***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: Abstract Background Diabetes prevalence is increasing . The Finnish Diabetes Prevention Study ( DPS ) showed a 58 % reduction in Type 2 Diabetes ( T2D ) incidence in adults with impaired glucose tolerance ( IGT ) . The European Diabetes Prevention Study ( EDIPS ) extends the DPS to different European population s , using the same study design . In the Newcastle arm of this study ( EDIPS-Newcastle ) , we tested the hypothesis that T2D can be prevented by lifestyle intervention and explored secondary outcomes in relation to diabetes incidence . Methods We recruited 102 participants ( 42 men and 60 women , mean age 57 years , mean BMI 34 kgm-2 ) with IGT to EDIPS-Newcastle and r and omised to Intervention and usual care Control groups .  The intervention included individual motivational interviewing aim ed at : weight reduction , increase in physical activity , fibre and carbohydrate intake and reduction of fat intake ( secondary outcomes ) . The primary outcome was diagnosis of T2D . Results Mean duration of follow-up was 3.1 years . T2D was diagnosed in 16 participants ( I = 5 , C = 11 ) . Absolute incidence of T2D was 32.7 per 1000 person-years in the Intervention-group and 67.1 per 1000 person-years in the Control-group . The overall incidence of diabetes was reduced by 55 % in the Intervention-group , compared with the Control-group : RR 0.45 ( 95%CI 0.2 to 1.2).Explanatory survival analysis of secondary outcomes showed that those who sustained beneficial changes for two or more years reduced their risk of developing T2D . Conclusion Our results are consistent with other diabetes prevention trials . This study was design ed as part of a larger study and although the sample size limits statistical significance , the results contribute to the evidence that T2D can be prevented by lifestyle changes in adults with IGT . In explanatory analysis small sustained beneficial changes in weight , physical activity or dietary factors were associated with reduction in T2D incidence . Trial Registration International St and ard R and omised Controlled Trial Number registry ( IS RCT N)Registry number : IS RCT N 15670600 http://www.controlled-trials.com/is rct n/ search .html?srch=15670600%26sort=3%26dir = Objective To evaluate the impact of combinations of lifestyle factors on  mortality in middle aged women . Design Prospect i ve cohort study . Setting Nurses ’ health study , United States . Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980 . Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors ( cigarette smoking , being overweight , taking little moderate to vigorous physical activity , no light to moderate alcohol intake , and low diet quality score ) . Results 8882 deaths were documented , including 1790 from cardiovascular disease and 4527 from cancer . Each lifestyle factor independently and significantly predicted mortality . Relative risks for five compared with zero lifestyle risk factors were 3.26 ( 95 % confidence interval 2.45 to 4.34 ) for cancer mortality , 8.17 ( 4.96 to 13.47 ) for cardiovascular mortality , and 4.31 ( 3.51 to 5.31 ) for all cause mortality . A total of 28 % ( 25 % to 31 % ) of deaths during follow-up could be attributed to smoking and 55 % ( 47 % to 62 % ) to the combination of smoking , being overweight , lack of physical activity , and a low diet quality . Additionally considering alcohol intake did not substantially change this estimate . Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower  mortality in middle aged women . Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified Background The workplace is an ideal setting for health promotion . Helping employees to be more physically active can not only improve their physical and mental health , but can also have economic benefits such as reduced sickness absence . The current paper describes the development of a three month theory-based intervention that aims to increase levels of moderate intensity physical activity amongst employees in sedentary occupations . Methods The intervention was developed using an intervention mapping protocol . The intervention was also informed by previous literature , qualitative focus groups , an expert steering group , and feedback from key contacts within a range of organisations . Results The intervention was design ed to target awareness ( e.g. provision of information ) , motivation ( e.g. goal setting , social support ) and environment ( e.g. management support ) and to address behavioural ( e.g. increasing moderate physical activity in work ) and interpersonal outcomes ( e.g. encourage colleagues to be more physically active ) . The intervention can be implemented by local facilitators without the requirement for a large investment of re sources . A facilitator manual was developed which listed step by step instructions on how to implement each component along with a suggested timetable . Conclusion Although time consuming , intervention mapping was found to be a useful tool for developing a theory based intervention . The length of this process has implication s for the way in which funding bodies allow for the development of interventions as part of their funding policy . The intervention will be evaluated in a cluster r and omised trial involving 1350 employees from 5 different organisations , results available September 2009 Background Cardiovascular disease is the leading cause of disability and mortality in most Western countries . The prevalence of several risk factors , most notably low physical activity and poor nutrition , is very high . Therefore , lifestyle behaviour changes are of great importance . The worksite offers an efficient structure to reach large groups and to make use of a natural social network . This study investigates a worksite health promotion programme with individually tailored advice in physical activity and nutrition and individual counselling to increase compliance with lifestyle recommendations and sustainability of a healthy lifestyle . Methods / Design The study is a pragmatic cluster r and omised controlled trial with the worksite as the unit of r and omisation . All workers will receive a st and ard worksite health promotion program .  Additionally , the intervention group will receive access to an individual Health Portal consisting of four critical features : a computer-tailored advice , a monitoring function , a personal coach , and opportunities to contact professionals at request . Participants are employees working for companies in the Netherl and s , being literate enough to read and underst and simple Internet-based messages in the Dutch language .A question naire to assess primary outcomes ( compliance with national recommendations on physical activity and on fruit and vegetable intake ) will take place at baseline and after 12 and 24 months . This question naire also assesses secondary outcomes including fat intake , self-efficacy and self-perceived barriers on physical activity and fruit and vegetable intake . Other secondary outcomes , including a cardiovascular risk profile and physical fitness , will be measured at baseline and after 24 months . Apart from the effect evaluation , a process evaluation will be carried out to gain insight into participation and adherence to the worksite health promotion programme . A cost-effectiveness analysis and sensitivity analysis will be carried out as well . Discussion The unique combination of features makes the individually tailored worksite health promotion programme a promising tool for health promotion . It is hypothesized that the Health Portal 's features will counteract loss to follow-up , and will increase compliance with the lifestyle recommendations and sustainability of a healthy lifestyle . Trial registration Current Controlled Trials IS RCT N52854353 AIM This paper is the report of a pilot study to assess if an Integrated Health Programme would reduce sick leave and subjective health complaints , and increase coping in a population of nursing personnel . BACKGROUND . The work group in Norway with most sick leave is healthcare workers . More than 50 % of the sick leave is because of subjective health complaints . Work place physical exercise interventions have a documented positive effect on sick leave . METHOD After baseline screening , employees who had agreed to participate ( n=40 ) were r and omized to an intervention or control group . The intervention group participated in an Integrated Health Programme twice weekly during working hours . The programme consisted of physical exercise , stress management training , health information and an examination of the participants ' workplace . The control group was offered the same intervention after the project was finished . This study was carried out from 2001 to 2002 . FINDINGS There were no statistically significant effects on sick leave or health-related quality of life . The intervention group reported fewer neck complaints compared to the control group , but otherwise there were no effects on subjective health complaints . However , the subjective effects were large and highly statistically significant , the intervention group reporting improvement in health , physical fitness , muscle pain , stress management , maintenance of health and work situation . CONCLUSION The Integrated Health Programme was not effective in reducing sick leave and subjective health complaints , but may be of use to employers wanting to increase employee job satisfaction and well-being Abstract Objective : To determine the association between adverse psychosocial characteristics at work and risk of coronary heart disease among male and female civil servants . Design : Prospect i ve cohort study ( Whitehall II study ) . At the baseline examination ( 1985 - 8 ) and twice during follow up a self report question naire provided information on psychosocial factors of the work environment and coronary heart disease . Independent assessment s of the work environment were obtained from personnel managers at baseline . Mean length of follow up was 5.3 years . Setting : London based office staff in 20 civil service departments . Subjects : 10 308 civil servants aged 35 - 55 were examined-6895 men ( 67 % ) and 3413 women ( 33 % ) . Main outcome measures : New cases of angina ( Rose question naire ) , severe pain across the chest , diagnosed ischaemic heart disease , and any coronary event . Results : Men and women with low job control , either self reported or independently assessed , had a higher risk of newly reported coronary heart disease during follow up . Job control assessed on two occasions three years apart , although intercorrelated , had cumulative effects on newly reported disease . Subjects with low job control on both occasions had an odds ratio for any subsequent coronary event of 1.93 ( 95 % confidence interval 1.34 to 2.77 ) compared with subjects with high job control at both occasions . This association could not be explained by employment grade , negative affectivity , or classic coronary risk factors . Job dem and s and social support at work were not related to the risk of coronary heart disease . Conclusions : Low control in the work environment is associated with an increased risk of future coronary heart disease  among men and women employed in government offices . The cumulative effect of low job control assessed on two occasions indicates that giving employees more variety in tasks and a stronger say in decisions about work may decrease the risk of coronary heart disease . Key messages Low job control in the work environment contributes to the development of coronary heart disease among British male and female civil servants The risk of heart disease is associated with both objective low job control and perceived low job control . Increase in job control over time decreases the risk of coronary heart disease . This suggests that policies giving people a stronger say in decisions about their work or providing them with more variety in work tasks may contribute to better cardiovascular The effectiveness of a behavioral parent training ( BPT ) intervention for improving maternal self-efficacy , maternal stress , and the quality of mother-toddler interactions has been demonstrated ( Gross , Fogg , & Tucker , 1995 ) . The 1-year follow-up of the 46 parents of toddlers ( assigned to an intervention or comparison group ) who participated in that study is reported . It was hypothesized that ( a ) BPT would lead to enduring positive changes in parenting self-efficacy , parenting stress , and parent-toddler interactions ; and ( b ) the amount of parent participation in the intervention would be correlated with greater gains in parent-child outcomes at 1 year . All the families were retained and significant gains in maternal self-efficacy , maternal stress , and mother-child interactions were maintained . Minimal  BPT effects were found for fathers . BPT dosage was related to reductions in mother critical statements and negative physical behaviors at 1-year postintervention . The findings are consistent with self-efficacy theory and support parenting self-efficacy as a target for BPT in families of young children Smokers ( N = 756 ) were r and omly assigned by stage of change to ( a ) st and ardized self-help manuals ( ALA+ condition ) , ( b ) individualized manuals matched to stage ( TTT condition ) , ( c ) interactive expert-system computer reports plus individualized manuals ( ITT condition ) , or ( d ) a personalized condition with 4 counselor calls , stage manuals , and computer reports ( PITT condition ) . Over 18 months , the ITT group 's results more than doubled those of the ALA+ group on abstinence measures . The ALA+ and TTT conditions were equivalent over 12 months , but at 18 months the TTT condition was more effective . The ITT condition was the best or comparable with the best treatment at all follow-ups for smokers at all stages of change . Results suggest that an effective expert system has been developed , and discussion focuses on delivering this system to entire population s of smokers Hospital nurses who are working mothers are challenged to maintain their personal health and model healthy behaviors for their children . This study aim ed to develop and test an innovative 10-week worksite physical activity intervention integrated into the work flow of hospital-based nurses who were mothers . Three volunteer adult medical-surgical nursing units participated as intervention units . Fifty-eight nurses ( 30 intervention and 28 control ) provided baseline and post-intervention repeated measurements of physical activity ( steps ) and body composition .  Intervention participants provided post-intervention focus group feedback . For both groups , daily steps averaged more than 12,400 at baseline and post-intervention . No significant effects were found for physical activity ; significant effects were found for fat mass , fat index , and percent fat ( p < .03 ) . 
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Outcomes included fewer cigarettes smoked during the intervention period , down from mean ( SD ) 20 (8)-12 ( 9 ) per day ( p < 0·001 ) ; significantly reduced fat mass ( 0·68 vs. 0·07 kg ; p = 0·028 ) ; and significant gains across a battery of fitness assessment s. The paucity of work focused on nurses ' health behaviours was the important finding .
The workplace is a potentially fruitful location for health promotion intervention but nurses have seldom been recognised as a target participant group .