Burdorf A, Sorock G S, Herrick R F, Courtney T K
Liberty Mutual Research Center for Safety and Health, Hopkinton, MA 01748, USA.
Am J Ind Med. 1997 Aug;32(2):180-3. doi: 10.1002/(sici)1097-0274(199708)32:2<180::aid-ajim8>3.0.co;2-2.
Despite increased attention to the epidemiology of occupational injuries and work-related musculoskeletal disorders, little is known about the relative contribution of risk factors for specific injuries and diseases and effective ways to prevent them. Building on the knowledge and ideas presented in the previous papers in this special issue, this paper describes the salient issues regarding the needs and the opportunities in design, conduct, and analysis of epidemiologic research on occupational injury. There is a clear need for standardization of definitions on exposure variables and health outcomes, since basic terminology is not used consistently across studies. Improved surveillance systems with linkage to other databases offer excellent opportunities to evaluate trends in risk factors and occupational injuries. New opportunities for etiologic studies include the case-crossover design, which focuses on relations between intermittent exposures and injuries, as well as several hybrid designs that combine advantages and strength of the traditional case-control and cohort study designs. Various suggestions are presented to capture the dynamics of exposure, including both intermittent and continuous factors in the assessment strategy. The importance of cohort studies is emphasized to clarify the temporal relations between causes and effects in work-related injury research. Finally, intervention studies are much needed and a hierarchical approach is suggested, starting with observational surveys, continuing with quasi-experimental studies and concluding with randomized controlled experiments of those interventions that hold the largest promise.
尽管对职业伤害和与工作相关的肌肉骨骼疾病的流行病学关注度有所提高，但对于特定伤害和疾病的危险因素的相对贡献以及预防它们的有效方法却知之甚少。基于本期特刊上先前论文中提出的知识和观点，本文描述了职业伤害流行病学研究在设计、实施和分析方面的需求和机遇等突出问题。由于各研究对基本术语的使用不一致，因此显然需要对暴露变量和健康结果的定义进行标准化。与其他数据库相链接的改进的监测系统为评估危险因素和职业伤害的趋势提供了绝佳机会。病因学研究的新机遇包括病例交叉设计，该设计关注间歇性暴露与伤害之间的关系，以及几种结合了传统病例对照研究和队列研究设计优点和优势的混合设计。本文提出了各种建议以捕捉暴露的动态变化，包括在评估策略中纳入间歇性和持续性因素。强调了队列研究在阐明与工作相关伤害研究中因果关系的时间关联方面的重要性。最后，迫切需要进行干预研究，并建议采用一种分层方法，从观察性调查开始，接着进行准实验研究，最后对最有前景的干预措施进行随机对照实验。
