工作场所干预以降低心血管风险：一项易于融入意大利职业健康监测组织的研究设计方案的建议。
A worksite intervention to reduce the cardiovascular risk: proposal of a study design easy to integrate within Italian organization of occupational health surveillance.
机构信息
Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
Health and Safety at Work Department (SPSAL), Local Health Authority No.20, Veneto Region, Via Salvo D'Acquisto 7, 37122, Verona, Italy.
出版信息
BMC Public Health. 2015 Jan 21;15:12. doi: 10.1186/s12889-015-1375-4.
BACKGROUND
Despite the substantial amount of knowledge on effectiveness of worksite health promotion (WHP) in reducing cardiovascular disease (CVD) risk, WHP programs are not systematically applied in Italy. The aim was to design an intervention easy to integrate within the Italian organization of workplace health surveillance.
METHODS
We used the "pretest-posttest design". Workers were employed in multiple occupations and resident in Veneto region, Italy. Occupational physicians (OPs) performed all examinations, including laboratory evaluation (capillary blood sampling and measure of glycaemia and cholesterolemia with portable devices), during the normal health surveillance at worksite. CVD risk was computed based on sex, age, smoking habit, diabetes, systolic pressure and cholesterol level. After excluding those with <40 years of age, missing consent, CVD diagnosis or current therapy for CVD, missing information, CVD risk <5%, out of 5,536 workers 451 underwent the intervention and 323 male workers were re-examined at 1 year. CVD risk was the most compelling argument for changing lifestyle. The counseling was based on the individual risk factors. Individuals examined at posttest were a small fraction of the whole (6% = 323/5,536). In these workers we computed the ratio pretest/posttest of proportions (such as percent of subjects with cardiovascular risk >5%) as well as the exact McNemar significance probability or the exact test of table symmetry.
RESULTS
CVD risk decreased by 24% (McNemar p = 0.0000) after the intervention; in a sensitivity analysis assuming that all subjects lost to follow-up kept their pretest cardiovascular risk value, the effect (-18%) was still significant (symmetry p < 0.0000). Each prevented CVD case was expected to cost about 5,700 euro.
CONCLUSIONS
The present worksite intervention promoted favorable changes of CVD risk that were reasonably priced and consistent across multiple occupations.
背景
尽管有大量关于工作场所健康促进（WHP）降低心血管疾病（CVD）风险的有效性的知识，但 WHP 计划并未在意大利系统地应用。目的是设计一种易于整合到意大利工作场所健康监测组织中的干预措施。
方法
我们使用“预测试-后测试设计”。工人从事多种职业，居住在意大利威尼托地区。职业医生（OPs）在工作场所进行所有检查，包括实验室评估（毛细血管采血和使用便携式设备测量血糖和胆固醇水平）。CVD 风险根据性别、年龄、吸烟习惯、糖尿病、收缩压和胆固醇水平计算。排除年龄<40 岁、不同意、CVD 诊断或当前 CVD 治疗、信息缺失、CVD 风险<5%的人群后，在 5536 名工人中，有 451 人接受了干预，323 名男性工人在 1 年后再次接受检查。改变生活方式是最有说服力的论点。咨询基于个体风险因素。在后测中接受检查的人数只是全部人数的一小部分（6%=323/5536）。在这些工人中，我们计算了比例（如心血管风险>5%的患者比例）的预测试/后测试比值，以及精确 McNemar 显著性概率或表格对称性的精确检验。
结果
干预后 CVD 风险降低了 24%（McNemar p=0.0000）；在一项假设所有失访患者保持其预测试心血管风险值的敏感性分析中（-18%），效果仍然显著（对称性 p<0.0000）。每预防一个 CVD 病例预计将花费约 5700 欧元。
结论
本工作场所干预措施促进了 CVD 风险的有利变化，且具有合理的价格，适用于多种职业。
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