电解铝厂工人职业性下背痛危险因素探讨

目的　探讨电解铝厂工人职业性下背痛患病情况及其危险因素。方法　采用横断面调查问卷对铝厂工人及对照组的下背痛有关危险因素逐一询问,并依据病史及症状作出下背痛的临床诊断。结果　电解铝厂工人职业性下背痛患病率４５－４ ％ ,不同车间工人患病率差异未见显著性,但均高于对照组（１６－４ ％ ） 。Ｌｏｇｉｓｔｉｃ 回归分析提示下背痛患病与性别、年龄、身高、文化程度、婚烟状况、子女数、吸烟、饮酒、工作紧张感、疲劳感、既往疾病史及劳动姿势有关。结论　提示改善作业方式及有关社会心理状况、降低工作和家庭劳动负荷以及杜绝不良生活习惯是减低下背痛患病率的重要途径。     

The recovery patterns of back pain among workers with compensated occupational back injuries

Objectives

To investigate the longitudinal patterns of recovery among workers with compensated occupational back injuries.

Methods

A longitudinal cohort study, with one‐year follow‐up via structured telephone interviews, among respondents off work because of “new” back injuries. Self‐reported pain intensity was recorded at baseline and at four follow‐up time points over the course of one year. Workers who answered the questionnaire on at least three occasions (n = 678) were classified into clusters according to their patterns of pain intensity over time using a two‐step cluster analysis.

Results

Four pain recovery patterns were identified: workers with high levels of pain intensity showing no improvement over time (43%); those experiencing recovery in the first four months with no further improvement or possibly even some deterioration, in the second half year (33%); those experiencing a slow consistent recovery but still with considerable back pain at the end of the follow‐up (12%); and those quickly progressing to low level of pain or resolution (12%). Trajectories of average Roland‐Morris Disability scores and SF‐36 Role of Physical scores for above clusters mapped consistently with the corresponding patterns in pain. However, individuals with fluctuating, recurrent pain patterns showed the shortest cumulative duration on 100% benefit and the earliest return‐to‐work among other clusters.

Conclusions

Four clinically sensible patterns were identified in this cohort of injured workers, suggesting inter‐individual differences in back pain recovery. The results confirm that recurrent or chronic back pain is a typical condition in respondents with new back injuries. Pain intensity and disability scores are good measures of recovery of back pain at the individual level. After initial return‐to‐work, or cessation of benefits, administrative measures of percentage of respondents back at work, or no longer on benefits, may not accurately reflect an individual''s condition of back pain.Low back disorders are the most common, costly and disabling of musculoskeletal health problem.¹ They are one of the most common reasons for visits to primary care,² and the single largest category of workers'' compensation claims in most compensation systems.³ While some cases of low back pain are transient and resolve or considerably improve over several weeks,^4,5 symptoms can often be recurrent or chronic.^6,7 Studies have shown that over 65% of back pain patients in primary care continued to experience at least mild pain one month after seeking care, and approximately 33% reported continuing pain of at least moderate intensity after 12 months.^5,8The course of back disorders can be characterised using measures of different aspects of health,⁹ such as pain, disability, activity limitations and/or participation.¹⁰ For instance, the course has been studied by assessing the prevalence of back pain at different time points, or by evaluating changes in the amount of pain across time in pre‐classified patient groups.^10,11,12 Transitions between different states such as resolution, improvement, aggravation and recurrence have also been used to study courses.¹³Participation in work is also a key outcome in studies of back pain. Duration of claim in workers'' compensation systems^10,14,15 and time to return to work^10,16 have also been used as end‐points in studies evaluating the duration of back‐pain episodes, or to identify prognostic factors or effective interventions. However, measures based on first return to work may underestimate the percentage of people impaired^17,18 because workers may continue to experience pain after returning to work, or may experience recurrent episodes of pain and disability. While some studies have shown a relation between pain and disability and time to claim closure,¹⁹ other factors also may influence the decision to return to work.¹⁰Von Korff described the course of back pain as highly variable, occurring in transient, recurrent, and chronic phases.⁷ Few longitudinal studies have been carried out to classify the different pathways of back pain.^13,20 Dunn et al used longitudinal latent class analysis to identify four groups of back pain patients with distinctive recovery patterns in a primary care setting.²⁰ It would be of interest to explore the course of back pain in a population of injured workers to determine similarities and differences to those among the general population.The purpose of this study is (1) to identify and summarise the course of pain in a cohort of injured workers off work because of back pain and (2) to describe the distribution of the patterns across other commonly used proxy measures of recovery.     

Cohort study of occupational risk factors of low back pain in construction workers

OBJECTIVES—To identify work related risk factors of future low back pain (LBP) in a cohort of construction workers free of LBP at the start of follow up.
METHODS—The Hamburg construction worker study comprises 571 male construction workers who have undergone two comprehensive interview and physical examination surveys. A cohort of 285 subjects without LBP at baseline was identified. After a follow up of 3 years, the 1 year prevalence of self reported LBP was determined in the 230 men followed up (80.7%). Prevalence ratios (PRs) with 95% confidence intervals (95% CIs) of LBP at follow up according to self reported work tasks of construction workers measured at baseline were estimated from Cox's regression models which were adjusted for age, and anthropometric measures.
RESULTS—At follow up 71 out of 230 workers (30.9%) reported LBP during the preceding 12 months. Four work tasks (scaffolding, erecting roof structures, sawing wood, laying large sandstones) with an increased risk of 1 year prevalence of LBP at follow up were further evaluated. After further adjustment for occupation the relative risk was increased for workers who had reported 2 hour/shifts laying large sandstones (PR=2.6; 95% CI 1.1 to 6.5). Work load of bricklayers was additionally estimated by an index on stone load (high exposure: PR=4.0; 95% CI 0.8 to 19.8), and an index for laying huge bricks/blocks (yes/no: PR=1.7; 95% CI 0.5 to 5.7).
CONCLUSIONS—The results suggest that self reported differences in brick characteristics (size and type of stone) and temporal aspects of the work of bricklayers (average hours per shift laying specified stones) can predict the future prevalence of LBP. The data have to be interpreted with caution because multiple risk factors were tested.


Keywords: construction industry; cohort studies; low back pain     

护理人员下背痛危险因素分析

目的：探讨护理作业人员职业性下背痛患病情况及其危险因素。方法：采用横断面调查方法对本市场规模相近的三所医院的752名护士进行问卷调查，内容涉及下背痛病史、症状及其相关影响因素。结果：护理作业人员下背痛患病率高达56.9％，Logistic回归分析提示：个体生物因素如年龄、体重、妊娠次数；家庭因素如家庭人口数、子女数、婚姻状况、承担家务劳动量；职业性因素，如工作紧张、疲劳、轮班、工龄；社会心理因素，如认为工作脏累、责任和压力大、工作条件和工资待遇不满意、工作紧张等；既往患病史的有无等与下背痛患病有关。结论：下背痛是护理人员常见疾患，其患病危险因素来自多个方面。     

Epidemiological study of low back pain and occupational risk factors among taxi drivers

A survey of taxi drivers was conducted to determine the actual situation of drivers' low back pain (LBP). The survey was carried out in October 2002, the target drivers were asked to complete a questionnaire which contains questions regarding physique of drivers, demographic features, working conditions, office environment, health conditions, the presence of low back pain, the level of low back pain based on Visual Analogue Scale and Roland-Morris Disability Questionnaire score. As a result, the total number of valid responses was 1,334 and the response rate was 71 percent, and the 1-wk prevalence of LBP was 20.5 percent of respondents. Regarding 275 subjects with LBP, Visual Analogue Scale (VAS) averaged 4.3. There was a positive weak correlation between VAS and Roland-Morris Disability Questionnaire score (R=0.41). And Logistic regression analysis was performed to examine the relationship between LBP and occupational factors, the results suggested following items as risk factors; such as history of LBP, suffering from fatigue, diseases other than LBP and smoking habit.     

Individual and occupational determinants of low back pain according to various definitions of low back pain

OBJECTIVES: To test associations between non-specific low back pain and several risk factors when definitions of low back pain vary. DESIGN/SETTING/PARTICIPANTS: A cross sectional study was set up in 1991, 725 workers from four occupational sectors answered a self administrated questionnaire including the Nordic questionnaire and questions about intensity of pain and individual and occupational factors. MAIN RESULTS: Prevalence of low back pain varied from 8% to 45% according to the definition used. Psychosomatic problems, bending or carrying loads were often associated to low back pain, whereas other risk factors were related to some specific dimensions of the disorder. CONCLUSIONS: Risk factors of low back pain vary with the definition. This could explain inconsistencies found in literature reviews. To be able to compare data, it seems important to be precise what definition is used and to use comparable questionnaires.     

Risk factors for first-ever low back pain among workers in their first employment

BACKGROUND: Low back pain has been estimated to be the most costly ailment of people of working age. Both work characteristics and individual factors have been identified as risk factors. The first interaction between work characteristics and individual factors occurs when workers start in their first job. AIMS: To investigate work-related risk factors for first-ever low back pain in young workers in their first employment. METHODS: A cross-sectional analysis was performed on 278 young workers in their first employment and without a history of low back pain prior to working. Work-related physical factors, psychosocial work characteristics, individual variables and first-ever low back pain were queried by means of a questionnaire. RESULTS: About half of the workers who developed low back pain after job start did so in the first year of employment. An increased risk was observed for (i) long periods of seated work [relative risk (RR) = 3.2, 95% confidence interval (CI) = 1.6-6.4]; (ii) more than 12 flexion or rotation movements of the trunk per hour (RR = 3.0, 95%CI = 1.4-6.4); and (iii) more than 3 years seniority in a job involving lifting more than 25 kg at least once an hour (RR = 3.7, 95%CI = 1.4-9.4). As to psychosocial work characteristics, first-ever low back pain was associated with a combination of low psychological job demands and low supervisor support. CONCLUSION: Work-related physical factors and psychosocial work characteristics should be considered as risk factors for first-ever low back pain. First-ever episodes of low back pain are common in the first year of employment. This may reflect a lack of work experience or training.     

某汽车厂工人下背痛患病率及其影响因素

目的 研究汽车生产工人下背痛（LBP）的患病情况及其影响因素。方法 于2013年6月采用二阶段整群随机抽样方法在湖北省十堰市某汽车公司抽取3 800名工人进行问卷调查。结果 该公司工人LBP年患病率为60.3%;单因素分析,对LBP发生的危险因素有：年龄＞30岁、几乎一直长时间站立（指持续时间＞1 h,下同）、工作时需做弯腰动作、工龄11~15年、工作时需做转身动作、工作时需保持弯腰姿势、高频率的重复性作业、人员短缺,它们对患病率影响依次递降,OR值范围在2.14~1.54,影响最大的是年龄30~39岁（OR=2.14,95%CI=1.70~2.68）和“几乎一直长时间站立”（OR=1.93,95%CI=1.56~2.40）;保护因素有：有充足的休息时间 （OR=0.56,95%CI=0.49~0.64）、可以自己决定何时开始和结束工作（OR=0.65,95%CI=0.55~0.77）、长时间坐着工作（OR=0.91,95%CI=0.78~1.07）;体质指数、长时间跪着工作、长时间坐着工作对LBP的影响无统计学意义（P>0.05）。多因素非条件logistic回归分析结果显示,女性、年龄≥30岁、工龄≥11年、工作时需做弯腰动作、几乎一直站立工作、几乎一直坐位工作、多次重复性操作、人员短缺为危险因素,休息时间充足、可以自己决定何时开始和结束工作为保护因素。结论 在汽车制造业工人中,LBP具有较高的患病率,需要采取改进工作体位、减少高频重复动作、改善劳动组织管理等措施予以干预。     

Occupational low back pain among workers in some small-sized factories in Ardabil, Iran

The main purpose of this study was to assess some of the individual and occupational risk factors contributing to induction or intensification of LBP among the employees suffering from this problem in four small size factories in Ardabil, Iran. This study was a cross-sectional study that was conducted among the personnel of four industrial companies. Interview, questionnaire survey, medical examination (Lasegue test), radiographic evaluation, and ergonomic survey (using the NIOSH checklist) were the methods to collect data. The result of the study was divided into two parts: individual factors and work-related factors. The highest frequency of low back pain was observed in the age of 30-34 years old, medium height and heavy weight with 34.4, 84.4, and 33.0 percent, respectively. With regard to work-related factors, load lifting with 44.7 and body posture with 18.4 percent contributed to low back pain as the most important occupational causes among the patients. Observing recommended regulations and limitations of load lifting, modifying and optimizing ergonomic conditions in the workplace, selecting workers with suitable body strength on the basis of a pre-employment examination and implementing a continuous educational program for employees were the most important methods recommended to prevent low back pain.     

Risk factors for low back pain among Filipino manufacturing workers and their anthropometric measurements

This study looked into the prevalence of and risk factors for low back pain among workers in manufacturing industries in the Philippines. Anthropometric measurements were also done to establish the design principles of the working equipment, protective equipment, and tools of the Filipino worker to prevent musculoskeletal disorder. This was a cross-sectional study using a stratified random sampling technique. Thirty-one industries were selected. Various workstations were sampled from each industry where subjects were selected. There were 495 workers surveyed for the symptoms questionnaire and 544 for the anthropometric measurements. Results showed that 5.1 percent experienced discomfort, 2 percent had trunk rigidity, and 1.4 percent had both limitations of trunk motion and activities of daily living. Logistic regression showed that low back pain was significantly associated with leaning, bending, and carrying for 2-8 hours (p at.05), and with standing for 2-8 hours (p at.001). It was also found to affect work performance and more likely to occur 14 times as often after work as during the initial work sessions. Anthropometric measurements of the workers showed that the mean height is 159.96 cm, mean chest height is 115.70 cm, waist height is 96.95 cm, and knee height is 47.37 cm. Anthropometric data between sexes was also presented. This anthropometry can be used for the design of working equipment of Filipino workers. It is recommended that risk factors for low back pain be understood and equipment be designed according to the body proportions of the workers identified in this study.     

Risk factors for low back pain among office workers in Ibadan,Southwest Nigeria

BACKGROUND: Low back pain is the most common musculo-skeletal problem in the workplace. Data from low-income countries are scant. OBJECTIVES: To determine the prevalence and risk factors for low back pain among office workers in Ibadan, Nigeria. METHODS: A cross-sectional study design was utilized. Questionnaires were distributed among office workers in the civil service in Ibadan, Nigeria. RESULTS: Eight hundred and forty questionnaires were analysed, with a response rate of 66%. The 12 month prevalence of low back pain was 38% and the point prevalence was 20%. Low back pain was significantly associated with senior staff grade and smoking. Severity of low back pain was associated with sitting for >3 h. Only 16 respondents (5%) reported sickness absence due to back pain in the previous year. A total of 75 days were lost, a mean of 4.7 days per year. CONCLUSIONS: The occurrence of low back pain in this study is comparable with that reported in studies from more industrialized countries, but does not constitute a major cause of sickness absence in this group of workers.     

Work environment and low back pain: the influence of occupational activities.

OBJECTIVES: To find associations between the prevalence of low back pain and occupational activities. METHODS: Interviews of a random sample of 5185 19-59 year old Danish employees analysed by logistic regression. RESULTS: Increased risks of low back pain were found for "vibration affecting the whole body" (odds ratio (OR) = 1.28), "physically hard work" (OR = 1.28), "frequently twisting or bending" (OR = 1.71), "standing up" (OR = 1.20), and "concentration demands" (OR = 1.28). In the analysis of dose-response relations between low back pain and the risk factors, the one year period prevalence increased with increasing exposure time during a working day to each of the risk factors. The prevalence proportion ratio for those reporting to be exposed for most of the working time were 1.30 for vibrations affecting the whole body, 1.54 for physically hard work, 1.48 for frequently twisting or bending, 1.29 for standing up, and 1.13 for concentration demands. These associations seemed to be stronger in the subset of subjects who worked for 37 hours or more per week. The population attributable fractions were 15.1% for frequently twisting or bending, 15.0% for standing up, 7.6% for concentration demands, and 4.4% for physically hard work. CONCLUSION: Vibrations affecting the whole body, physically hard work, frequently twisting or bending, standing up, and concentration demands proved to be risk factors for the occurrence of low back pain, even after controlling for age, sex, educational level, and duration of employment in a specific occupation.     

铸造工人腰背痛调查与脊柱力学负荷评定

目的 探讨脊柱力学负荷暴露与腰背痛患病率的关系。方法 617名铸造工人，分为后勤，车床，清理和造型四类工种，通过姿势分析和生物力学模型计算，评价其脊柱力学负荷暴露；以骨科体检和问卷方式分别调查工人腰背压痛和腰背疼痛主诉患病率。结果 后勤，车床，清理和造型工种脊柱力学负荷依次加重，而其腰背压痛阳性率则依次为1.7%,4.6%,9.5%和16.8%，与脊柱负荷呈剂量反应关系。结论 铸造工人腰背压痛与其脊柱力学负荷暴露有关。     

Studies on the low back pain among electric construction workers. Report 2. Workers' attitude to the prevention and the treatment of their low back pain.

In the previous report, the author demonstrated that the electric construction workers were exposed to the high risk of low back pain, and discussed on the ways to prevent and to treat their occupational disorders. He concluded that the improvement of their working conditions, especially lessening of the working load, was necessary to prevent occupational low back pain, and that it was the most helpful effect on their low back pain to take a rest on an after the attack of the disorder, while most of the medical treatment without a rest were almost helpless. In this report, the author studied and discussed on the workers' opinions on the ways to prevent and to treat their low back pain, by means of questionnaire-method. The workers examined were classified by whether they had the disorder or not and also by the grades of their working load. The results are as follow: 1. As for preventive measures, it is the most popular opinion that they should take care not to hurt their low back; nevertheless, as a matter of fact, their low back pain has been mainly resulted from overwork. 2. As for necessary means on the attack of low back pain, many workers believe that medical treatment is the most helpful to the disorder. Fewer workers recognize the low back pain as an occupational disorder and have opinion that they should take a rest on the attack of the disorder. 3. There is much discrepancy between the workers' opinions mentioned above and the occupational health doctors' recommendations that it is most desirable to improve the working conditions and to let the workers take a rest. 4. The more seriously they suffer from the disorder, the more practical and reasonable are the contents of their opinions. 5. In order to let these workers take a rest from labour more easily, the employers should recognize their low back pain as an occupational disorder, including offjob-payment.     

Cold exposure and low back pain in store workers in Israel

BACKGROUND: In recent years the demand for frozen food in the Western world has been growing, and the number of cold storeroom has increased proportionately. There are very few studies documenting cold exposure as a risk factor for musculoskeletal symptoms (MSS). This study describes the prevalence of MSS, in particular low back pain (LBP) among cold storeroom workers in Israel and explores the connection between exposure to cold at work and MSS. METHODS: A cross-section survey included 122 males between the ages of 20-45 who had been employed for at least 1 year in three food stores in Israel. The subjects were classified as an exposed group working at temperatures of -20 degrees C and a control group working at room temperatures (20 degrees C to 25 degrees C). The prevalence rate of MSS, in particular LBP, was assessed using the Standardized Nordic Questionnaire. RESULTS: Cold storeroom workers had increased odds of reporting back symptoms in the previous 12 months (odds ratio (OR) = 2.9, 95% CI = 1.3-6.7) and during work (OR = 4.8, 95% CI = 1.8-13.0) compared with their colleagues working in storerooms at regular temperatures. Among workers who described themselves as satisfied at work, the cold storeroom workers had increased odds of reporting back symptoms in the last 12 months and during work (OR = 3.9, 95% CI = 1.5-10.6, OR = 9.4, 95% CI = 2.0-44.6, respectively) while there was no association between store type and LBP among dissatisfied workers. CONCLUSIONS: The results of this study strengthen the hypothesis that workers in cold environments are at a greater risk of LBP.     

某汽车公司铸造厂工人腰背痛的危险因素分析

目的 通过横断面流行病学记查,寻找汽车铸造厂作业工人腰背痛的主要危险因素,为此类疾患的预防提供科学依据.方法 在某汽车公司铸造厂对1340名工人进行腰背痛和劳动负荷问卷调查,利用logistic回归进行危险因素分析.结果 铸造厂工人的腰背痛年患病率为58.9%,其中铸造、物流和造型工种工人腰背痛年患病率较高,分别为64.6%、64.6%和62.5%.以不适体位搬举、大幅度弯腰、弯腰与转身并存及搬运重物这些负荷因素导致患腰背痛危险性最高,其OR值分别为2.085、1.961、1.967和1.956.各个危险因素在不同工种中的分布不同.多元logistic同归分析表明,搬运重物、不适体位搬举、大幅度弯腰、弯腰与转身并存及工龄和性别均被选人模型.结论 手工搬运重物、不良劳动姿势或二者同时存在是导致腰背痛的首要危险因素,应从这方面入手,加强工效学干预研究,减少此类疾患.

Abstract：

Objective To study the main risk factors of low back pain of workers in a foundry factory of the automobile company using cross sectional epidemiological investigation, and to provide scientific base for preventing the disorder. Methods The low back pain and work loads of 1340 workers in a foundry factory of the automobile company were investigated using questionnaire, and logistic regression analysis was used to analyze the risk factors. Results The one-year morbidity of low back pain in workers was 58.9%the morbidities of low back pain in workers engaged in foundry, transportation and modeling were 64.6 %, 64.6 % and 62.5 %, respectively. The lifting with squat postures, bending trunk heavily, bending trunk with twisting and moving the heave objects were found to be the most dominant risk factors for low-back pain, the OR values were 2.085, 1.961, 1.967 and 1.956, respectively. The distributions of risk factors were different among the different jobs. The logistic regression analysis showed that moving the heave objects, lifting with squat postures, bending trunk heavily, bending trunk with twisting existed simultaneously, also the work years and gender were the risk factors. Conclusion The manual moving heave objects, awkward working posture or both were the most important risk factors for low-back pain. The intervene ergonomic study should be performed in future to reduce the morbidity of low-back pain.