Assessment of tuberculosis burden in China using a dynamic disease simulation model.

SETTING: Although a preventable and treatable disease, tuberculosis (TB) is among the top 10 causes of death worldwide. A consequence of inadequately treated drug-susceptible TB (DS-TB) is multidrug-resistant TB (MDR-TB). OBJECTIVES: To improve our understanding of the primary drivers of incidence and prevalence of DS- and MDR-TB in China. METHODS: The Tuberculosis Disease Transmission Model (TBDTM) uses historical and current disease epidemiology and transmission trends and treatment effectiveness, and accounts for annual changes to these to estimate future DS-TB and MDR-TB burden. RESULTS: The model shows that in China, by 2050, incidence, prevalence and mortality of DS-TB will decrease by 32%, 50% and 41%, respectively, whereas MDR-TB will increase by respectively 60%, 48% and 35%. Reduction in DS-TB is a result of high treatment and cure rates leading to a decrease in the prevalence of latent tuberculous infection (LTBI), while the increase in MDR-TB is attributed to inappropriate treatment, leading to high transmission of infection and increased LTBI prevalence. CONCLUSIONS: These results demonstrate a reduction in DS-TB in China over the next 40 years, while MDR-TB will increase. Improvements in the diagnosis and treatment of MDR-TB are needed to counter this threat. The TBDTM tool has potential value in public health practice by demonstrating the impact of interventions and estimating their cost-effectiveness.

Understanding weight stigmatization: a focus group study.

OBJECTIVES: The purpose of this research was to investigate, in a nonclinical sample of adults, thoughts on and experiences with weight stigmatization. DESIGN: Focus groups were used to collect information. Participants were recruited through a newspaper advertisement and flyers posted in public places in Minneapolis and St. Paul. During the focus groups, participants were led in a discussion about their thoughts on weight stigmatization and personal experiences of being treated differently or poorly because of their weight. SUBJECTS: Six gender-specific focus groups consisted of 31 adult volunteers (17 women and 14 men). VARIABLES MEASURED: Perceptions of weight-based stereotypes and weight stigmatization and personal reports of having been treated differently or poorly owing to weight were measured. RESULTS: Participants reported a variety of experiences of being treated differently or poorly because of their weight. These included teasing, harassment, slurs and insults, negative judgments and assumptions, and perceived discrimination. Participants reported that such experiences occurred at home, among friends and strangers, at work, and in health care settings. Women reported a greater number and a greater variety of negative experiences than men. IMPLICATIONS: The results indicated that participants experienced weight-based stigmatization in many aspects of their lives. Awareness of these experiences may assist in the development of treatments for overweight individuals.