职业应激与下肢肌肉骨骼系统疾患的关系

目的 探讨职业应激与下肢肌肉骨骼系统疾患的关系.方法 采用横断面研究设计和自报式问卷调查方法对13家企业5338名工人进行整群调查,采用修订的工作内容问卷和付出-回报失衡模式问卷调查职业应激状况.采用肌肉骨骼系统疾患调查表调查过去1年内下肢肌肉骨骼系统疾患和不良姿势情况.使用logistic回归分析职业应激因素与下肢肌肉骨骼系统疾患检出率之间的关系.结果 2个职业应激模式主要因子中,躯体需求和付出是臀部疾患的危险因素,而工作控制是臀部疾患的保护因素.当2个模式的主要因素一起分析时,仅有躯体需求是臀部疾患的危险因素.以4种工作类型的分类变量进行分析时,工作紧张是臀部疾患的危险因素,而付出-回报失衡是臀和膝部疾患的危险因素.随着患病部位的增多,工作紧张和付出-回报失衡的危险增加.工作控制的保护作用随患病部位的增加而增大.以连续变量进行分析时,以躯体需求计算的工作紧张是臀部疾患的危险因素,而付出-回报失衡是臀和膝部疾患的危险因素.结论 职业应激与下肢肌肉骨骼系统疾患存在统计学意义的相关,下肢肌肉骨骼系统疾患的预防应考虑控制职业应激因素和增加工作控制.     

职业人群工作紧张对工作耗竭影响的流行病学研究

目的探讨职业人群工作紧张对工作耗竭的影响。方法采用横断面研究方法,调查上海城区7种职业2 458名20～63岁职业人群。工作紧张评估采用工作要求与控制(JDC)、工作付出—回报(ERI)问卷,同时调查个体特征与行为因素,工作耗竭选用李超平教授在国内修订的MBI-GS,多因素非条件logistic回归方法分析社会心理因素对肌肉骨格症状患病的影响。结果教师、社区医护工作、公交车驾驶员情感耗竭、人格解离的评分明显高于其他职业人群,且工作耗竭的阳性率较高。工作耗竭与高工作紧张、低社会支持、高工作付出—回报不平衡、低工作回报存在联系。结论从事社会服务的职业人群工作耗竭阳性率较高,工作紧张可能是预测城市职业人群工作耗竭的危险因素。     

职业紧张对城市职业人群颈、肩、腰部症状的影响

目的探讨职业紧张对城市职业人群颈、肩、腰痛症状的影响。方法采用横断面研究方法,在2012年1—7月调查上海城区7种职业2 458名20~63岁职员。采用中文北欧肌肉骨骼问卷调查颈、肩、腰部症状,职业紧张评估采用中文版工作内容问卷(JDC)和工作付出-回报(ERI)问卷,同时调查社会人口和工作特征因素,采用多因素非条件logistic回归方法分析职业紧张对颈、肩、腰症状的影响。结果控制潜在混杂因素后,职业紧张可能是颈、肩、腰部症状的危险因素,OR值分别为1.44、1.27和1.60。工作付出-回报不平衡同样也是颈、肩、腰部症状的危险因素,OR值分别为1.31、1.34和1.33;工作满足度低则可能是肩、腰部症状患病的危险因素,OR值分别为1.33、1.32;抑郁能预测腰痛症状,OR值为1.37。结论职业紧张可能对城市职业人群颈、肩、腰部的患病产生一定的影响。     

民警工作满意感的影响因素分析

目的探讨民警职业紧张相关因素与工作满意感的关系。方法采用整群抽样方法,使用工作满意感问卷、工作内容问卷、付出-回报失衡问卷和职业紧张测量工具对244名某派出所民警进行工作满意感和职业紧张相关因素调查。将工作满意感和职业紧张相关因素按评分分成低水平与高水平组,分析民警职业紧张相关因素与工作满意感的关系。结果民警的年龄越大,工作满意感评分越高,差异有统计学意义(P0.05)。工龄15.7a的民警比工龄≤15.7a的民警工作满意感评分高,差异有统计学意义(P0.01)。决定自由度、工作控制、上级支持、回报、正性情感、自尊感高水平组工作满意感评分高于低水平组,差异有统计学意义(P0.01),而心理控制、心理需求、付出回报失衡、外在付出、内在付出、工作角色模糊、负性情感、抑郁症状、每日紧张感、睡眠障碍高水平组工作满意感评分低于低水平组,差异有统计学意义(P0.01)。工作满意感评分与决定自由度、工作控制、上级支持、回报、正性情感、自尊感呈正相关(P0.01),而与心理控制、心理需求、付出回报失衡、外在付出、内在付出、工作角色模糊、负性情感、抑郁症状、每日紧张感、睡眠障碍呈负相关(P0.01)。心理需求、心理控制源、抑郁症状、睡眠障碍是工作满意感的危险因素,而年龄、回报、自尊感、上级支持、正性情感是其保护因素。结论职业紧张可能对工作满意感存在影响。     

苏州市吴江区基层医疗机构医务人员职业紧张现况及影响因素分析

目的对苏州市吴江区基层医疗机构医务人员的职业紧张状况进行调查,并分析职业紧张的影响因素。方法采用随机整群抽样的方法,采用付出-回报失衡问卷(ERI)调查基层医疗机构的职业紧张状况。结果共调查356名医务人员,职业紧张发生率15.17%。多因素分析结果显示,男性、预防岗位、患有慢性病、工作时间≥6.5 h和月收入低是职业紧张发生的危险因素,差异有统计学意义(P0.05)。结论苏州市吴江区基层医疗机构医务人员职业紧张发生率不高,但随着医疗卫生职能转变,不能忽视该人群职业紧张,应采取有效措施控制职业紧张的发生。     

职业紧张对不同职业人群抑郁症状的影响

[目的]探讨职业紧张对不同职业人群抑郁症状的影响。[方法]采用横断面研究方法,调查上海市某区职业人群2458名,年龄为20～63岁。工作紧张评估采用中文工作内容问卷（C-JCQ）-9中文工作付出一回报（C．ERI）问卷,同时调查社会人7／特征与个体生活行为因素,抑郁症状使用流行病学研究抑郁量表（CES．D）。采用多因素非条件logistic回归分析社会人口特征与职业紧张因素对抑郁症状的影响。[结果]抑郁评估均分为（16．1±7．2）分,抑郁症状阳性率为44．0％。社会人口与行为特征因素中,职务、受教育程度、工作时间、吸烟与抑郁症状有统计学关联。职业紧张评估变量中,高工作紧张、低工作控制、低社会支持、高工作付出一回报不平衡、高内在驱动是抑郁症状的危险因素。[结论]社会人口特征与职业紧张因素均可能增加职业人群抑郁症状的风险。     

不同职业紧张因子与抑郁症状的关联分析

目的评估上海不同职业人群中抑郁症状现患状况,探讨不同职业紧张因子与抑郁症状间的关联。方法采用方便整群抽样,选择教师、生产性外企员工、行政管理与研究人员、服务性外企员工、交通警察、社区卫生服务员工与物业管理人员共7种不同职业人群,运用简明职业紧张问卷和流行病学研究用抑郁量表进行调查,由调查对象自主完成问卷。运用Logistic回归与层次多元回归分析职业紧张与抑郁症状的关联。结果共回收有效问卷1301份,抑郁得分均分为16.83±8.63,抑郁症状阳性率为46.2%。不同年龄组、不同受教育程度、不同职业间抑郁得分与抑郁症状阳性率间比较,差异均有统计学意义。拥有个人业余爱好可有助于缓解抑郁症状(OR=0.63,95%CI=0.48～0.82)。高社会支持是抑郁症状的保护因子OR=0.38(95%CI=0.25～0.55);高内在投入和高付出回报失衡是抑郁症状的危险因子,OR分别为2.72(95%CI=1.76～4.21)和2.77(95%CI=1.09～7.05)。付出-回报失衡模式比工作要求-自主模式在预报抑郁症状具有更大的效能。结论付出回报失衡、高内在投入是抑郁症状的危险因素,而高社会支持与拥有业余爱好是保护因素。     

煤矿工人职业紧张与职业性肌肉骨骼疾患相关性研究

目的探讨煤矿工人职业紧张和职业性肌肉骨骼疾患(OMD)的关系。方法采用整群抽样法,以362名煤矿工人为研究对象,采用中文版《北欧肌肉骨骼问卷》调查OMD患病情况;采用《工作内容问卷》和《付出-获得失衡问卷》评估研究对象职业紧张状况,采用《流行病学研究抑郁量表》调查煤矿工人的抑郁程度。结果煤矿工人OMD患病率为63.5%,45.9%(166/362)的煤矿工人存在工作要求-自主失衡型职业紧张,62.4%(226/362)的煤矿工人存在付出-获得失衡型职业紧张。多因素非条件Logistic回归分析显示,煤矿工人的职业病危害因素接触工龄越长者,周工作天数越长者,技术自由裁量权和决策权越低者,付出-获得失衡型职业紧张程度越高者,抑郁程度越高者,罹患OMD的风险均越高(P0.05)。结论职业紧张和抑郁均是煤矿工人罹患OMD的危险因素。     

民警职业紧张与睡眠障碍的关系

目的探讨民警职业紧张相关因素与睡眠障碍的关系。方法采用整群抽样方法,使用睡眠障碍、工作内容问卷、付出-回报失衡问卷和职业紧张测量工具对某市公安局派出所的244名民警进行睡眠障碍和职业紧张相关因素调查。将睡眠障碍和职业紧张相关因素按评分分成低水平与高水平组,分析民警职业紧张相关因素与睡眠障碍的关系。结果决定自由度、上级支持、回报、正性情感、自尊感、工作满意感等变量的高水平组睡眠障碍评分低于低水平组,而心理控制、心理需求、付出回报失衡、外在付出、内在付出、负性情感、抑郁症状、每日紧张感等变量的高水平组睡眠障碍评分高于低水平组,差异均有统计学意义(P0.05或P0.01),其余相关因素评分组间睡眠障碍评分比较,差异均无统计学意义(P0.05)。男女民警的睡眠障碍评分比较,差异无统计学意义(P0.05)。睡眠障碍评分与心理控制、心理需求、付出回报失衡、外在付出、内在付出、负性情感、抑郁症状、每日紧张感呈正相关,而与决定自由度、上级支持、回报、正性情感、自尊感、工作满意感呈负相关,相关系数有统计学意义(P0.05或P0.01)。多因素logistic回归分析表明,内在付出、心理需求、心理控制源、每日紧张感、抑郁症状、负性情感是睡眠障碍的危险因素,而年龄、回报、自尊感、工作满意感、正性情感是睡眠障碍的保护因素。结论职业紧张对睡眠存在影响。     

粤北地区某三甲医院医务人员职业紧张与工作满意度的相关性研究

目的 研究粤北地区某三甲医院医务人员的工作满意度及职业紧张现状,探讨工作满意度与职业紧张的关系。方法 采用随机抽样法,采用明尼苏达满意度问卷和付出回报失衡问卷对医务人员的工作满意度及职业紧张情况进行调查。结果 共有551人参与问卷调查,总体工作满意度得分75.07±4.26,有233人(42.30%)存在付出回报失衡状态,满意度得分及付出回报失衡状态在不同性别、年龄组、婚姻状态、工龄组、岗位类别、职称、学历、月收入、用工形式、每周工作时间的差异均有统计学意义(P<0.05)。工作满意度得分与付出呈负相关,与回报呈正相关,与内在投入呈负相关(P<0.05)。结论 本次调查的医务人员工作满意度一般,存在较高的职业紧张状态,工作满意度与职业紧张有一定的相关性。     

汽车驾驶员的高血压危险因素分析

目的了解汽车驾驶员的原发性高血压患病情况及主要危险因素,为该人群制定适宜的防治措施。方法采用现况调查的方法,对重庆市746名20～60岁的男性驾驶员行问卷调查、体格检查和血压测量等。同期检测了884名男性非驾驶员人员的血压值。结果男性驾驶员的高血压标化患病率为28.3%,高于非驾驶员18.26%。驾龄、平均每天开车时间、驾驶车型、工作责任和工作紧张感等职业因素与驾驶员高血压有关。多因素Logistic分析显示驾龄、工作责任和工作紧张感、父母患高血压及体重指数(BMI)>25是驾驶员高血压的主要危险因素。结论职业紧张等因素与驾驶员高血压患病有关,需采取相应的综合防治措施。     

Job strain and arteriosclerosis in three different types of arteries among male Japanese factory workers

OBJECTIVES: This study evaluated the association between job strain and subclinical indicators of arteriosclerosis simultaneously in the cerebral artery, the aorta, and the carotid artery. METHODS: The participants in this cross-sectional study consisted of 352 male factory workers between the ages of 24.9 to 55.8 (mean 41.7) years who had not been exposed to any hazardous chemicals in Japan. Job strain was measured using a Japanese version of the Job Content Questionnaire developed by Karasek. The following subclinical indicators of arteriosclerosis were examined by noninvasive procedures: hyperintense spots in T2-weighted images in brain magnetic resonance imaging (MRI), pulse wave velocity of the aorta, and the stiffness parameter of the carotid artery using ultrasound and systolic and diastolic blood pressure. RESULTS: After control for potential confounders, high job strain was associated with an increased prevalence of hyperintense spots (adjusted odds ratio 2.53, 95% confidence interval 1.14-5.63), and elevated pulse-wave velocity (adjusted increase in percent 3.5, 95% confidence interval 0.0-6.9). The stiffness parameter tended to be elevated in the high job-strain group although this trend was not statistically significant. Job strain showed no relation to blood pressure. CONCLUSIONS: In this study, job strain was associated with subclinical indicators of arteriosclerosis in different arteries although the association was not statistically significant for the carotid artery. New information is offered by brain MRI for arteriosclerosis in the cerebral artery. An increase in hyperintense spots may explain the link between job strain and cerebrovascular disease.     

Salivary biomarkers of stress among teachers in an urban setting

The aim of this study was to determine the prevalence of job stress among secondary school teachers using Karasek Job Content Questionnaire (JCQ), the association between salivary cortisol, salivary IgA, and sociodemographic characteristics, and the association between log cortisol, IgA levels, and job strain categories. A cross-sectional study was undertaken using JCQ and salivary cortisol and IgA samples. Cluster sampling was done yielding 302 respondents. The prevalence of stress among all teachers was 20.2%. Being a Malay, teaching experience of 5 to 10 years, and those without a supervisor's support had higher prevalence of high job strain. Teachers in the 31 to 40 years age bracket, educating handicapped children with the absence of supervisor support exhibited higher stress levels with lower log salivary IgA levels. Further studies must be conducted using salivary biomarkers to study the in-depth relationship of stress, extending into other occupational groups.     

Job strain and blood pressure in African Americans: the Pitt County Study.

OBJECTIVES: This report examined whether job strain (or its components, decision latitude and job demands) was associated with elevated blood pressure levels in a community-based sample of 726 African-American adults. METHODS: Blood-pressure, anthropometric, behavioral, demographic, and psychosocial data were collected for the current cross-sectional analyses during home interviews conducted for the second wave (1993) of the Pitt County Study (North Carolina), a prospective cohort study of hypertension among African Americans. RESULTS: Job strain was not associated with blood pressure among men or women in this study. However, men in the 80th percentile of decision latitude had more than a 50% decrease in the prevalence of hypertension compared with men in the 20th percentile (odds ratio = .46, 95% confidence interval = .22, .96). CONCLUSIONS: These results indicate that decision latitude may be important for hypertension risk among African-American men. More research is needed on African Americans to determine why job strain and its two component variables differ in their associations with blood pressure for men and women.     

The association of job strain with coronary heart disease and metabolic syndrome in municipal workers in Turkey

To explore the association of job strain with CHD and metabolic syndrome in municipal workers. A cross-sectional study was completed of 450 male workers. Coronary heart disease was defined as: physician diagnosed ischemic heart disease; and/or, ischemic findings in the ECG. Metabolic syndrome was defined according to the criterion set by the National Cholesterol Education Panel. The demand-control model was used to assess job strain. Self administered questionnaires were completed after a face to face interview. Logistic regression models were constructed to assess the association of job strain with CHD and metabolic syndrome. The prevalence of metabolic syndrome and CHD were 17.8% and 8.0% respectively. Both CHD and metabolic syndrome were found to be significantly higher in higher income groups. Job demand and job control were not found to be associated with either CHD or metabolic syndrome. Metabolic syndrome was significantly more prevalent among the high job strain workers, but the significance was lost when controlled for age. The findings suggest that there is no significant association between job strain and metabolic syndrome and CHD in this sample of Turkish workers. Job strain may possibly be perceived differently in different cultures and occupations. Future studies may benefit from using a combination of different stress models and more diverse study populations.     

Association between job strain and prevalence of hypertension: a cross sectional analysis in a Japanese working population with a wide range of occupations: the Jichi Medical School cohort study

OBJECTIVES—To explore the association between the prevalence of hypertension in a Japanese working population and job strain (a combination of low control over work and high psychological demands), and to estimate this association in different sociodemographic strata.METHODS—From a multicentre community based cohort study of Japanese people, sex specific cross sectional analyses were performed on 3187 men and 3400 women under 65 years of age, all of whom were actively engaged in various occupations throughout Japan. The baseline period was 1992-4. The association between job characteristics—measured with a Japanese version of the Karasek demand-control questionnaire—and the prevalence of hypertension defined by blood pressure and from clinical diagnoses were examined. Adjustments were made for possible confounders. The analyses were repeated for stratified categories of occupational class, educational attainment, and age group.RESULTS—In men, the level of job strain (the ratio of psychological job demands to job control) correlated with the prevalence of hypertension. In a multiple logistic regression model, job strain was significantly related to hypertension (odds ratio 1.18; 95% confidence interval 1.05 to 1.32), after adjustment for age, employment (white collar v blue collar), marital status, family history of hypertension, cigarette smoking, alcohol intake, physical activity, and body mass index. The stratified analyses showed significant excess risks in the subordinate groups compared with managers, blue collar workers, less educated workers, and the older age groups. This association was not significant in women. Multiple linear regression analyses, with systolic and diastolic blood pressures as dependent variables, did not show any significant association.CONCLUSIONS—The findings provided limited proof that job strain is related to hypertension in Japanese working men. Older men in a lower social class may be more vulnerable to the hypertensive effects of job strain.     

Work conditions and mental health among doctors from Salvador, Bahia, Brazil

This cross-sectional study investigated the association between work conditions and minor psychological disorders (MPD) in a random sample of 350 doctors from Salvador City, State of Bahia, Brazil. Data were gathered using an individual, self-report questionnaire that incorporated the demand-control model (Job Content Questionnaire) to evaluate psychosocial aspects of the doctors' work and the Self-report Questionnaire (SRQ-20) to evaluate their mental health. The study found increased work overload, overtime and extended work shifts, multiple jobs, low income per hour worked, and unstable work arrangements with payment per procedure. The prevalence of MPD was 26.0% and was more strongly associated with aspects of the psychological demands of work than with the doctors' control over it. Doctors with high strain (high demand and low control) jobs showed MPD prevalence of 3.07 (95%IC: 1.38-6.85) times higher than those in low strain (low demand and high control) jobs.     

职业应激与高血压的关系

目的 探讨职业应激对高血压的影响.方法 采用整群抽样的方法,对某热电厂工龄>2年的498名在职工人进行横断面调查,有效样本446例;排除了继发性高血压、糖尿病史、肝肾病史等后,确诊高血压病例84例(男58例,女26例),血压正常者362例.使用付出一回报失衡模式问卷、工作紧张模式问卷和职业应激测量工具对职业应激因素、个性特征、缓解因素和职业应激反应进行测评;调查高血压的常见危险因素,常规法测定血清中甘油三酯、总胆同醇及空腹血糖水平;应用多因素logistic回归分析和χ~2检验进行相关统计学处理.结果 (1)将研究中包括的所有因素引入方程进行多因素logistic同归分析,结果显示,父母高血压史、体质量指数(BMI)、血清中甘油三酯浓度、饮酒及对人负责、内控性、宏观决策、社会支持对高血压存在影响.(2)将付出一回报失衡模式的主要因素和其他相关冈素等同时引入以高血压发生与否为应变量的同归分析,结果显示,除父母有高血压史、饮酒、BMI、甘油三酯浓度和内控性对高血压的发生存在影响外,外在付出和付出-回报失衡比值(ERI)也对高血压的发生影响较大(OR分别为1.71和2.43).(3)将工作紧张模式主要因素和其他相关因素同时引入回归分析,结果显示,除父母有高血压史、饮酒、BMI、血清中甘油三酯浓度和内控性进入回归方程外,上级支持也进入了方程,且对高血压的发生有保护作用,工作需求和决定自由度等未能进入方程.(4)男性高、低应激水平组间高血压患病率比较,差异有统计学意义(OR为3.13,P<0.01);而女性不同应激水平组间高血压患病率比较,差异无统计学意义(P>0.05).结论 职业应激与高血压的发生有关;付出-回报失衡模式对高血压的预测作用大于工作紧张模式.     

Job strain and major risk factors for coronary heart disease among employed males and females in a Swedish study on work,lipids and fibrinogen

OBJECTIVES: The aim of this study was to analyze the relationship of job strain (high psychological job demands and low decision latitude) to hypertension, serum lipids, and plasmafibrinogen. METHODS: The study population consisted of employed persons between the ages of 15 and 64 years in the counties of Stockholm, V?sternorrland, and J?mtland, Sweden. The data collection was carried out during 1992-1998. A total of 10,382 subjects participated in a medical examination and completed a questionnaire. RESULTS: No strong associations were found between job strain and plasma fibrinogen. The males reporting job strain had lower levels of total cholesterol and high-density lipoprotein cholesterol than the other males. Similar tendencies were found for the females. The females, but not the males, with job strain had an increased prevalence of hypertension when compared with the subjects with relaxed psychosocial work characteristics. In the subgroups of younger males and females an adverse association between job strain and the ratio between low-density and high-density lipoprotein cholesterol was noted. CONCLUSIONS: The results do not support the hypothesis that job strain has an adverse impact on serum total cholesterol and plasma fibrinogen levels. They suggest that an increased risk of coronary heart disease in association with job strain, if causal, is mediated by other factors, possibly partly by hypertension and low levels of high-density lipoprotein cholesterol.     

Perceived job stress and incidence of coronary events: 3-year follow-up of the Belgian Job Stress Project cohort

Psychosocial characteristics have been linked to coronary heart disease. In the Belgian Job Stress Project (1994-1999), the authors examined the independent role of perceived job stress on the short-term incidence of clinical manifest coronary events in a large occupational cohort. A total of 14,337 middle-aged men completed the Job Content Questionnaire to determine the dimensions of the extended job strain model, job demands, decision latitude, and social support. Jobs were categorized into high strain, low strain, active jobs, and passive jobs. During the 3-year follow-up, 87 coronary events were registered. At baseline, 17% of workers experienced high strain. Job demands and decision latitude were not significantly related to the development of coronary heart disease after adjustment for covariates. The 38% risk excess among subjects classified in the high-strain category did not reach statistical significance. However, coronary heart disease incidence was substantially associated with the social support scale independently of other risk factors, with an adjusted hazard ratio of 2.4 (95% confidence interval: 1.4, 4.0) between extreme tertiles. No convincing evidence for an association of job demands, decision latitude, or job strain with the short-term incidence of coronary heart disease was found. However, our study underscores the importance of a supportive social work environment in the prevention of coronary heart disease.