***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 : Plasma prolactin levels are sensitive to dopamine and serotonin function , and fatigue . Low cortisol , dopamine and /or serotonin may be involved in burnout and detachment . Methods : In this double-blind within-subject study , we treated 9 female burnout subjects and 9 controls with 35 mg cortisol and placebo orally . We measured state affect and plasma prolactin , oxytocin , cortisol and adrenocorticotropic hormone levels , and administered an attachment question naire . Results : The burnout subjects displayed an extreme distribution of basal prolactin levels , displaying higher or lower levels compared to the controls . The low prolactin burnouts had profoundly low attachment scores and tended to have low oxytocin levels . The high prolactin burnout subjects tended to show cortisol-induced decreased prolactin and fatigue , and increased vigor . Conclusion : Results are consistent with the hypothesis that burnout subjects are either characterized by low serotonergic function or by low dopaminergic function , and that the latter group benefits from cortisol replacement . These preliminary results suggest that differentiating between two syndromes may resolve inconsistencies in research on burnout , and be necessary for selecting the right treatment strategy Burnout is presumed to be the result of chronic stress , and chronic stress is known to affect the HPA-axis . To date , studies on HPA-axis functioning in burnout have showed inconsistent results . In the present study , a large sample ( n=74 ) of clinical ly diagnosed burnout individuals , mostly on sick-leave , were included and compared with 35 healthy controls .  Salivary cortisol  was sample d on 2 days to determine the cortisol awakening response ( CAR ) and the day-curve . In addition , the dexamethasone suppression test ( DST ) was applied to assess the feedback efficacy of the HPA-axis . There were no differences observed in the CAR , day-curve or CAR after DST in the burnout group as compared to a healthy control group . Burnout shows overlap in symptoms with chronic fatigue syndrome ( CFS ) and depression . Therefore , differential changes in HPA-axis functioning that resemble the hypo-functioning of the HPA-axis in CFS , or rather the hyper-functioning of the HPA-axis in depression , might have obscured the findings . However , no effect of fatigue or depressive mood on HPA-axis functioning was found in the burnout group . We concluded that HPA-axis functioning in clinical ly diagnosed burnout participants as tested in the present study , seems to be normal The authors prospect ively tested the hypothesis that obesity predicts burnout and the reverse-causation hypothesis that burnout predicts obesity . Respondents were 724 men and 340 women , apparently healthy employees , who underwent routine periodic health examinations at 2 points of time about 18 months apart . Obesity was assessed by body mass index , waist-hip ratio , and waist circumference . In regression analyses , done separately for men and women , the authors controlled for depressive symptomatology , sport activity , and Time 1 levels of the criterion . The hypothesis that burnout predicts obesity was not supported . The authors found that  Time 1 measures of obesity  predicted reductions rather than the hypothesized elevations of Time 2 burnout levels . The authors also found that for male respondents with relatively higher levels of Time 1 burnout , the higher their level of Time 1 obesity measure , the lower their level of T2 burnout The author ’ goal was to document baseline pituitaryadrenal hormonal and related metabolic variables in 16 female patients with burnout . Then , following stress management intervention , to compare the changes with an equal number of untreated control subjects . At monthly intervals for 4 mo , 24-h urine sample s were obtained for determination of free cortisol excretion . In addition , fasting blood sample s were analyzed for levels of cortisol , dehydroepi and rosterone sulfate ( DHEAS ) , ACTH , aldosterone , and catecholamines . Other biochemical measurements included growth hormone , prolactin , insulin , glucose , and lipid components . The Maslach Burnout Inventory , General Health Question naire-28 , and Zung depression rating scale  were completed on each consecutive visit . The most striking finding was the reduction of urine free-cortisol excretion in the patients compared with controls . Initial urinary free cortisol was significantly lower in the patients ( mean ± SEM=47.2 ± 11.0 vs 79.0 ± 6.8 nmol/L , P=0.02 ) and remained significantly reduced at 4 mo ( mean ± SEM=44.0 ± 6.1 vs 91.1 ± 8.8 nmol/L , p=0.0001 ) . There were no significant changes in the other hormonal and biochemical data . We conclude that there is functional hypocortisolism in burnout , which is not immediately restored on stress management intervention despite clinical and psychological improvement Several studies have investigated the association between  burnout  and HPA-axis functioning , but the results are far from consistent . This does not preclude the possibility that within a group of burnout patients a recovery of symptoms in a longitudinal course corresponds to ( changes in ) cortisol parameters . The latter possibility is tested in the present study before and after treatment , and at follow-up . HPA-axis functioning and burnout complaints were assessed in burned-out participants at baseline ( n=74 ) , post-treatment ( n=62 ) and at follow-up ( n=53 ) .  Multilevel regression analysis was used to test the hypothesis . Burnout complaints were significantly reduced at 8.5 months post-treatment , but there was no further reduction in complaints at follow-up 6.3 months later . Cortisol after awakening , and after dexamethasone intake showed no changes from baseline to post-treatment and follow-up . There was a small decline in cortisol during the day over the longitudinal course . The cortisol level after awakening in the longitudinal course showed significant positive association with the initial exhaustion level , a negative association with the change in the burnout exhaustion score , and a positive association with the change in depression . Although these associations are statistically significant , they only explain a small fraction of the variance in cortisol after awakening between and within persons . This implies that changes at symptom level are hardly related to changes in cortisol functioning , therefore the clinical implication s of this finding are limited Objective : This prospect i ve study was design ed to test the extent to which the onset of type 2 diabetes in apparently healthy individuals was predicted by burnout , a unique affective response to combined exposure to chronic stressors . Methods : The study participants were 677 employed men and women who were followed up for 3 to 5 years ( mean = 3.6 years ) for the onset of diagnosed type 2 diabetes .  Burnout was assessed by the  Shirom-Melamed Burnout Measure  with its three subscales : emotional exhaustion , physical fatigue , and cognitive weariness . Results : The burnout symptoms were remarkably consistent over the follow-up period irrespective of changes in place of work and in employment status . During the follow-up period , 17 workers developed type 2 diabetes . Logistic regression results indicated that burnout was associated with a 1.84-fold increased risk of diabetes ( 95 % confidence interval [ CI ] = 1.19–2.85 ) even after adjusting for age , sex , body mass index , smoking , alcohol use , leisure time physical activity , initial job category , and follow-up duration . In a sub sample of 507 workers , the relative risk of diabetes was found to be much higher after additional control for blood pressure levels ( odds ratio = 4.32 , 95 % CI = 1.75–10.67 ) , available only for this sub sample . Conclusions : These findings suggest that chronic burnout might be a risk factor for the onset of type 2 diabetes in apparently healthy individuals . CI = confidence interval ; CVD = cardiovascular disease ; SMBM = Shirom-Melamed Burnout Measure ; HbA1c = glycosylated hemoglobin A1c ; VE = vital exhaustion ; MI = myocardial infa rct ion ; MBI = Maslach Burnout Inventory ; BMI = body mass index ; SBP = systolic blood pressure ; DBP = diastolic blood pressure ; OR = odds ratio ; APR = acute phase response ; CRP = C-reactive protein ; HDL = high-density lipoprotein ; HPA = hypothalamic – pituitary – adrenal OBJECTIVE To study the effects of occupational stress on immunological function , glucose , and blood lipid of female workers in oil-field . METHODS 900 female workers working in oil-field as observation group and 220 female not working in oil-field in 11 work types of oil industry in oil-field were selected as control group r and omly , occupational role , personal strain , and personal abilities of two groups were measured with occupational stress inventory-revised ( OSI-R ) . Then , 100 workers were selected r and omly from two groups Blood lipid , blood sugar , and immunological function were measured . RESULTS Occupational role and strain in observed group are significantly higher than control group ( P < 0.05 ) , However , there is no difference on personal abilities in two groups . Blood sugar , IgG , IgA , IgM , IL-6 content in observation group was significantly higher than control group , but CHO , HDL , LDL , IL-2 content was significantly less than control group ( P < 0.05 ) . TG content had no significant difference between both groups . There was positive correlation between occupational role , strain and , blood sugar , immunological function but negative correlation between personal abilities ( P < 0.05 ) . CONCLUSION The results show that blood sugar content was increased , CHO , HDL , LDL were decreased and immumological function was changed because of occupational stress . There was positive correlation between occupational role , strain and blood sugar , immunological function but negative correlation between personal re sources 
    Output:
    
Meta-analyses showed no differences for cortisol awakening response and cortisol awakening response after administration of dexamethasone , cortisol in blood , and blood pressure .