***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: STUDY OBJECTIVES The Work , Family , and Health Network Study tested the hypothesis that a workplace intervention design ed to increase family-supportive supervision and employee control over work time improves actigraphic measures of sleep quantity and quality . DESIGN Cluster-r and omized trial . SETTING A global information technology firm . PARTICIPANTS US employees at an information technology firm . INTERVENTIONS R and omly selected clusters of managers and employees participated in a 3-month , social , and organizational change process intended to reduce work-family conflict . The intervention included interactive sessions with facilitated discussion s , role playing , and games . Managers completed training in family-supportive supervision . MEASUREMENTS AND RESULTS Primary outcomes of total sleep time ( sleep duration ) and wake after sleep onset ( sleep quality ) were collected from week-long actigraphy recordings at baseline and 12 months . Secondary outcomes included self-reported sleep insufficiency and insomnia symptoms . Twelve-month interviews were completed by 701 ( 93 % retention ) , of whom 595 ( 85 % ) completed actigraphy . Restricting analyses to participants with e3 valid days of actigraphy yielded a sample of 473 - 474 for intervention effectiveness analyses . Actigraphy-measured sleep duration was 8 min/d greater among intervention employees relative to controls ( P < .05 ) . Sleep insufficiency was reduced among intervention employees ( P = .002 ) . Wake after sleep onset and insomnia symptoms were not different between groups . Path models indicated that increased control over work hours and subsequent reductions in work-family conflict mediated the improvement in sleep sufficiency . CONCLUSIONS The workplace intervention did not overtly address sleep , yet intervention employees slept 8 min/d more and reported greater sleep sufficiency . Interventions should address environmental and psychosocial causes of sleep deficiency , including workplace factors Objective : To examine the effects of different sit-st and protocol s on work-time sitting and physical activity ( PA ) of office workers . Methods : Participants ( n = 26 , 77 % women , mean age 42 ) were r and omly allocated to usual sitting ( control ) or one of three sit-st and protocol s ( intervention ) facilitated by height-adjustable workstations for a 4-week period between June and August 2015 . Sitting , st and ing , and stepping time were assessed by inclinometry ( activPAL ) ; leisure-time physical activity ( LTPA ) by self-report . One-way analysis of covariance ( ANCOVA ) and post-hoc ( Bonferroni ) tests explored between-group differences . Results : Compared with baseline , intervention groups reduced work sitting time by 113 minutes/8-hour workday ( 95 % confidence interval [ CI ] [ −147,−79 ] ) and increased work st and ing time by 96 minutes/8-hour workday ( 95 % CI [ 67,125 ] ) without significantly impacting LTPA/sleep time . Conclusions : Sit-st and protocol s facilitated by height-adjustable workstations appear to reduce office workers ’ sitting time without significant adverse effects on LTPA There has been growing interest in utilizing mobile phone applications ( apps ) to enhance traditional psychotherapy . Previous research has suggested that apps may facilitate patients ’ completion of cognitive behavioral therapy for insomnia ( CBT-I ) tasks and potentially increase adherence . This r and omized clinical trial pilot study ( n = 18 ) sought to examine the feasibility , acceptability , and potential impact on adherence and sleep outcomes related to CBT-I Coach use . All participants were engaged in CBT-I , with one group receiving the app as a supplement and one non-app group . We found that patients consistently used the app as intended , particularly the sleep diary and reminder functions . They reported that it was highly acceptable to use . Importantly , the app did not compromise or undermine benefits of cognitive behavioral therapy for insomnia and patients in both groups had significantly improved sleep outcomes following treatment Objective Insufficient time for recovery between workdays may cause fatigue and disturbed sleep . This study evaluated the impact of an intervention that reduced weekly working hours by 25 % on sleep , sleepiness and perceived stress for employees within the public sector . Method Participating workplaces ( N=33 ) were r and omized into intervention and control groups . Participants ( N=580 , 76 % women ) worked full-time at baseline . The intervention group ( N=354 ) reduced worktime to 75 % with preserved salary during 18 months . Data were collected at baseline and after 9 and 18 months follow-up . Sleep quality , sleep duration , sleepiness , perceived stress , and worries and stress at bedtime were measured with diary during one week per data collection . Result A multilevel mixed model showed that compared with the control group , at the 18-month follow-up , the intervention group had improved sleep quality and sleep duration ( + 23 minutes ) and displayed reduced levels of sleepiness , perceived stress , and worries and stress at bedtime on workdays ( P<0.002 ) . The same effects were shown for days off ( P<0.006 ) , except for sleep length . Effect sizes were small ( Cohen 's f2<0.08 ) . Adding gender , age , having children living at home , and baseline values of sleep quality and worries and stress at bedtime as additional between-group factors did not influence the results . Conclusion A 25 % reduction of weekly work hours with retained salary result ed in beneficial effects on sleep , sleepiness and perceived stress both on workdays and days off . These effects were maintained over an 18-month period . This r and omized intervention thus indicates that reduced worktime may improve recovery and perceived stress OBJECTIVE Cognitive behavioral therapy for insomnia ( CBT-I ) is an effective treatment for persistent insomnia . The purpose of this study was to examine the effectiveness of and response patterns to CBT-I among daytime and shift workers with insomnia over a 24-month follow-up in occupational health services ( OHS ) . METHODS The participants were 59 media workers with chronic insomnia , of whom 69 % were reached at 24-month follow-up .  Sleep diaries and question naires over seven measurement points were used as outcomes . Trained OHS nurses led the CBT-I groups . The study design was a non-r and omized group intervention . RESULTS Self-perceived severity of insomnia , sleep-related dysfunctional cognitions , and psychiatric symptoms in particular showed improvements over a 24-month follow-up . Working hour arrangements did not affect the results . Based on the Insomnia Severity Index ( ISI ) , 62 % of the participants showed a moderate improvement after CBT-I , whereas the remaining participants showed only a minor improvement . CONCLUSIONS Our results indicate that CBT-I delivered by OHS leads to long-term improvements among both daytime and shift workers . Two groups were identified according to the degree of improvement of insomnia ; one comprising two thirds of the participants with a moderate response and the other comprising one thirds of the participants with a modest response . The results need to be interpreted cautiously as insomnia was mild ( ISI was on average under 15 points at all measurement points ) and improvements were relatively small in the sample , and the study design was non-r and omized OBJECTIVES To inform the debate over whether human sleep can be chronically reduced without consequences , we conducted a dose-response chronic sleep restriction experiment in which waking neurobehavioral and sleep physiological functions were monitored and compared to those for total sleep deprivation . DESIGN The chronic sleep restriction experiment involved r and omization to one of three sleep doses ( 4 h , 6 h , or 8 h time in bed per night ) , which were maintained for 14 consecutive days . The total sleep deprivation experiment involved 3 nights without sleep ( 0 h time in bed ) . Each study also involved 3 baseline ( pre-deprivation ) days and 3 recovery days . SETTING Both experiments were conducted under st and ardized laboratory conditions with continuous behavioral , physiological and medical monitoring . PARTICIPANTS A total of n = 48 healthy adults ( ages 21 - 38 ) participated in the experiments . INTERVENTIONS Noctumal sleep periods were restricted to 8 h , 6 h or 4 h per day for 14 days , or to 0 h for 3 days . All other sleep was prohibited . RESULTS Chronic restriction of sleep periods to 4 h or 6 h per night over 14 consecutive days result ed in significant cumulative , dose-dependent deficits in cognitive performance on all tasks . Subjective sleepiness ratings showed an acute response to sleep restriction but only small further increases on subsequent days , and did not significantly differentiate the 6 h and 4 h conditions . Polysomnographic variables and delta power in the non-REM sleep EEG-a putative marker of sleep homeostasis -- displayed an acute response to sleep restriction with negligible further changes across the 14 restricted nights . Comparison of chronic sleep restriction to total sleep deprivation showed that the latter result ed in disproportionately large waking neurobehavioral and sleep delta power responses relative to how much sleep was lost . A statistical model revealed that , regardless of the mode of sleep deprivation , lapses in behavioral alertness were near-linearly related to the cumulative duration of wakefulness in excess of 15.84 h ( s.e . 0.73 h ) . CONCLUSIONS Since chronic restriction of sleep to 6 h or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation , it appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults . Sleepiness ratings suggest that subjects were largely unaware of these increasing cognitive deficits , which may explain why the impact of chronic sleep restriction on waking cognitive functions is often assumed to be benign . Physiological sleep responses to chronic restriction did not mirror waking neurobehavioral responses , but cumulative wakefulness in excess of a 15.84 h predicted performance lapses across all four experimental conditions . This suggests that sleep debt is perhaps best understood as result ing in additional wakefulness that has a neurobiological " cost " which accumulates over time Introduction The aim of this study was to examine the implementation and effectiveness of a cognitive behavioral group intervention model for chronic insomnia ( CBT-I ) in occupational health services ( OHS ) . We also studied if insomnia symptoms and intervention effects differed on work days and days off . Methods The study design was a  non-r and omized group intervention  , including a waiting period prior to CBT as a control condition . We followed up the results for a period of 6 months . Outcomes were assessed using a sleep diary , question naires , and actigraphy . The CBT-I groups were led by trained OHS nurses . Results A total of 26 participants completed the study . The intervention improved significantly participants ’ different self-reported sleep variables , perceived severity of insomnia , sleep-related dysfunctional cognitions , and psychiatric and somatic symptoms . The effects lasted , and partly increased during the follow-up . The participants generally slept significantly better on days off than on work days , but the treatment improved sleep on both . Conclusions The study showed that a non-pharmacological treatment of insomnia can be implemented into OHS with a reasonable amount of effort and that the treatment delivered by trained OHS nurses yields promising results . These findings , however , need to be interpreted cautiously , due to the non-r and omized design and small sample size The effectiveness of Internet-based self-help programs for insomnia is still unclear . A r and omized controlled trial was conducted to evaluate the effect of an Internet-based self-help program for better quality of sleep  among adult workers . Forty-three volunteers were recruited and r and omly assigned to either an intervention group ( n=21 ) or a waiting-list group ( n=22 ) . The intervention group participated in a two-week Internet-based program , including selecting and daily practicing sleep-related target behaviors and monitoring those behaviors along with sleep quality . At the same time , each participant received automatically generated , personalized messages and reports both daily and weekly . A total of 12 intervention group participants and 18 waiting-list group participants completed question naires at baseline , post-intervention , and at a 3-wk follow-up . Subjective sleep quality was measured by a self-reported question naire developed for this study . The sleep quality score increased in the intervention group at post-intervention , with a significant interaction effect [ F(1,28)=5.19 , p=0.031 ] . Sleep-related behaviors also greatly increased in the intervention group at post-intervention , with a significant interaction effect [ F(1,28)=7.14 , p=0.012 ] . Sleep-onset latency reduced in the intervention group at follow-up , with a marginally significant effect [ F(1,28)=3.52 , p=0.071 ] . The Internet-based self-help program improves subjective sleep quality and sleep-onset latency among adult workers Mindfulness-based stress reduction ( MBSR ) has produced behavioral , psychological , and physiological benefits , but these programs typically require a substantial time commitment from the participants . This study assessed the effects of a shortened ( low-dose [ ld ] ) work-site MBSR intervention ( MBSR-ld ) on indicators of stress in healthy working adults to determine if results similar to those obtained in traditional MBSR could be demonstrated . Participants were r and omized into  MBSR-ld  and wait-list control groups . Self-reported perceived stress , sleep quality , and mindfulness were measured at the beginning and end of the 6-week intervention . Salivary cortisol was assessed weekly . Significant reductions in perceived stress ( p = .0025 ) and increases in mindfulness ( p = .0149 ) were obtained for only the MBSR-ld group ( n = 22 ) . Scores on the global measure of sleep improved for the MBSR-ld group ( p = .0018 ) as well as for the control group ( p = .0072 ; n = 20 ) . Implication s and future research are discussed STUDY OB 
    Output:
    
Conclusions : Our study findings suggest health promotion programs may be helpful for increasing employee sleep duration and subsequent daytime performance