***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 Sustained employability and health are generating awareness of employers in an aging and more complex work force . To meet these needs , employers may offer their employees health surveillance programs , to increase opportunities to work on health and sustained employability . However , evidence for these health surveillance programs is lacking . The FLESH study ( Functional Labour Evaluation for Sustained Health and employment ) was developed to evaluate a comprehensive workers ’ health promotion program on its effectiveness , cost-benefit , and process of the intervention . Methods The study is design ed as a cluster r and omised stepped wedge trial with r and omisation at company plant level and is carried out in a large meat processing company . Every contracted employee is offered the opportunity to participate in the POSE program ( Promotion Of Sustained Employability ) . The main goals of the POSE program are 1 ) providing employee ’s insight into their current employability and health status , 2 ) offering opportunities to improve employability and decrease health risks and 3 ) improving employability and health sustainably in order to keep them healthy at work . The program consists of a broad assessment followed by a counselling session and , if needed , a tailored intervention . Measurements will be performed at baseline and will be followed up at 20 , 40 , 60 , 80 , 106 and 132 weeks . The primary outcome measures are work ability , productivity and absenteeism . Secondary outcomes include health status , vitality , and psychosocial workload . A cost-benefit study will be conducted from the employers ’ perspective . A process evaluation will be conducted and the satisfaction of employer and employees with the program will be assessed . Discussion This study provides information on the effectiveness of the POSE program on sustained employment . When the program proves to be effective , employees benefit by improved work ability , and health . Employers benefit from healthier employees , reduced sick leave ( costs ) and higher productivity . The study can expose key elements for a successful implementation and execution of the POSE program and may serve as an example to other companies inside and outside the industry . Trial registration The trial is registered at the Dutch Trial Register ( http://www.trialregister.nl ) : The study presented is a r and omized , controlled intervention study with the purpose of implementing an evidence ‐based skin disease prevention programme . The hypothesis explored in this article is whether a high‐fat petrolatum‐based moisturizer can be an alternative to protective gloves in wet‐work occupations . The study population was all gut cleaners in Danish swine slaughterhouses , and data were collected by telephone interviews using a st and ardized question naire – The Nordic Occupational Skin Question naire ( NOSQ‐2002 ) . At baseline , 644 ( 88 % ) gut cleaners responded and at 1‐year follow‐up 622 ( 72 % ) . 135 gut cleaners in the intervention and 277 in the comparison group responded at both telephone interviews . In the intervention group , the eczema frequency was reduced significantly . Detailed analyses revealed that protective gloves are the overall most effective protective means and did not indicate that a high‐fat moisturizer could be an alternative . Furthermore , the most extensive improvements could not be explained by combinations of protective behaviour but was found among those who had received information on , and was having discussion s on prevention of skin problems . This only applied to the intervention group . A continuous focus on prevention of skin problems with information and discussion s on the shop floor therefore seemed to be most important for reducing skin problems Objectives : The objective of the present implementation study is to document how an intervention to reduce work-related skin problems by means of implementing an evidence -based skin protection programme in six gut-cleaning departments in swine slaughterhouses was understood , accepted and carried out . The association between the degree of implementation and the reduction of work-related skin problems in each department is examined . The intervention included a top-down strategy with establishment of a management system focusing on skin risks and a bottom-up strategy with participation of a selected group of shop floor workers and the safety representative , as change agents , as well as an empowerment-based educational programme , where the middle management and representatives from the top management also participated . Methods : The study design was a r and omized controlled intervention study with a 1-year study period . The outcome of the intervention was evaluated by telephone interviews . Data on the implementation process consisted of self-administered question naires , focus interviews and compiled written material s. Four indexes referring to the management system and the change agents ’ intervention activities were constructed . Finally , the Pearson correlation coefficient was used to test the correlation between the degree of implementation and the eczema frequency at 1-year follow-up . Results : There was a statistically significant association ( p < 0.05 ) between both the index for the combined implementation method and the eczema frequency after 1 year of intervention , and between the activities of the change agents and the eczema frequency . In contrast to this there was only a weak association between the establishment of a formal management system alone and the outcome . Conclusion : The study evidence s that a combination of a top-down and a bottom-up implementation method is effective to reduce work-related skin problems  , and that the process of implementation is a significant determinant of the overall results This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence A novel procedure is described to establish knife steeling schedules for poultry and meat- processing operations based on increased force due to knife dullness from repetitive use to minimize operator exertions and physical stress associated with work-related musculoskeletal disorders . Knife dullness was quantified using a novel apparatus described in this article that measures the area cut by a knife into a carrageenan gel target for a controlled dynamic load at the knife h and le . Two meat-cleaning jobs in a poultry-processing plant were studied . One job required significantly more force and a greater number of cuts than the other . Eight experienced operators participated in the study .  Four freshly ground and honed knives were r and omly used by each operator for 4 , 45 , 75 , or 125 cutting cycles , measured for dullness and reconditioned by the operator using a steel sharpening rod . An empirical model for knife dulling and reconditioning was developed , and the corresponding increase in force was predicted for various cutting and reconditioning frequencies . The model showed that it took 57 and 125 cutting cycles for the high- and low-force jobs , respectively , to achieve a similar reduction in target surface area of 30 % . This reduction in target surface area corresponded to a similar percentage increase in force needed for the same cut in carrageenan gel as compared to a freshly honed knife as measured using strain gages . This method may be used in meat processing plants for determining effective reconditioning schedules that reduce operator exertions with minimum effect on quality and productivity Aims : To evaluate the effect of an intervention to reduce work related skin problems in gut cleaning departments in Danish swine slaughterhouses . The intervention consisted of an evidence based prevention programme and a documented method for implementation . Methods : R and omised controlled intervention study with a one year follow up . The intervention included educational activities and evidence based recommendations . The effect of the intervention was evaluated by telephone interviews using a st and ardised question naire based on the Nordic Occupational Skin Question naire ( NOSQ-2002 ) with modified and additional questions on exposure , preventive measures , information , and discussion s on prevention of skin problems , etc . Results : A total of 644 ( 87.5 % ) responded at the baseline interview and 622 ( 71.6 % ) at the one year follow up interview . A total of 495 participated in both interviews ( 67.3 % ) . In the intervention departments the frequency of eczema on h and s or forearms within the past three months at follow up was reduced significantly from 56.2 % at baseline to 41.0 % at follow up , while a slight non-significant increase was observed in the comparison departments ( from 45.9 % to 50.2 % ) . The intervention activities result ed in more frequent use of protective gloves in general and the use of cotton gloves worn underneath rubber and plastic gloves . At follow up three times as many in the intervention departments used the recommended high fat skin care products introduced as part of the intervention activities . At follow up , discussion of skin problems was increased in the intervention group while no changes were observed in the comparison group . Conclusions : A significant 27 % relative reduction of occupational eczema in a high risk group was feasible through implementation of an evidence based prevention programme A limited , r and omized , blind , placebo-controlled trial of Q fever and influenza vaccines has been conducted in three Queensl and abattoirs on a sequential analysis design . Ninety-eight subjects were given Q fever vaccine and 102 influenza vaccine .  Q fever cases were observed in unvaccinated workers in all three abattoirs during the period of observation . A total of seven Q fever cases in one group , one more than the number required to achieve statistical significance between the two vaccine groups , was reached after 15 months with the cases coming from two of the abattoirs . These Q fever cases were in the group which had been given influenza vaccine and none in that given Q fever vaccine .  Symptomless seroconversion rates of 24 % were found in the remaining influenza virus vaccinees , and those without immunity were given Q fever vaccine OBJECTIVES A program called the Project on Research and Intervention in Monotonous Work ( PRIM ) was initiated in 1994 as a prospect i ve cohort study of work-related musculoskeletal disorders . The group-based exposure assessment strategy , focusing on task-related exposure and used to obtain baseline measures of physical exposures , is reported in this paper . METHODS Monotonous , repetitive worktasks were evaluated at 19 factories . Tasks with an estimated similarity in physical exposure were aggregated before 103 exposure groups were formed . Subjects from the exposure groups were r and omly sample d for measurements , and task-related exposure levels were quantified by 43 single exposure items using a real-time video-based observation method that allowed computerized estimates of repetitiveness , body postures , force , and velocity . In combination with question naire-based data on task distribution , the duration of exposure was calculated at the individual level . RESULTS The video-based observational method and the large number of exposure variables enabled the establishment of detailed quantitative exposure profiles in 103 task-based exposure groups . However , method ological problems associated with the use of grouped exposure assessment were revealed . Despite efforts to optimize group homogeneity , the within-group variance was larger than the between-group variance for several shoulder postural variables . CONCLUSIONS A task-based exposure- assessment strategy can be successful in solving some of the main problems associated with the assessment of physical workplace exposures . The large within-group variance in exposure to nonneutral shoulder postures may eventually require individual assessment or the inclusion of groups with maximal contrast in exposure or both 
    Output:
    
There was limited evidence for added rest breaks result ing in improved productivity at the end of a workday and in reductions of perceived discomfort in various body regions at the end of the workday .
Conclusion This review presents evidence for the effectiveness of a variety of workplace interventions .
There was limited evidence for effectiveness of ergonomic interventions , moderate evidence of a skin protection intervention , and strong evidence for Q fever vaccination