大棚菜农MSDs及影响因素的结构方程模型分析
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摘要
背景
肌肉骨骼疾患(Musculoskeletal disorders, MSDs)是指影响肌肉、骨骼、神经、肌腱、韧带、关节、软骨和椎间盘的损伤和／或功能障碍。症状轻者会有不舒适或轻微疼痛等感觉,而症状严重者常常无法工作,需借助药物或特殊工具训练,且治疗效果不佳。MSDs在全世界的工作人群中很普遍并且是一个严重问题。鉴于此,美国国家职业安全与健康研究所(National Institute for Occupational Safety and Health, NIOSH)在2002年把MSDs列为重点研究的10个职业卫生问题之一,世界卫生组织把2000年至2010年确定为“骨与关节病十年”。农业作为劳动力密集型产业,尤其受到MSDs的影响。果农和菜农等某些劳动力密集型行业中MSDs患病率尤其突出。中国,作为农业大国,农民的MSDs却没有引起足够的重视。因此研究农民的MSDs及其影响因素具有重要意义。
大棚蔬菜已经在山东寿光地区广泛种植,由于其良好的经济效益正向全国范围内迅速普及。然而大棚蔬菜种植是一项十分艰辛的工作,加上蔬菜大棚的特殊工作环境(高温、高湿、高二氧化碳浓度等)及特殊的工作方式(手工作业、体力劳动、特殊体位)等使大棚菜农具有较高的职业健康危险因素暴露,大棚菜农更易患上诸如骨关节炎、下背痛、颈肩痛等MSDs。
MSDs的可疑危险因素除职业因素外,还包括个体因素、心理社会因素等。MSDs的危险因素在实际的人群调查中难以准确测量,难以计算各个危险因素的相对水平。并且在现况研究中可疑危险因素与疾病之问的因果关系难以确定。结构方程模型(Structural Equation Model, SEM)是一种建立、估计和验证因果关系的方法,可以筛选可疑危险因素并估计危险因素相对大小,被誉为二十世纪统计学的三大进展之一。近二十年来SEM在慢病等医学领域得到了广泛应用,但是使用SEM分析MSDs危险因素的研究却尚未见报道。本文使用SEM筛选大棚菜农MSDs的危险因素并对危险因素相对大小进行评估,对MSDs的预防、干预研究具有重要的指导和借鉴意义。
目的
调查大棚菜农和对照菜农MSDs患病情况,探索大棚菜农MSDs的危险因素,估计危险因素相对大小水平,提出针对大棚菜农MSDs的预防措施和建议。
方法
采用分层整群抽样方法,使用北欧国家肌肉骨骼疾患调查问卷与荷兰肌肉骨骼疾患调查问卷对某蔬菜大棚种植基地的大棚菜农和邻近村庄的非大棚菜农(对照组)进行面对面回顾性问卷调查,计算患病率,比较患病情况,并使用结构方程模型分析大棚菜农MSDs的危险因素。
结果
患病率
共调查639名大棚菜农和318名对照菜农。大棚菜农MSDs患病率为61.2%,对照菜农MSDs患病率为43.4%,并且大棚菜农MSDs患病率高于对照菜农(P<0.05)。大棚菜农前四位MSDs依次是下背疾患、肩部疾患、膝部疾患和颈部疾患。大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患的患病率分别为49.6%、29.0%、24.6%和12.8%,对照菜农分别为28.0%、11.6%、10.7%和4.4%,并且大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患患病率均高于对照菜农(P＜0.05)。
误工卧床情况
大棚菜农因MSDs误工364人,误工率为57.0%,对照菜农因MSDs误工135人,误工率为42.5%,并且大棚菜农MSDs误工率高于对照菜农(P＜0.05)。大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患的误工率分别为45.5%、25.0%、23.9%和12.5%,对照菜农分别为27.7%、11.3%、10.7%和3.8%,并且大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患的误工率均高于对照菜农(P＜0.05)。大棚菜农因MSDs卧床62人,对照菜农因MSDs卧床2人,大棚菜农高于对照菜农MSDs的卧床率(P＜0.05)。
危险因素结构方程模型分析
下背疾患在下背疾患的SEM中,潜因变量大棚菜农下背疾患的决定系数为0.847,力量施加因素、静态负荷、动态负荷、人体工效学环境因素、重复性负荷和社会心理学因素与下背疾患的结构系数分别为0.385、0.342、0.122、0.064、0.040和0.098(P＜0.05)。力量施加因素、静态负荷、人体工效学环境因素、动态负荷、社会心理学因素、重复性负荷和年龄因素对潜因变量下背疾患的总体影响分别是0.385、0.342、0.285、0.122、0.098、0.040和0.034。大棚环境中潜变量人体工效学环境因素对潜变量大棚菜农静态负荷的直接影响为0.646。
肩部疾患在肩部疾患的SEM中,潜因变量大棚菜农肩部疾患的决定系数为0.654,大棚因素、重复性负荷因素、力量施加因素、年龄因素、肩部姿势、性别和不舒适体位因素与肩部疾患的结构系数分别为0.448、0.283、0.106、0.079、0.069、0.065和0.033(P＜0.05)。大棚因素、重复性负荷、力量施加因素、年龄、肩部姿势、性别、不舒适体位因素对潜因变量肩部疾患的总体影响分别为0.660、0.283、0.106、0.079、0.069、0.065和0.033。大棚因素对大棚菜农力量施加因素的直接影响为0.553,对大棚菜农重复性负荷因素的直接影响为0.544。
膝部疾患在膝部疾患的SEM中,潜因变量大棚菜农膝部疾患的决定系数为0.674,大棚菜农不舒适体位因素、个体因素(身高、体重)、社会心理学因素和平时健康状况与大棚菜农膝部疾患的结构系数分别为0.632、0.259、0.089和0.039(P＜0.05)。不舒适体位因素、个体因素(身高、体重)、社会心理学因素和平时健康状况对大棚菜农膝部疾患的总体影响分别为0.632、0.259、0.089和0.039。
颈部疾患在颈部疾患的SEM中,潜因变量大棚菜农颈部疾患的决定系数为0.736,重复性负荷、颈部姿势、个体因素(年龄)、不舒适体位因素和社会心理学因素与大棚菜农颈部疾患的结构系数分别为0.559、0.344、0.037、0.030和0.001(P＜0.05)。重复性负荷、颈部姿势、个体因素(年龄)、不舒适体位因素和社会心理学因素对大棚菜农颈部疾患的总体影响分别为0.559、0.344、0.037、0.030和0.001。
结论
1.大棚菜农MSDs患病率较高,主要表现为下背疾患、肩部疾患、膝部疾患和颈部疾患,并且大棚菜农因MSDs明显影响了工作。
2.大棚菜农下背疾患的主要危险因素为力量施加、静态负荷、人体工效学环境和动态负荷；肩部疾患的主要危险因素为大棚因素、重复性负荷和力量施加因素；膝部疾患的主要危险因素为不舒适体位和肥胖；颈部疾患的主要危险因素为重复性负荷和颈部姿势。
3.建议：完善大棚配置；优化工作组织安排；改进操作方式。
Background
Musculoskeletal disorders (MSDs) are injuries or dysfunctions affecting muscles, bones, nerves, tendons, ligaments, joints, cartilages, and spinal discs. MSDs cases with mild symptoms often feel uncomfortable or slightly painful, while severe cases are often unable to work and need to be treated with medication or special tools training, usually with unexpected poor prognosis. MSDs are prevalent and are a serious problem among working population around the world. MSDs were listed as one of the ten occupational problems needing intensive research in2002by National Institute for Occupational Safety and Health, NIOSH, and the ten years of2000to2010was identified as "Bone and Joint Decade2000-2010" by world health organization, WHO. Agricultural workers are mostly affected by MSDs, especially in labor-intensive practices such as fruit and vegetable planting. China being a vast agricultural country, MSDs among farmers, however, have been paid scarce attention. Therefore, it is of vital significance to study farmers' MSDs and the risk factors.
Greenhouse vegetables have been widely planted in Shouguang, Shandong Province, and are increasingly being cultured in mainland China due to high economic profits. But due to the fact that greenhouse vegetable-planting is an arduous practice, and its peculiar greenhouse microenvironment (high temperature, high humidity, high carbon dioxide, etc.), greenhouse vegetable-planting farmers may be much more likely to be affected by MSDs such as osteoarthritis, low back pain, neck and shoulder pain.
Many factors could influence the occurrence and development of MSDs, such as occupational factors, individual factors, psychosocial factors, etc, which are difficult to determine and measure in surveys. What's more, the causal relationship between possible risk factors and diseases is usually difficult to demonstrate in cross-sectional studies. Structural equation model (SEM), one of the three achievements in statistics in the twentieth century, is a statistical technique for testing and estimating causal relations using a combination of statistical data and qualitative causal assumptions, allowing both confirmatory and exploratory modeling, meaning they are suited to both theory testing and theory development. SEM has been widely used in the field of medicine such as chronic diseases but there have been few studies reported in the application of analysis of MSDs'risk factors. The application of SEM to analyze risk factors of MSDs among greenhouse vegetable-planting farmers and to determine the relative levels, which would benefit the understanding of MSDs'risk factors, is of vital significance to guide future studies.
Objective
To study the prevalence of MSDs among both greenhouse vegetable-planting farmers and non-greenhouse vegetable-planting farmers, and to explore the risk factors influencing greenhouse vegetable-planting farmers'MSDs, and to seek measures preventing greenhouse vegetable-planting farmers'MSDs.
Methods
A self-administered questionnaire based on the Modified Nordic Questionnaire and the Dutch Musculoskeletal Questionnaire was conducted to both greenhouse vegetable-planting farmers in a greenhouse vegetable-planting area and non-greenhouse vegetable-planting farmers in the near villages by stratified cluster sampling. Then one-year prevalence rate of MSDs was calculated and compared between greenhouse vegetable-planting farmers and non-greenhouse vegetable-planting farmers (control group). Structural equation model was used to analyze the risk factors of greenhouse vegetable-planting farmners' MSDs and to determine the risk levels.
Results
1. Study of Prevalence
639greenhouse vegetable-planting farmers and318non-greenhouse vegetable-planting farmers completed the self-administered questionnaire. The1-year prevalence rate of MSDs was61.2%among greenhouse vegetable-planting farmers and43.4%among non-greenhouse farmers. The first four MSDs of greenhouse vegetable-planting farmers were low back disorders, shoulder(s) disorders, knee(s) disorders and neck disorders. The1-year prevalence rate of low back disorders, shoulder(s) disorders, knee(s) disorders and neck disorders among greenhouse vegetable-planting farmers was49.6%,29.0%,24.6%and12.8%respectively, statistically higher than that of non-greenhouse vegetable-planting farmers with the corresponding rate of28.0%,11.6%,10.7%and4.4%respectively (P<0.05).
2. Analysis of risk factors
The coefficient of determination of latent variables on low back disorders was0.847in the structural equation model. The structural coefficient of force exertion, static loads, dynamic loads, ergonomic environmental factors, repetitive loads and psychosocial factors on low back disorders was0.385,0.342,0.122,0.064,0.040and0.098respectively (P<0.05). The total effects of force exertion, static loads, ergonomic environmental factors, dynamic loads, psychosocial factors, repetitive loads and age on low back disorders were0.385,0.342,0.285,0.122,0.098,0.040and0.034respectively. The direct effect of ergonomic environmental factors on static loads was0.646.
The coefficient of determination of latent variables on shoulder(s) disorders in the structural equation model was0.654. The structural coefficients of greenhouse factors, repetitive factors, force exertion, age, postures of shoulder(s), gender and uncomfortable postures on shoulder(s) disorders were0.448,0.283,0.106,0.079,0.069,0.065and0.033respectively (P<0.05). The total effects of greenhouse factors, repetitive factors, force exertion, age, postures of shoulder(s), gender and uncomfortable postures on shoulder(s) disorders were0.660,0.283,0.106,0.079,0.069,0.065and0.033respectively. The direct effects of greenhouse factors on force exertion and repetitive loads were0.553and0.544respectively.
The coefficient of determination of latent variables on knee(s) disorders in the structural equation model was0.674. The structural coefficients of uncomfortable postures, individual factors (mainly height and bodyweight), psychosocial factors and health status on knee(s) disorders were0.632,0.259,0.089and0.039respectively (P<0.05). The total effects of uncomfortable postures, individual factors (mainly height and bodyweight), psychosocial factors and health status on knee(s) disorders were0.632,0.259,0.089and0.039respectively.
The coefficient of determination of latent variables on neck disorders was0.736in the structural equation model. The structural coefficients of repetitive loads, postures of neck, individual factors (age), uncomfortable postures and psychosocial factors on neck disorders were0.559,0.344,0.037,0.030and0.001respectively (P<0.05). The total effects of repetitive loads, postures of neck, individual factors (age), uncomfortable postures and psychosocial factors on neck disorders were0.559,0.344,0.037,0.030and0.001respectively.
Conclusions
1. The prevalence of MSDs among greenhouse vegetable-planting farmers was quite high, and the first four MSDs were low back disorders, shoulder(s) disorders, knee(s) disorders and neck disorders. What's more, the everyday work of greenhouse vegetable-planting farmers was affected due to MSDs.
2. The main risk factors of low back disorders among greenhouse vegetable-planting farmers were force exertion, static loads, ergonomic environmental factors and dynamic loads. The main risk factors of shoulder(s) disorders among greenhouse vegetable-planting farmers were greenhouse factors, repetitive loads and force exertion. The main risk factors of knee(s) disorders among greenhouse vegetable-planting farmers were uncomfortable postures and obesity. The main risk factors of neck disorders among greenhouse vegetable-planting farmers were repetitive loads and neck postures.
3. Suggestions:to improve greenhouse configuration; to optimize work organization; to meliorate operating styles.
肌肉骨骼疾患(Musculoskeletal disorders, MSDs)是指影响肌肉、骨骼、神经、肌腱、韧带、关节、软骨和椎间盘的损伤和／或功能障碍。症状轻者会有不舒适或轻微疼痛等感觉,而症状严重者常常无法工作,需借助药物或特殊工具训练,且治疗效果不佳。MSDs在全世界的工作人群中很普遍并且是一个严重问题。鉴于此,美国国家职业安全与健康研究所(National Institute for Occupational Safety and Health, NIOSH)在2002年把MSDs列为重点研究的10个职业卫生问题之一,世界卫生组织把2000年至2010年确定为“骨与关节病十年”。农业作为劳动力密集型产业,尤其受到MSDs的影响。果农和菜农等某些劳动力密集型行业中MSDs患病率尤其突出。中国,作为农业大国,农民的MSDs却没有引起足够的重视。因此研究农民的MSDs及其影响因素具有重要意义。
大棚蔬菜已经在山东寿光地区广泛种植,由于其良好的经济效益正向全国范围内迅速普及。然而大棚蔬菜种植是一项十分艰辛的工作,加上蔬菜大棚的特殊工作环境(高温、高湿、高二氧化碳浓度等)及特殊的工作方式(手工作业、体力劳动、特殊体位)等使大棚菜农具有较高的职业健康危险因素暴露,大棚菜农更易患上诸如骨关节炎、下背痛、颈肩痛等MSDs。
MSDs的可疑危险因素除职业因素外,还包括个体因素、心理社会因素等。MSDs的危险因素在实际的人群调查中难以准确测量,难以计算各个危险因素的相对水平。并且在现况研究中可疑危险因素与疾病之问的因果关系难以确定。结构方程模型(Structural Equation Model, SEM)是一种建立、估计和验证因果关系的方法,可以筛选可疑危险因素并估计危险因素相对大小,被誉为二十世纪统计学的三大进展之一。近二十年来SEM在慢病等医学领域得到了广泛应用,但是使用SEM分析MSDs危险因素的研究却尚未见报道。本文使用SEM筛选大棚菜农MSDs的危险因素并对危险因素相对大小进行评估,对MSDs的预防、干预研究具有重要的指导和借鉴意义。
目的
调查大棚菜农和对照菜农MSDs患病情况,探索大棚菜农MSDs的危险因素,估计危险因素相对大小水平,提出针对大棚菜农MSDs的预防措施和建议。
方法
采用分层整群抽样方法,使用北欧国家肌肉骨骼疾患调查问卷与荷兰肌肉骨骼疾患调查问卷对某蔬菜大棚种植基地的大棚菜农和邻近村庄的非大棚菜农(对照组)进行面对面回顾性问卷调查,计算患病率,比较患病情况,并使用结构方程模型分析大棚菜农MSDs的危险因素。
结果
患病率
共调查639名大棚菜农和318名对照菜农。大棚菜农MSDs患病率为61.2%,对照菜农MSDs患病率为43.4%,并且大棚菜农MSDs患病率高于对照菜农(P<0.05)。大棚菜农前四位MSDs依次是下背疾患、肩部疾患、膝部疾患和颈部疾患。大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患的患病率分别为49.6%、29.0%、24.6%和12.8%,对照菜农分别为28.0%、11.6%、10.7%和4.4%,并且大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患患病率均高于对照菜农(P＜0.05)。
误工卧床情况
大棚菜农因MSDs误工364人,误工率为57.0%,对照菜农因MSDs误工135人,误工率为42.5%,并且大棚菜农MSDs误工率高于对照菜农(P＜0.05)。大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患的误工率分别为45.5%、25.0%、23.9%和12.5%,对照菜农分别为27.7%、11.3%、10.7%和3.8%,并且大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患的误工率均高于对照菜农(P＜0.05)。大棚菜农因MSDs卧床62人,对照菜农因MSDs卧床2人,大棚菜农高于对照菜农MSDs的卧床率(P＜0.05)。
危险因素结构方程模型分析
下背疾患在下背疾患的SEM中,潜因变量大棚菜农下背疾患的决定系数为0.847,力量施加因素、静态负荷、动态负荷、人体工效学环境因素、重复性负荷和社会心理学因素与下背疾患的结构系数分别为0.385、0.342、0.122、0.064、0.040和0.098(P＜0.05)。力量施加因素、静态负荷、人体工效学环境因素、动态负荷、社会心理学因素、重复性负荷和年龄因素对潜因变量下背疾患的总体影响分别是0.385、0.342、0.285、0.122、0.098、0.040和0.034。大棚环境中潜变量人体工效学环境因素对潜变量大棚菜农静态负荷的直接影响为0.646。
肩部疾患在肩部疾患的SEM中,潜因变量大棚菜农肩部疾患的决定系数为0.654,大棚因素、重复性负荷因素、力量施加因素、年龄因素、肩部姿势、性别和不舒适体位因素与肩部疾患的结构系数分别为0.448、0.283、0.106、0.079、0.069、0.065和0.033(P＜0.05)。大棚因素、重复性负荷、力量施加因素、年龄、肩部姿势、性别、不舒适体位因素对潜因变量肩部疾患的总体影响分别为0.660、0.283、0.106、0.079、0.069、0.065和0.033。大棚因素对大棚菜农力量施加因素的直接影响为0.553,对大棚菜农重复性负荷因素的直接影响为0.544。
膝部疾患在膝部疾患的SEM中,潜因变量大棚菜农膝部疾患的决定系数为0.674,大棚菜农不舒适体位因素、个体因素(身高、体重)、社会心理学因素和平时健康状况与大棚菜农膝部疾患的结构系数分别为0.632、0.259、0.089和0.039(P＜0.05)。不舒适体位因素、个体因素(身高、体重)、社会心理学因素和平时健康状况对大棚菜农膝部疾患的总体影响分别为0.632、0.259、0.089和0.039。
颈部疾患在颈部疾患的SEM中,潜因变量大棚菜农颈部疾患的决定系数为0.736,重复性负荷、颈部姿势、个体因素(年龄)、不舒适体位因素和社会心理学因素与大棚菜农颈部疾患的结构系数分别为0.559、0.344、0.037、0.030和0.001(P＜0.05)。重复性负荷、颈部姿势、个体因素(年龄)、不舒适体位因素和社会心理学因素对大棚菜农颈部疾患的总体影响分别为0.559、0.344、0.037、0.030和0.001。
结论
1.大棚菜农MSDs患病率较高,主要表现为下背疾患、肩部疾患、膝部疾患和颈部疾患,并且大棚菜农因MSDs明显影响了工作。
2.大棚菜农下背疾患的主要危险因素为力量施加、静态负荷、人体工效学环境和动态负荷；肩部疾患的主要危险因素为大棚因素、重复性负荷和力量施加因素；膝部疾患的主要危险因素为不舒适体位和肥胖；颈部疾患的主要危险因素为重复性负荷和颈部姿势。
3.建议：完善大棚配置；优化工作组织安排；改进操作方式。
Background
Musculoskeletal disorders (MSDs) are injuries or dysfunctions affecting muscles, bones, nerves, tendons, ligaments, joints, cartilages, and spinal discs. MSDs cases with mild symptoms often feel uncomfortable or slightly painful, while severe cases are often unable to work and need to be treated with medication or special tools training, usually with unexpected poor prognosis. MSDs are prevalent and are a serious problem among working population around the world. MSDs were listed as one of the ten occupational problems needing intensive research in2002by National Institute for Occupational Safety and Health, NIOSH, and the ten years of2000to2010was identified as "Bone and Joint Decade2000-2010" by world health organization, WHO. Agricultural workers are mostly affected by MSDs, especially in labor-intensive practices such as fruit and vegetable planting. China being a vast agricultural country, MSDs among farmers, however, have been paid scarce attention. Therefore, it is of vital significance to study farmers' MSDs and the risk factors.
Greenhouse vegetables have been widely planted in Shouguang, Shandong Province, and are increasingly being cultured in mainland China due to high economic profits. But due to the fact that greenhouse vegetable-planting is an arduous practice, and its peculiar greenhouse microenvironment (high temperature, high humidity, high carbon dioxide, etc.), greenhouse vegetable-planting farmers may be much more likely to be affected by MSDs such as osteoarthritis, low back pain, neck and shoulder pain.
Many factors could influence the occurrence and development of MSDs, such as occupational factors, individual factors, psychosocial factors, etc, which are difficult to determine and measure in surveys. What's more, the causal relationship between possible risk factors and diseases is usually difficult to demonstrate in cross-sectional studies. Structural equation model (SEM), one of the three achievements in statistics in the twentieth century, is a statistical technique for testing and estimating causal relations using a combination of statistical data and qualitative causal assumptions, allowing both confirmatory and exploratory modeling, meaning they are suited to both theory testing and theory development. SEM has been widely used in the field of medicine such as chronic diseases but there have been few studies reported in the application of analysis of MSDs'risk factors. The application of SEM to analyze risk factors of MSDs among greenhouse vegetable-planting farmers and to determine the relative levels, which would benefit the understanding of MSDs'risk factors, is of vital significance to guide future studies.
Objective
To study the prevalence of MSDs among both greenhouse vegetable-planting farmers and non-greenhouse vegetable-planting farmers, and to explore the risk factors influencing greenhouse vegetable-planting farmers'MSDs, and to seek measures preventing greenhouse vegetable-planting farmers'MSDs.
Methods
A self-administered questionnaire based on the Modified Nordic Questionnaire and the Dutch Musculoskeletal Questionnaire was conducted to both greenhouse vegetable-planting farmers in a greenhouse vegetable-planting area and non-greenhouse vegetable-planting farmers in the near villages by stratified cluster sampling. Then one-year prevalence rate of MSDs was calculated and compared between greenhouse vegetable-planting farmers and non-greenhouse vegetable-planting farmers (control group). Structural equation model was used to analyze the risk factors of greenhouse vegetable-planting farmners' MSDs and to determine the risk levels.
Results
1. Study of Prevalence
639greenhouse vegetable-planting farmers and318non-greenhouse vegetable-planting farmers completed the self-administered questionnaire. The1-year prevalence rate of MSDs was61.2%among greenhouse vegetable-planting farmers and43.4%among non-greenhouse farmers. The first four MSDs of greenhouse vegetable-planting farmers were low back disorders, shoulder(s) disorders, knee(s) disorders and neck disorders. The1-year prevalence rate of low back disorders, shoulder(s) disorders, knee(s) disorders and neck disorders among greenhouse vegetable-planting farmers was49.6%,29.0%,24.6%and12.8%respectively, statistically higher than that of non-greenhouse vegetable-planting farmers with the corresponding rate of28.0%,11.6%,10.7%and4.4%respectively (P<0.05).
2. Analysis of risk factors
The coefficient of determination of latent variables on low back disorders was0.847in the structural equation model. The structural coefficient of force exertion, static loads, dynamic loads, ergonomic environmental factors, repetitive loads and psychosocial factors on low back disorders was0.385,0.342,0.122,0.064,0.040and0.098respectively (P<0.05). The total effects of force exertion, static loads, ergonomic environmental factors, dynamic loads, psychosocial factors, repetitive loads and age on low back disorders were0.385,0.342,0.285,0.122,0.098,0.040and0.034respectively. The direct effect of ergonomic environmental factors on static loads was0.646.
The coefficient of determination of latent variables on shoulder(s) disorders in the structural equation model was0.654. The structural coefficients of greenhouse factors, repetitive factors, force exertion, age, postures of shoulder(s), gender and uncomfortable postures on shoulder(s) disorders were0.448,0.283,0.106,0.079,0.069,0.065and0.033respectively (P<0.05). The total effects of greenhouse factors, repetitive factors, force exertion, age, postures of shoulder(s), gender and uncomfortable postures on shoulder(s) disorders were0.660,0.283,0.106,0.079,0.069,0.065and0.033respectively. The direct effects of greenhouse factors on force exertion and repetitive loads were0.553and0.544respectively.
The coefficient of determination of latent variables on knee(s) disorders in the structural equation model was0.674. The structural coefficients of uncomfortable postures, individual factors (mainly height and bodyweight), psychosocial factors and health status on knee(s) disorders were0.632,0.259,0.089and0.039respectively (P<0.05). The total effects of uncomfortable postures, individual factors (mainly height and bodyweight), psychosocial factors and health status on knee(s) disorders were0.632,0.259,0.089and0.039respectively.
The coefficient of determination of latent variables on neck disorders was0.736in the structural equation model. The structural coefficients of repetitive loads, postures of neck, individual factors (age), uncomfortable postures and psychosocial factors on neck disorders were0.559,0.344,0.037,0.030and0.001respectively (P<0.05). The total effects of repetitive loads, postures of neck, individual factors (age), uncomfortable postures and psychosocial factors on neck disorders were0.559,0.344,0.037,0.030and0.001respectively.
Conclusions
1. The prevalence of MSDs among greenhouse vegetable-planting farmers was quite high, and the first four MSDs were low back disorders, shoulder(s) disorders, knee(s) disorders and neck disorders. What's more, the everyday work of greenhouse vegetable-planting farmers was affected due to MSDs.
2. The main risk factors of low back disorders among greenhouse vegetable-planting farmers were force exertion, static loads, ergonomic environmental factors and dynamic loads. The main risk factors of shoulder(s) disorders among greenhouse vegetable-planting farmers were greenhouse factors, repetitive loads and force exertion. The main risk factors of knee(s) disorders among greenhouse vegetable-planting farmers were uncomfortable postures and obesity. The main risk factors of neck disorders among greenhouse vegetable-planting farmers were repetitive loads and neck postures.
3. Suggestions:to improve greenhouse configuration; to optimize work organization; to meliorate operating styles.
引文
1. Da Costa, B.R. and E.R. Vieira. Risk Factors for Work-Related Musculoskeletal Disorders:A Systematic Review of Recent Longitudinal Studies. Am J Ind Med,2010,53(3):285-323.
2. Cohen, A.L. Elements of ergonomics programs:a primer based on workplace evaluations of musculoskeletal disorders.1997:Diane Pub Co.
3. 徐雷,杨磊.职业性慢性骨骼肌损伤机理研究进展.工业卫生与职业病,2001,27(1)：59-62.
4. Disorders, N.R.C.P.o.M.. Workplace, and I.o. Medicine, Musculoskeletal disorders and the workplace:low back and upper extremities. 2001:National Academy Press.
5. Cassou, B., F. Derriennic, C. Monfort, et al. Chronic neck and shoulder pain, age, and working conditions:longitudinal results from a large random sample in France. Occup Environ Med,2002,59(8):537-544.
6. Buckle, P. Ergonomics and musculoskeletal disorders:overview. Occupational Medicine-Oxford,2005,55(3):164-167.
7. Polanyi, M.F.D., D.C. Cole, D.E. Beaton, et al. Upper limb work-related musculoskeletal disorders among newspaper employees: Cross-sectional survey results. Am J Ind Med,1997,32(6):620-628.
8. Arndt, V., D. Rothenbacher, U. Daniel, et al. Construction work and risk of occupational disability:a ten year follow up of 14 474 male workers. Occup Environ Med,2005,62(8):559-566.
9. Meerding, W.J., W. Ijzelenberg, M.A. Koopmanschap, et al. Health problems lead to considerable productivity loss at work among workers with high physical load jobs. J Clin Epidemiol,2005,58(5):517-523.
10. Gerr, F., C.P. Monteilh, and M. Marcus. Keyboard use and musculoskeletal outcomes among computer users. Journal of Occupational Rehabilitation,2006,16(3):265-277.
11. Juul-Kristensen, B. and C. Jensen. Self-reported workplace related ergonomic conditions as prognostic factors for musculoskeletal symptoms:the "BIT" follow up study on office workers. Occup Environ Med,2005,62(3): 188-194.
12. Hannan, L.M., C.P. Monteilh, F. Gerr, et al. Job strain and risk of musculoskeletal symptoms among a prospective cohort of occupational computer users. Scandinavian Journal of Work Environment & Health,2005, 31(5):375-386.
13. Punnett, L., J. Gold, J.N. Katz, et al. Ergonomic stressors and upper extremity musculoskeletal disorders in automobile manufacturing:a one year follow up study. Occup Environ Med,2004,61(8):668-674.
14. Halford, V. and H.H. Cohen. Technology use and psychosocial factors in the self-reporting of musculoskeletal disorder symptoms in call center workers. Journal of Safety Research,2003,34(2):167-173.
15. Lemasters, G.K., M.R. Atterbury, A.D. Booth-Jones, et al. Prevalence of work related musculoskeletal disorders in active union carpenters. Occup Environ Med,1998,55(6):421-427.
16. Ong, C.N., S.E. Chia, J. Jeyaratnam, et al. Musculoskeletal disorders among operators of visual display terminals. Scandinavian journal of work, environment & health,1995,21(1):60-64.
17.凌瑞杰,孙敬智,杨磊,某汽车铸造厂作业工人肌肉骨骼疾患调查研究,中华预防医学会第十八次全国职业病学术交流大会论文集.2009.
18.徐雷,王正伦,宋挺博登.某造船厂工人肌肉骨骼疾患调查.中华劳动卫生职业病杂志,2011,29(3)：180-183.
19.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.中华劳动卫生职业病杂志,2011,29(3)：190-193.
20.王忠旭,秦汝莉,李玉珍等.汽车装配作业工人肌肉骨骼损伤的流行病学调查研究.中华劳动卫生职业病杂志,2012,29(1)：6-12.
21.何丽华,苏艳,曹磊等.石油钻井行业工人肌肉骨骼疾患及影响因素分析.中华劳动卫生职业病杂志,2011,29(3)：163-166.
22.刘凤英,李丽萍,徐光兴等.某煤矿工作相关肌肉骨骼疾患现状及危险因素分析.中华疾病控制杂志,2011,15(6)：470-472.
23.周浩,肖吕武,吴琳等.汽车制造企业工人工效学负荷水平与肌肉骨骼疾患关系研究.中国职业医学,2011,38(4)：312-315.
24.郝元涛,方积乾.结构方程模型及其在医学中的应用研究.中国医院统计,2003,10(04)：240-244.
25. Anderson, J.C. and D.W. Gerbing. Structural equation modeling in practice:A review and recommended two-step approach. Psychol Bull,1988, 103(3):411-423.
26. Chan, F., G.K. Lee, E.-J. Lee, et al. Structural equation modeling in rehabilitation counseling research. Rehabilitation Counseling Bulletin,2007, 51(1):44-57.
27. Peek, M.K. Structural equation modeling and rehabilitation research. Am J Phys Med Rehabil,2000,79(3):301-309.
28. Hoyle, R.H. and G.T. Smith. Formulating clinical research hypotheses as structural equation models:a conceptual overview. J Consult Clin Psychol,1994,62(3):429-440.
29.张家放,医用多元统计.2002,武汉：华中科技大学出版社,337-370.
30.李国春,李春婷,黄蓝洋等.结构方程模型在慢性萎缩性胃炎中医证候分型中应用.中国卫生统计,2007,24(4)：357-360.
31.陆璐,王烈,孙晗潇等.结构方程模型在糖尿病控制影响因素中应用.中国公共卫生,2008,24(6)：740-741.
32. Kuorinka, I., B. Jonsson, A. Kilbom, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon, 1987,18(3):233-237.
33. Rosecrance, J.C., K.T. Ketchen, L.A. Merlino, et al. Test-retest reliability of a self-administered musculoskeletal symptoms and job factors questionnaire used in ergonomics research. Appl Occup Environ Hyg,2002, 17(9):613-621.
34.徐雷,罗孝文,关玉荣等.五金塑胶业作业工人肌肉骨骼疾患调查.热带医学杂志,2012,12(1)：75-79.
35.王静,曾敬,郭怀兰等.某医学院学生网络成瘾与肌肉骨骼疾患的关系.中国学校卫生,2010,31(3)：315-316.
36.张俐娜,张红娣,万松泉等.三种行业工人职业性肌肉骨骼疾患调查分析.公共卫生与预防医学,2006,17(2)：74-75.
37.刘长俊.护理人群职业性肌肉骨骼疾患的现况研究.成都：四川大学硕士学位论文,2006.
38. Jensen, C., V. Borg, L. Finsen, et al. Job demands, muscle activity and musculoskeletal symptoms in relation to work with the computer mouse. Scandinavian Journal of Work Environment & Health,1998,24(5):418-424.
39. Bovenzi, M. and C.T.J. Hulshof. An updated review of epidemiologic studies on the relationship between exposure to whole-body vibration and low back pain (1986-1997). Int Arch Occup Environ Health, 1999,72(6):351-365.
40. Walker-Bone, K., K.T. Palmer, I. Reading, et al. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis & Rheumatism-Arthritis Care & Research,2004,51(4): 642-651.
41. Hildebrandt, V.H., P.M. Bongers, F.J.H. van Dijk, et al. Dutch Musculoskeletal Questionnaire:description and basic qualities. Ergonomics, 2001,44(12):1038-1055.
42.杨磊,V. Hildebrandt,余善法等.肌肉骨骼疾患调查表介绍附调查表.工业卫生与职业病,2009,35(01)：25-31.
43.余善法,谷桂珍,孙世义等.制造业工人肌肉骨骼疾患和劳动负荷及工作姿势分析.中华劳动卫生职业病杂志,2011,29(3)：184-189.
44.李静芸,武珊珊,何丽华等.采油工人健康状况和工作有关肌肉骨骼疾患的现况调查.职业与健康,2011,27(19)：382-385.
45.张军.结构方程模型构建方法比较.统计与决策,2007(18)：137-139.
46. Maetzel, A. and L. Li. The economic burden of low back pain:a review of studies published between 1996 and 2001. Best Practice & Research in Clinical Rheumatology,2002,16(1):23-30.
47.徐光兴,李丽萍,刘凤英等.煤矿工人肌肉骨骼疾患健康教育的干预效果.中华劳动卫生职业病杂志,2011,29(9)：686-688.
48. Davis, K.G. and S.E. Kotowski. Understanding the ergonomic risk for musculoskeletal disorders in the United States agricultural sector. Am J Ind Med,2007,50(7):501-511.
49. Schneider, E., X. Irastorza, S. Copsey, et al. OSH in figures: Work-related musculoskeletal disorders in the EU-Facts and figures. Luxembourg:European Agency for Safety and Health at Work,2010.
50. Holmberg, S., E.L. Stiernstrom, A. Thelin, et al. Musculoskeletal symptoms among farmers and non-farmers:A population-based study. Int J Occup Environ Health,2002,8(4):339-345.
51. Stiernstrom, E.L., S. Holmberg, A. Thelin, et al. Reported health status among farmers and nonfarmers in nine rural districts. J Occup Environ Med,1998,40(10):917-924.
52. Maetzel, A., M. Makela, G. Hawker, et al. Osteoarthritis of the hip and knee and mechanical occupational exposure-A systematic overview of the evidence. J Rheumatol,1997,24(8):1599-1607.
53. Osborne, A., C. Blake, J. McNamara, et al. Musculoskeletal disorders among Irish farmers. Occupational Medicine-Oxford,2010,60(8): 598-603.
54. Lee, K. and H.-S. Lim. Work-related injuries and diseases of farmers in Korea. Ind Health,2008,46(5):424-434.
55. Bernard, C. and M. Tourne. Musculoskeletal disorders in agriculture. La Revue du praticien,2007,57(11 Suppl):45-50.
56. Stocks, S.J., S. Turner, M. Carder, et al. Medically reported work-related ill-health in the UK agricultural sector. Occupational Medicine-Oxford,2010,60(5):340-347.
57. Widanarko, B., S. Legg, M. Stevenson, et al. Prevalence of musculoskeletal symptoms in relation to gender, age, and occupational/industrial group. International Journal of Industrial Ergonomics, 2011,41(5):561-572.
58. Naidoo, S., H. Kromhout, L. London, et al. Musculoskeletal Pain in Women Working in Small-Scale Agriculture in South Africa. Am J Ind Med, 2009,52(3):202-209.
59. Fathallah, F.A. Musculoskeletal disorders in labor-intensive agriculture. Appl Ergon,2010,41(6):738-743.
60. Statistics, B.o.L., Nonfatal occupational injuries and illnesses requiring days away from work.2008:New York
61.张建文,马长利,张志新等.蔬菜大棚微小气候及其对菜农健康的影响.环境与健康杂志,2005,22(5)：387-388.
62. Rosecrance, J., G. Rodgers, and L. Merlino. Low back pain and musculoskeletal symptoms among Kansas farmers. Am J Ind Med,2006, 49(7):547-556.
63. Barrero, L.H., Y.-H. Hsu, H. Terwedow, et al. Prevalence and physical determinants of low back pain in a rural Chinese population. Spine, 2006,31(23):2728-2734.
64. Leino-Arjas, P., K. Hanninen, and P. Puska. Socioeconomic variation in back and joint pain in Finland. Eur J Epidemiol,1998,14(1): 79-87.
65. Manninen, P., H. Riihimak, and M. Heliovaara. Incidence and risk factors of low-back pain in middle-aged farmers. Occupational medicine (Oxford, England),1995,45(3):141-146.
66. Xiang, H.Y., L. Stallones, and T.J. Keefe. Back pain and agricultural work among farmers:An analysis of the Colorado Farm Family Health and Hazard Surveillance Survey. Am J Ind Med,1999,35(3):310-316.
67. Skovron, M.L., M. Szpalski, M. Nordin, et al. Sociocultural factors and back pain. A population-based study in Belgian adults. Spine,1994,19(2): 129-137.
68. Sakakibara, H., M. Miyao, T. Kondo, et al. Overhead work and shoulder-neck pain in orchard farmers harvesting pears and apples. Ergonomics,1995,38(4):700-706.
69. Palmer, K.T. Musculoskeletal problems in the tomato growing industry:'Tomato trainer's shoulder'? Occupational Medicine (London),1996, 46(6):428-431.
70. Bovenzi, M., A. Zadini, A. Franzinelli, et al. Occupational musculoskeletal disorders in the neck and upper limbs of forestry workers exposed to hand-arm vibration. Ergonomics,1991,34(5):547-562.
71. Nonnenmann, M.W., D. Anton, F. Gerr, et al. Musculoskeletal symptoms of the neck and upper extremities among Iowa dairy farmers. Am J Ind Med,2008,51(6):443-451.
72. Pinzke, S. Changes in working conditions and health among dairy farmers in southern Sweden. A 14-year follow-up. Ann Agric Environ Med, 2003,10(2):185-195.
73. Dillon, C., M. Petersen, and S. Tanaka. Self-reported hand and wrist arthritis and occupation:Data from the US National Health Interview Survey-Occupational Health Supplement. Am J Ind Med,2002,42(4): 318-327.
74. Bergenudd, H., B. Nilsson, and F. Lindgarde. Knee pain in middle age and its relationship to occupational work load and psychosocial factors. Clin Orthop,1989,24(5):210-215.
75. Jensen, L.K. and W. Eenberg. Occupation as a risk factor for knee disorders. Scandinavian Journal of Work Environment and Health,1996,22(3): 165-175.
76. Jensen, L.K., S. Mikkelsen, I.P. Loft, et al. Work-related knee disorders in floor layers and carpenters. J Occup Environ Med,2000,42(8): 835-842.
77. O'Reilly, S.C., K.R. Muir, and M. Doherty. Occupation and knee pain:a community study. Osteoarthritis Cartilage,2000,8(2):78-81.
78. da Silva, M.C., A.G. Fassa, M.R. Domingues, et al. Knee pain and associated occupational factors:a systematic review. Cad Saude Publica,2007, 23(8):1763-1775.
79. Rytter, S., L.K. Jensen, and J.P. Bonde. Knee complaints and consequences on work status; a 10-year follow-up survey among floor layers and graphic designers. Bmc Musculoskeletal Disorders,2007,8:93-99.
80. Szeto, G.P.Y. and P. Lam. Work-related musculoskeletal disorders in urban bus drivers of Hong Kong. Journal of Occupational Rehabilitation,2007, 17(2):181-198.
81. Chen, J.C., J.T. Dennerlein, T.S. Shih, et al. Knee pain and driving duration:A secondary analysis of the taxi drivers'health study. Am J Public Health,2004,94(4):575-581.
82. Craig, B.N., J.J. Congleton, C.J. Kerk, et al. A prospective field study of the relationship of potential occupational risk factors with occupational injury/illness. Aiha Journal,2003,64(3):376-387.
83. Walker-Bone, K. and K.T. Palmer. Musculoskeletal disorders in farmers and farm workers. Occupational Medicine-Oxford,2002,52(8): 441-450.
84. Rytter, S., L.K. Jensen, and J.P. Bonde. Clinical knee findings in floor layers with focus on meniscal status. Bmc Musculoskeletal Disorders, 2008,9:144-132.
85. Dimov, M., A. Bhattacharya, G. Lemasters, et al. Exertion and body discomfort perceived symptoms associated with carpentry tasks:an on-site evaluation. Aihaj,2000,61(5):685-691.
86. Kivimaki, J., K. Hanninen, U.M. Kujala, et al. Knee laxity in carpet and floor layers and painters. Ann Chir Gynaecol,1994,83(3):229-233.
87. Tanaka, S., W.E. Halperin, A.B. Smith, et al. Skin effects of occupational kneeling. Am J Ind Med,1985,8(4-5):341-349.
88. Harcombe, H., D. McBride, S. Derrett, et al. Prevalence and impact of musculoskeletal disorders in New Zealand nurses, postal workers and office workers. Aust N Z J Public Health,2009,33(5):437-441.
89. Sobti, A., C. Cooper, H. Inskip, et al. Occupational physical activity and long-term risk of musculoskeletal symptoms:A National Survey of Post Office Pensioners. Am J Ind Med,1997,32(1):76-83.
90. Miranda, H., E. Viikari-Juntura, R. Martikainen, et al. A prospective study on knee pain and its risk factors. Osteoarthritis Cartilage,2002,10(8): 623-630.
91. Hahn, T., A. Foldspang, and T. Ingemann-Hansen. Prevalence of knee instability in relation to sports activity. Scandinavian Journal of Medicine & Science in Sports,2001,11(4):233-238.
92. Partridge, R.E., J.A. Anderson, M.A. McCarthy, et al. Rheumatic complaints among workers in iron foundries. Ann Rheum Dis,1968,27(5): 441-453.
93. Waehrer, G., J.P. Leigh, and T.R. Miller. Costs of occupational injury and illness within the health services sector. Int J Health Serv,2005,35(2): 343-359.
94. Dunn, W.R., A.E. Lincoln, R.Y. Hinton, et al. Occupational disability after hospitalization for the treatment of an injury of the anterior cruciate ligament. Journal of Bone and Joint Surgery-American Volume,2003, 85A(9):1656-1666.
95. Sulsky, S.I., K.A. Mundt, C. Bigelow, et al. Risk factors for occupational knee related disability among enlisted women in the US Army. Occup Environ Med,2002,59(9):601-607.
96. Rossignol, M., A. Leclerc, F.A. Allaert, et al. Primary osteoarthritis of hip, knee, and hand in relation to occupational exposure. Occup Environ Med,2005,62(11):772-777.
97. Cha, E.S., K.A. Kong, E.K. Moon, et al. Prevalence and changes in chronic diseases among South Korean farmers:1998 to 2005. Bmc Public Health,2009,9:268-276.
98. Kang, X., M. Fransen, Y. Zhang, et al. The High Prevalence of Knee Osteoarthritis in a Rural Chinese Population:The Wuchuan Osteoarthritis Study. Arthritis & Rheumatism-Arthritis Care & Research,2009,61(5): 641-647.
99. Holmberg, S., A. Thelin, and N. Thelin. Is there an increased risk of knee osteoarthritis among farmers? A population-based case-control study. Int Arch Occup Environ Health,2004,77(5):345-350.
100.李莉,王生,姜家忠等.坐位作业工人下背痛流行病学调查及其工效学评价.工业卫生与职业病,1995,21(01)：4-7.
101.Stellman, J.M., Encyclopaedia of occupational health and safety. Vol. 1.1998:Intl Labour Organisation.
102. Devereux, J.J., I.G. Vlachonikolis, and P.W. Buckle. Epidemiological study to investigate potential interaction between physical and psychosocial factors at work that may increase the risk of symptoms of musculoskeletal disorder of the neck and upper limb. Occup Environ Med, 2002,59(4):269-277.
103. Holmberg, S., A. Thelin, E.L. Stiernstrom, et al. The impact of physical work exposure on musculoskeletal symptoms among farmers and rural non-farmers. A population-based study. Ann Agric Environ Med,2003, 10(2):179-184.
104. Callejon-Ferre, A.J., J. Perez-Alonso, J. Sanchez-Hermosilla, et al. Ergonomics and psycho-sociological quality indeces in greenhouses, Almeria (Spain). Spanish Journal of Agricultural Research,2009,7(1):50-58.
105. Andersen, J.H., J.P. Haahr, and P. Frost. Risk factors for more severe regional musculoskeletal symptoms-A two-year prospective study of a general working population. Arthritis Rheum,2007,56(4):1355-1364.
106. Sarikaya, S., S. Ozdolap, S. Gumustas, et al. Low back pain and lumbar angles in Turkish coal miners. Am J Ind Med,2007,50(2):92-96.
107. Stewart, M., J. Latimer, and M. Jamieson. Back extensor muscle endurance test scores in coal miners in Australia. Journal of Occupational Rehabilitation,2003,13(2):79-89.
108. Lloyd, M.H., S. Gauld, and C.A. Soutar. Epidemiologic study of back pain in miners and office workers. Spine,1986,11(2):136-140.
109. Sim, J., R.J. Lacey, and M. Lewis. The impact of workplace risk factors on the occurrence of neck and upper limb pain:a general population study. Bmc Public Health,2006,6:234-243.
110. Huang, G.D., M. Feuerstein, and S.L. Sauter. Occupational stress and work-related upper extremity disorders:Concepts and models. Am J Ind Med,2002,41(5):298-314.
111. Malchaire, J., N. Cock, and S. Vergracht. Review of the factors associated with musculoskeletal problems in epidemiological studies. Int Arch Occup Environ Health,2001,74(2):79-90.
112. Be, B. Musculoskeletal disorders and workplace factors:a critical review of epidemiologic evidence for work-related musculoskeletal disorders of neck, upper extremity, and low back.1997.
113. Stitik, T.P. Work Related Musculoskeletal Disorders (WMSDs):A Reference Book for Prevention. Am J Phys Med Rehabil,1996,75(3): 182-195.
114. Van Dieen, J.H. and H. Vrielink. Evaluation of work-rest schedules with respect to the effects of postural workload in standing work. Ergonomics, 1998,41(12):1832-1844.
115. Vanroelen, C., K. Levecque, and F. Louckx. Psychosocial working conditions and self-reported health in a representative sample of wage-earners: a test of the different hypotheses of the Demand-Control-Support-Model. Int Arch Occup Environ Health,2009,82(3):329-342.
116. Tornqvist, E.W., M. Hagberg, M. Hagman, et al. The influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users. Int Arch Occup Environ Health,2009,82(6):689-702.
117. Lipscomb, H., K. Kucera, C. Epling, et al. Upper extremity musculoskeletal symptoms and disorders among a cohort of women employed in poultry processing. Am J Ind Med,2008,51(1):24-36.
118. Messing, K., F. Tissot, and S. Stock. Distal lower-extremity pain and work postures in the Quebec population. Am J Public Health,2008,98(4): 705-713.
119. Lindfors, P., U. von Thiele, and U. Lundberg. Work characteristics and upper extremity disorders in female dental health workers. Journal of Occupational Health,2006,48(3):192-197.
120. Leroyer, A., J.L. Edme, X. Vaxevanoglou, et al. Neck, shoulder, and hand and wrist pain among administrative employees:Relation to work-time organization and psychosocial factors at work. J Occup Environ Med,2006, 48(3):326-333.
121.Hagen, K.B., P. Magnus, and K. Vetlesen. Neck/shoulder and low-back disorders in the forestry industry:relationship to work tasks and perceived psychosocial job stress. Ergonomics,1998,41(10):1510-1518.
122. Leroux, I., C.E. Dionne, R. Bourbonnais, et al. Prevalence of musculoskeletal pain and associated factors in the Quebec working population. Int Arch Occup Environ Health,2005,78(5):379-386.
123. Ortiz-Hernandez, L., S. Tamez-Gonzalez, S. Martinez-Alcantara, et al. Computer use increases the risk of musculoskeletal disorders among newspaper office workers. Arch Med Res,2003,34(4):331-342.
124. Croft, P.R., M. Lewis, A.C. Papageorgiou, et al. Risk factors for neck pain:a longitudinal study in the general population. Pain,2001,93(3): 317-325.
125. Hooftman, W.E., M.N.M. van Poppel, A.J. van der Beek, et al. Gender differences in the relations between work-related physical and psychosocial risk factors and musculoskeletal complaints. Scandinavian Journal of Work Environment & Health,2004,30(4):261-278.
126. Lundberg, U. Psychophysiology of work:Stress, gender, endocrine response, and work-related upper extremity disorders. Am J Ind Med,2002, 41(5):383-392.
127. Roquelaure, Y, C. Ha, C. Rouillon, et al. Risk Factors for Upper-Extremity Musculoskeletal Disorders in the Working Population. Arthritis & Rheumatism-Arthritis Care & Research,2009,61(10):1425-1434.
128. Andersen, J.H., A. Kaergaard, S. Mikkelsen, et al. Risk factors in the onset of neck/shoulder pain in a prospective study of workers in industrial and service companies. Occup Environ Med,2003,60(9):649-654.
2. Cohen, A.L. Elements of ergonomics programs:a primer based on workplace evaluations of musculoskeletal disorders.1997:Diane Pub Co.
3. 徐雷,杨磊.职业性慢性骨骼肌损伤机理研究进展.工业卫生与职业病,2001,27(1)：59-62.
4. Disorders, N.R.C.P.o.M.. Workplace, and I.o. Medicine, Musculoskeletal disorders and the workplace:low back and upper extremities. 2001:National Academy Press.
5. Cassou, B., F. Derriennic, C. Monfort, et al. Chronic neck and shoulder pain, age, and working conditions:longitudinal results from a large random sample in France. Occup Environ Med,2002,59(8):537-544.
6. Buckle, P. Ergonomics and musculoskeletal disorders:overview. Occupational Medicine-Oxford,2005,55(3):164-167.
7. Polanyi, M.F.D., D.C. Cole, D.E. Beaton, et al. Upper limb work-related musculoskeletal disorders among newspaper employees: Cross-sectional survey results. Am J Ind Med,1997,32(6):620-628.
8. Arndt, V., D. Rothenbacher, U. Daniel, et al. Construction work and risk of occupational disability:a ten year follow up of 14 474 male workers. Occup Environ Med,2005,62(8):559-566.
9. Meerding, W.J., W. Ijzelenberg, M.A. Koopmanschap, et al. Health problems lead to considerable productivity loss at work among workers with high physical load jobs. J Clin Epidemiol,2005,58(5):517-523.
10. Gerr, F., C.P. Monteilh, and M. Marcus. Keyboard use and musculoskeletal outcomes among computer users. Journal of Occupational Rehabilitation,2006,16(3):265-277.
11. Juul-Kristensen, B. and C. Jensen. Self-reported workplace related ergonomic conditions as prognostic factors for musculoskeletal symptoms:the "BIT" follow up study on office workers. Occup Environ Med,2005,62(3): 188-194.
12. Hannan, L.M., C.P. Monteilh, F. Gerr, et al. Job strain and risk of musculoskeletal symptoms among a prospective cohort of occupational computer users. Scandinavian Journal of Work Environment & Health,2005, 31(5):375-386.
13. Punnett, L., J. Gold, J.N. Katz, et al. Ergonomic stressors and upper extremity musculoskeletal disorders in automobile manufacturing:a one year follow up study. Occup Environ Med,2004,61(8):668-674.
14. Halford, V. and H.H. Cohen. Technology use and psychosocial factors in the self-reporting of musculoskeletal disorder symptoms in call center workers. Journal of Safety Research,2003,34(2):167-173.
15. Lemasters, G.K., M.R. Atterbury, A.D. Booth-Jones, et al. Prevalence of work related musculoskeletal disorders in active union carpenters. Occup Environ Med,1998,55(6):421-427.
16. Ong, C.N., S.E. Chia, J. Jeyaratnam, et al. Musculoskeletal disorders among operators of visual display terminals. Scandinavian journal of work, environment & health,1995,21(1):60-64.
17.凌瑞杰,孙敬智,杨磊,某汽车铸造厂作业工人肌肉骨骼疾患调查研究,中华预防医学会第十八次全国职业病学术交流大会论文集.2009.
18.徐雷,王正伦,宋挺博登.某造船厂工人肌肉骨骼疾患调查.中华劳动卫生职业病杂志,2011,29(3)：180-183.
19.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.中华劳动卫生职业病杂志,2011,29(3)：190-193.
20.王忠旭,秦汝莉,李玉珍等.汽车装配作业工人肌肉骨骼损伤的流行病学调查研究.中华劳动卫生职业病杂志,2012,29(1)：6-12.
21.何丽华,苏艳,曹磊等.石油钻井行业工人肌肉骨骼疾患及影响因素分析.中华劳动卫生职业病杂志,2011,29(3)：163-166.
22.刘凤英,李丽萍,徐光兴等.某煤矿工作相关肌肉骨骼疾患现状及危险因素分析.中华疾病控制杂志,2011,15(6)：470-472.
23.周浩,肖吕武,吴琳等.汽车制造企业工人工效学负荷水平与肌肉骨骼疾患关系研究.中国职业医学,2011,38(4)：312-315.
24.郝元涛,方积乾.结构方程模型及其在医学中的应用研究.中国医院统计,2003,10(04)：240-244.
25. Anderson, J.C. and D.W. Gerbing. Structural equation modeling in practice:A review and recommended two-step approach. Psychol Bull,1988, 103(3):411-423.
26. Chan, F., G.K. Lee, E.-J. Lee, et al. Structural equation modeling in rehabilitation counseling research. Rehabilitation Counseling Bulletin,2007, 51(1):44-57.
27. Peek, M.K. Structural equation modeling and rehabilitation research. Am J Phys Med Rehabil,2000,79(3):301-309.
28. Hoyle, R.H. and G.T. Smith. Formulating clinical research hypotheses as structural equation models:a conceptual overview. J Consult Clin Psychol,1994,62(3):429-440.
29.张家放,医用多元统计.2002,武汉：华中科技大学出版社,337-370.
30.李国春,李春婷,黄蓝洋等.结构方程模型在慢性萎缩性胃炎中医证候分型中应用.中国卫生统计,2007,24(4)：357-360.
31.陆璐,王烈,孙晗潇等.结构方程模型在糖尿病控制影响因素中应用.中国公共卫生,2008,24(6)：740-741.
32. Kuorinka, I., B. Jonsson, A. Kilbom, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon, 1987,18(3):233-237.
33. Rosecrance, J.C., K.T. Ketchen, L.A. Merlino, et al. Test-retest reliability of a self-administered musculoskeletal symptoms and job factors questionnaire used in ergonomics research. Appl Occup Environ Hyg,2002, 17(9):613-621.
34.徐雷,罗孝文,关玉荣等.五金塑胶业作业工人肌肉骨骼疾患调查.热带医学杂志,2012,12(1)：75-79.
35.王静,曾敬,郭怀兰等.某医学院学生网络成瘾与肌肉骨骼疾患的关系.中国学校卫生,2010,31(3)：315-316.
36.张俐娜,张红娣,万松泉等.三种行业工人职业性肌肉骨骼疾患调查分析.公共卫生与预防医学,2006,17(2)：74-75.
37.刘长俊.护理人群职业性肌肉骨骼疾患的现况研究.成都：四川大学硕士学位论文,2006.
38. Jensen, C., V. Borg, L. Finsen, et al. Job demands, muscle activity and musculoskeletal symptoms in relation to work with the computer mouse. Scandinavian Journal of Work Environment & Health,1998,24(5):418-424.
39. Bovenzi, M. and C.T.J. Hulshof. An updated review of epidemiologic studies on the relationship between exposure to whole-body vibration and low back pain (1986-1997). Int Arch Occup Environ Health, 1999,72(6):351-365.
40. Walker-Bone, K., K.T. Palmer, I. Reading, et al. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis & Rheumatism-Arthritis Care & Research,2004,51(4): 642-651.
41. Hildebrandt, V.H., P.M. Bongers, F.J.H. van Dijk, et al. Dutch Musculoskeletal Questionnaire:description and basic qualities. Ergonomics, 2001,44(12):1038-1055.
42.杨磊,V. Hildebrandt,余善法等.肌肉骨骼疾患调查表介绍附调查表.工业卫生与职业病,2009,35(01)：25-31.
43.余善法,谷桂珍,孙世义等.制造业工人肌肉骨骼疾患和劳动负荷及工作姿势分析.中华劳动卫生职业病杂志,2011,29(3)：184-189.
44.李静芸,武珊珊,何丽华等.采油工人健康状况和工作有关肌肉骨骼疾患的现况调查.职业与健康,2011,27(19)：382-385.
45.张军.结构方程模型构建方法比较.统计与决策,2007(18)：137-139.
46. Maetzel, A. and L. Li. The economic burden of low back pain:a review of studies published between 1996 and 2001. Best Practice & Research in Clinical Rheumatology,2002,16(1):23-30.
47.徐光兴,李丽萍,刘凤英等.煤矿工人肌肉骨骼疾患健康教育的干预效果.中华劳动卫生职业病杂志,2011,29(9)：686-688.
48. Davis, K.G. and S.E. Kotowski. Understanding the ergonomic risk for musculoskeletal disorders in the United States agricultural sector. Am J Ind Med,2007,50(7):501-511.
49. Schneider, E., X. Irastorza, S. Copsey, et al. OSH in figures: Work-related musculoskeletal disorders in the EU-Facts and figures. Luxembourg:European Agency for Safety and Health at Work,2010.
50. Holmberg, S., E.L. Stiernstrom, A. Thelin, et al. Musculoskeletal symptoms among farmers and non-farmers:A population-based study. Int J Occup Environ Health,2002,8(4):339-345.
51. Stiernstrom, E.L., S. Holmberg, A. Thelin, et al. Reported health status among farmers and nonfarmers in nine rural districts. J Occup Environ Med,1998,40(10):917-924.
52. Maetzel, A., M. Makela, G. Hawker, et al. Osteoarthritis of the hip and knee and mechanical occupational exposure-A systematic overview of the evidence. J Rheumatol,1997,24(8):1599-1607.
53. Osborne, A., C. Blake, J. McNamara, et al. Musculoskeletal disorders among Irish farmers. Occupational Medicine-Oxford,2010,60(8): 598-603.
54. Lee, K. and H.-S. Lim. Work-related injuries and diseases of farmers in Korea. Ind Health,2008,46(5):424-434.
55. Bernard, C. and M. Tourne. Musculoskeletal disorders in agriculture. La Revue du praticien,2007,57(11 Suppl):45-50.
56. Stocks, S.J., S. Turner, M. Carder, et al. Medically reported work-related ill-health in the UK agricultural sector. Occupational Medicine-Oxford,2010,60(5):340-347.
57. Widanarko, B., S. Legg, M. Stevenson, et al. Prevalence of musculoskeletal symptoms in relation to gender, age, and occupational/industrial group. International Journal of Industrial Ergonomics, 2011,41(5):561-572.
58. Naidoo, S., H. Kromhout, L. London, et al. Musculoskeletal Pain in Women Working in Small-Scale Agriculture in South Africa. Am J Ind Med, 2009,52(3):202-209.
59. Fathallah, F.A. Musculoskeletal disorders in labor-intensive agriculture. Appl Ergon,2010,41(6):738-743.
60. Statistics, B.o.L., Nonfatal occupational injuries and illnesses requiring days away from work.2008:New York
61.张建文,马长利,张志新等.蔬菜大棚微小气候及其对菜农健康的影响.环境与健康杂志,2005,22(5)：387-388.
62. Rosecrance, J., G. Rodgers, and L. Merlino. Low back pain and musculoskeletal symptoms among Kansas farmers. Am J Ind Med,2006, 49(7):547-556.
63. Barrero, L.H., Y.-H. Hsu, H. Terwedow, et al. Prevalence and physical determinants of low back pain in a rural Chinese population. Spine, 2006,31(23):2728-2734.
64. Leino-Arjas, P., K. Hanninen, and P. Puska. Socioeconomic variation in back and joint pain in Finland. Eur J Epidemiol,1998,14(1): 79-87.
65. Manninen, P., H. Riihimak, and M. Heliovaara. Incidence and risk factors of low-back pain in middle-aged farmers. Occupational medicine (Oxford, England),1995,45(3):141-146.
66. Xiang, H.Y., L. Stallones, and T.J. Keefe. Back pain and agricultural work among farmers:An analysis of the Colorado Farm Family Health and Hazard Surveillance Survey. Am J Ind Med,1999,35(3):310-316.
67. Skovron, M.L., M. Szpalski, M. Nordin, et al. Sociocultural factors and back pain. A population-based study in Belgian adults. Spine,1994,19(2): 129-137.
68. Sakakibara, H., M. Miyao, T. Kondo, et al. Overhead work and shoulder-neck pain in orchard farmers harvesting pears and apples. Ergonomics,1995,38(4):700-706.
69. Palmer, K.T. Musculoskeletal problems in the tomato growing industry:'Tomato trainer's shoulder'? Occupational Medicine (London),1996, 46(6):428-431.
70. Bovenzi, M., A. Zadini, A. Franzinelli, et al. Occupational musculoskeletal disorders in the neck and upper limbs of forestry workers exposed to hand-arm vibration. Ergonomics,1991,34(5):547-562.
71. Nonnenmann, M.W., D. Anton, F. Gerr, et al. Musculoskeletal symptoms of the neck and upper extremities among Iowa dairy farmers. Am J Ind Med,2008,51(6):443-451.
72. Pinzke, S. Changes in working conditions and health among dairy farmers in southern Sweden. A 14-year follow-up. Ann Agric Environ Med, 2003,10(2):185-195.
73. Dillon, C., M. Petersen, and S. Tanaka. Self-reported hand and wrist arthritis and occupation:Data from the US National Health Interview Survey-Occupational Health Supplement. Am J Ind Med,2002,42(4): 318-327.
74. Bergenudd, H., B. Nilsson, and F. Lindgarde. Knee pain in middle age and its relationship to occupational work load and psychosocial factors. Clin Orthop,1989,24(5):210-215.
75. Jensen, L.K. and W. Eenberg. Occupation as a risk factor for knee disorders. Scandinavian Journal of Work Environment and Health,1996,22(3): 165-175.
76. Jensen, L.K., S. Mikkelsen, I.P. Loft, et al. Work-related knee disorders in floor layers and carpenters. J Occup Environ Med,2000,42(8): 835-842.
77. O'Reilly, S.C., K.R. Muir, and M. Doherty. Occupation and knee pain:a community study. Osteoarthritis Cartilage,2000,8(2):78-81.
78. da Silva, M.C., A.G. Fassa, M.R. Domingues, et al. Knee pain and associated occupational factors:a systematic review. Cad Saude Publica,2007, 23(8):1763-1775.
79. Rytter, S., L.K. Jensen, and J.P. Bonde. Knee complaints and consequences on work status; a 10-year follow-up survey among floor layers and graphic designers. Bmc Musculoskeletal Disorders,2007,8:93-99.
80. Szeto, G.P.Y. and P. Lam. Work-related musculoskeletal disorders in urban bus drivers of Hong Kong. Journal of Occupational Rehabilitation,2007, 17(2):181-198.
81. Chen, J.C., J.T. Dennerlein, T.S. Shih, et al. Knee pain and driving duration:A secondary analysis of the taxi drivers'health study. Am J Public Health,2004,94(4):575-581.
82. Craig, B.N., J.J. Congleton, C.J. Kerk, et al. A prospective field study of the relationship of potential occupational risk factors with occupational injury/illness. Aiha Journal,2003,64(3):376-387.
83. Walker-Bone, K. and K.T. Palmer. Musculoskeletal disorders in farmers and farm workers. Occupational Medicine-Oxford,2002,52(8): 441-450.
84. Rytter, S., L.K. Jensen, and J.P. Bonde. Clinical knee findings in floor layers with focus on meniscal status. Bmc Musculoskeletal Disorders, 2008,9:144-132.
85. Dimov, M., A. Bhattacharya, G. Lemasters, et al. Exertion and body discomfort perceived symptoms associated with carpentry tasks:an on-site evaluation. Aihaj,2000,61(5):685-691.
86. Kivimaki, J., K. Hanninen, U.M. Kujala, et al. Knee laxity in carpet and floor layers and painters. Ann Chir Gynaecol,1994,83(3):229-233.
87. Tanaka, S., W.E. Halperin, A.B. Smith, et al. Skin effects of occupational kneeling. Am J Ind Med,1985,8(4-5):341-349.
88. Harcombe, H., D. McBride, S. Derrett, et al. Prevalence and impact of musculoskeletal disorders in New Zealand nurses, postal workers and office workers. Aust N Z J Public Health,2009,33(5):437-441.
89. Sobti, A., C. Cooper, H. Inskip, et al. Occupational physical activity and long-term risk of musculoskeletal symptoms:A National Survey of Post Office Pensioners. Am J Ind Med,1997,32(1):76-83.
90. Miranda, H., E. Viikari-Juntura, R. Martikainen, et al. A prospective study on knee pain and its risk factors. Osteoarthritis Cartilage,2002,10(8): 623-630.
91. Hahn, T., A. Foldspang, and T. Ingemann-Hansen. Prevalence of knee instability in relation to sports activity. Scandinavian Journal of Medicine & Science in Sports,2001,11(4):233-238.
92. Partridge, R.E., J.A. Anderson, M.A. McCarthy, et al. Rheumatic complaints among workers in iron foundries. Ann Rheum Dis,1968,27(5): 441-453.
93. Waehrer, G., J.P. Leigh, and T.R. Miller. Costs of occupational injury and illness within the health services sector. Int J Health Serv,2005,35(2): 343-359.
94. Dunn, W.R., A.E. Lincoln, R.Y. Hinton, et al. Occupational disability after hospitalization for the treatment of an injury of the anterior cruciate ligament. Journal of Bone and Joint Surgery-American Volume,2003, 85A(9):1656-1666.
95. Sulsky, S.I., K.A. Mundt, C. Bigelow, et al. Risk factors for occupational knee related disability among enlisted women in the US Army. Occup Environ Med,2002,59(9):601-607.
96. Rossignol, M., A. Leclerc, F.A. Allaert, et al. Primary osteoarthritis of hip, knee, and hand in relation to occupational exposure. Occup Environ Med,2005,62(11):772-777.
97. Cha, E.S., K.A. Kong, E.K. Moon, et al. Prevalence and changes in chronic diseases among South Korean farmers:1998 to 2005. Bmc Public Health,2009,9:268-276.
98. Kang, X., M. Fransen, Y. Zhang, et al. The High Prevalence of Knee Osteoarthritis in a Rural Chinese Population:The Wuchuan Osteoarthritis Study. Arthritis & Rheumatism-Arthritis Care & Research,2009,61(5): 641-647.
99. Holmberg, S., A. Thelin, and N. Thelin. Is there an increased risk of knee osteoarthritis among farmers? A population-based case-control study. Int Arch Occup Environ Health,2004,77(5):345-350.
100.李莉,王生,姜家忠等.坐位作业工人下背痛流行病学调查及其工效学评价.工业卫生与职业病,1995,21(01)：4-7.
101.Stellman, J.M., Encyclopaedia of occupational health and safety. Vol. 1.1998:Intl Labour Organisation.
102. Devereux, J.J., I.G. Vlachonikolis, and P.W. Buckle. Epidemiological study to investigate potential interaction between physical and psychosocial factors at work that may increase the risk of symptoms of musculoskeletal disorder of the neck and upper limb. Occup Environ Med, 2002,59(4):269-277.
103. Holmberg, S., A. Thelin, E.L. Stiernstrom, et al. The impact of physical work exposure on musculoskeletal symptoms among farmers and rural non-farmers. A population-based study. Ann Agric Environ Med,2003, 10(2):179-184.
104. Callejon-Ferre, A.J., J. Perez-Alonso, J. Sanchez-Hermosilla, et al. Ergonomics and psycho-sociological quality indeces in greenhouses, Almeria (Spain). Spanish Journal of Agricultural Research,2009,7(1):50-58.
105. Andersen, J.H., J.P. Haahr, and P. Frost. Risk factors for more severe regional musculoskeletal symptoms-A two-year prospective study of a general working population. Arthritis Rheum,2007,56(4):1355-1364.
106. Sarikaya, S., S. Ozdolap, S. Gumustas, et al. Low back pain and lumbar angles in Turkish coal miners. Am J Ind Med,2007,50(2):92-96.
107. Stewart, M., J. Latimer, and M. Jamieson. Back extensor muscle endurance test scores in coal miners in Australia. Journal of Occupational Rehabilitation,2003,13(2):79-89.
108. Lloyd, M.H., S. Gauld, and C.A. Soutar. Epidemiologic study of back pain in miners and office workers. Spine,1986,11(2):136-140.
109. Sim, J., R.J. Lacey, and M. Lewis. The impact of workplace risk factors on the occurrence of neck and upper limb pain:a general population study. Bmc Public Health,2006,6:234-243.
110. Huang, G.D., M. Feuerstein, and S.L. Sauter. Occupational stress and work-related upper extremity disorders:Concepts and models. Am J Ind Med,2002,41(5):298-314.
111. Malchaire, J., N. Cock, and S. Vergracht. Review of the factors associated with musculoskeletal problems in epidemiological studies. Int Arch Occup Environ Health,2001,74(2):79-90.
112. Be, B. Musculoskeletal disorders and workplace factors:a critical review of epidemiologic evidence for work-related musculoskeletal disorders of neck, upper extremity, and low back.1997.
113. Stitik, T.P. Work Related Musculoskeletal Disorders (WMSDs):A Reference Book for Prevention. Am J Phys Med Rehabil,1996,75(3): 182-195.
114. Van Dieen, J.H. and H. Vrielink. Evaluation of work-rest schedules with respect to the effects of postural workload in standing work. Ergonomics, 1998,41(12):1832-1844.
115. Vanroelen, C., K. Levecque, and F. Louckx. Psychosocial working conditions and self-reported health in a representative sample of wage-earners: a test of the different hypotheses of the Demand-Control-Support-Model. Int Arch Occup Environ Health,2009,82(3):329-342.
116. Tornqvist, E.W., M. Hagberg, M. Hagman, et al. The influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users. Int Arch Occup Environ Health,2009,82(6):689-702.
117. Lipscomb, H., K. Kucera, C. Epling, et al. Upper extremity musculoskeletal symptoms and disorders among a cohort of women employed in poultry processing. Am J Ind Med,2008,51(1):24-36.
118. Messing, K., F. Tissot, and S. Stock. Distal lower-extremity pain and work postures in the Quebec population. Am J Public Health,2008,98(4): 705-713.
119. Lindfors, P., U. von Thiele, and U. Lundberg. Work characteristics and upper extremity disorders in female dental health workers. Journal of Occupational Health,2006,48(3):192-197.
120. Leroyer, A., J.L. Edme, X. Vaxevanoglou, et al. Neck, shoulder, and hand and wrist pain among administrative employees:Relation to work-time organization and psychosocial factors at work. J Occup Environ Med,2006, 48(3):326-333.
121.Hagen, K.B., P. Magnus, and K. Vetlesen. Neck/shoulder and low-back disorders in the forestry industry:relationship to work tasks and perceived psychosocial job stress. Ergonomics,1998,41(10):1510-1518.
122. Leroux, I., C.E. Dionne, R. Bourbonnais, et al. Prevalence of musculoskeletal pain and associated factors in the Quebec working population. Int Arch Occup Environ Health,2005,78(5):379-386.
123. Ortiz-Hernandez, L., S. Tamez-Gonzalez, S. Martinez-Alcantara, et al. Computer use increases the risk of musculoskeletal disorders among newspaper office workers. Arch Med Res,2003,34(4):331-342.
124. Croft, P.R., M. Lewis, A.C. Papageorgiou, et al. Risk factors for neck pain:a longitudinal study in the general population. Pain,2001,93(3): 317-325.
125. Hooftman, W.E., M.N.M. van Poppel, A.J. van der Beek, et al. Gender differences in the relations between work-related physical and psychosocial risk factors and musculoskeletal complaints. Scandinavian Journal of Work Environment & Health,2004,30(4):261-278.
126. Lundberg, U. Psychophysiology of work:Stress, gender, endocrine response, and work-related upper extremity disorders. Am J Ind Med,2002, 41(5):383-392.
127. Roquelaure, Y, C. Ha, C. Rouillon, et al. Risk Factors for Upper-Extremity Musculoskeletal Disorders in the Working Population. Arthritis & Rheumatism-Arthritis Care & Research,2009,61(10):1425-1434.
128. Andersen, J.H., A. Kaergaard, S. Mikkelsen, et al. Risk factors in the onset of neck/shoulder pain in a prospective study of workers in industrial and service companies. Occup Environ Med,2003,60(9):649-654.
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