Holistic Approach Man And
Environment
Dr. Titiek Berniyanti drg.,MKes.
Tujuan Instruksional
• Kompetensi Umum:
At the end of the third semester the student should be
able to conceptualize environment to be an important
factor in the interaction of agent and Host in the
epidemiological or ecological triad, conceptualize the
physical, biological and psychosocial environment
and understand their impact on health, and be
expected to raise awareness about critical need for a
more holistic understanding of the links between
ecosystem wellbeing and Human health.
Objectives
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Bloodborne Pathogens
Statistics
Injury Process
Infection Control
Personal Protective Equipment
Water lines and Water Quality
General Safety (x-ray, laser, physical, drills)
Pandemic Preparedness
Life Expectancy
Determined by:
• Genetics
• Environment
Air
Water
Food / Nutrition
Shelter
Multiple Causation Theory
• “ Disease development does not rest
on a single cause.”
There are 3 models to explain the theory:
1. The Wheel
2. The Web
3. The Ecologic Triad
Ecological Triad
• The three elements of the triad
interact with one another in an
attempt to maintain an equilibrium.
• Any major change in any one of the
factors may bring about a disturbance in
the equilibrium provoking the appearance
of a health problem.
SEGITIGA EPIDEMIOLOGI MUTAKHIR
 Segitiga epidemiologi dalam penyakit menular merupakan dasar
dan landasan untuk semua bidang epidemiologi
Penyakit infeksi tidak lagi menjadi penyebab utama kematian di
negara industri
diperlukan
Model Segitiga Epidemiologi Mutakhir
mencakup semua aspek dalam model penyakit menular
dapat dipakai bersama penyebab kematian, kondisi, gangguan, defek
dan kematian saat ini
dapat mencerminkan penyebab penyakit dan kondisi saat ini
Perlu diperhitungkan
Perilaku, faktor-faktor gaya hidup,penyebab di lingkungan, unsur
ekologi, faktor fisik, penyakit kronis
Agens
• Agens adalah penyebab penyakit.
Bakteri, virus, parasit, jamur atau kapang
ditemukan sebagai penyebab penyakit
infeksius.
Pada penyakit, kondisi ketidak mampuan,
cedera atau kematian lain, agens dapat berupa
faktor kimia seperti pelarut atau solven, faktor
fisik seperti radiasi atau panas, defisiensi Gizi,
atau beberapa substansi lain seperti racun ular
berbisa. Satu atau beberapa agens dapat
berkontribusi dalam satu penyakit.
Penjamu
• Penjamu adalah organisme, biasanya manusia
atau hewan yang menjadi persinggahan
penyakit.Penjamu bisa terkena atau tidak
terkena penyakit.
a.Penjamu memberikan tempat dan kehidup
an pada suatu patogen (Mikroorganisme
penyebab penyakit atau substansi terkait
lainnya.
b.Tingkat imunitas, susunan genetik, tingkat
pajanan, status kesehatan dan kebugaran
tubuh penjamu dapat menentukan efek
yang ditimbulkan organisme penyakit
terhadap tubuh.
Penjamu
c. Kondisi tubuh penjamu dan kemampuan
organisme untuk menerima lingkungan yang
baru juga merupakan penentu, karena
beberapa organisme hanya dapat tumbuh
pada keadaan yang ideal dan terbatas.
Contohnya banyak organisme penyakit
infeksius yang hanya bisa Hidup dalam
rentang tubuh yang sempit.
Lingkungan
• Lingkungan adalah segala sesuatu yang
mengelilingi kita dan juga kondisi luar manusia
atau hewan yang menyebabkan atau
memungkinkan penularan penyakit. Faktor-faktor
lingkungan dapat mencakup:
Aspek biologis
Sosial,
Budaya
Aspek Fisik lingkungan
Sekitar tempat hidup organisme dan efek dari
lingkungan terhadap organisme
Holistic approach man and environment
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Mikroba dan timbulnya penyakit
- Patogenisitas
- Virulensi
- Infeksi
Patogenisitas :kemampuan mikroba untuk menimbulkan penyakit.(mikroba patogen)
Virulensi
: derajat kemampuan mikroba untuk
menyebabkan infeksi,yg. Dinyatakan
dengan jumlah mikroorganisme atau
mikrogram toksin.
Infeksi
:kemampuan mikroba untuk berpenetra
si ke jaringan mengatasi pertahanan
tubuh host (invasi),berkembangbiak dan
menyebar----gejala penyakit
•
Bloodborne Pathogens
OSHA 1910.1030
Definition:
Any pathogenic microorganism that is
present in human blood or other
potentially infectious materials (OPIM)
and can infect and cause disease in
persons who are exposed to blood
containing the pathogen.
Bloodborne Pathogens
Examples of bloodborne pathogens:
 HIV
 HBV
 HCV
 T.
pallidum
 Herpes
 M.
Virus
tuberculosis (typically an aerosol hazard)
 Human
T-lymphotropic Virus Type I (HTLV-I)
Bloodborne Pathogens
Examples of body fluids that can potentially
carry the HIV and HBV viruses:
 Blood
 Semen
and vaginal secretions
 Saliva involved in dental procedures
 Synovial fluids
 Cerebrospinal fluid
 human tissue and cell cultures
 All body fluids containing blood
Transmission
Mucous membrane contact - example splash to
the eyes, nose and/or mouth.
 Percutaneous inoculation - misuse of sharps
(broken glass, needles, etc.)
 Exposure to broken/damaged skin - the risk
increases, if contact involves a large area of the
skin or if contact is prolonged. Risk also
increases with increased HIV titer levels in the
source patient’s blood.

Methylmercury :
In the Body
• Methylmercury exposure in
humans is from
consumption of fish, marine
mammals, and crustaceans
• 95% of fish-derived
methylmercury is absorbed
into the gastrointestinal
tract and distributed
throughout the body
– Highest in concentration in
hair
www.mercury.utah.gov/images/health_effects.jpg
Minamata Disease in the
Nervous System
Areas in red show areas typically affected
by the presence of methylmercury in
the system . The lesions show
characteristic signs and symptoms in
Minamata disease.
1. Gait disturbance, loss of balance
(ataxia), speech disturbance
(Dysarthria)
2. Sight disturbance of peripheral areas
in the visual fields (constriction of
visual fields)
3. Stereo anesthesia (Disturbance of
sensation)
4. Muscle weakness, muscle cramp
(disturbance of movement)
5. Hardness of hearing (hearing
disturbance)
6. Disturbance of sense of pain, touch or
temperature (Disturbance of
sensation)
National institute of Minamata Disease Archives
Symptoms of the Disease
• Mild
–
–
–
–
Ataxia
Muscle weakness
Narrowed field of vision
Hearing and speech
damage
• Severe cases cause
–
–
–
–
Insanity
Paralysis
Coma
Death
W. Eugene Smith
Tomoko Uemura in Her Bath
Minamata, 1972
More Symptoms
• A significant effect of
Minamata is the onset of
symptoms similar to
those of cerebral palsy
• Fetal Minamata Disease
– A pregnant mother ingests
toxic fish and the
methylmercury
concetrates inside the
placenta.
– Harms the fetus while the
mother is relatively
unaffected
http://picasaweb.google.com/jazzyv0504/SA
KURA#5065603192708172658
These are all children with congenital (fetal) Minamata Disease due to
intrauterine methyl mercury poisoning (Harda 1986).
Mercury: The Basics
• Mercury (Hg) is the only metal
that is liquid at room
temperature. It melts at
38.9oC and boils at 356.6oC.
• Mercury conducts electricity,
expands uniformly with
temperature and easily forms
alloys with other metals (called
amalgams).
– For these reasons, it is used in
many products found in homes
and schools.
Mercury Chemistry
• Mercury exists in three
oxidation states:
– Hg0 (elemental mercury).
– Hg22+ (mercurous).
– Hg2+ (mercuric).
• Mercurous and mercuric
form numerous inorganic
and organic chemical
compounds.
– Organic forms of mercury,
especially methyl mercury,
CH3Hg(II)X, where “X” is a
ligand (typically Cl- or OH-) are
the most toxic forms.
Questions???