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 There is limited knowledge about what happens to people after long-term sick leave . The aim of this report was to conduct a prospect i ve study of individuals who were on prolonged sick leave during a particular year , considering their activities and sources of income during subsequent years . To enable comparison of different time periods , we used three cohorts of individuals with different starting years . Methods Using data from national registers , three separate cohorts were constructed that included all people living in Sweden who were 20 - 64 years of age ( > 5 million ) in the years 1995 , 2000 and 2005 , respectively . The individual members of the cohorts were classified into the following groups based on their main source of income and activity in 1995 - 2008 : on long-term sick leave , employed , old-age pensioner , long-term unemployed , disability pensioner , on parental leave , social assistance recipient , student allowance recipient , deceased , or emigrated . Results Most individuals on long-term ( > 6 months ) sick leave in 1995 were not employed 13 years later . Only 11 % of the women and 13 % of the men were primarily in employment after 13 years . Instead , a wide range of alternatives existed , for example , many had been granted disability pension , and about 10 % of the women and 17 % of the men had died during the follow-up period . A larger proportion of those with long-term sick leave were back in employment when 2005 was the starting year for the follow-up . Conclusions The low future employment rates for people on long-term sick leave may seem surprising . There are several possible explanations for the finding : The disorders these people may have , might have entailed longst and ing difficulties on the labor market . Besides , long-term absence from work , no matter what its causes were , might have worsen the chances of further employment . The economic cycles may also have been of importance . The improving labor market during later years seems to have improved the chances for employment among those earlier on long-term sick leave OBJECTIVE : To examine the effects of weight loss on health-related quality of life ( HRQL ) in subjects with severe obesity . DESIGN : Controlled clinical trial of the outcomes of surgical vs conventional weight reduction treatment . SUBJECTS : The first 487 surgical cases and their conventionally treated , matched controls were followed for two years in the Swedish Obese Subjects ( SOS ) intervention study . MEASUREMENTS : A battery of generic and study -specific self- assessment instruments or subscales was used to characterize HRQL in the severely obese ( BMI ) ≥34 kg/m2 for males and BMI ≥38 kg/m2 for females ) . Measures of general health perceptions ( general health rating index ; current health ) , mental well-being ( mood adjective check list ; pleasantness , activation and calmness ) , mood disorders ( hospital anxiety and depression scale ; anxiety and depression ) and social interaction ( sickness impact profile ) , were supplemented by obesity-specific modules on obesity-related psychosocial problems and eating behavior ( three-factor eating question naire ; restrained eating , disinhibition and perceived hunger ) . Assessment s were conducted prior to treatment and repeated after 6 , 12 and 24 months . RESULTS : Poor HRQL before intervention was dramatically improved after gastric restriction surgery , while only minor fluctuations in HRQL scores were observed in the conventionally treated controls . Peak values were observed in the surgical group at 6 or 12 months after intervention with a slight to moderate decrease at the two-year follow-up . The positive changes in HRQL after two years were related to the magnitude of weight loss , that is , the greater the weight reduction , the greater the HRQL improvements . Eating behavior improved accordingly . CONCLUSION : Quality of life in the severely obese is improved by substantial weight loss . Most patients benefit from weight reduction surgery , while HRQL in surgical patients with minor reduction in overweight is less positive . Further research is needed to determine outcome predictors of the surgical management of severe obesity and to ensure that HRQL improvements are maintained BACKGROUND Few long-term reports with high rates of follow-up are available after  gastric bypass .  We report changes in weight , co-morbidity , cardiovascular risk , and health-related quality of life ( HRQoL ) 5 years after gastric bypass .  METHODS Patients who had gastric bypass ( 2004 - 2006 ) were included . Prospect i ve data were review ed . Long-term complications , cardiovascular risk factors , and HRQoL were evaluated , and the 10-year risk for coronary heart disease was estimated ( Framingham risk score ) . Outcomes were compared in patients with body mass index ( BMI ) < 50 and ≥50 kg/m(2 ) . RESULTS A total of 184 of 203 patients ( 91 % ) met to follow-up . The mean ± SD preoperative BMI was 46 ± 5 kg/m(2 ) , and the mean ± SD age was 38 ± 9 years ; 75 % were women . Thirty-two percent of the patients had a BMI ≥50 kg/m(2 ) , and 30 % had type 2 diabetes . Follow-up was 63 ± 5 months . After 5 years , total weight loss was 27 % ± 11 % . Remission of type 2 diabetes had occurred in 67 % . The prevalence of hypertension , dyslipidemia , sleep apnea , and metabolic syndrome had decreased . HRQoL was improved . The Framingham risk score was reduced ( 5.6 % versus 4.6 % ; P = .021 ) . Sixty-one patients ( 33 % ) had long-term complications , most commonly chronic abdominal pain ( 10 % ) . BMI was 33 ± 5 and 37 ± 7 kg/m(2 ) in patients with preoperative BMI < 50 and ≥50 kg/m(2 ) , but changes in metabolic , cardiovascular risk profile and HRQoL were broadly similar . CONCLUSIONS Beneficial effects on weight loss , cardiovascular risk , and HRQoL were documented 5 years after gastric bypass in morbidly and super-obese patients OBJECTIVE To evaluate the private third-party payer return on investment for  bariatric surgery the United States . STUDY DESIGN Morbidly obese patients aged 18 years or older were identified in an employer cl aims data base of more than 5 million beneficiaries ( 1999 - 2005 ) using International Classification of Diseases , Ninth Revision , Clinical Modification code 278.01 . Each of 3651 patients who underwent bariatric surgery during this period was matched to a control subject who was morbidly obese and never underwent bariatric surgery . Bariatric surgery patients and controls were matched based on patient demographics , selected comorbidities , and costs . METHODS Total healthcare costs for bariatric surgery patients and their controls were recorded for 6 months before surgery through the end their continuous enrollment . To account for potential differences in patient characteristics , we calculated the cost differential by estimating a Tobit model . A return on investment was estimated from the result ing coefficients . Costs were inflation adjusted to 2005 US dollars using the Consumer Price Index for Medical Care , and the cost savings were discounted by 3.07 % , the month Treasury bill rate during the same period . RESULTS The mean bariatric surgery investment ranged from approximately $ 17,000 to $ 26,000 . After controlling for observable patient characteristics , we estimated all costs to have been recouped within 2 years for laparoscopic surgery patients and within 4 years for open surgery patients . CONCLUSIONS Downstream savings associated with bariatric surgery are estimated to offset the initial costs in 2 to 4 years . R and omized or quasiexperimental studies would be useful to confirm this conclusion , as unobserved characteristics may influence the decision to undergo surgery and can not be controlled for in this analysis BACKGROUND Physical , emotional , and social functioning are impaired in obesity . It is unknown whether and , if so , to what extent and in which domain obese subjects who lose weight may catch up to normal-weight levels . Our objective was to compare the health-related quality -of-life ( HRQL ) of obese subjects with that of a normal-weight reference group before and 1 year after a weight loss program that centered around laparoscopic and open gastric b and ing . METHODS An HRQL question naire consisting of a battery of both generic and specific measures was administered to 50 morbidly obese subjects on 2 occasions and to 100 healthy , normal-weight subjects , matched for age , gender , education , and vocational training . In addition to weight loss and health gain , the influences of achieved weight loss goals , satisfaction with outcome and operative approach ( laparoscopy/laparotomy ) were assessed . RESULTS Quality -of-life was significantly impaired in obese subjects . With a substantial weight loss of 35 kg and 42 % loss of excessive weight , and correction of disturbed metabolic parameters , they significantly improved in general well-being , health distress , and perceived attractiveness , approaching halfway the values of a normal-weight reference group . Improvement in values for depression and self-regard lagged behind . In physical activity , they bypassed the reference group . Days of sick leave decreased to the level of the reference group . Improvements in HRQL paralleled the rate of weight loss . Personal satisfaction and surgical approach were of minor influence . CONCLUSIONS The obese subjects ' impaired physical and social functioning improved considerably , catching up midway to normal-weight reference values after weight loss . Psychologic amelioration lagged behind . Whether the latter will catch up later and physical/social improvements will be maintained is the subject of further studies Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment BACKGROUND Obesity is an increasing public health problem . A small number of studies have examined the relationship between obesity and sickness absence , with mixed results , particularly regarding short-term sickness absence . AIMS To determine if obesity is associated with short- and long-term sickness absence and to investigate the mechanisms that may underlie any association . METHODS  Cross-sectional ( n = 1489 ) and prospect i ve ( n = 625 ) analyses were conducted on staff from London Underground Ltd. All participants underwent regular clinical examinations that involved their height and weight being measured , obesity-related medical problems being diagnosed and psychiatric disorders being identified . The number of days taken for short- ( < 10 days in an episode ) and  long-term sickness absence  were recorded by managers on an electronic data base . RESULTS There was a positive linear association between employees '  body mass index ( BMI ) and the number of days ' work missed due to sickness absence on both cross-sectional and prospect i ve analyses ( P < 0.001 ) . Obesity was a risk factor for both short- and long-term sickness absence . Obese individuals typically took an extra 4 days sick leave every year . The majority of the increased risk for long-term sickness absence appeared to be mediated via co-morbid chronic medical conditions . The excess short-term sickness absence was not explained by obesity-related medical problems , psychiatric disorders or workplace factors . CONCLUSIONS Obese employees take significantly more short- and long-term sickness absence than workers of a healthy weight . There is growing evidence to support employers becoming more involved in tackling obesity BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P 
    Output:
    
agent
However , the existing evidence does suggest that bariatric surgery has a generally positive impact on occupational outcomes .
This suggests that surgery may have wider economic , social and psychological benefits above and beyond its immediate health benefits
***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 There is limited knowledge about what happens to people after long-term sick leave . The aim of this report was to conduct a prospect i ve study of individuals who were on prolonged sick leave during a particular year , considering their activities and sources of income during subsequent years . To enable comparison of different time periods , we used three cohorts of individuals with different starting years . Methods Using data from national registers , three separate cohorts were constructed that included all people living in Sweden who were 20 - 64 years of age ( > 5 million ) in the years 1995 , 2000 and 2005 , respectively . The individual members of the cohorts were classified into the following groups based on their main source of income and activity in 1995 - 2008 : on long-term sick leave , employed , old-age pensioner , long-term unemployed , disability pensioner , on parental leave , social assistance recipient , student allowance recipient , deceased , or emigrated . Results Most individuals on long-term ( > 6 months ) sick leave in 1995 were not employed 13 years later . Only 11 % of the women and 13 % of the men were primarily in employment after 13 years . Instead , a wide range of alternatives existed , for example , many had been granted disability pension , and about 10 % of the women and 17 % of the men had died during the follow-up period . A larger proportion of those with long-term sick leave were back in employment when 2005 was the starting year for the follow-up . Conclusions The low future employment rates for people on long-term sick leave may seem surprising . There are several possible explanations for the finding : The disorders these people may have , might have entailed longst and ing difficulties on the labor market . Besides , long-term absence from work , no matter what its causes were , might have worsen the chances of further employment . The economic cycles may also have been of importance . The improving labor market during later years seems to have improved the chances for employment among those earlier on long-term sick leave OBJECTIVE : To examine the effects of weight loss on health-related quality of life ( HRQL ) in subjects with severe obesity . DESIGN : Controlled clinical trial of the outcomes of surgical vs conventional weight reduction treatment . SUBJECTS : The first 487 surgical cases and their conventionally treated , matched controls were followed for two years in the Swedish Obese Subjects ( SOS ) intervention study . MEASUREMENTS : A battery of generic and study -specific self- assessment instruments or subscales was used to characterize HRQL in the severely obese ( BMI ) ≥34 kg/m2 for males and BMI ≥38 kg/m2 for females ) . Measures of general health perceptions ( general health rating index ; current health ) , mental well-being ( mood adjective check list ; pleasantness , activation and calmness ) , mood disorders ( hospital anxiety and depression scale ; anxiety and depression ) and social interaction ( sickness impact profile ) , were supplemented by obesity-specific modules on obesity-related psychosocial problems and eating behavior ( three-factor eating question naire ; restrained eating , disinhibition and perceived hunger ) . Assessment s were conducted prior to treatment and repeated after 6 , 12 and 24 months . RESULTS : Poor HRQL before intervention was dramatically improved after gastric restriction surgery , while only minor fluctuations in HRQL scores were observed in the conventionally treated controls . Peak values were observed in the surgical group at 6 or 12 months after intervention with a slight to moderate decrease at the two-year follow-up . The positive changes in HRQL after two years were related to the magnitude of weight loss , that is , the greater the weight reduction , the greater the HRQL improvements . Eating behavior improved accordingly . CONCLUSION : Quality of life in the severely obese is improved by substantial weight loss . Most patients benefit from weight reduction surgery , while HRQL in surgical patients with minor reduction in overweight is less positive . Further research is needed to determine outcome predictors of the surgical management of severe obesity and to ensure that HRQL improvements are maintained BACKGROUND Few long-term reports with high rates of follow-up are available after  gastric bypass .  We report changes in weight , co-morbidity , cardiovascular risk , and health-related quality of life ( HRQoL ) 5 years after gastric bypass .  METHODS Patients who had gastric bypass ( 2004 - 2006 ) were included . Prospect i ve data were review ed . Long-term complications , cardiovascular risk factors , and HRQoL were evaluated , and the 10-year risk for coronary heart disease was estimated ( Framingham risk score ) . Outcomes were compared in patients with body mass index ( BMI ) < 50 and ≥50 kg/m(2 ) . RESULTS A total of 184 of 203 patients ( 91 % ) met to follow-up . The mean ± SD preoperative BMI was 46 ± 5 kg/m(2 ) , and the mean ± SD age was 38 ± 9 years ; 75 % were women . Thirty-two percent of the patients had a BMI ≥50 kg/m(2 ) , and 30 % had type 2 diabetes . Follow-up was 63 ± 5 months . After 5 years , total weight loss was 27 % ± 11 % . Remission of type 2 diabetes had occurred in 67 % . The prevalence of hypertension , dyslipidemia , sleep apnea , and metabolic syndrome had decreased . HRQoL was improved . The Framingham risk score was reduced ( 5.6 % versus 4.6 % ; P = .021 ) . Sixty-one patients ( 33 % ) had long-term complications , most commonly chronic abdominal pain ( 10 % ) . BMI was 33 ± 5 and 37 ± 7 kg/m(2 ) in patients with preoperative BMI < 50 and ≥50 kg/m(2 ) , but changes in metabolic , cardiovascular risk profile and HRQoL were broadly similar . CONCLUSIONS Beneficial effects on weight loss , cardiovascular risk , and HRQoL were documented 5 years after gastric bypass in morbidly and super-obese patients OBJECTIVE To evaluate the private third-party payer return on investment for  bariatric surgery the United States . STUDY DESIGN Morbidly obese patients aged 18 years or older were identified in an employer cl aims data base of more than 5 million beneficiaries ( 1999 - 2005 ) using International Classification of Diseases , Ninth Revision , Clinical Modification code 278.01 . Each of 3651 patients who underwent bariatric surgery during this period was matched to a control subject who was morbidly obese and never underwent bariatric surgery . Bariatric surgery patients and controls were matched based on patient demographics , selected comorbidities , and costs . METHODS Total healthcare costs for bariatric surgery patients and their controls were recorded for 6 months before surgery through the end their continuous enrollment . To account for potential differences in patient characteristics , we calculated the cost differential by estimating a Tobit model . A return on investment was estimated from the result ing coefficients . Costs were inflation adjusted to 2005 US dollars using the Consumer Price Index for Medical Care , and the cost savings were discounted by 3.07 % , the month Treasury bill rate during the same period . RESULTS The mean bariatric surgery investment ranged from approximately $ 17,000 to $ 26,000 . After controlling for observable patient characteristics , we estimated all costs to have been recouped within 2 years for laparoscopic surgery patients and within 4 years for open surgery patients . CONCLUSIONS Downstream savings associated with bariatric surgery are estimated to offset the initial costs in 2 to 4 years . R and omized or quasiexperimental studies would be useful to confirm this conclusion , as unobserved characteristics may influence the decision to undergo surgery and can not be controlled for in this analysis BACKGROUND Physical , emotional , and social functioning are impaired in obesity . It is unknown whether and , if so , to what extent and in which domain obese subjects who lose weight may catch up to normal-weight levels . Our objective was to compare the health-related quality -of-life ( HRQL ) of obese subjects with that of a normal-weight reference group before and 1 year after a weight loss program that centered around laparoscopic and open gastric b and ing . METHODS An HRQL question naire consisting of a battery of both generic and specific measures was administered to 50 morbidly obese subjects on 2 occasions and to 100 healthy , normal-weight subjects , matched for age , gender , education , and vocational training . In addition to weight loss and health gain , the influences of achieved weight loss goals , satisfaction with outcome and operative approach ( laparoscopy/laparotomy ) were assessed . RESULTS Quality -of-life was significantly impaired in obese subjects . With a substantial weight loss of 35 kg and 42 % loss of excessive weight , and correction of disturbed metabolic parameters , they significantly improved in general well-being , health distress , and perceived attractiveness , approaching halfway the values of a normal-weight reference group . Improvement in values for depression and self-regard lagged behind . In physical activity , they bypassed the reference group . Days of sick leave decreased to the level of the reference group . Improvements in HRQL paralleled the rate of weight loss . Personal satisfaction and surgical approach were of minor influence . CONCLUSIONS The obese subjects ' impaired physical and social functioning improved considerably , catching up midway to normal-weight reference values after weight loss . Psychologic amelioration lagged behind . Whether the latter will catch up later and physical/social improvements will be maintained is the subject of further studies Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment BACKGROUND Obesity is an increasing public health problem . A small number of studies have examined the relationship between obesity and sickness absence , with mixed results , particularly regarding short-term sickness absence . AIMS To determine if obesity is associated with short- and long-term sickness absence and to investigate the mechanisms that may underlie any association . METHODS  Cross-sectional ( n = 1489 ) and prospect i ve ( n = 625 ) analyses were conducted on staff from London Underground Ltd. All participants underwent regular clinical examinations that involved their height and weight being measured , obesity-related medical problems being diagnosed and psychiatric disorders being identified . The number of days taken for short- ( < 10 days in an episode ) and  long-term sickness absence  were recorded by managers on an electronic data base . RESULTS There was a positive linear association between employees '  body mass index ( BMI ) and the number of days ' work missed due to sickness absence on both cross-sectional and prospect i ve analyses ( P < 0.001 ) . Obesity was a risk factor for both short- and long-term sickness absence . Obese individuals typically took an extra 4 days sick leave every year . The majority of the increased risk for long-term sickness absence appeared to be mediated via co-morbid chronic medical conditions . The excess short-term sickness absence was not explained by obesity-related medical problems , psychiatric disorders or workplace factors . CONCLUSIONS Obese employees take significantly more short- and long-term sickness absence than workers of a healthy weight . There is growing evidence to support employers becoming more involved in tackling obesity BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P 
    Output:
    