脑力劳动人群中职业紧张对健康及其工作能力影响研究

发布时间：2018-05-28 09:26

本文选题：脑力劳动人群 + 职业紧张　；参考：《新疆医科大学》2017年博士论文

【摘要】：目的:通过了解脑力劳动人群工作中存在的职业紧张因素和职业紧张水平,并探讨职业紧张对其心身健康及工作能力的影响,为脑力劳动人群的职业健康服务提供基础数据,并补充我国脑力劳动人群职业紧张与健康研究方面的的资料,为政府和相关部门的决策提供科学依据。方法:1)通过分层整群抽样的方法,随机抽取工作1年以上的脑力劳动者17 000人作为研究对象,采用ISTA6.0、职业紧张问卷、中式职业倦怠问卷、心理疲劳问卷、社会支持问卷、应对方式问卷、慢性病患病情况问卷及WAI问卷进行问卷调查,共回收问卷14 259人份,回收率为83.88%;2)采用病例-对照研究,使用PCR-RFLP技术对380份样本(病例组190名、对照组190名)进行相关基因多态性检测。3)随机抽取380人,用酶联免疫吸附法测定血浆IL-2和IL-6的含量。研究结果:1)此次调查脑力劳动人群14 259人,其中男性6 942人;女性7 317人,包括:医务人员2 189人(15.4%);公务员6 791人(47.6%);教师5 279人(37.0%),平均年龄31.06岁;2)脑力劳动者工作中主要的职业紧张因素有复杂性、变化性、合作的需求程度、任务控制、时间控制、合作可能性、工作组织问题、不合理体位需求、任务危险性、合作的紧密性;另外医务人员工作中任务不确定性、工作干扰比较明显,交流可能性在公务员和教师人群显得较为突出;3)脑力劳动人群属于职业紧张水平较高的人群。医务人员、公务员和教师中高度职业紧张者最多,分别占92.3%、73.3%、70.0%;4)不同紧张水平、不同工种和不同人口学特征间脑力劳动人群心理健康状况存有差异:(1)不同职业紧张水平组间职业倦怠得分有差异(P0.01),其中随着职业紧张水平的增加工作倦怠呈逐渐增高趋势,高度紧张组工作倦怠得分最高。不同工种间医务人员在工作倦怠总分、情感耗竭和人格解体方面得分高于公务员和教师;不同工龄间10年者职业倦怠总分得分最高。另职业倦怠女性高于男性、少数民族倦怠状态比汉族严重,未婚者高于已婚者,低学历者倦怠水平较高;(2)不同紧张水平组间心理疲劳有差异(P0.01),其中高度紧张组心理疲劳得分最高。公务员除体力劳动得分较低外,在疲劳总分、活动减少、动力下降及脑力疲劳间得分均高于医务人员及教师;教师体力疲劳得分最高;工龄越低者在心理疲劳总分、体力疲劳及脑力疲劳方面得分均越高,在活动减少及动力下降方面得分最低;男性疲劳感高于女性、中年脑力人群心理疲劳感最强、少数民族脑力疲劳高于汉族、未婚者心理疲劳高于已婚者、本科及以上心理疲劳感较强;(3)不同紧张程度组间应对方式得分差异具有统计学意义(p0.01),其中高度紧张组消极应对均得分最高;低度紧张组积极应对得分处于最高水平。不同工种间应对方式得分有差异(p0.05),其中医务人员在解决问题及求助方面得分最高,公务人员在自责方面得分最高;不同工龄间在解决问题、求助、幻想方面得分均有差异(p0.05),其中10年组解决问题得分最高,≥20年组在求助和幻想方面得分最高。男性、少数民族、低年龄者、本科及以上者、医务人员及高级职称者更易采取积极应对方式去处理问题。;(4)不同紧张水平组间社会支持得分有差异(p0.01),其中低度职业紧张组社会支持得分要高于高度紧张组。不同工种、工龄间在社会支持得分差异具有统计学意义(p0.01),其中公务员高于教师,随着工龄增长社会支持各项目得分也随之增长,≥20年者得分最高。男性、年龄50岁组、少数民族、已婚者、本科及以上者在社会支持上均处于较高水平;(5)线性回归结果显示职业倦怠对职业紧张影响最大(β=14.326,p0.01),职业倦怠与职业紧张呈正相关(p0.01),社会支持与职业紧张呈负相关(p0.01);5)不同职业紧张水平对脑力劳动人群生理健康有影响:(1)脑力劳动人群常见疾病患病率由高到低的顺序是颈腰部疾病(33.6%)、口腔疾病(26.6%)、慢性消化系统疾病(22.7%)、高血脂14.4%、高血压10.1%;冠心病患4.5%,其中颈腰部疾病、口腔疾病和慢性消化系统疾病最多。fbg病例组高于对照组;hdl病例组低于对照组;tg病例组高于对照组;alt/ast病例组低于对照组;(2)不同职业紧张水平组间il-2、il-6含量不同,且随着职业紧张水平的增加,il-2含量降低,il-6含量增加(p0.05)。il-6指标在不同性别、职称和工龄间差异有统计学意义(p0.05);在控制年龄、民族、性别等人群特征因素后进行偏相关分析,结果显示il-2水平与工作紧张指数、工作压力指数呈负相关;il-6水平与工作紧张指数、工作压力指数呈正相关(p0.05);(3)不同职业紧张组间高血压患病的分布不同,随紧张程度增加高血压患病率呈现上升的趋势(p0.01)。高血压的危险因素有遗传史、被动吸烟、饮酒史、口味和职业紧张。高血压的基因多态性分析显示:t(-344)c和rs3918181基因多态性与高血压易感性有相关关系,其中t(-344)c位点等位基因t及rs3918181位点等位基因a是风险等位基因。对有连锁不平衡的rs1800780位点和rs3918181位点进行单倍体构建,得出其中a-a及a-g单倍型具有统计学意义(p0.05),前者为危险因素单倍型,后者为保护因素单倍型;6)职业紧张对脑力劳动人群的工作能力影响:(1)脑力劳动人群工作能力极好者占2.96%;好者占36.98%;中等者占51.57%;差者占8.49%,以工作能力中等者居多。医务人员处在高度职业紧张水平下缺勤者最多,占医务人员39.1%。不同性别、年龄、民族、婚姻、学历者工作能力上的差异具有统计学意义(p0.01)。男性工作能力高于女性;年龄长者工作能力较强;汉族工作能力高于少数民族;未婚者的工作能力高于已婚者;本科以上学历者高于本科以下者;(2)不同工种脑力劳动者工作能力存有差异(p0.05),公务员工作能力指数最高,医务人员最低;工作能力随着工龄增长也逐渐增高;(3)不同职业紧张水平组间工作能力水平的分布不同(P0.01)。职业紧张水平越高,工作能力越差。同时随着职业倦怠程度的增加,工作能力指数随之下降,在高度倦怠者中工作能力差者所占比例最高;(4)多重回归分析结果显示:年龄、职称、工龄、婚姻等个体特征,以及职业紧张、职业倦怠、心理疲劳、社会支持、应对方式与工作能力之间存在关联(P0.01),表明年龄、职称、工龄、婚姻和职业紧张、职业倦怠、心理疲劳、社会支持、应对方式均为脑力作业人群工作能力的影响因素,其中心理疲劳、社会支持、职业倦怠和工龄对工作能力的影响较大。回归方程式为:Y=48.584+0.639X3-0.320X4-0.595X5-0.807X6-0.475X7-0.037X8-0.184X9+0.090 X10+0.016 X11。结论:1)脑力劳动者接触的主要紧张因素:复杂性、变化性、合作的需求程度、任务控制、时间控制、合作可能性、工作组织问题、不合理体位需求、任务危险性、合作的紧密性;2)脑力劳动人群属于职业紧张水平较高的人群。其中工种、工龄、职称对其职业紧张水平有一定影响;3)不同紧张水平、不同工种和不同人口学特征间脑力劳动人群心理健康状况存有差异。随着职业紧张水平的增加工作倦怠、心理疲倦呈逐渐增高趋势;随着职业紧张水平的增加消极应对呈现增高趋势,而积极应对则随紧张水平增加而逐渐降低。社会支持可降低职业紧张水平;4)随着职业紧张水平的增加,IL-2含量降低,IL-6含量增加。职业紧张与高血压的患病有关联。T(-344)C位点等位基因T及rs3918181位点等位基因A是风险等位基因。rs1800780位点中A-A单倍型为危险因素,rs3918181位点中A-G单倍型是保护因素;5)职业紧张会对脑力劳动人群的工作能力造成不良影响,脑力劳动人群中以工作能力中等者居多。职业紧张水平越高,工作能力越差;年龄、工龄、职业紧张、职业倦怠、心理疲劳、社会支持、应对方式和婚姻均为脑力作业人群工作能力的影响因素。
[Abstract]:Objective: to understand the occupational stress and occupational stress levels in the work of the mental workers, and to explore the effects of occupational stress on their physical and mental health and working ability, and to provide basic data for the occupational health service of the mental workers, and to supplement the information on the study of occupational stress and health in the mental laboring population in China. In order to provide scientific basis for the decision of the government and related departments. Methods: 1) by stratified cluster sampling, 17000 of the 17000 mental workers who worked for more than 1 years were randomly selected as the research object, using ISTA6.0, occupational stress questionnaire, Chinese Job Burnout Questionnaire, psychological fatigue questionnaire, social support questionnaire, coping style questionnaire, chronic disease disease. The questionnaire and WAI questionnaire were used to collect questionnaires. The total recovery rate was 14259, the recovery rate was 83.88%; 2) a case-control study was used. 380 samples (190 case group and 190 control group) were used to detect 380 people randomly with PCR-RFLP technique. The content of IL-2 and IL-6 in plasma was measured by enzyme linked immunosorbent assay. The results were as follows: 1) there were 14259 people with mental labor, including 6942 men and 7317 women, including 2189 medical staff (15.4%), 6791 civil servants (47.6%), 5279 teachers (37%), average age 31.06, 2, and 2) the major occupational stress factors in the work of mental workers were complex, varied, cooperative demand, task. Control, time control, cooperation possibility, work organization problem, unreasonable body position demand, task danger, cooperation tightness; in addition, medical staff work uncertainty, work interference is obvious, communication possibility is more prominent in civil servants and teachers crowd; 3) mental laboring crowd belong to higher occupational stress level. The most highly occupational stress among the people, medical staff, civil servants and teachers accounted for 92.3%, 73.3%, 70% and 4). There were differences in mental health between different types of work and different demographic characteristics: (1) there were differences in job burnout among different occupational stress groups (P0.01), with occupational stress. The level of job burnout increased gradually, and the score of job burnout was the highest in the high tension group. The scores of job burnout, emotional exhaustion and disintegration were higher than those of the civil servants and teachers. The score of job burnout was the highest among the 10 years of different work age. The other job burnout women were higher than the male and a few people. The level of burnout was more serious than that of the Han people. The level of burnout was higher in the unmarried people than those of the married people. (2) there was a difference in psychological fatigue among the groups of different tension levels (P0.01), of which the high stress group had the highest score of mental fatigue. The scores of physical fatigue of teachers were higher than that of the medical staff and teachers, the lower the scores of mental fatigue, physical fatigue and mental fatigue were higher in those with lower work age, the lowest in the reduction of activity and the decline of power, the male fatigue feeling was higher than that of the female, the middle age mental fatigue was the strongest, and the mental fatigue of the minority nationalities was higher than that of the Han nationality. The mental fatigue of the unmarried people was higher than that of the married people. (3) there was a significant difference in the scores of coping styles among the groups of different tension (P0.01), among which the negative coping scores in the high tension group were the highest, and the positive coping scores in the low tension group were the highest. The scores of coping styles among different types of work were different (P 0.05), among them, the medical staff scored the highest score in solving problems and seeking help, and the public officials had the highest score in self remorse; the scores of solving problems, seeking help and fantasy were different (P0.05), among which the 10 year group had the highest score for solving problems, and the highest scores in help and fantasy in the group of more than 20 years were the men, minority and low age. People, undergraduate and above, medical staff and senior professional titles are more likely to take active coping styles to deal with the problem. (4) there is a difference in social support scores (P0.01) among the groups of different levels of tension, of which the score of social support in the low degree occupational stress group is higher than that in the high tension group. The difference in the social support scores between different types of work and the work age is statistically significant P0.01, among them, civil servants were higher than teachers, with the increase of social support in social support and the highest score in 20 years. Men, age 50, minority, married, undergraduate and above were at a high level in social support; (5) linear regression results showed that job burnout had the greatest impact on occupational stress (beta =14 .326, P0.01), job burnout has a positive correlation with occupational stress (P0.01), social support is negatively correlated with occupational stress (P0.01); 5) different occupational stress levels have an impact on the physical health of mental workers: (1) the prevalence of common diseases in mental workers from high to low is the neck and waist disease (33.6%), oral disease (26.6%), chronic digestive system. Disease (22.7%), hyperlipidemia 14.4%, hypertension 10.1%, coronary heart disease 4.5%, of which the neck waist disease, oral disease and chronic digestive system disease most.Fbg case group was higher than the control group; HDL case group was lower than the control group; TG case group was higher than the control group; alt/ast case group was lower than the control group; (2) the level of IL-2, IL-6 content of different occupational stress groups was not In the same way, with the increase of occupational stress level, IL-2 content decreased, IL-6 content increased (P0.05).Il-6 index in different sex, the difference between professional title and working age was statistically significant (P0.05). The partial correlation analysis was carried out after the control age, nationality, sex and other population characteristics, the results showed that the level of IL-2 and work stress index, the work stress index showed Negative correlation; IL-6 level was positively correlated with work stress index and work stress index (P0.05); (3) the distribution of hypertension among different occupational stress groups was different, and the prevalence rate of hypertension increased with the increase of tension (P0.01). The risk factors of hypertension were hereditary history, passive smoking, drinking history, taste and occupational stress. Genetic polymorphism analysis showed that the polymorphism of T (-344) C and rs3918181 gene was related to the susceptibility to hypertension, of which the T (-344) C allele T and rs3918181 alleles a were risk alleles. Statistical significance (P0.05), the former is the risk factor haplotype, the latter is the protective factor haplotype, the latter is the haplotype of the protective factor; 6) the occupational stress affects the working ability of the mental laboring crowd: (1) the people with the excellent working ability of the mental working crowd accounted for 2.96%, the good persons accounted for 36.98%, the medium accounted for 51.57%, the difference accounted for 8.49%, the medical staff were in the majority. At the level of high occupational stress, the most absenteeer, accounting for different sex of 39.1%., age, age, nationality, marriage and education, there were statistically significant differences (P0.01). Male working ability was higher than that of women; older workers had stronger working ability; the working ability of Han nationality was higher than that of ethnic minorities; the working ability of unmarried people was higher than that of married people. Those with bachelor degree or above are higher than those under the undergraduate level; (2) there are differences in the working ability of different types of mental workers (P0.05), the highest ability index of civil servants, the lowest medical staff, and the increase in working ability with the growth of working age; (3) the distribution of working ability of different occupational stress groups is different (P0.01). The higher the occupational stress level is, the more the level of occupational stress is, the more the level of occupational stress is, the more the level of occupational stress is, the more the level of occupational stress is, the more the level of occupational stress is, the more the level of occupational stress is, the more the level of occupational stress is, the more the level of occupational stress is, the more the level of occupational stress At the same time, with the increase of job burnout, the work ability index decreased, and the proportion of poor working ability was the highest in highly burnout. (4) multiple regression analysis showed that age, job title, work age, marriage and other individual characteristics, and occupational stress, job burnout, psychological fatigue, social support, coping style. There is a correlation with work ability (P0.01), which indicates that age, title, work age, marital and occupational stress, job burnout, psychological fatigue, social support, and coping style are all the factors affecting the working ability of the brain working crowd, of which psychological fatigue, social support, job burnout and work age have great influence on the working ability. Regression equation is Y=4 8.584+0.639X3-0.320X4-0.595X5-0.807X6-0.475X7-0.037X8-0.184X9+0.090 X10+0.016 X11. conclusion: 1) the main stressors of contact with mental workers: complexity, variability, demand for cooperation, task control, time control, cooperation possibility, work organization, unreasonable body position, task danger, tightness of cooperation; 2) The force working crowd belong to the higher level of occupational stress. Among them, the work type, the working age, the professional title have certain influence on their occupational stress level; 3) there is a difference in mental health status between the different stress levels, different types of work and different demographic characteristics. With the increase of job burnout, the psychological fatigue is gradual. The trend increased with the increase of occupational stress level, while positive coping gradually decreased with the increase of tension. Social support could reduce the level of occupational stress; 4) with the increase of occupational stress, IL-2 content decreased and IL-6 content increased. The occupational stress and hypertension were associated with.T (-344) C site. Allele T and rs3918181 allele A are risk factors for A-A haplotype in the.Rs1800780 locus of risk allele, and A-G haplotype in rs3918181 locus is a protective factor; 5) occupational stress will have a bad effect on the working ability of the mental workers, the majority of the workers in the mental working group are middle working ability. The higher the level, the poorer the working ability; age, work age, occupational stress, job burnout, psychological fatigue, social support, coping style and marriage are all the factors affecting the working ability of mental workers.
【学位授予单位】：新疆医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R13

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