Cross-sectional study of the health of southern African truck drivers

Working conditions of commercial drivers: a scoping review of psychosocial work factors, health outcomes, and interventions

BACKGROUND

Psychosocial work factors significantly influence both organisational and worker health. Poor management of these factors can create precarious working conditions, risking drivers' health. This review maps evidence on the health impact of these factors and health interventions targeting the working conditions and unhealthy habits of commercial drivers.

METHOD

The search was conducted in four main databases (PubMed, Central, JSTOR and Dimensions Ai) and other sources like Google Scholar. In All, 28,039 articles were retrieved and through a rigorous screening process, 68 records were included in this scoping review.

RESULTS

This review found that drivers work in precarious conditions like long driving hours, low job resources and social support, low job control, poor remuneration, workplace abuse and sexual harassment, work-family conflict, lone driving hour, irregular shift work, lack or insufficient breaks during work hours and difficult access to social protection and sanitation facilities. These precarious working conditions may expose drivers to mental health issues, cardiovascular diseases, HIV/AIDs, stroke, chronic fatigue, kidney and bladder issues and musculoskeletal pains. Most health promotion interventions target behaviour at the individual level, such as the benefits of a healthy diet and exercise, with little effort to improving working conditions.

CONCLUSION

Employers in the road transport sector need to implement health promotion interventions that focus on drivers' well-being. Additionally, improving working conditions and enforcing occupational health and safety standards in the road transport sector are essential for creating a safe and healthy workplace for all commercial drivers.

Global burden of HIV among long-distance truck drivers: a systematic review and meta-analysis

OBJECTIVES

The purpose of this study was to systematically summarise the empirical evidence on the prevalence of HIV among long-distance truck drivers (LDTDs) from all parts of the world.

DESIGN

A systematic review and meta-analysis were conducted.

DATA SOURCES

We searched PubMed, ProQuest Central, PubMed Central, Cumulated Index to Nursing and Allied Health Literature and Global Index Medicus to identify relevant information published from 1989 to 16 May 2023.

ELIGIBILITY CRITERIA

Peer-reviewed publications of English language reporting on the prevalence of HIV among LDTDs were included. Non-empirical studies like literature reviews were excluded.

DATA EXTRACTION AND SYNTHESIS

Using a standardised data abstraction form, we extracted information on study characteristics and HIV prevalence levels. Crude prevalence estimates per 100 participants were computed and later transformed using logit transformation to have them follow a normal distribution. A meta-analysis of prevalences using the random effects model was performed. The I2 statistic was used to quantify the degree of heterogeneity across studies. A subgroup analysis using meta-regression was performed to investigate factors that could explain variability across studies. The Joanna Briggs Institute tools and Newcastle-Ottawa Scale were used to assess the quality of the included studies. To assess the certainty of evidence, the Grading of Recommendations Assessment, Development, and Evaluation approach was used.

RESULTS

Of the 1787 articles identified, 42 were included. Most of the included studies were conducted in sub-Saharan Africa (45.23%, n=19) and Asia and the Pacific (35.71%, n=15). The pooled prevalence of HIV was 3.86%, 95% CI (2.22% to 6.64%). The burden of HIV was highest in sub-Saharan Africa at 14.34%, 95% CI (9.94% to 20.26%), followed by Asia and the Pacific at 2.12%, 95 CI (0.94% to 4.7%) and lastly Western, Central Europe and North America at 0.17%, 95% CI (0.03% to 0.82%). The overall heterogeneity score was (I2=98.2%, p<0.001).

CONCLUSION

The global burden of HIV among LDTDs is 3.86%, six times higher than that of the general population globally. Compared with other regions, the burden of HIV is highest in sub-Saharan Africa at 14.34%, where it is estimated to be 3% in the general population. Thus, LDTDs endure a disproportionately high burden of HIV compared with other populations. Consequently, more LDTD-centred HIV research and surveillance is needed at national and regional levels to institute tailored preventive policies and interventions.

PROSPERO REGISTRATION NUMBER

CRD42023429390.

Epidemiology of non-communicable diseases among professional drivers in LMICs: a systematic review and meta-analysis

This systematic review collected evidence on the burden of non-communicable diseases (NCDs) among professional drivers and reported on the most common factors that increase the risk of NCDs in this specific population in low- and middle-income countries (LMICs). The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We conducted a thorough search on PubMed/MEDLINE, EMBASE, Scopus, Global Health, Web of Science and Africa-wide information databases on 11 May 2023. We adapted the Joanna Briggs Institute (JBI) tool to assess the quality of the studies. We estimated the prevalence of hypertension, prediabetes, diabetes mellitus (DM), overweight and obesity among professional drivers using a random effect model to compute pooled and subgroup analyses. In addition, we conducted a narrative synthesis of the risk factors and recommendations presented in the included studies. Forty-one studies, including 48 414 study participants, met the criteria for inclusion. The pooled prevalence of hypertension, DM and obesity among professional drivers was 36.7% [95% confidence interval (CI): 31.8-41.6%], 15.2% (95% CI: 7.0-23.4%) and 27.2% (95% CI: 18.7-35.8%), respectively. Unsupportive environment, work stress, sedentary lifestyle, consumption of unhealthy foods and shift work were the most common modifiable risk factors reported. Our findings also show a significant burden of hypertension, DM and obesity among professional drivers in LMICs. The prevalence of DM and obesity was two- and three-fold higher than findings in general populations, respectively. Our findings indicate an urgent need for tailored interventions for different occupation-related risk factors for NCDs among professional drivers in LMICs.

Risk Factors for Chronic Non-Communicable Diseases of Long-Haul Truck Drivers during the COVID-19 Pandemic: An Integrative Review

Long-haul truck drivers are responsible for transporting goods valued at millions of dollars of the world economy, and may have their health affected by living and working conditions. This study analyzed and synthesized scientific findings about risk factors for the development of chronic non-communicable diseases in long-haul truck drivers. An integrative literature review was conducted. We identified 23 studies that met the inclusion criteria and evaluated the health of 7363 drivers. The biological risk factors identified were age, gender, race/ethnicity, genetics, and comorbidities, and were considered to be non-modifiable for chronic diseases. The behavioral risks considered to be modifiable were sedentary lifestyle, smoking, alcohol consumption, overweight, diet, stress, anxiety, and unfavorable socioeconomic conditions. Environmental risks involved working conditions such as the following: number of working hours per day, week, and month; time away from home; risk of musculoskeletal injury; and opportunities for rest, hours of sleep, and access to health services. The results were presented in two categories: (1) biological, behavioral, and environmental risks, and (2) general recommendations to promote physical, cognitive, and emotional health. Macro-structural changes are needed to reorganize work and rest, improve access to health services to control modifiable risk factors, and to support behavioral and environmental changes to reduce chronic non-communicable diseases and deaths.

Prevalence of pulmonary tuberculosis among casual labourers working in selected road construction sites in central Uganda

INTRODUCTION

Workers with occupational exposure to respirable silica dust, such as casual labourers at road construction sites (RCSs), are known to be at high risk of developing pulmonary tuberculosis (TB). There is limited literature about the burden of PTB among this subpopulation with high occupational exposure to silica dust at road construction sites. We aimed to determine the prevalence of PTB among casual labourers working at road construction sites in central Uganda.

METHODS

We enrolled 297 participants via consecutive sampling in a cross-sectional study between September 1st and September 30th, 2022, at four road construction sites in four districts in central Uganda. A structured questionnaire was administered, and the PTB patients were identified by using GeneXpert and/or computer-aided detection for TB (CAD4TB). The data were analysed with STATA version 17.0. Descriptive statistics adjusted for clustering were used to summarize the data, and the relationships between PTB and independent variables were assessed by using a mixed effects modified Poisson regression model to estimate the adjusted prevalence ratios.

RESULTS

Most participants were males (95.6% [284/297]), and the median age was 29 years (interquartile range [IQR]: 25-33). The prevalence of PTB among casual labourers was 2.4% (95% CI: 1.9, 2.8). Not being vaccinated with BCG (3.45, 95% CI: 1.02, 11.61), alcohol use (2.70, 95% CI: 1.52, 4.80) and staying in shared rooms (8.13, 95% CI: 4.37, 15.12) were positively associated with having PTB.

CONCLUSION

There is a high prevalence of PTB among casual labourers working at road construction sites in central Uganda. Individuals who had never been vaccinated with BCG, alcohol users and those staying in shared rooms were at an increased risk of having PTB. We recommend routine screening of casual labourers at road construction sites to optimize active TB case finding.

The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya

HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of offering the choice of self-administered oral HIV-testing (HIVST-Choice) compared with provider-administered testing only [standard-of-care (SOC)] among long-distance truck drivers. Effectiveness data came from a randomized-controlled trial conducted at two roadside wellness clinics in Kenya (HIVST-Choice arm, n = 150; SOC arm, n = 155). Economic cost data came from the literature, reflected a societal perspective and were reported in 2020 international dollars (I$), a hypothetical currency with equivalent purchasing power as the US dollar. Generalized Poisson and linear gamma regression models were used to estimate effectiveness and incremental costs, respectively; incremental effectiveness was reported as the number of long-distance truck drivers needing to receive HIVST-Choice for an additional HIV test-uptake. We calculated the incremental cost-effectiveness ratio (ICER) of HIVST-Choice compared with SOC and estimated 95% confidence intervals (CIs) using non-parametric bootstrapping. Uncertainty was assessed using deterministic sensitivity analysis and the cost-effectiveness acceptability curve. HIV test-uptake was 23% more likely for HIVST-Choice, with six individuals needing to be offered HIVST-Choice for an additional HIV test-uptake. The mean per-patient cost was nearly 4-fold higher in HIVST-Choice (I$39.28) versus SOC (I$10.80), with an ICER of I$174.51, 95% CI [165.72, 194.59] for each additional test-uptake. HIV self-test kit and cell phone service costs were the main drivers of the ICER, although findings were robust even at highest possible costs. The probability of cost-effectiveness approached 1 at a willingness-to-pay of I$200 for each additional HIV test-uptake. HIVST-Choice improves HIV-test-uptake among truck drivers at low willingness-to-pay thresholds, suggesting that HIV self-testing is an efficient use of resources. Policies supporting HIV self-testing in similar high risk, hard-to-reach sub-populations may expedite achievement of international targets.

Exploring the syndemic interaction between social, environmental and structural contexts of HIV infection in peri-mining areas in South Africa: a qualitative study

OBJECTIVE

To explore the syndemic interaction between social, environmental, and structural contexts and HIV infection in peri-mining areas in South Africa.

DESIGN

Mixed qualitative methods consisting of in-depth interviews (IDIs) and focus group discussions (FGDs) exploring the interaction between HIV infection and the social, environmental and structural factors affecting people living in the peri-mining areas of South Africa. Themes were analysed following the syndemic theoretical framework.

SETTING

Participants were recruited from three mining companies and locations in the peri-mining communities surrounding the mining companies in Limpopo, Mpumalanga, and Northern Cape provinces.

PARTICIPANTS

Inclusion criteria included mineworkers, healthcare workers, female sex workers (FSWs), injection drug users (IDUs), and other community members, ≥18 years, living in the peri-mining area at the time of participation. Three FGDs were conducted (n=30): 13 men and 17 women aged 18-55 years. IDIs were conducted with 45 participants: mineworkers (n=10), healthcare workers (n=11), FSWs (n=15), truck drivers (n=4) and IDUs (n=5).

RESULTS

The findings from this study indicate that a syndemic of four socio-behavioural factors is associated with HIV acquisition in peri-mining areas. These are migrancy, accessibility to alcohol and substance use, commercial and transactional sex, and uptake of HIV prevention services.

CONCLUSIONS

Our findings have implications for HIV prevention programmes in mining companies, which rely on male condom usage promotion. More emphasis on better education about HIV prevalence, transmission and up-to-date prevention alternatives, such as pre-exposure prophylaxis for mineworkers is recommended. Furthermore, collaboration with community-based organisations is recommended to wholly address the syndemic factors influencing HIV transmission in peri-mining communities.

The relationship between climate change, globalization and non-communicable diseases in Africa: A systematic review

Climate change and non-communicable diseases (NCDs) are considered the 21st Century's major health and development challenges. Both pose a disproportionate burden on low- and middle-income countries that are unprepared to cope with their synergistic effects. These two challenges pose risks for achieving many of the sustainable development goals (SDGs) and are both impacted by globalization through different pathways. While there are important insights on how climate change and or globalization impact NCDs in the general literature, comprehensive research that explores the influence of climate change and or globalization on NCDs is limited, particularly in the context of Africa. This review documents the pathways through which climate change and or globalization influence NCDs in Africa. We conducted a comprehensive literature search in eight electronic databases-Web of Science, PubMed, Scopus, Global Health Library, Science Direct, Medline, ProQuest, and Google Scholar. A total of 13864 studies were identified. Studies that were identified from more than one of the databases were automatically removed as duplicates (n = 9649). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 27 studies were eventually included in the final review. We found that the impacts of climate change and or globalization on NCDs act through three potential pathways: reduction in food production and nutrition, urbanization and transformation of food systems. Our review contributes to the existing literature by providing insights into the impact of climate change and or globalization on human health. We believe that our findings will help enlighten policy makers working on these pathways to facilitate the development of effective policy and public health interventions to mitigate the effects of climate change and globalization on the rising burden of NCDs and goal 3 of the SDG, in particular.

Use of "Strengthening Our Vows" Video Intervention to Encourage Negotiated Explicit Sexual Agreements in Zambian Heterosexual HIV Seroconcordant-Negative Couples

Negotiating sexual agreements in combination with couples' voluntary HIV counseling and testing (CVCT) may help further reduce HIV transmission in Zambian concordant HIV-negative couples (CNC). Though CVCT has been shown to reduce HIV transmission in CNC by 47%, approximately half of residual infections occur in this group. We developed a "Strengthening Our Vows" video session to foster communication and negotiation of explicit sexual agreements to reduce concurrent sexual exposures and prevent HIV transmission to the spouse due to unprotected, extramarital sex. CNC were recruited through CVCT services at five clinics in Lusaka and Ndola in 2016. Enrolled CNC attending the facilitated group video sessions were encouraged to discuss sexual agreements at home and return 1-2 weeks later for follow-up assessment. One-fourth of the 580 CNC returning reported a history of extramarital partners and/or a sexually transmitted infection (STI) prior to enrollment. More than 95% reported a friendly, supportive 15-60 min negotiation culminating in an agreement to remain monogamous or disclose sexual contacts and use condoms together until a repeat HIV test 30 days after an outside sexual exposure. Two-thirds of participants identified at least one threat to adherence of their agreements including alcohol use, financial pressures, travel, discord in the home, and post-partum or menstrual abstinence. CNC negotiated explicit sexual agreements to avoid exposure to HIV through concurrent partnerships and protect the spouse in the event of an outside sexual contact. Open communication was a consistent theme to facilitate mutual protective efforts. Long-term follow-up of HIV/STI incidence is ongoing to assess the impact of these agreements.Trial registration This sub-study is part of a trial retrospectively registered on ClinicalTrials.gov (Identifier: NCT02744586) on April 20, 2016.

Shift Work as a Cardiovascular Disease Risk Factor: A Narrative Review

Shift work has emerged as a significant health concern in recent years, and research has revealed a link to circadian rhythm dysregulation and atherosclerosis, both of which can increase the risk of cardiovascular disease (CVD). Currently, there is a lack of updated reviews regarding the impact of shiftwork on CVD. Thus, the present narrative review aims to provide a comprehensive summary of the latest research on the relationship between shift work and CVD, identify potential gaps in the current knowledge, and highlight areas for future research. Database searches for peer-reviewed articles published between January 2013 to January 2023 on shift work associated CVD revealed many studies that found shift work is linked with increased prevalence of carotid artery plaque, increased arterial stiffness, and carotid artery intima-media thickness (IMT) all suggestive of a progression of atherosclerosis attributable to shift work. Hypertension, diabetes, and a sedentary lifestyle are known risks for CVD, and the results of the present study suggest that shift work should be added to that list. The elevation of inflammatory markers and DNA damage in shift workers may be linked to their increased progression of atherosclerosis and the positive association of shift work with coronary artery disease. There are minimal studies on mitigating approaches for shift work-related CVD, such as diet modification or exercise, emphasizing the need for further directed research in this area.

A Retrospective Medical Record Review to Describe Health Status and Cardiovascular Disease Risk Factors of Bus Drivers in South Africa

Cardiovascular disease (CVD) is the leading cause of death globally. The occupational challenges of bus drivers may increase their risk of CVD, including developing obesity, hypertension, and diabetes. We evaluated the medical records of 266 bus drivers visiting an occupational medical practice between 2007 and 2017 in Johannesburg, South Africa, to determine the health status of bus drivers and investigate risk factors for CVD, and their impact on the ability to work. The participants were in majority male (99.3%) with a median age of 41.2 years (IQR 35.2); 23.7% were smokers, and 27.1% consumed alcohol. The median body mass index (BMI) was 26.8 m/kg² (IQR 7.1), with 63.1% of participants having above normal BMI. Smoking, BMI, and hypertension findings were in line with national South African data, but diabetes prevalence was far lower. Undiagnosed hypertension was found in 9.4% of participants, uncontrolled hypertension in 5.6%, and diabetes in 3.0%. Analysis by BMI category found that obesity was significantly associated with increased odds of hypertension. Uncontrolled hypertension was the main reason for being deemed 'unfit to work' (35.3%). Our research highlights the need for more regular screening for hypertension and interventions to address high BMI.

Hypertension and Its Associated Factors Among Long-Distance Truck Drivers in Ethiopia

Introduction

Hypertension is rising globally and is one of the leading causes of cardiovascular disease. It affects people of different groups; however, owing to a rise in a sedentary lifestyle it is more prevalent among long-distance truck drivers. However, the prevalence of hypertension and its associated factors among truck drivers in Ethiopia is not known. Therefore, this study aimed to determine the prevalence of hypertension and its associated factors among long-distance truck drivers in Ethiopia.

Methods

A cross-sectional study was conducted among 415 long-distance truck drivers selected by systematic random sampling technique at Modjo dry port from May 15 to 30, 2021. The data were collected and entered into Epi-data 4.6 then it was exported to SPSS version 25 for analysis. Descriptive statistics, bivariable, and multivariable logistic regression analyses were executed. The odds ratio with a 95% confidence interval was computed. In the final model, a variable with a p ≤ 0.05 was declared as a predictor of hypertension.

Results

The prevalence of hypertension among long-distance truck drivers in Ethiopia was 34.7%. The odds of hypertension was higher among drivers who were ≥45 years old [Adjusted odds ratio (AOR) = 4.32; 95% Confidence interval (CI): 2.16, 8.62], obese [AOR= 5.12; 95% CI: 1.33, 19.8], alcohol drinkers [AOR=3.05; 95% CI: 1.27, 7.31], and cigarette smokers [AOR= 3.74; 95% CI: 1.64, 8.51]. Drivers who had regular physical exercise were less likely [AOR=0.33; 95% CI: 0.17, 0.63] to have hypertension than drivers with no physical activity.

Conclusion

More than a third of the participants in Ethiopia had hypertension. Higher age, obesity, absence of rest between driving, short sleep duration, smoking, alcohol drinking, and physical inactivity were significantly associated with hypertension. Therefore, health education on lifestyle modifications, sleep habits, and the importance of rest breaks between driving should be considered to prevent hypertension and further complications.

M, Michelle. H, Anna. D, Reuben. R, Greg. K, Andre. JJ, Leslie L, Thomas. M, GF. TK. Impact of HIV on Cognitive Performance in Professional Drivers

BACKGROUND

The intellectually demanding modern workplace is often dependent on good cognitive health, yet there is little understanding of how neurocognitive dysfunction related to HIV presents in employed individuals working in high-risk vocations such as driving. HIV-associated neurocognitive impairment is also associated with poorer long-term cognitive, health, and employment outcomes.

SETTING

This study, set in Cape Town, South Africa, assessed the effects of HIV on neuropsychological test performance in employed male professional drivers.

METHOD

We administered a neuropsychological test battery spanning 7 cognitive domains and obtained behavioral data, anthropometry, and medical biomarkers from 3 groups of professional drivers (68 men with HIV, 55 men with cardiovascular risk factors, and 81 controls). We compared the drivers' cognitive profiles and used multiple regression modeling to investigate whether between-group differences persisted after considering potentially confounding sociodemographic and clinical variables (ie, income, home language, depression, and the Framingham risk score).

RESULTS

Relative to other study participants, professional drivers with HIV performed significantly more poorly on tests assessing processing speed (P < 0.003) and attention and working memory (P = 0.018). Group membership remained a predictor of cognitive performance after controlling for potential confounders. The cognitive deficits observed in men with HIV were, however, largely characterized as being mild or asymptomatic. Consistent with this characterization, their relatively poor performance on neuropsychological testing did not generalize to self-reported impairment on activities of daily living.

CONCLUSION

Drivers with HIV may be at risk of poorer long-term health and employment outcomes. Programs that monitor and support their long-term cognitive health are needed.

Influence of shift work on cardiovascular disease risk in Southern African long-distance truck drivers: a cross-sectional study

OBJECTIVES

Cardiovascular disease (CVD) is a major problem globally. Truck drivers have an increased risk of CVD due to a sedentary lifestyle, irregular working hours and behavioural choices. We aimed to get insight into the contribution of night shift work to CVD risk in long-distance truck drivers in South Africa.

DESIGN

A cross-sectional study.

SETTING

Enrolment took place at three South African truck stop locations in two provinces; Bloemfontein (Free State), Pomona Road (Gauteng) and Soweto (Gauteng).

PARTICIPANTS

607 males aged ≥18 years with full-time employment as a long-distance truck driver were included. The criteria for inclusion were willingness and being able to provide informed consent and to complete the study procedures.

PRIMARY AND SECONDARY OUTCOME MEASURES

Information was collected on sociodemographics, occupational and health characteristics. Physical measurements, an ECG and carotid intima-media thickness (CIMT) measurements were taken. A night shift was defined as working at least 3 hours between 22:00 and 6:00 hours once a week. CVD risk was defined with the Framingham Risk Score (FRS), the Atherosclerotic Cardiovascular Disease (ASCVD) risk algorithm, left ventricular hypertrophy (LVH) and CIMT.

RESULTS

In total, 607 truck drivers were included of which 305 (50.2%) worked in day shifts only and 302 (49.8%) worked day and night shifts. There was a high prevalence of CVD risk factors in both groups as 33% were hypertensive, 28% obese and 37% had abnormal lipid levels. Working day and night shifts compared with working only day shifts did not result in differences in FRS, ASCVD risk or LVH. No difference was found in CIMT measurements, except for the maximum bulb thickness which was higher in day shift workers.

CONCLUSIONS

CVD risk factors are considerably present in male truck drivers in South Africa. CVD risk does not differ between dayshift and day-night shift workers in this cross-sectional analysis.

Obesity as a Risk Factor for Hypertension and Diabetes among Truck Drivers in a Logistics Company, South Africa

Despite the occupational nature of truckers predisposing them to cardiovascular diseases and risk factors, data is scarce on their prevalence of obesity and its association with developing hypertension (HBP) and diabetes in South Africa. Extracted from the original cross-sectional study of a sample of 312 employees in a logistics company, a census of 96 male truckers was used to determine the prevalence of obesity and its association with HBP and diabetes. WHO STEPwise approach was used to collect data, including systolic (SBP) and diastolic (DBP) blood pressure and anthropometry measurements. HBP is defined as SBP/DBP ≥ 140/90 mmHg, overweight/obesity as BMI ≥ 25 kg/m2, abdominal obesity by waist circumference as WC ≥ 90cm, waist-to-hip-ratio as WHR ≥ 0.90, and waist-to-height ratio as WHtR ≥ 0.5. Data were analysed using SPSS 22. The mean age of truckers was 46 years, 29% were smokers, and 57% alcohol users, while 26% were physically inactive. The prevalence of overweight (44%) and obesity (30%) were observed, while abdominal obesity was high; WC (59%), WHR (65%), and WHtR (80%). HBP (57%) was prevalent and diabetes was 14%. The odds of developing HBP were high for obese truckers by WC [AOR = 4.68; CI = 1.92–11.34)] and by WHtR [AOR = 5.49 CI = 1.74–17.27), while diabetes was associated with WHR (AOR = 1.19; CI = 1.19–31.21). This study showed an associative link between obesity, HBP, and diabetes among the truckers, which is informative for a relevant prevention programme tailored to their needs.

Synchronous Generative Development amidst Situated Entropy

The Sustainable Development Goals have been criticized for not providing sufficient balance between human well-being and environmental well-being. By contrast, joint agent-environment systems theory is focused on reciprocal synchronous generative development. The purpose of this paper is to extend this theory towards practical application in sustainable development projects. This purpose is fulfilled through three interrelated contributions. First, a practitioner description of the theory is provided. Then, the theory is extended through reference to research concerned with multilevel pragmatics, competing signals, commitment processes, technological mediation, and psychomotor functioning. In addition, the theory is related to human-driven biosocial-technical innovation through the example of digital twins for agroecological urban farming. Digital twins being digital models that mirror physical processes; that are connected to physical processes through, for example, sensors and actuators; and which carry out analyses of physical processes in order to improve their performance. Together, these contributions extend extant theory towards application for synchronous generative development that balances human well-being and environmental well-being. However, the practical examples in the paper indicate that counterproductive complexity can arise from situated entropy amidst biosocial-technical innovations: even when those innovations are compatible with synchronous generative development.

Importance of testing the internal consistency and construct validity of the Pittsburgh Sleep Quality Index (PSQI) in study groups of day and night shift workers: Example of a sample of long-haul truck drivers in South Africa

Irregular work times promote inconsistent completion of the Pittsburgh Sleep Quality Index (PSQI) among shift workers. We aimed to demonstrate the importance of testing the internal consistency and construct validity of the PSQI and of the Epworth Sleepiness Scale (ESS) by presenting the methodology in a sample of long-haul truckers in South Africa. Internal consistency of the questionnaires was assessed by Cronbach's alpha (defined as raw alpha≥0.70), and construct validity by factor analysis. 302 participants (49.3%) reported at least one night shift/week. Overall, the PSQI and ESS's alpha were 0.42 and 0.85, respectively. The factors explained 19.6% of 57.0% of the variance. The PSQI's alpha was 0.46 in night shift workers and 0.38 in non-night shift workers. In this occupational group, the PSQI must be used with caution. Testing the internal consistency and construct validity among the assessed population seems necessary. Sleep questionnaires adapted to shift workers should be preferred.

Estimating the burden of hypertension and its significant risk factors among male commercial drivers in sub-Saharan Africa: A systematic review and meta-analysis

OBJECTIVE

The study was designed to assess the burden and significant risk factors among male commercial drivers in sub-Saharan Africa (SSA).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline via PubMed, Google Scholar, Cochrane databases and Africa Journal Online were searched from January 2010 to December 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The authors included observational studies reporting on the burden and/or risk factors for hypertension among commercial drivers in SSA. Male adult population ≥18 years working as a commercial driver in SSA as well articles published in English.

DATA EXTRACTION AND SYNTHESIS

Two independent coauthors used a prepared data extraction form to extract data from the eligible published papers and assessed the risk of bias. DerSimonian and Laird random effects model was used to pool the burden of hypertension and significant risk factors among male commercial drivers in SSA. The presence of heterogeneity among studies was quantified by estimating variance using both Cochrane's Q statistics and the I² statistics. A subgroup and sensitivity analyses were performed.

RESULTS

Overall, 14 articles met the inclusion criteria involving a total of 4285 male commercial drivers in SSA. The estimated pooled burden of hypertension among the male commercial drivers in SSA was 32% (95% CI 24% to 39%). The risk factors identified were age OR=1.10 (95% CI 1.06 to 1.15), overweight/obese OR=3.38 (95% CI 2.46 to 4.29), alcohol consumption OR=3.00 (95% CI 2.05 to 3.95) and duration of driving (≥5 years) OR=1.83 (95% CI 1.03 to 2.63). Funnel plot inspection and Egger's regression test of small effect (0.5838) showed no evidence of publication bias.

CONCLUSIONS

Our review showed that nearly one-third of male commercial drivers in SSA have hypertension. Reduction of modifiable risk factors such as overweight/obesity, alcohol consumption and long-term driving through multifaceted implementation strategies are recommended for prevention and control of hypertension among male commercial drivers in SSA.

TRIAL REGISTRATION NUMBER

CRD42021250910.

Timing of Health Service Use Among Truck Drivers After a Work-Related Injury or Illness

Purposes Timely delivery of treatment and rehabilitation is generally acknowledged to support injury recovery. This study aimed to describe the timing of health service use by injured truck drivers with work-related injury and to explore the association between demographic and injury factors and the duration of health service use. Methods Retrospective cohort study of injured truck drivers with accepted workers' compensation claims in the state of Victoria, Australia. Descriptive analyses examined the percentage of injured truck drivers using health services by service type. Logistic regression model examined predictors of any service use versus no service use, and predictors of extended service use (≥ 52 weeks) versus short-term use. Results The timing of health service use by injured truck drivers with accepted workers' compensation claims varies substantially by service type. General practitioner, specialist physician, and physical therapy service use peaks within the 14 weeks after compensation claim lodgement, whilst the majority of mental health services were accessed in the persistent phase beyond 14 weeks after claim lodgement. Older age, being employed by small companies, and claiming compensation for mental health conditions were associated with greater duration of health service use. Conclusions Injured truck drivers access a wide range of health services during the recovery and return to work process. Delivery of mental health services is delayed, including for those making mental health compensation claims. Health service planning should take into account worker and employer characteristics in addition to injury type.

Sexual practices, risk perception and HIV self-testing acceptability among long-distance truck drivers in Ekiti State, Nigeria

BACKGROUND

HIV/AIDS is a global health challenge with a high burden in sub-Saharan Africa. Long-distance drivers are a high-risk group whose assessment of HIV status, awareness and willingness to undergo HIV self-testing (HIVST) could help prevent the spread of HIV infections.

OBJECTIVE

This study examined the sexual practices, risk perception and HIVST acceptability among long-distance truck drivers in Ekiti State, Nigeria.

METHODS

A cross-sectional study was conducted among long-distance truck drivers between September 2019 and December 2019. A semi-structured questionnaire was designed to investigate the perceived sexual risk factors and willingness to undergo HIVST.

RESULTS

Of the 306 drivers that participated in the study, almost half (49.8%) had their first sexual experience before they turned 18 years. About one-third (38.6%) had multiple sex partners and (34.0%) patronised commercial sex workers in the past 6 months. Consistent use of condoms was reported in a negligible percentage (3.0%), while 7.4% used intravenous drugs. Two-thirds of the respondents were interested in HIVST, while 32.2% knew their HIV status. Significant factors associated with multiple sex partners were the duration of working as a long-distance truck driver and patronage of sex workers.

CONCLUSION

A significant proportion of the long-distance drivers were engaged in unsafe sexual practices and are at risk for HIV transmission. Considering the mobile nature of the long-distance drivers, the risky practices of these workers require intense advocacy, testing and treatment to reduce HIV transmission. Scaling-up testing using HIVST has the potential to bridge the gap in the diagnosis of HIV among long-distance drivers who are willing to be tested.

Incidence of ocular and systemic diseases affecting visual function among state bus drivers

Purpose:

To evaluate the incidence of ocular and systemic disease affecting visual function among state transport corporation bus drivers in a south Indian district.

Methods:

This retrospective study analysed the records of all the drivers who presented to a south Indian tertiary-care eye hospital in 2019 for their mandatory annual ocular check-up. Details reviewed included demographic details; refraction; presence of systemic and ocular diseases with vision-threatening potential; presence of ocular conditions responsible for visual loss and the treatment administered.

Results:

3042 drivers (mean age, 47.0 ± 5.7 years) were evaluated. Visual function-threatening systemic diseases were present in 25.0% drivers, out of which diabetes mellitus (18.7%) was the most common pathology. The most common ocular problem was refractive error (45.0%). Visual function-threatening ocular diseases were present in 9.5% drivers. Diabetic retinopathy, visually-significant cataract, glaucoma and central serous chorioretinopathy were noted in 4.0%, 1.9%, 1.7% and 0.8% drivers. Surgical intervention was required in 2.2% drivers. Thirteen drivers were temporarily deemed unfit for driving heavy-weight vehicles.

Conclusion:

Several bus drivers suffer from vision-threatening systemic and ocular diseases. Some of them require surgical intervention to retain fitness. A complete ocular and systemic evaluation of diseases with vision-threatening potential should be performed at the time of renewal of the driving license. The drivers should be educated about the systemic diseases which can affect their driving skills and must be encouraged to seek medical help at an early stage.

Interconnections between circadian clocks and metabolism

Circadian rhythms evolved through adaptation to daily light/dark changes in the environment; they are believed to be regulated by the core circadian clock interlocking feedback loop. Recent studies indicate that each core component executes general and specific functions in metabolism. Here, we review the current understanding of the role of these core circadian clock genes in the regulation of metabolism using various genetically modified animal models. Additionally, emerging evidence shows that exposure to environmental stimuli, such as artificial light, unbalanced diet, mistimed eating, and exercise, remodels the circadian physiological processes and causes metabolic disorders. This Review summarizes the reciprocal regulation between the circadian clock and metabolism, highlights remaining gaps in knowledge about the regulation of circadian rhythms and metabolism, and examines potential applications to human health and disease.

Undiagnosed Hypertension in a Workplace: The Case of a Logistics Company in Gauteng, South Africa

A large proportion of the population with hypertension remains undiagnosed, untreated, or inadequately treated, contributing to the rising burden of cardiovascular diseases in South Africa. A workplace may either mitigate or accentuate the risk factors for hypertension. A cross sectional study was conducted to determine the prevalence of undiagnosed hypertension and associated factors among 312 employees in a Logistics Company, South Africa. A modified, validated, self-administered WHO STEPwise questionnaire was used to collect data on demography, lifestyle factors, anthropometry and blood pressure (BP). Hypertension was defined at BP ≥ 140/90 mmHg. Data was analysed using STATA 14. Mean age of employees was 40 ± 10 years, with a 50% prevalence of undiagnosed hypertension. No significant association was observed between occupation and undiagnosed hypertension, except for high prevalence of undiagnosed hypertension among truck drivers and van assistants (43%), and general workers (27%), having higher odds of increased waist-to-height ratio. Hypertension was associated with age (OR = 2.3, 95%CI; 1.21–4.27), alcohol use (AOR = 1.8, 95%CI; 1.05–2.93), waist circumference (AOR = 2.3, 95%CI; 1.29–4.07) and waist-to-height-ratio (AOR = 3.7, 95%CI; 1.85–7.30). Improved and effective workplace health programs and policies are necessary for management of undiagnosed hypertension among employees. Longitudinal studies on mediation of occupation in association of demographic and lifestyle factors with hypertension in workplaces are needed.

Australian bus drivers' modifiable and contextual risk factors for chronic disease: A workplace study

INTRODUCTION

Little is known about workplace health promotion for bus drivers. Bus drivers are at-risk of chronic disease because they are exposed to the risk factor combination of poor nutrition, low levels of physical activity, high levels of sedentary time and are often overweight or obese. The purpose of this paper is to situate the quantitative baseline data collected from bus drivers within qualitative findings about the socio-cultural context of the workplace.

MATERIALS AND METHODS

Baseline data about physical activity, dietary intake and sedentary hours was collected from 58 drivers employed by a large bus company in southeast Queensland. Ten drivers and seven key workplace informants participated in interviews and discussion groups about driver health behaviours, workplace structure, culture, and resources.

RESULTS

The quantitative results of our study reveal bus drivers have a cluster of poor health behaviours-limited physical activity, lower than recommended consumption of fruit and vegetables and high levels of sitting time during working-hours-which contribute to a high prevalence of overweight and obesity and a heightened risk of chronic disease. The qualitative findings suggest there are individual and structural barriers to improving drivers' modifiable health behaviours. Individual barriers include ingrained poor habits and more pressing life concerns, while structural barriers in the context of the workplace include time constraints, shift work, long days, a lack of work amenities and a general disconnect of drivers with their workplace.

CONCLUSION

In this workplace, health promotion strategies for bus drivers should be prioritised as a means of improving drivers' health. To maximise uptake and effectiveness, these strategies should make use of existing workplace resources and consider the context of workplace health behaviour change. Further research is warranted in a broader sample of Australian bus companies to explore the context of workplace health behavior change so targeted strategies to improve bus drivers' health can be developed.

Relationship between sleep disorders, HIV status and cardiovascular risk: cross-sectional study of long-haul truck drivers from Southern Africa

OBJECTIVES

Long-haul truck drivers (TDs) may have lifestyles that promote cardiovascular disease (CVD), including diet, sleep and activity issues. Most studies conducted among truckers investigated the relationship between poor sleep and cardiometabolic health, but none assessed whether suspected obstructive sleep apnoea (OSA) and shortened sleep were associated with markers of cardiometabolic risk. We determined whether sleep disorders and circadian misalignment were associated with chronic inflammation and CVD risk in TDs from Southern Africa.

METHODS

Participants were recruited at roadside wellness centres in Gauteng and Free State Provinces, South Africa. OSA risk was assessed using the Berlin Questionnaire, while sleep duration and sleep quality were assessed using items from the Pittsburgh Sleep Quality Index. Clinical information, neck circumference (NC), metabolic profile, elevated BP, HIV status and C-reactive protein (CRP) were collected. CVD risk was assessed using the Framingham Risk Score (FRS).

RESULTS

Out of 575 participants aged on average 37.7 years, 17.2% were at OSA risk, 72.0% had elevated BP, 9.4% had HIV and 28.0% were obese. Mean sleep duration was 7.4±1.8 hours, and 49.6% reported working night shift at least once a week. Shortened sleep, OSA risk, age, body mass index, NC and years as full-time TD were associated with greater FRS independently of HIV status and night shift. Working night shift was associated with higher CRP levels in HIV+ compared with HIV- participants.

CONCLUSIONS

Circadian misalignment in HIV, and OSA and short sleep duration in all truckers were associated with increased CVD risk. Truckers should be given careful attention in terms of health management and sleep education.

Working nights and lower leisure-time physical activity associate with chronic pain in Southern African long-distance truck drivers: A cross-sectional study

Background

In South Africa, the trucking industry employs over 70,000 people and the prevalence of chronic pain in this occupational group was reported at 10%. We investigated factors associated with chronic pain in truck drivers including mental health, physical activity, and sleep, as no study has done so.

Methods

Southern African male, long-distance truck drivers were recruited at truck stops in Gauteng and Free State Provinces, South Africa (n = 614). Chronic pain was defined as pain present for at least the last three months. Depressive symptoms were assessed with the Patient Health Questionnaire-9, post-traumatic stress disorder with the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), exposure to traumatic events with the Life Events Checklist-5 (LEC-5) and daytime sleepiness with the Epworth Sleepiness Scale. Sleep quality was measured on a four-point Likert scale. Leisure-time physical activity was measured using the Godin-Shephard leisure-time physical activity questionnaire. Associations between these factors, demographic factors and chronic pain were investigated.

Results

Multivariate analysis showed that working ≥ 2 nights/week (OR = 2.68, 95% CI = 1.55–4.68) was associated with chronic pain and physical activity was protective (OR = 0.97, 95% CI 0.95–0.98). In an exploratory analysis, greater depressive symptoms (p = 0.004), daytime sleepiness (p = 0.01) and worse sleep quality (p = 0.001) was associated with working ≥ 2 nights/week. Lower leisure-time physical activity was associated with worse sleep quality (p = 0.006), but not daytime sleepiness or depressive symptoms (p>0.05).

Conclusions

There is a clear relationship between working nights and activity levels, and chronic pain, sleep quality, and depression in truck drivers.

Cardiometabolic risk factors and mental health status among truck drivers: a systematic review

OBJECTIVE

This study aimed to systematically review and summarise the literature on cardiometabolic risk factors, lifestyle health behaviours and mental health status of truck drivers globally to ascertain the scale of these health concerns.

DESIGN

Systematic review reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

PubMed, Scopus, PsycINFO and Web of Science were searched in January 2019 and updated in January 2020, from the date of inception to 16 January 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Papers were included if they (1) reported independent data on truck drivers, (2) included quantitative data on outcomes related to cardiometabolic markers of health, mental health and/or health behaviours, (3) were written in English and (4) were published in a peer-reviewed journal. Grey literature was ineligible for this review.

DATA EXTRACTION AND SYNTHESIS

One reviewer independently extracted data and assessed methodological quality using a checklist based on the National Heart, Lung and Blood Institute Quality Assessment tool. 20% were independently assessed for eligibility and quality by a second reviewer. Due to heterogeneity of the outcomes, results were narratively presented.

RESULTS

3601 titles and abstracts were screened. Seventy-three studies met the inclusion criteria. Truck driving is associated with enforced sedentarism, long and irregular working hours, lack of healthy foods, social isolation and chronic time pressures. Strong evidence was observed for truck drivers to generally exhibit poor cardiometabolic risk profiles including overweight and obesity, hypertension, hypercholesterolaemia, high blood glucose, poor mental health and cigarette smoking.

CONCLUSIONS

Improving truck driver health is vital for the longevity of the trucking industry, and for the safety of all road users. The workplace plays a vital role in truck driver health; policies, regulations and procedures are required to address this health crisis.

PROSPERO REGISTRATION NUMBER

CRD42019124499.

Prevalence and associated factors of chronic non-communicable diseases among cross-country truck drivers in Ethiopia

BACKGROUND

Non-communicable diseases (NCDs) are diseases that are not transmitted from one person to another. Currently, NCDs are the primary causes of morbidity and mortality globally. Truck driving is an occupation that prone drivers to risk factors for NCDs than other occupations. Eventhough risk of developing NCDs among these population is high, studies that showed the prevalence and associated factors of chronic NCDs among truck drivers in Ethiopia are not available. Therefore, this study aimed to assess the prevalence and associated factors of chronic NCDs among truck drivers in Ethiopia.

METHODS

A cross-sectional study was conducted among 422 cross-country truck drivers at the Modjo dry port in Ethiopia. The interviwer-administered questionnaire technique was used to collect the data. The body mass index of the study participants was measured using DHM-15A standardized scale (BMI Height and Weight body fat scale).

RESULTS

Of the 400 truck drivers interviewed, the prevalence of chronic non-communicable diseases was 28.5, 95% CI (24.1-32.9%). Eighty (20%) had hypertension followed by 32(8%), and 22 (5.5%) had diabetes mellitus and asthma, respectively. The study also found that being married (AOR = 3.14, 95%CI [1.78-5.86]) and Separated/Divorced/Widower (AOR = 2.31, 95% CI [1.12-3.55]), having 3 or more family sizes (AOR = 1.46, 95% CI [1.33-4.42]), BMI ≥ 25 (AOR = 4.66, 95% CI [2.85-7.62]), smoking cigarettes [AOR = 1.71, 95% CI [1.03-2.81]), driving 10 or more years (AOR = 3.48, 95% CI [1.89-5.24]) and driving 9 or more hours daily (AOR = 3.76, 95% CI [1.96-6.54]) were statistically associated with chronic non-communicable diseases.

CONCLUSION

The prevalence of chronic NCDs among truck drivers was significant (28.5%), and we can conclude that chronic NCDs are of public health importance among truck drivers in Ethiopia. This may create a substantial load on the healthcare system as an end result of increased demand and contact with healthcare services. Therefore, a rigorous effort is needed to develop strategies for the prevention and management of NCDs.

The Burden of Overweight and Obesity among Long-Distance Truckers in Ethiopia

BACKGROUND

Abnormal body mass index (BMI ≥ 25 kg/m²) has become a major global public health problem which is rising at a faster rate in urban areas of low- and middle-income countries. In Ethiopia, the prevalence gradually increases. Long-distance truckers are at a high risk of developing overweight or obesity due to the sedentary nature of their job. Despite these populations at a high risk of developing overweight/obesity such as drivers elsewhere, pieces of data that showed the prevalence and contributing factors of overweight and obesity among long-distance truckers in Ethiopia are not yet available.

OBJECTIVE

To assess the prevalence and contributing factors of overweight and obesity among long-distance truckers in Ethiopia.

METHODS

A cross-sectional study was conducted among 400 systematically selected truckers at Modjo dry port in Ethiopia from February to March, 2018. Data were collected through face-to-face interviews using a structured questionnaire. The final results were presented in tables and numerical summary measures such as mean and standard deviation (SD).

RESULTS

Of the 400 truckers interviewed, the prevalence of overweight and obesity was 56.5%, 95% CI (51.6%-61.4%). The study also found that a monthly income ≥220 USD (AOR = 1.83, 95% CI (1.05-3.18)), having 3 or more family sizes (AOR = 2.24, 95% CI (1.15-4.36)), less than 6 hours of sleep at night (AOR = 3.34, 95% CI (1.99-5.78)), driving for 9 or more hours daily (AOR = 2.29, 95% CI (1.09-4.81)), and a truck driving experience of 10 or more years (AOR = 2.13, 95% CI (1.29-4.18)) were significantly associated with overweight and obesity.

CONCLUSION

The prevalence of overweight and obesity was substantially high. The study also found that sociodemographic and occupational factors are mainly associated with overweight and obesity. Therefore, a health education program should be designed for awareness creation on the importance of reducing a sedentary lifestyle, consuming healthy foods or drinks, and having regular physical exercise to mitigate the problem.