Abstract

Few studies have been conducted on truck drivers with regard to their health problems, especially their drug consumption profile. This study aimed to determine the continuous use of drugs and to identify use-related professional characteristics among this category. A cross-sectional study was carried out with truck drivers parked at the sorting yard of the, Port of Paranaguá, Paraná. An interview to obtain socioeconomic data, data on health problems, working conditions and continued use of medication was performed. Of the drivers evaluated (n = 665), 21.1% reported a continuous use of some medication, mainly captopril (10.7%), metformin (10.3%), omeprazole (6.2%) and simvastatin (6.2%). Drivers with 16 or more years of professional experience (Prevalence Ratio [PR] 1.67; Confidence Interval [CI] 95% 1.11-2.51), truck owners (PR 1.38; CI 95% 1.03-1.86) and without formal labor contract (PR 1.49; CI 95% 1.11-2.00) had a higher prevalence of continuous use of medication. We noted that some working conditions play an important role in the continuous use of drugs by truck drivers.

Key words
Truck drivers; Drug use; Working conditions; Pharmacoepidemiology

Introduction

Drugs are the leading technology in the management of acute and chronic health diseases¹1. Vieira FS. Possibilidades de contribuição do farmacêutico para a promoção da saúde. Cien Saude Colet 2007; 12(1):213-220.. Despite the risk of adverse events, they contribute significantly to people's increased life expectancy and quality²2. Leite SN, Vieira M, Veber AP. Estudos de utilização de medicamentos: uma síntese de artigos publicados no Brasil e América Latina. Cien Saude Colet 2008; 13(Supl.):793-802.,³3. Paniz VMV, Fassa AG, Facchini LA, Bertoldi AD, Piccini RX, Tomasi E, Thumé E, Silveira DS, Siqueira FV, Rodrigues MA. Acesso a medicamentos de uso contínuo em adultos e idosos nas regiões sul e nordeste do Brasil. Cad Saude Publica 2008; 24(2):267-280.. Drug consumption is related to socioeconomic and demographic indicators, access to health services, life habits and the very presence of health disorders, especially chronic degenerative diseases⁴4. Costa KS, Barros MBA, Francisco PMSB, César CLG, Goldbaum M, Carandina L. Utilização de medicamentos e fatores associados: Um estudo de base populacional no município de Campinas, São Paulo, Brasil. Cad Saude Publica 2011; 27(4):649-658.,⁵5. Vosgerau MZS, Soares DA, Souza RKT, Matsuo T, Carvalho GS. Consumo de medicamentos entre adultos na área de abrangência de uma unidade de saúde da família. Cien Saude Colet 2011; 16(Supl. 1):1629-1638..

In this context, we highlight working conditions, which may hinder access and adherence to drug treatment⁶6. Passos VMA, Assis TD, Barreto SM. Hipertensão arterial no Brasil: estimativa de prevalência a partir de estudos de base populacional. Epidemiol Serv Saúde 2006; 15(1):35-45. and increase the risk of health problems and therefore lead to a greater use of medicines, mainly due to stress or caused by the unsanitary conditions of the working environment⁷7. Couto HA, Vieira FLH, Lima EG. Estresse ocupacional e hipertensão arterial sistêmica. Rev Bras Hipertens 2007; 14(2):112-115.. Thus, certain professions may differ in their drug consumption profile.

Thus, some segments of society are not studied enough with regard to profile and drug use-associated factors. We note that epidemiological studies seek to carry out such investigations in the general population⁴4. Costa KS, Barros MBA, Francisco PMSB, César CLG, Goldbaum M, Carandina L. Utilização de medicamentos e fatores associados: Um estudo de base populacional no município de Campinas, São Paulo, Brasil. Cad Saude Publica 2011; 27(4):649-658.,⁵5. Vosgerau MZS, Soares DA, Souza RKT, Matsuo T, Carvalho GS. Consumo de medicamentos entre adultos na área de abrangência de uma unidade de saúde da família. Cien Saude Colet 2011; 16(Supl. 1):1629-1638., children⁸8. Beckhauser GC, Souza JM, Valgas C, Piovezan AP, Galato D. Utilização de medicamentos na pediatria: a prática de automedicação em crianças por seus responsáveis. Rev Paul Pediatr 2010; 28(3):262-268., adolescents⁹9. Aquino DS, Barros JAC, Silva MDP. A automedicação e os acadêmicos da área de saúde. Cien Saude Colet 2010; 15(5):2533-2538., elderly¹⁰10. Loyola Filho AI, Uchoa E, Firmo JOA, Lima-Costa MF. Estudo de base populacional sobre o consumo de medicamentos entre idosos: Projeto bambuí. Cad Saude Publica 2005; 21(2):545-553. or pregnant women¹¹11. Brum LFS, Pereira P, Felicetti LL, Silveira RD. Utilização de medicamentos por gestantes usuárias do sistema único de saúde no município de Santa Rosa (RS, Brasil). Cien Saude Colet 2011; 16(5):2435-2442.. However, there are few studies on population groups with specific occupational exposures, such as truck drivers.

These professionals are mostly male¹²12. Leyton V, Sinagawa DM, Oliveira KCBG, Schmitz W, Andreuccetti G, De Martinis BS, Yonamine M, Munoz DR. Amphetamine, cocaine and cannabinoids use among truck drivers on the roads in the State of Sao Paulo, Brazil. Forensic Sci Int 2012; 215(1-3):25-27.,¹³13. Yonamine M, Sanches LR, Paranhos BA, De Almeida RM, Andreuccetti G, Leyton V. Detecting alcohol and illicit drugs in oral fluid samples collected from truck drivers in the state of Sao Paulo, Brazil. Traffic Inj Prev 2013; 14(2):127-131., married or in common-law marriage¹³13. Yonamine M, Sanches LR, Paranhos BA, De Almeida RM, Andreuccetti G, Leyton V. Detecting alcohol and illicit drugs in oral fluid samples collected from truck drivers in the state of Sao Paulo, Brazil. Traffic Inj Prev 2013; 14(2):127-131.

14. Villarinho L, Bezerra I, Lacerda R, Latorre MRDO, Paiva V, Stall R, Hearst N. Caminhoneiros de rota curta e sua vulnerabilidade ao HIV, Santos, SP. Rev Saude Publica 2002; 36(4):61-67.

15. Souza JC, Paiva T, Reimão R. Qualidade de vida de caminhoneiros. J Bras Psiquiatr 2006; 55(3):184-189.-¹⁶16. Ulhôa MA, Marqueze EC, Lemos LC, Silva LG, Silva AA, Nehme P, Fischer FM, Moreno CRC. Distúrbios psíquicos menores e condições de trabalho em motoristas de caminhão. Rev Saude Publica 2010; 44(6):1130-1136., with low schooling level¹³13. Yonamine M, Sanches LR, Paranhos BA, De Almeida RM, Andreuccetti G, Leyton V. Detecting alcohol and illicit drugs in oral fluid samples collected from truck drivers in the state of Sao Paulo, Brazil. Traffic Inj Prev 2013; 14(2):127-131.,¹⁴14. Villarinho L, Bezerra I, Lacerda R, Latorre MRDO, Paiva V, Stall R, Hearst N. Caminhoneiros de rota curta e sua vulnerabilidade ao HIV, Santos, SP. Rev Saude Publica 2002; 36(4):61-67.,¹⁷17. Souza JC, Paiva T, Reimão R. Sleep habits, sleepiness and accidents among truck drivers. Arq Neuro-Psiquiatr 2005; 63(4):925-930.

18. Knauth DR, Pilecco FB, Leal AF, Seffner F, Teixeira AM. Staying awake: Truck drivers’ vulnerability in Rio Grande do Sul, Southern Brazil. Rev Saude Pública 2012; 46(5):886-893.-¹⁹19. Takitane J, Oliveira LG, Endo LG, Oliveira KC, Munoz DR, Yonamine M, Leyton V. Uso de anfetaminas por motoristas de caminhão em rodovias do estado de são paulo: Um risco à ocorrência de acidentes de trânsito? Cien Saude Colet 2013; 18(5):1247-1254. and high professional experience²⁰20. Masson VA, Monteiro MI. Vulnerabilidade à doenças sexualmente transmissíveis/Aids e uso de drogas psicoativas por caminhoneiros. Rev Bras Enferm 2010; 63(1):79-83.. In addition, studies have evidenced a greater vulnerability of truck drivers to various health problems such as sexually transmitted diseases²⁰20. Masson VA, Monteiro MI. Vulnerabilidade à doenças sexualmente transmissíveis/Aids e uso de drogas psicoativas por caminhoneiros. Rev Bras Enferm 2010; 63(1):79-83.,²¹21. Teles SA, Matos MA, Caetano KaA, Costa LA, França DDS, Pessoni GC, Brunini SM, Martins RMB. Comportamentos de risco para doenças sexualmente transmissíveis em caminhoneiros no Brasil. Rev Panam Salud Pública 2008; 24(1):25-30., psychoactive substance abuse¹³13. Yonamine M, Sanches LR, Paranhos BA, De Almeida RM, Andreuccetti G, Leyton V. Detecting alcohol and illicit drugs in oral fluid samples collected from truck drivers in the state of Sao Paulo, Brazil. Traffic Inj Prev 2013; 14(2):127-131.,¹⁸18. Knauth DR, Pilecco FB, Leal AF, Seffner F, Teixeira AM. Staying awake: Truck drivers’ vulnerability in Rio Grande do Sul, Southern Brazil. Rev Saude Pública 2012; 46(5):886-893.,²²22. Gates J, Dubois S, Mullen N, Weaver B, Bedard M. The influence of stimulants on truck driver crash responsibility in fatal crashes. Forensic Sci Int 2013; 228(1-3):15-20., traffic accidents¹⁷17. Souza JC, Paiva T, Reimão R. Sleep habits, sleepiness and accidents among truck drivers. Arq Neuro-Psiquiatr 2005; 63(4):925-930.,²³23. Spielholz P, Cullen J, Smith C, Howard N, Silverstein B, Bonauto D. Assessment of perceived injury risks and priorities among truck drivers and trucking companies in Washington State. J Safety Res 2008; 39(6):569-576., workload-derived chronic pain¹⁹19. Takitane J, Oliveira LG, Endo LG, Oliveira KC, Munoz DR, Yonamine M, Leyton V. Uso de anfetaminas por motoristas de caminhão em rodovias do estado de são paulo: Um risco à ocorrência de acidentes de trânsito? Cien Saude Colet 2013; 18(5):1247-1254.,²⁴24. Saporiti AF, Borges LH, Salaroli LB, Molina MDCB. Dores osteomusculares e fatores associados em motoristas de carretas nas rodovias do Espírito Santo. Rev Bras Pesq Saúde 2010; 12(1):72-78.,²⁵25. Andrusaitis SF, Oliveira RP, Barros Filho TE. Study of the prevalence and risk factors for low back pain in truck drivers in the state of Sao Paulo, Brazil. Clinics 2006; 61(6):503-510., etc. Moreover, there are very few studies on the disease profile and drug consumption of this population of workers.

Truck drivers have access to professional and health services needs similar to the general population or that are specific to their own work²⁶26. Ferreira SS, Alvarez D. Organização do trabalho e comprometimento da saúde: Um estudo em caminhoneiros. Sist Gestão 2013; 8(1):58-66. and should also be covered by strategies to promote the safe and proper use of drugs. Truck driver-specific health care strategies have emerged in some road stop points and promoted by organizations such as the Transport Social Service (SEST) and the National Transport Learning Service (SENAT)²⁷27. Oliveira LG, Endo LG, Sinagawa DM, Yonamine M, Munoz DR, Leyton V. A continuidade do uso de anfetaminas por motoristas de caminhão no Estado de São Paulo, Brasil, a despeito da proibição de sua produção, prescrição e uso. Cad Saude Publica 2013; 29(9):1903-1909.,²⁸28. Oliveira LG, Santos B, Gonçalves PD, Carvalho HB, Massad E, Leyton V. Attention performance among Brazilian truck drivers and its association with amphetamine use: pilot study. Rev Saude Publica 2013; 47(5):1001-1005.

It is worth noting that a study by Guedes et al.²⁹29. Guedes HM, Paula AC, Conceição Silva AM, Almeida MEF. Utilização de serviços de atenção básica à saúde por caminhoneiros. Enferm Bras 2012; 11(6):347-352. showed that only 29.4% of truck drivers seek primary health care to treat their health problems, indicating the need for higher compression of this phenomenon, especially with regard to drug use. However, there is still a significant gap of studies investigating the characteristics of drivers’ drug consumption. Thus, this study aimed to demonstrate the continuous use of medications and identify professional features associated with truck drivers’ use at the Port of Paranaguá, Paraná, Brazil.

Methodology

This is a cross-sectional study of truck drivers parked at the Screening Courtyard, Port of Paranaguá, Paraná. The Screening Patio is a local annex to the Port in which truck drivers await the screening of grains (soy, corn and soybean meal) from the Brazilian harvest and unloading in Paranaguá Port's silo complexes.

Prior to data collection, we conducted a pilot study in that courtyard, which evaluated the operational logistics of the collection site, vehicle flow, truck parking system in the yard and performed a pre-test of the data collection tool with ten drivers. This pre-test attempted to verify the feasibility of implementation and tool language adaptation to the population under study.

The collection tool consisted of a form, which gathered information on socio-demographic and economic features, lifestyle habits, health issues, working conditions and use of drugs. The study sample was defined with StatCalc, infinite population, estimated prevalence of 50% and 4% error margin, totaling 600 individuals. Drivers who reported less than one-year professional experience were excluded from this study.

Trained researchers collected data in July 2012 through convenience sampling, since the systematic distribution of drivers in the courtyard was undefined. During collection, two researchers roamed around the Port's courtyard, addressing drivers sitting in their own trucks, while other two remained at drivers’ food or products purchase meeting points, and three more at a fixed spot, meeting drivers seeking information about the investigation voluntarily.

This study was approved by the Ethics Committee, State University of Londrina. Before the survey, drivers were informed about the objectives of the research and then read and signed the consent form.

The dependent variable analyzed was the continuous consumption of drugs. To assess this variable, at the time of the interview, we asked drivers whether they were continuously using any medication. If the answer was affirmative, we asked then what these drugs were by checking the prescription or package, when available. Drugs used were listed by their generic names and subsequently classified according to the Anatomical Therapeutic Chemical Classification (ATC) of the World Health Organization, according to the first subgroup, which corresponds to the therapeutic group³⁰30. World Health Organization (ONU). Guidelines for atc classification and ddd assignment 2013. 16ª ed. Oslo: WHO Collaborating Centre for Drug Statistics Methodology; 2013..

The independent variables (professional characteristics) were as follows: work experience as a driver (below sixteen years, sixteen years and over); work shift (fixed, alternating); truck ownership (employer; driver); employed (yes; no), income as a driver (below R$ 2,500; R$ 2,500.00 or more); driving time exceeding eight hours straight (yes, no); driving while being overly tired (yes, no); and wage (fixed, productivity or fixed + productivity). Variables work experience and income as a driver were categorized as median value.

The descriptive variables were sociodemographic and economic (age, schooling, marital status and access to private health insurance) and self-reported health disorders. All health problems were identified through truck drivers’ self-reporting and converted to appropriate medical language. Variables age (up to 40 years; above 40 years), schooling (less than eight years of study, eight years of study and over) and access to health insurance (yes, no) were also used as control variables.

Data were double entered in Epiinfo 3.5.4^® database for Windows^® and were compared in the same program. Data were then analyzed with SPSS software, version 19.0. Windows^®. Simple frequencies were calculated for qualitative variables, whereas quantitative variables were submitted to central tendency and dispersion (mean and standard deviation). Poisson logistic regression and 95% confidence interval (CI 95%), with an estimated prevalence ratio (PR) were used to determine the association between professional features and continuous use of drugs variables, with non-adjusted and adjusted analyzes (by age, schooling and access to health insurance plan). A p<0.05 value was used to establish statistical significance.

Results

We approached 773 drivers during the collection period and we excluded five (5) drivers because their experience as truck drivers was less than one year. Of the remaining 768, 98 (12.8%) refused to participate. Of the 670 drivers who started the interview, five were called in to unload their vehicles and did not provide all the necessary information. Thus, this study consisted of 665 truck drivers. All were male averaging 41.9 years (standard deviation [SD] = 11.1 years), with 50.2% aged over 40 years. Most of them (58.5%) had no more than eight schooling years, reported living maritally with companion (84.8%) and reported no access to private health plan (70.4%).

Average time experience as a truck driver was 18.2 years (SD = 11.4), ranging from one to 57 years, with 51.1% claiming having over 16 years of experience. Most drivers reported alternate work shifts (74.4%), not being truck owners (68.7%), being employed (62.4%) and receiving productivity-based wages (89.3%).

Most drivers (n = 421; 63.3%) - reported some health issue, with a total of 683 problems, highlighting chronic pain in general (arms, legs or back) (35.6%), systemic arterial hypertension (SAH) (16.2%), dyslipidemia (12.6%), hemorrhoids (8.7%) and diabetes mellitus (DM) (7.5%). On average, respondents had 1.03 health problems (SD = 1.05) with a minimum of zero and a maximum of five health disorders.

Of the 670 drivers interviewed, 140 (21.1%) reported continuous use of some medication at the time of investigation. Of these, 72.9% and 18.6% used one and two drugs, respectively. In total, 194 drugs were reported, with a mean of 1.38 (SD = 0.70) per driver and, at most, four drugs per driver. Drugs most often quoted by respondents were captopril (10.7%), metformin (10.3%), omeprazole (6.2%), simvastatin (6.2%), enalapril (5.6%) and hydrochlorothiazide (5.2%) (Table 1).

With regard to drug treatment, of the top five diseases reported by truck drivers, SAH and DM showed the highest proportion of treatment (47.2% and 48.0%, respectively). Moreover, chronic musculoskeletal pain reported by drivers showed 2.5% treatment proportion, and hemorrhoids, 3.4% (Table 2).

Professional features that were associated with the continuous use of medicines in the non-adjusted model were 16 or more years work experience as a driver; driver's own truck ownership; and no employment relationship (no record in working papers). After adjustments (for age, schooling and access to health plan), these variables remained associated with the continued use of drugs: 16 or more years work experience as a driver (PR 1.67; CI 95%; 1.11-2.51); driver's own truck ownership (PR 1.38; CI 95%; 1.03-1.86) and no employment relationship (PR 1.49; CI 95%; 1.11-2.00) (Table 3). The higher age group (over 40 years) was also associated with the continuous use of medicines in all the adjusted analyzes.

Discussion

Musculoskeletal chronic pain in general appeared as a major ailment reported by drivers analyzed, which is in line with previous studies that evaluated this professional category¹⁹19. Takitane J, Oliveira LG, Endo LG, Oliveira KC, Munoz DR, Yonamine M, Leyton V. Uso de anfetaminas por motoristas de caminhão em rodovias do estado de são paulo: Um risco à ocorrência de acidentes de trânsito? Cien Saude Colet 2013; 18(5):1247-1254.,²⁴24. Saporiti AF, Borges LH, Salaroli LB, Molina MDCB. Dores osteomusculares e fatores associados em motoristas de carretas nas rodovias do Espírito Santo. Rev Bras Pesq Saúde 2010; 12(1):72-78.,²⁵25. Andrusaitis SF, Oliveira RP, Barros Filho TE. Study of the prevalence and risk factors for low back pain in truck drivers in the state of Sao Paulo, Brazil. Clinics 2006; 61(6):503-510.,³¹31. Macedo E, Blank VLG. Processo de trabalho e prevalência de dor lombar em motoristas de caminhões transportadores de madeira, no sul do Brasil. Cad Saúde Coletiva 2006; 14(3):435-450.. The driver's role is not restricted to truck driving, with a need to perform or assist in the loading or unloading of transported goods³²32. Brasil. Ministério do Trabalho e Emprego (TEM). Secretaria de Políticas Públicas de Emprego. Classificação brasileira de ocupações: CBO – 2010. Brasília: MTE; 2010., as well as driving many hours straight, which can increase the risk of health injuries and diseases³³33. Souza JC, Paiva T, Reimão R. Sono, qualidade de vida e acidentes em caminhoneiros brasileiros e portugueses. Psicol Estud 2008; 13(3):429-436.,³⁴34. Costa LB, Koyama MaH, Minuci EG, Fischer FM. Morbidade declarada e condições de trabalho: O caso dos motoristas de São Paulo e Belo Horizonte. São Paulo Perspec 2003; 17(2):54-67..

The existence of cardiovascular risk factors (hypertension, diabetes and dyslipidemias) was also mentioned by other drivers evaluated in Brazil¹⁹19. Takitane J, Oliveira LG, Endo LG, Oliveira KC, Munoz DR, Yonamine M, Leyton V. Uso de anfetaminas por motoristas de caminhão em rodovias do estado de são paulo: Um risco à ocorrência de acidentes de trânsito? Cien Saude Colet 2013; 18(5):1247-1254.,³⁵35. Cavagioni LC, Bensenõr IM, Halpern A, Pierin AMG. Síndrome metabólica em motoristas profissionais de transporte de cargas da Rodovia BR-116 no trecho paulista-Régis Bittencourt. Arq Bras Endocrinol Metabol 2008; 52(6):1015-1023.

36. Lemos LC, Marqueze EC, Sachi F, Lorenzi-Filho G, Moreno CRC. Síndrome da apneia obstrutiva do sono em motoristas de caminhão. J Bras Pneumol 2009; 35(6):500-506.

37. Moulatlet EM, Codarin MaF, Nehme PXSA, Ulhôa MA, Moreno CRC. Hipertensão arterial sistêmica em motoristas de caminhão. Cad Saúde Colet 2010; 18(2):252-258.

38. Cavagioni LC, Pierin AMG. Hipertensão arterial e obesidade em motoristas profissionais de transporte de cargas. Acta Paul Enferm 2010; 23(4):455-460.-³⁹39. Oliveira LV, Sesti LFC, Oliveira SV. Perfil lipídico e glicêmico em caminhoneiros da região central do estado do rio grande do sul. Sci Plena 2012; 8(12):1-6., while lower than those mentioned in population-based prevalence studies⁴⁰40. Silva DAS, Petroski EL, Peres MA. Pré-hipertensão e hipertensão em adultos de Florianópolis: Estudo de base populacional. Rev Saude Publica 2012; 46(6):988-998.

41. Costa JSD, Olinto MTA, Assunção MCF, Gigante DP, Macedo S, Menezes AMB. Prevalência de diabetes mellitus em Pelotas, RS: um estudo de base populacional. Rev Saude Publica 2006; 40(3):542-545.

42. Moraes SA, Freitas ICM, Gimeno SGA, Mondini L. Prevalência de diabetes mellitus e identificação de fatores associados em adultos residentes em área urbana de Ribeirão Preto, São Paulo, Brasil, 2006: Projeto obediarp. Cad Saude Publica 2010; 26(5):929-941.-⁴³43. Salaroli LB, Barbosa GC, Mill JG, Molina MCB. Prevalência de síndrome metabólica em estudo de base populacional, Vitória, ES - Brasil. Arq Bras Endocrinol Metab 2007; 51(7):1143-1152., particularly SAH⁴⁴44. Ferreira SRG, Moura EC, Malta DC, Sarno F. Freqüência de hipertensão arterial e fatores associados: Brasil, 2006. Rev Saude Publica 2009; 43(2):98-106.,⁴⁵45. Mion Junior D, Pierin AM, Bensenor IM, Marin JCM, Costa KRA, Henrique LFO, Alencar NDP, Couto RDC, Laurenti TE, Machado TO. Hipertensão arterial na cidade de São Paulo: prevalência referida por contato telefônico. Arq Bras Cardiol 2010; 95(1):99-106.. It is believed that this occurs because self-reported information suffer the influence of underdiagnosis, failure to understand one's own condition or driver's choice not to report his ailment. In addition, worth noting is the healthy worker effect, in other words, workers with less complex health conditions are likely to continue working while those with the worst conditions tend to abandon the profession⁴⁶46. Kenny GP, Yardley JE, Martineau L, Jay O. Physical work capacity in older adults: implications for the aging worker. Am J Ind Med 2008; 51(8):610-625.,⁴⁷47. Shah D. Healthy worker effect phenomenon. Indian J Occup Environ Med 2009; 13(2):77-79., underestimating the prevalence of some diseases.

Regarding drug consumption, similarity was noted in those reported by drivers with those of the general population⁴4. Costa KS, Barros MBA, Francisco PMSB, César CLG, Goldbaum M, Carandina L. Utilização de medicamentos e fatores associados: Um estudo de base populacional no município de Campinas, São Paulo, Brasil. Cad Saude Publica 2011; 27(4):649-658.,⁵5. Vosgerau MZS, Soares DA, Souza RKT, Matsuo T, Carvalho GS. Consumo de medicamentos entre adultos na área de abrangência de uma unidade de saúde da família. Cien Saude Colet 2011; 16(Supl. 1):1629-1638.,⁴⁸48. Neves SJF, Marques APO, Leal MCC, Diniz AS, Medeiros TS, Arruda IKG. Epidemiologia do uso de medicamentos entre idosos em área urbana do nordeste do Brasil. Rev Saude Publica 2013; 47(4):759-768.,⁴⁹49. Marin MJS, Cecílio LCDO, Perez AEWUF, Santella F, Silva CBA, Gonçalves Filho JR, Roceti LC. Caracterização do uso de medicamentos entre idosos de uma unidade do programa saúde da família. Cad Saude Publica 2008; 24(7):1545-1555.. In a study in Campinas-SP, hydrochlorothiazide, captopril and enalapril stood out among the most consumed continuous-use drugs⁴4. Costa KS, Barros MBA, Francisco PMSB, César CLG, Goldbaum M, Carandina L. Utilização de medicamentos e fatores associados: Um estudo de base populacional no município de Campinas, São Paulo, Brasil. Cad Saude Publica 2011; 27(4):649-658.. In surveys conducted in Grossa-PR⁵5. Vosgerau MZS, Soares DA, Souza RKT, Matsuo T, Carvalho GS. Consumo de medicamentos entre adultos na área de abrangência de uma unidade de saúde da família. Cien Saude Colet 2011; 16(Supl. 1):1629-1638. Ponta and Campinas-SP⁴4. Costa KS, Barros MBA, Francisco PMSB, César CLG, Goldbaum M, Carandina L. Utilização de medicamentos e fatores associados: Um estudo de base populacional no município de Campinas, São Paulo, Brasil. Cad Saude Publica 2011; 27(4):649-658., continuous-use drugs for cardiovascular and digestive systems and metabolism were the most reported by respondents.

Reduced drug treatment proportion of reported major injuries is an important aspect identified in this study. Studies of individuals who recognized their condition of SAH⁵⁰50. Nogueira D, Faerstein E, Coeli CM, Chor D, Lopes CDS, Werneck GL. Reconhecimento, tratamento e controle da hipertensão arterial: estudo Pró-Saúde, Brasil. Rev Panam Salud Publica 2010; 27(2):103-109.,⁵¹51. Souza ARA, Costa A, Nakamura D, Mocheti LN, Stevanato Filho PR, Ovando LA. Um estudo sobre hipertensão arterial sistêmica na cidade de Campo Grande, MS. Arq Bras Cardiol 2007; 88(4):441-446. and DM⁵²52. Gontijo MF, Ribeiro AQ, Klein CH, Rozenfeld S, Acurcio FA. Uso de anti-hipertensivos e antidiabéticos por idosos: inquérito em Belo Horizonte, Minas Gerais, Brasil. Cad Saude Publica 2012; 28(7):1337-1346.,⁵³53. Francisco PMSB, Belon AP, Barros MBA, Carandina L, Alves MCGP, Goldbaum M, Cesar CLG. Diabetes auto-referido em idosos: prevalência, fatores associados e práticas de controle. Cad Saude Publica 2010; 26(1):175-184. carriers showed treatment rates results higher than those of this study. Low treatment rates found among truck drivers may be related to difficult access and adherence to drug treatment, especially because these professionals did not show a routine (working conditions) that facilitated and encouraged the proper and/or continuous use of drugs, as well as to their lifestyle, which often goes against the proper management of patients with chronic diseases such as SAH and DM.

We noticed that greater experience (16 years or more) as a truck driver showed a strong association with the continuous use of drugs. It is expected that drivers with more experience, with some exceptions, are the oldest (we emphasize that a higher age group was also associated with the use of drugs in this study). Thus, since studies in the general population show that there is a proportional increase in the consumption of drugs with age⁴4. Costa KS, Barros MBA, Francisco PMSB, César CLG, Goldbaum M, Carandina L. Utilização de medicamentos e fatores associados: Um estudo de base populacional no município de Campinas, São Paulo, Brasil. Cad Saude Publica 2011; 27(4):649-658.,⁵⁴54. Silva AL, Ribeiro AQ, Klein CH, Acurcio FA. Utilização de medicamentos por idosos brasileiros, de acordo com a faixa etária: um inquérito postal. Cad Saude Publica 2012; 28(6):1033-1045., there is also a greater level of this consumption with increased professional experience. Still, we can consider that working conditions experienced by drivers throughout the profession may have contributed to increased prevalence of some diseases²⁴24. Saporiti AF, Borges LH, Salaroli LB, Molina MDCB. Dores osteomusculares e fatores associados em motoristas de carretas nas rodovias do Espírito Santo. Rev Bras Pesq Saúde 2010; 12(1):72-78.,²⁵25. Andrusaitis SF, Oliveira RP, Barros Filho TE. Study of the prevalence and risk factors for low back pain in truck drivers in the state of Sao Paulo, Brazil. Clinics 2006; 61(6):503-510.,³⁵35. Cavagioni LC, Bensenõr IM, Halpern A, Pierin AMG. Síndrome metabólica em motoristas profissionais de transporte de cargas da Rodovia BR-116 no trecho paulista-Régis Bittencourt. Arq Bras Endocrinol Metabol 2008; 52(6):1015-1023., favoring a higher continuous use of drugs.

We expect that the lack of employment relationship, usually related to truck driver's own truck ownership, causes the driver to spend a long time waiting for goods to be loaded and transport, which would increase their working day and make it difficult to seek medical treatment. However, as this study found an association between higher prevalence of continuous use of medication and truck drivers with no employment relationship, we believe that drivers with formal ties would have greater difficulty in controlling their working hours, delaying access to health services and consequently the diagnosis and treatment of existing diseases.

We took some methodological precautions to ensure the internal validity of results, such as conducting pilot study and preparation of a manual of instructions for collectors. However, given the studied location's working dynamics, we chose participants through a convenience selection, a fact that makes it impossible to generalize the results to the total number of drivers who attended the screening of the Courtyard Port of Paranaguá in the study period. Furthermore, we should stress that there may be bias in the recall process, measurement or information in the variables obtained by indirect measurements with the use of a form, especially those relating to diseases and medications.

In the face of reported diseases and identified continuous-use drugs, we observe that the epidemiological and pharmacotherapeutic profile of rated drivers are similar to the general population, particularly concerning cardiovascular diseases and use of medicines for their treatment, with the exception of SAH, which showed the prevalence rates lower than population-based studies. Also noteworthy is the undertreatment of identified diseases, and especially identification of the relationship between some professional features (work experience, employment relationship and truck ownership) and the use of drugs.

Truck drivers have unique characteristics, specifically for staying many days, weeks or even months away from their homes and his families, which implies the need to adopt health promotion strategies different from those of the general population. Thus, encouraging stoppage points, carriers and the loading and unloading process to have more appropriate structures to meet this specific population may favor the reduction and the impact of major health problems identified in the health of this population group. Now, only specific initiatives at some gas filling stations of Brazilian roads are noted, where medical and dental care, tracking health problems and guidance on men health are conducted, but which are still incipient considering the needs of this population group. Thus, it is important to ensure drivers’ access to health professionals who can perform the correct diagnosis of their health problems and perform pharmacological and non-pharmacological therapy consistent with their unique needs.

Finally, it is worth emphasizing the importance of preventive and public health measures within the working conditions and actions related to workers’ health surveillance⁵⁵55. Brasil. Portaria n° 1.823, de 23 de agosto de 2012. Institui a Política Nacional de Saúde do Trabalhador e da Trabalhadora. Diário Oficial da União 2012; 23 ago., reducing the risks to which truck drivers are submitted, both for individual and collective health, such as the involvement in road traffic accidents.

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