human
***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 A prospect i ve study of computer users was performed to determine the occurrence of and evaluate risk factors for  neck or shoulder ( N/S ) and h and or arm ( H/A ) musculoskeletal symptoms ( MSS ) and disorders ( MSD ) . METHODS Individuals ( n = 632 ) newly hired into jobs requiring > or = 15 hr/week of computer use were followed for up to 3 years . At study entry , workstation dimensions and worker postures were measured and medical and psychosocial risk factors were assessed . Daily diaries were used to document work practice s and incident MSS . Those reporting MSS were examined for specific MSD . Incidence rates of MSS and MSD were estimated with survival analysis . Cox regression models were used to evaluate associations between participant characteristics at entry and MSS and MSD . RESULTS The annual incidence of N/S MSS was 58 cases/100 person-years and of N/S MSD was 35 cases/100 person-years . The most common N/S MSD was somatic pain syndrome . The annual incidence of H/A MSS was 39 cases/100 person-years and of H/A MSD was 21 cases/100 person-years . The most common H/A disorder was deQuervain 's tendonitis . Forty-six percent of N/S and 32 % of H/A MSS occurred during the first month of follow-up . Gender , age , ethnicity , and prior history of N/S pain were associated with N/S MSS and MSD . Gender , prior history of H/A pain , prior computer use , and children at home were associated with either H/A MSS or MSD . CONCLUSIONS H/A and N/S MSS and MSD were common among computer users . More than 50 % of computer users reported MSS during the first year after starting a new job Three groups of data entry female visual display terminal ( VDT ) workers from Norway ( n = 30 ) , Pol and ( n = 33 ) and the USA ( n = 29 ) were compared . Before intervention , the Norwegian group reported more neck pain compared with the Polish group . The Polish group reported less shoulder pain than both the U.S. and the Norwegian groups . The clinical examination documented fewer symptoms and signs of musculoskeletal illness among the Polish participants compared with the Norwegian and the U.S. groups . After intervention , the Norwegian group reported a reduction in neck pain while the U.S. group reported a reduction in shoulder pain . The Polish group reported an increase in neck , shoulder and forearm pain at follow-up compared to after intervention . The Polish group recorded higher flexion of the upper arm at follow-up parallel with an increase of pain in the upper part of the body . Visual discomfort showed variable results in the 3 countries A group of routine data entry operators ( female ) was included in the Polish MEPS ( musculoskeletal — eyestrain— psychosocial — stress ) study . Before the intervention , ergonomic assessment revealed improper working conditions such as inadequate lighting , uncomfortable chairs , and lack of forearm and wrist support while medical examination revealed that trapezius muscle load along with upper arm , head and back angles were higher than advisable . Subjects complained about neck and shoulder pain , visual problems , and psychosocial conditions . The ergonomic intervention included installation of new luminaires and Venetian blinds , new chairs , repair of ventilators , and optometric corrections . The results after the intervention showed mainly improvement in chair comfort , lighting conditions , visual strain , and sitting posture . However , financial limitations did not allow satisfactory completion of the intervention leading to a mixed interpretation of the results Background : Call centre work with computers is associated with increased rates of upper body pain and musculoskeletal disorders . Methods : This one year , r and omised controlled intervention trial evaluated the effects of a wide forearm support surface and a trackball on upper body pain severity and incident musculoskeletal disorders among 182 call centre operators at a large healthcare company . Participants were r and omised to receive ( 1  ) ergonomics training only , ( 2 ) training plus a trackball , ( 3 ) training plus a forearm support , or ( 4 ) training plus a trackball and forearm support . Outcome measures were weekly pain severity scores and diagnosis of incident musculoskeletal disorder in the upper extremities or the neck/shoulder region based on physical examination performed by a physician blinded to intervention . Analyses using Cox proportional hazard models and linear regression models adjusted for demographic factors , baseline pain levels , and psychosocial job factors . Results : Post-intervention , 63 participants were diagnosed with one or more incident musculoskeletal disorders  . Hazard rate ratios showed a protective effect of the armboard for neck/shoulder disorders ( HR = 0.49 , 95 % CI 0.24 to 0.97 ) after adjusting for baseline pain levels and demographic and psychosocial factors . The armboard also significantly reduced neck/shoulder pain ( p = 0.01 ) and right upper extremity pain ( p = 0.002 ) in comparison to the control group . A return-on-investment model predicted a full return of armboard and installation costs within 10.6 months . Conclusion : Providing a large forearm support combined with ergonomic training is an effective intervention to prevent upper body musculoskeletal disorders and reduce upper body pain associated with computer work among call centre employees Abstract . The overall aim of this study was to investigate whether time pressure and verbal provocation has any effect on physiological and psychological reactions during work with a  computer mouse . It was hypothesised that physiological reactions other than muscle activity ( i.e. wrist movements , forces applied to the computer mouse ) would not be affected when working under stressful conditions . Fifteen subjects ( 8 men and 7 women ) participated , performing a st and ardised text-editing task under stress and control conditions .  Blood pressure , heart rate , heart rate variability , electromyography , a force-sensing computer mouse and electrogoniometry  were used to assess the physiological reactions of the subjects . Mood ratings and ratings of perceived exertion were used to assess their psychological reactions . The  time pressure and verbal provocation  ( stress situation ) result ed in increased physiological and psychological reactions compared with the two control situations . Heart rate , blood pressure and muscle activity in the first dorsal interosseus , right extensor digitorum and right trapezius muscles were greater in the stress situation . The peak forces applied to the button of the computer mouse and wrist movements were also affected by condition . Whether the increases in the physiological reactions were due to stress or increased speed/productivity during the stress situation is discussed . In conclusion , work with a computer mouse under time pressure and verbal provocation ( stress conditions ) led to increased physiological and psychological reactions compared to control conditions OBJECTIVES Following a consensus statement from a multidisciplinary UK workshop , a structured examination schedule was developed for the diagnosis and classification of musculoskeletal disorders of the upper limb . The aim of this study was to test the repeatability and the validity of the newly developed schedule in a hospital setting . METHOD 43 consecutive referrals to a soft tissue rheumatism clinic ( group 1 ) and 45 subjects with one of a list of specific upper limb disorders ( including shoulder capsulitis , rotator cuff tendinitis , lateral epicondylitis and tenosynovitis ) ( group 2 ) , were recruited from hospital rheumatology and orthopaedic outpatient clinics . All 88 subjects were examined by a research nurse ( blinded to diagnosis ) , and everyone from group 1 was independently examined by a rheumatologist . Between observer agreement was assessed among subjects from group 1 by calculating Cohen 's κ for dichotomous physical signs , and mean differences with limits of agreement for measured ranges of joint movement . To assess the validity of the examination , a pre-defined algorithm was applied to the nurse 's examination findings in patients from both groups , and the sensitivity and specificity of the derived diagnoses were determined in comparison with the clinic 's independent diagnosis as the reference st and ard . RESULTS The between observer repeatability of physical signs varied from good to excellent , with κ coefficients of 0.66 to 1.00 for most categorical observations , and mean absolute differences of 1.4 ° –11.9 ° for measurements of shoulder movement . The sensitivity of the schedule in comparison with the reference st and ard varied between diagnoses from 58%–100 % , while the specificities ranged from 84%–100 % . The nurse and the clinic physician generally agreed in their diagnoses , but in the presence of shoulder capsulitis the nurse usually also diagnosed shoulder tendinitis , whereas the clinic physician did not . CONCLUSION The new examination protocol is repeatable and gives acceptable diagnostic accuracy in a hospital setting . Examination can feasibly be delegated to a trained nurse , and the protocol has the benefit of face and construct validity as well as consensus backing . Its performance in the community , where disease is less clear cut , merits separate evaluation , and further refinement is needed to discriminate between discrete pathologies at the shoulder The Norwegian MEPS ( musculoskeletal — eyestrain — psychosocial — stress ) study included 3 groups : data entry , data dialogue ( female ) and data dialogue  ( male ) . Before intervention , the data entry group reported significantly more symptoms and signs of musculoskeletal illness and had longer periods in front of the video display terminal ( VDT ) without a break . The ergonomic intervention consisted mainly of ergonomic information and training . After intervention , the data dialogue female group reported a significant reduction in shoulder pain in parallel with a reduction in trapezius load . Increasing the underst and ing in how to adjust the work st and and chair may have been contributing factors to reducing the pain level . There was a significant reduction in eye problems in all groups ; the greatest reduction in eye symptoms was seen in the groups who had new optometric corrections This special issue of the International Journal of Occupational Safety and Ergonomics ( JOSE ) reports the results from an extensive multinational and multidisciplinary collaborative investigation of the impacts on  visual display terminal ( VDT ) work  of musculoskeletal , visual , ergonomic , and psychosocial factors . For brevity , this effort has been referred to as the MEPS project ( musculoskeletal — eyestrain — psychosocial — stress ) . This paper lays out the basic method ological structure of the study . The study was conducted in 4 countries utilizing VDT data entry workers as the primary subject population . A battery of objective and subject assessment measures , including muscle load , visual function , physical and visual strain , postural , ergonomic and psychosocial factors , were assessed at 3 different points in time . A pre-test was given prior to an ergonomic intervention . Two post-tests were given 1 month and 1 year after the ergonomic intervention A prospect i ve epidemiological field study covering a 2 years period has earlier been published . The study has a parallel group design with two intervention groups ( T and S ) and one  control group ( C ) of Visual Display Unit ( VDU ) operators . The present paper covers the period from 2 to 6 years of the study . After 3.5 years , the C group got the same intervention in terms of new lighting system , new workplaces and at last an optometric examination and corrections if needed . The C group reported a significant reduction in visual discomfort after interventions while the two groups ( T and S ) continued to report significant reduction of visual discomfort after 6 years . By supporting the forearm on the table top , the C group reported significant reduction of shoulder and neck pain while the T group reported significant reduction in shoulder and back pain after 6 years . Organizational and psychosocial factors at work and outside work did not show any significant changes during the study period BACKGROUND Despite widespread recommendations regarding posture during computer use , associations between specific postures and musculoskeletal health are not well characterized . METHODS Six hundred and thirty-two newly hired computer users were followed prospect ively to evaluate associations between posture and neck or shoulder ( N/S ) and h and or arm ( H/A ) musculoskeletal symptoms and musculoskeletal disorders . Participants ' postures were measured at entry and they reported symptoms on weekly diaries . Participants reporting symptoms were examined for specific disorders . Multivariate Cox regression models were used to estimate associations between postural variables and risk of symptoms and disorders , controlling for confounding variables . RESULTS Keying with an inner elbow angle > 121 degrees , greater downward head tilt , and presence of armrests on the participants chair were associated with lower risk of N/S symptoms or N/S disorders .  Keying with elbow height below the height of the " J " key and the presence of a telephone shoulder rest were associated with a greater risk of N/S symptoms or N/S disorders . Horizontal location of the " J " key > 12 cm from the edge of the desk was associated with a lower risk of H/A symptoms and H/A disorders . Use of a keyboard with the " J " key > 3.5 cm above the table surface , key activation force > 48 g , and radial wrist deviation of > 5 degrees while using a mouse was associated with a greater risk of H/A symptoms or H/A disorders . The number of hours keying/week was associated with H/A symptoms and disorders . CONCLUSIONS The results suggest that the risk of musculoskeletal symptoms and musculoskeletal disorders may be reduced by encouraging specific seated postures OBJECTIVES This prospect i ve study concentrated on determining factors of computer work that predict  musculoskeletal symptoms in the shoulder , elbow , and low-back regions . METHODS A question naire on ergonomics , work pauses , work techniques , and psychosocial and work factors was delivered to 5033 office workers at baseline in early 1999 ( response rate 69 % ) and to 3361 respondents at the time of the follow-up in late 2000 ( response rate 77 % ) . An increased frequency or intensity of symptoms was the outcome variable , including only nonsymptomatic respondents from the baseline question naire ( symptom frequency below 8 days within the last 12 months or intensity score below 4 within the last 3 months ) . RESULTS In the follow-up , 1 
    Output:
    
agent
Limited evidence was also found for a causal relationship between  computer work per se and computer mouse time related to tension neck syndrome , but the evidence for keyboard time was insufficient .
Insufficient evidence was found for an association between other musculoskeletal diagnoses of the neck and upper extremities , including shoulder tendonitis and epicondylitis , and any aspect of computer work .
Conclusions There is limited epidemiological evidence for an association between aspects of computer work and some of the clinical diagnoses studied .
***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 A prospect i ve study of computer users was performed to determine the occurrence of and evaluate risk factors for  neck or shoulder ( N/S ) and h and or arm ( H/A ) musculoskeletal symptoms ( MSS ) and disorders ( MSD ) . METHODS Individuals ( n = 632 ) newly hired into jobs requiring > or = 15 hr/week of computer use were followed for up to 3 years . At study entry , workstation dimensions and worker postures were measured and medical and psychosocial risk factors were assessed . Daily diaries were used to document work practice s and incident MSS . Those reporting MSS were examined for specific MSD . Incidence rates of MSS and MSD were estimated with survival analysis . Cox regression models were used to evaluate associations between participant characteristics at entry and MSS and MSD . RESULTS The annual incidence of N/S MSS was 58 cases/100 person-years and of N/S MSD was 35 cases/100 person-years . The most common N/S MSD was somatic pain syndrome . The annual incidence of H/A MSS was 39 cases/100 person-years and of H/A MSD was 21 cases/100 person-years . The most common H/A disorder was deQuervain 's tendonitis . Forty-six percent of N/S and 32 % of H/A MSS occurred during the first month of follow-up . Gender , age , ethnicity , and prior history of N/S pain were associated with N/S MSS and MSD . Gender , prior history of H/A pain , prior computer use , and children at home were associated with either H/A MSS or MSD . CONCLUSIONS H/A and N/S MSS and MSD were common among computer users . More than 50 % of computer users reported MSS during the first year after starting a new job Three groups of data entry female visual display terminal ( VDT ) workers from Norway ( n = 30 ) , Pol and ( n = 33 ) and the USA ( n = 29 ) were compared . Before intervention , the Norwegian group reported more neck pain compared with the Polish group . The Polish group reported less shoulder pain than both the U.S. and the Norwegian groups . The clinical examination documented fewer symptoms and signs of musculoskeletal illness among the Polish participants compared with the Norwegian and the U.S. groups . After intervention , the Norwegian group reported a reduction in neck pain while the U.S. group reported a reduction in shoulder pain . The Polish group reported an increase in neck , shoulder and forearm pain at follow-up compared to after intervention . The Polish group recorded higher flexion of the upper arm at follow-up parallel with an increase of pain in the upper part of the body . Visual discomfort showed variable results in the 3 countries A group of routine data entry operators ( female ) was included in the Polish MEPS ( musculoskeletal — eyestrain— psychosocial — stress ) study . Before the intervention , ergonomic assessment revealed improper working conditions such as inadequate lighting , uncomfortable chairs , and lack of forearm and wrist support while medical examination revealed that trapezius muscle load along with upper arm , head and back angles were higher than advisable . Subjects complained about neck and shoulder pain , visual problems , and psychosocial conditions . The ergonomic intervention included installation of new luminaires and Venetian blinds , new chairs , repair of ventilators , and optometric corrections . The results after the intervention showed mainly improvement in chair comfort , lighting conditions , visual strain , and sitting posture . However , financial limitations did not allow satisfactory completion of the intervention leading to a mixed interpretation of the results Background : Call centre work with computers is associated with increased rates of upper body pain and musculoskeletal disorders . Methods : This one year , r and omised controlled intervention trial evaluated the effects of a wide forearm support surface and a trackball on upper body pain severity and incident musculoskeletal disorders among 182 call centre operators at a large healthcare company . Participants were r and omised to receive ( 1  ) ergonomics training only , ( 2 ) training plus a trackball , ( 3 ) training plus a forearm support , or ( 4 ) training plus a trackball and forearm support . Outcome measures were weekly pain severity scores and diagnosis of incident musculoskeletal disorder in the upper extremities or the neck/shoulder region based on physical examination performed by a physician blinded to intervention . Analyses using Cox proportional hazard models and linear regression models adjusted for demographic factors , baseline pain levels , and psychosocial job factors . Results : Post-intervention , 63 participants were diagnosed with one or more incident musculoskeletal disorders  . Hazard rate ratios showed a protective effect of the armboard for neck/shoulder disorders ( HR = 0.49 , 95 % CI 0.24 to 0.97 ) after adjusting for baseline pain levels and demographic and psychosocial factors . The armboard also significantly reduced neck/shoulder pain ( p = 0.01 ) and right upper extremity pain ( p = 0.002 ) in comparison to the control group . A return-on-investment model predicted a full return of armboard and installation costs within 10.6 months . Conclusion : Providing a large forearm support combined with ergonomic training is an effective intervention to prevent upper body musculoskeletal disorders and reduce upper body pain associated with computer work among call centre employees Abstract . The overall aim of this study was to investigate whether time pressure and verbal provocation has any effect on physiological and psychological reactions during work with a  computer mouse . It was hypothesised that physiological reactions other than muscle activity ( i.e. wrist movements , forces applied to the computer mouse ) would not be affected when working under stressful conditions . Fifteen subjects ( 8 men and 7 women ) participated , performing a st and ardised text-editing task under stress and control conditions .  Blood pressure , heart rate , heart rate variability , electromyography , a force-sensing computer mouse and electrogoniometry  were used to assess the physiological reactions of the subjects . Mood ratings and ratings of perceived exertion were used to assess their psychological reactions . The  time pressure and verbal provocation  ( stress situation ) result ed in increased physiological and psychological reactions compared with the two control situations . Heart rate , blood pressure and muscle activity in the first dorsal interosseus , right extensor digitorum and right trapezius muscles were greater in the stress situation . The peak forces applied to the button of the computer mouse and wrist movements were also affected by condition . Whether the increases in the physiological reactions were due to stress or increased speed/productivity during the stress situation is discussed . In conclusion , work with a computer mouse under time pressure and verbal provocation ( stress conditions ) led to increased physiological and psychological reactions compared to control conditions OBJECTIVES Following a consensus statement from a multidisciplinary UK workshop , a structured examination schedule was developed for the diagnosis and classification of musculoskeletal disorders of the upper limb . The aim of this study was to test the repeatability and the validity of the newly developed schedule in a hospital setting . METHOD 43 consecutive referrals to a soft tissue rheumatism clinic ( group 1 ) and 45 subjects with one of a list of specific upper limb disorders ( including shoulder capsulitis , rotator cuff tendinitis , lateral epicondylitis and tenosynovitis ) ( group 2 ) , were recruited from hospital rheumatology and orthopaedic outpatient clinics . All 88 subjects were examined by a research nurse ( blinded to diagnosis ) , and everyone from group 1 was independently examined by a rheumatologist . Between observer agreement was assessed among subjects from group 1 by calculating Cohen 's κ for dichotomous physical signs , and mean differences with limits of agreement for measured ranges of joint movement . To assess the validity of the examination , a pre-defined algorithm was applied to the nurse 's examination findings in patients from both groups , and the sensitivity and specificity of the derived diagnoses were determined in comparison with the clinic 's independent diagnosis as the reference st and ard . RESULTS The between observer repeatability of physical signs varied from good to excellent , with κ coefficients of 0.66 to 1.00 for most categorical observations , and mean absolute differences of 1.4 ° –11.9 ° for measurements of shoulder movement . The sensitivity of the schedule in comparison with the reference st and ard varied between diagnoses from 58%–100 % , while the specificities ranged from 84%–100 % . The nurse and the clinic physician generally agreed in their diagnoses , but in the presence of shoulder capsulitis the nurse usually also diagnosed shoulder tendinitis , whereas the clinic physician did not . CONCLUSION The new examination protocol is repeatable and gives acceptable diagnostic accuracy in a hospital setting . Examination can feasibly be delegated to a trained nurse , and the protocol has the benefit of face and construct validity as well as consensus backing . Its performance in the community , where disease is less clear cut , merits separate evaluation , and further refinement is needed to discriminate between discrete pathologies at the shoulder The Norwegian MEPS ( musculoskeletal — eyestrain — psychosocial — stress ) study included 3 groups : data entry , data dialogue ( female ) and data dialogue  ( male ) . Before intervention , the data entry group reported significantly more symptoms and signs of musculoskeletal illness and had longer periods in front of the video display terminal ( VDT ) without a break . The ergonomic intervention consisted mainly of ergonomic information and training . After intervention , the data dialogue female group reported a significant reduction in shoulder pain in parallel with a reduction in trapezius load . Increasing the underst and ing in how to adjust the work st and and chair may have been contributing factors to reducing the pain level . There was a significant reduction in eye problems in all groups ; the greatest reduction in eye symptoms was seen in the groups who had new optometric corrections This special issue of the International Journal of Occupational Safety and Ergonomics ( JOSE ) reports the results from an extensive multinational and multidisciplinary collaborative investigation of the impacts on  visual display terminal ( VDT ) work  of musculoskeletal , visual , ergonomic , and psychosocial factors . For brevity , this effort has been referred to as the MEPS project ( musculoskeletal — eyestrain — psychosocial — stress ) . This paper lays out the basic method ological structure of the study . The study was conducted in 4 countries utilizing VDT data entry workers as the primary subject population . A battery of objective and subject assessment measures , including muscle load , visual function , physical and visual strain , postural , ergonomic and psychosocial factors , were assessed at 3 different points in time . A pre-test was given prior to an ergonomic intervention . Two post-tests were given 1 month and 1 year after the ergonomic intervention A prospect i ve epidemiological field study covering a 2 years period has earlier been published . The study has a parallel group design with two intervention groups ( T and S ) and one  control group ( C ) of Visual Display Unit ( VDU ) operators . The present paper covers the period from 2 to 6 years of the study . After 3.5 years , the C group got the same intervention in terms of new lighting system , new workplaces and at last an optometric examination and corrections if needed . The C group reported a significant reduction in visual discomfort after interventions while the two groups ( T and S ) continued to report significant reduction of visual discomfort after 6 years . By supporting the forearm on the table top , the C group reported significant reduction of shoulder and neck pain while the T group reported significant reduction in shoulder and back pain after 6 years . Organizational and psychosocial factors at work and outside work did not show any significant changes during the study period BACKGROUND Despite widespread recommendations regarding posture during computer use , associations between specific postures and musculoskeletal health are not well characterized . METHODS Six hundred and thirty-two newly hired computer users were followed prospect ively to evaluate associations between posture and neck or shoulder ( N/S ) and h and or arm ( H/A ) musculoskeletal symptoms and musculoskeletal disorders . Participants ' postures were measured at entry and they reported symptoms on weekly diaries . Participants reporting symptoms were examined for specific disorders . Multivariate Cox regression models were used to estimate associations between postural variables and risk of symptoms and disorders , controlling for confounding variables . RESULTS Keying with an inner elbow angle > 121 degrees , greater downward head tilt , and presence of armrests on the participants chair were associated with lower risk of N/S symptoms or N/S disorders .  Keying with elbow height below the height of the " J " key and the presence of a telephone shoulder rest were associated with a greater risk of N/S symptoms or N/S disorders . Horizontal location of the " J " key > 12 cm from the edge of the desk was associated with a lower risk of H/A symptoms and H/A disorders . Use of a keyboard with the " J " key > 3.5 cm above the table surface , key activation force > 48 g , and radial wrist deviation of > 5 degrees while using a mouse was associated with a greater risk of H/A symptoms or H/A disorders . The number of hours keying/week was associated with H/A symptoms and disorders . CONCLUSIONS The results suggest that the risk of musculoskeletal symptoms and musculoskeletal disorders may be reduced by encouraging specific seated postures OBJECTIVES This prospect i ve study concentrated on determining factors of computer work that predict  musculoskeletal symptoms in the shoulder , elbow , and low-back regions . METHODS A question naire on ergonomics , work pauses , work techniques , and psychosocial and work factors was delivered to 5033 office workers at baseline in early 1999 ( response rate 69 % ) and to 3361 respondents at the time of the follow-up in late 2000 ( response rate 77 % ) . An increased frequency or intensity of symptoms was the outcome variable , including only nonsymptomatic respondents from the baseline question naire ( symptom frequency below 8 days within the last 12 months or intensity score below 4 within the last 3 months ) . RESULTS In the follow-up , 1 
    Output:
    