***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 This study exp and ed previous NIOSH-IRS research examining the effects of rest breaks and stretching exercises on symptoms and performance in data -entry workers . METHODS All workers spent 4 weeks with conventional breaks ( two 15 min breaks per day ) and 4 weeks with supplementary breaks ( two 15 min breaks plus four 5 min breaks per day ) . One-half were assigned at r and om to a group instructed to perform brief stretching exercises during breaks . The remainder comprised the " no stretching " ( control ) group . RESULTS 51 workers ( stretch group n = 21 ; no stretch group n = 30 ) completed the study symptom question naires . Discomfort and eyestrain were significantly lower with supplementary breaks , and supplementary breaks attenuated accumulation of discomfort and eyestrain during work sessions . Data -entry speed was significantly faster with supplementary breaks so that work output was maintained , despite replacing 20 min of work time with break time . In the stretch group , workers reported  stretching  during only 25 % of conventional breaks and 39 % of supplementary breaks , and no significant effects of stretching on discomfort or performance were observed . CONCLUSIONS These results provide further converging evidence that supplementary breaks reliably minimize discomfort and eyestrain without impairing productivity . Low compliance in performing stretches prevented valid assessment of stretching effects . Further research on stretching exercises and exercise compliance is warranted Objective : To investigate the effect of two contrasting physical activity worksite interventions versus a reference intervention ( REF ) on various health outcomes . Methods : A 1-year r and omized controlled trial was conducted with specific resistance training ( SRT ) , all-round physical exercise ( APE ) , and REF . Results : SRT and APE compared with REF showed significant reductions in systolic blood pressure ( ∼6 mm Hg ) , body fat percentage ( ∼2.2 body fat% ) , as well as shoulder and back pain ( ∼30 % reduction in duration ) . Muscle strength ( APE and SRT ) and maximal oxygen uptake ( APE ) increased approximately 10 % . Conclusions : Worksite intervention with both SRT as well as APE is recommended , since these activities compared with REF result ed in clinical ly relevant reductions of cardiovascular and metabolic syndrome-related risk factors as well as musculoskeletal pain symptoms , in combination with minor increases in physical capacity UNLABELLED This study was design ed to evaluate the health and economic benefits of a workplace vaccination programme against influenza funded by the employer . Employees of a Malaysian petrochemical plant volunteered to take part in this prospect i ve , non-r and omised , non-placebo-controlled study . Demographic and health information , including influenza-like symptoms , sick leave and post-vaccination adverse events were collected via question naires . Cost-benefit analyses were performed from the employer 's perspective . RESULTS A total of 1,022 employees took part in the study , with 504 choosing to be vaccinated against influenza , and 518 remaining unvaccinated . The rate of influenza-like illness ( ILI ) was lower among vaccinated ( 8.13 % ) than non-vaccinated subjects ( 30.31 % ) . Fever and respiratory symptoms were associated with all ILI cases . ILI-related sick leave was taken by 58.54 % of vaccinated employees with ILI and 71.34 % of non-vaccinated employees with ILI . Vaccination was financially beneficial , with the employer saving up to US dollar 53.00 per vaccinated employee when labour costs only were considered . Savings rose to up to US dollar 899.70 when the operating income of each employee was also considered . Workplace vaccination of healthy adults against influenza had a clear impact on ILI rates , absenteeism and reduced productivity in this Malaysian company . The health benefits translated into financial benefits for the employer , with cost savings significantly outweighting the costs of the vaccination programme Abstract Background : While preliminary laboratory tests indicate that a hip belt reduces the load on the back , neck and shoulders associated with musculoskeletal strain , an orchard trial is needed to more realistically assess both effectiveness and acceptability . Objective : to evaluate the hip belt 's effectiveness in three areas : worker acceptance , worker productivity , and one-day muscle fatigue of the back and shoulder . Methods : Ninety-six New York apple harvest workers were r and omly assigned to use the intervention hip belt or placebo belt for one week . In a second week all workers switched conditions . Subjects were interviewed at the end of each week to ascertain intervention acceptance . Employer records were review ed to determine bushels picked per day . Subjects also underwent muscle fatigue testing at the beginning and again at the end of one workday during each week . Results : Ninety-one percent of the subjects favored the intervention hip belt . Use of the intervention did not appreciably slow picking speed ( bushels per hour ) as compared to placebo ( 8.8 bu/ hr vs. 8.89 bu/hr ) . Both were significantly faster than the regular equipment condition ( 8.13 bu/hr ) . No significant differences in one-day muscle fatigue were found with intervention use . Conclusions : The belt was acceptable to the workers and did not hinder productivity . However , the anticipated ergonomic benefits were not demonstrable using one-day strength testing Background Cost-effective interventions to improve diet and physical activity are a public health priority . Alive ! is an email-based intervention to increase physical activity , reduce saturated and trans fats and added sugars , and increase fruit and vegetable consumption . It was shown to improve these behaviors in a large r and omized controlled trial . Objective ( 1 ) To describe the components and behavioral principles underlying Alive ! , and ( 2 ) to report effects of the intervention on the secondary outcomes : health-related quality of life , presenteeism , self-efficacy , and stage of change . Methods The Alive ! behavior change model is design ed to elicit healthy behaviors and promote their maintenance . Behavioral strategies include assessment s followed by individualized feedback , weekly goal - setting , individually tailored goals and tips , reminders , and promotion of social support . Alive ! was tested among non-medical employees of Kaiser Permanente of Northern California , who were r and omized to either the intervention group or the wait-list control group .  After r and omization , intervention group participants chose one topic to undertake for the intervention period : increasing physical activity , increasing fruits and vegetables , or decreasing saturated and trans fats and added sugars . Pre-post question naires assessed changes in SF-8 health-related quality of life , presenteeism , self-efficacy , and stage of change . Mixed effects multiple linear regression and ordinal logistic regression models were used , with department as a r and om effect factor . Analyses were by intention to treat : the 30 % ( 238/787 ) who did not respond to the follow-up question naires were assigned change scores of zero . Results Participants were 19 to 65 years ( mean 44.0 + /- 10.6 ) , and 74.3 % ( 585/787 ) were female . Mean SF-8 Physical quality of life score increased significantly more in the intervention group than in the control group , 1.84 ( 95 % CI 0.96 - 2.72 ) vs 0.72 ( 95 % CI -0.15 - 1.58 ) respectively , P = .02 . SF8 Mental score also improved significantly more in the intervention group than in the control group ( P = .02 ) . The odds ratio for improvement in self-assessed health status was 1.57 ( 95 % CI 1.21 - 2.04 , P < .001 ) for the intervention group compared to the control group . The odds ratio for having a reduction in difficulty accomplishing work tasks because of physical or emotional problems , a measure of presenteeism , was 1.47 ( 95 % CI 1.05 - 2.05 , P = .02 ) for the intervention group compared to the control group . The odds of having an improvement in self-efficacy for changing diet was 2.05 ( 95 % CI 1.44 - 2.93 ) for the intervention vs the control group ( P < .001 ) . Greater improvement in stage of change for physical activity ( P = .05 ) , fats ( P = .06 ) , and fruits/vegetables ( P = .006 ) was seen in the intervention group compared to the control group . Significant effects on diet and physical activity behavior change are reported elsewhere . Conclusions Cost-effective methods that can reach large population s with science-based interventions are urgently needed . Alive ! is a fully automated low-cost intervention shown to effect significant improvements in important health parameters . Trial Registration Clinical trials.gov NCT00607009 ; http:// clinical trials.gov/ct2/show/NCT00607009 ( Archived by WebCite at http://www.webcitation.org/5cLpCWcT6 This study examined the effects of supplementary rest breaks on musculoskeletal discomfort , eyestrain , mood , and performance in data -entry workers . Two rest break schedules were compared in a within-subjects design . Workers alternated between a ‘ conventional ’ and a ‘ supplementary ’ schedule in 4-week intervals . The conventional schedule contained a 15-min break during the first half of the work shift and a 15-min break during the second half of the shift . The supplementary schedule contained the same two 15-min breaks , and a 5-min break during each hour which otherwise did not contain a break , for a total of 20 extra minutes of break time . Results are based on data from 42 workers . They indicated that discomfort in several areas of the body , and eyestrain , were significantly lower under the supplementary than under the conventional schedule . While symptoms increased from pre- to post-work periods under both schedules , the magnitude of the increases was significantly less under the supplementary schedule . In addition , increases in discomfort of the right forearm , wrist and h and over the course of the work week under the conventional schedule were eliminated under the supplementary schedule . These beneficial effects were obtained without reductions in data -entry performance Objective .The objective of this work was to develop a psychometrically sound question naire for measuring the on-the-job impact of chronic health problems and /or treatment ( “ work limitations ” ) . Research Design .Three pilot studies ( focus groups , cognitive interviews , and an alternate forms test ) generated c and i date items , dimensions , and response scales . Two field trials tested the psychometric performance of the question naire ( studies 1 and 2 ) . To test recall error , study 1 subjects were r and omly assigned to 2 different question naire groups , a question naire with a 4-week reporting period completed once or a 2-week version completed twice . Responses were compared with data from concurrent work limitation diaries ( the gold st and ard ) . To test construct validity , we compared question naire scores of patients with those of healthy job-matched control subjects . Study 2 was a cross-sectional mail survey testing scale reliability and construct validity . Subjects . The study subjects were employed individuals ( 18–64 years of age ) from several chronic condition groups ( study 1 , n = 48 ; study 2 , n = 121 ) and , in study 1 , 17 healthy matched control subjects . Measures . Study 1 included the assigned question naires and weekly diaries . Study 2 included the new question naire , SF-36 , and work productivity loss items . Results .In study 1 , question naire responses were consistent with diary data but were most highly correlated with the most recent week . Patients had significantly higher ( worse ) limitation scores than control subjects . In study 2 , 4 scales from a 25-item question naire achieved Cronbach alphas of ≥0.90 and correlated with health status and self-reported work productivity in the hypothesized manner ( P ≤0.05 ) . Conclusions .With 25 items , 4 dimensions ( limitations h and ling time , physical , mental-interpersonal , and output dem and s ) , and a 2-week reporting period , the Work Limitations Question naire demonstrated high reliability and validity Background Women working in the public human service sector in ' overstrained ' situations run the risk of musculoskeletal symptoms and long-term sick leave . In order to maintain the level of health and work ability and strengthen the potential re sources for health , it is important that employees gain greater control over decisions and actions affecting their health – a process associated with the concept of self-efficacy . The aim of this study was to describe the effects of a self-efficacy intervention and an ergonomic education intervention for women with musculoskeletal symptoms , employed in the public sector . Methods The design of the study was a 9-month prospect i ve study describing the effects of two interventions , a comprehensive self-efficacy intervention ( n = 21 ) and an ergonomic education intervention ( n = 21 ) . Data were obtained by a self-report question naire on health- and work ability-related factors at baseline , and at ten weeks and nine months follow-up . Within-group differences over time were analysed . Results Over the time period studied there were small magnitudes of improvements within each group . Within the self-efficacy intervention group positive effects in perceived work ability were shown . The ergonomic education group showed increased positive beliefs about future work ability and a more frequent use of pain coping strategies . Conclusion Both interventions showed positive effects on women with musculoskeletal symptoms , but in different ways . Future research in this area should tailor interventions to participants ' motivation and readiness to change OBJECTIVE The effects and constancy of a worksite physical exercise intervention were examined in relation to the physical fitness , perceived health status , and work ability of female service workers during periods of 1 and 5 years . METHODS The subjects comprised female home care workers divided into an intervention group ( n = 50 , mean age 41.8 ( SD 10.4 ) years ) and a control group ( n = 37 , mean age 43 
    Output:
    
There is preliminary evidence that some WHP programs can positively affect presenteeism and that certain risk factors are of importance .