工作相关肌肉骨骼疾患与人体工效学负荷研究进展

工作相关肌肉骨骼疾患(WMSDs)是常见的慢性非传染性疾病。WMSDs已成为影响工人健康、降低工人生命质量和造成经济损失的重要因素,可见于多个行业、工种。本文对WMSDs流行现状及人体工效学负荷相关研究进行综述,以期找到职业人群保护的可行方法。     

工作场所工效学负荷对肌肉骨骼功能的影响

目的 探讨工作场所工效学负荷对肌肉骨骼功能的影响.方法 采用现场观察和自评的方法评估人造板制造工人现场工效学负荷,结合实验室测量研究对象的肌肉骨骼功能,包括背肌耐力、手部握力、腹肌力、躯干柔韧性以及肌肉骨骼功能指数(MSFI),运用多元回归分析工效学负荷对肌肉骨骼功能的影响.结果 不同工效学负荷水平肌肉骨骼功能存在明显差异,其中低负荷水平Ⅰ肌肉骨骼功能各指标均高于高负荷水平Ⅳ,在背肌力和MSFI指标上表现得尤为明显,即随着负荷水平的增高,肌肉骨骼功能呈现下降的趋势.分析身体各部位工效学负荷高低对肌肉骨骼功能的影响,显示高负荷组背部的背肌耐力低于低负荷组,高负荷组肩(臂)部位的背肌耐力和手部握力低于低负荷组,高负荷组下肢的各指标均低于低负荷组,差异均有统计学意义(P＜0.05).控制其他混杂因素后,工作场所工效学负荷与肌肉骨骼功能(除腹肌力外)存在明显的负相关(P＜0.05).结论 工作场所工效学负荷的增高在一定程度上使肌肉骨骼功能降低.     

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

目的 研究汽车制造企业工人工效学负荷因素暴露水平及相关因素与肌肉骨骼疾患(MSD)问的关系.方法 选取我国南方3家汽车生产企业,使用快速暴露检查表(QEC)及北欧标准化肌肉骨骼症状分析调查表(NMQ)对1 065名生产工人进行问卷调查,分析其工效学负荷及MSD发生的相关危险因素.结果 本次调查企业的生产工人背部MSD症状的阳性率最高(61.8%).各部位患MSD者工效学负荷评分均高于未患MSD者(P<0.01).男性的工效学负荷水平显著高于女性(JP<0.01).工种间比较,背部负荷评分冲压、焊装(P<0.01)均高于总装,肩/臂部负荷评分焊装高于其他各工种(P<0.01).多因素logistic回归分析中,各部位工效学负荷均为其患MSD的危险因素,工作节奏与工作压力也是其重要的危险因素.结论 本次调查的汽车企业焊装工种工效学负荷相对水平较高,其身体各部位MSD的发生与工效学负荷得分相关,需加以控制.此外,工作节奏与压力因素对工人MSD的患病也有较大影响,需在工效学评价与干预中加以考虑.     

深圳市20家企业人类工效学及劳动者职业性肌肉骨骼疾患现状调查

目的了解深圳市福田区企业人类工效学现状及流水线作业劳动者人类工效学负荷、肌肉骨骼疾患现状。方法对辖区内20家小型企业进行人类工效学现场巡检,并对流水作业生产线上492名劳动者进行人类工效学负荷及肌肉骨骼疾患进行问卷调查。结果人类工效学巡检项目符合率为53．93％,港资企业在物料存放和运输、工作台、生产设备安全、照明等的符合率高于私营企业（P〈0．05或P〈0．01）;流水线作业劳动者以长时间坐位工作、长时间同一姿势工作、上臂手指每分钟多次做同一动作、经常用手或臂取物、手腕长时间弯曲、手保持在肩及以下水平、经常稍微弯腰、经常稍微转身、颈部长时间前倾等负荷为主;流水线作业劳动者中,症状阳性率较高的身体部位为背部（39．02％）、肩肘部（38．21％）,膝盖及以下部位最低（5．89％）。结论企业对人类工效学措施未给予足够重视,流水线作业劳动者背部、肩肘部、颈部、手腕／手掌疼痛等症状与其作业中相应部位典型工效学危险活动或姿势有关,应针对劳动者作业特点积极采取工效学手段进行干预。     

参与式工效学在预防工作相关肌肉骨骼疾患中的应用

工作相关肌肉骨骼疾患是一种慢性非致死性疾病,是职业人群常见的健康问题,尤其在劳动密集型行业。在国外,参与式工效学已广泛应用于工作场所中肌肉骨骼疾患的预防。本文依据参与式工效学的组织、实施及其影响因素和特点,介绍参与式工效学在预防肌肉骨骼疾患中的应用。参与式工效学方式可帮助工人识别作业过程中的危险因素并制定相应的干预方案。企业可通过开展参与式工效学项目改善工作条件、减少肌肉骨骼疾患相关危险因素的暴露及预防相关疾患的发生,以促进职工健康。     

口腔医生工效学负荷和工作相关肌肉骨骼疾患的研究

目的 评估口腔医生工效学负荷水平，探讨其与工作相关肌肉骨骼疾患（WMSDs）的相关性。方法 采用《中国肌肉骨骼疾患问卷》调查口腔医生WMSDs的患病情况，采用快速上肢评估（RULA）法进行现场工效学评估，并分析其相关性。结果 口腔医生WMSDs患病率为56.1%，各部位患病率差异有统计学意义（X2=62.400，P<0.01），颈部最高；女性患病率高于男性（X2=16.020，P<0.01）。RULA法评估口腔医生工效学负荷平均得分为5.6±1.1，82.4%的口腔医生工效学负荷等级Ⅲ～Ⅳ级。多因素Logistic回归分析显示，工效学负荷Ⅲ级和Ⅳ级（OR=2.413、14.700）、女性（OR=3.670）、中级职称（OR=2.479）、身高<160 cm或≥175 cm（OR=3.708）均为WMSDs的危险因素。WMSDs患病率与工效学负荷之间存在相关性（P<0.05），患病率随工效学负荷的增加而递增。结论 工效学负荷是WMSDs的危险因素；口腔医生WMSDs患病率高，工效学负荷水平高，需予以关注并尽快加以改善。     

工作场所工效学负荷暴露评估方法

本文综述了目前国内外现有工效学负荷暴露评估方法,其主要方法有自评法、观察法和直接测量法,分析各自的优缺点,提出在今后应用工效学负荷评估方法时需要考虑的因素,以及建立适合我国职业人群应用的工效学评估方法的重要性。     

汽车维修工人工作相关肌肉骨骼疾患的工效学评估

目的 对汽车维修行业中存在的工作相关肌肉骨骼疾患（work-related musculoskeletal disorders,WMSDs）相关的工效学危险因素进行识别和危险评估。方法 2018年1月—2020年12月,采用整群抽样方法,选取重庆市23家汽车维修企业的作业人员作为研究对象,采用美国《工效学基本因素检查表》（baseline risk identification of ergonomic factors,BRIEF）和瑞典《工效学因素识别表》（method for the identification of musculoskeletal stress factors which may have injurious effects,PLIBEL）识别汽车维修作业过程中的不良工效学危险因素,并采用快速全身评估法（rapid entire body assessment,REBA）进行姿势负荷等级评估。结果 本研究共对193名作业工人进行了工效学评估,其中维修工86人、喷漆工60人和钣金工47人。BRIEF识别结果显示,维修工、喷漆工和钣金工的颈部、背部、手腕为WMSDs...     

农业从业人员肌肉骨骼疾患工效学干预研究进展

肌肉骨骼疾患(MSDs)作为一种慢性非致死性疾病,是农业从业人员中最常见的疾病之一。本文综述了农业生产中能降低从业人员肌肉骨骼疾患的简易低成本工效学干预措施。低成本工效学干预措施主要减少已知危险因素的暴露,包括工程干预、管理干预和个体/行为干预。尽管一些干预措施能在很大程度上改善不良工作姿势并提高生产效率,但仍有一些不足。有效的工效学干预需要对工效学设施的实用性进行深入探讨,并且需要目标群体的积极参与,新技术的应用也应与当地的社会文化、风俗及教育程度相适应。今后应加强肌肉骨骼疾患干预新技术实用性、经济性等方面的研究,并加强发展中国家与发达国家之间的合作。     

基于BRIEF、PLIBEL和RULA方法的制鞋工人工作相关肌肉骨骼疾患工效学危险评估

目的 对制鞋生产中存在的工作相关肌肉骨骼疾患(WMSDs)工效学危害因素进行识别和危险评估。方法 选择18家制鞋企业53个重点岗位884名工人作为研究对象,采用美国工效学基本因素检查表(BRIEF)和瑞典工效学因素识别表(PLIBEL)两种方法识别作业人员作业过程中WMSDs罹患部位及不良工效学危害因素,并采用快速上肢评估(RULA)法进行WMSDs危险等级评估。结果 BRIEF识别结果显示,作业工种/岗位普遍存在手/腕部、肘部、颈部、肩部和背部的WMSDs危害因素,52个工种/岗位(98.11%)存在颈部和右腕部WMSDs危害因素;PLIBEL识别发现,存在≥6个WMSDs危害因素的工种/岗位有18个(33.96%)、有5个危害因素的14个(26.42%)、4个危害因素的有16个(30.19%)、3个危害因素的有5个(9.43%);RULA评估制鞋业生产工人WMSDs危险等级为Ⅱ～Ⅳ级,其中,Ⅱ级工种/岗位14个(26.42%)、Ⅲ级37个(69.81%)、Ⅳ级2个(3.78%),其主要得分源为不良姿势。结论 制鞋作业普遍存在中高风险的不良工效学危害因素,集中在颈部、手/腕部、肩部和...     

工作场所工效学负荷综合暴露评估方法的建立及信度评价

[目的]建立一种新的工效学负荷评估方法,检验方法的信度。[方法]引进国外工效学快速暴露检查法(QEC),进行修订和补充;应用Kendall和谐系数W、Kappa值以及ICC对方法进行评估者间和评估者内(重测)的信度检验。[结果]新建的CQEC法简单实用,有9个观察条目和8个自评条目,评估身体5个部位。在不同评估者间,W值0.532~0.800,各部位负荷得分ICC值0.340~0.799,负荷等级分类的Kappa值0.528~0.819,表明CQEC评估者间的信度较好(P<0.01)。对同一评估者,观察条目的Kappa值0.409~0.778,ICC值0.681~0.911,等级分类Kappa值0.549~0.645,说明CQEC在评估者内的一致性较好(P<0.01)。[结论]新建立的CQEC方法具有一定的可靠性,适合我国职业人群应用。     

Comparative Study of Upper Limb Load Assessment and Occurrence of Musculoskeletal Disorders at Repetitive Task Workstations

This study explored the relationship between subjectively assessed complaints of pain in the arm, forearm and hand, and musculoskeletal load caused by repetitive tasks. Workers (n=942) were divided into 22 subgroups, according to the type of their workstations. They answered questions on perceived musculoskeletal pain of upper limbs. Basic and aggregate indices from a questionnaire on the prevalence, intensity and frequency of pain were compared with an upper limb load indicator (repetitive task index, RTI) calculated with the recently developed Upper Limb Risk Assessment (ULRA). There was relatively strong correlation of RTI and general intensity and frequency of pain in the arm, and general intensity and frequency of pain in the arm and forearm or prevalence of pain in the arm. Frequency and intensity of pain in the arm were weakly correlated. An aggregate indicator of evaluation of MSDs, which was calculated on the basis of the prevalence, intensity and frequency of pain, was to a higher degree associated with the musculoskeletal load of a task than basic evaluative parameters. Thus, such an aggregate indicator can be an alternative in comparing subjectively assessed MSDs with task-related musculoskeletal load and in establishing limit levels for that load.     

双酚A与健康的关系

双酚A（BPA）作为一种环境雌激素,广泛应用于日常生活的各个领域,而且其可通过多种途径（主要食物）进入人体。因此双酚A对人类健康的影响逐渐引起广泛关注和重视。目前,双酚A对生殖系统的研究较为广泛,过量暴露双酚A可引起雄性哺乳动物性腺发育不良,也会对雌性哺乳动物的卵巢和乳腺等造成严重危害;最近一些新的研究发现双酚A对脑及行为的发育也有很大影响;双酚A对心血管疾病,2型糖尿病及肥胖等疾病的影响也有一些报道。我国对BPA的研究刚刚起步,本文对双酚A的代谢与暴露情况以及对人体健康影响的最新观点和进展进行如下综述。     

蛋白免疫印迹法试验结果与HIV感染关系的探讨

目的通过对蛋白免疫印迹法(WB)试验结果的观察，确定个体是否感染HIV以及HIV感染状况。方法对50份抗-HIV初筛阳性血清使用WB法进行确认实验。结果在被检测样品中，HIV-1型确认试验阳性45例，占90％；HIV-1型确认试验阳性，且提示HIV-2阳性感染1例，占2％；HIV-1型确认试验弱阳性(不确定)2例，占4％；HIV-1型确认试验阴性2例，占4％。结论WB法试验为确定个体有无HIV感染以及HIV感染状况提供依据。     

Evaluating the Relationship between Inflammatory Load of a Diet and Depression in Young Adults

The aim of this study is to investigate the relationship between dietary inflammatory index (DII) and depression. The study was carried out with 134 female university students staying in dormitory. The data were collected using questionnaire form. The questionnaire contains socio-demographic information, physical activity, anthropometric measurements, depression scale, and the 3-day food intake record. The DII score was calculated based on the food intake record form. It was found that 56 of the participants did not have any depression symptoms. The participants‘ mean DII scores were 0.76 ± 0.59 and they were found to have a pro-inflammatory dietary pattern. The third-tertile depression score was 56.3 ± 8.6, which was statistically higher than the others (p < 0.05). Upon modeling, a significant association between high DII scores and increased odds of incidence DepS was observed (odds ratio (OR) = 2.90; 95% CI = 1.51–5.98). Finally there is a need to conduct cohort studies to identify DII scores of the individuals in our country, investigate the relationship between these scores and depression, and establish a cause and effect relationship.     

Relationship between accessibility and resources to treat acute ischemic stroke. Hokkaido,Japan: Analysis of inequality and coverage using geographic information systems

ObjectivesThis study aimed to clarify the relationship between the institution and resident with respect to accessibility to acute ischemic stroke (AIS) treatment in Hokkaido and to propose new methodology monitoring for accessibility to healthcare resources.MethodsThis study involves the use of geographic information system (GIS) network analysis. We established hospital/clinic with one of the following conditions as resources for AIS treatment: (1) medical facility practicing AIS treatment, (2) having computed tomography (CT) equipment, (3) having angiography equipment, and (4) having AIS specialists (neurosurgeons). We evaluated the coverage of population resources using transport time between ambulance departure and arrival at the healthcare facility. Furthermore, we compared the population coverage rate using available resources and calculated a Gini coefficient to analyze its relation with inequality. Empirical analysis was performed, and public database for data collection was utilized. We calculated the rate of population coverage with a transport time within 10 min as an indicator of accessibility to medical resources by GIS.ResultsThe Gini coefficients of practicable facilities, CT, angiography, and neurosurgeons are 0.35, 0.16, 0.18, and 0.30, respectively. The inequality of accessibility differs depending on the resources, and Gini coefficients indicate that hospital/clinic and neurosurgeons were considered to have higher allocation inequalities than CT and angiography.ConclusionsCombining Gini coefficient and GIS network analysis in accessibility can be useful in quantifying and monitoring variation by region. We propose this combination as a new method for helping the government to make evidence-based healthcare planning.     

妊娠期糖尿病75gOGTT不同时点血糖异常与妊娠结局的相关性分析

目的 探讨妊娠期糖尿病孕妇不同血糖指标异常与妊娠结局的关系.方法 选择2016年1至12月于昆山市第一人民医院定期产检并分娩的937例妊娠期糖尿病孕妇,孕24~28周均直接行75g葡萄糖耐量试验(75gOGTT),单纯空腹血糖异常为A组,餐后1h或2h血糖异常而空腹血糖正常为B组,空腹及餐后1h或2h血糖异常为C组,分析三组孕妇妊娠结局及胰岛素使用率的差异.为分析不同指标血糖异常与新生儿出生体重的相关性,将单纯空腹血糖异常为空腹血糖组,单纯OGTT1h异常为OGTT1h组,单纯OGTT2h异常为OGTT2h组,分别将三组的空腹血糖、OGTT1h血糖、OGTT2h血糖与相应的新生儿出生体重进行相关性分析.结果 在937例GDM孕妇中,A组323例(34.47%)、B组436例(46.53%)、C组178例(19.00%).A、B、C三组在早产、巨大儿及产后出血的比较中具有显著差异(χ2值分别为6.72、12.00、6.29,均P<0.05);两两比较,C组的早产、产后出血率均明显高于A组和B组(χ2值分别为4.37、4.61、5.78、4.89,均P<0.05),A组和C组的巨大儿发生率均显著高于B组(χ2值分别为4.75和11.86,均P<0.05),而A组和C组的巨大儿发生率无明显差异(χ2=1.99,P>0.05),A组和B组在早产及产后出血方面的比较无明显差异(χ2值分别为0.03、0.00,均P>0.05).三组在胎膜早破、妊娠合并甲状腺机能减退、妊娠高血压疾病方面无明显差异(χ2值分别为0.94、0.39、0.56,均P>0.05).三组胰岛素使用率比较,C组明显高于GDM A组,且A组显著高于B组,差异均有统计学意义(χ2值分别为15.81、5.44,均P<0.05);在相关性比较中发现,在诊断的GDM孕妇中,OGTT中的空腹血糖与新生儿的出生体重呈正相关,差异有统计学意义(r=0.12,P<0.05);而OGTT1h及OGTT2h血糖与新生儿出生体重无明显相关(r值分别为0.08,0.01,均P>0.05).结论 GDM孕妇空腹血糖异常合并l项或两项不同时间点血糖异常,其不良妊娠结局发生率明显增加,OGTT空腹血糖值对于妊娠期糖尿病检测及新生儿体重的预测具有重要意义.临床上应根据OGTT异常情况进行分层管理.     

北京市城区学龄儿童载脂蛋白E多态性与血脂谱水平的关系

目的 了解载脂蛋白E（ApoE)基因多态性与儿童血脂谱水平的关系。方法 采用聚合酶链反应－限制性内切酶图谱分析法,对307名7－11岁在校儿童进行血脂谱水平测定及ApoE基因多态性检测.结果 307名儿童最常见基因型E3／3检出率为54．7％,其他基因型依次为E4／3（23．8％）、E4／4（9．1％）、E3／2（8．1％）、E4／2（3．9％）、E2／2（0．3％）,不同性别基因型构成的差异无显性;常见等位基因E3频率为70．7％,E4、E2分别为23．0％和6．4％,其中E4频率明显高于国内其他报道,E2频率接近于国内报道;男童E4／3、E3／3基因型总胆固醇（TC,4．19、4．29、3．41mmol/L)、低密度脂蛋白－胆固醇（LDL－C）、载脂蛋白AI（ApoA I)、载脂蛋白B（ApoB)水平高于E3／2基因型,E4／2基因型TC（4．28和3．42mmol/L)、ApoA I水平高于E3／2基因型,女童不同基因型血脂谱水平的差异无显性;高胆固醇组与正常组儿童ApoE-Hha I位点基因型分布比较差异无显性;ApoE2可使TC水平降低0．377mmol/L,LDL-C水平降低0．329mmol/L。结论 ApoE基因多态性与男童血清胆固醇水平相关,E2等位基因携带TC、LDL－C、ApoB水平最低。     

Nonlinear associations between dietary exposures to perfluorooctanoic acid (PFOA) or perfluorooctane sulfonate (PFOS) and type 2 diabetes risk in women: Findings from the E3N cohort study

The incidence of type 2 diabetes (T2D) is steadily rising worldwide since the past 30 years. There is increasing interest in understanding the contribution of exposure to endocrine disrupting chemicals (EDCs) to T2D trend. Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) are stable, persistent, and bioaccumulative synthetic compounds, suspected to act as EDCs and for which the diet is the main route of exposure. We investigated associations between estimated dietary exposure to PFOS and PFOA and the risk of T2D in the large E3N prospective cohort study.Among 71 270 women included in this study, 2680 cases of incident type 2 diabetes were validated during follow-up (1993–2012). Dietary exposure was estimated combining dietary consumption data collected in E3N and food contamination data provided by ANSES in the 2nd French Total Diet Study. The estimated mean dietary exposure to PFOS and PFOA was 0.50?ng/kg _{body weight}/day and 0.86?ng/kg _{body weight}/day respectively. An inverse U-shape association was found when considering PFOA and T2D: women in the 4th, 5th, and 6th decile groups had a HR [95%CI] of 1.21 [1.06–1.46], 1.35 [1.15–1.59], and 1.33 [1.05–1.41], respectively, when compared to women of the 1st decile group, while the other decile groups were not associated to the risk of T2D. The positive association had the strongest effect size for non-obese women (body mass index (BMI) ≤25?kg/m²). No association was found between dietary exposure to PFOS and T2D, except when considering only women with BMI≤25?kg/m2, in which a positive nonlinear association was observed (HR [95%CI]?=?1.46 [1.09–1.96], 1.52 [1.09–2.11], and 1.44 [1.01–2.06] for the 6th, 8th, and 9th decile groups respectively).This is the first study to evaluate the association between dietary exposure to PFOA and PFOS and the risk of developing T2D in a large observational study with over 15 years of follow-up. The present study highlights the importance of studying the effects of EDCs in large epidemiological studies including not occupationally exposed populations, as well as the importance of considering exposure to PFOS and PFOA as a relevant risk factor for T2D.