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 : Plasma prolactin levels are sensitive to dopamine and serotonin function , and fatigue . Low cortisol , dopamine and /or serotonin may be involved in burnout and detachment . Methods : In this double-blind within-subject study , we treated 9 female burnout subjects and 9 controls with 35 mg cortisol and placebo orally . We measured state affect and plasma prolactin , oxytocin , cortisol and adrenocorticotropic hormone levels , and administered an attachment question naire . Results : The burnout subjects displayed an extreme distribution of basal prolactin levels , displaying higher or lower levels compared to the controls . The low prolactin burnouts had profoundly low attachment scores and tended to have low oxytocin levels . The high prolactin burnout subjects tended to show cortisol-induced decreased prolactin and fatigue , and increased vigor . Conclusion : Results are consistent with the hypothesis that burnout subjects are either characterized by low serotonergic function or by low dopaminergic function , and that the latter group benefits from cortisol replacement . These preliminary results suggest that differentiating between two syndromes may resolve inconsistencies in research on burnout , and be necessary for selecting the right treatment strategy Background Occupational burnout is associated with severe negative health effects . While stress management programs proved to have a positive influence on the well-being of patients suffering from burnout , it remains unclear whether aerobic exercise alleviates burnout severity and other parameters related to occupational burnout . Therefore , the main purpose of this study was to pilot-test the potential outcomes of a 12-week exercise training to generate hypotheses for future larger scale studies . Methods The sample consisted of 12 male participants scoring high on the MBI emotional exhaustion and depersonalization subscales . The training program took place in a private fitness center with a 17.5 kcal/kg minimum requirement of weekly energy expenditure . Results The key findings are that increased exercise reduced overall perceived stress as well as symptoms of burnout and depression . The magnitude of the effects was large , revealing changes of substantial practical relevance . Additionally , profiles of mood states improved considerably after single exercise sessions with a marked shift towards an iceberg profile . Conclusion Among burnout patients , the findings provide preliminary evidence that exercise has the potential to reduce stress and prevent the development of a deeper depression . This has important health implication s given that burnout is considered an antecedent of depressive disorders . Trial registration Clinical Trials.gov Identifier : OBJECTIVE To evaluate the efficacy of Qigong in rehabilitation for patients with burnout . DESIGN Prospect i ve , r and omized controlled trial . SUBJECTS Eighty-two patients ( 68 women and 14 men , mean age 44.3 ( st and ard deviation 9.1 ) years ) diagnosed with burnout . METHODS Basic care was offered to both the intervention and the control group . Patients in the intervention group received basic care and , in addition , performed Qigong twice a week for 12 weeks .  Psychological variables , health-related quality of life , perceived relaxation and physical measurements were assessed at baseline and after the intervention period . RESULTS No significant difference in treatment efficacy between the groups was found by either intention-to-treat or per- protocol analyses . Both groups improved significantly over time , with reduced levels of burnout , fatigue , anxiety and depression , and increased dynamic balance and physical capacity . CONCLUSION In this study , a Qigong intervention twice a week for 12 weeks had no additional effect beyond basic care for patients with burnout Conundrums in musculoskeletal research are common . Halliday and colleagues1 demonstrated similar outcomes for patients with chronic low back pain who received two seemingly different interventions : ( 1 ) a McKenzie approach and ( 2 ) motor control exercises .  Chmielewski and associates2 reported similar knee function and psychosocial status scores in those who received either low intensity or high intensity plyometric exercise programmes . Finally , van Beijsterveildt et al found no differences in the prevention of injuries among amateur footballers when usual care was compared against an exercise strategy that consisted of core stability , eccentric training of thigh muscles , proprioceptive training , dynamic stabilisation and plyometrics exercises.3 These findings beg the question : Why do we see similar outcomes in r and omised trials , which compare treatment strategies that are ostensibly different ? Our goal is to provide explanations beyond the obvious answers —such as treatments that have similarly effective or ineffective causal mechanisms or failing to account for patient heterogeneity in trial design and consequent insufficient statistical power to detect differences . In this editorial , we present the reader with four additional yet plausible explanations for why trials report similar outcomes . # # # Reason 1 : the type of outcome assessment may bias findings Our first explanation is the most obvious one . Outcome measures that capture direct measurements of strength and /or flexibility , or other indices of physical performance , may yield findings that are notably different from outcome measures that capture self-reports of pain , function , overall health status or quality of life . Therefore , null findings ( no difference among groups ) may be related to the fact that different sets of outcome measures are being used to compare the groups being studied . Examples of variant findings among outcomes are present in the literature . One month after total hip arthroplasty , Dayton and colleagues4 report that performance-based function ( eg , timed up and go , 6 min walk test and stair climbing test ) declined compared with baseline , whereas self-reported Background Patients with stress-related exhaustion suffer from cognitive impairments , which often remain after psychological treatment or work place interventions . It is important to find effective treatments that can address this problem . Therefore , the aim of this study was to investigate the effects on cognitive performance and psychological variables of a 12-week aerobic training program performed at a moderate-vigorous intensity for patients with exhaustion disorder who participated in a multimodal rehabilitation program . Methods In this open-label , parallel , r and omized and controlled trial , 88 patients diagnosed with exhaustion disorder participated in a 24-week multimodal rehabilitation program . After 12 weeks in the program the patients were r and omized to either a 12-week aerobic training intervention or to a control group with no additional training . Primary outcome measure was cognitive function , and secondary outcome measures were psychological health variables and aerobic capacity . Results In total , 51 % patients in the aerobic training group and 78 % patients in the control group completed the intervention period . The aerobic training group significantly improved in maximal oxygen uptake and episodic memory performance . No additional improvement in burnout , depression or anxiety was observed in the aerobic group compared with controls . Conclusion Aerobic training at a moderate-vigorous intensity within a multimodal rehabilitation program for patients with exhaustion disorder facilitated episodic memory . A future challenge would be the clinical implementation of aerobic training and methods to increase feasibility in this patient group . Trial registration Clinical Trials.gov : NCT03073772 . Retrospectively registered 21 February 2017 BACKGROUND A glucose drink has been shown to improve memory in persons with poor glucose regulation and poor cognition . OBJECTIVE The objective of this study was to determine 1 ) whether an association between cognition and glucose regulation is apparent in healthy seniors and 2 ) the effects of dietary carbohydrates on cognition . DESIGN After an overnight fast , 10 men and 10 women ( aged 60 - 82 y ) consumed 50 g carbohydrate as glucose , potatoes , or barley or a placebo on 4 separate mornings . Cognitive tests were administered 15 , 60 , and 105 min after ingestion of the carbohydrate .  Plasma glucose and serum insulin were measured . RESULTS In a multiple regression analysis , poor baseline ( placebo )  verbal declarative memory ( immediate and 20-min delayed paragraph recall and word list recall ) and visuomotor task performance were predicted by poor beta cell function , high incremental area under the glucose curve , low insulin resistance , and low body mass index . The difference in plasma glucose after food consumption [ glucose > potatoes > barley > placebo ( P : < 0.03 ) ] did not predict performance . Although overall performance did not differ with consumption of the different test foods , baseline score and beta cell function correlated with improvements in immediate and delayed paragraph recall for all 3 carbohydrates ( compared with placebo ) ; the poorer the baseline memory or beta cell function , the greater the improvement ( correlation between beta cell function and improvement in delayed paragraph recall : r > -0.50 , P : < 0.03 ) . Poor beta cell function correlated with improvement for all carbohydrates in visuomotor task performance but not on an attention task . CONCLUSIONS Glucose regulation was associated with cognitive performance in elderly subjects with normal glucose tolerance . Dietary carbohydrates ( potatoes and barley ) enhanced cognition in subjects with poor memories or beta cell function independently of plasma glucose Objectives The present study evaluated the efficacy of an exercise intervention to reduce work-related fatigue ( emotional exhaustion , overall fatigue , and need for recovery ) . The effects of exercise on self-efficacy , sleep , work ability , cognitive functioning and aerobic fitness ( secondary outcomes ) were also investigated . Methods Employees with high levels of work-related fatigue were r and omly assigned to either a 6-week exercise intervention  ( EI ; N=49 ) or a wait-list control group ( WLC  ; N=47 ) . All participants were measured pre- ( T0 ) and post-intervention ( T1 ) . EI participants were also measured 6 ( T2 ) and 12 weeks ( T3 ) after the end of the intervention . Analyses were based on intention-to-treat ( ITT ) and per- protocol ( PP ) . PP analyses only included EI participants ( N=31 ) who completed the intervention and WLC participants ( N= 35 ) who did not increase their exercise level during the wait period . Results Analyses of covariance ( ANCOVA ) revealed that , at T1 , the EI group reported lower emotional exhaustion and overall fatigue than the WLC group , however , only according to PP analyses . Both according to ITT and PP analyses , EI participants showed higher sleep quality , work ability , and self-reported cognitive functioning at T1 compared to WLC participants . Intervention effects were maintained at T2 and T3 . Conclusions The exercise intervention had enduring effects on work-related fatigue and broader indicators of employee well-being . This study demonstrates that , in case of work-related fatigue , exercise does constitute a powerful medicine for those who comply with the treatment BACKGROUND Diets and Omega-3 polyunsaturated fatty acids have been considered as important factors to reduce the risk of cardiovascular and inflammatory diseases , but there are few details on the effects on healthy subjects . The aim of the present study was to examine the variation of several physiological parameters in healthy subjects on different diets supplemented with Omega-3 fatty acids .  MATERIAL S AND METHODS The experiment was carried out on 33 subjects divided into four groups according to a double-blind cross-over design with a 1 : 1 ratio for Omega-3 ( vs. placebo ) and open-label parallel-groups with a 1 : 1 ratio for the Zone diet ( vs. the diet suggested by the Italian National Research Institute for Nutrition and Foods ) . Blood sample s were collected at the beginning of the experiment and after 35 ( cross-over ) and 70 days . The Profile of Mood States test ( POMS ) was also performed . RESULTS The arachidonic acid/eicosapentaenoic acid ratio ( AA/EPA ) was strongly reduced by Omega-3 with a supplementary effect of the diet and in particular the Zone diet . The AA/EPA reduction was correlated with a concomitant decrease of insulin and homocysteine levels . The Zone diet reduced skinfold thickness and body fat percentage and also showed antioxidant effects . The mood state changed after Omega-3 supplementation , with an increased POMS index . This was related to a concomitant reduction of AA/EPA and was particularly evident in the Zone diet . CONCLUSION AA/EPA and mood state are differently influenced by diet and Omega-3 , body fat is particularly reduced by Zone diet , while blood parameters such as triglycerides/HDL ratio , insulin and homocysteine are related to AA/EPA variations . These findings are discussed in terms of differences in the composition of the diets and the influences of Omega-3 on physiological functions Background Evidence suggests a link between sedentary behaviours and depressive symptoms . Mechanisms underlying this relationship are not understood , but inflammatory processes may be involved . Autonomic and inflammatory responses to stress may be heightened in sedentary individuals contributing to risk , but no study has experimentally investigated this . Aims To examine the effect of sedentary time on mood and stress responses using an experimental design . Method Forty-three individuals were assigned to a free-living sedentary condition  and to  a control condition ( usual activity ) in a cross-over , r and omised fashion and were tested in a psychophysiology laboratory after spending 2 weeks in each condition . Participants completed mood question naires ( General Health Question naire and Profile of Mood States ) and wore a motion sensor for 4 weeks . Results Sedentary time increased by an average of 32 min/day ( P = 0.01 ) during the experimental condition compared with control . Being sedentary result ed in increases in negative mood independent of changes in moderate to vigorous physical activity ( ΔGHQ = 6.23 , ΔPOMS = 2.80 ) . Mood disturbances were associated with greater stress-induced inflammatory interleukin-6 ( IL-6 ) responses ( β = 0.37 ) . Conclusions Two weeks of exposure to greater free-living sedentary time result ed in mood disturbances independent of reduction in physical activity . Stress-induced IL-6 responses were associated with changes in mood BACKGROUND Obesity and mental health disorders are 2 major public health problems 
    Output:
    
agent
It can be concluded that physical activity may be effective in reducing burn-out risk .
The few observational studies linking sedentary and dietary behavior with burn-out risk suggest that being more sedentary and eating less healthy are each associated with higher burn-out risk .
***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 : Plasma prolactin levels are sensitive to dopamine and serotonin function , and fatigue . Low cortisol , dopamine and /or serotonin may be involved in burnout and detachment . Methods : In this double-blind within-subject study , we treated 9 female burnout subjects and 9 controls with 35 mg cortisol and placebo orally . We measured state affect and plasma prolactin , oxytocin , cortisol and adrenocorticotropic hormone levels , and administered an attachment question naire . Results : The burnout subjects displayed an extreme distribution of basal prolactin levels , displaying higher or lower levels compared to the controls . The low prolactin burnouts had profoundly low attachment scores and tended to have low oxytocin levels . The high prolactin burnout subjects tended to show cortisol-induced decreased prolactin and fatigue , and increased vigor . Conclusion : Results are consistent with the hypothesis that burnout subjects are either characterized by low serotonergic function or by low dopaminergic function , and that the latter group benefits from cortisol replacement . These preliminary results suggest that differentiating between two syndromes may resolve inconsistencies in research on burnout , and be necessary for selecting the right treatment strategy Background Occupational burnout is associated with severe negative health effects . While stress management programs proved to have a positive influence on the well-being of patients suffering from burnout , it remains unclear whether aerobic exercise alleviates burnout severity and other parameters related to occupational burnout . Therefore , the main purpose of this study was to pilot-test the potential outcomes of a 12-week exercise training to generate hypotheses for future larger scale studies . Methods The sample consisted of 12 male participants scoring high on the MBI emotional exhaustion and depersonalization subscales . The training program took place in a private fitness center with a 17.5 kcal/kg minimum requirement of weekly energy expenditure . Results The key findings are that increased exercise reduced overall perceived stress as well as symptoms of burnout and depression . The magnitude of the effects was large , revealing changes of substantial practical relevance . Additionally , profiles of mood states improved considerably after single exercise sessions with a marked shift towards an iceberg profile . Conclusion Among burnout patients , the findings provide preliminary evidence that exercise has the potential to reduce stress and prevent the development of a deeper depression . This has important health implication s given that burnout is considered an antecedent of depressive disorders . Trial registration Clinical Trials.gov Identifier : OBJECTIVE To evaluate the efficacy of Qigong in rehabilitation for patients with burnout . DESIGN Prospect i ve , r and omized controlled trial . SUBJECTS Eighty-two patients ( 68 women and 14 men , mean age 44.3 ( st and ard deviation 9.1 ) years ) diagnosed with burnout . METHODS Basic care was offered to both the intervention and the control group . Patients in the intervention group received basic care and , in addition , performed Qigong twice a week for 12 weeks .  Psychological variables , health-related quality of life , perceived relaxation and physical measurements were assessed at baseline and after the intervention period . RESULTS No significant difference in treatment efficacy between the groups was found by either intention-to-treat or per- protocol analyses . Both groups improved significantly over time , with reduced levels of burnout , fatigue , anxiety and depression , and increased dynamic balance and physical capacity . CONCLUSION In this study , a Qigong intervention twice a week for 12 weeks had no additional effect beyond basic care for patients with burnout Conundrums in musculoskeletal research are common . Halliday and colleagues1 demonstrated similar outcomes for patients with chronic low back pain who received two seemingly different interventions : ( 1 ) a McKenzie approach and ( 2 ) motor control exercises .  Chmielewski and associates2 reported similar knee function and psychosocial status scores in those who received either low intensity or high intensity plyometric exercise programmes . Finally , van Beijsterveildt et al found no differences in the prevention of injuries among amateur footballers when usual care was compared against an exercise strategy that consisted of core stability , eccentric training of thigh muscles , proprioceptive training , dynamic stabilisation and plyometrics exercises.3 These findings beg the question : Why do we see similar outcomes in r and omised trials , which compare treatment strategies that are ostensibly different ? Our goal is to provide explanations beyond the obvious answers —such as treatments that have similarly effective or ineffective causal mechanisms or failing to account for patient heterogeneity in trial design and consequent insufficient statistical power to detect differences . In this editorial , we present the reader with four additional yet plausible explanations for why trials report similar outcomes . # # # Reason 1 : the type of outcome assessment may bias findings Our first explanation is the most obvious one . Outcome measures that capture direct measurements of strength and /or flexibility , or other indices of physical performance , may yield findings that are notably different from outcome measures that capture self-reports of pain , function , overall health status or quality of life . Therefore , null findings ( no difference among groups ) may be related to the fact that different sets of outcome measures are being used to compare the groups being studied . Examples of variant findings among outcomes are present in the literature . One month after total hip arthroplasty , Dayton and colleagues4 report that performance-based function ( eg , timed up and go , 6 min walk test and stair climbing test ) declined compared with baseline , whereas self-reported Background Patients with stress-related exhaustion suffer from cognitive impairments , which often remain after psychological treatment or work place interventions . It is important to find effective treatments that can address this problem . Therefore , the aim of this study was to investigate the effects on cognitive performance and psychological variables of a 12-week aerobic training program performed at a moderate-vigorous intensity for patients with exhaustion disorder who participated in a multimodal rehabilitation program . Methods In this open-label , parallel , r and omized and controlled trial , 88 patients diagnosed with exhaustion disorder participated in a 24-week multimodal rehabilitation program . After 12 weeks in the program the patients were r and omized to either a 12-week aerobic training intervention or to a control group with no additional training . Primary outcome measure was cognitive function , and secondary outcome measures were psychological health variables and aerobic capacity . Results In total , 51 % patients in the aerobic training group and 78 % patients in the control group completed the intervention period . The aerobic training group significantly improved in maximal oxygen uptake and episodic memory performance . No additional improvement in burnout , depression or anxiety was observed in the aerobic group compared with controls . Conclusion Aerobic training at a moderate-vigorous intensity within a multimodal rehabilitation program for patients with exhaustion disorder facilitated episodic memory . A future challenge would be the clinical implementation of aerobic training and methods to increase feasibility in this patient group . Trial registration Clinical Trials.gov : NCT03073772 . Retrospectively registered 21 February 2017 BACKGROUND A glucose drink has been shown to improve memory in persons with poor glucose regulation and poor cognition . OBJECTIVE The objective of this study was to determine 1 ) whether an association between cognition and glucose regulation is apparent in healthy seniors and 2 ) the effects of dietary carbohydrates on cognition . DESIGN After an overnight fast , 10 men and 10 women ( aged 60 - 82 y ) consumed 50 g carbohydrate as glucose , potatoes , or barley or a placebo on 4 separate mornings . Cognitive tests were administered 15 , 60 , and 105 min after ingestion of the carbohydrate .  Plasma glucose and serum insulin were measured . RESULTS In a multiple regression analysis , poor baseline ( placebo )  verbal declarative memory ( immediate and 20-min delayed paragraph recall and word list recall ) and visuomotor task performance were predicted by poor beta cell function , high incremental area under the glucose curve , low insulin resistance , and low body mass index . The difference in plasma glucose after food consumption [ glucose > potatoes > barley > placebo ( P : < 0.03 ) ] did not predict performance . Although overall performance did not differ with consumption of the different test foods , baseline score and beta cell function correlated with improvements in immediate and delayed paragraph recall for all 3 carbohydrates ( compared with placebo ) ; the poorer the baseline memory or beta cell function , the greater the improvement ( correlation between beta cell function and improvement in delayed paragraph recall : r > -0.50 , P : < 0.03 ) . Poor beta cell function correlated with improvement for all carbohydrates in visuomotor task performance but not on an attention task . CONCLUSIONS Glucose regulation was associated with cognitive performance in elderly subjects with normal glucose tolerance . Dietary carbohydrates ( potatoes and barley ) enhanced cognition in subjects with poor memories or beta cell function independently of plasma glucose Objectives The present study evaluated the efficacy of an exercise intervention to reduce work-related fatigue ( emotional exhaustion , overall fatigue , and need for recovery ) . The effects of exercise on self-efficacy , sleep , work ability , cognitive functioning and aerobic fitness ( secondary outcomes ) were also investigated . Methods Employees with high levels of work-related fatigue were r and omly assigned to either a 6-week exercise intervention  ( EI ; N=49 ) or a wait-list control group ( WLC  ; N=47 ) . All participants were measured pre- ( T0 ) and post-intervention ( T1 ) . EI participants were also measured 6 ( T2 ) and 12 weeks ( T3 ) after the end of the intervention . Analyses were based on intention-to-treat ( ITT ) and per- protocol ( PP ) . PP analyses only included EI participants ( N=31 ) who completed the intervention and WLC participants ( N= 35 ) who did not increase their exercise level during the wait period . Results Analyses of covariance ( ANCOVA ) revealed that , at T1 , the EI group reported lower emotional exhaustion and overall fatigue than the WLC group , however , only according to PP analyses . Both according to ITT and PP analyses , EI participants showed higher sleep quality , work ability , and self-reported cognitive functioning at T1 compared to WLC participants . Intervention effects were maintained at T2 and T3 . Conclusions The exercise intervention had enduring effects on work-related fatigue and broader indicators of employee well-being . This study demonstrates that , in case of work-related fatigue , exercise does constitute a powerful medicine for those who comply with the treatment BACKGROUND Diets and Omega-3 polyunsaturated fatty acids have been considered as important factors to reduce the risk of cardiovascular and inflammatory diseases , but there are few details on the effects on healthy subjects . The aim of the present study was to examine the variation of several physiological parameters in healthy subjects on different diets supplemented with Omega-3 fatty acids .  MATERIAL S AND METHODS The experiment was carried out on 33 subjects divided into four groups according to a double-blind cross-over design with a 1 : 1 ratio for Omega-3 ( vs. placebo ) and open-label parallel-groups with a 1 : 1 ratio for the Zone diet ( vs. the diet suggested by the Italian National Research Institute for Nutrition and Foods ) . Blood sample s were collected at the beginning of the experiment and after 35 ( cross-over ) and 70 days . The Profile of Mood States test ( POMS ) was also performed . RESULTS The arachidonic acid/eicosapentaenoic acid ratio ( AA/EPA ) was strongly reduced by Omega-3 with a supplementary effect of the diet and in particular the Zone diet . The AA/EPA reduction was correlated with a concomitant decrease of insulin and homocysteine levels . The Zone diet reduced skinfold thickness and body fat percentage and also showed antioxidant effects . The mood state changed after Omega-3 supplementation , with an increased POMS index . This was related to a concomitant reduction of AA/EPA and was particularly evident in the Zone diet . CONCLUSION AA/EPA and mood state are differently influenced by diet and Omega-3 , body fat is particularly reduced by Zone diet , while blood parameters such as triglycerides/HDL ratio , insulin and homocysteine are related to AA/EPA variations . These findings are discussed in terms of differences in the composition of the diets and the influences of Omega-3 on physiological functions Background Evidence suggests a link between sedentary behaviours and depressive symptoms . Mechanisms underlying this relationship are not understood , but inflammatory processes may be involved . Autonomic and inflammatory responses to stress may be heightened in sedentary individuals contributing to risk , but no study has experimentally investigated this . Aims To examine the effect of sedentary time on mood and stress responses using an experimental design . Method Forty-three individuals were assigned to a free-living sedentary condition  and to  a control condition ( usual activity ) in a cross-over , r and omised fashion and were tested in a psychophysiology laboratory after spending 2 weeks in each condition . Participants completed mood question naires ( General Health Question naire and Profile of Mood States ) and wore a motion sensor for 4 weeks . Results Sedentary time increased by an average of 32 min/day ( P = 0.01 ) during the experimental condition compared with control . Being sedentary result ed in increases in negative mood independent of changes in moderate to vigorous physical activity ( ΔGHQ = 6.23 , ΔPOMS = 2.80 ) . Mood disturbances were associated with greater stress-induced inflammatory interleukin-6 ( IL-6 ) responses ( β = 0.37 ) . Conclusions Two weeks of exposure to greater free-living sedentary time result ed in mood disturbances independent of reduction in physical activity . Stress-induced IL-6 responses were associated with changes in mood BACKGROUND Obesity and mental health disorders are 2 major public health problems 
    Output:
    