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ERRATUM01-13-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
DOI 10.1590/0034-7167.20247706e08
Views0In the article “Brazilian nursing specific situation, middle and micro-range theories: a bibliometric study”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(4):e20230520, Chart 1: Where it read: […]See more -
ERRATUM01-13-2024
ERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
Abstract
ERRATUMERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
DOI 10.1590/0034-7167.20247706e06pt
Views0No artigo “Crenças e atitudes de pais ou responsáveis legais sobre a vacinação infantil: revisão de escopo”, com número DOI: , publicado no periódico Revista Brasileira de Enfermagem, 2024;77(4):e20240126, página 5:Onde se lia:[…]See more -
ORIGINAL ARTICLE01-13-2024
Indicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
Abstract
ORIGINAL ARTICLEIndicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
DOI 10.1590/0034-7167-2024-0204
Views0See moreABSTRACT
Objectives:
to compare the sociodemographic and clinical severity indicators of hospitalized people with HIV in relation to clinical outcomes and urgent hospital admission.
Methods:
a retrospective cohort study was conducted with 102 medical records of HIV-infected individuals hospitalized in a hospital in southern Brazil. In addition to descriptive analysis, Fisher’s exact test, Pearson’s Chi-square, and logistic regression were used.
Results:
the data showed a significant direct effect on severity indicators in the following variables: male sex (p=0.013), skin color (p=0.023), level of education (p=0.000), urgent admissions (p=0.000), late diagnosis (p=0.001), diabetes mellitus (p=0.001), hypertension (p=0.004), kidney disease (p=0.002), high viral load (p=0.006), CD4+ count below 200 (p=0.005), fever (p=0.016), weight loss (p=0.013), co-infection with hepatitis C (p=0.004), and mortality (p=0.007).
Conclusions:
three sociodemographic and thirteen clinical markers were identified as being associated with the risk of clinical deterioration in hospitalized people with HIV.
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ORIGINAL ARTICLE01-13-2024
Nurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
Abstract
ORIGINAL ARTICLENurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
DOI 10.1590/0034-7167-2023-0481
Views1See moreABSTRACT
Objectives:
to understand the perspective of nurses on the use of telemonitoring in the management of people with type 2 diabetes mellitus and arterial hypertension in primary care.
Methods:
this qualitative research involved sixteen nurses from eight municipalities in Paraná. Data were collected between November 2022 and January 2023 through inperson or remote interviews, which were audio-recorded and subjected to content analysis.
Results:
according to the nurses, telemonitoring enhances users’ knowledge about these conditions, communication and connection with the team, and productivity. However, the lack of electronic resources and equipment, high staff turnover, low user adherence, and the limited availability of professional time present significant challenges.
Final Considerations:
the effective implementation and operation of telemonitoring in the management of people with diabetes and hypertension involve both potential benefits and barriers. It is essential to have the availability of human and technological resources, managerial support, and the commitment of professionals and users.
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ORIGINAL ARTICLE01-13-2024
Knowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
Abstract
ORIGINAL ARTICLEKnowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
DOI 10.1590/0034-7167-2023-0424
Views0ABSTRACT
Objectives:
to investigate the knowledge, attitudes, and practices of nurses regarding blood culture collection.
Methods:
a cross-sectional study was conducted in five Brazilian public hospitals with 112 nurses. Data were collected using an adapted questionnaire and analyzed through descriptive and inferential statistics.
Results:
nurses who did not consider themselves capable of collecting blood cultures had a 72% lower chance of performing the collection at the recommended site and an 83% lower chance of using the same needle for blood inoculation into the vials. Nurses working in the emergency department had a 75% lower chance of knowing the international benchmark for blood culture contamination rates, and those with less than 5 years in the position decreased their chance of accuracy in this matter by 79%.
Conclusions:
there are gaps in the knowledge, attitudes, and practices of nurses regarding blood culture collection. Standardization of the technique, periodic education, supervision and guidance of the collection team, and process auditing are recommended coping strategies.
Keywords:Blood CultureBlood Specimen CollectionHealth Knowledge, Attitudes, PracticeNursing CareQuality of Health CareSee more -
ORIGINAL ARTICLE01-13-2024
Evaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
Abstract
ORIGINAL ARTICLEEvaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
DOI 10.1590/0034-7167-2023-0190
Views0ABSTRACT
Objectives:
to verify the construct validation of an instrument for evaluating care for people living with HIV in Primary Health Care.
Methods:
methodological study carried out in 2021 with 260 health professionals in Recife, PE. Validation based on the internal structure was carried out at this stage using exploratory and confirmatory factor analysis, and validity based on item response theory.
Results:
the validation determined the retention of five factors and 63 items. The instrument’s internal consistency and quality of fit was 0.90, the Tukey-Lewis index was 0.915 and the comparative fit index was 0.918 in the confirmatory factor analysis. The indication for the absolute majority of items is adequate fit.
Conclusions:
the instrument has construct validity, making it possible to use it to evaluate the decentralization process and care for People Living with HIV in Primary Health Care.
Keywords:Acquired Immunodeficiency SyndromeComprehensive Health CareHIVPrimary Health CareProgram EvaluationSee more -
ORIGINAL ARTICLE01-10-2024
Inventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
Abstract
ORIGINAL ARTICLEInventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
DOI 10.1590/0034-7167-2023-0539
Views0See moreABSTRACT
Objective:
to construct and validate the content of an inventory of ethical problems experienced by nurses in mobile pre-hospital care.
Method:
a psychometric approach study, developed with the following stages: (1) instrument construction through a theoretical matrix based on deliberative bioethics, scoping review and online qualitative research; (2) content validity by judges; (3) pre-testing with Mobile Emergency Care Service nurses in various Brazilian states. For content validity analysis, the Content Validity Ratio was calculated (CVR>0.45 for judges and CVR>0.35 for the target population).
Results:
the instrument had 44 items, distributed across four dimensions.
Final considerations:
the constructed instrument presented sources of evidence of content validity, providing good psychometric measurements and constituting a useful tool for nurses’ practice in the pre-hospital setting.
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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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EXPERIENCE REPORT01-01-2017
Acercamiento al escenario de estudio fenomenológico en México: relato de experiencia
Revista Brasileira de Enfermagem. 2017;70(4):885-890
Abstract
EXPERIENCE REPORTAcercamiento 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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RESEARCH01-01-2017
Evaluation of the safety of hospitalized older adults as for the risk of falls
Revista Brasileira de Enfermagem. 2017;70(4):860-867
Abstract
RESEARCHEvaluation 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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RESEARCH01-01-2017
Quality of life of elderly people with chronic kidney disease in conservative treatment
Revista Brasileira de Enfermagem. 2017;70(4):851-859
Abstract
RESEARCHQuality 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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RESEARCH01-01-2017
Hospitalization of people 50 years old or older living with HIV/AIDS
Revista Brasileira de Enfermagem. 2017;70(4):845-850
Abstract
RESEARCHHospitalization 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 ARTICLE06-14-2024
Mid-range theory of the nursing diagnosis Overweight
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
Abstract
ORIGINAL ARTICLEMid-range theory of the nursing diagnosis Overweight
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
DOI 10.1590/0034-7167-2023-0372
Views0See moreABSTRACT
Objective:
To build a mid-range theory for the nursing diagnosis Overweight in adolescents and young adults.
Methods:
A methodological study in the light of the theoretical frameworks of Roy and of Lopes, Silva and Herdman. A total of 3,925 articles were retrieved and assessed using the State of the Art Through Systematic Review software. The final sample consisted of 28 articles.
Results:
The findings converged to 3 essential attributes, 13 antecedents, and 7 consequences. A mid-range theory was built consisting of an illustrated diagram, 11 propositions, and 12 causal relationships.
Final considerations:
From the creation of the theory, it was possible to better understand the nursing diagnosis Overweight within the context of adolescents and young adults. Understanding nursing phenomena contributes to nursing science’s advancement and strengthening.
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ORIGINAL ARTICLE06-14-2024
Cardiovascular Risk and Lifestyle: comparison between teaching workers in Portugal and Brazil
Revista Brasileira de Enfermagem. 2024;77(2):e20230354
Abstract
ORIGINAL ARTICLECardiovascular Risk and Lifestyle: comparison between teaching workers in Portugal and Brazil
Revista Brasileira de Enfermagem. 2024;77(2):e20230354
DOI 10.1590/0034-7167-2023-0354
Views0ABSTRACT
Objective:
Compare Cardiovascular Risk between workers in Brazil and Portugal who work in the teaching context and its relationship with Lifestyle and Common Mental Disorder.
Methods:
Cross-sectional study that compared the cardiovascular health conditions of teaching workers in Manaus (Brazil) and Coimbra (Portugal). The odds ratio between groups was estimated.
Results:
The differences were: Smoking and hypercholesterolemia in participants from Portugal. Hypertension, chronic disease, increased abdominal perimeter, common mental disorder, and absence from work in Brazil. The variables with the greatest effect for high cardiovascular risk were: Country-Portugal [17.273 (95%CI1.538-193.951)], sex-male [61.577 (95%CI5.398-702.469)] and smoking [593.398 (95%CI57.330-6.142.020)].
Conclusion:
The differences in risk between groups showed that participants from Portugal, men, with high blood pressure and/or smokers are the most vulnerable to having a cardiovascular event. There is a need for interventions to promote cardiovascular health in the workplace in both countries.
Keywords:Community-Based Participatory ResearchHeart Disease Risk FactorsLife StyleOccupational HealthUniversitiesSee more -
ORIGINAL ARTICLE06-14-2024
Functional performance assessment scale for children and adolescents with cancer: cross-cultural study
Revista Brasileira de Enfermagem. 2024;77(2):e20230331
Abstract
ORIGINAL ARTICLEFunctional performance assessment scale for children and adolescents with cancer: cross-cultural study
Revista Brasileira de Enfermagem. 2024;77(2):e20230331
DOI 10.1590/0034-7167-2023-0331
Views0ABSTRACT
Objectives:
to describe the methodological process of cross-cultural adaptation of the PlayPerformance Scale for Children to Brazilian Portuguese.
Methods:
methodological study of translation and cross-cultural adaptation in six stages: translation, synthesis of translations, back-translation, evaluation by a committee of judges, evaluation by expert nurses, and pretest. The agreement and representativeness of the items were assessed using the content validity index. A minimum value of 80% agreement was considered.
Results:
all stages of the translation and cross-cultural adaptation process were satisfactory. In the evaluation performed by the committee of judges, all items obtained agreement above 80%. Fifteen pediatric nurses conducted the content validation, suggesting necessary modifications for understanding and application. Thirty children and adolescents with cancer were assessed with the scale for the pre-test.
Conclusions:
the scale was cross-culturally adapted to Brazilian Portuguese. The need for psychometric testing in a consistent sample is emphasized.
Keywords:Cross-Cultural ComparisonNursing Methodology ResearchOncologyPediatric NursingPhysical Functional PerformanceSee more -
ORIGINAL ARTICLE06-14-2024
Meanings attributed to health-related quality of life by caregivers of adolescents with diabetes
Revista Brasileira de Enfermagem. 2024;77(2):e20230314
Abstract
ORIGINAL ARTICLEMeanings attributed to health-related quality of life by caregivers of adolescents with diabetes
Revista Brasileira de Enfermagem. 2024;77(2):e20230314
DOI 10.1590/0034-7167-2023-0314
Views0See moreABSTRACT
Objective:
to interpret the meanings attributed to the health-related quality of life by caregivers of adolescents with type 1 diabetes mellitus.
Methods:
qualitative, descriptive-exploratory study of 14 caregivers of adolescents with diabetes developed at the reference outpatient clinic for endocrine diseases in a city in the state of Paraíba. Interviews were performed between May and September 2021. Inductive thematic analysis of the empirical material, and its interpretation in light of the concepts of health-related quality of life and family functioning were performed.
Results:
the meanings attributed by caregivers to the health-related quality of life of adolescents converged on the feeling of being healthy, healthy eating, satisfactory family income, family involvement in care and effective access to the care network.
Final Considerations:
knowledge of these meanings enables health professionals to develop strategies that meet the unique demands of caregivers experiencing this diagnosis.
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REVIEW06-14-2024
Critical analysis of the scientific production on Jean Watson’s Theory of Human Care
Revista Brasileira de Enfermagem. 2024;77(2):e20230231
Abstract
REVIEWCritical analysis of the scientific production on Jean Watson’s Theory of Human Care
Revista Brasileira de Enfermagem. 2024;77(2):e20230231
DOI 10.1590/0034-7167-2023-0231
Views0See moreABSTRACT
Objectives:
to analyze current scientific production on the use of the theoretical-methodological precepts of Jean Watson’s Theory of Human Care/Clinical Caritas Process.
Methods:
quantitative, exploratory, descriptive study using data from 1979 to 2023 in the Scopus database. Analysis was carried out using VOSviewer software.
Results:
the 73 studies included establish a network of collaboration among 221 authors from 155 institutions in 18 countries, who discuss the development of ethical behavior in nursing staff, through technical improvement, implementation, and validation of instrumental strategies capable of measuring and evaluating the quality of holistic and empathetic care. The Theory of Human Caring contributes to nursing training and care, and Process Clinical Caritas-Veritas is useful for the different possibilities of practice and education.
Conclusions:
it is important to strengthen with more empirical data a nursing work model centered on individual human care, supporting the evolution of scientific nursing knowledge.
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REVIEW06-14-2024
Primary health care professionals’ practice in the face of leprosy: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230207
Abstract
REVIEWPrimary health care professionals’ practice in the face of leprosy: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230207
DOI 10.1590/0034-7167-2023-0207
Views0See moreABSTRACT
Objectives:
to identify Primary Health Care professionals’ practice in the face of leprosy.
Methods:
a scoping review, carried out between November 2022 and January 2023, conducted according to the methodological structure proposed by JBI and checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in six databases and additional literature.
Results:
the sample consisted of 11 articles, published between 2008 and 2022. The findings were synthesized into three categories: Early diagnosis and timely treatment; Physical disability prevention; and Household and social contact surveillance.
Final Considerations:
there is a need to align the practices carried out with those recommended by the Brazilian National Program for Leprosy Control and Elimination, as some were not identified in studies, which implies losses to qualified assistance directed to patient demands, with a view to control and elimination of leprosy.
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ORIGINAL ARTICLE06-14-2024
Validity of the TBApp mobile application for self-care management for people with tuberculosis
Revista Brasileira de Enfermagem. 2024;77(2):e20230195
Abstract
ORIGINAL ARTICLEValidity of the TBApp mobile application for self-care management for people with tuberculosis
Revista Brasileira de Enfermagem. 2024;77(2):e20230195
DOI 10.1590/0034-7167-2023-0195
Views1See moreABSTRACT
Objectives:
to describe the validity process of the TBApp mobile application for self-care management for people with tuberculosis linked to Primary Health Care.
Methods:
methodological research developed with ten expert judges, carried out virtually. The application was assessed in relation to content and technology quality in seven domains (objectivity; structure and appearance; relevance; functionality; reliability; usability; and efficiency), using an instrument with a Likert scale.
Results:
TBApp was considered valid, relevant, functional, reliable and effective by expert judges. The objectives, structure and presentation and relevance domains presented an overall Content Validity Index of 0.93, and the functionality, reliability, usability and efficiency domains presented characteristics and sub-characteristics values greater than 0.80.
Conclusions:
TBApp is a creative and innovative tool that can be used by people with TB and disseminated in the scientific community.
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