'Cough-triggered' tuberculosis screening among adults with diabetes in Tanzania.

AIMS: Diabetes increases the risk of tuberculosis and the prevalence of diabetes is rising in tuberculosis-endemic regions such as sub-Saharan Africa. Resource-appropriate strategies for tuberculosis case finding among African adults with diabetes are needed. The aims of this study were to determine prevalence of tuberculosis and evaluate one screening strategy among adult Tanzanians with diabetes. METHODS: In this prospective cohort study, we evaluated a 'cough-triggered' strategy for tuberculosis case finding among adults with diabetes at our zonal hospital in Tanzania. All adults with diabetes and cough underwent further tuberculosis symptom assessment, and those with productive cough had sputum collected for microscopy and Mycobacterium tuberculosis culture. RESULTS: Between September 2011 and March 2012, 700 adults with diabetes attended our hospital. A total of 693 were enrolled, 121/693 (17.5%) had cough and 32/693 (4.6%) had at least two of the classic symptoms of tuberculosis. Of note, 87/121 (71.9%) of patients with cough could not produce sputum spontaneously. Nine patients were diagnosed with tuberculosis for a prevalence of 1299/100 000 (1.3%), sevenfold greater than the national average. CONCLUSIONS: Tuberculosis is common among Tanzanian adults with diabetes, but tuberculosis case finding is challenging because of the high prevalence of non-productive cough. This low-cost, 'cough-triggered' tuberculosis case-finding strategy may serve as a reasonable first step for improving tuberculosis screening among adults with diabetes in sub-Saharan Africa.

Personal food systems of male college hockey players.

This study sought to improve the understanding of processes involved in food choice and dietary change by examining how members of a college men's ice hockey team experienced the multiple factors influencing their food choices. The study employed a theory-guided, grounded-theory approach, participant observation, and open-ended interviews with ten team members. Field notes and transcripts were analysed using the constant comparative method. Going to college and playing hockey involved adjusting to new food and athletic environments, increased personal responsibility for food choices, and new meanings for food and eating. Players viewed hockey, health, and taste as major determinants of their food practices. Hockey meant structured schedules, a social network, and performance expectations. Health meant "feeling good" for hockey, having a lean body composition, and a desirable body image. Low-fat foods were viewed generally as healthy, but as not providing taste satisfaction or reward. Players' food practices cycled through four phases over the year according to the changing meanings and importance of hockey, health, and taste. The findings advance the concept of personal food system to represent the way that a person constructs the options, barriers, trade-offs, rules, and routines in food choice in response to how s/he views his/her relationships with food and the environment.