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8 LITERATURE REVIEW--HEALTH EXECUTIVE SUMMARY the duration of this activity and the disruption of the sleep cycle. The purpose of this literature review is to provide infor- Based on exposure assessments, noise-induced hearing mation that clearly discusses in a scientific, experimental, loss could well be a result of a working lifetime as a dri- qualitative, and quantitative way the relationship between the ver. This effect would be mitigated by the improvement hours a person works, drives, and the structure of the work in cab design reported to be occurring with consequent schedule (on-duty/off-duty cycles, time on task, especially reduction in the intensity of noise reaching the driver. time in continuous driving, sleep time, etc.) and the impact The evidence concerning a relationship between whole- on the health of truck drivers. body vibration (WBV) and musculoskeletal effects, The PubMed access service was used for the literature such as low back pain (LBP) syndrome, relies primarily search. PubMed was developed by the National Center for on self-reporting and application of risks derived from Biotechnology Information (NCBI) at the National Library other environments. There are several studies available of Medicine (NLM), located at the National Institutes of though that contain objective evidence of vertebral path- Health (NIH). The database contains bibliographic citations ology related to an occupation as a professional driver. and author abstracts from more than 4,800 biomedical jour- In conclusion, the available data support the hypothesis nals published in the United States and 70 other countries and that there is likely a causative relationship between pro- is available via the NCBI Entrez retrieval system. fessional driving and a variety of vertebral disorders as The initial search resulted in more than 1,850 articles. After well as LBP syndrome. While the literature suggests a screening and comparison with the questions to be answered role for WBV in the genesis of these disorders, it cannot in this exercise, 55 articles were reviewed. Twenty-five arti- be established based on current published materials. cles were chosen and summarized by a primary reviewer to be The literature related to commercial driving and other included in the synthesis based on the validity of the method- musculoskeletal disorders has the same limitations as ology, the relevance of the studied population to truck driving, the previous item, and while a causative relationship is and the quality of the statistical analysis of health outcomes. logical, it can only be viewed as suggestive within this This review excluded those end points of fatigue, accidents, context. and road safety. The team evaluated the available information Gastrointestinal (GI) disorders would be expected to be concerning driver health, with emphasis on chronic condi- impacted by varying shift assignments and disruption to tions, potentially associated with the 2003 HOS Regulations normal circadian rhythm. While the information cur- under consideration by the FMCSA. rently available documents an increase in symptoms in drivers, it is inadequate to implicate the specific risk fac- tors that impact on these symptoms. The literature suggests, but does not establish, that dis- Findings from the Literature ruption of circadian rhythm may have negative impacts on the general health of workers. The stabilization of The following findings were drawn from the available lit- shift especially when stabilized to a day schedule appears erature reviewed as part of this synthesis. to have a beneficial effect on subjective health com- plaints though stabilizing to an evening or night sched- Lung cancer is likely caused by exposure to diesel exhaust ule may not provide the same benefit. and the longer that exposure lasts the more likely it is Finally, the literature contains no definitive information that a cancer will develop. Though the evidence linking concerning (a) the relationship between reproductive this exposure to bladder cancer is less robust than that to health and duration of driving, (b) the effects of pro- lung cancer, it remains likely that there is such a rela- longed work hours, or (c) increasing driving from 10 to tionship and that it is governed by a positive dose- 11 hr while decreasing overall work time from 15 to 14 response curve. hr on the general health of workers. No data are avail- There is some evidence that cardiovascular disease is able concerning the effects of allowing for increased caused in part by truck driving and its risk increases with sleep time from 6 to 8 hr in an adult working population.