{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:13:53Z","timestamp":1791285233467,"version":"4.1.0"},"reference-count":66,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Occup Environ Med"],"published-print":{"date-parts":[[1998,2]]},"abstract":"<jats:p>OBJECTIVE: To investigate, in a population heavily exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the possible unusual occurrence of diseases other than cancer. METHODS: Five year extension of the follow up of the cohort involved in the Seveso accident. Soil measurements identified three exposure zones: (A) highest contamination, (B) substantial, and (R) low but higher than background contamination. Blood TCDD measurements, although limited in number, confirmed zone exposure ranking. The 15 year mortality in the exposed cohort was compared with that of a large population in the surrounding non-contaminated territory. Relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated with Poisson regression techniques. RESULTS: The already noted increased occurrence of cardiovascular deaths was confirmed, in particular in zone A, among males for chronic ischaemic heart disease (five deaths, RR 3.0, 95% CI 1.2 to 7.3), and among females for hypertensive disease (three deaths, RR 3.6, 95% CI 1.2 to 11.4) and chronic rheumatic heart disease. Novel findings were the increase of chronic obstructive pulmonary disease, most notably among males in zone A (four deaths, RR 3.7, 95% CI 1.4 to 9.9) and females in zone B (seven deaths, RR 2.4, 95% CI 1.1 to 5.1); and from diabetes, which was significantly increased in females in zone B (13 deaths, RR 1.9, 95% CI 1.1 to 3.2). In zone R, chronic ischaemic heart disease (males and females), hypertension (females), and diabetes (females) showed less pronounced, although significant excesses. CONCLUSIONS: As well as high TCDD exposure, the accident caused a severe burden of strain in the population. Both these factors might have contributed to the noted increased risks (in particular, circulatory and respiratory). The cardiovascular and immune toxicity of TCDD, as well as its complex interaction with the endocrine system, might be relevant to the explanations of these findings. These results, although not conclusive, concur with previous data in suggesting cardiopulmonary and endocrine effects in humans highly exposed to TCDD.<\/jats:p>","DOI":"10.1136\/oem.55.2.126","type":"journal-article","created":{"date-parts":[[2009,1,1]],"date-time":"2009-01-01T00:13:30Z","timestamp":1230768810000},"page":"126-131","source":"Crossref","is-referenced-by-count":108,"title":["Dioxin exposure and non-malignant health effects: a mortality study."],"prefix":"10.1136","volume":"55","author":[{"given":"A C","family":"Pesatori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Zocchetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Guercilena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Consonni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Turrini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P A","family":"Bertazzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1998,2,1]]},"reference":[{"key":"ref_1","first-page":"68","article-title":"Health risks of dioxins: a review of environmental and toxicological considerations","volume":"35","author":"Dickson, L.C.; Buzik, B.S.P.","year":"1993","unstructured":"Dickson LC, Buzik BSP. Health risks of dioxins: a review of environmental and toxicological considerations. Vet Hum Toxicol 1993;35:68\u201377.","journal-title":"Vet Hum Toxicol"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1289\/ehp.93100189","article-title":"Environmental toxicology of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans","volume":"100","author":"JP, Vanden Heuvel; G, Lucier","year":"1993","unstructured":"Vanden Heuvel JP, Lucier G. Environmental toxicology of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans. Environ Health Perspect 1993;100:189\u2013200.","journal-title":"Environ Health Perspect"},{"key":"ref_3","first-page":"139","article-title":"Toxicology of dioxins and related chemicals","author":"MJ, De Vito; LS, Birnbaum","year":"1994","unstructured":"De Vito MJ, Birnbaum LS. Toxicology of dioxins and related chemicals. In: Schecter A, ed. Dioxins and health. New York: Plenum Press; 1994:139\u201362."},{"key":"ref_4","article-title":"International Agency for Research on Cancer. Monographs on the evaluation of carcinogenic risks to humans. Vol 69. Polichlorinated dibenzo-para dioxins and polichlorinated dibenzofurans","year":"1997","unstructured":"International Agency for Research on Cancer. Monographs on the evaluation of carcinogenic risks to humans. Vol 69. Polichlorinated dibenzo-para dioxins and polichlorinated dibenzofurans. Lyon: IARC, 1997."},{"key":"ref_5","first-page":"433","article-title":"Committee to Review the Health EVects in Vietnam Veterans of Exposure to Herbicides. Cancer. In: Veterans and agent orange: health eVects of herbicides used in Vietnam","author":"Institute of Medicine","year":"1994","unstructured":"Institute of Medicine, Committee to Review the Health EVects in Vietnam Veterans of Exposure to Herbicides. Cancer. In: Veterans and agent orange: health eVects of herbicides used in Vietnam. Washington: National Academy Press, 1994:433\u2013590."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1080\/00039896.1971.10665850","article-title":"A health survey of workers in a 2,4-D and 2,4,5-T plant with special attention to chloracne, porphyria cutanea tarda, and psychologic parameters","volume":"22","author":"Poland, A.P.; Smith, D.; Metter, G.","year":"1971","unstructured":"Poland AP, Smith D, Metter G, et al. A health survey of workers in a 2,4-D and 2,4,5-T plant with special attention to chloracne, porphyria cutanea tarda, and psychologic parameters. Arch Environ Health 1971;22:316\u201327.","journal-title":"Arch Environ Health"},{"key":"ref_7","first-page":"12","article-title":"Critically acute chloracne caused by trichlorophenol decomposition products","volume":"7","author":"Goldman, P.J.","year":"1972","unstructured":"Goldman PJ. Critically acute chloracne caused by trichlorophenol decomposition products. Arbeitsmed Sozialmed Arbeitshyg 1972;7:12\u20138.","journal-title":"Arbeitsmed Sozialmed Arbeitshyg"},{"key":"ref_8","first-page":"145","article-title":"Acne chlorina, porphyria cutanea tarda and other manifestations of general intoxication during the manufacture of herbicides","volume":"49","author":"Jirasek, L.; Kalensky, J.; Kubec, K.","year":"1974","unstructured":"Jirasek L, Kalensky J, Kubec K, et al. Acne chlorina, porphyria cutanea tarda and other manifestations of general intoxication during the manufacture of herbicides. II. Ceskoslovenska Dermatologic 1974;49:145\u201357.","journal-title":"II. Ceskoslovenska Dermatologic"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1093\/ije\/10.2.135","article-title":"Chloracne following environmental contamination by TCDD in Seveso, Italy","volume":"10","author":"Caramaschi, F.; Del Corno, G.; Favaretti, C.","year":"1981","unstructured":"Caramaschi F, Del Corno G, Favaretti C, et al. Chloracne following environmental contamination by TCDD in Seveso, Italy. Int J Epidemiol 1981;10:135\u201343.","journal-title":"Int J Epidemiol"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2687","DOI":"10.1001\/jama.1986.03380190057025","article-title":"Clinical laboratory manifestations of exposure to dioxin in children. A six year study of the eVects of an environmental disaster near Seveso, Italy","volume":"256","author":"Mocarelli, P.; Marocchi, A.; Brambilla, P.","year":"1986","unstructured":"Mocarelli P, Marocchi A, Brambilla P, et al. Clinical laboratory manifestations of exposure to dioxin in children. A six year study of the eVects of an environmental disaster near Seveso, Italy. 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J Occup Med 1989;31:771\u20134.","journal-title":"J Occup Med"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/BF00383591","article-title":"Thirty-four-year mortality follow up of BASF employees exposed to 2,3,7,8,-TCDD after the 1953 accident","volume":"62","author":"Zober, A.; Messerer, P.; Huber, P.","year":"1990","unstructured":"Zober A, Messerer P, Huber P. Thirty-four-year mortality follow up of BASF employees exposed to 2,3,7,8,-TCDD after the 1953 accident. Int Arch Occup Environ Health 1990;62:139\u201357.","journal-title":"Int Arch Occup Environ Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1016\/0045-6535(94)90411-1","article-title":"Laboratory results for selected target organs in 138 individuals occupationally exposed to TCDD","volume":"29","author":"Ott, M.G.; Zober, A.; Germann, C.","year":"1994","unstructured":"Ott MG, Zober A, Germann C. Laboratory results for selected target organs in 138 individuals occupationally exposed to TCDD. Chemosphere 1994;29:2423\u201337.","journal-title":"Chemosphere"},{"key":"ref_15","first-page":"128","article-title":"Tetrachlorodibenzodioxin: a survey of subjects 10 years after exposure","volume":"39","author":"May, G.","year":"1982","unstructured":"May G. Tetrachlorodibenzodioxin: a survey of subjects 10 years after exposure. Br J Ind Med 1982;39:128\u201335.","journal-title":"Br J Ind Med"},{"key":"ref_16","first-page":"254","article-title":"Lipid abnormalities in workers exposed to dioxin","volume":"41","author":"Martin, J.V.","year":"1984","unstructured":"Martin JV. Lipid abnormalities in workers exposed to dioxin. Br J Ind Med 1984; 41:254\u20136.","journal-title":"Br J Ind Med"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/0020-711X(84)90134-4","article-title":"Development of chronic hepatic porphyria (porphyria cutanea tarda) with inherited uroporphyrinogen decarboxylase deficiency under exposure to dioxin","volume":"16","author":"Doss, M.; Sauer, H.; Von Tieperman, R.","year":"1984","unstructured":"Doss M, Sauer H, Von Tieperman R, et al. Development of chronic hepatic porphyria (porphyria cutanea tarda) with inherited uroporphyrinogen decarboxylase deficiency under exposure to dioxin. Int J Biochem 1984;16:369\u201373.","journal-title":"Int J Biochem"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1002\/ajim.4700050303","article-title":"Health status of workers with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin in the manifacture of 2,4,5-thrichlorophenoxyacetic acid: comparison of findings with and without chloracne","volume":"5","author":"Moses, M.; Lilis, R.; Crow, K.D.","year":"1984","unstructured":"Moses M, Lilis R, Crow KD, et al. Health status of workers with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin in the manifacture of 2,4,5-thrichlorophenoxyacetic acid: comparison of findings with and without chloracne. Am J Ind Med 1984;5:161\u201382.","journal-title":"Am J Ind Med"},{"key":"ref_19","first-page":"151","article-title":"Urinary D-glucaric acid excretion in the Seveso area, polluted by tetrachlorodibenzo-p-dioxin (TCDD): five years of experience","volume":"60","author":"Ideo, G.; Bellati, G.; Bellobuono, A.","year":"1985","unstructured":"Ideo G, Bellati G, Bellobuono A, et al. Urinary D-glucaric acid excretion in the Seveso area, polluted by tetrachlorodibenzo-p-dioxin (TCDD): five years of experience. Environ Health Perspect 1985;60:151\u20137.","journal-title":"Environ Health Perspect"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1001\/jama.1992.03480160067036","article-title":"Hepatic and gastrointestinal eVects in an occupational cohort exposed to 2,3,7,8-tetrachlorodibenzo-para-dioxin","volume":"267","author":"Calvert, G.M.; Hornung, R.W.; Sweeney, M.H.","year":"1992","unstructured":"Calvert GM, Hornung RW, Sweeney MH, et al. Hepatic and gastrointestinal eVects in an occupational cohort exposed to 2,3,7,8-tetrachlorodibenzo-para-dioxin. JAMA 1992; 267:2209\u201314.","journal-title":"JAMA"},{"key":"ref_21","article-title":"Air Force health study: an epidemiologic investigation of health eVects in Air Force personnel following exposure to herbicides. Serum dioxin analysis of 1987 examination results","author":"Roegner, R.H.; Grubbs, W.D.; Lustik, M.B.","year":"1991","unstructured":"Roegner RH, Grubbs WD, Lustik MB, et al. Air Force health study: an epidemiologic investigation of health eVects in Air Force personnel following exposure to herbicides. Serum dioxin analysis of 1987 examination results. Washington DC: National Technical Information Service, 1991. (Ad A-237\u2013 516 through AD A-237\u2013524.)","journal-title":"Washington DC: National Technical Information Service; A-237\u2013 516 through AD A-237\u2013524"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1289\/ehp.93101504","article-title":"EVects of preand postnatal exposure to chlorinated dioxins and furans on human neonatal thyroid hormone concentrations","volume":"101","author":"Pluim, H.J.; de Vijlder, J.J.M.; Olie, K.","year":"1993","unstructured":"Pluim HJ, de Vijlder JJM, Olie K, et al. EVects of preand postnatal exposure to chlorinated dioxins and furans on human neonatal thyroid hormone concentrations. Environ Health Perspect 1993;101:504\u20138.","journal-title":"Environ Health Perspect"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1203\/00006450-199410000-00009","article-title":"EVects of dioxins and polychlorinated biphenyls on thyroid hormone status of pregnant women and their infants","volume":"36","author":"Koopman-Esseboom, C.; Morse, D.C.; Weisglas-Kuperus, N.","year":"1994","unstructured":"Koopman-Esseboom C, Morse DC, Weisglas-Kuperus N, et al. EVects of dioxins and polychlorinated biphenyls on thyroid hormone status of pregnant women and their infants. Pediatr Res 1994;36:468\u201373.","journal-title":"Pediatr Res"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1289\/ehp.96104422","article-title":"Persistence of decreased T-helper cell function in industrial workers 20 years after exposure to 2,3,7,8-tetrachlorodibenzo-pdioxin","volume":"104","author":"Tonn, T.; Esser, C.; Schneider, E.M.","year":"1996","unstructured":"Tonn T, Esser C, Schneider EM, et al. Persistence of decreased T-helper cell function in industrial workers 20 years after exposure to 2,3,7,8-tetrachlorodibenzo-pdioxin. Environ Health Perspect 1996;104:422\u20136.","journal-title":"Environ Health Perspect"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1080\/00039896.1996.9936001","article-title":"Evaluation of serum lipid concentrations among US workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin","volume":"51","author":"Calvert, G.M.; Willie, K.K.; Sweeney, M.H.","year":"1996","unstructured":"Calvert GM, Willie KK, Sweeney MH, et al. Evaluation of serum lipid concentrations among US workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Arch Environ Health 1996;51:100\u20137.","journal-title":"Arch Environ Health"},{"key":"ref_26","first-page":"279","article-title":"Diabetes versus dioxin body burden in veterans of operation ranch hand","volume":"10","author":"Wolfe, W.H.; Michalek, J.E.; Miner, J.C.","year":"1992","unstructured":"Wolfe WH, Michalek JE, Miner JC. Diabetes versus dioxin body burden in veterans of operation ranch hand. Organohalogen Compounds 1992;10:279\u201382.","journal-title":"Organohalogen Compounds"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1093\/oxfordjournals.aje.a117575","article-title":"Exposure to polychlorinated dioxins and furans (PCDD\/F) and mortality in a cohort of workers from a herbicideproducing plant in Hamburg, Federal Republic of Germany","volume":"142","author":"Flesch-Janys, D.; Berger, J.; Gurn, P.","year":"1995","unstructured":"Flesch-Janys D, Berger J, Gurn P, et al. Exposure to polychlorinated dioxins and furans (PCDD\/F) and mortality in a cohort of workers from a herbicideproducing plant in Hamburg, Federal Republic of Germany. Am J Epidemiol 1995;142:1165\u201375.","journal-title":"Am J Epidemiol"},{"key":"ref_28","first-page":"185","article-title":"Preliminary results of the second follow-up of a Dutch cohort of workers occupationaly exposed to phenoxy heribicides, chlorophenols, and contaminants","volume":"30","author":"Hooiveld, M.; Heederick, D.; Bueno de Mesquita, B.","year":"1996","unstructured":"Hooiveld M, Heederick D, Bueno de Mesquita B. Preliminary results of the second follow-up of a Dutch cohort of workers occupationaly exposed to phenoxy heribicides, chlorophenols, and contaminants. Organohalogen Compounds 1996;30:185\u20139.","journal-title":"Organohalogen Compounds"},{"key":"ref_29","first-page":"549","article-title":"Reproductive epidemiology of dioxins","volume-title":"health","author":"Sweeney, A.","year":"1994","unstructured":"Sweeney A. Reproductive epidemiology of dioxins. In: Schecter A, ed. Dioxins and health. New York: Plenum Press; 1994:549\u201385"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/0147-6513(80)90032-9","article-title":"Accidental release of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)","volume":"4","author":"di Domenico A; V, Silano; G, Viviano","year":"1980","unstructured":"di Domenico A, Silano V, Viviano G, et al. Accidental release of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) at Seveso, Italy. II. TCDD distribution in the soil surface layer. Ecotoxicol Environ Saf 1980;4:298\u2013320.","journal-title":"Ecotoxicol Environ Saf; TCDD distribution in the soil surface layer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/j.1749-6632.1979.tb56597.x","article-title":"Toxicopathology characteristics of the halogenated aromatics","volume":"320","author":"McConnel, E.E.; Moore, J.A.","year":"1979","unstructured":"McConnel EE, Moore JA. Toxicopathology characteristics of the halogenated aromatics. Ann N Y Acad Sci 1979;320: 138\u201350.","journal-title":"Ann N Y Acad Sci"},{"key":"ref_32","first-page":"342","article-title":"The Seveso accident","volume-title":"environmental epidemiology: methods for small area studies","author":"Bertazzi, P.A.; Pesatori, A.C.; Zocchetti, C.","year":"1992","unstructured":"Bertazzi PA, Pesatori AC, Zocchetti C. The Seveso accident. In: Elliott P, Kuzick J, English D, Stern R, eds. Geographical and environmental epidemiology: methods for small area studies. New York: Oxford University Press, 1992:342\u201358."},{"key":"ref_33","article-title":"and health aspects of the Seveso, Italy, accident","author":"Bertazzi, P.A.; di Domenico A. Chemical; environmental","unstructured":"Bertazzi PA, di Domenico A. Chemical, environmental, and health aspects of the Seveso, Italy, accident. In: Schecter A, ed. Dioxins and health. New York: Plenum Press, 1994:587\u2013 632."},{"key":"ref_34","first-page":"215","article-title":"Health impact of the accidental release of TCDD at Seveso","volume-title":"exposure to dioxins: human health aspects","author":"Bruzzi, P.","year":"1983","unstructured":"Bruzzi P. Health impact of the accidental release of TCDD at Seveso. In: Coulston F, Pocchiari F, eds. Accidental exposure to dioxins: human health aspects. New York: Academic Press, 1983:215\u201325."},{"key":"ref_35","first-page":"1","article-title":"Special OYce for Seveso, International Steering Committee. Minutes of the sixth meeting of the International Steering Committee, February 19\u201321, 1984. Final report and recommendations","year":"1984","unstructured":"Special OYce for Seveso, International Steering Committee. Minutes of the sixth meeting of the International Steering Committee, February 19\u201321, 1984. Final report and recommendations, Milan: Regione Lombardia, 1984:1\u201317."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1097\/00001648-199309000-00004","article-title":"Cancer incidence in a population accidentally exposed to 2,3,7,8- tetrachlorodibenzo-para-dioxin","volume":"4","author":"Bertazzi, P.A.; Pesatori, A.C.; Consonni, D.","year":"1993","unstructured":"Bertazzi PA, Pesatori AC, Consonni D, et al. Cancer incidence in a population accidentally exposed to 2,3,7,8- tetrachlorodibenzo-para-dioxin. Epidemiology 1993;4:398\u2013 406.","journal-title":"Epidemiology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1093\/oxfordjournals.aje.a115240","article-title":"Ten-year mortality study of the population involved in the Seveso incident in 1976","volume":"129","author":"Bertazzi, P.A.; Zocchetti, C.; Pesatori, A.C.","year":"1989","unstructured":"Bertazzi PA, Zocchetti C, Pesatori AC, et al. Ten-year mortality study of the population involved in the Seveso incident in 1976. Am J Epidemiol 1989;129:1187\u2013200.","journal-title":"Am J Epidemiol"},{"key":"ref_38","article-title":"Istituto Centrale di Statistica. XII Population census, October 25, 1981. Data on population structure and housing characteristics","volume-title":"Provincial dossier n.15-Milano","author":"II, Tome I","year":"1984","unstructured":"Istituto Centrale di Statistica. XII Population census, October 25, 1981. Data on population structure and housing characteristics. Vol II, Tome I. Provincial dossier n.15-Milano. Roma, ISTAT, 1984."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1016\/S0140-6736(97)24025-0","article-title":"Concentrations of dioxin 20 years after Seveso","volume":"349","author":"Landi, M.T.; Needham, L.L.; Lucier, G.","year":"1997","unstructured":"Landi MT, Needham LL, Lucier G, et al. Concentrations of dioxin 20 years after Seveso. Lancet 1997;349:1811.","journal-title":"Lancet"},{"key":"ref_40","first-page":"316","article-title":"Mortality in an area contaminated by TCDD following an industrial accident","volume":"80","author":"Bertazzi, P.A.; Zocchetti, C.; Pesatori, A.C.","year":"1989","unstructured":"Bertazzi PA, Zocchetti C, Pesatori AC, et al. Mortality in an area contaminated by TCDD following an industrial accident. Med Lav 1989;80:316\u201329.","journal-title":"Med Lav"},{"key":"ref_41","first-page":"1129","article-title":"Dioxin and dibenzofuran levels in human blood samples from","volume":"25","author":"Schecter, A.J.; P\u00e4pke, O.; Ball, M.","year":"1992","unstructured":"Schecter AJ, P\u00e4pke O, Ball M, et al. Dioxin and dibenzofuran levels in human blood samples from Guam, Russia, Germany, Vietnam, and the USA. Chemosphere 1992;25:1129\u201334."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/0041-008X(87)90072-X","article-title":"EVects of 2,3,7,8- tetrachlorodibenzo-p-dioxin treatment on mechanical function of the rat heart","volume":"91","author":"Kelling, C.K.; Menahan, L.A.; Peterson, R.E.","year":"1987","unstructured":"Kelling CK, Menahan LA, Peterson RE. EVects of 2,3,7,8- tetrachlorodibenzo-p-dioxin treatment on mechanical function of the rat heart. Toxicol Appl Pharmacol 1987;91: 497\u2013501.","journal-title":"Toxicol Appl Pharmacol"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/0041-008X(88)90154-8","article-title":"Biochemical and functional eVects of 2,3,7,8-tetrachlorodibenzo-pdioxin (TCDD) on the heart of female rats","volume":"95","author":"Hermansky, S.J.; Holcslaw, T.L.; Murray, W.J.","year":"1988","unstructured":"Hermansky SJ, Holcslaw TL, Murray WJ, et al. 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Proc Natl Acad Sci","volume":"85","author":"Canga, L.; Levi, R.; Rifkind, A.B.","year":"1988","unstructured":"Canga L, Levi R, Rifkind AB. Heart as a target organ in 2,3,7,8-tetrachlorodibenzo-p-dioxin toxicity: decreased adrenergic responsiveness and evidence of increased intracellular calcium. Proc Natl Acad Sci USA 1988;85: 905\u20139."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/0041-008X(78)90075-3","article-title":"Results of a two-year chronic toxicity study and oncogenicity study of 2,3,7,8- tetrachlorodibenzo-p-dioxin in rats","volume":"46","author":"Kociba, R.J.; Keyes, D.G.; Beyer, J.E.","year":"1978","unstructured":"Kociba RJ, Keyes DG, Beyer JE, et al. Results of a two-year chronic toxicity study and oncogenicity study of 2,3,7,8- tetrachlorodibenzo-p-dioxin in rats. Toxicol Appl Pharmacol 1978;46:279\u2013303.","journal-title":"Toxicol Appl Pharmacol"},{"key":"ref_47","first-page":"401","article-title":"Morphological changes in monkeys consuming a diet containing low levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin. Food Cosmet Toxicol","volume":"15","author":"Allen, JR, Barsotti; DA, Van Miller; J.P.","year":"1977","unstructured":"Allen JR, Barsotti DA, Van Miller JP, et al. Morphological changes in monkeys consuming a diet containing low levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin. Food Cosmet Toxicol 1977;15:401\u201310."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/0041-008X(79)90475-7","article-title":"2,3,7,8-tetrachlorodibenzo-pdioxin tissue distribution, excretion, and eVects on clinical chemical parameters in guinea pigs","volume":"51","author":"Gasiewicz, T.A.; Neal, R.A.","year":"1979","unstructured":"Gasiewicz TA, Neal RA. 2,3,7,8-tetrachlorodibenzo-pdioxin tissue distribution, excretion, and eVects on clinical chemical parameters in guinea pigs. Toxicol Appl Pharmacol 1979;51:329\u201339.","journal-title":"Toxicol Appl Pharmacol"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/S0006-291X(84)80106-0","article-title":"TCDD (2,3,7,8- tetrachlorodibenzo-p-dioxin) reduces lipoprotein lipase activity in the adipose tissue of the guinea pig","volume":"122","author":"Brewster, D.W.; Matsumura, F.","year":"1984","unstructured":"Brewster DW, Matsumura F. TCDD (2,3,7,8- tetrachlorodibenzo-p-dioxin) reduces lipoprotein lipase activity in the adipose tissue of the guinea pig. Biochem Biophys Res Commun 1984;122:810\u20137.","journal-title":"Biochem Biophys Res Commun"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/0041-008X(84)90079-6","article-title":"Increased plasma and aortic triglycerides in rabbits after acute administration of 2,3,7,8-tetrachlorodibenzo-p-dioxin","volume":"75","author":"Lovati, M.R.; Galbussera, M.; Franceschini, G.","year":"1984","unstructured":"Lovati MR, Galbussera M, Franceschini G, et al. Increased plasma and aortic triglycerides in rabbits after acute administration of 2,3,7,8-tetrachlorodibenzo-p-dioxin. Toxicol Appl Pharmacol 1984;75:91\u20137.","journal-title":"Toxicol Appl Pharmacol"},{"key":"ref_51","first-page":"1","article-title":"and ischaemic heart disease","volume-title":"Atherosclerosis","author":"Lipids, Castelli W.P.; risk factors","year":"1996","unstructured":"Castelli WP. Lipids, risk factors, and ischaemic heart disease. Atherosclerosis 1996;(suppl):S1\u20139."},{"key":"ref_52","first-page":"318","article-title":"Medical and morbidity surveillance findings among employees potentially exposed to TCDD","volume":"40","author":"Bond, G.G.; Ott, M.G.; Brenner, F.E.; et","year":"1983","unstructured":"Bond GG, Ott MG, Brenner FE, et. Medical and morbidity surveillance findings among employees potentially exposed to TCDD. Br J Ind Med 1983;40:318\u201324.","journal-title":"Br J Ind Med"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2372","DOI":"10.1001\/jama.1984.03340420038023","article-title":"Human health eVects of 2,4,5-T and its toxic contaminants","volume":"251","author":"Suskind, R.R.; Hertzberg, V.S.","year":"1984","unstructured":"Suskind RR, Hertzberg VS. Human health eVects of 2,4,5-T and its toxic contaminants. JAMA 1984;251: 2372\u201380.","journal-title":"JAMA"},{"key":"ref_54","first-page":"1927","article-title":"Cancer mortality in workers exposed to chlorophenoxy herbicides and chlorophenols","volume":"338","author":"Saracci, R.; Kogevinas, M.; Bertazzi, P.A.","year":"1991","unstructured":"Saracci R, Kogevinas M, Bertazzi PA, et al. Cancer mortality in workers exposed to chlorophenoxy herbicides and chlorophenols. Lancet 1991;338:1927\u201332.","journal-title":"Lancet"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1056\/NEJM199101243240402","article-title":"Cancer mortality in workers exposed to 2,3,7,8-tetrachlorodibenzop-dioxin","volume":"324","author":"Fingerhut, M.A.; Halperin, W.E.; Marlow, D.A.","year":"1991","unstructured":"Fingerhut MA, Halperin WE, Marlow DA, et al. Cancer mortality in workers exposed to 2,3,7,8-tetrachlorodibenzop-dioxin. N Engl J Med 1991;324:212\u20138.","journal-title":"N Engl J Med"},{"key":"ref_56","first-page":"225","article-title":"Low mortality rates in industrial cohort studies due to selection for work and survival in the industry","volume":"30","author":"Fox, A.J.; Collier, P.F.","year":"1976","unstructured":"Fox AJ, Collier PF. Low mortality rates in industrial cohort studies due to selection for work and survival in the industry. Br J Prev Soc 1976;30:225\u201330.","journal-title":"Br J Prev Soc"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1136\/oem.53.9.606","article-title":"Cause specific mortality and cancer incidence among employees exposed to 2,3,7,8-TCDD after a 1953 reactor accident","volume":"53","author":"Ott, M.G.; Zober, A.","year":"1996","unstructured":"Ott MG, Zober A. Cause specific mortality and cancer incidence among employees exposed to 2,3,7,8-TCDD after a 1953 reactor accident. Occup Environ Med 1996;53:606\u2013 12.","journal-title":"Occup Environ Med"},{"key":"ref_58","article-title":"An epidemiologic investigation of health eVects in Air Force personnel following exposure to herbicides. Serum dioxin analysis of 1987 examination results","author":"Air Force Health Study","year":"1991","unstructured":"Air Force Health Study. An epidemiologic investigation of health eVects in Air Force personnel following exposure to herbicides. Serum dioxin analysis of 1987 examination results. Brooks AFB, TX: USAF School of Aerospace Medicine, 1991:9."},{"key":"ref_59","first-page":"111","article-title":"Dioxin contamination in Seveso: the social tragedy and the scientific challenge","volume":"86","author":"Pesatori, A.C.","year":"1995","unstructured":"Pesatori AC. Dioxin contamination in Seveso: the social tragedy and the scientific challenge. Med Lav 1995;86:111\u2013 24.","journal-title":"Med Lav"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"85","DOI":"10.5271\/sjweh.1867","article-title":"Industrial disasters and epidemiology. A review of recent experiences","volume":"15","author":"Bertazzi, P.A.","year":"1989","unstructured":"Bertazzi PA. Industrial disasters and epidemiology. A review of recent experiences. Scand J Work Environ Health 1989;15:85\u2013100.","journal-title":"Scand J Work Environ Health"},{"key":"ref_61","first-page":"14","article-title":"Committee to Review the Health EVects In Vietnam Veterans of Exposure to Herbicides. In: Veterans and agent orange: health eVects of herbicides used in Vietnam","volume":"708","author":"Institute of Medicine","year":"1994","unstructured":"Institute of Medicine, Committee to Review the Health EVects In Vietnam Veterans of Exposure to Herbicides. In: Veterans and agent orange: health eVects of herbicides used in Vietnam. Washington: National Academy Press, 1994:708\u2013 14."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1093\/oxfordjournals.epirev.a036206","article-title":"Epidemiology of chronic mucus hypersecretion and obstructive airway disease","volume":"1","author":"Speizer, F.E.; Tager, I.B.","year":"1979","unstructured":"Speizer FE, Tager IB. Epidemiology of chronic mucus hypersecretion and obstructive airway disease. Epidemiol Rev 1979;1:124\u201342.","journal-title":"Epidemiol Rev"},{"key":"ref_63","article-title":"Dioxin exposure and cancer risk. A 15-year mortality study after the Seveso accident","author":"Bertazzi, P.A.; Zocchetti, C.; Guercilena, S.","year":"1997","unstructured":"Bertazzi PA, Zocchetti C, Guercilena S, et al. Dioxin exposure and cancer risk. A 15-year mortality study after the Seveso accident. Epidemiology 1997;8.","journal-title":"Epidemiology"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/ajim.4700130107","article-title":"Indirect methods of assessing the eVects of tobacco use in occupationale studies","volume":"13","author":"Axelson, A.; Steenland, K.","year":"1988","unstructured":"Axelson A, Steenland K. Indirect methods of assessing the eVects of tobacco use in occupationale studies. Am J Ind Med 1988;13:105\u201318.","journal-title":"Am J Ind Med"},{"key":"ref_65","first-page":"225","article-title":"The development and prognosis of chronic intoxication by tetrachlorodibenzo-p-dioxin in men. Arch Environ Health 1981; 36: 5\u201311 68 Sweeney MH, Hornung RW, Wall DK, Fingerhut MA, Halperin WE. Prevalence of diabetes and increased fasting serum glucose in workers with long-term exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin","volume":"10","author":"Pazderova-Vejlupkova, J.; Lukas, E.; Nemcova, M.","year":"1992","unstructured":"Pazderova-Vejlupkova J, Lukas E, Nemcova M, et al. The development and prognosis of chronic intoxication by tetrachlorodibenzo-p-dioxin in men. Arch Environ Health 1981;36:5\u201311 68 Sweeney MH, Hornung RW, Wall DK, Fingerhut MA, Halperin WE. Prevalence of diabetes and increased fasting serum glucose in workers with long-term exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Organohalogen Compounds 1992;10:225\u20136.","journal-title":"Organohalogen Compounds"},{"key":"ref_66","first-page":"1391","article-title":"Ovarian hormones enhance 2,3,7,8-tetrachlorodibenzo-p-dioxin mediated increases in cell proliferation and preneoplastic foci in a two-stage model for rat hepatocarcinogenesis","volume":"51","author":"Lucier, G.W.; Tritscher, A.; Goldsworthy, T.","year":"1991","unstructured":"Lucier GW, Tritscher A, Goldsworthy T, et al. Ovarian hormones enhance 2,3,7,8-tetrachlorodibenzo-p-dioxin mediated increases in cell proliferation and preneoplastic foci in a two-stage model for rat hepatocarcinogenesis. 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