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: This study evaluated a two-year multidisciplinary early intervention pilot programme for back-injured nurses employed at a large teaching hospital , using a pre- versus post-programme analysis . The purpose was to ascertain whether this programme could reduce the incidence , morbidity , time lost and cost due to  back injuries in the 250 nurses employed on ten targeted high-risk wards . Injuries in the remaining 1395 nurses employed on the other 45 wards were monitored concurrently for comparison . The programme consisted of prompt assessment , treatment and rehabilitation through modified work . Evaluative data were gathered by one research nurse on st and ardized forms at the time of injury , weekly until return to work , and at a six-month follow-up . Time lost and cost data for up to one-year post-injury were derived from workers ' compensation statements . Compared to the two years prior to introduction of the programme , the rates of back injuries and lost-time back injuries decreased by 23 % and 43 % , respectively , on the targeted wards , while these increased on the control wards . Combined expenditure was 32 % lower per injury and 34 % lower per lost-time injury for those in the targeted group who consented to take part in the programme compared to their counterparts on the control wards , as the increased assessment and treatment costs per case attributable to the programme were more than offset by the savings in lower compensation ( wage loss ) costs . This programme thus reduced the incidence and time lost due to back injuries and was cost-beneficial Aims : To identify the work factors that predict  intense low back pain ( LBP ) and LBP related sick leaves in nurses ’ aides . Methods : The sample comprised 4266 r and omly selected Norwegian nurses ’ aides , not bothered or only a little bothered by LBP during the previous three months , and not on sick leave when completing a mailed question naire in 1999 . Of these , 3808 ( 89.3 % ) completed a second question naire 3 months later and 3651 ( 85.6 % ) completed a third question naire 15 months later . Intensity of low back symptoms and certified sick leaves attributed to LBP during the observation period were assessed by self reports at the follow ups . Results : After adjustments for LBP during the three months prior to baseline , baseline health complaints , demographic and familial factors , and a series of physical , psychological , and social work factors , logistic regression analyses revealed the following associations : intense low back symptoms were predicted by frequent positioning of patients in bed , perceived lack of support from immediate superior , and perceived lack of pleasant and relaxing culture in the work unit . LBP related sick leaves were predicted by frequent h and ling of heavy objects , medium level of work dem and s , perceived lack of supportive and encouraging culture in the work unit , working night shifts , and working in a nursing home . Long term LBP related sick leaves were associated with changes of work or work tasks during the observation period that result ed in a perceived reduction of support and encouragement at work . Conclusions : Not only frequent mechanical exposures , but also organisational , psychological , and social work factors , such as night shift work , perceived lack of support from superior , and perceived lack of a pleasant and relaxing or supporting and encouraging culture in the work unit , are associated with an increased risk of intense low back symptoms and LBP related sick leaves in nurses ’ aides RATIONALE Low back pain ( LBP ) remains a common and costly problem among the nursing profession . Several studies have indicated that LBP is attributed to mentally straining or dem and ing work , fatigue or exhaustion or general work satisfaction . AIMS This study aims to measure the magnitude of LBP among Hong Kong nurses and its association with the work-related psychological strain and patients h and ling activities . RESEARCH METHODS AND MEASURES : A cross-sectional study of Hong Kong hospital nurses was conducted . Three hundred and seventy-seven nurses were recruited from six district hospitals . They were registered nurses or enrolled nurses working full-time for at least 1 month in the current ward . One hundred and seventy-eight ( 47.2 % ) study subjects were r and omly selected from two district hospitals and 199 ( 52.8 % ) study nurses made up the convenience sample . Possible bias from psychological distress , socio-demographics and lifestyle factors was controlled for . Data were collected by face-to-face interviews . The data included work factors ( both psychological stress and patient h and ling activities related to work ) , demographics , psychological distress and lifestyle factors and the occurrence of LBP . RESULTS Of the 377 nurses interviewed , 153 ( 40.6 % ) reported having LBP within the last 12 months . With symptoms of LBP as the outcome , risks were increased where nurses self-reported that they only occasionally or never enjoyed their work [ adjusted odds ratio ( OR ) 2.07 ] , where frequent manual repositioning of patients on the bed was required ( adjusted OR 1.84 ) and where they were required to assist patients while walking ( adjusted OR 2.11 ) after adjustment for other potential confounders . CONCLUSION The results indicate that an association exists between work stress , manual lifting and LBP prevalence . The main route to prevention of LBP among nurses is likely to lie in improved ergonomics and psychological health in their work place . Good posture and correct transferring techniques in ward situations should be reinforced with h and s-on practice performed on nurses ' common types of clients The objective of this study was to investigate the low-back loading during common  patient-h and ling  tasks . Ten female health care workers without formal training in patient h and ling performed nine patient-h and ling tasks including turning , lifting and repositioning a male stroke patient .  The low-back loading was quantified by net moment , compression , and shear forces at the L4/L5 joint , measured muscle activity ( EMG ) in erector spinae muscles and rate of perceived exertion ( RPE ; Borg scale ) . The experiments were videotaped with a 50Hz video system using five cameras , and the ground and bedside reaction forces of the health care worker were recorded by means of force platforms and force transducers on the bed . The biomechanical load was calculated using a dynamic 3D seven-segment model of the lower part of the body , and the forces at the L4/L5 joint were estimated by a 14 muscles cross-sectional model of the low back ( optimisation procedure ) . Compression force and torque showed high task dependency whereas the EMG data and the RPE values were more dependent on the subject . The peak compression during two tasks involving lifting the patient ( 4132/4433N ) was significantly higher than all other tasks . Four tasks involving repositioning the patient in the bed ( 3179/3091/2932/3094N ) did not differ , but showed higher peak compression than two tasks turning the patient in the bed ( 1618/2197N ) . Thus , in this study the patient-h and ling tasks could be classified into three groups-characterised by lifting , repositioning or turning-with different levels of peak net torque and compression at the L4/L5 joint Back pain disability is a serious and costly problem affecting the nursing profession . The purpose s of this study were to determine risk factors for  work-related low back pain ( WRLBP ) in registered nurses and to record the reported use or reasons for nonuse of mechanical lifts . Our hypothesis was that workers who attributed the cause of WRLBP to their own actions would be knowledgeable about back safety , would be more likely to use lifts , and would report less WRLBP . A r and om sample of 270 registered nurses was selected from two acute care hospitals in central Illinois to identify WRLBP risk factors . This cross-sectional study gathered information on individual , physical workload , psychological , and organizational factors that may present a risk for WRLBP . Information was also collected on the use of  safety devices and back pain symptoms . The response rate was 50.4 % . Nearly 84 % of respondents had  WRLBP  in the past , and 36.2 % had WRLBP in the past year that limited movement or interfered with routine activities . Among the risk factors significantly associated with WRLBP were more years worked in nursing , frequent lifting , and low social support . Only 11 % reported that they routinely used mechanical lifting devices , and the primary reason given for failure to use lifting equipment was unavailability of equipment . The reasons for the lack of use of mechanical lifts should be investigated and addressed The aim of this Intervention was to evaluate the effect of training on patient-h and ling skills and prospect ively to assess the effect of skill on subsequent back pain and back injuries  in nursing . Of a total of 255 nurses , 199 were assessed for their skill in patient-h and ling .  One-half (  control  group ) received traditional training in patient-h and ling , and the other half ( trained group ) received a curriculum of instruction totaling 40 hours . The skills of both groups were assessed on graduation . The control group was rated as less competent in patient-h and ling .  Nurses in both groups were question ed about the prevalence of back pain and incidence of back injuries in the first year after graduation . In multiple regression analysis , the major risk Indicators for back injuries were poor patient-h and ling skill , low numbers of repetitions in the sit-up test , and high work-load scores . High score on the hysteria scale of Middlesex Hospital Question naire was a risk Indicator for all kinds of back pain . Though back pain was Independent of patient-h and ling skill , those rated as “ bad ” or “ poor ” had more back injuries ( 24 % ) than those who had been rated as “ good ” or “ excellent ” ( 2 % ) ( P < 0.001 ) , but the difference between the trained and control groups was not statistically significant . It was concluded that back Injuries may be prevented by the teaching of patient-h and ling skills Aims : To assess dose-response relations between occupational exposures to physical and psychosocial factors and the risk of  low back pain .  Methods : A cohort of 523 subjects , working in nursing homes and homes for the elderly , was followed prospect ively for one year . Physical load for different occupations was assessed by quantitative observations at the workplace . Information on low back pain and other factors was gathered with question naires administered at baseline and at one year . Two outcome measures of low back pain incidence were used : any new episode of pain lasting for at least a few hours during follow up ( LBP ) ; and any new episode of disabling pain that interfered with daily activities during follow up ( LBP/D ) . Hierarchical regression analysis with a spline function was used to estimate dose-response relations . Results : The risk of LBP was not associated with physical factors , controlling for confounders ; but this outcome was inversely associated with age and weakly , though imprecisely , associated with two psychosocial factors — low decision authority and high work dem and s. In contrast , the risk of LBP/D was positively associated with age and not associated with the psychosocial factors . Trunk flexion over 45 degrees was monotonically associated with the risk of LBP/D ; the estimated relative risk was 3.18 ( 95 % CI 1.13 to 9.00 ) for 1 hour and 45 minutes of bending per week ( 90th centile ) , relative to 30 minutes per week . The hierarchical estimates of effect were more stable than were the maximum likelihood estimates . Conclusion : Occupational exposure to trunk flexion over 45 degrees appears to be a risk factor for low back pain with disability among persons employed in nursing homes and homes for the elderly in the Netherl and Back injuries are a serious problem for nursing personnel who perform frequent patient-h and ling activities . Common prevention strategies include body mechanics education , technique training , and ergonomic interventions such as the introduction of assistive equipment . This investigation assessed and compared the effectiveness of two patient-h and ling approaches to reducing injury risk . One strategy involved using improved patient-h and ling technique with existing equipment , and the other approach aim ed at eliminating manual patient h and ling through the use of additional mechanical and other assistive equipment . Both intervention arms received training in back care , patient assessment , and use of the equipment available on their particular wards . An analysis of compliance with interventions and the effects of patient-h and ling methods on both peak and cumulative spinal compression and shear during various tasks was conducted . Results showed greater compliance with interventions that incorporated new assistive patient-h and ling equipment , as opposed to those consisting of education and technique training alone . In several tasks , subjects who were untrained or non-compliant with interventions experienced significantly higher peak spinal loading . However , patient-h and ling tasks conducted with the aid of assistive equipment took substantially longer than those performed manually . This , along with variations in techniques , led to increases in cumulative spinal loading with the use of patient-h and ling equipment on some tasks . Thus , the use of mechanical assistive devices may not always be the best approach to reducing back injuries in all situations . No single intervention can be recommended ; instead all patient-h and ling tasks should be examined separately to determine which methods maximize reductions in both peak and cumulative lumbar forces during a manoeuver As noted by Wesley Salmon and many others , causal concepts are ubiquitous in every branch of theoretical science , in the practical disciplines and in everyday life . In the theoretical and practical sciences especially , people often base cl aims about causal relations on applications of statistical methods to data . However , the source and type of data place important constraints on the choice of statistical methods as well as on the warrant attributed to the causal cl aims based on the use of such methods . For example , much of the data used by people interested in making causal cl aims come from non-experimental , observational studies in which r and om allocations to treatment and control groups are not present . Thus , one of the most important problems in the social and health sciences concerns making justified causal inferences using non-experimental , observational data . In this paper , I examine one method of justifying such inferences that is especially widespread in epidemiology and the health sciences generally – the use of causal criteria .  I argue that while the use of causal criteria is not appropriate for either deductive or 
    Output:
    
agent
Overall studies showed that nursing activities conferred increased risk for , and were associated with back disorders regardless of nursing technique , personal characteristics , and non-work-related factors .
Patient h and ling appears to confer the highest risk , but other nursing duties are also associated with elevated risk , and confound dose – response assessment s related to patient h and ling alone .
A threshold of nursing activities below which the risk of back disorders is not elevated has not been established .
***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: This study evaluated a two-year multidisciplinary early intervention pilot programme for back-injured nurses employed at a large teaching hospital , using a pre- versus post-programme analysis . The purpose was to ascertain whether this programme could reduce the incidence , morbidity , time lost and cost due to  back injuries in the 250 nurses employed on ten targeted high-risk wards . Injuries in the remaining 1395 nurses employed on the other 45 wards were monitored concurrently for comparison . The programme consisted of prompt assessment , treatment and rehabilitation through modified work . Evaluative data were gathered by one research nurse on st and ardized forms at the time of injury , weekly until return to work , and at a six-month follow-up . Time lost and cost data for up to one-year post-injury were derived from workers ' compensation statements . Compared to the two years prior to introduction of the programme , the rates of back injuries and lost-time back injuries decreased by 23 % and 43 % , respectively , on the targeted wards , while these increased on the control wards . Combined expenditure was 32 % lower per injury and 34 % lower per lost-time injury for those in the targeted group who consented to take part in the programme compared to their counterparts on the control wards , as the increased assessment and treatment costs per case attributable to the programme were more than offset by the savings in lower compensation ( wage loss ) costs . This programme thus reduced the incidence and time lost due to back injuries and was cost-beneficial Aims : To identify the work factors that predict  intense low back pain ( LBP ) and LBP related sick leaves in nurses ’ aides . Methods : The sample comprised 4266 r and omly selected Norwegian nurses ’ aides , not bothered or only a little bothered by LBP during the previous three months , and not on sick leave when completing a mailed question naire in 1999 . Of these , 3808 ( 89.3 % ) completed a second question naire 3 months later and 3651 ( 85.6 % ) completed a third question naire 15 months later . Intensity of low back symptoms and certified sick leaves attributed to LBP during the observation period were assessed by self reports at the follow ups . Results : After adjustments for LBP during the three months prior to baseline , baseline health complaints , demographic and familial factors , and a series of physical , psychological , and social work factors , logistic regression analyses revealed the following associations : intense low back symptoms were predicted by frequent positioning of patients in bed , perceived lack of support from immediate superior , and perceived lack of pleasant and relaxing culture in the work unit . LBP related sick leaves were predicted by frequent h and ling of heavy objects , medium level of work dem and s , perceived lack of supportive and encouraging culture in the work unit , working night shifts , and working in a nursing home . Long term LBP related sick leaves were associated with changes of work or work tasks during the observation period that result ed in a perceived reduction of support and encouragement at work . Conclusions : Not only frequent mechanical exposures , but also organisational , psychological , and social work factors , such as night shift work , perceived lack of support from superior , and perceived lack of a pleasant and relaxing or supporting and encouraging culture in the work unit , are associated with an increased risk of intense low back symptoms and LBP related sick leaves in nurses ’ aides RATIONALE Low back pain ( LBP ) remains a common and costly problem among the nursing profession . Several studies have indicated that LBP is attributed to mentally straining or dem and ing work , fatigue or exhaustion or general work satisfaction . AIMS This study aims to measure the magnitude of LBP among Hong Kong nurses and its association with the work-related psychological strain and patients h and ling activities . RESEARCH METHODS AND MEASURES : A cross-sectional study of Hong Kong hospital nurses was conducted . Three hundred and seventy-seven nurses were recruited from six district hospitals . They were registered nurses or enrolled nurses working full-time for at least 1 month in the current ward . One hundred and seventy-eight ( 47.2 % ) study subjects were r and omly selected from two district hospitals and 199 ( 52.8 % ) study nurses made up the convenience sample . Possible bias from psychological distress , socio-demographics and lifestyle factors was controlled for . Data were collected by face-to-face interviews . The data included work factors ( both psychological stress and patient h and ling activities related to work ) , demographics , psychological distress and lifestyle factors and the occurrence of LBP . RESULTS Of the 377 nurses interviewed , 153 ( 40.6 % ) reported having LBP within the last 12 months . With symptoms of LBP as the outcome , risks were increased where nurses self-reported that they only occasionally or never enjoyed their work [ adjusted odds ratio ( OR ) 2.07 ] , where frequent manual repositioning of patients on the bed was required ( adjusted OR 1.84 ) and where they were required to assist patients while walking ( adjusted OR 2.11 ) after adjustment for other potential confounders . CONCLUSION The results indicate that an association exists between work stress , manual lifting and LBP prevalence . The main route to prevention of LBP among nurses is likely to lie in improved ergonomics and psychological health in their work place . Good posture and correct transferring techniques in ward situations should be reinforced with h and s-on practice performed on nurses ' common types of clients The objective of this study was to investigate the low-back loading during common  patient-h and ling  tasks . Ten female health care workers without formal training in patient h and ling performed nine patient-h and ling tasks including turning , lifting and repositioning a male stroke patient .  The low-back loading was quantified by net moment , compression , and shear forces at the L4/L5 joint , measured muscle activity ( EMG ) in erector spinae muscles and rate of perceived exertion ( RPE ; Borg scale ) . The experiments were videotaped with a 50Hz video system using five cameras , and the ground and bedside reaction forces of the health care worker were recorded by means of force platforms and force transducers on the bed . The biomechanical load was calculated using a dynamic 3D seven-segment model of the lower part of the body , and the forces at the L4/L5 joint were estimated by a 14 muscles cross-sectional model of the low back ( optimisation procedure ) . Compression force and torque showed high task dependency whereas the EMG data and the RPE values were more dependent on the subject . The peak compression during two tasks involving lifting the patient ( 4132/4433N ) was significantly higher than all other tasks . Four tasks involving repositioning the patient in the bed ( 3179/3091/2932/3094N ) did not differ , but showed higher peak compression than two tasks turning the patient in the bed ( 1618/2197N ) . Thus , in this study the patient-h and ling tasks could be classified into three groups-characterised by lifting , repositioning or turning-with different levels of peak net torque and compression at the L4/L5 joint Back pain disability is a serious and costly problem affecting the nursing profession . The purpose s of this study were to determine risk factors for  work-related low back pain ( WRLBP ) in registered nurses and to record the reported use or reasons for nonuse of mechanical lifts . Our hypothesis was that workers who attributed the cause of WRLBP to their own actions would be knowledgeable about back safety , would be more likely to use lifts , and would report less WRLBP . A r and om sample of 270 registered nurses was selected from two acute care hospitals in central Illinois to identify WRLBP risk factors . This cross-sectional study gathered information on individual , physical workload , psychological , and organizational factors that may present a risk for WRLBP . Information was also collected on the use of  safety devices and back pain symptoms . The response rate was 50.4 % . Nearly 84 % of respondents had  WRLBP  in the past , and 36.2 % had WRLBP in the past year that limited movement or interfered with routine activities . Among the risk factors significantly associated with WRLBP were more years worked in nursing , frequent lifting , and low social support . Only 11 % reported that they routinely used mechanical lifting devices , and the primary reason given for failure to use lifting equipment was unavailability of equipment . The reasons for the lack of use of mechanical lifts should be investigated and addressed The aim of this Intervention was to evaluate the effect of training on patient-h and ling skills and prospect ively to assess the effect of skill on subsequent back pain and back injuries  in nursing . Of a total of 255 nurses , 199 were assessed for their skill in patient-h and ling .  One-half (  control  group ) received traditional training in patient-h and ling , and the other half ( trained group ) received a curriculum of instruction totaling 40 hours . The skills of both groups were assessed on graduation . The control group was rated as less competent in patient-h and ling .  Nurses in both groups were question ed about the prevalence of back pain and incidence of back injuries in the first year after graduation . In multiple regression analysis , the major risk Indicators for back injuries were poor patient-h and ling skill , low numbers of repetitions in the sit-up test , and high work-load scores . High score on the hysteria scale of Middlesex Hospital Question naire was a risk Indicator for all kinds of back pain . Though back pain was Independent of patient-h and ling skill , those rated as “ bad ” or “ poor ” had more back injuries ( 24 % ) than those who had been rated as “ good ” or “ excellent ” ( 2 % ) ( P < 0.001 ) , but the difference between the trained and control groups was not statistically significant . It was concluded that back Injuries may be prevented by the teaching of patient-h and ling skills Aims : To assess dose-response relations between occupational exposures to physical and psychosocial factors and the risk of  low back pain .  Methods : A cohort of 523 subjects , working in nursing homes and homes for the elderly , was followed prospect ively for one year . Physical load for different occupations was assessed by quantitative observations at the workplace . Information on low back pain and other factors was gathered with question naires administered at baseline and at one year . Two outcome measures of low back pain incidence were used : any new episode of pain lasting for at least a few hours during follow up ( LBP ) ; and any new episode of disabling pain that interfered with daily activities during follow up ( LBP/D ) . Hierarchical regression analysis with a spline function was used to estimate dose-response relations . Results : The risk of LBP was not associated with physical factors , controlling for confounders ; but this outcome was inversely associated with age and weakly , though imprecisely , associated with two psychosocial factors — low decision authority and high work dem and s. In contrast , the risk of LBP/D was positively associated with age and not associated with the psychosocial factors . Trunk flexion over 45 degrees was monotonically associated with the risk of LBP/D ; the estimated relative risk was 3.18 ( 95 % CI 1.13 to 9.00 ) for 1 hour and 45 minutes of bending per week ( 90th centile ) , relative to 30 minutes per week . The hierarchical estimates of effect were more stable than were the maximum likelihood estimates . Conclusion : Occupational exposure to trunk flexion over 45 degrees appears to be a risk factor for low back pain with disability among persons employed in nursing homes and homes for the elderly in the Netherl and Back injuries are a serious problem for nursing personnel who perform frequent patient-h and ling activities . Common prevention strategies include body mechanics education , technique training , and ergonomic interventions such as the introduction of assistive equipment . This investigation assessed and compared the effectiveness of two patient-h and ling approaches to reducing injury risk . One strategy involved using improved patient-h and ling technique with existing equipment , and the other approach aim ed at eliminating manual patient h and ling through the use of additional mechanical and other assistive equipment . Both intervention arms received training in back care , patient assessment , and use of the equipment available on their particular wards . An analysis of compliance with interventions and the effects of patient-h and ling methods on both peak and cumulative spinal compression and shear during various tasks was conducted . Results showed greater compliance with interventions that incorporated new assistive patient-h and ling equipment , as opposed to those consisting of education and technique training alone . In several tasks , subjects who were untrained or non-compliant with interventions experienced significantly higher peak spinal loading . However , patient-h and ling tasks conducted with the aid of assistive equipment took substantially longer than those performed manually . This , along with variations in techniques , led to increases in cumulative spinal loading with the use of patient-h and ling equipment on some tasks . Thus , the use of mechanical assistive devices may not always be the best approach to reducing back injuries in all situations . No single intervention can be recommended ; instead all patient-h and ling tasks should be examined separately to determine which methods maximize reductions in both peak and cumulative lumbar forces during a manoeuver As noted by Wesley Salmon and many others , causal concepts are ubiquitous in every branch of theoretical science , in the practical disciplines and in everyday life . In the theoretical and practical sciences especially , people often base cl aims about causal relations on applications of statistical methods to data . However , the source and type of data place important constraints on the choice of statistical methods as well as on the warrant attributed to the causal cl aims based on the use of such methods . For example , much of the data used by people interested in making causal cl aims come from non-experimental , observational studies in which r and om allocations to treatment and control groups are not present . Thus , one of the most important problems in the social and health sciences concerns making justified causal inferences using non-experimental , observational data . In this paper , I examine one method of justifying such inferences that is especially widespread in epidemiology and the health sciences generally – the use of causal criteria .  I argue that while the use of causal criteria is not appropriate for either deductive or 
    Output:
    