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BackgroundFew studies have directly assessed the association of secondhand smoke (SHS) with cardiovascular disease-related inflammatory markers, and the findings are inconsistent.ObjectivesWe assessed the association between SHS exposure and the inflammatory markers high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and soluble intercellular adhesion molecule-1 (sICAM-1) in 199 nonsmoking U.S. trucking industry workers.MethodsParticipants provided blood samples either by mail (blood drawn at local health care provider near home) or at the work site (blood drawn by research staff on-site) and completed a health and work history questionnaire at the time of blood draw. Exposure to SHS was measured by plasma cotinine concentrations. We used multivariate regression analyses to assess the associations between levels of cotinine and inflammatory markers.ResultsThe median cotinine level was 0.10 ng/mL (interquartile range, 0.04-0.23 ng/mL). The odds ratios of elevated hs-CRP (above highest CRP tertile, 1.5 mg/L) were 2.85 [95% confidence interval (CI), 1.03-7.89] for the high-cotinine group (> 0.215 ng/mL) and 2.80 (95% CI, 1.11-7.10) for the moderate-cotinine group (0.05-0.215 ng/mL), compared with the low-cotinine group (< 0.05 ng/mL), adjusting for age, sex, race, educational level, obesity, previous smoking history, job title, and medical history. Plasma cotinine levels were not associated with IL-6 or sICAM-1.ConclusionsSHS exposure, as assessed by plasma cotinine, was positively associated with hs-CRP in this group of blue-collar workers. The strength of the association with hs-CRP depended on the cut points selected for analysis.

BackgroundAlthough the smoking rate in the United States is declining because of an increase of smoke-free laws, among blue-collar workers it remains higher than that among many other occupational groups.ObjectivesWe evaluated the factors influencing workplace secondhand smoke (SHS) exposures in the U.S. unionized trucking industry.MethodsFrom 2003 through 2005, we measured workplace SHS exposure among 203 nonsmoking and 61 smoking workers in 25 trucking terminals. Workers in several job groups wore personal vapor-phase nicotine samplers on their lapels for two consecutive work shifts and completed a workplace SHS exposure questionnaire at the end of the personal sampling.ResultsMedian nicotine level was 0.87 microg/m3 for nonsmokers and 5.96 microg/m3 for smokers. As expected, smokers experienced higher SHS exposure duration and intensity than did nonsmokers. For nonsmokers, multiple regression analyses indicated that self-reported exposure duration combined with intensity, lack of a smoking policy as reported by workers, having a nondriver job, and lower educational level were independently associated with elevated personal nicotine levels (model R2 = 0.52). Nondriver job and amount of active smoking were associated with elevated personal nicotine level in smokers, but self-reported exposure, lack of a smoking policy, and lower educational level were not.ConclusionsDespite movements toward smoke-free laws, this population of blue-collar workers was still exposed to workplace SHS as recently as 2005. The perceived (reported by the workers), rather than the official (reported by the terminal managers), smoking policy was associated with measured SHS exposure levels among the nonsmokers. Job duties and educational level might also be important predictors of workplace SHS exposure.

Introduction: Retention on antiretroviral therapy (ART) is critical for the successful adoption of the test and treat policy by sub-Saharan African countries, and for realizing the United Nations programme on HIV and AIDS target of 90-90-90. This qualitative study explores HIV positive clients' reasons for discontinuing ART under the MaxART test and treat implementation study in Swaziland. Methods: Clients identified as lost to follow-up (LTFU) in the programme database, who had initiated ART under the intervention arm of the MaxART study, were purposively selected from two facilities. LTFU was defined as stopping ART refill for three months or longer from the date of last appointment, and not being classified as transferred out or deceased. Semi-structured face-to-face interviews were conducted with nine clients and one treatment supporter between July and August 2017. All interviews were conducted in the local language, audio-recorded, summarized or transcribed and translated to English for thematic analysis. Results: Respondents described mobility as the first step in a chain of events that affected retention in care. It was entwined with precarious employment, care delivery, interactions with health workers, lack of social support, anticipated stigma and ART-related side-effects, including the exacerbation of hunger. The chains of events involved several intersecting reasons that occurred one after the other as a series of contiguous and linked events that led to clients' eventual discontinuation of ART. The individual accounts of step-by-step decision-making revealed the influence of multi-layered contexts and the importance of critical life-events. Conclusions: Clients' reasons for abandoning ART are a complex, inextricably interwoven chain of events rather than a single occurrence. Mobility is often the first step in the process and commonly results from precarious economic and social circumstances. Currently the health system poorly caters to the reality of people's mobile lives. Interventions should seek to increase healthcare workers' understanding of the chain of events leading up to discontinuation on ART and the social dilemmas that clients face. Keywords: ARV; Retention; Linkage to care; Intervention; Swaziland; Test and Treat, 1 | INTRODUCTION Between 2000 and 2015, the number of people living with HIV (PLHIV) who access antiretroviral therapy (ART) saw a thirty-fold global increase: from 250,000 to more than [...]

Introduction: Global scale up of anti-retroviral therapy (ART) has led to expansion of HIV treatment and prevention across sub-Saharan Africa. However, age and gender-specific disparities persist leading to failures in fulfillment of Sustainability Development Goals, including SDG3 (achieving healthy lives and wellbeing for all, at all ages) and SDG5 (gender equality). We assessed ART initiation and adherence, loss to follow-up, all-cause death and early death, according to SDG3 and SDG5 indicators among a cohort of HIV-infected children and adolescents enrolled in care in Dar-es-Salaam, Tanzania Methods: SDG3 indicators included young ( Results: A total of 18,315 enrollees with at least one clinic visit were included in this cohort study. Of these 7238 (40%) were young paediatric, 4169 (23%) older paediatric, 2922 (16%) early adolescent and 3986 (22%) late adolescent patients at enrolment. Just over half of paediatric and early adolescents and around four fifths of the late adolescents were female. Young paediatric patients were at greater risk of early death, being almost twice as likely to die within 90 days. Males were at greater risk of early death once initiated on ART (HR 1.35, 95% CI 1.09, 1.66)), while females in late adolescence were at greatest risk of late death (HR 2.44 [1.60, 3.74] Conclusion: These findings highlight equity concerns critical to the fulfillment of SDG3 and SDG5 within services for children and adolescents living with HIV in sub-Saharan Africa. Young paediatric and late adolescent age groups were at increased risk of late diagnosis, early death, delayed treatment initiation and loss of continuity of care. Males were more likely to die earlier. Special attention to SDG3 and SDG5 disparities for children and adolescents living with HIV will be critical for fulfillment of the 2030 SDG agenda. Keywords: gender; SDGs; equity; antiretrovirals; HIV-infected; children; adolescents, 1 | INTRODUCTION Global expansion of anti-retroviral therapy (ART) has led to the marked success of prevention of mother-to-child transmission (PMTCT) programmes and increased enrolment into HIV care programmes across [...]

Objective To evaluate the service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania. Methods Using existing data from service provision assessments of the health systems of the 10 study countries, we calculated a service readiness index for each of 8443 health facilities. This index represents the percentage availability of 50 items that the World Health organization considers essential for providing health care. For our analysis we used 37-49 of the items on the list. We used linear regression to assess the independent explanatory power of four national and four facility- level characteristics on reported service readiness. Findings The mean values for the service readiness index were 77% for the 636 hospitals and 52% for the 7807 health centres/clinics. Deficiencies in medications and diagnostic capacity were particularly common. The readiness index varied more between hospitals and health centres/clinics in the same country than between them. There was weak correlation between national factors related to health financing and the readiness index. Conclusion Most health facilities in our study countries were insufficiently equipped to provide basic clinical care. If countries are to bolster health-system capacity towards achieving universal coverage, more attention needs to be given to within-country inequities. Objectif Evaluer la disponibilite des services dans les etablissements de sante du Bangladesh, d'Haiti, du Kenya, du Malawi, de Namibie, du Nepal, d'Ouganda, de Republique-Unie deTanzanie, du Rwanda et du Senegal. Methodes En nous appuyant sur les donnees existantes tirees de l'evaluation de la prestation des services dans les systemes de sante des 10 pays etudies, nous avons calcule un indice de disponibilite des services pour chacun des 8443 etablissements de sante. Cet indice correspond a la disponibilite en pourcentage de 50 elements que l'organisation mondiale de la Sante estime essentiels pour assurer les soins de sante. Dans le cadre de notre analyse, nous avons utilise entre 37 et 49 elements de la liste. Nous avons eu recours a une regression lineaire pour evaluer le pouvoir explicatif independant de quatre caracteristiques nationales et quatre caracteristiques au niveau des etablissements concernant la disponibilite des services etablie. Resultats Les valeurs moyennes de l'indice de disponibilite des services etaient de 77% pour les 636 hopitaux et de 52% pour les 7807 centres de sante/dispensaires. L'analyse a revele des insuffisances particulierement courantes en matiere de medicaments et de capacites de diagnostic. L'indice de disponibilite variait davantage entre les hopitaux et les centres de sante/dispensaires d'un meme pays qu'entre differents pays. Une faible correlation a ete constatee entre les facteurs nationaux lies au financement de la sante et l'indice de disponibilite. Conclusion La plupart des etablissements de sante des pays etudies n'etaient pas dotes d'equipements suffisants pour prodiguer les soins cliniques de base. Il est necessaire de preter davantage attention aux inegalites au sein des pays pour qu'ils renforcent les capacites de leur systeme de sante en vue d'assurer une couverture universelle. Objetivo Evaluar la disponibilidad del servicio de los centros sanitarios en Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, la Republica Unida de Tanzania, Rwanda, Senegal y Uganda. Metodos Usando los datos existentes de las evaluaciones sobre prestacion de servicios de sistemas sanitarios de los 10 paises de estudio, se ha calculado un indice de disponibilidad del servicio para cada uno de los 8443 centros sanitarios. El indice representa el porcentaje de disponibilidad de 50 elementos que la organizacion Mundial de la Salud considera esenciales para proporcionar atencion sanitaria. Para el analisis, se han utilizado entre 37 y 49 de los elementos de la lista. Se ha utilizado la regresion lineal para evaluar el poder independiente descriptivo de cuatro caracteristicas nacionales y cuatro a nivel del centro sobre la disponibilidad del servicio registrado. Resultados Los valores medios del indice de la disponibilidad del servicio fueron del 77% para los 636 hospitales y del 52% para los 7807 centros de salud/clinicas. Las deficiencias en los medicamentos y la capacidad de diagnostico fueron particularmente comunes. El indice de disponibilidad vario mas entre hospitales y centros de salud/clinicas en el mismo pais que entre paises. Existe una correlacion debil entre los factores nacionales relacionados con la financiacion sanitaria y el indice de disponibilidad. Conclusion La mayoria de los centros sanitarios en nuestros paises de estudio fueron equipados de forma insuficiente para proporcionar atencion sanitaria basica. Si los paises van a reforzar la capacidad del sistema sanitario hasta conseguir la cobertura universal, se necesita poner mas atencion a las desigualdades dentro del pais., Introduction In adopting the sustainable development goals (SDGs) in September 2015, global governments and multilateral organizations endorsed universal health coverage as both a critical element of sustainable development and a [...]