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Introduction

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Cardiovascular diseases (CVDs) are among the most common causes of illness and death in the working population, particularly in industrialized countries. They are also increasing in developing countries (Wielgosz 1993). In the industrialized countries, 15 to 20% of all working people will suffer from a cardiovascular dis- order sometime during their working lives and the frequency climbs sharply with age. Among those between 45 to 64 years of age, more than a third of the deaths among men and more than a quarter of deaths among women are caused by this group of diseases (see table 1). In recent years, CVDs have become the most frequent cause of death among post-menopausal women.

Table 1. Mortality from cardiovascular diseases in 1991 and 1990 in the age groups 45-54 and 55-64 for selected countries.

Country

Men

Women

 

45-54 Years

55-64 Years

45-54 Years

55-64 Years

 

Rate

%

Rate

%

Rate

%

Rate

%

Russia**

528

36

1,290

44

162

33

559

49

Poland**

480

38

1,193

45

134

31

430

42

Argentina*

317

40

847

44

131

33

339

39

Britain**

198

42

665

47

59

20

267

32

USA*

212

35

623

40

83

24

273

31

Germany**

181

29

597

38

55

18

213

30

Italy*

123

27

404

30

41

18

148

25

Mexico**

128

17

346

23

82

19

230

24

France**

102

17

311

22

30

12

94

18

Japan**

111

27

281

26

48

22

119

26

*1990. **1991. Rate=Deaths per 100,000 inhabitants. % is from all causes of death in the age group.

Because of their complex aetiology, only a very small pro- portion of the cases of cardiovascular disease are recognized as occupational. Many countries, however, recognize that occu- pational exposures contribute to CVDs (sometimes referred to as work-related diseases). Working conditions and job demands play an important role in the multifactorial process that leads to these diseases, but ascertaining the role of the individual causal com- ponents is very difficult. The components interact in close, shifting relationships and often the disease is triggered by a combination or accumulation of different causal factors, including those that are work related.

The reader is referred to the standard cardiology texts for details of the epidemiology, pathophysiology, diagnosis and treatment of cardiovascular diseases. This chapter will focus on those aspects of cardiovascular disease that are particularly relevant in the workplace and are likely to be influenced by factors in the job and work environment.

 

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Contents

Cardiovascular System References

Acha, P and B Szyfres. 1980. Zoonoses and Communicable Diseases Common to Man and Animals. Washington, DC: Regional Office of the WHO.

al-Eissa, YA. 1991. Acute rheumatic fever during childhood in Saudi Arabia. Ann Trop Paediat 11(3):225-231.

Alfredsson, L, R Karasek, and T Theorell. 1982. Myocardial infarction risk and psychosocial work environment: An analysis of male Swedish working force. Soc Sci Med 16:463-467.

Alfredsson, L, C-L Spetz, and T Theorell. 1985. Type of occupation and near-future hospitalization for myocardial infarction (MI) and some other diagnoses. Int J Epidemiol 14:378-388.

Altura, BM. 1993. Extraaural effects of chronic noise exposure on blood pressure, microcirculation and electrolytes in rats: Modulation by Mg2+. In Lärm und Krankheit [Noise and Disease], edited by H Ising and B Kruppa. Stuttgart: Gustav Fischer.

Altura, BM, BT Altura, A Gebrewold, H Ising, and T Gunther. 1992. Noise-induced hypertension and magnesium in rats: Relationship to microcirculation and calcium. J Appl Physiol 72:194-202.

American Industrial Hygiene Association (AIHA). 1986. Biohazards—Reference Manual. Akron, Ohio: AIHA.

Arribada, A, W Apt, X Aguilera, A Solari, and J Sandoval. 1990. Chagas cardiopathy in the first region of Chile. Clinical, epidemiologic and parasitologic study. Revista Médica de Chile 118(8):846-854.

Aro, S and J Hasan. 1987. Occupational class, psychosocial stress and morbidity. Ann Clin Res 19:62-68.

Atkins, EH and EL Baker. 1985. Exacerbation of coronary artery disease by occupational carbon monoxide exposure: A report of two fatalities and a review of the literature. Am J Ind Med 7:73-79.

Azofra, J, R Torres, JL Gómez Garcés, M Górgolas, ML Fernández Guerrero, and M Jiménez Casado. 1991. Endocarditis por erysipelothrix rhusiopathiae. Estudio de due casos y revisión de la literatura [Endocarditis for erysipelothrix rhusiopathiae. Study of two cases and revision of the literature]. Enfermedades Infecciosas y Microbiologia Clinica 9(2):102-105.

Baron, JA, JM Peters, DH Garabrant, L Bernstein, and R Krebsbach. 1987. Smoking as a risk factor in noise-induced hearing loss. J Occup Med 29:741-745.

Bavdekar, A, M Chaudhari, S Bhave, and A Pandit. 1991. Ciprofloxacin in typhoid fever. Ind J Pediatr 58(3):335-339.

Behymer, D and HP Riemann. 1989. Coxiella burnetii infection (Q-fever). J Am Vet Med Assoc 194:764-767.

Berlin, JA and GA Colditz. 1990. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 132:612-628.

Bernhardt, JH. 1986. Biological Effects of Static and Extremely Low Frequency Magnetic Fields. Munich: MMV Medizin Verlag.

—. 1988. The establishment of frequency dependent limits for electric and magnetic fields and evaluation of indirect effects. Radiat Environ Biophys 27: 1-27.

Beschorner, WE, K Baughman, RP Turnicky, GM Hutchins, SA Rowe, AL Kavanaugh-McHugh, DL Suresch, and A Herskowitz. 1990. HIV-associated myocarditis pathology and immunopathology. Am J Pathol 137(6):1365-1371.

Blanc, P, P Hoffman, JF Michaels, E Bernard, H Vinti, P Morand, and R Loubiere. 1990. Cardiac involvement in carriers of the human immunodeficiency virus. Report of 38 cases. Annales de cardiologie et d’angiologie 39(9):519-525.

Bouchard, C, RJ Shephard, and T Stephens. 1994. Physical Activity, Fitness and Health. Champaign, Ill: Human Kinetics.

Bovenzi, M. 1990. Autonomic stimulation and cardiovascular reflex activity in the hand-arm-vibration syndrome. Kurume Med J 37:85-94.

Briazgounov, IP. 1988. The role of physical activity in the prevention and treatment of noncommunicable diseases. World Health Stat Q 41:242-250.

Brouqui, P, HT Dupont, M Drancourt, Y Berland, J Etienne, C Leport, F Goldstein, P Massip, M Micoud, A Bertrand 1993. Chronic Q fever. Ninety-two cases from France, including 27 cases without endocarditis. Arch Int Med 153(5):642-648.

Brusis, OA and H Weber-Falkensammer (eds). 1986. Handbuch der Koronargruppenbetreuung
[Handbook of Coronary Group Care]. Erlangen: Perimed.

Carter, NL. 1988. Heart rate and blood pressure response in medium artillery gun crews. Med J Austral 149:185-189.

Centers for Disease Control and Prevention. 1993. Public health focus: Physical activity and the prevention of coronary heart disease. Morb Mortal Weekly Rep 42:669-672.

Clark, RP and OG Edholm. 1985. Man and his Thermal Environment. London: Edward Arnold.

Conolly, JH, PV Coyle, AA Adgey, HJ O’Neill, and DM Simpson. 1990. Clinical Q-fever in Northern Ireland 1962-1989. Ulster Med J 59(2):137-144.

Curwen, M. 1991. Excess winter mortality: A British phenomenon? Health Trends 22:169-175.
Curwen, M and T Devis. 1988. Winter mortality, temperature and influenza: Has the relationship changed in recent years? Population Trends 54:17-20.

DeBacker, G, M Kornitzer, H Peters, and M Dramaix. 1984. Relation between work rhythm and coronary risk factors. Eur Heart J 5 Suppl. 1:307.

DeBacker, G, M Kornitzer, M Dramix, H Peeters, and F Kittel. 1987. Irregular working hours and lipid levels in men. In Expanding Horizons in Atherosclerosis Research, edited by G Schlierf and H Mörl. Berlin: Springer.

Dökert, B. 1981. Grundlagen der Infektionskrankheiten für medizinische Berufe [Fundamentals of Infectious Diseases for the Medical Profession]. Berlin: Volk und Wissen.

Douglas, AS, TM Allan, and JM Rawles. 1991. Composition of seasonality of disease. Scott Med J 36:76-82.

Dukes-Dobos, FN. 1981. Hazards of heat exposure. Scand J Work Environ Health 7:73.

Dupuis, H and W Christ. 1966. On the vibrating behavior of the stomach under the influence of sinusoidal and stochastic vibration. Int J Appl Physiol Occup Physiol 22:149-166.

Dupuis, H and G Zerlett. 1986. The Effects of Whole-Body Vibration. Berlin: Springer.

Dupuis, H, E Christ, DJ Sandover, W Taylor, and A Okada. 1993. Proceedings of 6th International Conference on Hand-Arm Vibration, Bonn, Federal Republic of Germany, May 19-22, 1992. Essen: Druckzentrum Sutter & Partner.

Edwards, FC, RI McCallum, and PJ Taylor. 1988. Fitness for Work: The Medical Aspects. Oxford: Oxford Univ. Press.

Eiff, AW v. 1993. Selected aspects of cardiovascular responses to acute stress. Lärm und Krankheit [Noise and Disease], edited by H Ising and B Kruppa. Stuttgart: Gustav Fischer.

Fajen, J, B Albright, and SS Leffingwell. 1981. A cross-sectional medical and industrial hygiene survey of workers exposed to carbon disulfide. Scand J Work Environ Health 7 Suppl. 4:20-27.

Färkkilä, M, I Pyykkö, and E Heinonen. 1990. Vibration stress and the autonomic nervous system. Kurume Med J 37:53-60.

Fisher, LD and DC Tucker. 1991. Air jet noise exposure rapidly increases blood pressure in young borderline hypertensive rats. J Hypertension 9:275-282.

Frauendorf, H, U Kobryn, and W Gelbrich. 1992. [Circulatory reactions to physical strains of noise effects relevant to occupational medicine (in German)]. In Arbeitsmedizinische Aspekte der Arbeits (-zeit) organisation [Occupational Medical Aspects of the Organization of the Workplace and Working Time], edited by R Kreutz and C Piekarski. Stuttgart: Gentner.

Frauendorf, H, U Kobryn, W Gelbrich, B Hoffman, and U Erdmann. 1986. [Ergometric examinations on the different muscle groups and their effects on heart beat frequency and blood pressure (in German).] Zeitschrift für klinische Medizin 41:343-346.

Frauendorf, H, G Caffier, G Kaul, and M Wawrzinoszek. 1995. Modelluntersuchung zur Erfassung und Bewertung der Wirkung kombinierter physischer und psychischer Belastungen auf Funktionen des Herz-Kreislauf-Systems (Schlußbericht) [Model Research on the Consideration and Assessment of the Effects of Combined Physical and Psychic Stresses on the Functions of the Cardiovascular System
(Final Report)]. Bremerhaven: Wirtschaftsverlag NW.

Fritze, E and KM Müller. 1995. Herztod und akuter Myokardinfarkt nach psychischen oder physischen Belastungen—Kausalitätsfragen und Versicherungsrecht. Versicherungsmedizin 47:143-147.

Gamberale, F. 1990. Physiological and psychological effects of exposure to extremely low-frequency and magnetic fields on humans. Scand J Work Environ Health 16 Suppl. 1:51-54.

Gemne, G. 1992. Pathophysiology and pathogenesis of disorders in workers using hand-held vibrating tools. In Hand-Arm Vibration: A Comprehensive Guide for Occupational Health Professionals, edited by PL Pelmear, W Taylor, and DE Wasserman. New York: Van Nostrand Reinhold.
—. 1994. Where is the research frontier for hand-arm vibration? Scand J Work Environ Health 20, special issue:90-99.

Gemne, G and W Taylor. 1983. Hand-arm vibration and the central autonomic nervous system. Proceedings of International Symposium, London, 1983. J Low Freq Noise Vib special issue.

Gierke, HE and CS Harris. 1990. On the potential association between noise exposure and cardiovascular disease. In Noise As a Public Health Problem, edited by B Berglund and T Lindvall. Stockholm: Swedish Council for Building Research.

Glantz, SA and WW Parmley. 1995. Passive smoking and heart disease. JAMA 273:1047-1053.

Glasgow, RE, JR Terborg, JF Hollis, HH Severson, and MB Shawn. 1995. Take Heart: Results from the initial phase of a work site wellness program. Am J Public Health 85: 209-216.

Gomel, M, B Oldenberg, JM Sumpson, and N Owen. 1993. Work site cardiovascular risk reduction: A randomized trial of health risk assessment, education, counseling and incentives. Am J Public Health 83:1231-1238.

Gordon, DJ, J Hyde, and DC Trost. 1988. Cyclic seasonal variation in plasma lipid and lipoprotein levels: The Lipid Research Clinics Coronary Primary Prevention Trial placebo group. J Clin Epidemiol 41:679-689.

Griffin, MJ, 1990. Handbook of Human Vibration. London: Academic.

Gross, R, D Jahn, and P Schölmerich (eds). 1970. Lehrbuch der Inneren Medizin [Textbook of Internal Medicine]. Stuttgart: Schattauer.

Gross, D, H Willens, and St Zeldis. 1981. Myocarditis in Legionnaire’s disease. Chest 79(2):232-234.

Halhuber, C and K Traencker (eds). 1986. Die Koronare Herzkrankheit—eine Herausforderung an Politik und Gesellschaft [Coronary Heart Disease—A Political and Social Challenge]. Erlangen: Perimed.

Härenstam, A, T Theorell, K Orth-Gomer, U-B Palm, and A-L Unden. 1987. Shift work, decision latitude and ventricular ectopic activity: A study of 24-hour electrocardiograms in Swedish prison personnel. Work Stress 1:341-350.

Harris, JS. 1994. Health promotion in the workplace. In Occupational Medicine, edited by C Zenz. St. Louis: Mosby.

Harrison, DW and PL Kelly. 1989. Age differences in cardiovascular and cognitive performance under noise conditions. Perceptual and Motor Skills 69:547-554.

Heinemann, L. 1993. MONICA East Germany Data Book. Berlin: ZEG.

Helmert, U, S Shea, and U Maschewsky-Schneider. 1995. Social class and cardiovascular disease risk factor changes in West Germany 1984-1991. Eur J Pub Health 5:103-108.

Heuchert, G and G Enderlein. 1994. Occupational registers in Germany—diversity in approach and setout. In Quality Assurance of Occupational Health Services. Bremerhaven: Wirtschaftsverlag NW.
Higuchi, M de L, CF DeMorais, NV Sambiase, AC Pereira-Barretto, G Bellotti, and F Pileggi. 1990. Histopathological criteria of myocarditis—A study based on normal heart, chagasic heart and dilated cardiomyopathy. Japan Circul J 54(4):391-400.

Hinderliter, AL, AF Adams, CJ Price, MC Herbst, G Koch, and DS Sheps. 1989. Effects of low-level carbon monoxide exposure on resting and exercise-induced ventricular arrhythmias in patients with coronary artery disease and no baseline ectopy. Arch Environ Health 44(2):89-93.

Hofmann, F (ed). 1993. Infektiologie—Diagnostik Therapie Prophylaxe—Handbuch und Atlas für Klinik und Praxis [Infectology—Diagnostic Therapy Prophylaxis—Handbook and Atlas for Clinic and Practice]. Landsberg: Ecomed.

Ilmarinen, J. 1989. Work and cardiovascular health: Viewpoint of occupational physiology. Ann Med 21:209-214.

Ising, H and B Kruppa. 1993. Lärm und Krankheit [Noise and Disease]. Proceedings of the International Symposium “Noise and Disease”, Berlin, September 26-28, 1991. Stuttgart: Gustav Fischer.

Janssen, H. 1991. Zur Frage der Effektivität und Effizienz betrieblicher Gesundheitsförderung—Ergebnisse einer Literatur recherche [On the question of the effectiveness and efficiency of company health research—Results of a literature search]. Zeitschrift für Präventivmedizin und Gesundheitsförderung 3:1-7.

Jegaden, D, C LeFuart, Y Marie, and P Piquemal. 1986. Contribution à l’étude de la relation bruit-hypertension artérielle à propos de 455 marins de commerce agés de 40 à 55 ans. Arch mal prof (Paris) 47:15-20.

Kaji, H, H Honma, M Usui, Y Yasuno, and K Saito. 1993. Analysis of 24 cases of Hypothenar Hammer Syndrome observed among vibration exposed workers. In Proceedings of 6th International Conference on Hand-Arm-Vibration, edited by H Dupuis, E Christ, DJ Sandover, W Taylor, and A Okade. Essen: Druckzentrum Sutter.

Kannel, WB, A Belanger, R D’Agostino, and I Israel. 1986. Physical activity and physical demand on the job and risk of cardiovascular disease and death: The Framingham Study. Am Heart J 112:820-825.

Karasek, RA and T Theorell. 1990. Healthy Work. New York: Basic Books.

Karnaukh, NG, GA Petrow, CG Mazai, MN Zubko, and ER Doroklin. 1990. [The temporary loss of work capacity in workers in the hot shops of the metallurgical industry due to disease of the circulatory organs (in Russian)]. Vracebnoe delo 7:103-106.

Kaufmann, AF and ME Potter. 1986. Psittacosis. Occupational Respiratory Diseases, edited by JA Merchant. Publication No. 86-102. Washington, DC: NIOSH.

Kawahara, J, H Sano, H Fukuzaki, H Saito, and J Hirouchi. 1989. Acute effects of exposure to cold on blood pressure, platelet function and sympathetic nervous activity in humans. Am J Hypertension 2:724-726.

Keatinge, WR, SRW Coleshaw, JC Eaton et al. 1986. Increased platelet and red cell counts, blood viscosity and plasma cholesterol levels during heat stress, and mortality from coronary and cerebral thrombosis. Am J Med 81: 795-800.

Khaw, K-T. 1995. Temperature and cardiovascular mortality. Lancet 345: 337-338.

Kleinman, MT, DM Davidson, RB Vandagriff, VJ Caiozzo, and JL Whittenberger. 1989. Effects of short-term exposure to carbon monoxide in subjects with coronary artery disease. Arch Environ Health 44(6):361-369.

Kloetzel, K, AE deAndrale, J Falleiros, JC Pacheco. 1973. Relationship between hypertension and prolonged exposure to heat. J Occup Med 15: 878-880.

Knave, B. 1994. Electric and magnetic fields and health outcomes—an overview. Scand J Work Environ Health 20, special issue: 78-89.

Knutsson, A. 1989. Relationships between serum triglycerides and gamma-glutamyltransferase among shift and day workers. J Int Med 226:337-339.

Knutsson, A, T Åkerstedt, BG Jonsson, and K Orth-Gomer. 1986. Increased risk of ischemic heart disease in shift workers. Lancet 2:89-92.

Kornhuber, HH and G Lisson. 1981. Bluthochdruck—sind Industriestressoren, Lärm oder Akkordarbeit wichtige Ursachen? Deutsche medizinische Wochenschrift 106:1733-1736.

Kristensen, TS. 1989. Cardiovascular diseases and the work environment. Scand J Work Environ Health 15:245-264.

—. 1994. Cardiovascular disease and the work environment. In Encyclopedia of Environmental Control Technology, edited by PN Cheremisinoff. Houston: Gulf.

—. 1995. The demand-control-support model: Methodological challenges for future research. Stress Medicine 11:17-26.

Kunst, AE, CWN Looman, and JP Mackenbach. 1993. Outdoor air temperature and mortality in the Netherlands: A time series anlaysis. Am J Epidemiol 137:331-341.

Landsbergis, PA, SJ Schurman, BA Israel, PL Schnall, MK Hugentobler, J Cahill, and D Baker. 1993. Job stress and heart disease: Evidence and strategies for prevention. New Solutions :42-58.

Lavie, P, N Chillag, R Epstein, O Tzischinsky, R Givon, S Fuchs and B Shahal. 1989. Sleep disturbance in shift-workers: As marker for maladaptation syndrome. Work Stress 3:33-40.

Lebedeva, NV, ST Alimova, and FB Efendiev. 1991. [Study of mortality among workers exposed to heating microclimate (in Russian)]. Gigiena truda i professionalnye zabolevanija 10:12-15.

Lennernäs, M, T Åkerstedt, and L Hambraeus. 1994. Nocturnal eating and serum cholesterol of three-shift workers. Scand J Work Environ Health 20:401-406.

Levi, L. 1972. Stress and distress in response to psychosocial stimuli. Acta Med Scand Suppl. 528.

—. 1983. Stress and coronary heart disease—causes, mechanisms, and prevention. Act Nerv Super 25:122-128.

Lloyd, EL. 1991. The role of cold in ischaemic heart disease: A review. Public Health 105:205-215.

Mannebach, H. 1989. [Have the last 10 years improved the chances for preventing coronary heart disease? (in German)]. J Prev Med Health Res 1:41-48.

Marmot, M and T Theorell. 1991. Social class and cardiovascular disease: The contribution of work. In The Psychosocial Work Environment, edited by TV Johnson and G Johannson. Amityville: Baywood.

Marshall, M and P Bilderling. 1984. [The Hypothenar-Hammer syndrome, and important differential diagnosis on vibration-related white-finger disease (in German)]. In Neurotoxizität von Arbeitsstoffen. Kausalitätsprobleme beim Berufskrebs. Vibration. [Neurotoxicity from Workplace Substances. Causality Problems with Occupational Cancer], edited by H Konietzko and F Schuckmann. Stuttgart: Gentner.

Michalak, R, H Ising, and E Rebentisch. 1990. Acute circulatory effects of military low altitude flight noise. Int Arch Occup Environ Health 62:365-372.

Mielck, A. 1994. Krankheit und soziale Ungleichheit. Opladen: Leske & Budrich.

Millar, K and MJ Steels. 1990. Sustained peripheral vasoconstriction while working in continuous intense noise. Aviat Space Environ Med 61:695-698.

Mittleman, MA, M Maclure, GH Tofler, JB Sherwood, RJ Goldberg, and JE Muller. 1993. Triggering of acute myocardial infarction by heavy physical exertion. New Engl J Med 329:1677-1683.
Morris, JN, JA Heady, and PAB Raffle. 1956. Physique of London busmen: Epidemiology of uniforms. Lancet 2:569-570.

Morris, JN, A Kagan, DC Pattison, MJ Gardner, and PAB Raffle. 1966. Incidence and prediction of ischaemic heart-disease in London busmen. Lancet 2:553-559.

Moulin, JJ, P Wild, B Mantout, M Fournier-Betz, JM Mur, and G Smagghe. 1993. Mortality from lung cancer and cardiovascular diseases among stainless-steel producing workers. Cancer Causes Control 4:75-81.

Mrowietz, U. 1991. Klinik und Therapie der Lyme-Borreliose. Informationen über Infektionen [Clinic and Therapy of Lyme-Borreliosis. Information on Infections—Scientific Conference, Bonn, June 28-29, 1990]. Basel: Editiones Roches.

Murza, G and U Laaser. 1990, 1992. Hab ein Herz für Dein Herz [Have a Heart for Your Heart]. Gesundheitsförderung [Health research]. Vol. 2 and 4. Bielefeld: IDIS.

National Heart, Lung and Blood Institute. 1981. Control for Blood Pressure in the Work Setting, University of Michigan. Washington, DC: US Government Printing Office.

Neild, PJ, P Syndercombe-Court, WR Keatinge, GC Donaldson, M Mattock, and M Caunce. 1994. Cold-induced increases in erythrocyte count, plasma cholesterol and plasma fibrinogen of elderly people without a comparable rise in protein C or factor X. Clin Sci Mol Med 86:43-48.

Nurminen, M and S Hernberg. 1985. Effects of intervention on the cardiovascular mortality of workers exposed to carbon disulphide: A 15 year follow up. Brit J Ind Med 42:32-35.

Olsen, N. 1990. Hyperreactivity of the central sympathetic nervous system in vibration-induced white finger. Kurume Med J 37:109-116.

Olsen, N and TS Kristensen. 1991. Impact of work environment on cardiovascular diseases in Denmark. J Epidemiol Community Health 45:4-10.

Orth-Gomer, K. 1983. Intervention on coronary risk factors by adapting a shift work schedule to biologic rhythmicity. Psychosom Med 45:407-415.

Paffenbarger, RS, ME Laughlin, AS Gima, and RA Black. 1970. Work activity of longshoremen as related to death from coronary heart disease and stroke. New Engl J Med 282:1109-1114.

Pan, W-H, L-A Li, and M-J Tsai. 1995. Temperature extremes and mortality from coronary heart disease and cerebral infarction in elderly Chinese. Lancet 345:353-355.

Parrot, J, JC Petiot, JP Lobreau, and HJ Smolik. 1992. Cardiovascular effects of impulse noise, road traffic noise, and intermittent pink noise at LAeq=75 dB, as a function of sex, age and level of anxiety: A comparative study. Int Arch Occup Environ Health 63:477-484;485-493.

Pate, RR, M Pratt, SN Blair, WL Haskell, et al. 1995. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 273:402-407.

Pelmear, PL, W Taylor, and DE Wasserman (eds). 1992. Hand-Arm Vibration: A Comprehensive Guide for Occupational Health Professionals. New York: Van Nostrand Reinhold.

Petiot, JC, J Parrot, JP Lobreau, and JH Smolik. 1988. Individual differences in cardiovascular responses to intermittent noise in human females. Int J Psychophysiol 6:99-109;111-123.

Pillsburg, HC. 1986. Hypertension, hyperlipoproteinemia, chronic noise exposure: Is there synergism in cochlear pathology? Laryngoscope 96:1112-1138.

Powell, KE, PD Thompson, CJ Caspersen, and JS Kendrick. 1987. Physical activity and the incidence of coronary heart disease. Ann Rev Pub Health 8:253-287.

Rebentisch, E, H Lange-Asschenfeld, and H Ising (eds). 1994. Gesundheitsgefahren durch Lärm: Kenntnisstand der Wirkungen von arbeitslärm, Umweltlärm und lanter Musik [Health Hazards from Noise: State of the Knowledge of the Effects of Workplace Noise, Environmental Noise, and Loud Music]. Munich: MMV, Medizin Verlag.

Redmond, CK, J Gustin, and E Kamon. 1975. Long-term mortality experience of steelworkers: VIII. Mortality patterns of open hearth steelworkers. J Occup Med 17:40-43.

Redmond, CK, JJ Emes, S Mazumdar, PC Magee, and E Kamon. 1979. Mortality of steelworkers employed in hot jobs. J Environ Pathol Toxicol 2:75-96.

Reindell, H and H Roskamm (eds). 1977. Herzkrankheiten: Pathophysiologie, Diagnostik, Therapie
[Heart Diseases: Pathophysiology, Diagnostics, Therapy]. Berlin: Springer.

Riecker, G (ed). 1988. Therapie innerer Krankheiten [Therapy of Internal Diseases]. Berlin: Springer.

Rogot, E and SJ Padgett. 1976. Associations of coronary and stroke mortality with temperature and snowfall in selected areas of the United States 1962-1966. Am J Epidemiol 103:565-575.

Romon, M, M-C Nuttens, C Fievet, P Pot, JM Bard, D Furon, and JC Fruchart. 1992. Increased triglyceride levels in shift workers. Am J Med 93:259-262.

Rutenfranz, J, P Knauth, and D Angersbach. 1981. Shift work research issues. In Biological Rhythms, Sleep and Shift Work, edited by LC Johnson, DI Tepas, WP Colquhoun, and MJ Colligan. New York: Spectrum.

Saltin, B. 1992. Sedentary lifestyle: An underestimated health risk. J Int Med 232:467-469.
Schnall, PL, PA Landsbergis, and D Baker. 1994. Job strain and cardiovascular disease. Ann Rev Pub Health 15:381-411.

Schulz, F-H and H Stobbe (eds). 1981. Grundlagen und Klinik innerer Erkrankungen [Fundamentals and Clinic of Internal Diseases]. Vol. III. Berlin: Volk and Gesundheit.

Schwarze, S and SJ Thompson. 1993. Research on non-auditory physiological effects of noise since 1988: Review and perspectives. In Bruit et Santé [Noise and Man ’93: Noise As a Public Health Problem], edited by M Vallet. Arcueil: Inst. national de recherche sur les transports et leur securité.

Siegrist, J. 1995. Social Crises and Health (in German). Gottingen: Hogrefe.

Shadick, NA, CB Phillips, EL Logigian, AC Steere, RF Kaplan, VP Berardi, PH Duray, MG Larson, EA Wright, KS Ginsburg, JN Katz, and MH Liang. 1994. The long-term clinical outcomes of Lyme disease—A population-based retrospective cohort study. Ann Intern Med 121:560-567.

Stern, FB, WE Halperin, RW Hornung, VL Ringenburg, and CS McCammon. 1988. Heart disease mortality among bridge and tunnel officers exposed to carbon monoxide. Am J Epidemiol 128(6):1276-1288.

Stout, RW and V Grawford. 1991. Seasonal variations in fibrinogen concentrations among elderly people. Lancet 338:9-13.

Sundermann, A (ed). 1987. Lehrbuch der Inneren Medizin [Textbook of Internal Medicine]. Jena: Gustav Fischer.

Suurnäkki, T, J Ilmarinen, G Wägar, E Järvinen, and K Landau. 1987. Municipal employees’ cardiovascular diseases and occupational stress factors in Finland. Int Arch Occup Environ Health 59:107-114.

Talbott, E, PC Findlay, LH Kuller, LA Lenkner, KA Matthews, RA Day, and EK Ishii. 1990. Noise-induced hearing loss: A posssible marker for high blood pressure in older noise-exposed populations. J Occup Med 32:690-697.

Tanaka, S, A Konno, A Hashimoto. 1989. The influence of cold temperatures on the progression of hypertension: An epidemiological study. J Hypertension 7 Suppl. 1:549-551.

Theorell, T. 1993. Medical and psychological aspects of job interventions. Int Rev Ind Organ Psychol 8: 173-192.

Theorell, T, G Ahlberg-Hulten, L Alfredsson, A Perski, and F Sigala. 1987. Bullers Effekter Pa Människor. Stress Research Reports, No. 195. Stockholm: National Institute of Psychosocial Factors and Health.

Theorell, T, A Perski, K Orth-Gomér, U deFaire. 1991. The effects of the strain of returning to work on the risk of cardiac death after a first myocardial infraction before the age of 45. Int J Cardiol 30: 61-67.

Thompson, SJ. 1993. Review: Extraaural health effects of chronic noise exposure in humans. In Lärm und Krankheit [Noise and Disease], edited by H Ising and B Kruppa. Stuttgart: Gustav Fischer.

Tüchsen, F. 1993. Working hours and ischaemic heart disease in Danish men: A 4-year cohort study of hospitalization. Int J Epidemiol 22:215-221.

United Nations Environment Programme (UNEP), World Health Organization (WHO), and International Radiation Protection Association (IRPA). 1984. Extremely low frequency (ELF) fields. Environmental Health Criteria, No. 35. Geneva: WHO.

—. 1987. Magnetic fields. Environmental Health Criteria, No. 69. Geneva: WHO.

van Dijk, FJH. 1990. Epidemiological research on non-auditory effects of occupational noise exposure. Environ Int 16 (special issue):405-409.

van Dijk, FJH, JHA Verbeek, and FF de Vries. 1987. Non-auditory effects of occupational noise in industry. V. A field study in a shipyard. Int Arch Occup Environ Health 59:55-62;133-145.

Virokannas, H. 1990. Cardiovascular reflexes in workers exposed to hand-arm vibration. Kurume Med J 37:101-107.

Weir, FW and VL Fabiano. 1982. Reevaluation of the role of carbon monoxide in production or aggravation of cardiovascular disease processes. J Occup Med 24(7):519-525

Wells, AJ. 1994. Passive smoking as a cause of heart disease. JAMA 24:546-554.

Wielgosz, AT. 1993. The decline in cardiovascular health in developing countries. World Health Stat Q 46:90-150.

Wikström, B-O, A Kjellberg, and U Landström. 1994. Health effects of long-term occupational exposure to whole-body vibration: A review. Int J Ind Erg 14:273-292.

Wild, P, J-J Moulin, F-X Ley, and P Schaffer. 1995. Mortality from cardiovascular diseases among potash miners exposed to heat. Epidemiology 6:243-247.

Willich, SN, M Lewis, H Löwel, H-R Arntz, F Schubert, and R Schröder. 1993. Physical exertion as a trigger of acute myocardial infarction. New Engl J Med 329:1684-1690.

Wojtczak-Jaroszowa, J and D Jarosz. 1986. Health complaints, sicknesses and accidents of workers employed in high environmental temperatures. Canad J Pub Health 77:132-135.

Woodhouse, PR, KT Khaw, and M Plummer. 1993a. Seasonal variation in blood pressure in relation to temperature in elderly men and women. J Hypertension 11:1267-1274.

—. 1993b. Seasonal variation of lipids in an elderly population. Age Ageing 22:273-278.

Woodhouse, PR, KT Khaw, TW Meade, Y Stirling, and M Plummer. 1994. Seasonal variations of plasma fibrinogen and factor VII activity in the elderly: Winter infections and death from cardiovascular disease. Lancet 343:435-439.

World Health Organization MONICA Project. 1988. Geographical variation in the major risk factors of coronary heart disease in men and women aged 35-64 years. World Health Stat Q 41:115-140.

—. 1994. Myocardial infarction and coronary deaths in the World Health Organization MONICA project. Registration procedures, event rates, and case-fatality in 38 populations from 21 countries in four continents. Circulation 90:583-612.

World Health Organization (WHO). 1973. Report of a WHO Expert Committee on Environmental and Health Monitoring in Occupation Health. Technical Report Series, No. 535. Geneva: WHO.

—. 1975. International Classification of Diseases, 9th Revision. Geneva: WHO

—. 1985. Identification and control of work-related diseases. Technical Report Series, No. 714. Geneva: WHO.

—. 1994a. Cardiovascular disease risk factors: New areas for research. Technical Report Series, No. 841.Geneva: WHO.

—. 1994b. World Health Statistics Annual 1993. Geneva: WHO.

Wyndham, CH and SA Fellingham. 1978. Climate and disease. S Afr Med J 53:1051-1061.

Zhao, Y, S Liu, and S Zhang. 1994. Effects of short-term noise exposure on heart rate and ECG ST segment in male rats. In Health Hazards from Noise: State of the Knowledge of the Effects of Workplace Noise, Environmental Noise, and Loud Music, edited by E Rebentisch, H Lange-Asschenfeld, and H Ising. Munich: MMV, Medizin Verlag.