . Data were collected from 209 dyads ( 88 % ) at 4 months and 173 ( 73 % ) at 9 months . At 4 months , compared with controls , COPE patients had less functional dependence ( adjusted mean difference , 0.24 ; 95 % CI , 0.03 - 0.44 ; P = .02 ; Cohen d = 0.21 ) and less dependence in instrumental activities of daily living ( adjusted mean difference , 0.32 ; 95 % CI , 0.09 - 0.55 ; P = .007 ; Cohen d = 0.43 ) , measured by a 15-item scale modeled after the Functional Independence Measure ; COPE patients also had improved engagement ( adjusted mean difference , 0.12 ; 95 % CI , 0.07 - 0.22 ; P = .03 ; Cohen d = 0.26 ) , measured by a 5-item scale . COPE caregivers improved in their well-being ( adjusted mean difference in Perceived Change Index , 0.22 ; 95 % CI , 0.08 - 0.36 ; P = .002 ; Cohen d = 0.30 ) and confidence using activities ( adjusted mean difference , 0.81 ; 95 % CI , 0.30 - 1.32 ; P = .002 ; Cohen d = 0.54 ) , measured by a 5-item scale . By 4 months , 64 COPE dyads ( 62.7 % ) vs 48 control group dyads ( 44.9 % ) eliminated 1 or more caregiver-identified problems ( chi(2/1 ) = 6.72 , P = . 01 ) . CONCLUSION Among community-living dyads , a nonpharmacologic biobehavioral environmental intervention compared with control result ed in better outcomes for COPE dyads at 4 months . Although no group differences were observed at 9 months for patients , COPE caregivers perceived greater benefits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00259454 ABSTRACT Objectives : Evaluation of long-term effects of an individualized short-term telephone intervention ( seven sessions ) , based on a comprehensive cognitive behavioral therapy ( CBT ) approach . The study goal was to evaluate the maintenance of intervention effects regarding well-being , quality of life , and health at two years post treatment . Method : Participants ( n = 105 ) were ( partly ) r and omized after baseline assessment in a two-arm study ( intervention , control group/usual care ) .  Depressive symptoms were assessed with the German version of the Center for Epidemiologic Studies Depression Scale ( CES-D ) . Caregivers ’ physical complaints were measured with the Gießener Beschwerdebogen ( GBB-24 ) , and quality of life with the World Health Organization quality of life -BREF ( WHOQOL-BREF ) . Emotional well-being and perceived health status were assessed using thermometer scaling . Data were analyzed by intention-to-treat analyses , including for those who terminated the intervention prematurely but still delivered data , using ANCOVAs . Results : Long-term intervention effects were found for emotional well-being ( p = 0.019 ) . For the subgroup of caregivers who were still caring at home at follow-up , the intervention led to an increased health status ( p = 0.023 ) , fewer bodily complaints ( global measure p= 0.014 , rheumatic pain p = 0.027 , heart trouble p = 0.042 ) , and a higher quality of life ( overall p = 0.044 and subscale environment p = 0.030 ) . Conclusion : The short-term CBT intervention via telephone showed long-term effects two years after treatment on emotional well-being , health status , bodily complaints , and quality of life PURPOSE OF STUDY The authors determined short-term effects of a home environmental intervention on self-efficacy and upset in caregivers and daily function of dementia patients . They also determined if treatment effect varied by caregiver gender , race , and relationship to patient . DESIGN AND METHODS Families ( N = 171 ) of dementia patients were r and omized to intervention or usual care control group .  The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications . RESULTS Compared with controls , intervention caregivers reported fewer declines in patients ' instrumental activities of daily living ( p = .030 ) and less decline in self-care and fewer behavior problems in patients at 3 months post-test . Also , intervention spouses reported reduced upset ( p = .049 ) , women reported enhanced self-efficacy in managing behaviors ( p = .038 ) , and women ( p = .049 ) and minorities ( p = .037 ) reported enhanced self-efficacy in managing functional dependency . IMPLICATION S The environmental program appears to have a modest effect on dementia patients ' IADL dependence . Also , among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving The goal of this study was to evaluate a community-based psychoeducational-nursing intervention design ed to teach home caregivers  to manage behavioral problems of persons with Alzheimer 's disease and related dementias ( ADRD ) using the Progressively Lowered Stress Threshold ( PLST ) model , and to compare this intervention with routine information and referrals for case management , community-based services , and support groups . Previous caregiver studies have overwhelmingly pointed to the adverse effects of caregiving on the caregivers ' physical and mental health , and high prevalence rates of depression among caregivers of persons with ADRD have consistently been reported . Therefore , a primary aim was to evaluate the impact of the intervention on caregivers ' affect 
    Output:
    