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9 PROCESS AND METHODOLOGY Spontaneous abortion Musculoskeletal disorders Literature Search Source and Terms In addition, the following was searched: The PubMed access service was used for the literature search. PubMed was designed to provide access to citations Swing shift work and health from biomedical literature, including bibliographic informa- Rotating shift and health tion that includes MEDLINE. MEDLINE is the NLM's pre- Sleep cycle and health mier bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care sys- tem, and the preclinical sciences. MEDLINE contains bibli- SELECTION CRITERIA ographic citations and author abstracts from more than 4,800 biomedical journals published in the United States and Primary Sources 70 other countries. The database contains more than 12 million citations dating back to the mid-1960s. Coverage is world- The initial search resulted in more than 1,850 articles. When wide, but most records are from English-language sources or deemed appropriate by title, the abstracts were reviewed for have English abstracts. relevance to the topics of CMV operator health and the health A search for articles after 1975 was performed on the data- effects of work hours, shift work, and sleep schedule. The base using the following terms: preliminary list included 139 abstracts. Those not pertaining Health effects and the following to duration of work shift, duration of driving, working periods that shift over a 24-hr day, duration of sleep more than 6 hr, Commercial vehicle operator and effects of cumulative driving, were then removed from Commercial driver the list. Driver occupation This left approximately 70 articles. Fifteen were not avail- Vibration and motor vehicle able either because they were published in foreign languages without translation or they were not found in the periodical Based on the results from these searches, each of the search section of the University of Illinois at Chicago's Health Sci- terms--motor vehicle operator, truck driver, occupation-- ences Library. They were not judged to provide unique infor- was entered with the following: mation for the analysis, were not translated, and no further efforts were made to obtain them. Bladder cancer The remaining 55 articles were reviewed. Twenty-five were Lung cancer chosen and summarized by a primary reviewer to be included Cardiovascular disease in the synthesis based on the validity of the methodology, the Myocardial infarction relevance of the studied population to truck driving and the Spermatogenesis quality of the statistical analysis of health outcomes. Low back pain These were abstracted and evaluated according to the form Musculoskeletal disorder provided by FMCSA to highlight the relevance to this review. Kidney The assessments of these articles and of the conclusions as to Renal cancer their meaning for the report are the product of the primary Hypertension reviewers. The summaries focused specifically on the effects of extend- Each of the search terms--work hours, shift work, sleep ing driving time from 10 to 11 hr per day and extending the schedule--was entered with the following: total hours worked per week provided for in the new regula- tions. They focused as well on the effects of disrupting cir- Gastrointestinal cadian rhythm through swing swifts and of sleeping not more Diabetes than 6 hr--conditions potentially relieved by the new regu- Glycemic control lations. The health effects of exposure to carcinogens and Lipid noise are cumulative so articles pertaining to long-term expo- Cholesterol sure, not just hours per day or week, were included in the can- Obesity cer and hearing loss summaries. Mental health Depression Peripheral neuropathy Secondary Sources Neurologic disorder Reproductive Articles pertaining to causality alone, for example, the link Fertility between diesel exhaust and lung cancer, are included in the