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1、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CV ill-health retirement心血管疾病相關工作危險因子Shift WorkNoiseRadiationStressJob categorySubstancesMetabolic SyndromeFatty Liver,勞工死亡原因統計,CV ill-health retirement,心血管疾病相關工作危險因子Prevalent,A PIHRR of 1 means there i
2、s no difference between the proportions of those from a class who retired due to a particular disease compared with the standard.,心血管疾病相關工作危險因子,Shift Work,心血管疾病工作危險因子Shifting,Noise,心血管疾病工作危險因子Noise,心血管疾病工作危險因子Noise,心血管疾病工作危險因子Noise,台灣與美國相關法規之比較,OSHA: PEL(permissible exposure limit):90 dBA Action lev
3、el of hearing conservation program : 85 dBA Maximal exposure : 115 dBA Exchange rate: 5 dBA NIOSH: REL(recommended exposure limit):85 dBA Action level of hearing conservation program : 85 dBA Maximal exposure : 115 dBA Exchange rate : 5 dBA (1972) 3 dBA (1998) Taiwan: PEL(permissible exposure limit)
4、:90 dBA Action level of hearing conservation program : 85 dBA Maximal exposure : 140 dBA Exchange rate : 5 dBA,22,Radiation,心血管疾病工作危險因子Radiation,Stress,心血管疾病工作危險因子Stress,Job category,心血管疾病工作危險因子Job category,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
5、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,工作時間,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。
6、,Substances,具有心臟毒性的化學物質,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,Metabolic Syndrome,38,心血管疾病與代謝症候群,Lakka HM, et al. JAMA. 2002;288:2709-2716.,39,代謝症候群之治療,40,代謝症候群之治療,41,代謝症候群之治療,42,代謝症候群之治療,43,代謝症候群之治療,44,代謝症候群之治療 Dietary Approaches to Stop Hypertension (DASH),45,代謝症候群之治療,46,47,48,49,代謝症候群之治療Framingham poin
7、t score,High risk：10%Moderate risk：5-10%Low risk：4%,Fatty Liver,Fatty liver and uric acid levels predict incident coronary heart disease but not stroke among atomic bomb survivors in Nagasaki. Hypertens Res. 2007 Sep;30(9):823-9.Fatty liver now, diabetes and heart attack later? The liver as a barome
8、ter of metabolic health. J Gastroenterol Hepatol. 2007 Jul;22(7):967-9.,Non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease: an open question. Nutr Metab Cardiovasc Dis. 2007 Nov;17(9):684-98. Epub 2007 Jun 7. The presence of NAFLD should always be looked for in subjects with featur
9、es belonging to the metabolic syndromeNonalcoholic fatty liver disease and cardiovascular disease risk.Curr Diab Rep. 2007 Jun;7(3):181-7. Evidence is now accumulating that NAFLD may serve as a predictor of cardiovascular disease. Long-term outcome studies need to establish whether treatment of NAFL
10、D will affect the long-term outcome.,Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patientsNonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetes Care. 2007This relationship is independent of classical risk factors and is only partly explained by occurrence of metabolic syndrome.,Thanks for Your Attention,
