OCCUPATIONAL HEALTH GRADIENTS IN HOSPITAL WORKERS

描述（摘自研究者摘要） 健康状况的社会经济梯度在太空中无处不在， 在时间上，并且在不同的健康结果中普遍存在。 然而，我们所知甚少， 它们是如何产生的，具体来说， 成年生活中的工作条件。 现有的职业群组研究， 例如具有里程碑意义的白厅出版物， 观察者认为，与工作有关的“心理社会”暴露，例如，程度 员工对工作的控制感，构成了关键的因果关系， 影响，负责社会经济梯度的健康， 一般成人人群，特别是慢性病的梯度。 大程度 到目前为止，辩论中缺少的是关于梯度的高质量证据， 有着广泛工作范围的工作场所--例如，白厅， 基本上是一个办公室工作人员的研究。 本建议载于 认为，丰富的见解，这种健康的起源“梯度”可能是 通过详细研究，多年来，工作场所，如 医院，有一个非常广泛的工作范围，和员工来自不同的 社会阶级。 到目前为止，这一劳动力的主要“短期”职业健康问题， 和许多其他疾病，是与工作有关的肌肉骨骼疾病（WRMSDs）-一种广泛的 包括腰痛和上肢损伤在内的一类结局，如 肌腱炎和腕管综合症 社会心理和 工作中的人体工程学暴露现在被认为是共同的决定因素 这些肌肉骨骼问题。 因此，工作的心理社会方面是 越来越多地被认为是两种疾病过程的风险因素： 创伤性和慢性疾病。 然而，似乎缺乏研究 将WRMSD风险中的社会经济和工作类别差异联系起来， 许多长期健康结果中众所周知的梯度，特别是 冠心病及其危险因素（如高血压）。 的 研究人员提出了一项研究，以揭示性质和多因素 医院梯度的病因学，跨工作类别和员工社会 阶级背景，在发生几个潜在的工作有关的 医院的健康结果。 研究的结果将是损失的时间， 与工作有关的肌肉骨骼疾病，非侵入性的适应性措施 负荷（唾液皮质醇和血压），整体健康相关 生活质量和损伤特异性功能状态，心理健康状态， 以及因病/工伤缺勤。 两者的直接影响 观察到的工作中的物理-人机工程学因素和心理社会职业因素 这些条件的风险在社会经济梯度上的暴露将是 评估。 最后，他们建议通过定性研究来检查 方法，参与医院内的社会背景因素， 影响工作条件。 研究小组还将与一个 劳动管理团队制定可能的干预措施， 都是通过这项研究确定的。

DESCRIPTION (Taken from the Investigators' Abstract) Socioeconomic gradients in health status are ubiquitous in space, persistent in time, and pervasive across diverse health outcomes. Yet little is known of how they arise, and specifically, how great a contribution is made to them by working conditions during adult life. Existing occupational cohort studies, such as the landmark Whitehall publications, have failed to convince some observers that work-related "psychosocial" exposures, e.g., the degree of control felt by employees over their jobs, constitute the key causal influences responsible for socioeconomic gradients in the health of the general adult population, especially gradients in chronic disease. Largely missing in the debate thus far is high-quality evidence on gradients from workplaces with a wide range of jobs -- Whitehall, for example, is fundamentally an office worker study. The present proposal is premised on the view that rich insights into the genesis of such health "gradients" may be gained by studying in detail, over some years, a workplace, such as a hospital, that has a very wide range of jobs, and of employees from different social classes. By far the major "short-term" occupational health problem of this workforce, and many others, is work-related musculoskeletal disorders (WRMSDs) -- a broad class of outcomes including low back pain and upper extremity injuries, such as tendinitis and carpal tunnel syndrome. Both psychosocial and physical-ergonomic exposures at work are now thought to be joint determinants of these musculoskeletal problems. Thus, psychosocial aspects of work are increasingly recognized as risk factors for both sorts of illness processes: traumatic and chronic disease. Yet there appears to be a dearth of research linking socioeconomic and job-category disparities in the risk of WRMSDs, with well-known gradients in many longer-term health outcomes, particularly coronary heart disease and its risk factors (such as hypertension). The investigators propose a study to shed light on the nature and multi-factorial etiology of hospital gradients, across job categories and employee social class backgrounds, in the occurrence of several potentially work-related health outcomes in hospitals. The outcomes studied will be lost-time, work-related musculoskeletal disorders, non-invasive measures of allostatic load (salivary cortisol and blood pressure), overall health-related quality-of-life and injury-specific functional status, mental health status, and total sickness/injury absence from work. The influence of both directly observed physical-ergonomic factors at work and psychosocial occupational exposures on socioeconomic gradients in the risk of these conditions will be assessed. Finally they propose to examine, through qualitative research methods, the social contextual factors within participating hospitals, which influence working conditions. The study team will also work with a labor-management team to develop possible interventions for the problems that are identified by this study.