臺灣博碩士論文加值系統

前言: 根據台灣勞工保險局調查，上肢肌肉骨骼疾病為一常見之職業疾病，而製造業族群為此疾病之重要族群之一，而肌肉骨骼疾病發生前會有肌肉骨骼症狀的發生，因此，預防肌肉骨骼症狀為重要之議題。過去已有許多文獻探討社會心理因子和肌肉骨骼的關係，然而鮮少有研究探討社會心理因子中職場正義、社會支持以及就業不安定性對於肌肉骨骼的影響，因此，本研究目的為探討職場正義、職場社會支持以及就業不安定性與上肢及肩頸肌肉骨骼症狀之影響。

方法: 本研究為橫斷性研究，以台灣5家製造業工廠員工為對象，利用自填式問卷進行調查。以台灣人因工程危害預防指引來評估肌肉骨骼不適症狀。使用職場正義問卷(7項)、職場社會支持問卷(8項)以及就業不安定性問卷(6項)評估員工職場社會心理狀況，並以人因工程因子(11項)評估工作中所暴露的人因因子。以多變項回歸進行分析，並且使用族群可歸因風險性(PAR)計算職場社會心理因子對於肩頸及上肢肌肉骨骼症狀之貢獻。

結果: 總共有710位員工參與此問卷調查，可使用之資料有658位。其中有會影響工作之肩頸肌肉骨骼症狀有7.60%，上肢肌肉骨骼症狀有4.41%。21.73%低職場正義、36.93%缺乏社會支持，54.10%自覺就業不安定。經過多變項調整個人因子、職場人因工程暴露因子後，低職場正義與肩頸肌肉骨骼症狀有顯著相關性，其可歸因風險比率(PAR)為16.29%。而就業不安性與上肢肌肉骨骼症狀有顯著相關性。其可歸因風險比率(PAR)為31.25%。

結論: 在製造業受僱者中，職場正義與肩頸肌肉骨骼症狀有顯著相關，以及就業不安定性與上肢肌肉骨骼症狀有顯著相關。建議未來可以針對低職場正義及自覺就業不安定性危險因子進行探討，並設計預防策略，以降低勞工肌肉骨骼症狀之盛行率。

Objective: According to the Bureau of Labor Insurance in Taiwan, musculoskeletal disorders are the commonest occupational diseases. Among workers who received the labor insurance benefits for upper limb musculoskeletal disorders, manufacturing workers are an important population. Thus, preventions of diseases of neck/shoulder and upper limb are an important issue. The contribution of workplace psychosocial factors has not been studied thoroughly. Research is lacking on the workplace social support, justice, and job insecurity among workers with neck/shoulder and upper limb complaints. This investigation aimed to determine the contribution of workplace social support, justice, and job insecurity to neck/shoulder and upper limb complaints among manufacturing workers in Taiwan.

Method: This is a cross-sessional study. The employees of five manufacturing companies were invited to participate in a self-administered questionnaire survey. Musculoskeletal Symptom Checklist from Ergonomic Prevention Guidelines in Taiwan was used to assess musculoskeletal discomforts. Self-reported neck/shoulder and upper limb (hand/arm) pains that affected work performance were considered positive outcomes. Workplace justice (7 items), social support (8 items), job insecurity (6 items) and self-reported ergonomic factors (11 items) were also assessed by using previously validated instruments.

Result: A total of 710 workers participated in Taiwan, among them, 658 were included for the final analysis. After adjusting for personal demographic and ergonomic factors, low workplace justice showed significant associations with symptoms of neck/shoulder. The population attributable risk (PAR) for low workplace justice was 16.29%. After adjusting for personal demographic and ergonomic factors, job insecurity was associated with symptoms of upper limb. The PAR of and job insecurity for upper limb symptoms were 31.25% respectively.

Conclusion: Among the manufacturing workers, workplace justice showed significant association with neck/shoulder musculoskeletal symptoms, and job insecurity was associated with symptoms of upper limb. We suggest that to prevent musculoskeletal symptoms in manufacturing workers, the strategy should be developed to increase workplace justice and reduce job insecurity.

口試委員會審定書 I
致謝 II
摘要 III
Abstract V
Contents VII
List of Tables IX
List of Figures X
Chapter 1 Introduction 1
Chapter 2 Paper Review 3
A. Musculoskeletal symptoms (MSSs) 3
B. Psychosocial hazards at work 4
C. Psychosocial hazards at work and musculoskeletal symptoms 5
Chapter 3 Material and Methods 9
A. Study participants 9
B. Questionnaire 10
B-1. Covariate factors 10
B-2. Predictive variables 11
B-3. Outcomes 13
C. Statistical analysis 14
Chapter 4 Results 16
A. Characters of study subjects 16
B. Effect of psychosocial factors on musculoskeletal symptoms of neck/shoulder and upper limb 17
C. Population attributable risks (PARs) 20
Chapter 5 Discussion 22
A. Psychosocial hazards at work and musculoskeletal symptoms 22
B. Workplace social support and musculoskeletal symptoms 23
C. Job insecurity and musculoskeletal symptoms 23
D. Workplace justice and musculoskeletal symptoms 23
E. Population attribute risk (PAR) 24
F. Limitations 25
Chapter 6 Conclusion 27
Reference 28
Appendix 1. Institutional Review Board of the National Health Research Institutes 49
Appendix 2. Formulas of questionnaires 50
Appendix 3. Study Questionnire 52

1.Kilbom, s., Armstrong, T., Buckle, P., et al., Musculoskeletal disorders: work-related risk factors and prevention. Int J Occup Environ Health, 1996. 2(3): p. 239-246.
2.Meyers, A.R., Gerr F., and Fethke, N.B., Evaluation of alternate category structures for the Strain Index: an empirical analysis. Hum Factors, 2014. 56(1): p. 131-42.
3.Bureau of Labor Insurance in Taiwan. 2015.
4.Guo, Y.L., Introduction to Occupational Medicine. 2007.
5.Institute of Labor, Occupational Safety And Health, Ministry Of Labor, 2014. Ergonomic Hazard Prevention Program Guidelines.
6.Bongers, P.M., Kremer, A.M., and Laak, J., Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist?: A review of the epidemiological literature. Am J Ind Med, 2002. 41(5): p. 315-42.
7.Cox, T., et al., Organizational interventions for work stress: a risk management approach. Sudbury: HSE Books, 2000.
8.Johnson, J.V., Stewart, W., Hallet, E.M., al., Long-term psychosocial work environment and cardiovascular mortality among Swedish men. Am J Public Health, 1996. 86(3): p. 324-31.
9.Piros, S., Karlehagen, S., Lappas, G., et al., Psychosocial risk factors for myocardial infarction among Swedish railway engine drivers [corrected]. J Cardiovasc Risk, 2000. 7(5): p. 389-94.
10.Elovainio, M., Kivimaki, M., and Vahtera, J., Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health, 2002. 92(1): p. 105-8.
11.Gimeno, D., Benavides, F., Benavides, F., et al., Psychosocial factors and work related sickness absence among permanent and non-permanent employees. J Epidemiol Community Health, 2004. 58(10): p. 870-6.
12.Nielsen, M.L., Rugulies, R., Christensen, K.B., et al., Impact of the psychosocial work environment on registered absence from work: A two-year longitudinal study using the IPAW cohort. Work and Stress, 2004. 18(4): p. 323-335.
13.Ahr, P.R., Support systems and community mental health - lectures on concept development - Caplan,G. Hospital and Community Psychiatry, 1974. 25(10): p. 682-683.
14.Clays, E., Delanghe, J., Kittel, F., et al., Associations between dimensions of job stress and biomarkers of inflammation and infection. J Occup Environ Med., 2005. 47(9): p. 878-883.
15.Shaw, W.S., Feuerstein, M., Lincoln, A.E., et al., Ergonomic and psychosocial factors affect daily function in workers'' compensation claimants with persistent upper extremity disorders. J Occup Environ Med, 2002. 44(7): p. 606-15.
16.Kumar, S., Theories of musculoskeletal injury causation. Ergonomics, 2001. 44(1): p. 17-47.
17.Moorman, R.H., Relationship between organizational justice and organizational citizenship behaviors - do fairness perceptions influence employee citizenship. Journal of Applied Psychology, 1991. 76(6): p. 845-855.
18.Kivimaki, M., Ferrie, J., Head, J., et al., Organisational justice and change in justice as predictors of employee health: the Whitehall II study. J Epidemiol Community Health, 2004. 58(11): p. 931-7.
19.Herr, R.M., Bosch, J.A., Loerbroks, A., et al., Three job stress models and their relationship with musculoskeletal pain in blue- and white-collar workers. Journal of Psychosomatic Research, 2015. 79(5): p. 340-347.
20.Fujii, T., Matsudaira, K., Yoshimura, N., et al., Associations between neck and shoulder discomfort (Katakori) and job demand, job control, and worksite support. Modern Rheumatology, 2013. 23(6): p. 1198-1204.
21.Gerr, F., Fethke, N.B., Anton, D., et al., A prospective study of musculoskeletal outcomes among manufacturing workers: II. effects of psychosocial stress and work organization factors. Human Factors, 2014. 56(1): p. 178-190.
22.Benach, J., Gimeno, D., Benavides, F.G., et al., Types of employment and health in the European union: changes from 1995 to 2000. Eur J Public Health, 2004. 14(3): p. 314-21.
23.Benach, J., Benavides, F. G., Platt, S., et al., The health-damaging potential of new types of flexible employment: a challenge for public health researchers. Am J Public Health, 2000. 90(8): p. 1316-7.
24.Silla, I., Gracia, F.J., and Peiro, J.M., Job insecurity and health-related outcomes among different types of temporary workers. Economic and Industrial Democracy, 2005. 26(1): p. 89-117.
25.Virtanen, P., Vahtera, J., Kivimäki, M., et al., Employment security and health. J Epidemiol Community Health, 2002. 56(8): p. 569-74.
26.Yang, H., Hitchcock, E., Haldeman, S., et al., Workplace psychosocial and organizational factors for neck pain in workers in the United States. Am J Ind Med, 2016. 59(7): p. 549-60.
27.d''Errico, A., Caputo, P., Falcone, U., et al., Risk factors for upper extremity musculoskeletal symptoms among call center employees. J Occup Health, 2010. 52(2): p. 115-24.
28.Institute of Labor, Occupational Safety And Health, Ministry Of Labor, 2013. Survey of perceptions of safety and health in the work environment in 2013 Taiwan.
29.Cheng, Y., Luh,W.M., and Guo, Y.L., Reliability and validity of the Chinese version of the Job Content Questionnaire in Taiwanese workers. Int J Behav Med, 2003. 10(1): p. 15-30.
30.Cheng, Y., Huang, H.Y., Li, P.R., et al., Employment insecurity, workplace justice and employees'' burnout in Taiwanese employees: a validation study. Int J Behav Med, 2011. 18(4): p. 391-401.
31.Pien, L.C., Chen, D.R., Chen, C.J., et al., Associations of neighborhood-level workplace violence with workers'' mental distress problems: a multilevel analysis of Taiwanese employees. J Occup Health, 2015. 57(6): p. 555-64.
32.Coughlin, S.S.,. Benichou, J., and Weed, D.L., Attributable risk estimation in case-control studies. Epidemiol Rev, 1994. 16(1): p. 51-64.
33.Aptel, M., Aublet-Cuvelier, A., and Cnockaert, J.C., Work-related musculoskeletal disorders of the upper limb. Joint Bone Spine, 2002. 69(6): p. 546-555.
34.Hales, T.R., Sauter, S.L., Peterson, M.R., et al., Musculoskeletal disorders among visual-display terminal users in a telecommunications company. Ergonomics, 1994. 37(10): p. 1603-1621.
35.Lipscomb, H., Kucera, K., Epling, C.,et al., Upper extremity musculoskeletal symptoms and disorders among a cohort of women employed in poultry processing. Am J Ind Med, 2008. 51(1): p. 24-36.
36.Saastamoinen, P., Laaksonen, M., Lahelma, E., et al., Psychosocial risk factors of pain among employees. European Journal of Pain, 2009. 13(1): p. 102-108.
37.Institute of Labor, Occupational Safety And Health, Ministry Of Labor, 2010. Survey of perceptions of safety and health in the work environment in 2010 Taiwan.