Epidemiologi Kesehatan Kerja dan Lingkungan. Aria Gusti

Transkripsi

1 Epidemiologi Kesehatan Kerja dan Lingkungan Aria Gusti

2 Learning Objective The student should be able to discuss exposure assessment that are relevant to assessing environmental or occupational hazards in epidemiology. The student should be able to explain the strengths and limitations of epidemiological study designs for evaluating environmental or occupational hazards. The student should be able to identify study designs that are especially relevant to studying environmental or occupational hazards, and explain the rationale for these study designs

3 Environmental Health Whoever wishes to investigate medicine properly should proceed thus: When he comes into a strange city, he ought to consider its situation, how it lies to the wind and the sun, and consider the waters the people use. For if he knows these things well, he cannot miss knowing the diseases peculiar to the place." Hippocrates (340 B.C.)

4 Definition: Environment [Segala] segala sesuatu yang diluar diri manusia sebagai host. [Itu] dapat dipilah menjadi lingkungan fisika, biologi, sosial budaya dimana sebagian atau seluruhnya dapat mempengaruhi status kesehatan di dalam populasi. (WHO, 1995)

5 Definition: Environmental Epidemiology Ilmu yang mempelajari efek dari faktor fisika, biologi dan kimia di lingkungan eksternal terhadap kesehatan manusia, dalam artian luas. Dengan menguji secara spesifik populasi atau komunitas terpapar dengan lingkungan ambien berbeda, adalah upaya untuk mempertegas hubungan antara faktor fisika, kimia dan biologi dengan kesehatan manusia. National Research Council, USA (1991)

6 Definition: Environmental Epidemiology adalah studi atau cabang keilmuan yang mempelajari faktor-faktor lingkungan yang mempengaruhi timbulnya kejadian suatu penyakit, dengan cara mempelajari dan mengukur dinamika hubungan interaktif antara penduduk dengan lingkungan yang memiliki potensi bahaya pada suatu waktu dan kawasan tertentu, untuk upaya promotif lainnya (Achmadi, 1991).

7 Individual Risk and Population Rate Individual: Dose Response Risk: likelihood of effect in the individual based on the dose Population: Exposure Response Risk: proportion of persons with outcome based on the exposure

8 Epidemiologi Lingkungan A. Features and Challenges

9 Classic Environmental Epidemiology Studies Cholera in London and its relationship to water supply location for different households (Snow, 1854) Nuclear bombs at Hiroshima and Nagasaki - studies of radiation effects among bomb survivors Severe air pollution in London led to a epidemic of deaths from heart and lung disease (1952)

10 Classic Environmental Epidemiology Studies Water Supply Number of House Cholera Deadths Deaths per house Southwark & Vauxhall Co Lambeth & co Rest of London

11 Classic Environmental Epidemiology Studies "Minamata disease mengkonsumsi ikan yang terkontaminasi dengan methyl mercury "Itai-Itai disease mengkonsumsi beras yang terkontaminasi dengan cadmium Legionnaires' disease penyakit infeksi yang menyebar melalui sistem ventilasi

12 Disease Group Subgroup Diseases Linked with Environmental Factors Environmental factor Gastrointestinal Diarrheal disease Bacteria and viruses in water/water Cancer Lung Tobacco smoke, metals, radiation Blood cells Hydrocarbons, radiation Soft tissue Hydrocarbons, herbicides Liver Hydrocarbons Urinary tract Certain chemical compounds Respiratory Asthma Climate, particles, ozone Bronchitis Particulate, sulfates Emphysema Smoke, sulfates, ozone Reproductive Malformations Chemical mixtures, solvents Abortions Metals, hydrocarbons Low birth weight Tobacco smoke, chemical mixtures Neurological Development Lead Transmission Lead, organic solvents

13 Epidemiologi Lingkungan features and challenges Mengidentifikasi kerangka sampling dan populasi studi yang cocok di komunitas Exposure assessment Multiple hazards and multi-level risks Hazards sering tidak bisa dikontrol secara individual dan mungkin tidak tercatat Small effects pada populasi yang besar bisa menjadi bermakna, tapi sulit untuk dideteksi

14 Population Attributable Risk: Effect of Relative Risk and Proportion Exposed Large relative risk, small exposed population Small relative risk, Large exposed population Relative Risk 0% 25% 0% 80% Proportion Proportion Exposed Exposed Population

15 Major Steps in Conducting Epidemiological Study Establish objectives and hypotheses Determine study design Establish sampling frame Select study population Measure relevant variables Exposures Health Outcomes Compare populations

16 Typical Sampling Frames for Environmental Studies Community studies Census (select all persons in population jarang digunakan) Multi-level cluster sample (e.g., all households on selected blocks) Schools, workplaces, primary health care, community groups Case-control studies Cases from registry or hospitals; controls by random digit dialing

17 Determining Exposure Status Existing environmental data Questionnaires Recalled exposures Time-activity patterns Environmental monitoring Area sampling, personal monitoring Examination Laboratory tests for biological markers

18 Question?