Multilevel Factors Influencing Interruptions in PrEP Use Among Young Women in Siaya County, Kenya

Young women in sub-Saharan Africa continue to be disproportionately at risk for HIV. Oral pre-exposure prophylaxis (PrEP) can reduce women's HIV risk when taken daily throughout their "seasons of risk". We used photovoice to describe community views on factors influencing interruptions in PrEP use among young cisgender women in Siaya County, Kenya. Through group discussions, young women taking PrEP and their social network members (female peers, male peers/partners, family, and community members) shared photographs and identified broad social-ecological causes of PrEP interruptions, including: (1) widespread misinformation about PrEP, (2) social pressures from religious communities, (3) health care staff recommendations to interrupt PrEP use, (4) partner rejection of PrEP, (5) changes in women's risk awareness, and (6) a personal desire to occasionally pause daily use. Collectively, participants identified strategies to address these challenges. These findings can inform future programs targeting the broader social-ecological influences on young women's persistent use of PrEP.

Episodic Use of Pre-Exposure Prophylaxis Among Young Cisgender Women in Siaya County, Kenya

The concept "seasons of risk" promotes use of pre-exposure prophylaxis (PrEP) only during periods of HIV risk. PrEP guidelines are aligned on daily use in women having vaginal sex during a risk period, and daily use for 28 days after the last potential exposure is recommended. However, when starting a "season of risk," guidelines vary on "time to protection," and unknowns remain in pharmacological research on PrEP protection in this population. During our iterative research on PrEP persistence using photovoice and in-depth interviews, we identified an ineffective pattern of PrEP use based on current guidelines-that is, routine, episodic use-among young cisgender women (YCW) in Siaya County, Kenya. Through same-group (n = 33 participants) and mixed-group (n = 31 participants) photovoice activities with YCW taking PrEP and female peers, participants explained that YCW associate their HIV risk with the sexual behaviors of their male partners who frequently travel from home. PrEP is considered unnecessary when partners are away because of no perceived risk. YCW re-start PrEP on or around the day of their partners' return because of heightened risk perceptions. Among the YCW interviewed (n = 18), nearly all of their partners traveled for about 1 week to 1 month at a time; about one-third of these women reported stopping PrEP during their partners' absence and re-starting it soon before or immediately upon their partners' arrival home. Additional research is critically needed to better inform PrEP guidelines and the decisions adolescent girls and young women make on how to use PrEP based on their risk context. In the interim, counseling on current dosing guidance when stopping and re-starting PrEP within a "season of risk" is needed.

US long-haul truck driver work organization and the association with cardiometabolic disease risk

Work organization, including long working hours, irregular work schedules, and job stress, has been associated with increased cardiometabolic disease (CMD) risk for numerous working populations. The purpose of this study was to examine the associations between work hours, work schedules, job stress, and CMD risk for a sample of US long-haul truck drivers (LHTDs). A nonexperimental, descriptive, cross-sectional design was employed to collect survey and anthropometric data from 260 US LHTDs at a major truck stop. The mean BMI was 33.40 kg/m² and mean waist circumference was 114.77 cm. Using logistic regression, researchers found longer work hours, especially greater than 11 hours daily, were associated with increased odds for an extremely high risk of CMD. Results support comprehensive and integrated approaches that address work organization, and in particular long working hours, to reduce drivers' CMD risk.

US long-haul truck driver health demands integrated approach

Purpose

The purpose of this paper is to provide a review of both occupational safety and health (OSH) and worksite health promotion (WHP) efforts targeted at long-haul truck drivers (LHTDs) and to identify strengths and weaknesses to inform future interventions and/or policy changes.

Design/methodology/approach

Review of the literature was done to identify theoretical and methodological approaches frequently used for protecting and promoting the health and well-being of LHTDs.

Findings

Health and safety issues impacting LHTDs are complex and naturally interrelated. Historically, the majority of approaches to the health and safety of LHTDs have emphasized the safety side and there has been a lack of comprehensive and integrated WHP/OSH attempts.

Originality/value

The literature pertaining to LHTD health has expanded in recent years, but intervention and policy efforts have had limited success. Several scholars have discussed the need for integrating WHP/OSH efforts for LHTD health, but have not actually provided a description or a framework of what it entails in which the authors provide a conclusion to the review of the literature. The authors provide a critical discussion regarding a collaborative approach focused on National Institute of Occupational Safety and Health’s Total Worker Health model. The integration further promotes an advancement of theoretical and methodological strategies.

Using the Internet to pilot a questionnaire on childhood disability in Rett syndrome

There is increasing use of the Internet for the transfer and sharing of medical information. Opportunities to pilot surveys online are now also available. An online HTML questionnaire allowed us to pilot a questionnaire about functional ability and the use of health services in Rett syndrome, a rare neurological disorder. Subscribers to a list server completed the online questionnaire and returned data by CGI script-formatted e-mail. Text boxes were provided for open-ended questions. Eighty-six questionnaires were returned from 224 subscribers with 76% returned within the first week. Almost all respondents were Caucasian, well educated and English speaking. The issue of selection bias and the need for mechanisms to validate the diagnosis are important considerations in any research facilitated through the Internet. However, we were able to contact an otherwise inaccessible group in a fast and cost-efficient manner and effectively pilot our survey without tapping into our own study population.

X-ray focusing with lobster-eye optics: a comparison of theory with experiment

We report an experimental investigation and comparison with simulation of the x-ray focusing of a flat, square profile microchannel plate. We use x rays with an energy of ~1.5 keV from a laser-produced plasma. The images were recorded with x-ray film. We find the focal structure to be consistent with theoretical expectations. The angular resolution of the focus is 0.96 mrad, which is a major improvement over previous results. The measured peak intensity gain is 27 ± 4, which is ~33% of that for a perfect optic.

Adaptive behaviour of laboratory rats feeding in hot conditions

1. A group of six rats, living at thermoneutrality, but with access to food only under a high heat load, was compared with a similar group living and eating at thermoneutrality. 2. Animals eating in the heat reduced total food intake, meal duration, total feeding time, and rate of weight gain; they increased frequency of feeding and had higher water intakes. 3. Identifiable behavioral and nutritional responses explained some of the difference in adaptation between the groups through other factors may also have played a role.

Temperature and humidity of expired air of sheep

The temperature and humidity of expired air from three adult Merino sheep were measured at air temperatures of 20, 30 and 40 degrees C before and after the animals were shorn. Expired air was apparently always saturated with water vapour. At the higher air temperatures the temperature of expired air was close to deep body temperature; at lower air temperatures, expired air had been significantly cooled, e.g. to 32.3 degrees C in shorn sheep at 20 degrees C air temperature. Expired air was cooler from shorn than from unshorn animals at 20 and 30 degrees C air temperature, possibly due to thermally induced vasomotor changes in the upper respiratory tract. Cooling of expired air would be expected to lead to recovery of some of the water evaporated during inspiration; at 20 degrees C air temperature, this fraction was estimated to be 25% in unshorn sheep and 36% in shorn sheep.