Gender differences in upper extremity musculoskeletal complaints in the working population

Objectives: This study analysed the association between gender and upper extremity musculoskeletal complaints, among the general working population and in various occupational groups. The hypothesis was tested whether the higher risk for women in the general working population for these complaints could partly be explained by differences in the distribution of men and women in occupations with different risks for the onset of upper extremity musculoskeletal complaints. Methods: The data for this study came from cross-sectional questionnaire data from 16,874 employees categorised in 21 different occupational classes. Associations between gender and complaints of the upper extremities were analysed for the total study sample and for each occupational class separately. An adjustment was made for the variable `occupational class' in the final model in order to study the impact of occupational gender segregation on gender differences in upper extremity complaints in the working population. Results: In the total study sample, significantly higher risks of complaints of the neck, shoulder, elbow, and wrist among the women were observed. Within many occupational classes, women reported significantly higher risks than did men, in particular for complaints of the neck and shoulder. Adjustment for occupational class showed increased risks for female workers for complaints of the neck, shoulder, elbow, and wrist, hence, rejecting our hypothesis on occupational gender segregation as an explanation for the higher risks for upper extremity complaints among women in the general working population. Conclusions: This study confirmed the presence of gender differences in upper extremity musculoskeletal complaints among the working population and in many occupational classes, with female workers having the higher risk. The results, however, do not lend support to a differential occupational exposure theory as an explanation for the higher risks for these complaints among women in the general working population. Careful consideration of gender influence in ergonomic epidemiological studies is recommended. Received: 16 February 2000 / Accepted: 10 June 2000     

肌肉骨骼疾患危险因素的现场评价

目的 探讨职业接触快速检查表(Quick Exposure Check,QEC)在肌肉骨骼疾患危险因素现场研究中的可使用性.方法 在某造船厂和汽车制造厂,应用QEC观察不同工种工人的操作,评价其劳动负荷.根据调查结果 评价QEC的可信度,并分析劳动负荷QEC分值与工人肌肉骨骼疾患患病率间的关系.结果 观察者之间可信度组内相关系数(ICC)为0.737～1.000,不同观察者之间可信度Spearman系数为0.605～1.000.不同工种危险因素接触水平(QEC总分)在造船厂是管工＞装配工＞电焊工;在汽车厂为电焊工＞冲压工＞机加工＞铸造工＞装配工.身体某部位QEC分值与其年患病率相关分析表明,肩、手腕、背(静态活动)接触水平与其患病率有密切关系(r2值分别为0.670、0.740、0.958,P＜0.05).结论 QEC在造船和汽车制造厂可用于接触肌肉骨骼疾患危险因素的现场评价,方法 具有可信度,且接触水平与患病率密切相关.

Abstract：

Objective To investigate the usability of quick exposure check (Quick Exposure Check,QEC) for the field assessment of occupational musculoskeletal disorder risk factors. Method In the shipyard and automobile manufacturing plants, QEC was used to observe the operations among workers with different jobs and to assess the work loads of workers. On the basis of results, the reliability of QEC was evaluated, and the correlation between QEC scores and morbidities of musculoskeletal disorders in workers was analyzed. Results The inter-observer reliability (ICC) was in the range from 0.737 to 1.000, and intraobserver reliability (Spearman coefficient ) was from 0.605 to 1.000. The order of exposure levels to risk factors of workers engaged in different jobs (QEC scores) in the shipyard factory was plumbers ＞ assemblers ＞ welders; The order of exposure levels to risk factors of workers engaged in different jobs (QEC scores ) in the automobile factory was welders ＞ punching workers ＞ machinists ＞ casters＞ assemblers. In different body parts, the exposure level at back and neck parts was the highest and the exposure level at the shoulder and wrist parts was the second. The regression analysis between QEC scores of body parts and the morbidities of musculoskeletal disorders showed that there was a good correlation between exposure levels and morbidities,the coefficients (r2) at the shoulder, wrist, and back (static work) were 0.670, 0.740 and 0.958, respectively (P＜0.05). Conclusion The QEC method is suitable and reliable as demonstrated by the field assessment on the exposure to risk factors in shipyard and automobile workers, and its results is correlated closely to the disease prevalence.     

Evaluation of symptom surveys for occupational musculoskeletal disorders

Symptom surveys have been used extensively as part of workplace ergonomic screening programs and epidemiologic assessments of musculoskeletal disorders in groups of workers. This paper examines the reliability and validity of two musculoskeletal symptom surveys, the Nordic Musculoskeletal Questionnaire (NMQ) and a survey used in conjunction with epidemiologic assessments by the National Institute for Occupational Safety and Health (NIOSH). Journal articles assessing the validity and reliability of the NMQ were reviewed. A retrospective assessment combining two NIOSH cohorts with a total of 852 workers assessed the reliability and validity of that survey. Reliability was assessed through test-retest methods and interitem correlations between similar questions. Validity was assessed by comparison with results from physical examination assessments of workers and self-reports of workers seeking medical care. Both reliability and validity were found to be acceptable for the purposes of workplace ergonomics programs. Implications for use of these surveys for prevention and treatment outcomes research are discussed. (This article is a US Government work and, as such, is in the public domain in the United States of America.) © 1996 Wiley-Liss, Inc.     

心理因素及物理负荷对职业性肌肉骨骼疾患的影响分析

目的 探讨心理因素与物理负荷的交互作用及其对职业性肌肉骨骼疾患(WMSDs)的影响.方法 选取653名来源于电子行业流水线作业、缝纫行业、制造行业的工人及行政管理人员作为调查对象.采用改良的北欧国家肌肉骨骼疾患标准调查表调查肌肉骨骼疾患情况,心理社会状况调查采用工作内容量表(JCQ),进行流行病学横断面调查,并应用快速暴露检查法(QEC)问卷对其进行工效学的物理负荷评价.结果 不同暴露等级下,肩部、上背、下背、手/腕的肌肉骨骼疾患的年患病率的差异有统计学意义(P＜0.05或P＜0.01),同时暴露在高的物理和心理负荷时,工作人员各部位的年患病率明显高于暴露在其他等级时的肌肉骨骼疾患的患病率.调整工龄、年龄、性别后,用logistics回归分析结果表明,在肩部、上背、下背和手/腕部的WMSDs影响中可能存在物理负荷和心理负荷的交互作用(P＜0.05).结论 高物理负荷下,不良心理因素对工人WMSDs的发生造成的影响远大于工人处于低物理负荷工作时,实施工效学干预不仅要从过度负荷,不良姿势,静态负荷等物理因素方面进行干预来降低WMSD的发生,也要关注心理因素方面的干预.

Abstract：

Objective To investigate the interactive effect of job task and psychosocial factors on the outcomes of musculoskeletal disorders. Methods 653 workers from different type of manufacturing industries and administration office recruited in a cross-sectional epidemiological survey. The Quick Exposure Check (QEC) was applied to assess the ergonomic load of job task, Job Content Questionnaire (JCQ) for identifying psychological characteristics, and Nordic Standardized Questionnaire for investigating outcomes of WMSDs.Results The prevalence of WMSD in shoulder, upper back, lower back and hand/wrist were significantly different under a variety of combined job task and psychosocial characteristics (P＜0.05 or P＜0.01 ). The more physical and psychological loads, the higher prevalence of WMSDs were revealed. By using multivariate analyses, a potential interactive effect was found in terms of the WMSDs symptoms in hand/wrist shoulder,upper back and lower back after adjusted by work year, age, and gender. Conclusions Higher physical load and greater psychosocial risk are more frequent self-reported symptoms of WMSDs than those of lower exposures. Ergonomic intervention strategies aimed at reducing the incidence of WMSDs should not only be focused on control of physical work factors but also psychosocial risks of relevance.     

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.     

某煤矿工作相关肌肉骨骼疾患现状及危险因素分析

目的 了解煤矿工人工作相关肌肉骨骼疾患(work-related musculoskeletal diseases,WMSDs)的患病情况并探索其危险因素.方法 采用整群抽样的方法,对某煤矿职工进行问卷调查,主要采用χ2检验和多因素Logistic回归分析的方法对数据进行统计学分析.结果 煤矿工人WMSDs年患病率为78.46%.单因素χ2检验显示有19个变量具有统计学意义.经多因素Logistic回归分析,有7个变量进入方程,分别为:总工龄,工作单调,重复性操作,休息不足,长时间站立,长时间蹲位和空间受限.结论 煤矿工人WMSDs年患病率较高,影响因素较多,应从多方面入手预防和控制此种职业健康问题.     

煤矿工人肌肉骨骼疾患健康教育的干预效果

目的 探讨煤矿工人肌肉骨骼疾患的干预措施,为更好地进行肌肉骨骼疾患控制提供依据。方法 通过开展现场培训、发放宣传资料、张贴海报等活动,对538名煤矿工人进行职业健康教育的干预,并调查干预前后煤矿工人对肌肉骨骼疾患认识和态度的变化。结果 干预后,煤矿工人对关于肌肉骨骼疾患知识的知晓率为52.3％,较干预前(33.8％)明显提高,差异有统计学意义（P＜0.05）;干预后煤矿工人对该疾病的防治态度有所改善。结论 实施职业健康教育对于提高煤矿工人对肌肉骨骼疾患的认识水平,改变对该疾病的防治态度有重要作用,是一种经济有效的干预措施,适宜在煤矿行业中开展应用。