DR.Robiana Modjo, SKM, MKes 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 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 pArteri TD

STANDAR TESTING - Promosi Kesehatan Kerja Pengaruh Tingkat pekerjaan TD Pekerjaan banyak m’gunakan fikiran stress Pekerjaan dgn kerja otot t otot jantung m curah jantung m TD Penyebab hipertensi Idiopatik (tdk diketahui) Keturunan sering b’hubungan dgn kelainan pDarah (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

Tes cardiovascular endurance step test STANDAR TESTING - Promosi Kesehatan Kerja Tes cardiovascular endurance step test Orang normal kenaikan TD setelah tes tercapai 20-40 mmHg 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 180 mg/100 cc plasma Fosfolipid 160 Trigliserida 160 Lipoprotein 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 pDarah nadi Plak m’hambat & m’nyumbat aliran darah serius Plak di pDarah jKoroner serangan jantung Plak di pDarah otak stroke

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

Kadar Kolesterol ANDA Ditentukan : Pola makan Pola gerak tubuh Bawaan/familial Kolesterol Risiko PJK 10% 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, dSup, sosis, ham,”cold cut” Susu Full cream, krim Yogurt susu full cream, keju Otak, kuning telur, saos kTelur Sayuran dgn mentega, krim saus lain Pie, cake, donat, croissant, pastries, muffins, biskuit, cracker & cookies tinggi lemak Coklat Mentega, mKelapa/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 ( 2pTelur = 1 telur utuh) mGoreng tdk jenuh ; jagung, bMatahari, wijen, kedele,mKacang, 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:………………………………………………

Name :……………………………………………Employee number ……………… HEALTH RISK ASSESSMENT FOR CARDIOVASCULAR DISEASE OF EMPLOYEE FOR USE IN STARTING AND EVALUATING HEALTH PROMOTION PROGRAM IN THE WORK PLACE Name :……………………………………………Employee number ……………… Dept:……………………………………………...Date:………… Risk factor of cardiovascular disease Level of risk & Category of risk factor Established Atherosclerosis 1 None   4 Yes Note: Dyslipidemia (fasting blood lipids in mg/dl) LDL Chol. 0-130 HDL Chol. >60 Triglyceride 30-200 1.5 LDL 130 – 159 HDL Chol.: 35-60 Triglyceride 200-400 2 LDL>160–190 HDL Chol. <35 Triglyceride > 400 3 LDL >190 Hypertension (BP=Blood Pressure) 1 BP<120/<80 1.5 BP120-139/80-89 2BP140-159/90-99 BP >160 />100 Smoking Never or stopped smoking for > 5 yrs 1.25 Stopped smoking for = or < 5 yrs Current smoker ‘s index: : 1 –6 Current smoker’s index: : 7 – 11 Diabetes Mellitus (fasting glucose in mg/dl) 70 - 110 mg/dl 111 – 125 mg/dl 126 – 200 mg/dl >200 mg/dl Obesity (BMI= Body Mass Index, kg/m2) BMI 20,5-24.9 BMI 25- 29.9 2.0 BMI 30 –34.9 2.5 BMI 35 and above Physical inactivity 61-100 41-60 21-40 1-20 Workaholic Work stress Shift Work 1None 1.4Yes

Family history of premature cardiovascular disease 1 None 1.4 Yes Sex/age (F=Female; M=Male : age in years) 1 (F <35 ) 1 (M < 35 ) 1.25 1.25 (M: 35-45 ) (F : 35 – 65 ) 1.35 (M : > 46-55 ) 1.5 (F >65 ) 1.5 (M >55 ) Environmental chemicals affecting Cardio-Vascular System None or below BEI/TLV 2 Yes and above BEI/TLV BEI= Biological Exposure Indices. TLV= Threshold Limit Value TOTAL RISK by multiplying each risk of the above risk factors/ health hazards …………………. (L/M/H/VH) Cardiovascular event…………., dated……….,at total risk……… ………… Level of Physical Work Capacity by Bruce protocol in A,B,C,D or E A= High B= Good C Average D Fair E Low   Ischemic response (ST horizontal’s depression = or > 2 mm on treadmill test) Yes/No Level of Health status (A the highest) A Promotional health B Asymptomatic health Serious illness D= Partial permanent Impairment E= Total permanent impairment

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

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