Knowledge and stigma of latent tuberculosis infection in Brazil: implications for tuberculosis prevention strategies.

BACKGROUND: Tuberculosis (TB) elimination requires treatment of millions of persons with latent M. tuberculosis infection (LTBI). LTBI treatment acceptance depends on population-wide TB knowledge and low stigma, but limited data are available on the relationship between stigma and knowledge. We assessed knowledge of TB disease and LTBI throughout Brazil and examined their association with TB stigma and incidence. METHODS: We performed a nationwide survey with multi-stage probability design through AmericasBarometer from April-May 2017; the sample was representative of Brazil at regional and national levels. Knowledge of and stigma toward TB were assessed by validated survey questions. RESULTS: Survey-weighted responses of 1532 individuals suggest that 57% of the population knew LTBI can occur, and 90% would seek treatment for it. Regarding active TB, 85% knew TB symptoms, 70% reported they should avoid contact with someone with active TB, and 24% had stigma toward persons with TB (i.e., thought persons with tuberculosis should feel ashamed, or deserved their illness). In regression models adjusting for clinical and demographic variables, knowledge of LTBI was associated with increased stigma toward persons with TB (adjusted odds ratio [OR] = 2.13, 95% confidence interval [CI]: 1·25-3.63, for "should feel ashamed"; OR = 1·82, 95% CI: 1·15-2·89, for "deserve illness"). Adjusting for regional TB incidence did not affect this association. CONCLUSIONS: High proportions of this representative Brazilian population had knowledge of LTBI and were willing to seek treatment for it. However, such knowledge was associated with TB-specific stigma. Strategies to educate and implement treatment of latent tuberculosis must include efforts to decrease TB stigma.

Physical Function in U.S. Older Adults Compared With Other Populations: A Multinational Study.

Objective: We compare physical performance from three U.S. national surveys and nationally representative surveys in England, Taiwan, and Costa Rica. Method: For each performance test, we use local mean smoothing to plot the age profiles by sex and survey wave and then fit a linear regression model to the pooled data, separately by sex, to test for significant differences across surveys controlling for age and height. Results: Age profiles of performance vary across U.S. surveys, but levels of lung function (peak expiratory flow) and handgrip strength in the United States are as high as they are in the other three countries. Americans also perform as well on the chair stand test as the English and Costa Ricans, if not better, but exhibit slower gait speed than the English at most ages. Discussion: With the exception of walking speed, we find little evidence that older Americans have worse physical performance than their peers.

Trends and correlates of age at menarche in Colombia: Results from a nationally representative survey.

Surveillance of age at menarche could provide useful information on the impact of changing environmental conditions on child health. Nevertheless, nationally representative data are exceedingly rare. The aim of this study was to examine trends and sociodemographic correlates of age at menarche of Colombian girls. The study sample included 15,441 girls born between 1992 and 2000 who participated in the Colombian National Nutrition Survey of 2010. We estimated median menarcheal age using Kaplan-Meier time-to-event analyses. Hazard ratios with 95% confidence intervals were estimated with Cox regression models. The median age at menarche was 12.6 years. There was an estimated decline of 0.54 years/decade (P<0.001) over the birth years; this decline was only observed among girls from urban areas, and was more pronounced among girls from wealthier versus poorer families. Child height and BMI, maternal BMI and education, and family wealth were each inversely associated with menarcheal age whereas food insecurity and number of children in the household were positively associated with age at menarche. In conclusion, a negative trend in age at menarche is ongoing in Colombia, especially in groups most likely to benefit from socioeconomic development.