Chronic disease risks and use of a smartphone application during a physical activity and dietary intervention in Australian truck drivers

Objective : This study examined chronic disease risks and the use of a smartphone activity tracking application during an intervention in Australian truck drivers (April‐October 2014). Methods : Forty‐four men (mean age=47.5 [SD 9.8] years) completed baseline health measures, and were subsequently offered access to a free wrist‐worn activity tracker and smartphone application (Jawbone UP) to monitor step counts and dietary choices during a 20‐week intervention. Chronic disease risks were evaluated against guidelines; weekly step count and dietary logs registered by drivers in the application were analysed to evaluate use of the Jawbone UP. Results : Chronic disease risks were high (e.g. 97% high waist circumference [≥94 cm]). Eighteen drivers (41%) did not start the intervention; smartphone technical barriers were the main reason for drop out. Across 20‐weeks, drivers who used the Jawbone UP logged step counts for an average of 6 [SD 1] days/week; mean step counts remained consistent across the intervention (weeks 1–4=8,743[SD 2,867] steps/day; weeks 17–20=8,994[SD 3,478] steps/day). The median number of dietary logs significantly decreased from start (17 [IQR 38] logs/weeks) to end of the intervention (0 [IQR 23] logs/week; p<0.01); the median proportion of healthy diet choices relative to total diet choices logged increased across the intervention (weeks 1–4=38[IQR 21]%; weeks 17–20=58[IQR 18]%). Conclusions : Step counts were more successfully monitored than dietary choices in those drivers who used the Jawbone UP. Implications : Smartphone technology facilitated active living and healthy dietary choices, but also prohibited intervention engagement in a number of these high‐risk Australian truck drivers.     

货柜车司机艾滋病相关知识、态度及行为调查

目的了解货柜车司机艾滋病知识水平,探索有效的干预模式。方法采用整群抽样方法,对深圳市货柜车司机257人进行调查。结果货柜车司机对艾滋病基本知识缺乏了解,只有65.19%的司机知道艾滋病的3种传播途径,有97.28%的司机希望了解更多的AIDS相关知识。货柜车司机性伴关系较复杂,但其中只有61.44%司机与暗娼发生性行为时坚持使用安全套。虽未检出人类免疫缺陷病毒（HIV）感染者,但乙肝病毒和梅毒螺旋体感染检出率分别为13.62%和0.78%,提示货柜车司机普遍存在高危行为。结论货柜车司机高危行为普遍,是感染HIV的高危人群,应采取有针对性的综合干预措施,使其改变高危行为或采取安全性行为,控制艾滋病由高危人群向一般人群传播。     

南宁市长卡司机艾滋病知识、态度、行为的调查分析

目的了解南宁市长卡司机艾滋病性病知识认知状况和行为危险因素。方法采取整群随机抽样方法,抽取南宁市区三个长途卡车停车场249名长卡司机作为调查对象,采用面对面无关联匿名问卷调查方法。结果98.8%的人听说过艾滋病,92.8%的人认为艾滋病是一种严重的传染病。对于艾滋病三条传播途径90%以上人回答正确。100%人有过性生活经历,初次性交11.2%的人为商业性行为。8.03%的人有过同性性行为,最近一次发生商业性行为时安全套使用率为32.35%,而24.5%从未使用安全套。过去半年有40.56%人出现过与性病相关症状。结论加强长卡司机艾滋病防治知识健康教育,提高该人群艾滋病预防知识水平,降低该人群感染艾滋病的危险性。     

The Prevalence of Arthritis and Activity Limitation and Their Predictors in Missouri

Arthritis and other rheumatic conditions comprise the leading cause of disability in the United States. In 1990, an estimated 16.7% of Missourians had arthritis. By 2020, an estimated 20% of Missourians will have this condition. We examined Missouri's prevalence of self- reported physician-diagnosed arthritis, chronic joint symptoms, and activity limitation due to joint symptoms and their associations with selected predictors (i.e., socio-demographic, access to health care, risk factor, and co-morbidity indicators) from Missouri's 1996 Behavioral Risk Factor Surveillance System. We conducted logistic regression analysis to generate Odds Ratios and 95% Confidence Intervals of arthritis and activity limitation across levels of predictors. Analysis indicates arthritis is under- diagnosed in younger individuals and that arthritis and activity limitation due to joint symptoms are significant contributors to functional limitation, enhancing dependency while decreasing the quality of life. As the population ages, arthritis, chronic joint symptoms, and activity limitation will become a larger public health problem.     

2014-2019年北京城市癌症早诊早治项目人群肺癌筛查结果分析

目的分析2014—2019年北京城市癌症早诊早治项目肺癌筛查结果。方法基于国家城市癌症早诊早治项目,以北京市东城、西城、朝阳、海淀、丰台和石景山区的80个筛查项目实施街道为研究现场,采用整群抽样的方法,将街道/居委会所辖的88044名40~69岁北京市户籍居民纳入研究。对问卷初筛肺癌阳性的人群,采用低剂量螺旋CT(LDCT)进行筛查,同时每年通过主动和被动随访相结合的方式对募集的全部人群进行随访,获取其健康结局信息(确诊肺癌/未确诊肺癌)。计算不同特征人群经问卷初筛的肺癌高危率、LDCT筛查参与率、肺部阳性结节检出率、肺癌发病密度(率)、累积发病率以及早诊率;采用Cox比例回归模型计算不同筛查模式下肺癌发生的风险。结果88044名研究对象年龄为(57.4±7.4)岁,其中男性占38.76%(34128例)。问卷初筛肺癌高危率为23.14%,临床筛查参与率为52.26%,肺部阳性结节检出率为10.99%。平均随访3年后,40~69岁男性肺癌发病密度为172.82/10万人年,女性肺癌发病密度为133.52/10万人年;肺癌发生风险随年龄升高而上升(P_趋势<0.001)。问卷初筛阳性人群发病密度为259.22/10万人年;与问卷初筛阴性人群相比,问卷初筛阳性人群肺癌发病风险HR(95%CI)值为2.27(1.83~2.81)。接受LDCT筛查且被判定为阳性结节人群的肺癌发病密度为1825.03/10万人年,3年内的累积发病率为4615.38/10万;与结节阴性人群相比,结节阳性人群肺癌发病风险HR(95%CI)值为13.80(8.91~21.36)。接受LDCT筛查者三年内确诊肺癌的早诊率为70.21%,高于未接受临床筛查者确诊肺癌时的早期比例(45.45%,P=0.016)。结论北京城市癌症早诊早治项目肺癌临床筛查依从性较好;在高危人群中应用LDCT筛查肺癌,能够提高肺癌患者检出率和早诊率。     

Social Vaccine for HIV Prevention

Abstract

Nearly everywhere that AIDS has been found, HIV infection is fast spreading. No one is known to have recovered from HIV infection. There is no vaccine to cure AIDS (Population Reports, 1989 and The Hindu, dated 9.3.2000). Until a cure or vaccine for HIV infection is found, the only way to prevent the spread of the disease is by changing people's behaviour through AIDS education programmes (Population Reports, 1986). Many national governments are using broadcast, print media, personal contact, counselling methods, etc., to educate people on AIDS and safer sex. Thus, the best vaccine is the ‘Social Vaccine.’ Social vaccine involves spreading education on how to protect oneself, hundred percent condom use, and changing sexual behaviour. In fact, the social vaccine was so successful in Thailand that the infection rate has come down by 50 per cent (The Hindu, dated 9.3.2000).

Truck drivers, prostitutes, and young adults are considered high risk groups for HIV/AIDS in India. An action research study was conducted in Chittoor District of Andhra Pradesh (India) among truck drivers. As part of this study, different strategies, namely mass media, personal contact, group discussion, folk media, and counselling, were adopted to provide AIDS education, to encourage increase in condom use for safer sex, and bring changes in their sexual behaviour. The strategies adopted in this study greatly enhanced the knowledge of the truck drivers on AIDS, changed their attitudes on sex, increased the use of condoms, and modified their sexual behaviour.

Thus, the social vaccine would help spread education on AIDS, bring changes in the sexual behaviour of the people, increase condom use, and thus help to prevent the AIDS scourge throughout the world. The social vaccine suggested in this study can also be extended to all the high risk group population for successful prevention of this dreadful disease in the world.     

Assessment of condom use among Bolivian truck drivers through the lens of social cognitive theory

This study demonstrates that Bolivian long distance truck drivers are a high risk population of HIV infection and transmission, supporting other global studies involving truck drivers and their high risk. The aims of this investigation were to estimate the prevalence of high risk behaviors and to identify predictors of condom use in this population. Analysis was completed on survey results from 246 male truckers (aged 18-67). About one in three of the truck drivers (30%) reported having had a sexually transmitted infection sometime in their past. More than half (56%) reported having sex with casual partners. Other risks involved unprotected anal sex. Age and two social cognitive constructs (outcome expectations and perceived social norms) predicted condom use from logistic regression analysis. The authors discuss the need for expanded HIV/sexually transmitted infection prevention programs that incorporate social cognitions.     

Lung cancer mortality among women employed in high-risk industries and occupations in Harris County, Texas, 1977-1980

Lung cancer is rapidly becoming the leading cause of cancer mortality among women. Interviews conducted with 259 women with lung cancer and 278 women without lung cancer or with their next-of-kin in Harris County, Texas from July 1, 1977 to June 30, 1980 revealed that 12 (4.6%) of the women with lung cancer had never smoked cigarettes. The odds ratio (OR) for current smoking was 15.7. Odds ratios for smoking for living women (OR = 17.5) were higher than for those who were deceased (OR = 12.6). Lifetime occupational histories were classified a priori into high- and low-risk categories. Data were stratified according to employment in a high-risk industry or occupation, a high-risk industry, a high-risk occupation, or both a high-risk industry and occupation. Although not statistically significant, odds ratios for employment in high-risk categories support earlier estimates that attributed 5% of lung cancer mortality in women to employment in hazardous occupations. Employment of a husband or household member in selected industries and occupations yielded significantly increased odds ratios. More cases (15.9%) than controls (6.9%) reported a family history of lung cancer (OR = 2.4). No significant increase in smoking-adjusted odds ratios was found for the use of hair spray, hand-held dryers, or alcohol, or for having lived with a household member who smoked cigarettes.     

Pancreatic cancer in industrial branches and occupations in finland

An examination of the risk of pancreatic cancer associated with occupation, by industrial branch and job title, was undertaken in a nationwide case-referent study in Finland. The results are based on job history information from the next-of-kin of 625 incident cases of primary malignant exocrinic pancreatic neoplasms, and of 1,700 cancer referents (stomach, colon, and rectum). All cases and referents were between 40 and 74 years at diagnosis. The diagnoses were made in 1984-87, and both cases and referents were known to be dead by April 1, 1990. The source of the cases and referents was the Finnish Cancer Registry. Increases in risk of pancreatic cancer were suggested for a small number of industrial branches and job titles, including stone mining (odds ratio 3.7), cement and building materials (11.1), pharmacists and sales associates in pharmacies (12.9), male wood machinists (4.1), male gardeners (6.7), female textile workers (5.4), and male transport inspectors and supervisors (9.4). The exposures potentially implicated are discussed. In agreement with the overall results of epidemiologic studies conducted elsewhere, direct occupational determinants probably do not account for a substantial share of the etiology of pancreatic cancer, at least in conditions resembling Finnish working environments some 15-40 years ago.     

Stress among package truck drivers

In 1992, a cross-sectional questionnaire study of package truck drivers in one company was conducted at four widely scattered sites throughout the US; 317 drivers participated, representing 82% of those eligible. The package truck drivers scored significantly above the US working population comparison norm on all summary and individual scales derived from the SCL 90-R, indicating a substantial increase in psychologic distress for this group. The Global Severity Index, the best single summary measure of psychological distress in the SCL 90-R, revealed a mean T score for the drivers of 64.20, 91st percentile of the normative population. The group perceived significantly more daily stressful events than the average working adult, and their sensitivity to these events was also increased. Role overload, a component of the Occupational Stress Inventory, was the most consistent factor associated with symptoms of psychological distress on multiple regression analysis. This study suggests that job stress is a psychological health hazard for these drivers. Am. J. Ind. Med. 31:202–210, 1997. © Wiley-Liss, Inc.     

Structure and agency in long-distance truck drivers’ lived experiences of condom use for HIV prevention

Condom promotion has emerged as a mainstay of targeted HIV prevention interventions in India, with its emphasis on individual behaviour change and personal responsibility. However, such approaches often do not account for marginalised populations’ structural vulnerability to HIV, arising from social, economic and political factors in the lived environment. In this paper, I use a critical health communication framework to analyse how structure and agency interact in influencing condom use among long-distance truck drivers in India. Drawing on an abductive discourse analysis of condom-use discourses among truckers and peer educators in two Indian cities, findings reveal that while truckers understand the biomedical logic of condoms as barriers, they also express anxiety about condom breakage and experience structural barriers to condom use. The paper concludes by calling for greater attention to structural vulnerabilities in future HIV prevention efforts with truck drivers.     

Mapping U.S. long-haul truck drivers’ multiplex networks and risk topography in inner-city neighborhoods

This article illustrates how urban inner-city trucking milieux may influence STI/BBI/HIV acquisition and transmission risks for U.S. long-haul truckers, as well as their social and risk relationships. Using mixed methods, we collected ethnoepidemiological and biological data from long-haul truck drivers and their risk contacts in inner-city trucking milieux in Atlanta, Georgia, United States. Key findings indicate that within the risk-endemic environment of distressed inner-city areas, diverse trucking risk milieux can amplify STI/BBI/HIV risk for multiplex networks of truckers. Inner-city neighborhood location, short geographic distance among risk contacts, and trucker concurrency can potentially exacerbate transmission via bridging higher-risk individuals with lower-risk populations at disparate geographic and epidemiological locations.     

A novel COVID-19 based truck driver syndemic? Implications for public health,safety, and vital supply chains

U.S. long-haul truck drivers traverse great distances and interact with numerous individuals, rendering them vulnerable to acquiring and transmitting coronavirus disease 2019 (COVID-19). Together, the unique co-occurrence of pronounced health disparities and known COVID-19 infection, morbidity, and mortality risks suggest the possibility of a novel COVID-19 based truck driver syndemic due to advanced driver age and endemic health issues. In turn, COVID-19 sequelae may perpetuate existing health disparities. The co-occurrence of afflictions may also result in compromised safety performance. To curb the likelihood of a COVID-19 based truck driver syndemic, several action stepsare needed. First, key COVID-19 metrics need to be established for this population. Second, relationships between long-haul trucker network attributes and COVID-19 spread need to bedelineated. Third, mutually reinforcing interactions between endemic health disparities and COVID-19 vulnerability need to be elucidated. Finally, grounded in the aforementioned steps, policies and interventions need to be identified and implemented.     

Lung cancer risk in male workers occupationally exposed to diesel motor emissions in Germany.

BACKGROUND: Although in several epidemiological studies exposure to diesel motor emissions (DME) shows an elevated lung cancer risk, it is still controversial whether DME is a human carcinogen. METHODS: In a pooled analysis of two case-control studies on lung cancer in Germany a total of 3498 male cases with histologically or cytologically ascertained lung cancer and 3541 male population controls were included. Information about lifelong occupational and smoking history was obtained by questionnaire. Drivers of lorries, buses, taxies, diesel locomotives and forklift trucks, bulldozers, graders, excavators, and tractors, were considered as exposed to DME and their cumulative exposure was estimated. All odds ratios were adjusted for smoking and asbestos exposure. RESULTS: The evaluation of lung cancer risk for all jobs with DME-exposure combined showed an odds ratio of OR=1.43 (95%-CI: 1.23-1.67). Most pronounced was the increase in lung cancer risk in heavy equipment operators (OR=2. 31 95%-CI: 1.44-3.70). The risk of tractor drivers increased with length of employment and reached statistical significance for exposures longer than 30 years (OR=6.81, 95%-CI: 1.17-39.51). The group of professional drivers (e.g., trucks, buses, and taxies), showed an increased risk only in West Germany (OR=1.44, 95%-CI: 1. 18-1.76), but not in East Germany (OR=0.83, 95%-CI: 0.60-1.14). DME-exposure in other traffic related jobs (e.g., diesel engine locomotive drivers, switchmen, forklift operators) was associated with an odds ratio of OR=1.53 (95%-CI: 1.04-2.24). CONCLUSIONS: The study provides further evidence that occupational exposure to diesel motor emissions is associated with an increased lung cancer risk.     

Multivariate meta‐analysis of prognostic factor studies with multiple cut‐points and/or methods of measurement

A prognostic factor is any measure that is associated with the risk of future health outcomes in those with existing disease. Often, the prognostic ability of a factor is evaluated in multiple studies. However, meta‐analysis is difficult because primary studies often use different methods of measurement and/or different cut‐points to dichotomise continuous factors into ‘high’ and ‘low’ groups; selective reporting is also common. We illustrate how multivariate random effects meta‐analysis models can accommodate multiple prognostic effect estimates from the same study, relating to multiple cut‐points and/or methods of measurement. The models account for within‐study and between‐study correlations, which utilises more information and reduces the impact of unreported cut‐points and/or measurement methods in some studies. The applicability of the approach is improved with individual participant data and by assuming a functional relationship between prognostic effect and cut‐point to reduce the number of unknown parameters. The models provide important inferential results for each cut‐point and method of measurement, including the summary prognostic effect, the between‐study variance and a 95% prediction interval for the prognostic effect in new populations. Two applications are presented. The first reveals that, in a multivariate meta‐analysis using published results, the Apgar score is prognostic of neonatal mortality but effect sizes are smaller at most cut‐points than previously thought. In the second, a multivariate meta‐analysis of two methods of measurement provides weak evidence that microvessel density is prognostic of mortality in lung cancer, even when individual participant data are available so that a continuous prognostic trend is examined (rather than cut‐points). © 2015 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.