Melhorn J M
Department of Surgery, University of Kansas School of Medicine-Wichita, USA.
J Occup Environ Med. 1996 Dec;38(12):1264-71. doi: 10.1097/00043764-199612000-00013.
Occupational diseases affect 15 to 20% of all Americans. Cumulative trauma disorders (CTDs) account for 56% of all occupational injuries. The recognition and control of occupational injuries has become a major concern of employees, employers, medicine, and the federal government because of health risk and related costs. Upper-extremity CTDs are identified by the National Institute for Occupational Safety and Health as one of the ten most significant occupational health problems in the United States. It is estimated by the year 2000 that 50 cents on the dollar will be spent on CTDs. Although enlightened aircraft employers have developed primary prevention strategies, primary prevention can never be expected to eliminate 100% of the cases. To evaluate several preventive activities, a CTD risk-assessment program was developed and implemented in cooperation with a major aircraft manufacturer employing over 8000 workers. This program was focused on objectively identifying the relationship of work and other activities to an individual worker experiencing CTDs. Early identification has been linked, when applicable, to intervention algorithms for medical care, job task modification, workplace accommodation, and training. A prospective study group of 212 workers who used rivet guns was placed into a four-way experimental design for ergonomic posture training, exercise training, and rivet-gun type (primary factors). A statistical model was developed for the level of CTD risk and evaluated using the SAS software program (SAS Institute, Inc, Carry, NC). Statistical analysis of the primary factors without regard to associated variables (covariates) demonstrated that only posture training had a beneficial risk reduction for the individual. The impact (beneficial or detrimental) for exercise training and for vibration-dampening rivet guns was probably obscured because of the large variability of the responses regarding the associated variables (covariates). When the covariates were analyzed in conjunction with the four experimental groups, a positive benefit from ergonomic posture training and exercise training was demonstrated for the following groups: the dominant han, time spend in an awkward position, number of standard rivets bucked, number of parts routed, number of parts ground, number of vibration-dampening rivets bucked, and newly hired individuals. A negative effect (increase in individual risk level) for current employees using a vibration-dampening rivet gun was demonstrated. This prospective study helps to identify the possible benefit of education and training for controlling CTDs and demonstrates the usefulness of being able to evaluate materials, methods, machines, and environments as they relate to the individual's risk level for the development of upper-extremity CTDs.
职业病影响着15%到20%的美国人。累积性创伤失调症（CTDs）占所有职业伤害的56%。由于健康风险和相关成本，职业伤害的识别与控制已成为员工、雇主、医学界和联邦政府主要关注的问题。美国国家职业安全与健康研究所将上肢累积性创伤失调症列为美国十大最重要的职业健康问题之一。据估计，到2000年，用于累积性创伤失调症的花费将占到总花费的50%。尽管开明的飞机制造雇主已经制定了一级预防策略，但一级预防永远无法期望消除100%的病例。为了评估几种预防措施，与一家拥有8000多名工人的大型飞机制造商合作开发并实施了一项累积性创伤失调症风险评估项目。该项目专注于客观确定工作及其他活动与患有累积性创伤失调症的个体工人之间的关系。在适用的情况下，早期识别已与医疗护理、工作任务调整、工作场所适应性改造及培训的干预算法相关联。一个由212名使用铆钉枪的工人组成的前瞻性研究小组被纳入一个针对人体工程学姿势训练、运动训练和铆钉枪类型（主要因素）的四路实验设计中。针对累积性创伤失调症风险水平建立了一个统计模型，并使用SAS软件程序（SAS Institute, Inc, Carry, NC）进行评估。在不考虑相关变量（协变量）的情况下，对主要因素进行的统计分析表明，只有姿势训练对个体有降低风险的有益效果。运动训练以及减震铆钉枪的影响（有益或有害）可能由于相关变量（协变量）的反应差异很大而被掩盖。当将协变量与四个实验组一起进行分析时，人体工程学姿势训练和运动训练对以下几组显示出积极效果：优势手、处于别扭姿势的时间、标准铆钉扣紧数量、传送的零件数量、打磨的零件数量、减震铆钉扣紧数量以及新入职员工。对于使用减震铆钉枪的在职员工，显示出负面影响（个体风险水平增加）。这项前瞻性研究有助于确定教育和培训对控制累积性创伤失调症的潜在益处，并证明能够评估材料、方法、机器和环境与个体患上肢累积性创伤失调症风险水平之间关系的实用性。
