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REFLECTION01-01-2017
Transcendence, historicity and temporality of being elderly: nursing reflection-using Heidegger
Revista Brasileira de Enfermagem. 2017;70(4):891-895
Abstract
REFLECTIONTranscendence, historicity and temporality of being elderly: nursing reflection-using Heidegger
Revista Brasileira de Enfermagem. 2017;70(4):891-895
DOI 10.1590/0034-7167-2016-0275
Views0See moreABSTRACT
The objective is to reflect on historicity and temporality as paths for the transcendence of being elderly, based on the phenomenological concepts of Martin Heiddeger. A review of the concepts of transcendence, historicity and temporality was carried out in the work of Martín Heidegger, integrating them in the perspective of nursing for the elderly. The transcendence of the elderly adult is feasible by accessing the temporality of self in the path of its historicity to arrive at the understanding of itself that he has achieved: transcending, which is but a process of the Being itself. Being is time in itself existing in the world, existence given by the encounter of the past (to have been), present and future (becoming), the same encounter that determines the historicity of the Being. The encounter has been consummated and the Being is transcendence, with the understanding of the Being itself as a supreme point.
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Acercamiento al escenario de estudio fenomenológico en México: relato de experiencia
Revista Brasileira de Enfermagem. 2017;70(4):885-890
Abstract
Acercamiento al escenario de estudio fenomenológico en México: relato de experiencia
Revista Brasileira de Enfermagem. 2017;70(4):885-890
DOI 10.1590/0034-7167-2016-0601
Views0See moreRESUMEN
Objetivo:
Relatar la experiencia del acercamiento al escenario de un estudio fenomenológico en enfermería en México.
Método:
Relato de experiencia sobre el acercamiento al escenario de estudio para convivir con adultos mayores con la finalidad de seleccionar a los participantes de un estudio fenomenológico.
Resultados:
Se llevaron a cabo visitas durante el año 2016, en un periodo de cuatro meses a dos grupos de adultos mayores en donde se realizaron diversas actividades. La convivencia con los adultos mayores a través del acompañamiento en las actividades que realizaban en los grupos y el diálogo conjunto permitió seleccionar a aquellos que respondían a las características del objeto de estudio.
Conclusión:
Es necesaria la aproximación al escenario de estudios fenomenológicos, no sólo con la finalidad de ganar empatía de los participantes sino para sumergirse en el fenómeno de estudio, mismo que se va mostrando desde los primeros acercamientos del investigador.
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EXPERIENCE REPORT01-01-2017
Scenario approximation in a phenomenological study in Mexico: experience report
Revista Brasileira de Enfermagem. 2017;70(4):885-890
Abstract
EXPERIENCE REPORTScenario approximation in a phenomenological study in Mexico: experience report
Revista Brasileira de Enfermagem. 2017;70(4):885-890
DOI 10.1590/0034-7167-2016-0601
Views0See moreABSTRACT
Objective:
To report our experience using scenario approximation in a phenomenological study of nursing in Mexico.
Method:
Experience report on scenario approximation to coexist with elderly in order to select the participants of a phenomenological study.
Results:
During a four-month period in 2016, visits were carried out two groups of elderly individuals where several activities were carried out. Coexistence with the elderly throughout accompaniment in the groups’ activities together with joint dialogue allowed selection of those who corresponded to the characteristics of the study objective.
Conclusion:
Scenario approximation is necessary in phenomenological studies, not only for creating empathy among the participants but also for the researchers to immerse themselves in the phenomenon under study, as shown by the first approaches of the researcher.
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REVIEW01-01-2017
Functional health literacy and adherence to the medication in older adults: integrative review
Revista Brasileira de Enfermagem. 2017;70(4):868-874
Abstract
REVIEWFunctional health literacy and adherence to the medication in older adults: integrative review
Revista Brasileira de Enfermagem. 2017;70(4):868-874
DOI 10.1590/0034-7167-2016-0625
Views1See moreABSTRACT
Objective:
to characterize the national and international scientific production on the relationship of Functional Health Literacy and the adherence to the medication in older adults.
Method:
integrative review of literature, searching the following online databases: Scientific Electronic Library Online (SCIELO); Latin American and Caribbean Health Sciences Literature (LILACS); Medical Literature Analysis and Retrieval System Online (MEDLINE); and Cumulative Index to Nursing & Allied Health Literature (CINAHL), in June 2016. We selected 7 articles that obeyed the inclusion criteria.
Results:
all articles are from the USA. The inappropriate Functional Health Literacy affects the non-adherence to medication; however, there are several strategies and interventions that can be practiced to change this relationship.
Conclusion:
nursing needs to explorefurther this theme, since it can exert a differentiated care for adherence to medication in older adults, considering the literacy.
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Evaluation of the safety of hospitalized older adults as for the risk of falls
Revista Brasileira de Enfermagem. 2017;70(4):860-867
Abstract
Evaluation of the safety of hospitalized older adults as for the risk of falls
Revista Brasileira de Enfermagem. 2017;70(4):860-867
DOI 10.1590/0034-7167-2017-0098
Views0See moreABSTRACT
Objective:
To evaluate the safety of hospitalized older adults as for the risk of falls according to the parameters of the Morse Fall Scale.
Method:
Epidemiological, cross-sectional, prospective and descriptive study with n=75.
Results:
Average age of 71.3 years (SD±8.2); 58.7% male; 44% with low educational level; 38.7% hospitalized for cardiovascular diseases; average hospitalization of 10 days (SD±9.38); 78.7% with comorbidities; 61.3% with the calf circumference ≥ 31 cm; 62.7% were former smokers for more than 10 years; 65% did not drink alcohol; 100% did not have identification bracelet; 22.7% had similar names in the infirmary; 48% took up to five medicines; and 93.3% received some invasive procedure, especially the vessel puncture (65.3%). There was a high risk of falls in 52% of older adults.
Conclusion:
The results pointed to imminent risk of breach of patient safety, emphasizing the need for implementation of protocols and predictive scales such as the Morse scale.
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Quality of life of elderly people with chronic kidney disease in conservative treatment
Revista Brasileira de Enfermagem. 2017;70(4):851-859
Abstract
Quality of life of elderly people with chronic kidney disease in conservative treatment
Revista Brasileira de Enfermagem. 2017;70(4):851-859
DOI 10.1590/0034-7167-2017-0103
Views0See moreABSTRACT
Objective:
To describe the quality of life (QOL) of elderly people with Chronic Kidney Disease (CKD) in conservative treatment, correlating it with sociodemographic and health-related aspects.
Method:
This is a quantitative, cross-sectional, and descriptive study that used: a previously validated instrument for data collection; the WHOQOL-BREF and WHOQOL-OLD QOL scales; and the Mini-Mental State Examination.
Results:
Thirty-five elderly people (54.30% females), with mean age of 68.26 years, took part in the study. They reported, on average, 3.70 comorbidities and 5.60 complications related to CKD. Regarding QOL, the “psychological” domain (54.40±16.29) and the “death and dying” facet (37.32±23.79) were considered the most damaged ones; the most strengthened were “social relationships” (70.36±18.32) and “intimacy” (66.61±16.80). A positive correlation was verified between comorbidities and complications (p = 0.015), and an inverse correlation between the number of complications and QOL (p = 0.004).
Conclusion:
These results, if considered during the care planning, may help improving the quality of the care provided for elderly people with CKD.
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Hospitalization of people 50 years old or older living with HIV/AIDS
Revista Brasileira de Enfermagem. 2017;70(4):845-850
Abstract
Hospitalization of people 50 years old or older living with HIV/AIDS
Revista Brasileira de Enfermagem. 2017;70(4):845-850
DOI 10.1590/0034-7167-2017-0113
Views0See moreABSTRACT
Objective:
Identify the rate and predictive factors of the hospitalization of people living with HIV/AIDS (PLHA), aged 50 years or older.
Method:
A quantitative, cross-sectional study was conducted at two inpatient units specialized in infectious diseases in a teaching hospital. Data were gathered through individual interviews between August 2011 and February 2015. All ethical precepts were followed.
Results:
Of the 532 admitted patients, 95 were PLHA 50 years old or older; 30.5% were admitted 3 to 4 times after being diagnosed with HIV/AIDS.
Conclusion:
Rate of hospitalization was 17.8%, and being 50 to 60 years old was a protective factor against hospitalization.
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ORIGINAL ARTICLE11-22-2024
Prevalence of prescription and effectiveness of analgesia for treating vaginal delivery pain
Revista Brasileira de Enfermagem. 2024;77(5):e20230327
Abstract
ORIGINAL ARTICLEPrevalence of prescription and effectiveness of analgesia for treating vaginal delivery pain
Revista Brasileira de Enfermagem. 2024;77(5):e20230327
DOI 10.1590/0034-7167-2023-0327
Views0See moreABSTRACT
Objectives:
to assess pain management during labor.
Methods:
a cross-sectional study was carried out by reviewing medical records and conducting postpartum interviews. Prevalence and effectiveness of analgesia were assessed.
Results:
the prevalence of non-pharmacological analgesia was 61.86% of 215 women in labor in Obstetric Center and 82.51% of 62 in midwife-led unit. Prevalence of severe pain, on the Visual Analogue Scale, before and after non-pharmacological analgesia, was from 92.16% to 64.04% (p=0.00) in Obstetric Center and from 85.96% to 52.63% (p=0.01) in midwife-led unit. Prevalence of pharmacological analgesia in Obstetric Centers was 15.81%, with no variation in severe pain (p=0.57). Patients’ request for analgesia was associated with education (p=0.00) and pain intensity (p=0.02).
Conclusions:
non-pharmacological analgesia improved pain intensity. Prevalence of pharmacological analgesic prescription was lower than that identified in developed countries. Pain management needs to consider the preferences and needs of women in labor.
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ORIGINAL ARTICLE11-22-2024
Knowledge sharing: nurse managers’ practices
Revista Brasileira de Enfermagem. 2024;77(5):e20230287
Abstract
ORIGINAL ARTICLEKnowledge sharing: nurse managers’ practices
Revista Brasileira de Enfermagem. 2024;77(5):e20230287
DOI 10.1590/0034-7167-2023-0287
Views0ABSTRACT
Objective:
To analyze how management practices for sharing knowledge are developed in public hospitals in the context of nursing.
Methods:
Qualitative research, carried out with 15 nurse managers from six public hospitals, from July to September 2022. Data were collected through semi-structured interviews and analyzed according to content analysis and in a model for sharing knowledge at work.
Results:
Knowledge sharing in nursing occurs through intraand extra-organizational training (training, courses and events), use of digital communication tools (media and social networks) and individual and collective contact between professionals during the service (experiences, exchange of experiences and assessment feedback).
Final considerations:
Sharing knowledge is relevant to nursing work. To improve it, it must be understood that effective sharing occurs from person to person, in their daily practices, and must be conducted as a strategically planned process by nurse managers.
Keywords:Health Information ManagementHealth Services AdministrationKnowledge ManagementNursing Service, HospitalNursing Staff, HospitalSee more -
ORIGINAL ARTICLE11-22-2024
Transitions experienced by people living with limitations resulting from leprosy: a research-care study
Revista Brasileira de Enfermagem. 2024;77(5):e20230229
Abstract
ORIGINAL ARTICLETransitions experienced by people living with limitations resulting from leprosy: a research-care study
Revista Brasileira de Enfermagem. 2024;77(5):e20230229
DOI 10.1590/0034-7167-2023-0229
Views0See moreABSTRACT
Objective:
to understand the transitional processes that affect the adaptation of people who live with limitations resulting from leprosy.
Methods:
This is a qualitative study based on the precepts of Transition Theory, mediated by care-research, with 24 people with limitations resulting from leprosy in an ex-hospital colony in Piauí. Semi-structured interviews were carried out. The interviews were analyzed using Iramuteq software.
Results:
the researched-caregivers experienced the four types of transitions, including feelings of fear, worry, loneliness, hopelessness, guilt and a tendency to hide the diagnosis. Breakdowns and resignation were revealed, with spirituality, adaptation to the new life situation and acceptance as facilitating conditions for coping with the transitional process, with a consequent improvement in quality of life.
Final considerations:
the transitional processes had a positive significance, since they contributed to adaptation and the achievement of quality of life.
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ORIGINAL ARTICLE11-22-2024
Study for the validation of evaluation indicators of electronic health records in immunization: Delphi technique
Revista Brasileira de Enfermagem. 2024;77(5):e20230112
Abstract
ORIGINAL ARTICLEStudy for the validation of evaluation indicators of electronic health records in immunization: Delphi technique
Revista Brasileira de Enfermagem. 2024;77(5):e20230112
DOI 10.1590/0034-7167-2023-0112
Views0ABSTRACT
Objective:
To develop and validate indicators for the evaluation of computerized systems in vaccination rooms.
Methods:
Methodological study. From the construction of a logical model for managing information produced in computerized systems in vaccination rooms, an evaluation indicator matrix was developed, and its contents were validated by specialists using the Delphi method. The degree of relevance and clarity were judged, using the following parameters: agreement percentage ≥ 90%; content validity index > 0.78. Internal consistency was tested using Cronbach’s alpha coefficient of 0.93.
Results:
Of the 55 proposed indicators, 48 were validated and composed the final matrix, with 13 in the structure dimension, 29 in the process dimension, and six in the outcome dimension.
Conclusion:
The set of indicators shows validity and high reliability, and can be used to evaluate computerized systems in vaccination rooms throughout the country, as it adhered to the recommendations of the National Immunization Program.
Keywords:Delphi TechniquesElectronic Health RecordsImmunization ProgramsInformation TechnologyValidation StudySee more -
ORIGINAL ARTICLE11-22-2024
Interpersonal violence in the state of Espírito Santo: analysis of mandatory notifications between 2011 and 2018
Revista Brasileira de Enfermagem. 2024;77(5):e20230081
Abstract
ORIGINAL ARTICLEInterpersonal violence in the state of Espírito Santo: analysis of mandatory notifications between 2011 and 2018
Revista Brasileira de Enfermagem. 2024;77(5):e20230081
DOI 10.1590/0034-7167-2023-0081
Views0See moreABSTRACT
Objective:
To identify the frequency of notifications of interpersonal violence in Espírito Santo from 2011 to 2018, and the factors associated with this issue.
Methods:
This is a cross-sectional study in which all cases of interpersonal violence from the Information System for Notifiable Diseases in the state of Espírito Santo during the period from 2011 to 2018 were analyzed. Absolute and relative frequencies and 95% confidence intervals were calculated, as well as Poisson regression.
Results:
During the analyzed period, 27,277 cases were reported in Espírito Santo (P: 75%; 95% CI: 74.5-75.4), being more prevalent among females, children, and the elderly, individuals of black/mixed race, people without disabilities, and residents of urban areas. Regarding the perpetrator, there was a higher prevalence of individuals aged 25 years and older, males, with a current or former intimate partner relationship with the victim, and suspected alcohol use at the time of the aggression. In terms of the characteristics of the aggression, there was a higher prevalence of repeat violence, involving a single aggressor, and occurring in the residence.
Conclusions:
The notification of interpersonal violence in Espírito Santo showed a high prevalence and was associated with characteristics of the victim, aggressor, and event. This scenario reinforces the need for interventions such as professional qualification, expansion of intersectoral actions, and reformulation of public policies.
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ORIGINAL ARTICLE11-22-2024
Sociodemographic and occupational influences on health professionals’ quality of life
Revista Brasileira de Enfermagem. 2024;77(4):e20240010
Abstract
ORIGINAL ARTICLESociodemographic and occupational influences on health professionals’ quality of life
Revista Brasileira de Enfermagem. 2024;77(4):e20240010
DOI 10.1590/0034-7167-2024-0010
Views0See moreABSTRACT
Objective:
To analyze the sociodemographic and occupational influences on health professionals’ quality of life.
Method:
This descriptive-exploratory, cross-sectional, analytical, and quantitative study addressed 94 health workers, including nursing technicians, nurses, and physical therapists working in Intensive Care Units in a town in the extreme south of Brazil in 2023. The student’s t-test and Spearman correlation were used.
Results:
A significant positive correlation was found between being a woman and the psychological domain and between income and the social and environmental domain while working hours were inversely related to general QoL. Additionally, workload negatively impacted the physical, psychological, and general QOL, furniture negatively influenced the psychological domain, and equipment was negatively associated with the physical and psychological domain.
Conclusion:
The characteristics of the work environment interfere with several areas of quality of life.
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REVIEW11-22-2024
Concept analysis of youth: understanding the plurality of subjects
Revista Brasileira de Enfermagem. 2024;77(4):e20240002
Abstract
REVIEWConcept analysis of youth: understanding the plurality of subjects
Revista Brasileira de Enfermagem. 2024;77(4):e20240002
DOI 10.1590/0034-7167-2024-0002
Views0See moreABSTRACT
Objective:
To analyze the concept of “youth.”
Methods:
This is a concept analysis guided by the method proposed by Walker and Avant, operationalized through an integrative literature review. The search in scientific databases was carried out using the descriptors: youth; young; adolescence. To compose the literary corpus, 22 studies were selected.
Results:
Various factors were found in the antecedents that influence the separation of youth groups, contributing to the heterogenization of this population. The attributes include characteristics that comprise the formation of youth groups, especially the idea of shared experiences and social construction, as well as the consequences of the mentioned concept. After systematizing the variables, the analysis was conducted, highlighting the conceptions that influence youth.
Conclusion:
The study demonstrated the multifactorial complexity of the formulation of the concept of youth, highlighting various factors that contribute to this construction. For nursing, this conceptual field allows for an understanding of the population and effective engagement with this group.
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Perceptions of adolescent students about drugs
Revista Brasileira de Enfermagem. 2015;68(3):517-523
Abstract
Perceptions of adolescent students about drugs
Revista Brasileira de Enfermagem. 2015;68(3):517-523
DOI 10.1590/0034-7167.2015680320i
Views0See moreABSTRACT
Objective:
To analyze the perceptions of adolescent public school students about drugs.
Method:
Qualitative approach of focus groups with 16 adolescent students. The data collected were analyzed by means of content analysis, leading to the following categories: meaning of drugs; living with drug use; opinions, beliefs and attitudes toward drug use; and preventing drug abuse in adolescence.
Results:
The adolescent students know about some drugs, and associate their use with delinquent and criminal behavior. The students identifi ed factors that lead to drug abuse, such as easy access, use by family and friends, idleness, dropping out of school and the characteristic vulnerability of adolescence.
Conclusion:
the results point to the need for educational activities in the context of where the adolescents live, including school, community and family environments, to support and to minimize their vulnerability.
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Cognitive stimulation for older people with Alzheimer’s disease performed by the caregiver
Revista Brasileira de Enfermagem. 2015;68(3):510-516
Abstract
Cognitive stimulation for older people with Alzheimer’s disease performed by the caregiver
Revista Brasileira de Enfermagem. 2015;68(3):510-516
DOI 10.1590/0034-7167.2015680319i
Views0See moreABSTRACT
Objective:
to learn the infl uence of cognitive therapy at home, conducted by the caregivers of older people with Alzheimer’s Disease.
Method:
a case study was developed with fi ve older people with Alzheimer’s Disease and their caregivers. The stages of research development were: orientation with the caregivers; selection of older people and caregivers; approach of the study subjects at home; weekly meetings and reapplication of tests to follow up the cognitive function of the participants.
Results:
in three months it was possible to identify improved cognition, verifi ed by the result of the Mini-Mental State Examination (MMSE). The scores of the other tests (KATZ, LAWTON, CLOCK TEST and VFT) remained the same.
Conclusion:
this strategy can be considered a light technology of nursing care for older people with dementia. When providing this care with the support of a nurse, caregivers re feel less anxious and understand the disease better.
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Anxiety and spirituality in university students: a cross-sectional study
Revista Brasileira de Enfermagem. 2015;68(3):504-509
Abstract
Anxiety and spirituality in university students: a cross-sectional study
Revista Brasileira de Enfermagem. 2015;68(3):504-509
DOI 10.1590/0034-7167.2015680318i
Views0See moreABSTRACT
Objective:
to study anxiety and spirituality and the relationship between them in university students.
Method:
the State-Trait-Anxiety Inventory (STAI) and Pinto and Pais-Ribeiro Spirituality Scales were used for data collection.
Results:
six hundred and sixty-nine students participated in the study, of whom 91.5% had moderate and high levels of trait anxiety and 92.9% of state anxiety; 93.8% had high spirituality scores. The multiple linear regression test showed a signifi cant relationship between anxiety and the presence of physical discomfort, unusual body movements, and the need for treatment. Furthermore, higher levels of anxiety were associated with the female gender, the lack of leisure activities, and low levels of optimism in the spirituality scale.
Conclusion:
it is important to develop strategies for coping with anxiety, which in turn can be oriented toward protective factors such as spirituality.
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Nursing guidance on bed baths to reduce anxiety
Revista Brasileira de Enfermagem. 2015;68(3):497-503
Abstract
Nursing guidance on bed baths to reduce anxiety
Revista Brasileira de Enfermagem. 2015;68(3):497-503
DOI 10.1590/0034-7167.2015680317i
Views0See moreABSTRACT
Objective:
to evaluate the effectiveness of a nursing guidance protocol to reduce the anxiety of patients with acute coronary syndrome undergoing bed bath, and the correlation of vital signs with state-anxiety.
Method:
randomized clinical trial study. The sample consisted of 120 patients. The intervention group received a nursing guidance protocol about bed bath and the control group received the unit’s routine information. The STAI-State scale was used to assess anxiety, and data were collected at three times: immediately after informing the patients about the bed bath; immediately after interventions; and immediately after the bath.
Results:
the intervention group presented signifi cantly lower state-anxiety compared to the control group (p<0.001) after the intervention.
Conclusion:
the nursing orientation was effective to reduce anxiety in patients with acute coronary syndrome undergoing bed bath.
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Body language in health care: a contribution to nursing communication
Revista Brasileira de Enfermagem. 2015;68(3):490-496
Abstract
Body language in health care: a contribution to nursing communication
Revista Brasileira de Enfermagem. 2015;68(3):490-496
DOI 10.1590/0034-7167.2015680316i
Views0See moreABSTRACT
Objective:
to classify body language used in nursing care, and propose “Body language in nursing care” as an analytical category for nursing communication.
Method:
quantitative research with the systematic observation of 21:43 care situations, with 21 members representing the nursing teams of two hospitals. Empirical categories: sound, facial, eye and body expressions.
Results:
sound expressions emphasized laughter. Facial expressions communicated satisfaction and happiness. Eye contact with members stood out in visual expressions. The most frequent body expressions were head movements and indistinct touches.
Conclusion:
nursing care team members use body language to establish rapport with patients, clarify their needs and plan care. The study classifi ed body language characteristics of humanized care, which involves, in addition to technical, non-technical issues arising from nursing communication.
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Health promotion in supplementary health care: outsourcing, microregulation and implications for care
Revista Brasileira de Enfermagem. 2015;68(3):482-489
Abstract
Health promotion in supplementary health care: outsourcing, microregulation and implications for care
Revista Brasileira de Enfermagem. 2015;68(3):482-489
DOI 10.1590/0034-7167.2015680315i
Views0See moreABSTRACT
Objective:
to analyze health promotion programs in the supplementary health care.
Methods:
This was a multiple case study with a qualitative approach whose data were obtained from interviews with coordinators of providers contracted by the corporations of health insurance plans in Belo Horizonte, Minas Gerais. The data were submitted to Critical Discourse Analysis.
Results:
Home care has been described as the main action in the fi eld of health promotion transferred to the providers, followed by management of patients and cases, and the health education.groups. The existence of health promotion principles is questionable in all programs. Outsourcing is marked by a process with a division between cost and care management. Implications of this process occur within admission and interventions on the needs of the benefi ciaries.
Conclusions:
Statements revealed rationalization of cost, restructuring of work, and reproduction of the dominant logic of capital accumulation by the health insurance companies.
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Gateway to the diagnosis of tuberculosis among elders in Brazilian municipalities
Revista Brasileira de Enfermagem. 2015;68(3):467-473
Abstract
Gateway to the diagnosis of tuberculosis among elders in Brazilian municipalities
Revista Brasileira de Enfermagem. 2015;68(3):467-473
DOI 10.1590/0034-7167.2015680313i
Views0See moreABSTRACT
Objective:
to analyze the factors associated with the gateway of the health systems of Brazilian municipalities for the diagnosis of tuberculosis in older people.
Method:
survey study type, with a sample of 91 elders, in a population with 706 cases of tuberculosis. Data were collected by means of an instrument based on the Primary Care Assessment Tool (PCAT) adapted for tuberculosis care, emphasizing the gateway variable. Variables were categorized and compared between primary health care (PHC) and specialized care (SC) services. Bivariate analysis and the Chi-square association test were used.
Results:
a statistically signifi cant association (p = 0.0001) was found between the fi rst health service sought and the unit that diagnosed tuberculosis, showing better performance of specialized care services in the diagnosis.
Conclusion:
it is necessary to improve primary health care services to tackle delayed diagnosis of tuberculosis in older people.
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