107年春季班研討會 從空勤人員的 subjective health complaints (SHCs)中 musculoskeletal complaints 我們能做甚麼? 國防部醫務組組長 蔡偉奇 2018/11/11 國防部醫務組
Aircrew members experience a number of occupational risk factors related to their work environment radiation poor air quality time-zone shifts noise physically demanding monotonous work vibration (Sanlorenzo M, et al. The risk of melanoma in airline pilots and cabin crew: a meta-analysis. JAMA Dermatol 2015.) They have a higher prevalence of some specific diseases, such as malignant melanoma. (Sykes AJ, et al.. A study of airline pilot morbidity. Aviat Space Environ Med 2012.) 2018/11/11 國防部醫務組
However, all aircrew need to pass strict regulation criteria and medical standards and in general they have lower morbidity and mortality rates than other populations. (De Stavola BL, et al. Cause-specific mortality in professional flight crew and air traffic control officers: findings from two UK population-based cohorts of over 20,000 subjects. Int Arch Occup Environ Health 2012.) 2018/11/11 國防部醫務組
In addition to the physical work, aircrew members’ health may be affected by various organizational and psychosocial factors. Cabin crew in particular might experience a high psychosocial load due to dealing with passenger service and safety. (Ballard TJ, et al. Self perceived health and mental health among women flight attendants. Occup Environ Med 2006) 2018/11/11 國防部醫務組
The aviation industry has undergone substantial changes in the last decade and increased competition, new company structures, increased security demands and changes in legislation have led to a more demanding work environment and higher job insecurity. 2018/11/11 國防部醫務組
The Norwegian civilian aviation industry has been described in harsh terms as ‘a hostile place for people to work’, due to long work shifts and stressful schedules. (Pettersen KA, et al. Organizational contradictions between safety and security—perceived challenges and ways of integrating critical infrastructure protection in civil aviation. Safety Sci 2015) Such a work environment could lead to higher levels of perceived stress, which in turn could be associated with increased health complaints. (Greubel J, et al. The impact of organizational changes on work stress, sleep, recovery and health. Ind Health 2011) 2018/11/11 國防部醫務組
often non-specific, with no findings of significant pathology Health complaints musculoskeletal pain, gastrointestinal complaints, fatigue depression often non-specific, with no findings of significant pathology have been termed subjective health complaints (SHCs). (Eriksen HR, et al. Subjective health complaints. Scand J Psychol 2002.) 2018/11/11 國防部醫務組
Sustained activation of the central nervous system has been suggested as a mechanism through which high levels of perceived stress influence SHCs. (Ursin H, Eriksen HR. Cognitive activation theory of stress (CATS). Neurosci Biobehav Rev 2010) 2018/11/11 國軍高雄總醫院左營分院 復健科
Subjective Health Complaints (SHCs) SHCs were measured using the Subjective Health Complaints Inventory, which consists of 29 common health complaints. The respondents were asked to grade the intensity of each complaint in the previous month on a four-point scale (0 = not at all, 1 = a little, 2 = some, 3 = severe). 2018/11/11 國防部醫務組
Subjective Health Complaints (SHCs) The complaints are usually divided into five factors (sum scores): musculoskeletal complaints (headache, migraine, neck pain, shoulder pain, pain in arms, pain in upper back, low back pain and leg pain); psychological (or pseudoneurological) complaints (extra heartbeats, heat flushes, sleep problems, tiredness, dizziness, anxiety and sadness/depression) ; gastrointestinal complaints (heartburn, stomach discomfort, ulcer/non-ulcer dyspepsia, stomach pain, gas discomfort, diarrhoea and constipation) ; allergic complaints (asthma, breathing difficulties, eczema, allergies and chest pain); flu (cold, flu and cough). (Eriksen HR, et al. A scoring system for subjective health complaints (SHC). Scand J Public Health 1999) 2018/11/11 國防部醫務組
SHCs- musculoskeletal complaints Headache Migraine Neck pain Shoulder pain Pain in arms Pain in upper back, low back pain Leg pain 2018/11/11 國防部醫務組
The most prevalent single complaints reported by cockpit crew were tiredness, sleep problems, bloating, low back pain and headache. The most prevalent severe complaints were tiredness, sleep problems and low back pain. 2018/11/11 國防部醫務組
The most prevalent single complaints reported by cabin crew were tiredness, bloating, sleep problems, headaches and neck pain, with tiredness, sleep problems and shoulder pain as the most severe. Cabin crew had significantly higher prevalences of all SHCs (P < 0.05), except for sleep problems, low back pain, diarrhoea, heartburn, allergies, eczema and asthma. 2018/11/11 國防部醫務組
Most prevalent SHCs The most prevalent SHCs (among Norwegian cockpit and cabin crew). Tiredness, sleep problems, bloating, low back pain, headaches and neck pain Cabin crew reported significantly higher prevalence and mean values for all SHC factors compared to cockpit crew. 2018/11/11 國防部醫務組
Stress 2018/11/11 國防部醫務組
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That feeling of self-worth contributes to stress relief. How it works Think about those times when you’ve been physically active. Haven’t you felt better about yourself? That feeling of self-worth contributes to stress relief. 2018/11/11 國防部醫務組
Exercising Helps Manage Stress --nutritious food People who exercise regularly tend to eat more nutritious food. And it’s no secret that good nutrition helps your body manage stress better. See you at the gym! 2018/11/11 國防部醫務組
3 Types of Exercise For Stress Relief 2018/11/11 國防部醫務組
Tai Chi • An ancient Chinese martial art which has been practiced rather widely. • Uses very fluid and graceful movements that are slow and precise, allowing practitioners to work on strengthening their body while also having a focused mind. • People who practice Tai Chi experience benefits such as having a better sense of balance, increased sleep quality, greater sense of clarity and focus, overall improvement in their health as well as mental wellbeing. 2018/11/11 國防部醫務組
2. Pilates • Originally developed as a method of rehabilitation for the injured. • Pilates movements stretches and lengthens your muscles while also working at improving the strength and stability of your core. • Much like yoga, it is also very calming thus making it a great choice of workout to do for stress relief. • Other benefits of practicing pilates includes building a stronger spine, having better posture, as well as developing stronger and toner muscles. 2018/11/11 國防部醫務組
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3. Water Aerobics • If you would like do something slightly more rigorous to get your heart pumping while also improving on your overall tone and health, water aerobics is definitely an ideal choice. • Having your body submerged in the water actually lessens the impact of the movements on your joints and spine. • Although being in water may seem to make your motions effortless, the water resistance actually do give a good and solid workout too. 2018/11/11 國防部醫務組
Physical activity is the best stress buster. 2018/11/11 國防部醫務組
Workout for 45 Minutes Daily Engage yourself in just walking for 45 minutes. Make it your daily routine. Come what may, you will not skip walking. Walking gives you required oxygen supply to the brain by improving blood circulation. You can engage in any sports, go to the gym regularly or any other strenuous physical activity on a regular basis that makes you sweat. 2018/11/11 國防部醫務組
Health-related Physical Fitness 2018/11/11 國防部醫務組
Muscular strength and endurance Muscular strength and muscular endurance training can elicit benefits in increased strength, lean tissue mass, and bone density. Muscular strength can be assessed by using some sort of Repetition Maximum (1-RM, 5-RM or 10-RM) test on a variety of different exercises that involve major muscles groups. The bench press and squat are commonly used tests in assessing strength. The choice of test is based on the exerciser’s experience and ability. Muscular endurance testing might include timed tests, where the exerciser has to perform as many repetitions of a given movement as possible in a specific time period (i.e., 1 minute of curl-ups or push-ups). Results from both muscular strength and endurance tests can assist in recommending proper intensities and loads for strength training exercises. 2018/11/11 國防部醫務組
Flexibility The degree to which a joint moves through a normal, pain-free range of motion, can be a determining factor in the performance of Activities of Daily Living (ADLs) as we age. A reduction in tissue elasticity and deterioration of joint anatomy with age has been shown to decrease flexibility and may lower the performance in ADLs, which can decrease quality of life. Because flexibility can vary joint to joint, there is no single test for overall flexibility. The sit-and-reach test is a commonly used test for assessment of flexibility of the hamstrings, hips and lower back. 2018/11/11 國防部醫務組
柔軟度的重要性 有良好的柔軟度，肢體的活動範圍較大，肌肉不易拉傷，關節也較不易扭傷。 若柔軟度不好，也會造成姿勢不良問題，如下背痛及肩頸疼痛等。 不常運動是造成柔軟度降低的主因。 ◎造成下背疼痛的原因中有80%與缺乏肌肉運動及柔軟性不好有關。因為腹部肌肉肌力、耐力不好，使得骨盆前傾，導致腰椎過度彎曲，容易壓迫神經而產生下背痛。
肌肉適能的運動處方 運動類型：肌肉用力性的運動/ 反覆次數：約10~20次/回合，出現肌肉適當疲勞程度；1~3回合/動作 重量訓練 反覆次數：約10~20次/回合，出現肌肉適當疲勞程度；1~3回合/動作 運動頻數：平均2~3天/週
柔軟性的運動處方 運動類型：靜性伸展操 運動強度：伸展至肌肉明顯而合理繃緊 持續時間： 10~30秒/次； 反覆3~5次/動作 運動頻數： 至少兩天一趟（包括全身大的關節） 理想是一天1~3趟
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肌肉、骨骼與韌帶勞損 空服員最普遍的傷害就是肌肉、骨骼與韌帶的勞損，因為長期需要站立服務，因而容易有腰痠背痛；而且經常得要搬重物，手腳與背部的負擔都很大； 再加上艙廚的空間狹小，在有限的空間工作，容易有難纏的慢性疼痛，甚至會因此而使頸椎與腰椎受到傷害； 以及長站造成的腿部壓力，會造成血液循環不良而出現靜脈曲張、足底筋膜炎。 2018/11/11 國防部醫務組
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背痛 空服員的工作內容主要是提供乘客旅途中的安全和舒適，指導乘客使用機上安全設備、為乘客供應飲食、飲料、在緊急情況下協助乘客逃離飛機。工作內容看似簡單卻容易產生職業病，如處理飛機餐食時，必須把幾百個餐盒一個個塞到餐車中，這過程需要頻繁的使用腰，加上送餐、收餐、倒茶、咖啡、協助乘客放置行李、聆聽旅客問題，也都需要不停地彎腰，尤其廚房補給品、行李都重達十多公斤，長時間下來負荷很大，因此大部分空服員都深受下背痛之苦。 2018/11/11 國防部醫務組
背痛 推拉重物時不要彎腰拱背 坐下時在腰部墊一個捲枕 躺下時在頸部墊一個筒狀物支撐 讓身體可以充分休息外，也可以做伸展動作，讓身體在有限空間內達到放鬆 2018/11/11 國防部醫務組
下肢靜脈曲張 長時間久站、頻繁走動的關係，造成血液淤積於腿部靜脈，產生疼痛及各種不適的靜脈曲張，即便穿著束緊度很高的200den的彈性絲襪，還是會因為工作時間的長度，造成腿部腫脹不舒服 使用溫水由下往上沖小腿，促進血液回流、搭配按摩油，由下往上按摩小腿及按壓腳掌外，肌內效貼布也可以協助症狀的舒緩 2018/11/11 國防部醫務組
足底筋膜炎 長期站立，造成足底長期受壓，令筋膜被過度拉扯致發炎。 治療: 急性期搭配冰敷，緩解期可搭配按摩與熱敷。 2018/11/11 國防部醫務組
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See you at the gym! 2018/11/11 國軍高雄總醫院左營分院 復健科
Thanks for your attention!! 2018/11/11 國防部醫務組