本文選題：腦力勞動(dòng)人群 + 職業(yè)緊張　； 參考：《新疆醫(yī)科大學(xué)》2017年博士論文

【摘要】：目的:通過了解腦力勞動(dòng)人群工作中存在的職業(yè)緊張因素和職業(yè)緊張水平,并探討職業(yè)緊張對(duì)其心身健康及工作能力的影響,為腦力勞動(dòng)人群的職業(yè)健康服務(wù)提供基礎(chǔ)數(shù)據(jù),并補(bǔ)充我國腦力勞動(dòng)人群職業(yè)緊張與健康研究方面的的資料,為政府和相關(guān)部門的決策提供科學(xué)依據(jù)。方法:1)通過分層整群抽樣的方法,隨機(jī)抽取工作1年以上的腦力勞動(dòng)者17 000人作為研究對(duì)象,采用ISTA6.0、職業(yè)緊張問卷、中式職業(yè)倦怠問卷、心理疲勞問卷、社會(huì)支持問卷、應(yīng)對(duì)方式問卷、慢性病患病情況問卷及WAI問卷進(jìn)行問卷調(diào)查,共回收問卷14 259人份,回收率為83.88%;2)采用病例-對(duì)照研究,使用PCR-RFLP技術(shù)對(duì)380份樣本(病例組190名、對(duì)照組190名)進(jìn)行相關(guān)基因多態(tài)性檢測。3)隨機(jī)抽取380人,用酶聯(lián)免疫吸附法測定血漿IL-2和IL-6的含量。研究結(jié)果:1)此次調(diào)查腦力勞動(dòng)人群14 259人,其中男性6 942人;女性7 317人,包括:醫(yī)務(wù)人員2 189人(15.4%);公務(wù)員6 791人(47.6%);教師5 279人(37.0%),平均年齡31.06歲;2)腦力勞動(dòng)者工作中主要的職業(yè)緊張因素有復(fù)雜性、變化性、合作的需求程度、任務(wù)控制、時(shí)間控制、合作可能性、工作組織問題、不合理體位需求、任務(wù)危險(xiǎn)性、合作的緊密性;另外醫(yī)務(wù)人員工作中任務(wù)不確定性、工作干擾比較明顯,交流可能性在公務(wù)員和教師人群顯得較為突出;3)腦力勞動(dòng)人群屬于職業(yè)緊張水平較高的人群。醫(yī)務(wù)人員、公務(wù)員和教師中高度職業(yè)緊張者最多,分別占92.3%、73.3%、70.0%;4)不同緊張水平、不同工種和不同人口學(xué)特征間腦力勞動(dòng)人群心理健康狀況存有差異:(1)不同職業(yè)緊張水平組間職業(yè)倦怠得分有差異(P0.01),其中隨著職業(yè)緊張水平的增加工作倦怠呈逐漸增高趨勢,高度緊張組工作倦怠得分最高。不同工種間醫(yī)務(wù)人員在工作倦怠總分、情感耗竭和人格解體方面得分高于公務(wù)員和教師;不同工齡間10年者職業(yè)倦怠總分得分最高。另職業(yè)倦怠女性高于男性、少數(shù)民族倦怠狀態(tài)比漢族嚴(yán)重,未婚者高于已婚者,低學(xué)歷者倦怠水平較高;(2)不同緊張水平組間心理疲勞有差異(P0.01),其中高度緊張組心理疲勞得分最高。公務(wù)員除體力勞動(dòng)得分較低外,在疲勞總分、活動(dòng)減少、動(dòng)力下降及腦力疲勞間得分均高于醫(yī)務(wù)人員及教師;教師體力疲勞得分最高;工齡越低者在心理疲勞總分、體力疲勞及腦力疲勞方面得分均越高,在活動(dòng)減少及動(dòng)力下降方面得分最低;男性疲勞感高于女性、中年腦力人群心理疲勞感最強(qiáng)、少數(shù)民族腦力疲勞高于漢族、未婚者心理疲勞高于已婚者、本科及以上心理疲勞感較強(qiáng);(3)不同緊張程度組間應(yīng)對(duì)方式得分差異具有統(tǒng)計(jì)學(xué)意義(p0.01),其中高度緊張組消極應(yīng)對(duì)均得分最高;低度緊張組積極應(yīng)對(duì)得分處于最高水平。不同工種間應(yīng)對(duì)方式得分有差異(p0.05),其中醫(yī)務(wù)人員在解決問題及求助方面得分最高,公務(wù)人員在自責(zé)方面得分最高;不同工齡間在解決問題、求助、幻想方面得分均有差異(p0.05),其中10年組解決問題得分最高,≥20年組在求助和幻想方面得分最高。男性、少數(shù)民族、低年齡者、本科及以上者、醫(yī)務(wù)人員及高級(jí)職稱者更易采取積極應(yīng)對(duì)方式去處理問題。;(4)不同緊張水平組間社會(huì)支持得分有差異(p0.01),其中低度職業(yè)緊張組社會(huì)支持得分要高于高度緊張組。不同工種、工齡間在社會(huì)支持得分差異具有統(tǒng)計(jì)學(xué)意義(p0.01),其中公務(wù)員高于教師,隨著工齡增長社會(huì)支持各項(xiàng)目得分也隨之增長,≥20年者得分最高。男性、年齡50歲組、少數(shù)民族、已婚者、本科及以上者在社會(huì)支持上均處于較高水平;(5)線性回歸結(jié)果顯示職業(yè)倦怠對(duì)職業(yè)緊張影響最大(β=14.326,p0.01),職業(yè)倦怠與職業(yè)緊張呈正相關(guān)(p0.01),社會(huì)支持與職業(yè)緊張呈負(fù)相關(guān)(p0.01);5)不同職業(yè)緊張水平對(duì)腦力勞動(dòng)人群生理健康有影響:(1)腦力勞動(dòng)人群常見疾病患病率由高到低的順序是頸腰部疾病(33.6%)、口腔疾病(26.6%)、慢性消化系統(tǒng)疾病(22.7%)、高血脂14.4%、高血壓10.1%;冠心病患4.5%,其中頸腰部疾病、口腔疾病和慢性消化系統(tǒng)疾病最多。fbg病例組高于對(duì)照組;hdl病例組低于對(duì)照組;tg病例組高于對(duì)照組;alt/ast病例組低于對(duì)照組;(2)不同職業(yè)緊張水平組間il-2、il-6含量不同,且隨著職業(yè)緊張水平的增加,il-2含量降低,il-6含量增加(p0.05)。il-6指標(biāo)在不同性別、職稱和工齡間差異有統(tǒng)計(jì)學(xué)意義(p0.05);在控制年齡、民族、性別等人群特征因素后進(jìn)行偏相關(guān)分析,結(jié)果顯示il-2水平與工作緊張指數(shù)、工作壓力指數(shù)呈負(fù)相關(guān);il-6水平與工作緊張指數(shù)、工作壓力指數(shù)呈正相關(guān)(p0.05);(3)不同職業(yè)緊張組間高血壓患病的分布不同,隨緊張程度增加高血壓患病率呈現(xiàn)上升的趨勢(p0.01)。高血壓的危險(xiǎn)因素有遺傳史、被動(dòng)吸煙、飲酒史、口味和職業(yè)緊張。高血壓的基因多態(tài)性分析顯示:t(-344)c和rs3918181基因多態(tài)性與高血壓易感性有相關(guān)關(guān)系,其中t(-344)c位點(diǎn)等位基因t及rs3918181位點(diǎn)等位基因a是風(fēng)險(xiǎn)等位基因。對(duì)有連鎖不平衡的rs1800780位點(diǎn)和rs3918181位點(diǎn)進(jìn)行單倍體構(gòu)建,得出其中a-a及a-g單倍型具有統(tǒng)計(jì)學(xué)意義(p0.05),前者為危險(xiǎn)因素單倍型,后者為保護(hù)因素單倍型;6)職業(yè)緊張對(duì)腦力勞動(dòng)人群的工作能力影響:(1)腦力勞動(dòng)人群工作能力極好者占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。醫(yī)務(wù)人員處在高度職業(yè)緊張水平下缺勤者最多,占醫(yī)務(wù)人員39.1%。不同性別、年齡、民族、婚姻、學(xué)歷者工作能力上的差異具有統(tǒng)計(jì)學(xué)意義(p0.01)。男性工作能力高于女性;年齡長者工作能力較強(qiáng);漢族工作能力高于少數(shù)民族;未婚者的工作能力高于已婚者;本科以上學(xué)歷者高于本科以下者;(2)不同工種腦力勞動(dòng)者工作能力存有差異(p0.05),公務(wù)員工作能力指數(shù)最高,醫(yī)務(wù)人員最低;工作能力隨著工齡增長也逐漸增高;(3)不同職業(yè)緊張水平組間工作能力水平的分布不同(P0.01)。職業(yè)緊張水平越高,工作能力越差。同時(shí)隨著職業(yè)倦怠程度的增加,工作能力指數(shù)隨之下降,在高度倦怠者中工作能力差者所占比例最高;(4)多重回歸分析結(jié)果顯示:年齡、職稱、工齡、婚姻等個(gè)體特征,以及職業(yè)緊張、職業(yè)倦怠、心理疲勞、社會(huì)支持、應(yīng)對(duì)方式與工作能力之間存在關(guān)聯(lián)(P0.01),表明年齡、職稱、工齡、婚姻和職業(yè)緊張、職業(yè)倦怠、心理疲勞、社會(huì)支持、應(yīng)對(duì)方式均為腦力作業(yè)人群工作能力的影響因素,其中心理疲勞、社會(huì)支持、職業(yè)倦怠和工齡對(duì)工作能力的影響較大�；貧w方程式為:Y=48.584+0.639X3-0.320X4-0.595X5-0.807X6-0.475X7-0.037X8-0.184X9+0.090 X10+0.016 X11。結(jié)論:1)腦力勞動(dòng)者接觸的主要緊張因素:復(fù)雜性、變化性、合作的需求程度、任務(wù)控制、時(shí)間控制、合作可能性、工作組織問題、不合理體位需求、任務(wù)危險(xiǎn)性、合作的緊密性;2)腦力勞動(dòng)人群屬于職業(yè)緊張水平較高的人群。其中工種、工齡、職稱對(duì)其職業(yè)緊張水平有一定影響;3)不同緊張水平、不同工種和不同人口學(xué)特征間腦力勞動(dòng)人群心理健康狀況存有差異。隨著職業(yè)緊張水平的增加工作倦怠、心理疲倦呈逐漸增高趨勢;隨著職業(yè)緊張水平的增加消極應(yīng)對(duì)呈現(xiàn)增高趨勢,而積極應(yīng)對(duì)則隨緊張水平增加而逐漸降低。社會(huì)支持可降低職業(yè)緊張水平;4)隨著職業(yè)緊張水平的增加,IL-2含量降低,IL-6含量增加。職業(yè)緊張與高血壓的患病有關(guān)聯(lián)。T(-344)C位點(diǎn)等位基因T及rs3918181位點(diǎn)等位基因A是風(fēng)險(xiǎn)等位基因。rs1800780位點(diǎn)中A-A單倍型為危險(xiǎn)因素,rs3918181位點(diǎn)中A-G單倍型是保護(hù)因素;5)職業(yè)緊張會(huì)對(duì)腦力勞動(dòng)人群的工作能力造成不良影響,腦力勞動(dòng)人群中以工作能力中等者居多。職業(yè)緊張水平越高,工作能力越差;年齡、工齡、職業(yè)緊張、職業(yè)倦怠、心理疲勞、社會(huì)支持、應(yīng)對(duì)方式和婚姻均為腦力作業(yè)人群工作能力的影響因素。
[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.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R13

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