【作者】 王强；

【导师】 朱益民；

【作者基本信息】 浙江大学 ， 流行病与卫生统计学， 2009， 硕士

【摘要】 [目的]由于职业性有害因素直接或间接导致的肌肉骨骼疾患通称为工作有关的肌肉骨骼疾患(WRMDs)。WRMDs涉及行业广泛,患病率高,危害严重。WRMDs造成患者的长期病痛,严重影响了劳动者健康、工作能力和职业生活质量,同时也给个人、集体和国家带来沉重负担,已成为许多工业发达国家的主要职业健康问题。WRMDs的严重危害已经逐渐引起了经济发达国家政府和卫生研究机构的普遍关注。我国WRMDs的患病率非常高,危害程度可能比预期想象更为严重。本次调查研究是为了了解WRMDs在杭州市中学教师人群中的分布特征,明确WRMDs的危害范围;通过评价WRMDs对杭州市中学教师人群工作能力水平的影响,明确WRMDs的危害程度,并分析杭州市中学教师WRMDs的主要影响因素,根据筛选出的主要影响因素提出有的放矢的干预措施、改善中学教师职业生活质量。[方法]采用整群抽样方法,考虑区域平衡和学校类别,抽取杭州市有代表性13所中学在职教师作为调查研究对象。本次研究主要采用问卷调查的方式,调查内容和方法包括以下4部分:(1)调查对象基本信息采集;(2)采用标准化北欧国家肌肉骨骼系统症状分析量表(Nordic量表),从三个时间层面(曾经、最近1年和最近1周)对研究对象颈部、肩部、下背部是否存在肌肉骨骼系统症状进行调查;(3)采用工作能力指数(WAI)评价教师的工作能力;(4)对有可能影响教师肌肉骨骼疾患的一些职业性影响因素和非职业性影响因素进行问卷调查。此次研究采用曾患率、年患率、周患率三个患病指标描述WRMDs的患病水平。采用因病(伤)工休率、因病(伤)就诊率、工作能力指数描述WRMDs的危害程度。应用MicrosoftVisual FoxPro6.0数据库管理软件建立数据库,录入、核实和维护数据;应用SAS 9.01 for Windows软件包进行统计分析。根据不同的资料类型,应用t检验、方差分析、x~2检验、秩和检验等统计方法进行差异性检验。应用Pearson相关分析研究符合正态分布的双变量相关关系;应用非条件Logistic回归分析研究WRMDSs影响因素。检验水准(α)定为0.05。此次研究在研究设计、资料的收集、整理与分析等方面采用严格的质量控制措施,确保研究结果的准确性和可靠性。[结果]此次研究共调查了808人,发放调查表808份,回收784份,回收率为97.03%(784/808),有效调查表718份,有效率为91.58%(718/784)。从总体看,研究对象的基本特征(年龄、工龄)均衡可比。杭州市中学教师颈部WRMDs患病率最高,曾患率、年患率和周患率分别为55.01%、45.13%、26.32%,其次是肩部(46.52%,38.02%,19.36%),下背部最低(35.52%,29.39%,17.97%),差异有统计学意义(P＜0.05)。WRMDs患病率(曾患率、年患率、周患率)基本表现为脑力劳动者最高,其次为脑体混合劳动者,体力劳动者最低,差异具有统计学意义(P＜0.01)。无论是颈部、肩部还是下背部,女性WRMDs曾患率、年患率、周患率均高于男性,除下背部年患率(P＝0.0810)、周患率(P＝0.2731)外,差异均具有统计学意义(P＜0.05)。从整体看,各年龄段(＜30岁、30岁～、35岁～、40岁～、45岁～、≥50岁)由低到高,颈部、肩部和下背部WRMDs曾患率、年患率、周患率经x~2检验,差异均无统计学意义(P＞0.05)。但总体上随着年龄段由低到高,呈现出逐步增高再降低的趋势,患病率高的年龄段在30～40岁之间。从整体看,各工龄段(＜10年、10年～和≥20年)由低到高,颈部、肩部和下背部WRMDs曾患率、年患率、周患率经x~2检验,差异均无统计学意义(P＞0.05)。但总体上随着工龄段由低到高,呈现出逐步增高再降低的趋势,患病率高的工龄段在10～20之间。杭州市中学教师因WRMDs病(伤)工休率为12.67%,因病(伤)就诊率为3.06%。最近1年内患病组教师工作能力均低于非患病组,差异有统计学意义(P＜0.003);分劳动类型看,最近1年各劳动类型患病组教师工作能力也均低于非患病组,差异有统计学意义(P＜0.05)。非患病组与患病组教师工作能力分级构成比不同,两组之间工作能力分级存在程度上的差别(P＜0.001),患病组工作能力“差”、“中”者明显高于非患病组,而工作能力“优”者明显低于非患病组。从各劳动类型看,非患病组与患病组工作能力分级构成比分级程度也表现出类似特征(P＜0.001)。采用非条件Logistic回归分析,对调查的中学教师WRMDs影响因素通过逐步回归法建立Logistic回归方程,计算标准化偏回归系数(Standardized PartialRegression Coefficient)、优势比(Odds Ratio,OR)及其95%可信区间(ConfidenceInterval,CI)。分析结果共有四个因素有统计学意义(P＜0.01)进入Logistic回归模型,分别是每日站立时间、每日低头次数、工作疲劳感、工作满意度。其中颈部为工作满意度、工作疲劳感、每日低头次数,标准化偏回归系数工作满意度为-0.2716、工作疲劳感为0.2198、低头次数为0.1823,工作满意度优势比OR=0.742,95%CL:0.634-0.868;工作疲劳感优势比OR=1.240,95%CL:1.066-1.443;每日低头次数优势比OR=1.171,95%CL:1.012-1.356。肩部为工作满意度、工作疲劳感,标准化偏回归系数工作满意度为-0.186、工作疲劳感别为0.286,工作满意度优势比OR=0.815,95%CL:0.708-0.938;工作疲劳感优势比OR=1.324,95%CL:1.171-1.498。下背部为工作满意度、工作疲劳感、每日站立时间,标准化偏回归系数工作满意度为-0.2422、工作疲劳感为0.2190、每日站立时间为0.1863。工作满意度优势比OR=0.766,95%CL:0.657-0.894;工作疲劳感优势比OR=1.239,95%CL:1.069-1.436;每日站立时间数优势比OR=1.212,95%CL:1.058-1.387。[结论]杭州市中学教师颈部、肩部、下背部WRMDs的患病率(曾患率)分别为55.01%、46.52%、35.52%。脑力劳动者WRMDs患病率最高,其次为脑体混合劳动者,体力劳动者最低。女性教师患病率明显高于男性。患病的中学教师人群工作能力明显低于非患病教师,患病的中学教师人群工作能力“差”、“中”者比例明显高于非患病教师人群,而工作能力“优”者明显低于非患病教师人群。工作满意度、工作疲劳感、每日低头次数、每日站立时间是中学教师WRMDs的主要影响因素。其中每日低头次数、每日站立时间、工作疲劳感为危险因素,而工作满意度是保护性因素。研究结果对于制定中学教师WRMDs有针对性的干预措施、改善中学教师职业生活质量具有直接价值。未来中学教师WRMDs的研究重点应是进一步明确主要危险因素,明确危险因素与WRMDs的剂量反应关系,以期采用更有针对性的预防干预措施。更多还原

【Abstract】 [Objective] Work-related musculoskeletal disorders (WRMDs) are the Musculoskeletal disorders ,which were resulted directly or indirectly from occupational harmful factors. WRMDs had a high prevalence rate and was involved in many industries. Many persons were suffered from WRMDs and their health, work abilities, and life quality were affected seriously. At the same time, it brought a heavy burden on individuals, society and the country and had become a main occupational health problem in many developed countries. The hazard of WRMDs had gradually aroused the universal concern of the developed governments and health research institutes. There was a high incidence of WRMDs in our country and its harm might have exceeded our expectation. The study was carried out to investigate the distribution of WRMDs among middle school teachers in Hangzhou and to get to know the harm of WRMDs by evaluating its effects on teachers’ work abilities. The study also analyzed the main influencing factors of WRMDs among middle school teachers, and then brought forward some intervention measures on the basis of selected influencing factors in order to improve middle school teachers’ life quality.[Methods] This study was a cross-sectional investigation. Teachers from 13 middle schools in Hangzhou were selected by cluster sampling considering the region balance and school’s category. Questionnaire was used to collect related information. The contents and methods of the investigation included: 1) basic information of subjects, 2) musculoskeletal disorders of subjects in three different stages (ever, the recent one year, the recent one week) was investigated with Standardized Nordic Questionnaire for the Analysis of Musculoskeletal Symptoms, 3) teachers’ work abilities were evaluated with Work Ability Index, 4) some occupational and unprofessional factors that might affect teachers’ musculoskeletal disorders were investigated. Three indexes, ever prevalence rate, year prevalence rate, and week prevalence rate, were used in this study to describe the prevalence of WRMDs. And the day off rate because of WRMDs, hospital visiting rate because of WRMDs and Work Ability Index were used to describe the seriousness of WRMDs. The data were analyzed with Microsoft Visual FoxPro 6.0 and SAS 9.01 for Windows. T-test, Analysis of variance, Chi-square test and Rank sum test were used to test the differences of data. Analysis of Pearson correlation was applied to analyze the bivariate correlation according with normal distribution and Logistic regression was applied to evaluate the risk of possible factors. The data were analyzed at alpha level of 0.05.The study took strict quality control measures in research design, data collection and data collation and analysis to ensure the accuracy and reliability of the results.[Results] Totally 808 teachers were investigated in the study. And 784 questionnaires were returned including 718 qualified, with a recovery rate of 97.03% (784/808) and an effective of 91.58% (718/784). On the whole, the basic characteristics (age, working age) of effective respondents were balanced and comparable.The highest prevalence rate of WRMDs in middle school teachers of Hangzhou happened in the neck, with an ever prevalence rate of 55.01%, a year prevalence rate of 45.13%, and a week prevalence rate of 26.32% respectively, followed by those in shoulders(46.52%,38.02%,19.36%) and the low back(35.52%,29.39%,17.97%), the differences were statistically significant (P<0.05). The prevalence rate of mental workers ranked the first, followed by mental-manual workers and manual workers (p<0.01). The prevalence rate of female teachers was higher than that of male, and except a year prevalence (p=0.081) and a week prevalence in the low back (p=0.2731), the other differences were statistically significant (p<0.05). On the whole, there was no statistically significant differences of the prevalence rates in the neck, shoulders, and the low back with the increasing of the age (age<30, age≥30, age≥35, age≥40, age≥45, and age≥50) (p>0.05). But the prevalence rates in the neck, shoulders and the low back presented a trend as that of the middle aged were high and that of the young and the old were low. The highest prevalence rates happened in the age 30-40. Quiet similarly, there was no statistically significant differences of the prevalence rates in the neck, shoulders, and the low back with the increasing of the working age (working age<10 years, working age≥10 years, and working age>20 years) (p>0.05). But the prevalence rates presented a trend as that of the middle working aged were high and that of the young and the old were low. And the highest prevalence rate happened in the working age 10-20. The day off rate because of WRMDs was 12.67%, and the hospital visiting rate because of WRMDs was 3.06% in middle school teachers in Hangzhou.In the recent one year, the work ability of teachers suffered WRMDs was poorer than that of those without WRMDs (p<0.003). The work ability of teachers of all types of work suffered WRMDs was also poorer than that of those without WRMDs in the recent one year (p<0.05). The work ability of teachers suffered WRMDs and teachers without WRMDs had different component ratio (p<0.001). The percentage of those with poor and moderate work ability was significantly higher in teachers suffered WRMDs than that in teachers without WRMDs, and the percentage of those with excellent work ability was lower in teachers suffered WRMDs. The situation was quite similar as analyzed according to work types (p<0.001).Logistic regression was used to evaluate the possible risk factors of WRMDs. Logistic regression equation was established to count Standardized Partial Regression Coefficient, Odds Ratio and Confidence Interval. Four factors with statistical significance (p<0.01) were selected in the Logistic regression model, which were standing time per day, the times of bowing head per day, job fatigue, and job satisfaction. WRMDs in the neck was related to job satisfaction, job fatigue, and the times of bowing head per day. Standardized Partial Regression Coefficients of them were -0.2716, 0.2198, and 0.1823 respectively. Odds Ratios of them were 0.742 (95%CI:1.171-1.498), 1.240 (95%CI: 1.066-1.443), and 1.171 (95%CI:1.012-1.356) respectively. WRMDs in shoulders was related to job satisfaction and job fatigue. Standardized Partial Regression Coefficients of them were -0.186 and 0.286. And Odds Ratio of them were 0.815 (95%CI:0.708-0.938) and 1.324 (95%CI:1.171-1.498). WRMDs in the low back was related to job satisfaction, job fatigue, and standing time per day. Standardized Partial Regression Coefficients of them were -0.2422, 0.219, and 0.1863. Odds Ratios of them were 0.766 (95%CI:0.657-0.894) , 1.239 (95%CI: 1.069-1.436), and 1.212 (95%CI: 1.058-1.397).[Conclusion] The prevalence rates of WRMDs in the neck, shoulders and the low back among middle school teachers were 55.01%, 46.52% and 35.52% respectively in Hangzhou. The prevalence rate of mental workers was the highest, followed by mental-manual workers and manual workers. In female teachers the rate was significantly higher than that in male teachers. The work ability of the teachers with WRMDs was significantly poorer than those without WRMDs. The percentage of the teachers with poor or moderate work ability was also significantly higher in teachers with WRMDs than that in those without WRMDs, and the percentage with good work ability was significantly lower than that in those without WRMDs. The main influencing factors of WRMDs among middle school teachers include job satisfaction, job fatigue, standing time per day, and the times of bowing head per day. Of these factors, the times of bowing head per day, standing time per day, and job fatigue are risk factors, and job satisfaction is protective factor. The results of the study are valuable in making intervention measures and improving occupational life quantity of middle school teachers. In the future, it is important to further make sure of the main risk factors of WRMDs and the dose-response relationship between the risk factors and WRMDs, and thus more pertinent intervention measures can be taken.更多还原