OCCUPATIONAL HEALTH GRADIENTS IN HOSPITAL WORKERS: THE

描述(摘自调查人员摘要) 在太空中，健康状况的社会经济梯度无处不在，持续存在 在时间上，并在不同的健康结果中普遍存在。然而，人们对此知之甚少。 它们是如何产生的，具体来说，它们对它们的贡献有多大 成年后的工作条件。现有的职业队列研究， 例如具有里程碑意义的白厅出版物，未能说服一些人 与工作有关的“心理社会”暴露的观察者，例如， 员工对工作的控制感，构成了关键原因 对老年人健康的社会经济梯度负有责任的影响 一般成人人口，特别是慢性病的梯度。大体上 到目前为止，这场辩论中缺少的是关于来自 工作范围广泛的工作场所--例如，白厅 从根本上讲，这是一项办公室工作人员的研究。本建议的前提是 认为对这种健康“梯度”成因的丰富见解可能是 经过几年的详细研究，获得了一个工作场所，例如 医院，有非常广泛的工作，以及来自不同国家的员工 社会阶层。 到目前为止，这一劳动力的主要“短期”职业健康问题， 还有许多其他的，是与工作相关的肌肉骨骼疾病(WRMSD)--一种广泛的 包括下腰痛和上肢损伤在内的结果类别，如 如肌腱炎和腕管综合征。无论是心理社会还是 工作中的身体工效学暴露现在被认为是联合决定因素 这些肌肉骨骼问题。因此，工作的心理社会方面是 越来越多的人认识到这两种疾病过程的风险因素： 创伤性和慢性病。然而，这方面的研究似乎很少。 将WRMSD风险的社会经济和职业类别差异与 许多较长期健康结果的众所周知的梯度，特别是 冠心病及其危险因素(如高血压)。这个 研究人员提议进行一项研究，以阐明这种疾病的性质和多因素 跨工作类别和员工社会的医院梯度的病因 阶级背景，在发生的几件潜在的工作中 医院的健康结果。研究的结果将会失去-时间， 与工作相关的肌肉骨骼疾病，非侵入性的异位镇静措施 总体健康相关负荷(唾液皮质醇和血压) 生活质量和伤害-特定的功能状态，心理健康状态， 以及总病假/工伤缺勤。两者的直接影响 工作中观察到的身体工效学因素与心理社会职业 在这些情况的风险中暴露的社会经济梯度将是 评估过了。最后，他们建议通过定性研究来检验 方法：对参与医院内部的社会环境因素进行分析， 影响工作条件。研究小组还将与一个 劳工管理团队为以下问题制定可能的干预措施 都是由这项研究确定的。

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.