| ObjectiveTo study the prevalence of MSDs among vegetable greenhouse workers and its influencing factors, also the knowledge level about musculoskeletal health and the need of the health education in musculoskeletal protection in greenhouse work, such that to provide supportive evidence in MSDs intervention research.Methods1. Analysis of posture and load in greenhouse workers:The activities of a worker in cucumber greenhouse were observed with split-second observations. The work postures were analyzed with adapted OWAS analysis system with additional work phase and work tool related codes which is recommended by Finnish Institute of Occupational Health. The weight of each posture component is then calculated.2. The focused group interview:based on the accidental sampling and judgment sampling, we chose 7 vegetable greenhouse workers that had worked for more than one year to constitute the focused group. Under the direction of researcher, some special topics were freely discussed by the 7 workers. We have got some useful information from the discussion.3. Questionnaire survey:Choosing 1823 vegetable greenhouse workers from the five main vegetable cultivating areas in Shouguang, Shandong province to form the research sample. Ask about the MSDs, related work delaying, work type, external load, harmful work position, repetitive operation, work space, vibrating tool, break in work, and the knowledge, attitudes and behavior and needs of health education among the research sample. Data were exported into a SAS 9.2 to carry out chi-square test, univariate and multivariate Logistic analysis.Results1. The research sample consists of 1780 people, with the ratio of male and female is 53.3% and 46.7%, respectively. The age ranged from 24 to 75, with median of 50.0. The ratio of junior middle school as the highest education is 62.2%. The time of occupying greenhouse work ranged from 1 to 45 years, with median of 20.0 year. The time of working in greenhouse everyday ranged from 1 to 20 hours, with median of 10.0 hours. The ratio of respondent that self-reported in good health is 17.0%, most thought their health condition were normal (64.1%). After a whole day working in greenhouse, most respondents reported being tired (55%),21% of the respondents felt very tired. Only 27.9% of the respondents have ever seen doctors in the past year.2. The prevalence of overall MSDs in the past year is 78.4%, with that of low back, knee, neck and shoulder are 62.4%,41.9%,22.9%,20.3%, respectively. The following areas in MSDs prevalence are upper back, hand/twist, elbow, ankle, hip/thigh. The rate of work delaying resulting from overall MSDs is 23.0%, with that from low back is 16.7%. The annual prevalence of MSDs of overall, low back, knee, neck linearly increased with the increase in age and years in work. In the Focused Group Interview, the greenhouse workers and bare-foot doctors all reported that MSDs are serious among the greenhouse workers. But because of the timeliness of vegetable harvest, the workers go to seek treatment only when the pains are beyond their endurance or they cannot move due to the pain.3. The risk factors reported by the interviewees included age, gender, hours on work everyday, harmful working postures, over-load, etc. The interviewees reported that even though they have some protection knowledge of musculoskeletal, for the reasons that they thought it must be inconvenient or uncomfortable to wear protecting equipment in work or low working efficiency, they had never protected themselves in work. Meanwhile, the interviewees were longing for more professional protective knowledge of musculoskeletal system. In the observation study of working behavior, the back postures’ rank in ratio from highest to lowest is up-right, forerake, forward bending, lateral bending, turning around while foreraking; the main postures of upper limbs are single hand working above elbow, single elbow working above shoulder, both hands working above elbows. The main postures of lower limbs are unbending, barycenter on one foot, squat. Labor form is mainly pinching, bits are spade.4. In the univariate Logistic regression analysis,17 related factors such as gender, age, education, years in work, the mode curling the curtain, working long in squat position, working long on knee, et al were found significantly related with overall MSDs.25 related factors such as gender, age, education, years in work, working hours everyday, the mode curling the curtain, working long in squat position, working long on knees, raising weight more than 20Kg, doing work needing the greatest strength in short time, raising weight in uncomfortable positions, raising weights that are uneasy to be grabbed, et al were found significantly related with low back MSDs.29 related factors such as gender, age, BMI, education, drinking, years in work, the overall areas of greenhouse, the mode curling the curtain, raising weights that are uneasy to be grabbed, working in uncomfortable positions, turning around heavily in a long while, working long in positions that contain bending and turning around meanwhile, working long in neck forward position, working long in neck backward position, et al were found significantly related with knee MSDs.19 related factors such as gender, age, years in work, forced bending as the limited space above, doing the same work everyday, work is done by several people by turns, et al were found significantly related with neck MSDs.5. In the multivariate Logistic regression analysis, gender, age, BMI, years in work, the mode curling the curtain, working long in sit position, working long in squat position, working long in walk position, raising weight more than 20Kg, doing grabbing work by fingers, raising weight in uncomfortable position, raising weights that are uneasy to be grabbed, turning around heavily in a long while, working long in neck backward position, forced bending as the limited space above, doing the same work everyday, work is done by several people by turns, break times in the work whole day are found significantly related with overall, low back, knee and neck MSDs.6. Almost half of the respondents have no idea about the severity of MSDs in greenhouse workers, with the group working more years have more knowledge about the severity than those working less years. The musculoskeletal protection knowledge is seriously lacked among the respondents. The 3 main routes that musculoskeletal protection knowledge is gained are "from self-conclusion", "from TV and newspapers", "hearing from others", the ratio that gained the knowledge from professional health education is only 2.5%. Even among those who have already gained some protection knowledge, that ratio that have protected themselves according to their knowledge is not high, only 54.7%. The 2 main reasons that they have not protected themselves according to their knowledge are "think the protection makes no difference", "the protection hinder the work process". The ratio of respondent that ever had health education in their local is very low (4.9%), but most of the ones (96.8%) that have attended the precious education think it is very helpful. If there is health education available in the county or town, most of the respondents (96.7%) express they will attend it.Conclusions1. MSDs are a group of chronic cumulative diseases, with a high prevalence in vegetable greenhouse workers. There commonly exist the problem of heavy labor intensity, long working time in the greenhouse work, which pose a heavy load onto the workers.2. MSDs are the results of multiple factors. In the future we should improve the design of greenhouses and the operation tools in the work, and optimize the break mode during work, such that can prevent MSDs in some extent.3. Most greenhouse workers are bothered by MSDs, but many of them have not enough knowledge about the harm of MSDs. The protection knowledge against MSDs is commonly lacked among greenhouse workers, and they ungently need more professional health education. The problem of there are not enough available protective and assistant tools in greenhouse work is serious.
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