流水线作业工人积极职业安全态度与发生职业性肌肉骨骼疾患的关联性
Correlation between positive occupational safety attitude and occupational musculoskeletal disorders of assembly line workers
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摘要:
背景 研究发现流水线作业工人的职业性肌肉骨骼疾患（OMD）患病率高达38.03%，而心理因素可能影响工人罹患OMD。积极职业安全态度是指工人良性的心理暗示和积极的心理倾向，其对OMD的影响研究目前较少见。
目的 探讨流水线作业工人积极职业安全态度与OMD发生的关联性。
方法 采用判断抽样法抽取三家珠三角某市制造企业2 172名工龄超过一年的流水线作业工人，采用自行编制的《基本信息和工作信息调查表》调查工人的年龄、性别、婚姻状况、文化程度和工种、工龄、工作负荷、是否长期保持同一姿势等。采用改良版《北欧肌肉骨骼问卷》调查研究对象在过去的12个月内，因职业活动导致的身体某个部位OMD的发生情况。采用《积极安全态度问卷》获取工人的支持安全政策的态度、支持管理者的态度和乐观态度等积极安全态度。
结果 2 172名研究对象中：男工1 479名，女工693名；年龄为（37.9±8.2）岁；流水线作业工龄为（6.4±1.6）年；汽车及其零件制造749人，木质家具制造781人，衣服制作642人。826名工人在过去1年内曾发生OMD（38.03%），疼痛出现在以腰部和（或）下背部为主的有467名（56.54%），出现在颈肩部的有201名（24.33%），出现在双上肢、双下肢部分别为97名（11.74%）和61名（7.38%）。χ2检验显示，男性的OMD发生率高于女性（P < 0.001）。年龄>30岁者OMD发生率高于≤ 30岁者（P < 0.001）。流水线作业工龄>5年者OMD发生率高于≤ 5年者（P < 0.001）。工种负荷较重者OMD发生率高于一般者（P < 0.001）。保持同一姿势者OMD发生率高于非保持同一姿势者（P=0.028）。不同工种之间OMD发生率相比，差异有统计学意义（P < 0.001）。对"支持安全政策态度""支持管理者态度""乐观态度"持认同态度的工人OMD发生率均低于持不认同态度者，差异有统计学意义（P < 0.001）。Logistic回归分析显示，年龄≥均值OR及其95% CI为2.25（2.07，2.43）、流水线作业工龄≥均值2.64（2.31，2.97）、工作负荷较重3.10（2.86，3.34）、工作中保持同一姿势2.80（2.53，3.07）是OMD发生的危险因素，而支持安全政策0.70（0.56，0.84）、支持管理者0.75（0.61，0.89）、乐观0.66（0.47，0.85）的态度是OMD发生的保护因素（P < 0.05）。
结论 积极职业安全态度可能是流水线作业工人发生OMD的潜在保护因素，但其减少OMD发生的机制和原因尚需进一步的探讨。
Abstract:Background The prevalence rate of occupational musculoskeletal diseases (OMD) of assembly line workers is reported up to 38.03%. Psychology is a potential impact factor of OMD. Positive occupational safety attitude refers to benign cues and positive psychological tendency of workers, but its influence on OMD is rarely reported.
Objective The study aims to explore the correlation between positive occupational safety attitude and OMD of assembly line workers.
Methods A total of 2 172 assembly line workers with more than one year of employment were selected from three manufacturing factories in a city of Pearl River Delta after excluding those not eligible by judgement sampling method. Self-administered General and Work Information Questionnaire was used to collect information on workers' age, gender, marriage, education, work category, work age, work stress, and stationary work posture. Improved Nordic Musculoskeletal Questionnaires were used to survey OMD concerning different body parts in the past 12 months. Questionnaire of Positive Occupational Safety Attitude was used to investigate workers' attitudes towards safety policy, leaders, and optimism.
Results There were 1479 male workers and 693 female workers in the 2172 study subjects; their average age was (37.9±8.2) years; their average work age in assembly lines was (6.4±1.6) years. They were 749 workers from a car and car-parts manufacturer, 781 workers from a wooden furniture manufacturer, and 642 workers from a clothing manufacturer. There were 826 cases (38.03%) of OMD in the past 12 months, including 467 cases (56.54%) in waist and/or low back, 201 cases (24.33%) in shoulders, 97 cases (11.74%) in upper limbs, and 61 cases (7.38%) in lower limbs. The prevalence of OMD was higher in males (versus females) (P < 0.001), the workers at >30 years of age (versus those at ≤ 30 years) (P < 0.001), the workers of >5 years of service in assembly lines (versus those of ≤ 5 years) (P < 0.001), the workers with high work stress (versus those with low work stress) (P < 0.001), and the workers with stationary work postures (versus those not) (P=0.028). A statistical difference in the prevalence of OMD (P < 0.001) was found among the workers in different work categories. The prevalence of OMD was also lower in the workers supporting safety policy, supporting leaders, and holding optimistic attitude than those not (P < 0.001). The results of logistic regression analysisOR (95% CI) revealed that age above average2.25 (2.07, 2.43), work age in assembly lines above average2.64 (2.31, 2.97), heavy work stress3.10 (2.86, 3.34), and keeping stationary work postures2.80 (2.53, 3.07) were the risk factors of OMD, while supporting safety policy0.70 (0.56, 0.84), supporting leaders0.75 (0.61, 0.89), and holding optimistic attitude0.66 (0.47, 0.85) were the protective factors of OMD (P < 0.05).
Conclusion Positive occupational safety attitude is a potential protective factor of OMD, but the mechanism and cause of reducing OMD require further study.
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