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ORIGINAL ARTICLE07-29-2024
Adaptation strategies for preparing for childbirth in the context of the pandemic: Roy’s Theory
Revista Brasileira de Enfermagem. 2024;77(3):e20230159
Abstract
ORIGINAL ARTICLEAdaptation strategies for preparing for childbirth in the context of the pandemic: Roy’s Theory
Revista Brasileira de Enfermagem. 2024;77(3):e20230159
DOI 10.1590/0034-7167-2023-0159
Views0See moreABSTRACT
Objectives:
to understand the process of adapting to childbirth during the COVID-19 pandemic from the perspective of a group of pregnant women.
Methods:
a qualitative, descriptive-exploratory study was conducted with 23 women. Data were collected between October and December 2021 through documentation and semi-structured interviews, which were analyzed using Minayo’s methodology and Roy’s Adaptation Model.
Results:
various types of stimuli – focal, contextual, and residual – were identified as influencing childbirth preparation. The online group was essential for facilitating pregnant women’s adaptation, offering significant support and generating positive feedback for childbirth preparation.
Final Considerations:
the importance of pregnant women’s groups as a strategy for improving adaptation to childbirth was identified, underscoring the effectiveness of this support among professionals and participants, as well as among pregnant women. This support network strengthened preparation for childbirth during a challenging period like the pandemic.
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ORIGINAL ARTICLE07-29-2024
Profile of patients in private home care who developed ventilator-associated pneumonia
Revista Brasileira de Enfermagem. 2024;77(3):e20230146
Abstract
ORIGINAL ARTICLEProfile of patients in private home care who developed ventilator-associated pneumonia
Revista Brasileira de Enfermagem. 2024;77(3):e20230146
DOI 10.1590/0034-7167-2023-0146
Views0ABSTRACT
Objectives:
to analyze the profile and clinical outcomes of patients who developed Ventilator-Associated Pneumonia (VAP) in private home care and to compare the incidence with national data.
Methods:
this was a retrospective study with data collected from July 2021 to June 2022 from patient records at a private clinic. Patients using intermittent ventilation or without ventilatory support were excluded.
Results:
the utilization rate of mechanical ventilation was 15.9%. The incidence density of pneumonia in pediatrics was 2.2 cases per 1000 ventilation-days and in adults was 1.7 cases per 1000 ventilation-days, figures lower than those reported by the National Health Surveillance Agency. There were 101 episodes of pneumonia in 73 patients, predominantly male (65.8%), adults (53.4%), and those with neurological diseases (57.5%). The treatment regimen predominantly took place at home (80.2%), and there was one death.
Conclusions:
patients in home care showed a low incidence and mortality rate from ventilator-associated pneumonia.
Keywords:ArtificialHealth Systems AgenciesHome Care ServicesIntensive Care UnitsPneumoniaRespirationVentilator-AssociatedSee more -
ORIGINAL ARTICLE07-29-2024
Impact of educational intervention on understanding health recommendations after liver transplantation
Revista Brasileira de Enfermagem. 2024;77(3):e20230132
Abstract
ORIGINAL ARTICLEImpact of educational intervention on understanding health recommendations after liver transplantation
Revista Brasileira de Enfermagem. 2024;77(3):e20230132
DOI 10.1590/0034-7167-2023-0132
Views0See moreABSTRACT
Objectives:
to evaluate the impact of educational intervention on understanding health recommendations after liver transplantation.
Methods:
randomized and prospective clinical trial, with 68 liver transplant recipients in two institutions. The level of understanding was assessed using a statement agreement scale and the understanding score was classified. Chi-square test was used to compare groups.
Results:
the level of understanding was reasonable in 77.9% of patients, 73.5% in the Control Group and 82.3% in the Intervention Group (p=0.399). For topics covered after educational action, there were more than 80% correct answers regarding nutrition, frequent hydration, usage and function of immunosuppressants. However, there were less than 10% correct answers regarding hand hygiene, contact with animals and crowds of people. The use of the patient’s audio, visual and tactile resources led to improved understanding of skin care (p=0.014).
Conclusions:
the level of understanding acquired regarding health recommendations was only reasonable.
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ORIGINAL ARTICLE07-29-2024
Trends in cesarean section rates in Brazil by Robson classification group, 2014-2020
Revista Brasileira de Enfermagem. 2024;77(3):e20230099
Abstract
ORIGINAL ARTICLETrends in cesarean section rates in Brazil by Robson classification group, 2014-2020
Revista Brasileira de Enfermagem. 2024;77(3):e20230099
DOI 10.1590/0034-7167-2023-0099
Views0ABSTRACT
Objectives:
to evaluate the trends in cesarean sections from 2014 to 2020 across both public and private sectors, utilizing the Robson Classification.
Methods:
this time series study analyzed the proportion of women who underwent cesarean sections between 2014 and 2020, considering both the Robson classification and the type of healthcare service. Trend analysis was conducted using the Prais-Winsten regression.
Results:
higher proportions of cesarean sections were observed in all Robson groups within the private sector compared to the public sector. This was despite a decreasing trend in the private sector and an increasing trend in the public sector. Notably, elevated proportions of cesarean sections were recorded in groups that are typically favorable to normal childbirth (Robson 1, 4, and 5).
Conclusions:
although there was a decreasing trend in cesarean sections within the private sector, an increasing trend was observed in the public sector. Additionally, there was a high proportion of cesarean sections among women with conditions favorable to normal childbirth. It is crucial to continuously monitor these indicators to evaluate and implement interventions aimed at reducing unnecessary cesarean sections.
Keywords:Cesarean SectionMaternal Health ServicesNursingObstetricReproductive HealthTime Serie StudiesSee more -
ORIGINAL ARTICLE07-29-2024
Healthcare judicialization: an analysis of indicators and official data on medications
Revista Brasileira de Enfermagem. 2024;77(3):e20220413
Abstract
ORIGINAL ARTICLEHealthcare judicialization: an analysis of indicators and official data on medications
Revista Brasileira de Enfermagem. 2024;77(3):e20220413
DOI 10.1590/0034-7167-2022-0413
Views0ABSTRACT
Objectives:
to analyze judicial demands for medications in Campo Grande, Brazil, between July 2018 and June 2020.
Methods:
the four dimensions of the Manual of Indicators for Evaluation and Monitoring of Judicial Demands for Medications were examined.
Results:
676 judicial processes were identified, corresponding to 1006 requests for 284 different medications. In 92.74% of the processes, access to medications was granted, with 88.80% granted on an urgent basis. The median time between the decision and delivery of the medication was 146 days. The average monthly cost of acquiring medications was R$ 2,183.68 Brazilian reais. Among the identified medications, 90.22% had at least one therapeutic alternative available in the public healthcare system.
Conclusions:
characterizing and analyzing judicial demands related to medications can support discussions on updating medication lists and clinical protocols, organizing healthcare services, allocating resources, and implementing actions to reduce judicialization.
Keywords:Health CareHealth LitigationHealth Services AccessibilityPharmaceutical ServicesProcess AssessmentRight to HealthSee more -
ORIGINAL ARTICLE07-19-2024
Nursing students’ perception: Escape Room use in teaching leadership skills
Revista Brasileira de Enfermagem. 2024;77(2):e20230414
Abstract
ORIGINAL ARTICLENursing students’ perception: Escape Room use in teaching leadership skills
Revista Brasileira de Enfermagem. 2024;77(2):e20230414
DOI 10.1590/0034-7167-2023-0414
Views0See moreABSTRACT
Objectives:
to understand nursing students’ perception regarding Escape Room use to develop leadership skills.
Methods:
a qualitative exploratory-descriptive study, with 97 nursing students. Escape Room game sessions were held, totaling ten. Subsequently, a debriefing and analysis was carried out using the Discourse of the Collective Subject method, through the focus group technique. Ethical procedures were respected.
Results:
students’ perceptions about using this methodology to develop leadership skills were positive and significant. The effectiveness of the game in teaching and developing these skills in nursing practice stands out.
Final Considerations:
the game was an effective active methodology in approaching the proposed content, promoting satisfaction and easy assimilation.
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ORIGINAL ARTICLE07-19-2024
Validation of an instrument for patient classification to support obstetric nursing care
Revista Brasileira de Enfermagem. 2024;77(2):e20230401
Abstract
ORIGINAL ARTICLEValidation of an instrument for patient classification to support obstetric nursing care
Revista Brasileira de Enfermagem. 2024;77(2):e20230401
DOI 10.1590/0034-7167-2023-0401
Views0ABSTRACT
Objectives:
to develop and validate an instrument for the classification of pregnant and postpartum women according to the demand for nursing care.
Methods:
a methodological study conducted in three stages: 1) construction of the instrument based on literature review; 2) content validation using the Delphi technique with 12 experts; and 3) Evaluation of the convergent construct validity through the correlation between the scores of the constructed instrument and the Fugulin instrument.
Results:
an instrument with ten indicators of specific care for pregnant and postpartum women was developed. A content validity index higher than 0.9 was obtained, requiring only one round of the Delphi technique. The Spearman coefficient was 0.64 between the instruments, indicating a strong correlation.
Conclusions:
the classification instrument specifically constructed for pregnant and postpartum women showed evidence of content validity and convergent construct validity with a widely used instrument in the national territory.
Keywords:Hospital AdministrationNursing AssessmentObstetric NursingPersonnel ManagementValidation StudySee more -
ORIGINAL ARTICLE07-19-2024
The use of spirituality/religiosity by oncology nurse residents in nursing care
Revista Brasileira de Enfermagem. 2024;77(2):e20230383
Abstract
ORIGINAL ARTICLEThe use of spirituality/religiosity by oncology nurse residents in nursing care
Revista Brasileira de Enfermagem. 2024;77(2):e20230383
DOI 10.1590/0034-7167-2023-0383
Views0See moreABSTRACT
Objectives:
to analyze the use of spirituality/religiosity by oncology nurse residents in caring for patients with cancer.
Methods:
a census, descriptive, sectional study, with 46 nurse residents from three public hospitals in Rio de Janeiro. Data collection took place between August 2020 and January 2021, using a sociodemographic questionnaire, including a question about the use of spirituality/ religiosity to deal with work situations. Descriptive analysis was carried out using SPSS software version 22.0.
Results:
participants stated that they use religiosity/spirituality in work situations related to patients or themselves. In relation to patients, death was the most mentioned situation among professionals, and for themselves, everyday situations and emotional vulnerability were the most mentioned.
Final Considerations:
spirituality and religiosity are dimensions that guide oncology nurse residents’ attitudes.
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Mudança de pressão do balonete traqueal antes e depois da realização dos cuidados de enfermagem
Revista Brasileira de Enfermagem. 2017;70(6):1145-1150
Abstract
Mudança de pressão do balonete traqueal antes e depois da realização dos cuidados de enfermagem
Revista Brasileira de Enfermagem. 2017;70(6):1145-1150
DOI 10.1590/0034-7167-2016-0486
Views0See moreRESUMEN
Objetivo:
verificar los câmbios de presión del manguito traqueal antes y después de la higiene oral, elevación de la cabecera del lecho a 0º, 30º y 60º, cambio de decúbito, aspiración traqueal y baño en el lecho.
Método:
La población fue compuesta por 88 pacientes, totalizando 3696 verificaciones de julio a septiembre de 2014.
Resultados:
Los valores de presión fueron analisados em siete procedimentos de atención de enfermeira realizados em la parte de la mañana. Seis apresentaron alteraciones significativas antes y después de la realización de los procedimentos de enfermería. En el periodo de la tarde, cinco de los procedimentos de atención de enfermería realizados apresentaron alteraciones, y por la noche, sólo dos.
Conclusión:
Hubo diferencias antes y después de la realización de la atención de enfermería, demostrando alteración de la presión del manguito. El baño em el lecho y la elevación de la cabecera del lecho a 30º presentó valores de presíonmásalterados em los tres turnos de trabajo, preferentemente después del baño.
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RESEARCH01-01-2017
Tracheal cuff pressure change before and after the performance of nursing care
Revista Brasileira de Enfermagem. 2017;70(6):1145-1150
Abstract
RESEARCHTracheal cuff pressure change before and after the performance of nursing care
Revista Brasileira de Enfermagem. 2017;70(6):1145-1150
DOI 10.1590/0034-7167-2016-0486
Views0See moreABSTRACT
Objective:
Verify the changes of endotracheal cuff pressure before and after oral hygiene, head-of-bed elevation at 0º, 30º, and 60º, change in body position, aspiration of the endotracheal tube, and in-bed bathing.
Method:
The study sample was composed of 88 patients. We performed 3,696 checks from July to September 2014.
Results:
Pressure values were analyzed in seven nursing care in the morning. Six of them were significantly altered before and after nursing procedure. In the afternoon, five of the health care provided were altered, and in the evening, only two. Most of pressure values were below recommended.
Conclusion:
There were differences before and after health care provided, showing changes in cuff pressure. In-bed bathing and head-of-bed elevation at 30º were the ones that most altered pressure values in the three working shifts. Therefore, it is necessary to measure cuff pressure at least twice per working shift, preferably after bathing.
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RESEARCH01-01-2017
Technical nursing students interacting with family members of hospitalized children
Revista Brasileira de Enfermagem. 2017;70(6):1137-1144
Abstract
RESEARCHTechnical nursing students interacting with family members of hospitalized children
Revista Brasileira de Enfermagem. 2017;70(6):1137-1144
DOI 10.1590/0034-7167-2016-0374
Views0See moreABSTRACT
Objective:
To understand technical nursing students’ meaning of interacting with family members of hospitalized children.
Method:
Symbolic Interactionism was used as the theoretical framework and Qualitative Content Analysis was the methodological procedure. A total of eight graduates from an institution situated in the city of Osasco, Sao Paulo state, participated in this study. Data were collected through semi-structured interviews.
Results:
A total of five representative themes were revealed: Dealing with difficult situations with family members; Perceiving oneself to be unprepared to interact with family members; Family members being a helpful tool; Developing strategies to obtain a good interaction with family members; and Teachers being facilitators of the interaction with family members.
Final considerations:
To be acquainted with this experience has led to the understanding of the need to include the theme of family care in the curriculum of the Technical Nursing Course. Additionally, the present study contributed to reflections on the importance of such knowledge for this population and to the development of future studies, as this theme has been scarcely explored in the literature.
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RESEARCH01-01-2017
Family interview guide: strategy to develop skills in novice nurses
Revista Brasileira de Enfermagem. 2017;70(6):1129-1136
Abstract
RESEARCHFamily interview guide: strategy to develop skills in novice nurses
Revista Brasileira de Enfermagem. 2017;70(6):1129-1136
DOI 10.1590/0034-7167-2016-0072
Views0See moreABSTRACT
Objective:
describe the skills of nurses to conduct family interviews based on the Family Care Guide for Nursing Clinical Practice.
Method:
exploratory case study that analyzed the content of 16 guides applied to a child emergency service by a novice nurse from the family nursing area.
Results:
the records indicated the presence of perceptual, conceptual, and executive skills required to conduct family interviews, in particular skills for the development of genograms, therapeutic relationships, and actions to fulfill family needs.
Final considerations:
the Family Care Guide for Nursing Clinical Practice is a useful tool to guide the training processes, promote the development of family interview skills in novice nurses, and allow the cognitive consolidation of essential elements of patient- and family-centered care.
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RESEARCH01-01-2017
Actions of nurses in early detection of breast cancer
Revista Brasileira de Enfermagem. 2017;70(6):1119-1128
Abstract
RESEARCHActions of nurses in early detection of breast cancer
Revista Brasileira de Enfermagem. 2017;70(6):1119-1128
DOI 10.1590/0034-7167-2016-0155
Views0ABSTRACT
Objective:
Identify the actions for early detection of breast cancer performed by nurses from basic health units; compare the compliance of these actions with the recommendations from the Ministry of Health; analyze the availability of documents to check these recommendations and analyze the association of variables “training,” “lato sensu training,” and “years of activity” of these professionals with the actions performed.
Method:
A cross-sectional study conducted with 133 nurses from 38 basic health units in the Southeast region of the municipality of São Paulo, interviewed with a validated questionnaire.
Result:
Most nurses reported actions to detect this neoplasm. Guidance on the first mammogram age was significantly associated with training, years of activity and availability of Basic Attention Book nº 13.
Conclusion:
This study observed a positive influence of training and years of activity on the actions for early detection of breast cancer and the need for adjustments in national guidelines.
Keywords:Breast NeoplasmsNursing Professional RoleOncology NursingPrimary HealthcareScreening programsSee more -
EDITORIAL01-01-2017
In memoriam – Irmã Maria Tereza Notarnicola
Revista Brasileira de Enfermagem. 2017;70(6):1117-1118
Abstract
EDITORIALIn memoriam – Irmã Maria Tereza Notarnicola
Revista Brasileira de Enfermagem. 2017;70(6):1117-1118
DOI 10.1590/0034-7167.2017700601
Views0Maria Notarnicola, descendente de italianos, nasceu em São Paulo, onde realizou seus estudos primários e secundários. Ingressou na Companhia das Filhas da Caridade de São Vicente de Paulo em 1937, quando estava com quase 17 anos de idade, com o nome de Irmã Maria Tereza. Trabalhou por cinco anos na Creche Catarina Labouré, em São […]See more -
EDITORIAL01-01-2017
In memoriam – Sister Maria Tereza Notarnicola
Revista Brasileira de Enfermagem. 2017;70(6):1117-1118
Abstract
EDITORIALIn memoriam – Sister Maria Tereza Notarnicola
Revista Brasileira de Enfermagem. 2017;70(6):1117-1118
DOI 10.1590/0034-7167.2017700601
Views0Maria Notarnicola, of Italian descent, was born in São Paulo, where she held her primary and secondary studies. She joined the Company of the Daughters of Charity of Saint Vincent de Paul in 1937, when she was almost 17 years old, with the name of Sister Maria Tereza. She worked for five years in Catarina […]See more -
REFLECTION01-01-2017
The essence of care in health vulnerability: a Heideggerian construction
Revista Brasileira de Enfermagem. 2017;70(5):1112-1116
Abstract
REFLECTIONThe essence of care in health vulnerability: a Heideggerian construction
Revista Brasileira de Enfermagem. 2017;70(5):1112-1116
DOI 10.1590/0034-7167-2016-0570
Views0See moreABSTRACT
Objective:
Reflect on the essence of care in health vulnerability from the phenomenological perspective of Martin Heidegger.
Method:
Theoretical-reflexive study, anchored in three essential parts: 1) Care in Heidegger; 2) The essence of care in health vulnerability; And 3) Nursing care actions on health vulnerability.
Results:
Vulnerability must be recognized as an indelible trait of the human condition and has its constituents in the human being, co-presence and care. Caring is an interactive process that reveals itself in the relationship with the other. Respecting the integrity of the Being in vulnerability must be a priority in nursing care, through behaviors that privilege the Being.
Conclusion:
Understanding ontological care and its relation to vulnerability under Heidegger’s phenomenological view allowed us to uncover the facets of care in health vulnerability by adding to the nursing knowledge body a comprehensive and reflective perspective.
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ORIGINAL ARTICLE01-10-2024
Nursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
Abstract
ORIGINAL ARTICLENursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
DOI 10.1590/0034-7167-2023-0459
Views0See moreABSTRACT
Objectives:
to identify how first-year nursing students use cyberspace and propose an orientation guide with criteria guiding the use of cyberspace.
Methods:
qualitative and descriptive research, carried out with 24 nursing students from a federal public institution in Rio de Janeiro. Data collection was carried out through semi-structured interviews. Data analysis occurred using IRAMUTEQ®. The research was approved by the institution’s Research Ethics Committee.
Results:
students use cyberspace to communicate, study, find “cool things”, share photos and memories. Furthermore, they are concerned about hate speech, intolerance and fake news. The good and bad sides and the types of technologies most used were also portrayed.
Final considerations:
the moral and ethical values of physical coexistence, together with awareness of individual responsibility, are the pillars for using cyberspace. The guide comes as an awareness tool.
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ORIGINAL ARTICLE01-10-2024
Maternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
Abstract
ORIGINAL ARTICLEMaternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
DOI 10.1590/0034-7167-2022-0576
Views0See moreABSTRACT
Objective:
to analyze how motherhood is expressed in female prison units from the perspective of Bioethics of Protection.
Method:
qualitative research with an ethnographic approach, developed in two women’s prison units. Participantes were: six mothers deprived of liberty, 15 health professionals, and nine prison officers. For data collection, semi-structured interviews and descriptive observation were used. Data analysis was based on the Content Analysis technique, thematic category.
Results:
three categories emerged: women and children violated behind bars (inequities); mothers and children in prison exacerbating imbalances, tensions and conflicts; and limits and references for resocialization.
Final Considerations:
the Bioethics of Protection proposal appears as a valid tool for the analytical direction of the process of confronting issues in the scope of public health in prison units, considering vulnerable groups and aiming at equity and human dignity.
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ORIGINAL ARTICLE01-10-2024
Self-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
Abstract
ORIGINAL ARTICLESelf-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
DOI 10.1590/0034-7167-2024-0289
Views0See moreABSTRACT
Objective:
to analyze occurrence of self-harm, sociodemographic profile of victims and referrals in the first 24 months of the COVID-19 pandemic in São Paulo.
Method:
cross-sectional study carried out by the Notifiable Diseases Information System with data on self-harm in São Paulo. The period outlined was March 2020 to February 2022. R (4.0.2) software and chi-square test were used.
Results:
there were 15,946 incidents. Victims were young, white, single, heterosexual women. There was high incidence of people with previous mental disorders more than once and without clear motivation. The method used was poisoning/intoxication. There was a considerable number of referrals to the health network, although not totalitarian.
Conclusion:
the years of greater insecurity in relation to the pandemic have given rise to self-harm cases with peculiar characteristics. Agile health policies must be applied in atypical conditions, such as pandemics, especially for adolescents/young people with previous mental disorders.
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REVIEW01-10-2024
Health of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
Abstract
REVIEWHealth of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
DOI 10.1590/0034-7167-2024-0106
Views0See moreABSTRACT
Objective:
to map the literature on quilombola children’s health and its relationship with the Sustainable Development Goals.
Method:
a scoping review, which followed the JBI protocol and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in the LILACS, BDENF, Web of Science, Scopus, MEDLINE databases and Google Scholar platform. The research protocol was registered in the Open Science Framework.
Results:
eighteen articles out of 2,055 studies were selected as relevant for this study. The articles were grouped into four axes: Access to healthcare services; Nutritional aspects of quilombola children; Health problems of quilombola children; and Care for quilombola children. The relationship between these articles and SDGs 1, 3, 4, 6 and 10 was observed.
Final considerations:
the study provided an extremely important mapping of the theme of quilombola children’s health and themes related to the Sustainable Development Goals.
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REVIEW01-10-2024
Prevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
Abstract
REVIEWPrevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
DOI 10.1590/0034-7167-2024-0052
Views0See moreABSTRACT
Objectives:
To identify in the scientific literature the prevalence, diagnostic methods, and exposure variables of latent infection by Mycobacterium tuberculosis in healthcare workers.
Methods:
An integrative review of the scientific literature based on the following review question: What are the available scientific evidence in the literature that address the prevalence of latent infection by Mycobacterium tuberculosis in healthcare workers and its association with possible risk factors among these workers?
Results:
Being a physician or nurse, being older, and being male were generally associated with higher prevalences. The study also showed that interferon-gamma release assays were more commonly used as a diagnostic method compared to skin tests.
Conclusions:
More studies are needed regarding the epidemiology of latent infection by Mycobacterium tuberculosis in the context of healthcare workers, aiming for higher impact actions that contribute to the reduction of tuberculosis worldwide.
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