***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 : To investigate the association between job strain and components of the job strain model and  coronary heart disease ( CHD ) risk . Design : Prospect i ve cohort study ( Whitehall II study ) . At the first phase of the study ( 1985–1988 ) , data on self reported psychosocial work characteristics were collected from all participants . Participants were followed up until the end of phase 5 ( 1997–2000 ) , with mean length of follow up of 11 years . Setting : London based office staff in 20 civil service departments . Participants : 6895 male and 3413 female civil servants aged 35–55 . Outcome measures : Incident vali date d CHD . Main results : People with concurrent low decision latitude and high dem and s ( job strain ) were at the highest risk for CHD . High job dem and s , and , less consistently , low decision latitude , predicted CHD incidence . The effect of job strain on CHD incidence was strongest among younger workers , but there was no effect modification by social support at work , or employment grade . Conclusions : Job strain , high job dem and s , and , to some extent , low decision latitude , are associated with an increased risk of CHD among British civil servants Abstract Objective : To examine the association between work stress , according to the job strain model and the effort-reward imbalance model , and the risk of death from cardiovascular disease . Design : Prospect i ve cohort study . Baseline examination in 1973 determined cases of cardiovascular disease , behavioural and biological risks , and stressful characteristics of work . Biological risks were measured at 5 year and 10 year follow up . Setting : Staff of a company in the metal industry in Finl and . Participants : 812 employees ( 545 men , 267 women ) who were free from cardiovascular diseases at baseline . Main outcome measure : Cardiovascular mortality 1973 - 2001 from the national mortality register . Results : Mean length of follow up was 25.6 years . After adjustment for age and sex , employees with high job strain , a combination of high dem and s at work and low job control , had a 2.2-fold ( 95 % confidence interval 1.2 to 4.2 ) cardiovascular mortality risk compared with their colleagues with low job strain . The corresponding risk ratio for employees with effort-reward imbalance ( low salary , lack of social approval , and few career opportunities relative to efforts required at work ) was 2.4 ( 1.3 to 4.4 ) . These ratios remained significant after additional adjustment for occupational group and biological and behavioural risks at baseline . High job strain was associated with increased serum total cholesterol at the 5 year follow up . Effort-reward imbalance predicted increased body mass index at the 10 year follow up . Conclusions : High job strain and effort-reward imbalance seem to increase the risk of cardiovascular mortality . The evidence from industrial employees suggests that attention should be paid to the prevention of work stress Where patients receive therapy as a group , there are good theoretical reasons to believe that variation in the outcome will be smaller for patients treated in the same group than for patients treated in different groups . Similarly , where different therapists treat different groups of patients , outcome for patients treated by the same therapist may differ less than outcome for patients treated by different therapists . Clinical trials evaluating such therapies need to consider this potential lack of independence . As with cluster-r and omized trials , this has implication s for the precision of treatment effects estimates and statistical power . There are nevertheless differences between clustering due to the organization of treatment and that due to r and omization . In cluster-r and omized trials the distribution of cluster sizes in each treatment arm should be similar as a consequence of r and omization unless there is differential loss to follow-up . With clustering due to therapy group or therapist , cluster size may differ systematic ally between treatment arms , due to size of therapy groups or differing health professional caseload . Intra-cluster correlation may also differ between treatment arms . The implication s of differential cluster size and intracluster correlation for design and analysis will be illustrated by data from two trials , the first comparing nurse practitioner care with general practitioner care , and the second comparing a  group therapy with individual treatment as usual . The special case where a group therapy or therapist is compared with an unclustered treatment is examined in detail using a simulation study . The implication s of differential clustering effects for sample size and power are addressed . It is argued that the design and analysis of this type of trial should take account of possible heterogeneity in cluster size and intracluster correlation Research ers assessed the possible moderating effects of school organizational characteristics ( school climate , school health , and job satisfaction ) on outcomes of a  teacher health behavior change program . Thirty-two public schools were matched and r and omly assigned either to treatment or control conditions .  Organizational , dietary , and physiologic data were collected from third to fifth grade teachers over three years . Treatment schools received a  teacher wellness program for two years . Psychometrics of most organizational scales achieved acceptable levels of reliability . Mixed model analyses were conducted to test for moderating effects . Treatment schools with high organizational climate and health scores reported higher fruit and juice and vegetable consumption at Year 2 compared with intervention schools with low scores . Treatment schools with high job satisfaction scores reported higher fruit and juice and lower-fat food consumption at Year 3 compared with intervention schools with low scores . These measures may be used as a tool to assess the environment in which school health promotion programs are presented . Future interventions may need to be tailored to the organizational characteristics of schools This study contributes to ongoing scholarship at the nexus of translational research , education reform , and the developmental and prevention sciences . It reports 2-year experimental impacts of a universal , integrated school-based intervention in social-emotional learning and literacy development on children 's social-emotional , behavioral , and academic functioning . The study employed a school-r and omized , experimental design with 1,184 children in 18 elementary schools . Children in the intervention schools showed improvements across several domains : self-reports of hostile attributional bias , aggressive interpersonal negotiation strategies , and depression , and teacher reports of attention skills , and aggressive and socially competent behavior . In addition , there were effects of the intervention on children 's math and reading achievement for those identified by teachers at baseline at highest behavioral risk . These findings are interpreted in light of developmental cascades theory and lend support to the value of universal , integrated interventions in the elementary school period for promoting children 's social-emotional and academic skills 
    Output:
    
We found low- quality evidence that organisational interventions lead to improvements in teacher wellbeing and retention rates .