大棚菜农MSDs及影响因素的结构方程模型分析

发布时间：2018-04-12 06:18

本文选题：肌肉骨骼疾患 + 危险因素　；参考：《山东大学》2013年硕士论文

【摘要】：背景肌肉骨骼疾患(Musculoskeletal disorders, MSDs)是指影响肌肉、骨骼、神经、肌腱、韧带、关节、软骨和椎间盘的损伤和／或功能障碍。症状轻者会有不舒适或轻微疼痛等感觉,而症状严重者常常无法工作,需借助药物或特殊工具训练,且治疗效果不佳。MSDs在全世界的工作人群中很普遍并且是一个严重问题。鉴于此,美国国家职业安全与健康研究所(National Institute for Occupational Safety and Health, NIOSH)在2002年把MSDs列为重点研究的10个职业卫生问题之一,世界卫生组织把2000年至2010年确定为“骨与关节病十年”。农业作为劳动力密集型产业,尤其受到MSDs的影响。果农和菜农等某些劳动力密集型行业中MSDs患病率尤其突出。中国,作为农业大国,农民的MSDs却没有引起足够的重视。因此研究农民的MSDs及其影响因素具有重要意义。大棚蔬菜已经在山东寿光地区广泛种植,由于其良好的经济效益正向全国范围内迅速普及。然而大棚蔬菜种植是一项十分艰辛的工作,加上蔬菜大棚的特殊工作环境(高温、高湿、高二氧化碳浓度等)及特殊的工作方式(手工作业、体力劳动、特殊体位)等使大棚菜农具有较高的职业健康危险因素暴露,大棚菜农更易患上诸如骨关节炎、下背痛、颈肩痛等MSDs。 MSDs的可疑危险因素除职业因素外,还包括个体因素、心理社会因素等。MSDs的危险因素在实际的人群调查中难以准确测量,难以计算各个危险因素的相对水平。并且在现况研究中可疑危险因素与疾病之问的因果关系难以确定。结构方程模型(Structural Equation Model, SEM)是一种建立、估计和验证因果关系的方法,可以筛选可疑危险因素并估计危险因素相对大小,被誉为二十世纪统计学的三大进展之一。近二十年来SEM在慢病等医学领域得到了广泛应用,但是使用SEM分析MSDs危险因素的研究却尚未见报道。本文使用SEM筛选大棚菜农MSDs的危险因素并对危险因素相对大小进行评估,对MSDs的预防、干预研究具有重要的指导和借鉴意义。目的调查大棚菜农和对照菜农MSDs患病情况,探索大棚菜农MSDs的危险因素,估计危险因素相对大小水平,提出针对大棚菜农MSDs的预防措施和建议。方法采用分层整群抽样方法,使用北欧国家肌肉骨骼疾患调查问卷与荷兰肌肉骨骼疾患调查问卷对某蔬菜大棚种植基地的大棚菜农和邻近村庄的非大棚菜农(对照组)进行面对面回顾性问卷调查,计算患病率,比较患病情况,并使用结构方程模型分析大棚菜农MSDs的危险因素。结果患病率共调查639名大棚菜农和318名对照菜农。大棚菜农MSDs患病率为61.2%,对照菜农MSDs患病率为43.4%,并且大棚菜农MSDs患病率高于对照菜农(P0.05)。大棚菜农前四位MSDs依次是下背疾患、肩部疾患、膝部疾患和颈部疾患。大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患的患病率分别为49.6%、29.0%、24.6%和12.8%,对照菜农分别为28.0%、11.6%、10.7%和4.4%,并且大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患患病率均高于对照菜农(P＜0.05)。误工卧床情况大棚菜农因MSDs误工364人,误工率为57.0%,对照菜农因MSDs误工135人,误工率为42.5%,并且大棚菜农MSDs误工率高于对照菜农(P＜0.05)。大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患的误工率分别为45.5%、25.0%、23.9%和12.5%,对照菜农分别为27.7%、11.3%、10.7%和3.8%,并且大棚菜农下背疾患、肩部疾患、膝部疾患和颈部疾患的误工率均高于对照菜农(P＜0.05)。大棚菜农因MSDs卧床62人,对照菜农因MSDs卧床2人,大棚菜农高于对照菜农MSDs的卧床率(P＜0.05)。危险因素结构方程模型分析下背疾患在下背疾患的SEM中,潜因变量大棚菜农下背疾患的决定系数为0.847,力量施加因素、静态负荷、动态负荷、人体工效学环境因素、重复性负荷和社会心理学因素与下背疾患的结构系数分别为0.385、0.342、0.122、0.064、0.040和0.098(P＜0.05)。力量施加因素、静态负荷、人体工效学环境因素、动态负荷、社会心理学因素、重复性负荷和年龄因素对潜因变量下背疾患的总体影响分别是0.385、0.342、0.285、0.122、0.098、0.040和0.034。大棚环境中潜变量人体工效学环境因素对潜变量大棚菜农静态负荷的直接影响为0.646。肩部疾患在肩部疾患的SEM中,潜因变量大棚菜农肩部疾患的决定系数为0.654,大棚因素、重复性负荷因素、力量施加因素、年龄因素、肩部姿势、性别和不舒适体位因素与肩部疾患的结构系数分别为0.448、0.283、0.106、0.079、0.069、0.065和0.033(P＜0.05)。大棚因素、重复性负荷、力量施加因素、年龄、肩部姿势、性别、不舒适体位因素对潜因变量肩部疾患的总体影响分别为0.660、0.283、0.106、0.079、0.069、0.065和0.033。大棚因素对大棚菜农力量施加因素的直接影响为0.553,对大棚菜农重复性负荷因素的直接影响为0.544。膝部疾患在膝部疾患的SEM中,潜因变量大棚菜农膝部疾患的决定系数为0.674,大棚菜农不舒适体位因素、个体因素(身高、体重)、社会心理学因素和平时健康状况与大棚菜农膝部疾患的结构系数分别为0.632、0.259、0.089和0.039(P＜0.05)。不舒适体位因素、个体因素(身高、体重)、社会心理学因素和平时健康状况对大棚菜农膝部疾患的总体影响分别为0.632、0.259、0.089和0.039。颈部疾患在颈部疾患的SEM中,潜因变量大棚菜农颈部疾患的决定系数为0.736,重复性负荷、颈部姿势、个体因素(年龄)、不舒适体位因素和社会心理学因素与大棚菜农颈部疾患的结构系数分别为0.559、0.344、0.037、0.030和0.001(P＜0.05)。重复性负荷、颈部姿势、个体因素(年龄)、不舒适体位因素和社会心理学因素对大棚菜农颈部疾患的总体影响分别为0.559、0.344、0.037、0.030和0.001。结论 1.大棚菜农MSDs患病率较高,主要表现为下背疾患、肩部疾患、膝部疾患和颈部疾患,并且大棚菜农因MSDs明显影响了工作。 2.大棚菜农下背疾患的主要危险因素为力量施加、静态负荷、人体工效学环境和动态负荷；肩部疾患的主要危险因素为大棚因素、重复性负荷和力量施加因素；膝部疾患的主要危险因素为不舒适体位和肥胖；颈部疾患的主要危险因素为重复性负荷和颈部姿势。 3.建议：完善大棚配置；优化工作组织安排；改进操作方式。
[Abstract]:Background

Musculoskeletal disorders ( MSDs ) refer to the damage and / or dysfunction affecting muscles , bones , nerves , tendons , ligaments , joints , cartilage and intervertebral discs . Symptoms may be uncomfortable or painful . The World Health Organization ( WHO ) has identified MSDs as one of the 10 occupational health problems of the focus study in 2002 .

Greenhouse vegetable has been widely cultivated in Shouguang area of Shandong province , because its good economic benefit is rapidly popularized in the whole country . However , vegetable planting in greenhouse is a very arduous task , and the special working environment of vegetable greenhouse ( high temperature , high humidity , high carbon dioxide concentration , etc . ) and special working mode ( manual operation , manual labor , special body position ) etc . and special working mode ( manual operation , manual labor , special body position ) etc . make the large - shed vegetable farm have higher occupational health risk factor exposure , and the large - shed vegetable farm is more susceptible to MSDs such as osteoarthritis , lower back pain , and cervical shoulder pain .

The risk factors of MSDs are difficult to accurately measure in the actual population survey , it is difficult to calculate the relative level of risk factors . The structural equation model ( SEM ) is a method to establish , estimate and verify the causal relationship .

Purpose

To investigate the prevalence of MSDs in vegetable agriculture and control vegetable , explore the risk factors of large shanty vegetable agriculture MSDs , estimate the relative size level of dangerous factors , and put forward the preventive measures and suggestions for the large shanty vegetable agriculture MSDs .

method

Using a stratified cluster sampling method , a face - to - face retrospective survey was conducted to investigate the prevalence and prevalence of non - large shantyvegetable farmers ( control group ) in a vegetable greenhouse planting base and the non - large shannon ( control group ) of neighboring villages by using a questionnaire of musculoskeletal disorders in the Nordic countries and a questionnaire survey of musculoskeletal disorders in the Netherlands . The risk factors of the large - shed vegetable agriculture MSDs were analyzed by using the structural equation model .

Results

Prevalence

The prevalence of MSDs was 61.2 % , and the prevalence of MSDs was 43.4 % . The prevalence of MSDs was 49.6 % , 29.0 % , 24 . 6 % and 12 . 8 % , respectively , and that of the control group were 28 . 0 % , 11.6 % , 10.7 % and 4.4 % , respectively .

error - bed condition

The rate of misdiagnosis was 45.7 % , 25.0 % , 23.9 % and 12.5 % , respectively , and the rate of misdiagnosis in vegetable and rural areas was 27.5 % , 25.0 % , 10.9 % and 12.5 % , respectively , and the rate of error in the middle - back disease , shoulder disease , knee disease and neck disease was higher than that of control vegetable growers ( P < 0.05 ) .

Analysis of Structural Equation Model of Risk Factors

The main factors , static load , ergonomic environmental factors , dynamic load , social psychological factors , repetitive load and age factors were 0.385 , 0.342 , 0.285 , 0.122 , 0.098 , 0.040 and 0.034 respectively .

In the SEM of shoulder disease , the determinants of shoulder disease were 0.648 , 0.283 , 0.106 , 0.079 , 0.069 , 0.065 and 0.033 respectively ( P & lt ; 0.05 ) .

In the SEM of knee disease , the determinants of knee disease were 0.632 , 0.259 , 0.089 and 0.039 ( P & lt ; 0.05 ) . The overall effects of non - comfortable physical factors , individual factors ( height , weight ) , social psychology factor and normal health status on the knee disease were 0.632 , 0.259 , 0.089 and 0.039 , respectively .

In the SEM of cervical diseases , the determinants of neck disease were 0.759 , 0.344 , 0.037 , 0.030 and 0.001 respectively ( P < 0.05 ) . The overall effects of repetitive load , neck posture , individual factor ( age ) , discomfort posture factors and social psychology factors on the neck disease were 0.5559 , 0.344 , 0.037 , 0.030 and 0.001 , respectively .

Conclusion

1 . The prevalence of MSDs in large shanty vegetable was higher , mainly manifested as lower back disease , shoulder disease , knee disease and neck disease .

2 . The main risk factors of back - to - back diseases are force application , static load , ergonomic environment and dynamic load .
The main risk factors of shoulder disease are the factors of greenhouse factor , repetitive load and force application .
The main risk factors of knee disease are discomfort body position and obesity .
The main risk factors for neck disease are repetitive load and neck posture .

3 . Recommendation : perfect the shed configuration ;
Optimizing organization of work organization ;
improve that mode of operation .

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R139.2

【参考文献】