讲座主题职场心血管疾病之检测与工作危险因子

講座主題:職場心血管疾病之檢測與工作危險因子時間:97/02/22地點:竹科管理局勞工育樂中心第一會議室衛生署桃園醫院職業醫學科林育正醫師職場心血管疾病之檢測與工作危險因子勞工死亡原因統計CVill-healthretirement心血管疾病相關工作危險因子ShiftWorkNoiseRadiationStressJobcategorySubstancesMetabolicSyndromeFattyLiver勞工死亡原因統計CVill-healthretirementAPIHRRof1meansthereisnodifferencebetweentheproportionsofthosefromaclasswhoretiredduetoaparticulardiseasecomparedwiththestandard.ShiftWorkNoiseOSHA:PEL(permissibleexposurelimit):90dBAActionlevelofhearingconservationprogram:85dBAMaximalexposure:115dBAExchangerate:5dBANIOSH:REL(recommendedexposurelimit):85dBAActionlevelofhearingconservationprogram:85dBAMaximalexposure:115dBAExchangerate:5dBA(1972)3dBA(1998)Taiwan:PEL(permissibleexposurelimit):90dBAActionlevelofhearingconservationprogram:85dBAMaximalexposure:140dBAExchangerate:5dBA22RadiationStressJobcategory超時工作輪班工作或夜班工作期限壓力或隨時間變動的工作量靜態性工作多份工作：除正職外另有兼職多變的職務內容或勤務地點海外出差（特別是有時差之出差）需持續高度警戒之工作發生意外或企業改造等突發性之高度緊張事件睡眠時間通勤時間職業引起急性循環系統疾病死亡之前二十四小時仍繼續不斷工作。死亡前一星期每天工作超過十六小時以上。另以每週四十八小時或兩週八十四小時工時以外之時數來計算加班時數：•在發病日前一至六個月間，每月加班超過四十五小時以上。•發病當日往前推算一個月，其加班時間超過一百小時，或發病日往前推二至六月，每月加班累計超過八十小時者。工作時間是判定的重要依據之一，但並非僅考量工作時數對健康的效應，當加班時數並未超過上述時數時，或由於工作狀況不固定而造成加班時數有變動時，此時除了以工作時數作為「量」的考量外，也會配合對工作內容造成的心理負荷來進行「質」的考量以作客觀綜合的判定。Substances二硫化碳二氧化硫氟氯碳化物二氯甲烷一氧化碳硝化甘油砷鉛鎘鹵化溶劑MetabolicSyndrome38LakkaHM,etal.JAMA.2002;288:2709-2716.39AbnormalityDietandphysicalactivityinterventionsPracticaladviceAbdominalobesityReduceweight.Reduceportionsizestolowercalorieintake.Increasephysicalactivity.30minutesofmoderate-intensityexercisedaily40AbnormalityDietandphysicalactivityinterventionsPracticaladviceHypertriglyceridemiaReduceweight.Reduceportionsizestolowercalorieintake.Increasephysicalactivity.30minutesofmoderate-intensityexercisedailyIncreaseintakeoflow-glycemic-indexfoods.Replacerefinedcarbohydrates(whitebread,potatoes,pasta)withlegumes,wholegrains,andmonounsaturatedfats(nuts,avocado,canolaoil,oliveoil).Reducetotalcarbohydrateintake.Replacesodaandjuiceswithwater,seltzer,anddietbeverages.Increaseomega-3fattyacids.Eatfishatleastonceperweek.Limitalcoholconsumption.Limitalcoholtonomorethantwodrinksperdayformen,oronedrinkperdayforwomen.41AbnormalityDietandphysicalactivityinterventionsPracticaladviceLowHDLcholesterollevelReduceweight.Reduceportionsizestolowercalorieintake.Increasephysicalactivity.30minutesofmoderate-intensityexercisedailyIncreaseconsumptionofmonounsaturatedfats.Eatfish,nuts,andavocados.Useoliveorcanolaoilsinsaladdressingandforcooking.Stopsmoking.Joinasmokingcessationprogram.42AbnormalityDietandphysicalactivityinterventionsPracticaladviceHighbloodpressureReduceweight.Reduceportionsizestolowercalorieintake.Increasephysicalactivity.30minutesofmoderate-intensityexercisedailyReducesaturatedfatintake.Chooselow-fatdairyproductsandreduceconsumptionofredmeat,butter,andfull-fatdairyproducts.Reducesodiumintake.Reducesodiumintaketonomorethan2.4gperdayor6gperdayofsaltbyusingmoreherbsincooking;readlabelsforsodiumcontent;skipthesaltshaker.Increaseconsumptionoffruitsandvegetables.Consumemorethanfiveservingsoffruitsandvegetableseveryday.Increaselow-fatdairyproducts.Consumethreeservingsoflow-fatdairyproductsdaily.LimitalcoholconsumptionLimitalcoholtonomorethantwodrinksperdayformenandonedrinkperdayforwomen.43AbnormalityDietandphysicalactivityinterventionsPracticaladviceHighfastingglucoselevelReduceweight.Reduceportionsizestolowercalorieintake.Increasephysicalactivity.30minutesofmoderate-intensityexercisedailyReducetotalcarbohydrateintake;replacecarbohydrateswithmonounsaturatedfat.Replacerefinedgrainswithwholegrains(oatmeal,brownrice,corn,andwholewheat)andmonounsaturatedfats(nuts,avocados,canolaoil,oliveoil).Increasedietaryfiber(morethan30gperday).Addlegumesandfruitforsolublefiber.44EmphasizingReducingfruitssaturatedfatsvegetablesredmeatlow-fatdairyfoodssweetswholegrainssodiumintakepoultrysugar-containingbeveragesfishnuts45KeyclinicalrecommendationStrengthofrecommendationTheAmericanHeartAssociationrecommendsmeasurementofhighlysensitiveC-reactiveproteinforriskstratificationinpatientsathighriskofcardiovasculardisease.CEvidencefromalargeandsmalltrialshowedthatalow-sodiumdiethelpstomaintainlowerbloodpressurefollowingwithdrawalofantihypertensivemedications.AResultsfromclinicaltrialsoflow-fatdietsinwhichparticipantswereinvolvedformorethantwoyearsshowedsignificantreductionsintherateofcardiovasculareventsandsuggestedprotectionfromtotalmortality.ATheU.S.PreventiveServicesTaskForcerecommendsintensivebehavioraldietarycounselingforadultpatientswithknownriskfactorsforcardiovasculardisease.B46Estimateof10-yearriskformen(Framinghampointscores)Age(yr)20-3435-3940-4445-4950-5455-5960-6465-6970-7475-791.Age-9-40368101112132.Totalcholesterol1600000000000160-1994433221100200-2397755331100240-2799966442211≧2801111885533113.Smokenon-smoker0000000000smoker88553311114.HDL(mg/dL)≧60-1-1-1-1-1-1-1-1-1-150-59000000000040-491111111111＜4022222222225.SystolicBP(mmHg)untreated＜1200000000000120-1290000000000130-1391111111111140-1591111111111≧1602222222222treated＜1200000000000120-1291