Promosi Keselamatan dan Kesehatan Kerja Health Assessment Standard

Promosi Keselamatan dan Kesehatan Kerja Health Assessment & Standard Testing (ss. 5) DR. Robiana Modjo, SKM, MKes

STANDAR TESTING Promosi Kesehatan Kerja • • Tekanan darah Kolesterol darah & HDL ratio Distribusi lemak waist-hip ratio & BMI Cardiovascular endurance step test Abdominal curl-up/menit Flexibilities Test reaksi

STANDAR TESTING - Promosi Kesehatan Kerja • Tekanan darah (TD) § Alat ukur : Sfigmomanometer § Komponen § Sistolik Normal < 120 § Diastolik Normal < 80 § Efek peningkatan TD § Stroke § non-hemoragis § Kontrol Rutin § Diet § Istirahat § Obat

STANDAR TESTING - Promosi Kesehatan Kerja Yang mempengaruhi TD • Fikiran/stress • Makanan • Tingkat pekerjaan • Hipotensi • • Tdk terlalu memberatkan kondisi fisik Aktivitas tinggi TD normal Lebih cocok bidang pekerjaan dinamis Kurang larangan

STANDAR TESTING - Promosi Kesehatan Kerja Pengaruh Fikiran TD • Rangsangan-rangsangan • terkejut, kesal, marah adrenalin m • adrenalin R. S. Simpatis TD • Pengaruh makanan thd TD • Makanan banyak mengandung garam/kolesterol • Kolesterol p’numpukan pd p. Arteri TD

STANDAR TESTING - Promosi Kesehatan Kerja Pengaruh Tingkat pekerjaan • Pekerjaan banyak m’gunakan fikiran • Pekerjaan dgn kerja otot t curah jantung m TD stress otot jantung m TD • Penyebab hipertensi • Idiopatik (tdk diketahui) • Keturunan sering b’hubungan dgn kelainan p. Darah (merupakan faktor endogen) • Penyakit metabolisme • Penyakit ginjal • Sirhosis • Obesitas

STANDAR TESTING - Promosi Kesehatan Kerja Tanda tanda Hipertensi • • Dari gejala-gejala dgn riwayat penyakit Faktor fisik (obesitas) & keturunan Tes cardiovascular endurance step test Tindakan Control TD

STANDAR TESTING - Promosi Kesehatan Kerja Tes cardiovascular endurance step test • Orang normal kenaikan TD setelah tes tercapai 20 -40 mm. Hg • Setelah 10 mnt TD akan menetap/seperti sebelum tes • Orang TD tinggi/berbakat, setelah masa pemulihan 10 mnt kenaikan akan menetap • Tes jarang dilakukan pada medical chek-up • Keterbatasan waktu dan tempat • Olahragawan/ABRI wajib dilakukan tes

STANDAR TESTING - Promosi Kesehatan Kerja Kolesterol Darah & HDL Ratio • Sebagai bagian dari lipida/lemak • Ada tiga macam senyawa lipid • Lemak netral/trigliserida • Fosfolipid • Kolesterol • Lipoprotein Utama • VLDL (very low density lipoprotein) • LDL (low density lipoprotein) • HDL (high density lipoprotein) – VLDL : Konsentrasi trigliserida t & konsentrasi moderat » Fosfolipid & kolesterol – LDL: Konsentrasi trigliserida sedikit sangat tinggi – HDL: 50% protein, sedikit lipid

STANDAR TESTING - Promosi Kesehatan Kerja Konsentrasi Lipoprotein dalam darah • Kolesterol • Fosfolipid • Trigliserida • Lipoprotein 180 mg/100 cc plasma 160 200 7000/100 cc

STANDAR TESTING - Promosi Kesehatan Kerja Kolesterol ? • • Zat lemak yang diproduksi hati Mirip lilin, beredar dalam darah Diperlukan tubuh Bila berlebih timbunan lemak (plak) di dinding p. Darah nadi • Plak m’hambat & m’nyumbat aliran darah serius • Plak di p. Darah j. Koroner serangan jantung • Plak di p. Darah otak stroke

Kolesterol BAIK & JAHAT Kolesterol dalam paket : Lipoprotein HDL Baik HDL Jahat Membersihkan Cenderung kelebihan menumpuk kolesterol pada dalam p. Nadi

Kadar Kolesterol ANDA Ditentukan : • Pola makan • Pola gerak tubuh • Bawaan/familial Kolesterol 10% Risiko PJK 20%

Hasil pemeriksaan Kolesterol di LAB : • < 200 mg/dl Baik • 200 – 239 mg/dl Batas Nilai Normal Waspada bila ada faktor risiko PJK • > 240 mg/dl Sangat Tinggi Ke dokter Olah raga teratur Pola makan sehat Pola hidup sehat

Diet untuk menurunkan kolesterol • Kurangi : • Daging b’lemak dari sapi, kambing, babi Misal : iga, jeroan, buntut, sandung lamur, d. Sup, sosis, ham, ”cold cut” • Susu Full cream, krim • Yogurt susu full cream, keju • Otak, kuning telur, saos k. Telur • Sayuran dgn mentega, krim saus lain • Pie, cake, donat, croissant, pastries, muffins, biskuit, cracker & cookies tinggi lemak • Coklat • Mentega, m. Kelapa/sawit, santan, lemak babi/sapi

Diet untuk menurunkan kolesterol • Anjuran : • Sayuran & buah-buahan • Roti tinggi serat & sereal (gandum) • Pilih ikan, unggas tanpa kulit • Tempe, tahu & kacang-kacangan • Putih telur ( 2 p. Telur = 1 telur utuh) • m. Goreng tdk jenuh ; jagung, b. Matahari, wijen, kedele, m. Kacang, zaitun • Susu skim/rendah lemak, yogurt not fat • Keju rendah lemak • Mayonaise/selai rendah lemak

Gerakan Hidup Sehat (1997) • Hindari makanan b’lemak & B’lebih • Olah Raga Teratur • Tidak Merokok • Kelola Stres Dgn Bijak • Pelihara Keharmonisan RT untuk mencegah AIDS

HEALTH RISK ASSESSMENT FOR CARDIOVASCULAR DISEASE OF EMPLOYEE FOR USE IN STARTING AND EVALUATING HEALTH PROMOTION PROGRAM IN THE WORK PLACE Name : ……………………… NPM …………………. . Date: ………………………

Risk factor of cardiovascular disease Level of risk Established Atherosclerosis 1 & Category of risk factor 4 Yes Note: 3 LDL >190 4 None Dyslipidemia 1 1. 5 2 (fasting blood lipids in mg/dl) LDL Chol. 0 -130 LDL 130 – 159 LDL>160– 190 1. 5 2 1 HDL Chol. >60 1 HDL Chol. : 35 -60 HDL Chol. <35 1. 5 2 Triglyceride 200 -400 Triglyceride > 400 1. 5 BP 120 -139/80 -89 2 BP 140 -159/90 -99 Triglyceride 30 -200 Hypertension 1 BP<120/<80 BP >160 />100 (BP=Blood Pressure) Smoking 1 Never or stopped smoking for > 5 yrs Diabetes Mellitus (fasting glucose in mg/dl) Obesity (BMI= Body Mass Index, kg/m 2) Physical inactivity 1 70 - 110 mg/dl 1 BMI 20, 5 -24. 9 1 61 -100 1. 25 Stopped smoking for = 1. 5 2 or < 5 yrs Current smoker ‘s index: : 1 – 6 Current smoker’s index: : 7 – 11 1. 25 1. 5 2 111 – 125 mg/dl 1. 25 BMI 25 - 29. 9 126 – 200 mg/dl 2. 0 BMI 30 – 34. 9 >200 mg/dl 2. 5 BMI 35 and above 1. 25 1. 5 2 41 -60 21 -40 1 -20 Workaholic 1 None 2 Yes Work stress 1 None 2 Yes Shift Work 1 None 1. 4 Yes

Family history of premature cardiovascular disease 1 Sex/age (F=Female; M=Male : age in years) 1 1 None (F <35 ) (M < 35 ) Environmental chemicals affecting Cardio-Vascular System 1 None or below BEI/TLV TOTAL RISK by multiplying each risk of the above risk factors/ health hazards …………………. (L/M/H/VH) Level of Physical Work Capacity by Bruce protocol in A, B, C, D or E A= High B= Good Ischemic response (ST horizontal’s depression = or > 2 mm on treadmill test) Yes/No Level of Health status A Promotional health in A, B, C, D or E (A the highest) 1. 4 Yes 1. 25 (M: 35 -45 ) (F : 35 – 65 ) 1. 35 (M : > 46 -55 ) 1. 5 (F 1. 5 (M >65 ) >55 ) 2 Yes and above BEI/TLV BEI= Biological Exposure Indices. TLV= Threshold Limit Value Cardiovascula r event…………. , dated………. , at total risk……… ………… C Average D Fair E Low B Asymptomatic health C Serious illness D= Partial permanent Impairme nt E= Total permanent impairme nt

Note: Risk of having a certain characteristic indicates multiplication of probability of suffering from a disease, as compared to a recommended characteristic. A risk of two means the probability is twice, if compared to a risk of one. Since the effect of interaction of several risk factors on single organ of endothelial tissue of blood vessels is synergistic, thus its total risk is counted by multiplying each risk. A total risk below 5 is low risk (L), 5 -10 is moderate (M) , 11 – 20 is high (H), and > 20 is very high (VH). Probability of occurrence of risk condition, i. e. cardiovascular event is 5 to 10 years. Each preventable risk factor should be modified to achieve “standard” (leftist column). The highest status of promotional health is achieved, when total risk is below five and level of Physical Work Capacity (PWC) is A or B. The highest levels of PWC may be achieved if physical activity is moved on long-term basis to reach Physical Activity Index above 40

PRAKTIKUM • Hasil pengukuran: – Berat badan – Tinggi badan – IMT – Kadar lemak tubuh – Tekanan darah (Sfigmomanometer) – Denyut nadi