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研究生:林育正
研究生(外文):Yu-Cheng Lin
論文名稱:輪班工作對勞工健康之影響研究
論文名稱(外文):Health effect research of shift workers
指導教授:陳保中陳保中引用關係
口試委員:陳文鍾劉紹興莊弘毅郭育良何豐名鄭尊仁
口試日期:2011-01-07
學位類別:博士
校院名稱:國立臺灣大學
系所名稱:職業醫學與工業衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文出版年:2011
畢業學年度:99
語文別:英文
論文頁數:105
中文關鍵詞:輪班工作代謝症候群疲勞恢復青壯員工
外文關鍵詞:shift workmetabolic syndromeneed for recoveryearly-middle aged adult
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中文摘要
研究背景:
輪班工作是一個相關於現代職場勞工健康的重要議題。然而對於台灣勞工,至今仍鮮有完整的追蹤研究著墨於探討日夜輪班工作如何影響勞工的身心健康。
研究方法:
本研究以一群電子產品製造公司的青壯員工為觀察對象,利用橫斷及世代分析方法,以工作相關疲勞及代謝症候群的發生為觀測結果,探討輪班工作對於勞工身心健康情況的影響。分析數據包括:工作相關疲勞問卷結果、職業暴露因子、教育程度、輪班狀況及常規健康檢查數據等。
結果與討論:
在調整各種可能的干擾因素後,分析顯示:輪班工作者較常日班員工有2.0 倍(95%信賴區間(CI): 1.5 - 2.6)疲勞難以回復之風險。以輪班狀態而言,與常日班員工對照比較,最近一年暴露於輪班工作的勞工有高達4.0 倍(95%CI: 2.7 - 5.9)疲勞難以回復之風險;而持續五年輪班的員工,及先前暴露輪班但最近一年不再輪班的員工分別有比常日班員工高出 2.2 倍(95%CI: 1.5 - 3.3)和2.1 倍(95%CI: 1.4 - 3.2疲勞難以回復之風險。勞工主觀的疲勞症狀,顯然與日夜輪班之工作型態相關。另一方面,女性員工暴露於持續日夜輪班者,其發生代謝症候群的風險為3.5 倍於常日班員工( 95%CI: 1.3 - 9.0)。而持續日夜輪班且同時有異常肝功能指數的男性員工,其發展成為代謝症候群的風險也顯著升高(較常日班健康男性工作者高出2.7 倍; 95%CI: 1.4 - 5.3)。以生理健康觀點言之,持續日夜輪班工作對於女性員工以及肝功能異常的男性員工,明顯增加了代謝症候群發生的風險。
結論:
從工作相關疲勞及代謝症候群的促發研究中發現,長期持續日夜輪班工作對於青壯勞工在心理及生理健康,均有顯著負面的影響。對長期暴露於日夜輪班的勞工,周全的身心健康風險評估及因應對策,應列為職場健康管理的重要課題。

Background and Objectives: Shift work is a worldwide health hazard among industrialized societies. However, for Taiwanese employees, limited comprehensive follow-up studies are available for modern workplaces as to whether day-night rotating shift work contributes to work related-fatigue and progression of metabolic syndrome (MetS).
Methods: Cross-sectional and longitudinal modern workplace surveys on shift work affecting health conditions including work related-fatigue and metabolic syndrome development of workers were conducted by utilizing registration records, job contents and general health evaluation data. Present study retrospectively examined a cohort of workers from an electronics manufacturing company from 2002-2007. Health records of workers with relatively homogeneous socioeconomic status were used for analysis. The health checkups included personal and need for recovery scale questionnaires, physical examinations, abdominal ultrasound, blood tests. Data analyzed included lifestyle factors, job type, occupational exposures and educational levels.
Results: After adjusted for potential confounders, shiftworkers had a 2.0-fold (95% CI = 1.5 - 2.6) increased risk for high need for recovery after work. The workers recently exposing to shift jobs had a 4.0-fold (95% confidence interval (CI) =2.7 – 5.9) increased risk of h-NFR compared with persistent daytime workers. The persistent 5-year shift workers and the workers formerly exposing to shift works had a 2.2-fold (95% CI = 1.5 – 3.3) and a 2.1-fold (95% CI = 1.4 – 3.2) increased risk of h-NFR, respectively. In terms of development of metabolic syndrome, significantly raised risks of developing MetS were found in the female workers with persistent rotating shift-work exposure (odds ration (OR), 3.5; 95% confidence interval (CI), (1.3 – 9.0) vs. day workers). Persistent rotating shift-works with elevated alanine aminotransferase posed a significant risk for MetS development (odds ratio, 2.7; 95% confidence interval, 1.4 – 5.3, vs. workers without baseline abnormal liver function nor rotating shift work exposures).
Conclusions: For our apparently healthy workers, high need for recovery after work apparently is associated shift works. Physically, persistent day-night rotating shift work associate with the progression toward metabolic syndrome for middle-aged female workers; also, early middle-aged male employees with abnormal liver function should be evaluated and managed for metabolic syndrome. Particularly in terms of job arrangements, impacts of long-term rotating shift work on MetS development should be assessed for all the female and the male employees having baseline abnormal liver function.

口試委員會審定書…………………………………………………….…….…….…….i
謝 誌…………………………....................................................ii
中文摘要………………………………………………………….………………..iii
英文摘要…………………………………………………….……....…….……......iv
第一章 Introduction……………………………………………..…....…….……..1
1.1 Background………………………………………....…….……. ………1
1.2 Hypotheses……………………………………...............2
第二章 Material and Methods………………………………….……………….…..5
2.1 Study design and population…………………………..……5
2.1.1 Cross sectional survey for work-related fatigue……5
2.1.2 Follow ups for metabolic syndrome development.......5
2.2 Definitions……………………………………………………………6
2.2.1 Occupational and lifestyle factors………………………6
2.2.2 Metabolic syndrome and related risk factors………….8
2.3 Statistic analysis……………………………………………10
第三章 Results…………………………………………………………………12
3.1 Shift work exposure and work-related fatigue……………12
3.2 Rotating shift work exposure and MetS among middle-aged female employess…16
3.3 Shift work exposure and MetS development among male employees…17
3.4 Screening programs for predicting the development of metabolic syndrome.19
第四章 Discussions…………………………………………………….……………21
4.1 Work-related fatigue, shift work and related risk factors……………21
4.2 Shift work exposure and MetS development among female employees..27
4.3 Shift work exposure and MetS development among male employees..31
4.4 Screening programs for predicting the development of metabolic syndrome.34
第五章 Conclusions……………………………………………………………38
參考文獻…………………………………………………………………39
附表………………………………………………………………………53
附圖………………………………………………..…………………73
附錄…………………………………………….………………………76

表目錄

Table 1 Need for recovery (NFR) scores, baseline data and distribution of characteristics………………………………53
Table 2 Distribution of potential risk factors according to the NFR after work score……………………………………54
Table 3 General characteristics grouping by h-NFR……55
Table 4 General characteristics grouping by shift work statuses………56
Table 5 General characteristics grouping by shift work statuses, for both genders………………………………57
Table 6 Baseline characteristics of subjects without metabolic syndrome…58
Table 7 Metabolic syndrome component changes of subjects without/with the MetS outcomes………………………………………………59
Table 8 Summary of characteristics of variables at baseline according to job types……………………………………60
Table 9 Change of abnormality rates based on a five-year follow-up among the three work groups…………………………61
Table 10 The adjusted risks of metabolic syndrome…………62
Table 11 The adjusted risks of metabolic syndrome……...…………63
Table 12 Baseline characteristics of subjects stratified by alanine aminotransferase and rotating shift work status…...……………………………64
Table 13 Baseline abnormality rates of subjects stratified by alanine aminotransferase and rotating shift work status……………………65
Table 14 Change of abnormalities based on a five-year follow-up among the subgroups stratified by alanine aminotransferase and shift work…......…66
Table 15 Multivariate analysis for the risk of development of metabolic syndrome among male workers ………………67
Table 16 Baseline characteristics for Taiwanese adult workers not fulfilling metabolic syndrome criteria initially…………………………68
Table 17 Baseline prevalence rates for Taiwanese adult workers not fulfilling metabolic syndrome criteria initially…………………………69
Table 18 Model 1, adjusted risks for metabolic syndrome, conventionally, individual MetS-components are not separated apart............................70
Table 19 Model 2, adjusted risks for metabolic syndrome using MetS-component count as potential risk factors………………………………………………71
Table 20 Model 3, adjusted risks for metabolic syndrome calculated using each MetS component and their combinations as potential risk factors………72


圖目錄

Figure 1 Odds ratio of risk factors for high NFR after work among workers……73
Figure 2 Odds ratio of risk factors for high NFR after work among workers……74
Figure 3 Distributions of MetS-components number changes at five-year follow-up, sub-grouped by elevated alanine aminotransferase and persistent rotating shift work………………………………………….....75


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