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1 The prevalence of musculoskeletal symptoms and related factors among a general hospital workers Yoonbum Choi 1, Soojin Lee 1, Hwanjin Park 1 1 Department of Occupational and Environmental Medicine, College of Medicine, Hanyang University, Seoul, ABSTRACT Objective: The purpose of this study was to investigate the prevalence of musculoskeletal symptoms in general hospital workers and to evaluate related factors. Background: Hospital workers are highly exposed to musculoskeletal disease risk factors. But, enough studies have not been performed in Korea. Method: A questionnaire was performed to workers who work at the general hospital. A self-reported questionnaire include following information: general characteristics, health behaviors, job-related factors, ergonomic factor, job stress, and musculoskeletal symptoms. Ergonomic factor was measured by ANSI Z-365. Job stress was measured by KOSS-26 and musculoskeletal symptoms were measured by NIOSH questionnaire. Results: The prevalence of musculoskeletal symptoms was 631(53.3%). The prevalence per body part for shoulder, lower back, leg/foot, and neck were 393(33.2%), 330 (27.9%), 266(22.5%), and 250(21.1%) respectively. After adjusting for confounding factors, three shift workers were at higher risk compared to daytime workers(or=1.8, 95%CI= ), nurses were at higher risk compared to other position(or=1.7, 95%CI= ), and high risk group were at higher risk compared to normal group(or=3.7, 95%CI= ). In the domains of job stress, job demand(or=2.0, 95%CI= ), job insecurity(or=1.5, 95%CI= ), organizational system(or=2.0, 95%CI= ), lack of reward(or=1.6, 95%CI= ), occupational climate(or=1.6, 95%CI= ), and physical environment(or=2.7, 95%CI= ) showed statistically association with musculoskeletal symptoms. Conclusion: Musculoskeletal symptoms were highly prevalent in the general hospital workers. Authors concluded shift work, ANSI high risk group, job stress were seem to be related with musculoskeletal symptoms. Application: Our study suggest it is important to make a safety plan to prevent musculoskeletal diseases. Keywords: Musculoskeletal symptoms, Job stress, Hospital workers 1. Introduction 작업관련성근골격계질환 (Work-related musculoskeletal disorder, WMSDs) 은장기간의반복작업, 부적절한자세, 과도한힘, 불충분한휴식, 진동등에근로자들이노출되어근골격계에미세손상이누적되어발생한다고알려져있다. 작업관련성근골격계질환의원인은흔히인간공학적위험요인이중요하다고생각되었지만 (KOSHA, 2003; NIOSH, 2007), 미국산업안전보건연구원 (National Institutes of Safety and Health, NIOSH) 은직무만족도, 노동강도강화, 단조로운작업, 직무재량, 사회적지지등과같은사회 심리적요인들또한작업관련성근골격계질환과연관이있을수있다고하였다 (NIOSH, 2007; Bernard, 1997). 이와같이작업관련성근골격계질환은다양한측면에서직무와관련하여발생할수있다. 병원에서종사하는보건의료인은관리자, 전문가, 준전문가, 사무원및기능자, 단순노무자등으로분류할수있다 (Hong and Goo, 2010). 그동안병원에서종사하는근로자는다른근무환경보다더안전한장소에서근무하고의료시설에의접근성이높다고생각되어상대적으로근골격계질환의발병위험이적을것으로생각되어졌다. 하지만병원에서종사하는근로자는병원의업무특성상직업군에따라수행하는일이다르고한직업군이여러가지의일을수

2 행하는경우가많으며부서에따라서직무의차이가존재하기때문에다양한위험요인에노출되어있다. 산업안전보건연구원의산업재해보상자료를바탕으로한통계에의하면 2007 년에우리나라전체업무상질병중근골격계질환요양자수는 67.32% 에이르고있다 (KOSHA, 2009) 년산업재해분석자료에의하면근골격계질환으로요양승인된보건의료인은보건및사회복지사업근로자의산업재해승인자 2,173 명중총 322 명 (14.8%) 를차지했으며, 2008 년전체신체부담작업과요통에의한작업관련성근골격계질환자총 6,703 명의 4.8% 를차지하고있다 (Hong and Goo, 2010). 이와같이보건의료인은근골격계질환의위험에노출되어있는데적절한보호나예방조치가이루어지지않고있는것이현실이다. 그동안일부직종의보건의료인을대상으로근골격계증상에대한연구 (Lim and Ahn, 2003; Kim et al., 2003; Woo and Kim, 2009; Park et al., 2008) 들이진행되었지만보건의료인과관련한근골격계증상에대한연구는미흡한실정이다. 따라서본연구는일개종합병원의보건의료인에대한근골격계증상유병률을확인하고증상과직무특성사이의관련성을분석함으로써향후보건의료인의근골격계질환예방관리대책수립을위한기초자료를제시하고자하였다. 2.1 Subjects 2. Method 본연구는사전에연구의취지에대해설명을듣고이에동의한일개대학병원에근무하는보건의료인 1,842 명을대상으로실시되었다. 설문응답자는 1,198 명으로응답률은 64.2% 였으며그중응답이부실한 15 명을제외하고 1,183 명을최종연구대상으로하였다. 2.2 Questionnaire 설문지는성별, 나이, 결혼상태, 교육수준, 운동등의개인력과근무기간, 근무형태, 직급등의직업관련항목을포함하고있다. 직무스트레스를측정하기위해서개발된한국인직무스트레스척도 (KOSS-26) 를사용하였다 (Chang, 2004). 인간공학적요인을측정하기위해서 Park et al.(2006) 에의해신뢰도와타당도가입증된미국표준연구원 (American National Standards Institute, ANSI) 평가표 (ANSI Z-365 Quick Checklist) 를사용하였다 (ANSI, 2004). 근골격계증상에대한조사는한국산업안전보건공단의근골격계질환증상조사표 KOSHA code(h ) 양식을이용하여수행하였고, 유증상자는 NIOSH 에서적용한기준 ( 지난 1 년간증상이 1 주일이상지속되거나매월 1 회이상증상을경험한경우이면서통증의정도가중간통증이상인경우 ) 으로정의하였다 (NIOSH, 1993; KOSHA, 2007). 2.3 Analysis 개인력, 작업특성, 직무스트레스에대한분포는기술적통계방법으로분석하였다. 개인적특성들에따른근골격계증상유병률의비교분석은교차분석 (χ²-test) 을실시하였고, 이분형로지스틱회귀분석으로변수들을보정하여각변수들의교차비와 95% 신뢰구간을확인하였다. 통계결과는 p 값이 0.05 미만인경우를통계적으로유의한것으로판단하였다. 3. Results 조사대상자중여성은 858 명 (72.5%), 남성은 324 명 (27.4%) 이었다. 30 대가 467 명 (39.5%) 으로가장많았으며그다음으로 40 대 300 명 (25.4%), 20 대 286 명 (24.2%), 50 대이상 130 명 (11.0%) 순이었다. 기혼자가 689 명 (60.1%) 로미혼자보다많았으며음주, 흡연여부에서는현재흡연자가 121 명 (10.2%) 이었으며평소술을마시지않는사람이 492 명 (41.6%) 이었다. 학력은대졸이상 551 명 (46.6%), 전문대졸 349 명 (29.5%), 고졸 201 명 (17.0%) 순이었다. 규칙적으로운동을하는사람 269 명 (22.7%) 보다는하지않는사람이 864 명 (73.0%) 으로더많았다. 가사노동의경우거의하지않는경우가 233 명 (20.6%), 하루에 1 시간에서 3 시간사이가 444 명 (39.3%), 3 시간에서 5 시간사이가 188 명 (16.7%), 5 시간이상하는경우는 264 명 (23.4%) 이었다. 근속년수는 10 년이상이 606 명 (51.2%) 로절반을넘었으며 5 년미만이 348 명 (29.4%), 5-10 년사이가 161 명 (13.6%) 순이었다. 근무형태에서주간근무

3 를하는경우가 600 명 (54.2%) 으로가장많았다. 직종의경우일반직이 539 명 (46.5%), 간호사가 469 명 (40.5%), 의사가 151 명 (13.0%) 순이었다. ANSI 조사결과정상군이 830 명 (75.7%) 이었고, 저위험군이 168 명 (15.3%), 고위험군이 99 명 (9.0%) 이었다. Variable Table 1. Musculoskeletal symptom & characteristics of study population N(%) Symptom Positive N(%) p-value * General Gender Male 324(27.4) 83(25.6) Female 858(72.5) 548(63.9) Age(year) (24.2) 160(55.9) (39.5) 273(58.5) (25.4) 152(50.7) (11.0) 46(35.4) Marital status Unmarried 453(39.5) 240(53.0) Married 689(60.1) 373(54.1) Education High school 201(17.0) 111(55.2) College 349(29.5) 215(61.6) University 551(46.6) 273(49.5) Housework hours per No 233(20.6) 106(45.5) Day (39.3) 226(50.9) (16.7) 103(54.8) <5 264(23.4) 179(67.8) Health behavior Regular exercise Yes 269(22.7) 123(45.7) Work-related factors * : p<0.05 by χ 2 -test No 864(73.0) 494(57.2) Drinking Yes 636(56.4) 312(49.1) No 492(43.6) 296(60.2) Smoking Yes 121(10.2) 34(28.1) Quit 77(6.5) 19(24.7) No 910(76.9) 550(60.4) Position Etc. 539(46.5) 261(48.4) Doctor 151(13.0) 44(29.1) Nurse 469(40.5) 324(69.1) Tenure(years) <5 348(29.4) 174(50.0) Work hours Week per (13.6) 98(60.9) (51.2) 338(55.8) (52.9) 262(53.3) (36.6) 218(64.1) 50 98(10.5) 47(48.0) Work type Daytime 600(54.2) 261(43.5) Double shift 66(6.0) 35(53.0) Three Shift 440(39.8) 297(67.5) ANSI Normal 830(75.7) 424(51.1) Low risk 168(15.3) 115(68.5) High risk 99(9.0) 74(74.7) 남성과여성의근골격계증상유병률은각각

4 25.6%, 63.9% 로여성에서유의하게높았다. 연령별로는 20 대 55.9%, 30 대 58.5%, 40 대 50.7%, 50 세이상에서는 35.4% 로젊은연령에서높았다. 결혼상태에대해서는통계적으로유의한차이가나지않았고, 학력의경우고졸에서 55.2%, 전문대졸에서 61.6%, 대학교졸에서 49.5% 로통계적으로유의한차이가났다. 가사노동의경우노동시간이길수록유병률이유의하게높게나타났다. 운동을하지않는군에서 57.2%, 하는군에서 45.7% 로운동을하지않는군에서유의하게유병률이높은것으로나타났다. 음주와흡연은하지않는군에서모두유의하게유병률이높게나타났다. 직종별로는일반직에서 48.4%, 의사 29.1%, 간호사 69.1% 로간호사에서유의하게유병률이높게나타났다. 근무기간에대해서는유의한차이가없었고, 근무시간은주당 40 시간이하에서 53.3%, 40~50 시간에서 64.1%, 50 시간이상에서 48.0% 로 40~50 시간에서유의하게유병률이높게나타났다. 근무형태는주간근무에서 43.5%, 2 교대에서 53.0%, 3 교대에서 67.5% 로 3 교대근무자에서유의하게유병률이높게나타났다. ANSI 분류별로는정상군에서 51.1%, 저위험군에서 68.5%, 고위험군에서 74.7% 로위험이높아질수록유의하게유병률이높게나타났다 (Table 1). 부위별근골격계증상유병률은한부위이상양성자가 631 명 (53.3%) 이고, 어깨 393 명 (33.2%), 허리 330 명 (27.9%), 다리 / 발 266 명 (22.5%), 목 250 명 (21.1%) 순으로나타났다 (Table 2). Table 2. Prevalence of musculoskeletal symptoms according to body regions Body region Symptom positive N % Neck Shoulder Back Arm/Elbow Wrist/Finger Knee Leg/Foot Any region 연구대상의직무스트레스각하위영역별평균값과총점수를남녀별로우리나라근로자 12,681 명으로부터도출된참고치 (Chang et al., 2005) 와비교하였는데, 남, 녀모두총점수가 50~75% 에해당하여우리나라평균에비해다소높은수치를보였다. 남, 녀간직무스트레스하위영역별평균을비교한결과관계갈등을제외한모든항목과직무스트레스전체평균점수가유의하게차이가났다 (p<0.05). 관계갈등을제외한모든항목에서여성의직무스트레스점수가높은것으로나타났다. 직무스트레스에대해서남녀별로근골격계증상정상군과유증상군사이에평균값을비교하였는데총점수에서남, 녀모두정상군과증상군간에유의한차이가있는것으로나타났다. 하부영역별로는남자의경우직무요구 (p<0.01), 조직체계 (p<0.01), 보상부적절 (p<0.01), 직장문화 (p<0.05), 물리환경 (p<0.01) 에서, 여자의경우직무요구 (p<0.01), 직무자율 (p<0.01), 직무불안정 (p<0.01), 조직체계 (p<0.01), 보상부적절 (p<0.01), 직장문화 (p<0.01), 물리환경 (p<0.01) 에서두군간에유의한차이가있었다 (Table 3, 4, 5). 마지막으로직무관련특성과근골격계증상의관련성을파악하기위하여우선단변량분석을실시하고, 그후개인적특성을보정하여다중로지스틱회귀분석을실시하였다. 그결과직무스트레스하부영역들을우리나라참고치에의하여저위험군과고위험군으로나누었는데직무스트레스전체평균 (OR 2.3, 95% CI=1.71~3.08), 직무요구 (OR 2.0, 95% CI=1.46~2.61), 직무불안정 (OR 1.5, 95% CI=1.09~2.07), 조직체계 (OR 2.0, 95% CI=1.51~2.65), 보상부적절 (OR 1.6, 95% CI=1.20~2.16), 직장문화 (OR 1.6, 95% CI=1.20~2.19), 물리환경 (OR 2.7, 95% CI=2.02~3.63) 가근골격계증상과유의한관련성을보였다. 근무형태에서는 3 교대가주간근무에비하여 (OR 1.8, 95% CI=1.32~2.54) 로근골격계증상과유의한관련성을보였다. 직종의경우간호사에서일반직에비하여 (OR 1.7, 95% CI=1.18~2.49) 로근골격계증상과유의한관련성을보였다. ANSI 에대해서는고위험군이정상군에비하여 (OR 3.7, 95% CI=2.10~6.68) 로근골격계증상과유의한관련성을보였다 (Table 6). 4. Discussion

5 본연구결과, 전체대상자의근골격계증상유병률은 53.3% 였으며성별로는여성에서남성에비해유의하게증상유병률이 2 배이상높게나타났는데이는기존의연구들 (Kim et al., 2003; Park et al., 2005) 과비슷한결과였다. 신체부위별증상유병률은어깨 33.2%, 허리 27.9%, 다리 / 발 22.5%, 목 21.1% 로병원의근로자들을대상으로한다른연구 (Park et al., 2008) 와비슷한경향을나타냈다. 연구와비슷하게운동하지않는군에서증상유병률이높았다. 흡연과음주의경우기존의연구들 (Malchaire et al., 2001; Friedmann et al., 1999) 과는다른경향을나타냈다. 직무관련특성을살펴보면근무기간에대해서는증상유병률이유의하게차이나지는않았지만대체적으로근무기간이길수록증상유병률이높은것을확인할수있었다. 직종에따라 Table 3. The distribution of job stress scores for hospital workers by gender Variable Gender Mean(SD) Reference value * of occupational stress <25% 25~<50% 50~<75% 75 Job demand Male 51.6(15.7) Female 66.7(17.3) Insufficient job control Male 50.1(16.9) Female 57.7(15.4) Interpersonal conflict Male 41.1(14.7) Female 40.1(13.2) Job insecurity Male 43.4(20.9) Female 47.2(18.5) Organizational system Male 57.5(17.0) Female 62.8(15.3) Lack of reward Male 51.8(17.8) Female 57.7(15.8) Occupational climate Male 41.1(14.7) Female 46.2(14.0) Physical environment Male 52.3(19.6) Female 57.2(18.4) Total job stress Male 48.5(10.6) Female 54.5(9.4) * median of job stress score for 12,681 Korean workers 연령대에따라서는오히려 40 세이후에증상유병률이낮게나타난점이특이하였다. 가사노동시간에따라서는노동시간이많아질수록유의하게증상유병률이증가하는것을확인할수있었다. 건강관련행위와관련해서는운동을하지않는군이, 담배와술역시하지않는군에서유의하게증상유병률이높게나타났다. 다른연구 (Bae et al., 2011) 에서도본 서는간호사군에서유의하게증상유병률이높게나타났다. 주당근무시간에대해서는주당 40 시간에비해서 40 시간을초과하는군이유의하게증상유병률이높게나타나장시간근무자에서증상유병률이높은것을확인할수있었다. 근무형태에대해서는주간근무에비해 3 교대근무의경우가유의하게증상유병률이높게나타났다. ANSI 와관련해서는정상군에비해위험도가높아질수록유의하게증상유

6 병률이높게나타났다. 직무스트레스는 KOSS-26 을이용하여평가했는데총점수의평균이남자 48.5, 여자 54.5 로한국의평가기준 (Chang et al., 2005) 과비교할때모두높은것으로나타났다. 이는병원근로자들또는간호사들을대상으로조사한직무스트레스수준 (Woo and Kim, 2009; Jeon et al., 2009) 과비교해서도높은수준이다. 환자를상대하는병원의업무특성상높은스트레스가반영된결과라고생각해볼수있겠다. 하위영역별로보면남자의경우직무요구, 직무자율성결여, 관계갈등, 조직 Table 4. Difference between male and female workers of job stress 외한나머지영역에서고위험군에서근골격계증상의위험도가유의하게높게나타났다. 3 교대근무에서주간근무에비해 1.8 배정도위험도가높았고, 간호사직이일반직에비해 1.7 배정도위험도가높은것을확인할수있었다. 작업강도와관련해서는 ANSI 고위험군에서저위험군에비해 3.7 배정도위험도가높게나타났고우울증상군에서비증상군에비해위험도가 1.6 배정도높게나타났다. ANSI Z-365 체크리스트는다양한인간공학적인위 Variable Male Gender Female p-value * Job demand 51.6(15.7) 66.7(17.3) 0.00 Insufficient job control 50.1(16.9) 57.7(15.4) 0.00 Interpersonal conflict 41.1(14.7) 40.1(13.2) 0.28 Job insecurity 43.4(20.9) 47.2(18.5) 0.01 Organizational system 57.5(17.0) 62.8(15.3) 0.00 Lack of reward 51.8(17.8) 57.7(15.8) 0.00 Occupational climate 41.1(14.7) 46.2(14.0) 0.00 Physical environment 52.3(19.6) 57.2(18.4) 0.00 Total job stress 48.5(10.6) 54.5( 9.4) 0.00 * by independent T-test 체계, 물리환경영역에서여자의경우전하부영역에서우리나라평균에비해높은점수를나타냈다. 근골격계증상이없는군과있는군의직무스트레스평균을비교하였을때남자의경우직무자율성결여, 관계갈등, 직무불안정에서여자의경우관계갈등만제외하고는통계적으로유의하게차이가나타났다. 이것으로직무스트레스와근골격계증상간에는관련성이있다고생각해볼수있다. 개인적인특성을보정하여다중로지스틱회귀분석을실시한결과직무스트레스의경우하위 50% 와상위 50% 를각각저위험군과고위험군으로하여서분석하였는데총직무스트레스점수의경우고위험군에서 2.3 배정도위험도가높았다. 하위영역별로는직무자율성결여, 관계갈등을제 험요인을반영하여쉽게다양한작업의형태를평가할수있다는장점이있다 (Park et al., 2006). ANSI 점수에의한고위험군에서근골격계증상의위험도가높았는데이는이전의연구 (Sul et al., 2007) 와비슷했다. 이를통하여작업내용이위험할경우근골격계증상의발생가능성이높아질수있다는것을유추해볼수있었다. 직무스트레스와근골격계증상의관련성을보고자하였는데하위영역중직무요구, 직무불안정, 조직체계, 보상부적절, 직장문화, 물리환경등이근골격계증상과유의한상관관계를보였다. 이는이전의연구 (Jo et al., 2009) 와비교해보면직무요구, 직무불안정, 직장문화, 물리환경등에서공통적으로상관성을나타냈는데, 보상부적절, 조직체계는본연구에서만관련성을나타냈다.

7 Table 5. Difference between normal group and musculoskeletal symptom positive group of job stress Variable Gender Normal Musculoskeletal symptom Positive p-value * Mean(SD) Mean(SD) Job demand Male 48.5(13.5) 59.8(18.0) Female 62.5(17.8) 68.9(16.7) Insufficient job control Male 49.9(17.6) 50.7(14.6) Female 55.7(15.4) 58.7(15.3) Interpersonal conflict Male 40.1(13.7) 43.9(17.0) Female 39.7(12.6) 40.2(13.5) Job insecurity Male 42.0(19.9) 47.3(23.0) Female 44.9(17.9) 48.5(18.8) Organizational system Male 55.1(16.4) 64.1(16.8) Female 59.6(13.8) 64.5(15.8) Lack of reward Male 49.5(17.4) 58.1(17.4) Female 54.6(14.7) 59.3(16.2) Occupational climate Male 40.1(13.9) 44.2(16.5) Female 44.1(13.3) 47.3(14.3) Physical environment Male 48.6(18.2) 62.4(19.8) Female 50.7(17.2) 60.7(18.2) Total job stress Male 46.6(10.0) 53.9(10.5) Female 51.3(8.4) 56.1(9.4) * by independent T-test 직무요구는그동안여러연구에서근골격계증상에상당한영향을끼치는것으로밝혀졌다 (Ariens et al., 2001; Leroyer et al., 2006; Skov et al., 1996; Leroux et al., 2005). 직무스트레스와근골격계증상호소를설명하는가설 (Huang et al., 2002; Carayon et al., 1999; Warren, 2001; Schleifer et al., 2002; Visser and van Dieen, 2006) 은직무스트레스가근육의긴장도를증가시킨다는것이다. 병원의업무특성상정형화되지않은다양한업무를수행하고, 환자를돌봐야하는등의직무스트레스정도가높았을것이고이점은근골격계증상이발생하는데일조를했을것이라고생각된다. 본연구의제한점은첫째, 일개대학병원의자료로서일반화하기어렵다는점이다. 둘째, 근골 격계증상에대한자가설문지를이용하였기때문에다분히주관적인판단이개입되었을것이고의사에의한정확한진단과는차이가난다는점이다. 셋째, 연구대상자들의평소생활습관과취미활동등근골격계증상에영향을줄수있는요인들에대해서조사하지못한점이다. 넷째, 본연구는단면조사이기때문에근골격계증상과관련요인들의선후관계가명확하지않다는점이다. 이러한한계점이존재하지만대학병원에서근무하는다양한직종의보건의료인들의근골격계증상유병률을알아보고관련요인들을파악했다는점은의미가있다고판단된다. 근골격계증상과직종, 3 교대근무, 노동강도, 직무스트레스등이연관성이높다는것을밝혔다.

8 Factor Table 6. Odds ratios of musculoskeletal symptoms by multivariate analysis Unadjusted OR Adjusted OR * OR 95% CI OR 95% CI Job demand Low risk group High risk group ~ ~2.61 Insufficient job control Low risk group High risk group ~ ~1.66 Interpersonal conflict Low risk group High risk group ~ ~1.73 Job insecurity Low risk group High risk group ~ ~2.07 Organizational system Low risk group High risk group ~ ~2.65 Lack of reward Low risk group High risk group ~ ~2.16 Occupational climate Low risk group High risk group ~ ~2.19 Physical environment Low risk group High risk group ~ ~3.63 Total job stress Low risk group High risk group ~ ~3.08 Work type Daytime Double shift ~ ~2.39 Three Shift ~ ~2.54 Tenure(Years) < ~ ~ ~ ~2.14 Work hours per week ~ ~ ~ ~2.43 Position Etc Doctor ~ ~1.18 Nurse ~ ~2.49 ANSI Normal Low risk ~ ~3.35 High risk ~ ~6.68 * : odds ratio adjusted for gender, age, marital status, education, regular exercise, drinking, smoking, house work hours analysed by binary logistic regression 작업성근골격계질환은다양한원인에의해서복합적으로발생하게되는데, 조기에위험요인을발견하여예방하는것이매우중요하다. 본연구는이런측면에서근골격계증상발생의위험이될수있는위험요인을밝혀서추후 에이에대한연구의기초를마련하였다는의의가있다. 본연구를토대로더욱다양하고정확한연구방법을통하여보건의료인의근골격계질환예방사업을추진하여야할것이다.

9 5. Conclusion 종합병원근로자들에대한연구를수행하였는데근골격계증상과관련된직무특성으로노동강도, 교대근무, 간호직, 직무스트레스등이관련이높은것으로나타났다. References ANSI pp 17-41, p 130, (Korean) Ariens, G.A., van Mechelen, W., Bongers, P.M., Bouter, L.M. & van der Wal, G., Psychosocial risk factors for neck pain: a systematic review, Am J Ind Med, 39(2),180-93, Bae, K.J., Lee, K.S., Kong, Y.K., Oh, G.J. & Lee, S.J., The Prevalence of Musculoskeletal Symptoms and the Ergonomic Risk Factors among Oriental Melon-growing Farmers, Korean J Occup Environ Med, 23(1), 1-8, (Korean) Bernard, B.P., Musculoskeletal disorders and workplace factors: A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. 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10 musculoskeletal disorders of the neck, shouuuuus, and lower back in salespeople, Occup Environ Med, 53(5), 351-6, Sul, J.G., Kang, D.M., Lee, S.I. & Kim, Y.K., Dose-Response Relationships between Work-Related Musculoskeletal Neck Symptom and Physical Risk Factors (2 year follow-up study), Korean J Occup Environ Med, 19(2), , (Korean) Visser, B. & van Dieen, J.H., Pathophysiology of upper extremity muscle disorders, J Electromyogr Kinesiol, 16(1), 1-16, Warren, N., Work stress and musculoskeletal disorder etiology: The relative roles of psychosocial and physical risk factors. Work, 17(3), , Woo, N.H. & Kim, S.Y., Job stress and work-related musculoskeletal symptoms of general hospital nurses, Korean J Occup Health Nursing, 18(2), , (Korean) Author listings Yoonbum Choi: bummy76@hanmail.net Highest degree: M.B., College of medicine, Hanyang University Position title: Resident, Department of occupational and environmental medicine, Hanyang University Hospital Areas of interest: Work-related disease Soo-Jin Lee: sjlee@hanyang.ac.kr Highest degree: M.D., PhD., Department of Preventive Medicine, Catholic University Position title: Associated professor, Department of occupational and environmental medicine, Hanyang University Areas of interest: Agricultural medicine, Work-related disase Hwan Jin Park: ppakans@gmail.com Highest degree: M.B., College of medicine, Hanyang University Position title: Resident, Department of occupational and environmental medicine, Hanyang University Hospital Areas of interest: Work-related disease

한국성인에서초기황반변성질환과 연관된위험요인연구

한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -