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49 SUMMARY OF FINDINGS OF LITERATURE duration of driving, nor on the effects of prolonged work hours or increased driving time from 10 to 11 hr while decreasing The review of the available literature has excluded the end overall work time from 15 to 14 hr on the general health of points of fatigue, accidents, and road safety. The available workers. No data are available concerning the effects of information has reviewed topics concerning driver health, allowing for increased sleep time from 6 to 8 hr in an adult with emphasis on chronic conditions. working population. The literature indicates lung cancer is likely caused by exposures to diesel exhaust and the longer that exposure lasts the more likely it is that a cancer will develop. Though the evidence for exposure as a truck driver causing bladder can- BIBLIOGRAPHY OF PRIMARY AND SECONDARY SOURCES cer is less robust than that for cancer of the lung, it remains likely that there is such a relationship and that it is governed Primary by a positive dose-response curve. The literature offers evidence that cardiovascular disease is Cardiovascular Disease caused in part by truck driving and its risk increases with the duration of this activity and the disruption of the sleep cycle. Gustavsson, P., Plato, N., Hallqvist, J., Hogstedt, C., Lewne, The literature indicates that it is clear based on exposure M., Reuterwall, C., and Scheele, P. "A population-based assessments and the knowledge of the relationship between case-referent study of myocardial infarction and occupa- noise and hearing loss that this could well be a result of a tional exposure to motor exhaust, other combustion prod- working lifetime as a driver with increasing likelihood based ucts, organic solvents, lead, and dynamite. Stockholm Heart on duration of exposure depending on truck design. This Epidemiology Program (SHEEP) Study Group." Epidemi- effect would be mitigated by improvement in cab design ology. 2001 Mar;12(2):2228. reported to be occurring with a consequent reduction in the Sokejima, S. and Kagamimori, S. "Working hours as a risk fac- intensity of noise that reaches the driver. tor for acute myocardial infarction in Japan: case-control The evidence concerning a relationship between WBV and study." BMJ. 1998 Sep 19;317(7161):77580. musculoskeletal effects, such as LBP syndrome, relies pri- marily on self-reporting and application of risks derived from other environments. There are several studies available that Lung Cancer contain objective evidence of vertebral pathology related to an occupation as a professional driver. The available litera- Bruske-Hohlfeld, I., Mohner, M., Ahrens, W., Pohlabeln, H., ture supports the hypothesis that there is likely a causative Heinrich, J., Kreuzer, M., Jockel, K.H., and Wichmann, relationship between professional driving and a variety of H.E. "Lung cancer risk in male workers occupationally vertebral disorders as well as LBP syndrome. While it is log- exposed to diesel motor emissions in Germany." Am J Ind ical to assume, and the literature suggests, a role for WBV in Med. 1999 Oct;36(4):40514. the genesis of these disorders, it cannot be established based Soll-Johanning, H., Bach, E., and Jensen, S.S. "Lung and on current published materials. bladder cancer among Danish urban bus drivers and tram- The literature related to CMV driving and other muscu- way employees: a nested case-control study." Occup Med loskeletal disorders suffers from the same limitations and (Lond). 2003 Feb;53(1):2533. while a causative relationship is logical it can only be viewed Steenland, K., Deddens, J., and Stayner, L. "Diesel exhaust and as suggestive within this context. lung cancer in the trucking industry: exposure-response The literature indicates that GI disorders would be expected analyses and risk assessment." Am J Ind Med. 1998 to be impacted by varying shift assignments and disruption to Sep;34(3):2208. normal circadian rhythm. While the information currently available documents an increase in symptoms, it is inade- quate to implicate the specific risk factors that impact on these symptoms. Bladder Cancer and Other Cancers The literature suggests, but does not establish, that disrup- tion of circadian rhythm may have negative impacts on the Boffetta, P. and Silverman, D.T. "A meta-analysis of bladder general health status of workers. The stabilization of shift cancer and diesel exhaust exposure." Epidemiology. 2001 especially when stabilized to a day schedule appears to have Jan;12(1):12530. a beneficial effect on subjective health complaints though sta- Colt, J.S., Baris, D., Stewart, P., Schned, A.R., Heaney, J.A., bilizing to an evening or night schedule may not provide the Mott, L.A., Silverman D., and Karagas, M. "Occupation same benefit. and bladder cancer risk in a population-based case-control Finally, the literature does not contain definitive information study in New Hampshire." Cancer Causes Control. 2004 concerning the relationship between reproductive health and Oct;15(8):75969.

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