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

The first author (AG) has received funding for their PhD Studentship from the Colt Foundation. The Colt Foundation had no role in study design; election, synthesis and interpretation of data; writing of the report; or the decision to submit the manuscript for publication. SC and JAK are in receipt of funding from the NIHR Public Health Research Programme (reference: NIHR PHR 15/190/42) for the evaluation of a multi-component health behaviour intervention in truck drivers. They are also supported by the NIHR Leicester Biomedical Research Centre – Lifestyle theme. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.Peer reviewedPublisher PD

Attenuated cardiovascular reactivity is related to higher anxiety and fatigue symptoms in truck drivers

ACKNOWLEDGEMENTS The authors would like to thank all the truck drivers who participated in this study. The data presented in this paper were collected as part of the baseline measures from the “Structured Health Intervention For Truckers (SHIFT)” randomized controlled trial, which is funded by the NIHR Public Health Research Programme (reference: NIHR PHR 15/190/42). SAC, JAK, AS and NJP are supported by the NIHR Leicester Biomedical Research Centre—Lifestyle theme. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The first author (AG) has received funding for their PhD Studentship from the Colt Foundation (reference: JD/618). The Colt Foundation had no role in study design; election, synthesis, and interpretation of data; writing of the report; or the decision to submit the manuscript for publicationPeer reviewedPublisher PD

Time in Nature Associated with Decreased Fatigue in UK Truck Drivers

Funding: The data presented in this paper were collected as part of the ‘Structured Health Interven- tion For Truckers (SHIFT)’ randomised controlled trial. This research was funded by the National Institute for Health Research (NIHR) Public Health Research Programme (reference: NIHR PHR 15/190/42). Funding Acquisition, S.A.C., J.A.K., V.V-M. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Acknowledgments: SAC: JAK, AS and NJP are supported by the NIHR Leicester Biomedical Re- search Centre—Lifestyle theme. AG has received funding for their PhD Studentship from the Colt Foundation (reference: JD/618).Peer reviewedPublisher PD

Drivers with and without Obesity Respond Differently to a Multi-Component Health Intervention in Heavy Goods Vehicle Drivers

Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme (reference: NIHR PHR 15/190/42). The study was also supported by the NIHR Leicester Biomedical Research Centre which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University and the University of Leicester. Laura Gray is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Funding to cover the intervention costs (Fitbits and cab workout equipment) was provided by the Higher Education Innovation Fund, via the Loughborough University Enterprise Projects Group. The Colt Foundation provided funding for a PhD Studentship, awarded to Amber Guest (reference: JD/618), which covered Amber’s time and contributions to this project. The funders played no role in study design, data collection, data analysis, data interpretation or in the preparation of this manuscript.Peer reviewedPublisher PD

The structured health intervention for truckers (SHIFT) cluster randomised controlled trial : a mixed methods process evaluation

Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme (reference: NIHR PHR 15/190/42). The study was also supported by the NIHR Leicester Biomedical Research Centre which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University, and the University of Leicester. Laura Gray is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Funding to cover intervention costs (Fitbits, cab workout equipment) was provided by the Higher Education Innovation Fund, via the Loughborough University Enterprise Projects Group. The Colt Foundation provided funding for a PhD Studentship, awarded to Amber Guest (reference: JD/618), which covered Amber’s time and contributions to this project. None of the funding bodies had any role in study design; election, synthesis, and interpretation of data; writing of the report; or the decision to submit the manuscript for publication. Acknowledgements We gratefully acknowledge the support provided by senior Health and Safety personnel and Transport Managers at our partner logistics company in facilitating this research. We also thank all participants for taking part. We are grateful to the independent members of the Trial Steering Committee for their continued support and advice throughout the trial: Dr. Derrick Bennett, Prof Emma McIntosh, Prof Petra Wark and Mr. Paul Gardiner.Peer reviewedPublisher PD

The establishment, maintenance, and adaptation of high- and low-impact chronic pain: a framework for biopsychosocial pain research

We present a framework for the study of states of chronic pain and transitions between those states. We capture in the framework the dynamic nature of pain: people live with pain that changes over time. First, we offer definitions of both acute and chronic pain and explore the contextual considerations related to the common use of this temporal dichotomy. Second, we promote the importance of incorporating the impact pain has on a person's life. Finally, we discuss the challenges and opportunities inherent in implementing this common approach. Our goal is to produce a framework for the study of the development, maintenance, and resolution of chronic pain. Whether a single brief event or a constant feature of life, pain interrupts to prioritise protection, interferes with activity, reduces quality of life, and can alter identity.44 Protection is achieved by escape from harm, avoidance of perceived danger, withdrawal for respite and repair, and communication of incapacity and environmental risk; longer-term protection is achieved by learning the cues for pain and injury.53 From this perspective, pain is most usefully considered a need state, fundamentally a motivational drive to protect.49 This approach centres our attention on the consequences of pain for the person in their context, on its duration and its impact

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Assessing the implementation of a multicomponent health intervention in truck drivers and its interaction with psychophysiological responses to stress

Truck drivers endure systemic working conditions that are not conducive to health. Minimal access to healthy foods, alongside compulsory sedentary time, long working hours, and irregular shift patterns, create fundamental barriers to the adoption of a healthy lifestyle. This contributes to the poor health profiles seen in truck drivers compared to the general population. Furthermore, truck driving is a safety critical role, where the ill-health of an individual may compromise their ability to operate the heavy machinery at high speeds, and thereby posing a significant risk to the safety of others. It is therefore vital to provide targeted health interventions to this occupational group, in order to promote a healthier workforce. This will also contribute to the safety of all road users, and support both longevity and productivity of the logistics sector. There is limited research on the health behaviours and health profiles of truck drivers in the UK, resulting in them being an understudied at-risk occupational group. The research presented in this thesis uses a mixed methods approach to increase our understanding of the health of truck drivers. This thesis can be viewed in two related, but distinct sections. First, it looks to identify the current cardiometabolic and mental health status of truck drivers globally using a PROSPERO registered, PRISMA reported systematic review (Chapter 2), followed by a process evaluation of an NIHR funded randomised controlled trial which evaluated an intervention designed to improve the health of truck drivers (Chapter 4). Second, the thesis aims to measure cardiovascular reactivity to mental stressors in truck drivers and seeks to understand potential associations with current (Chapter 5) and future mental health (Chapter 6).  The thesis highlights that truck drivers present a poor cardiometabolic and mental health status globally, and truck drivers reported enthusiasm and necessity for a targeted intervention that targets health behaviours. The systematic review in Chapter 2 revealed that truck drivers exhibit poor cardiometabolic risk profiles including overweight and obesity, hypertension, hypercholesterolaemia, high blood glucose, poor mental health, and cigarette smoking. The process evaluation of a randomised controlled trial designed to improve the health of truck drivers in Chapter 4 indicated that participants had favourable attitudes towards the Structured Health Intervention for Truckers (SHIFT), specifically towards the Fitbit with a high proportion of drivers reporting regularly using it. Critically, managers and drivers reported enthusiasm and necessity for SHIFT to be included in future Certificate of Professional Competence training. The cross-sectional study in Chapter 5 produced novel findings where both anxiety and persistent fatigue were related to an attenuated systolic blood pressure (SBP) reactivity. Further prospective research into this relationship (conducted in Chapter 6) indicated that cardiovascular reactivity to stress was predictive of future fatigue symptoms. This may have serious implications for both cardiovascular disease and driver safety in this safety-critical workforce. Overall, the findings from this thesis indicate that truck drivers are an at-risk occupational group. Health should become a primary focus in future ‘certificate of professional competence’ training in this occupational group. The workplace plays a vital role in truck driver health; policies, regulations and procedures are required to address this health crisis.</p