某船舶制造厂工人工作相关肌肉骨骼疾患的发生情况及危险因素
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摘要
[目的]调查某船舶制造厂工人工作相关肌肉骨骼疾患(WMSDs)的发生情况,探讨可能的危险因素。[方法]采用流行病学横断面调查方法,选用经修订的肌肉骨骼损伤情况调查问卷,对我国某船舶制造厂工人近1年内肌肉骨骼疾患与工效学负荷以及心理社会因素开展调查。采用卡方检验以及logistic回归分析导致WMSDs发生的危险因素。[结果]共发放问卷830份,收回有效问卷809份(有效率97.5%)。工人各部位WMSDs年发生率为12.2%~39.4%,发生率排在前四位的部位依次是下背部(39.4%)、颈部(31.3%)、手腕部(26.8%)和肩部(26.3%)。下背部、颈部、手腕部、膝部和踝/足部WMSDs的发生率在不同工种之间的差异具有统计学意义(P<0.05)。多因素logistic回归分析结果显示:弯腰同时转身是导致下背部和肩部(OR=1.53,1.68)、手腕部长时间弯曲是导致手腕部(OR=1.62)WMSDs的危险因素;身高是导致下背部(OR=1.03)WMSDs的危险因素;经常加班是导致下背部和手腕部(OR=1.62,1.55)WMSDs的危险因素;主观工作姿势舒适是下背部、颈部、手腕部和肩部(OR=0.68,0.52,0.62,0.54)的保护因素;自主控制工作进度是手腕部(OR=0.67)WMSDs的保护因素;工作节奏快是导致颈部、手腕部和肩部(OR=1.60,1.66,1.60)WMSDs的危险因素;上司关心下属是颈部和肩部(OR=0.67,0.69)WMSDs的保护因素。[结论]造船业工人WMSDs的发生率较高,亟须根据WMSDs的职业、个体、心理社会因素制定相关措施,以降低此类疾患对工人健康的不良影响。
[Objective] To investigate the incidence and risk factors of work-related musculoskeletal disorders(WMSDs) among workers in a shipyard.[Methods] A cross-sectional epidemiological survey was conducted using a revised musculoskeletal disorders questionnaire to investigate the incidence,ergonomic load,and psychosocial factors of musculoskeletal disorders in the past year among workers in a shipyard in China.Chi-square test and logistic regression models were used to analyze the risk factors of WMSDs.[Results] A total of 830 questionnaires were distributed,and 809 valid questionnaires were returned with a valid response rate of 97.5%.The incidence rates of WMSDs in different body parts were 12.2%-39.4%.The top four WMSDs incidence rates by body parts were low back(39.4%),neck(31.3%),wrist(26.8%),and shoulder(26.3%).The incidence rates of WMSDs in low back,neck,wrist,knee,and ankle/foot were different among different types of work(P<0.05).Multivariate logistic regression analysis results showed that stooping and turning round simultaneously was a risk factor for WMSDs in low back and shoulder(OR=1.53,1.68);wrist bent for a long time was a risk factor for WMSDs in wrist(OR=1.62);height was a risk factor for WMSDs in low back(OR=1.03);working overtime frequently was a risk factor for WMSDs in low back and wrist(OR=1.62,1.55);subjective comfortable working posture was a protective factor for WMSDs in low back,neck,wrist,and shoulder(OR=0.68,0.52,0.62,0.54);controlling work progress independently was a protective factor for WMSDs in wrist(OR=0.67);fast work pace was a risk factor for WMSDs in neck,wrist,and shoulder(OR=1.60,1.66,1.60);concerns from supervisors was a protective factor for WMSDs in neck and shoulder(OR=0.67,0.69).[Conclusion] The incidence rate of WMSDs in shipbuilding industry is at a high level.Therefore,it is urgent to formulate relevant policies and measures considering occupational,individual,and psychosocial factors of WMSDs to reduce the adverse health effects.
[Objective] To investigate the incidence and risk factors of work-related musculoskeletal disorders(WMSDs) among workers in a shipyard.[Methods] A cross-sectional epidemiological survey was conducted using a revised musculoskeletal disorders questionnaire to investigate the incidence,ergonomic load,and psychosocial factors of musculoskeletal disorders in the past year among workers in a shipyard in China.Chi-square test and logistic regression models were used to analyze the risk factors of WMSDs.[Results] A total of 830 questionnaires were distributed,and 809 valid questionnaires were returned with a valid response rate of 97.5%.The incidence rates of WMSDs in different body parts were 12.2%-39.4%.The top four WMSDs incidence rates by body parts were low back(39.4%),neck(31.3%),wrist(26.8%),and shoulder(26.3%).The incidence rates of WMSDs in low back,neck,wrist,knee,and ankle/foot were different among different types of work(P<0.05).Multivariate logistic regression analysis results showed that stooping and turning round simultaneously was a risk factor for WMSDs in low back and shoulder(OR=1.53,1.68);wrist bent for a long time was a risk factor for WMSDs in wrist(OR=1.62);height was a risk factor for WMSDs in low back(OR=1.03);working overtime frequently was a risk factor for WMSDs in low back and wrist(OR=1.62,1.55);subjective comfortable working posture was a protective factor for WMSDs in low back,neck,wrist,and shoulder(OR=0.68,0.52,0.62,0.54);controlling work progress independently was a protective factor for WMSDs in wrist(OR=0.67);fast work pace was a risk factor for WMSDs in neck,wrist,and shoulder(OR=1.60,1.66,1.60);concerns from supervisors was a protective factor for WMSDs in neck and shoulder(OR=0.67,0.69).[Conclusion] The incidence rate of WMSDs in shipbuilding industry is at a high level.Therefore,it is urgent to formulate relevant policies and measures considering occupational,individual,and psychosocial factors of WMSDs to reduce the adverse health effects.
引文
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[7]张蔚,陈西峰,张雪艳,等.肌肉骨骼疾患问卷(中文版)应用于造船行业的信效度[J].环境与职业医学,2017,34(1):27-31.
[8]曹扬,王菁菁,张蔚,等.《肌肉骨骼损伤情况调查问卷》应用于搬运作业人群的信效度评价[J].中国工业医学杂志,2017,30(2):87-93.
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[11]NELSON-WONG E,CALLAGHAN J P.The impact of a sloped surface on low back pain during prolonged standing work:a biomechanical analysis[J].Appl Ergon,2010,41(6):787-795.
[12]BULDUK E?,BULDUK S,SüREN T,et al.Assessing exposure to risk factors for work-related musculoskeletal disorders using Quick Exposure Check(QEC)in taxi drivers[J].Int J Ind Ergon,2014,44(6):817-820.
[13]POPE M H,GOH K L,MAGNUSSON M L.Spine ergonomics[J].Annu Rev Biomed Eng,2002,4:49-68.
[14]GROOTEN W J A,WERNSTEDT P,CAMPO M.Work-related musculoskeletal disorders in female Swedish physical therapists with more than 15 years of job experience:prevalence and associations with work exposures[J].Physiother Theory Pract,2011,27(3):213-222.
[15]CATARINA N,GERT-?KE H,KERSTINA O,et al.Exposureresponse relationships for work-related neck and shoulder musculoskeletal disorders—Analyses of pooled uniform data sets[J].Appl Ergon,2016,55:70-84.
[16]徐光兴,李丽萍,刘凤英,等.某煤矿工人肌肉骨骼损伤情况及其危险因素[J].中华劳动卫生职业病杂志,2011,29(3):190-193.
[17]贾宁,李涛,朱新河,等.风电场运行维护人员下背痛及危险因素研究[J].工业卫生与职业病,2016,42(1):31-36.
[18]LANG J,OCHSMANN E,KRAUS T,et al.Psychosocial work stressors as antecedents of musculoskeletal problems:a systematic review and meta-analysis of stability-adjusted longitudinal studies[J].Soc Sci Med,2012,75(7):1163-1174.
[19]ZAMRI E N,MOY F M,HOE V C W.Association of psychological distress and work psychosocial factors with selfreported musculoskeletal pain among secondary school teachers in Malaysia[J].PLo S One,2017,12(2):e0172195.
[20]HEIDEN B,WEIGL M,ANGERER P,et al.Association of age and physical job demands with musculoskeletal disorders in nurses[J].Appl Ergon,2013,44(4):652-658.
[21]WERNER R A,FRANZBLAU A,GELL N,et al.Predictors of persistent elbow tendonitis among auto assembly workers[J].J Occup Rehabil,2005,15(3):393-400.
[22]曹磊,杜薇薇,王生,等.心理因素及物理负荷对职业性肌肉骨骼疾患的影响分析[J].中华劳动卫生职业病杂志,2011,29(3):176-179.
[23]金玉兰,陈通,姚三巧,等.某市外科医生职业紧张对工作满意感的影响[J].环境与职业医学,2013,30(9):680-685.
[24]?STERGREN P O,HANSON B S,BALOGH I,et al.Incidence of shoulder and neck pain in a working population:effect modification between mechanical and psychosocial exposures at work?Results from a one year follow up of the Malm?shoulder and neck study cohort[J].J Epidemiol Community Health,2005,59(9):721-728.
[25]杨永丽,周意,刘慧珠.护士职业性肌肉骨骼疾患的危险因素及防护对策[J].护理学杂志,2008,23(2):76-78.
[26]罗孝文,沙焱,于洋,等.职业性肌肉骨骼疾患与社会心理因素相关性调查分析[J].中国职业医学,2012,39(3):202-205.
[2]NIOSH.National occupational research agenda[EB/OL](2016-02-10)[2017-11-09].https://www.cdc.gov/niosh/docs/96-115/norbib.html.
[3]庄惠民,赵金桂,唐杰,等.《造船行业职业病危害控制规范》的研制[J].环境与职业医学,2013,30(5):392-394.
[4]李旭东,苏世标,闫雪华,等.船舶制造业职业病危害风险和防护措施分析[J].中国安全生产科学技术,2013,9(3):87-93.
[5]杨磊,HILDEBRANDT V H,余善法,等.肌肉骨骼疾患调查表介绍附调查表[J].工业卫生与职业病,2009,35(1):25-31.
[6]KARASEK R,BRISSON C,KAWAKAMI N,et al.The Job Content Questionnaire(JCQ):an instrument for internationally comparative assessments of psychosocial job characteristics[J].J Occup Health Psychol,1998,3(4):322-355.
[7]张蔚,陈西峰,张雪艳,等.肌肉骨骼疾患问卷(中文版)应用于造船行业的信效度[J].环境与职业医学,2017,34(1):27-31.
[8]曹扬,王菁菁,张蔚,等.《肌肉骨骼损伤情况调查问卷》应用于搬运作业人群的信效度评价[J].中国工业医学杂志,2017,30(2):87-93.
[9]KUORINKA I,JONSSON B,KILBOM A,et al.Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms[J].Appl Ergon,1987,18(3):233-237.
[10]徐雷,王正伦,宋挺博,等.某造船厂工人肌肉骨骼疾患调查[J].中华劳动卫生职业病杂志,2011,29(3):180-183.
[11]NELSON-WONG E,CALLAGHAN J P.The impact of a sloped surface on low back pain during prolonged standing work:a biomechanical analysis[J].Appl Ergon,2010,41(6):787-795.
[12]BULDUK E?,BULDUK S,SüREN T,et al.Assessing exposure to risk factors for work-related musculoskeletal disorders using Quick Exposure Check(QEC)in taxi drivers[J].Int J Ind Ergon,2014,44(6):817-820.
[13]POPE M H,GOH K L,MAGNUSSON M L.Spine ergonomics[J].Annu Rev Biomed Eng,2002,4:49-68.
[14]GROOTEN W J A,WERNSTEDT P,CAMPO M.Work-related musculoskeletal disorders in female Swedish physical therapists with more than 15 years of job experience:prevalence and associations with work exposures[J].Physiother Theory Pract,2011,27(3):213-222.
[15]CATARINA N,GERT-?KE H,KERSTINA O,et al.Exposureresponse relationships for work-related neck and shoulder musculoskeletal disorders—Analyses of pooled uniform data sets[J].Appl Ergon,2016,55:70-84.
[16]徐光兴,李丽萍,刘凤英,等.某煤矿工人肌肉骨骼损伤情况及其危险因素[J].中华劳动卫生职业病杂志,2011,29(3):190-193.
[17]贾宁,李涛,朱新河,等.风电场运行维护人员下背痛及危险因素研究[J].工业卫生与职业病,2016,42(1):31-36.
[18]LANG J,OCHSMANN E,KRAUS T,et al.Psychosocial work stressors as antecedents of musculoskeletal problems:a systematic review and meta-analysis of stability-adjusted longitudinal studies[J].Soc Sci Med,2012,75(7):1163-1174.
[19]ZAMRI E N,MOY F M,HOE V C W.Association of psychological distress and work psychosocial factors with selfreported musculoskeletal pain among secondary school teachers in Malaysia[J].PLo S One,2017,12(2):e0172195.
[20]HEIDEN B,WEIGL M,ANGERER P,et al.Association of age and physical job demands with musculoskeletal disorders in nurses[J].Appl Ergon,2013,44(4):652-658.
[21]WERNER R A,FRANZBLAU A,GELL N,et al.Predictors of persistent elbow tendonitis among auto assembly workers[J].J Occup Rehabil,2005,15(3):393-400.
[22]曹磊,杜薇薇,王生,等.心理因素及物理负荷对职业性肌肉骨骼疾患的影响分析[J].中华劳动卫生职业病杂志,2011,29(3):176-179.
[23]金玉兰,陈通,姚三巧,等.某市外科医生职业紧张对工作满意感的影响[J].环境与职业医学,2013,30(9):680-685.
[24]?STERGREN P O,HANSON B S,BALOGH I,et al.Incidence of shoulder and neck pain in a working population:effect modification between mechanical and psychosocial exposures at work?Results from a one year follow up of the Malm?shoulder and neck study cohort[J].J Epidemiol Community Health,2005,59(9):721-728.
[25]杨永丽,周意,刘慧珠.护士职业性肌肉骨骼疾患的危险因素及防护对策[J].护理学杂志,2008,23(2):76-78.
[26]罗孝文,沙焱,于洋,等.职业性肌肉骨骼疾患与社会心理因素相关性调查分析[J].中国职业医学,2012,39(3):202-205.