Occupational Medicine: State of the Art Reviews
THE WORKPLACE AND CARDIOVASCULAR DISEASE

Edited by Peter Schnall, Karen Belkic, Paul Landsbergis and Dean Baker
Published by Hanley & Belfus, Inc. Occup Med 15(1), 2000

Reviews of The Workplace and Cardiovascular Disease


CHAPTER 1. Why the Workplace and Cardiovascular Disease? by Peter Schnall, Karen Belkic, Paul Landsbergis and Dean Baker

Cardiovascular disease (CVD) remains the major cause of morbidity and mortality in the industrialized world. Current approaches to managing the CVD epidemic are based on powerful engineering models and use advanced medical techniques. Innovative research has resulted in the identification of a number of risk factors for hypertension and cvd. However, our understanding of the etiology of hypertension and cardiovascular disease, as well as our ability to manage the epidemic, still remains limited. A social epidemiologic paradigm suggests that essential hypertension and CVD are diseases of industrialized society of rather recent historical origins. To better understand the CVD epidemic, current models need to incorporate a heretofore relatively neglected realm of social life in the workplace.


CHAPTER 2. Research Findings linking Workplace Factors to Cardiovascular Disease Outcomes
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a) Shift Work, Long Hours, and Cardiovascular Disease: a Review
Kyle Steenland
b) Chemical and Physical Factors
Lawrence Fine
c) Psychosocial Factors: Review of the Empirical Data Among Men
Karen Belkic, Paul Landsbergis, Peter Schnall, Dean Baker, Tores Theorell, Johannes Siegrist, Richard Peter, Robert Karasek
d) Social Class, Occupational Status and Cardiovascular Disease
Michael Marmot
e) Women, Work and Cardiovascular Disease
Chantal Brisson
f) High Risk Occupations for Cardiovascular Disease
Finn Tuchsen


CHAPTER 3. Stressors At The Workplace: Theoretical Models
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a) A Historical Overview
Lennart Levi
b) Social Class and Power Relations at the Workplace
Mel Bartley, Michael Marmot.
c) The Demand-Control-Support Model and Cardiovascular Disease
Tores Theorell and Robert Karasek
d) The Effort-Reward Imbalance Model
Johannes Siegrist and Richard Peter
e) Dehumanization Versus Humanization of Work: Insights from Cognitive Ergonomics and Brain Research
Karen Belkic, Cedo Savic
f) Multiple Exposures: A Model of Total Occupational Burden
Karen Belkic, Peter Schnall, Cedo Savic, Paul Landsbergis


CHAPTER 4. The Central Nervous System: Bridge between the External Milieu and the Cardiovascular System
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a) The Environment-Brain-Heart Connection: Econeurocardiology
Stewart Wolf
b) The Forebrain: Central Stress Mechanisms and Cardiovascular Responses
Karen Belkic


CHAPTER 5. Evidence for Mediating Econeurocardiologic Mechanisms
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a) Cardiac Electrical Stability and Environmental Stress
Karen Belkic
b) Mechanisms Leading to Hypertension and Cardiovascular Morbidity
Joseph Schwartz, Karen Belkic, Peter Schnall, Tom G. Pickering
c) Myocardial Oxygen Supply and Demand: Environmental Triggers of Imbalance
Karen Belkic
d). Atherogenesis, Coagulation and Stress
Andrew Steptoe, Michael Marmot
e) Neuroendocrine Mechanisms
Tores Theorell
f) The Cardiovascular Metabolic Syndrome
Eigil Fossum, Aud Hoieggen, Andreas Moan, Morten Rostrup, Sverre E. Kjeldsen


CHAPTER 6. Measurement of Psychosocial Workplace Exposure Variables
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a) Self-Report Questionnaires
Paul Landsbergis and Tores Theorell
b) Imputation of Job Characteristic Scores
Joseph Schwartz
c) Expert-Observer Assessment of Job Characteristics
Birgit Greiner, Niklas Krause
d) Conclusions and Recommendations
Paul Landsbergis, Birgit Greiner, Niklas Krause, Joseph Schwartz, Tores Theorell


CHAPTER 7. Assessment of the Cardiovascular System at the Workplace
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a) Obtaining a CVD History: Obstacles and Challenges
Peter Schnall and Karen Belkic
b). Blood Pressure Measurement: Casual, Self-Measured, and Ambulatory Monitoring
Thomas G. Pickering
c). Ambulatory Electrocardiographic Monitoring: Stress-Mediated Clinically Relevant Endpoints
Karen Belkic
d). Point Estimates of Blood Pressure at the Worksite
Peter Schnall and Karen Belkic


CHAPTER 8. Cardiovascular Evaluation of the Worker and Workplace: A Practical Guide for Clinicians by Karen Belkic, Peter Schnall and Mira Ugljesic

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Unlike several other branches of medicine, (e.g., pulmonology), primary cardiology has yet to fully develop a discipline of occupational cardiology. The authors outline an approach for including a focused occupational history in the CV work-up and present a graded, risk-stratified algorithm for occupational cardiologic assessment. This work-up can help clinicians make specific recommendations concerning working conditions, as these impact upon the patient's CV status.


CHAPTER 9. Clinical Issues: Return to Work and Public Safety by Regis de Gaudemaris

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Return to work after cardiac events is an especially delicate question for the clinician. The cardiologic caregiver must evaluate the full clinical picture, including symptoms and morphological and functional status, as well as address complex personal, psychological, social, economic, legal, and ethical issues. The importance of job characteristics is illustrated by the existing, albeit limited, longitudinal data showing that return to high-strain work is a significant independent predictor of mortality in young men post-myocardial infarction.


CHAPTER 10. Screening and Management of the Workplace for CVD Risk
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a) Individual Stress Management: Effective or Not?
Kenneth Nowack
b) Hypertension: Could Lowering Job Strain be a Therapeutic Modality?
Peter Schnall
c) The Clinician's Role
Samuel Melamed and Paul Froom
d) A Public Health Approach in Clinical Practice
June Fisher and Karen Belkic


CHAPTER 11. Costs of Occupational Circulatory Disease by J. Paul Leigh and Peter Schnall

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This chapter analyzes the overt and hidden economic costs of work-related cardiovascular diseases. Affected individuals and society at large, rather than employers, pay much of the costs. Economic interventions to motivate public health approaches to preventing CVD are explored.


CHAPTER 12. Legal and Legislative Issues
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a) Legislation to Protect Worker Cardiovascular Health In Europe
Lennart Levi
b) Chemical and Physical Exposure Regulations
Larry Fine
c) Shift Work Regulations
Kyle Steenland
d) U.S. Regulations for Work Organization
Nick Warren
e) Working Life in Japan
Teruichi Shimomitsu and Yuko Odagiri
f) Workers' Compensation: Workplace Stress and the CVD Connection
Mark Kimmel
g) Collective Bargaining to Reduce CVD Risk Factors
Paul Landsbergis


CHAPTER 13. Workplace Intervention Studies by Tage Kristensen

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The author reviews and discusses several intervention studies with implications for CVD or CV risk. The studies address chemical exposures, work schedules and working hours, and psychosocial factors at work. Effective strategies for prevention of CVD at the workplace are based on intervention research and integrate prevention at different levels.


CHAPTER 14. The Workplace and Cardiovascular Health: Conclusions and Thoughts for a Future Agenda by Karen Belkic, Peter Schnall, Paul Landsbergis and Dean Baker

The evidence in this book provides convergent validation of a causal relationship between workplace stressors and CVD. Here, the editors explore new strategies for enhanced prevention and clinical management, workplace interventions, and social policy to reduce the impact of CVD. These strategies acquire an urgent public health dimension, given the magnitude of the CVD epedemic and the current deterioration in conditions of working life.


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