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ORIGINAL ARTICLE09-06-2024
Factors associated with burnout in military police officers in a city in Paraná
Revista Brasileira de Enfermagem. 2024;77(4):e20230510
Abstract
ORIGINAL ARTICLEFactors associated with burnout in military police officers in a city in Paraná
Revista Brasileira de Enfermagem. 2024;77(4):e20230510
DOI 10.1590/0034-7167-2023-0510
Views0See moreABSTRACT
Objective:
to analyze the association between burnout and sociodemographic, work factors, lifestyle habits and health conditions of military police officers in a municipality in the state of Paraná, Brazil.
Method:
cross-sectional research with 131 military police officers. Data were analyzed using the Statistical Package for the Social Sciences software and the R program. Chi-square, Fisher’s exact and Poisson Generalized Linear Model tests were used.
Results:
most participants (65.6%) had a high level of burnout. In relation to protective factors, those who carried out leisure activities had a 33.6% chance of not developing burnout. Conjugality was also a protective factor. Not practicing physical activity and leisure activities are factors that can contribute to the occurrence of burnout.
Conclusions:
important factors and high rates of burnout were observed in the police officers investigated. It is necessary to implement public health policies to reduce burnout with attention focused on this professional category.
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ORIGINAL ARTICLE09-06-2024
Development and content validation of a risk classification instrument
Revista Brasileira de Enfermagem. 2024;77(4):e20230502
Abstract
ORIGINAL ARTICLEDevelopment and content validation of a risk classification instrument
Revista Brasileira de Enfermagem. 2024;77(4):e20230502
DOI 10.1590/0034-7167-2023-0502
Views0See moreABSTRACT
Objective:
Develop and validate the content of an instrument for patient risk classification in emergency services of Primary Health Care.
Method:
The study included two stages: item generation and content validity. A literature review and retrospective analysis of medical records were conducted to create the instrument items. The Content Validity Ratio (CVR) was used to assess agreement among judges during content validation.
Results:
In the first and second rounds, 75 and 71 judges validated the risk classification instrument, respectively. The minimum adherence score for the latent variable item based on the final number of judges was 0.22 and 0.18; thus, 52 items, divided into three classification categories (red, orange, and yellow), were retained.
Conclusion:
The instrument was considered valid regarding clarity, relevance, pertinence, and agreement regarding the severity indicated in the item.
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REVIEW09-06-2024
Nursing students’ mindfulness and emotional regulation: an integrative review
Revista Brasileira de Enfermagem. 2024;77(4):e20230466
Abstract
REVIEWNursing students’ mindfulness and emotional regulation: an integrative review
Revista Brasileira de Enfermagem. 2024;77(4):e20230466
DOI 10.1590/0034-7167-2023-0466
Views0See moreABSTRACT
Objective:
to identify the scientific evidence available in national and international literature on the relationships between nursing students’ mindfulness and emotional regulation.
Methods:
an integrative literature review, in four databases, with a time frame from January 2002 to December 2022. Articles in English, Spanish and Portuguese available in full were included.
Results:
the sample consisted of six original articles, predominantly with a quantitative approach, with cross-sectional designs standing out.
Conclusion:
the synthesis of scientific production revealed that there is a lack of research at national and international level on the subject with experimental and qualitative designs that enable conclusions about cause and effect and/or take into account subjective experiences of the applicability of mindfulness-based practice in nursing students’ emotional regulation.
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ORIGINAL ARTICLE09-06-2024
Nursing Process implementation in a gerontogeriatric context: qualitative research
Revista Brasileira de Enfermagem. 2024;77(4):e20230465
Abstract
ORIGINAL ARTICLENursing Process implementation in a gerontogeriatric context: qualitative research
Revista Brasileira de Enfermagem. 2024;77(4):e20230465
DOI 10.1590/0034-7167-2023-0465
Views0See moreABSTRACT
Objective:
to describe Nursing Process implementation in a faith-based senior living community.
Method:
strategic action research with 19 nursing professionals and three managers of a faith-based senior living community. Implementation took place in four phases: diagnosis, planning, implementation and assessment. The data collected through semi-structured interviews and focus groups were subjected to discursive textual analysis.
Results:
the central categories were constructed: Nursing Process in faith-based senior living community: diagnosis of knowledge and application; Nursing Process in faith-based senior living community: implementation; Nursing process in faith-based senior living community: assessment after its implementation.
Conclusion:
Nursing Process implementation made it possible to structure work management/organization, contributing to knowledge, organization and continuity of care for safety and professional support.
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ORIGINAL ARTICLE09-06-2024
Adherence to sepsis protocol in a high-risk maternity reference center
Revista Brasileira de Enfermagem. 2024;77(4):e20230453
Abstract
ORIGINAL ARTICLEAdherence to sepsis protocol in a high-risk maternity reference center
Revista Brasileira de Enfermagem. 2024;77(4):e20230453
DOI 10.1590/0034-7167-2023-0453
Views0See moreABSTRACT
Objective:
To describe the adherence to the sepsis protocol by obstetric nurses in the obstetric triage of a high-risk maternity reference center.
Methods:
This was a quantitative, documental, and retrospective study involving 105 pregnant women treated in obstetric triage under sepsis criteria. Data were collected through electronic medical records using structured forms and were organized into tables employing descriptive statistics. This research adhered to ethical principles concerning human studies.
Results:
Of the checklists for initiating the SEPSIS protocol by obstetric nurses, 105 were identified. Regarding the protocol steps performed, lactate was collected in 97.1% of cases and blood cultures in 98.1%, antibiotic therapy was administered in 94.3%, and hydration was carried out in 51.4% of the cases.
Conclusion:
The initiation of the sepsis protocol for all women meeting the criteria was confirmed. However, the steps were not fully implemented as recommended by the institutional protocol, and the recommended broad-spectrum antibiotic was not administered.
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ORIGINAL ARTICLE09-06-2024
Effect of Brazilian green propolis in chronic ulcer treatment: a randomized clinical trial
Revista Brasileira de Enfermagem. 2024;77(4):e20230418
Abstract
ORIGINAL ARTICLEEffect of Brazilian green propolis in chronic ulcer treatment: a randomized clinical trial
Revista Brasileira de Enfermagem. 2024;77(4):e20230418
DOI 10.1590/0034-7167-2023-0418
Views0See moreABSTRACT
Objective:
to assess the effectiveness of 5% Brazilian green propolis (ointment) in individuals with chronic ulcers.
Methods:
a randomized clinical trial, developed with 40 patients randomized equally to control group (treated with essential fatty acid) and experimental group (treated with 5% green propolis) for 30 days. The outcomes of interest were sociodemographic, clinical and laboratory characteristics, lesion characteristics, such as type of tissue in the bed, presence of exudate, edge characteristics, microbial content and pain.
Results:
regarding sociodemographic, clinical and laboratory characteristics, the two groups did not show statistically significant differences. After assessment in 30 days, an effect was observed for both treated groups, but for the experimental group, greater effectiveness in terms of the type of tissue in the bed, type of exudate, edge characteristics, microbial content and pain.
Conclusion:
propolis-based ointment showed a healing effect, presenting itself as a potential tool in healing chronic ulcers.
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Progress Test in nursing: perspectives for undergraduate education
Revista Brasileira de Enfermagem. 2024;77(4):e20230413
Abstract
Progress Test in nursing: perspectives for undergraduate education
Revista Brasileira de Enfermagem. 2024;77(4):e20230413
DOI 10.1590/0034-7167-2023-0413
Views0ABSTRACT
Objective:
to reflect on the perspectives of adopting the Progress Test in undergraduate nursing education.
Methods:
this is a reflective study, based on authors’ critical thinking and supported by national and international literature on the Progress Test application in undergraduate health courses.
Results:
the Progress Test is as a valuable teaching-learning strategy, with potential applications and benefits for students, professors, and academic management.
Final considerations:
systematic nursing education assessment indicates valuable information for different stakeholders. Understanding its potential benefits, the Progress Test is presented as a strategy that can be replicated in undergraduate nursing education, either individually, by institutions, or collaboratively, by the establishment of partnerships or consortiums of institutions.
Keywords:Academic PerformanceEducation, NursingEducational MeasurementNursing Faculty PracticeSchoolsSee more -
ORIGINAL ARTICLE09-06-2024
Physical and psychological changes of the COVID-19 infodemic by the older adult population
Revista Brasileira de Enfermagem. 2024;77(4):e20230339
Abstract
ORIGINAL ARTICLEPhysical and psychological changes of the COVID-19 infodemic by the older adult population
Revista Brasileira de Enfermagem. 2024;77(4):e20230339
DOI 10.1590/0034-7167-2023-0339
Views0See moreABSTRACT
Objective:
to analyze the physical and psychological changes of the COVID-19 infodemic for the older adult population of Rio de Janeiro.
Method:
a cross-sectional, web-based survey to find out about access to news and information about COVID-19 among older adult in Rio de Janeiro, between July and December 2020. Univariate analysis and bivariate analysis were carried out using non-parametric statistical methods.
Results:
390 older adults took part, predominantly female (75.1%), aged between 66 and 75 (35.4%), married (51.0%), white (60.3%), owning their own home (81.8%), located in urban areas (91%), with complete or incomplete primary education (31.8%) and retired or pensioners (79.2%). Younger people were significantly affected both physically and psychologically by social networks when compared to television (<0.001).
Conclusion:
Physical and psychological changes from exposure to information about COVID-19 have affected the lives of the older adult, having an impact on this population.
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RESEARCH01-01-2017
Older adults abuse in three Brazilian cities
Revista Brasileira de Enfermagem. 2017;70(4):783-791
Abstract
RESEARCHOlder adults abuse in three Brazilian cities
Revista Brasileira de Enfermagem. 2017;70(4):783-791
DOI 10.1590/0034-7167-2017-0114
Views0See moreABSTRACT
Objective:
To analyze the police reports filed by older adults who suffered abuse in order to identify the socio-demographic characteristics of victims and aggressors, type of violence, location, as well as to compare rates in three Brazilian cities in the period from 2009 to 2013.
Method:
Ecological study, in which 2,612 police reports registered in Police Stations were analyzed. An instrument was used to obtain data from the victim, the aggressor and the type of violence.
Results:
Psychological abuse predominated and most cases occurred in the older adults own home. In the cities of Ribeirão Preto and João Pessoa, the older adults presented similar rates for both gender. Regarding the standardized rates, in João Pessoa, there was a rise of this type of abuse in the two first years, and later there was a certain stability. In the city of Teresina, there was an increase, also observed in the city of Ribeirão Preto in the three first years, followed by a decrease.
Conclusion:
Older adults abuse is a cultural phenomenon difficult to be reported by them, since it occurs in the family context.
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RESEARCH01-01-2017
Validation of educational booklet for HIV/Aids prevention in older adults
Revista Brasileira de Enfermagem. 2017;70(4):775-782
Abstract
RESEARCHValidation of educational booklet for HIV/Aids prevention in older adults
Revista Brasileira de Enfermagem. 2017;70(4):775-782
DOI 10.1590/0034-7167-2017-0145
Views0See moreABSTRACT
Objective:
To describe the process of manufacturing and validation of an educational booklet for HIV/Aids prevention in older adults
Methods:
Methodological study developed in two phases – manufacturing of the booklet and validation of the educational material by judges. The manufacturing process involved a situational diagnosis with older adults, and its result indicated gaps in the knowledge with respect to HIV/Aids. The validation process was performed by nine judges, selected by convenience. It was considered an agreement index of at least 0.80, analyzed through the content validity index.
Results:
We opted for a dialogue between two older adults divided into three categories: myths and taboos; ignorance; and prevention and importance of diagnosis. The average of the items was 0.90. The suggestions made by the judges were observed and modified for the final version.
Conclusion:
The material had relevant content for the judges, in addition to being able to be used by health professionals in the education and clarification of issues on the subject.
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RESEARCH01-01-2017
Association between filial responsibility when caring for parents and the caregivers overload
Revista Brasileira de Enfermagem. 2017;70(4):767-774
Abstract
RESEARCHAssociation between filial responsibility when caring for parents and the caregivers overload
Revista Brasileira de Enfermagem. 2017;70(4):767-774
DOI 10.1590/0034-7167-2017-0133
Views0See moreABSTRACT
Objective:
To analyze the association between filial responsibility and the overload of the children when caring for their older parents.
Method:
Cross-sectional study with 100 caregiver children of older adults. Filial liability was assessed by the attitudes of the responsible child (scale of expectation and filial duty) and by care behaviors (assistance in activities of daily living, emotional and financial support, and keeping company). The overload was assessed by the Caregiver Burden Inventory. To assess the associations, the correlation coefficients of Pearson and Spearman, Kruskal-Wallis Test, and Mann-Whitney were employed. Variables that presented p-value<0.20 in the bivariate analysis were inserted in a multivariate linear regression model.
Results:
The factors associated with overload were: formal employment (p=0.002), feelings regarding family life (p<0.001), financial support (p=0.027), and assistance with Activities of Daily Living (ADLs) (p<0.001).
Conclusion:
Children who were more involved with the ADLs and provided financial support showed higher levels of overload.
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RESEARCH01-01-2017
Religiosity and spirituality as resilience strategies among long-living older adults in their daily lives
Revista Brasileira de Enfermagem. 2017;70(4):761-766
Abstract
RESEARCHReligiosity and spirituality as resilience strategies among long-living older adults in their daily lives
Revista Brasileira de Enfermagem. 2017;70(4):761-766
DOI 10.1590/0034-7167-2016-0630
Views0See moreABSTRACT
Objective:
to investigate religiosity and spirituality as a resilience strategy for the long-living older adults in their daily lives.
Method:
Qualitative research of phenomenological approach based on Martin Heidegger thoughts. Interviews were conducted with 14 older adults registered at a family health unit in the city of Jequié, BA, Brazil. The data were analyzed in the light of Being and Time.
Results:
The results revealed that God occupies a central position in their lives, and the reading of the bible, praying the rosary and prayers are resilience strategies used for coping with unfavorable situations, recovery and/or maintenance of health, personal and family protection, and, above all, the experience of a satisfactory aging.
Final considerations:
Religiosity and spirituality were presented as an important resilience strategy in the existence of older adults, showing that through them it is possible to achieve well-being and cope with health and social problems.
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RESEARCH01-01-2017
Family of older adults with mental disorder: perception of mental health professionals
Revista Brasileira de Enfermagem. 2017;70(4):753-760
Abstract
RESEARCHFamily of older adults with mental disorder: perception of mental health professionals
Revista Brasileira de Enfermagem. 2017;70(4):753-760
DOI 10.1590/0034-7167-2016-0646
Views0ABSTRACT
Objective:
to understand the perceptions of healthcare professionals of the Psychosocial Care Centers regarding the family of older adults with mental disorders.
Method:
study of a Qualitative Case conducted with 12 healthcare professionals from a Psychosocial Care Center, with a convenient and exhaustive sample. Conducting semi-structured interviews to collect data, which were analyzed with the Content Analysis technique.
Results:
the following categories stood out: “Family exhaustion and deterioration in the perception of the healthcare professional” and “The abandonment of older adults by family members and their distancing in the perception of the healthcare professional.”
Final considerations:
culpability of older adults and penalization of the family were verified by healthcare professionals. To bring awareness about the difficulties faced in the attempt to bring the family closer to the healthcare service, it is necessary to analyze the care given to the older adult and to overcome challenges in the effective construction of the bond between family, healthcare user and mental health service.
Keywords:Community PsychiatryFrail Older AdultsGeriatric PsychiatryOlder adultsProfessional-Family RelationshipSee more -
RESEARCH01-01-2017
Frailty in the elderly: prevalence and associated factors
Revista Brasileira de Enfermagem. 2017;70(4):747-752
Abstract
RESEARCHFrailty in the elderly: prevalence and associated factors
Revista Brasileira de Enfermagem. 2017;70(4):747-752
DOI 10.1590/0034-7167-2016-0633
Views0See moreABSTRACT
Objective:
to know the prevalence and factors associated with frailty in elderly assisted by the Centro Mais Vida de Referência em Assistência à Saúde do Idoso (Mais Vida Health Reference Center for the Elderly) in the North of Minas Gerais, Brazil.
Method:
cross-sectional study, with sampling by convenience. Data collection occurred in 2015. Demographic and socioeconomic variables, morbidities, use of health services and the score of the Edmonton Frail Scale were analyzed. The adjusted prevalence ratios were obtained by multiple analysis of Poisson regression with robust variance.
Results:
360 elderly aged 65 or older were evaluated. Frailty prevalence was 47.2%. The variables associated with frailty were the following: advanced age elderly, who live without a partner, have a caregiver, present depressive symptoms, osteoarticular disease, as well as history of hospitalization and falls in the last twelve months.
Conclusion:
knowledge of factors associated with frailty allows development of health actions aimed at the elderly.
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RESEARCH01-01-2017
Falls in long-term care institutions for elderly people: protocol validation
Revista Brasileira de Enfermagem. 2017;70(4):740-746
Abstract
RESEARCHFalls in long-term care institutions for elderly people: protocol validation
Revista Brasileira de Enfermagem. 2017;70(4):740-746
DOI 10.1590/0034-7167-2017-0109
Views0See moreABSTRACT
Objectives:
To validate the content of a fall management risk protocol in long-term institutions for elderly people.
Methods:
Methodological, quanti-qualitative study using the Delphi technique. The tool, based on the literature, was sent electronically to obtain consensus among the 14 experts that meet the defined inclusion criteria.
Results:
The 27 indicators of the protocol are organized in three dimensions: prepare for the institutionalization (IRA=.88); manage the risk of falls throughout the institutionalization (IRA=.9); and lead the communication and formation (IRA=1), with a CVI=.91. Two rounds were performed to get a consensus superior to 80% in every item.
Conclusion:
The values obtained in the reliability test (>0.8) show that the protocol can be used to meet the intended goal. The next step is the clinic validation of the protocol with residents of long-term care institutions for elderly people.
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RESEARCH01-01-2017
Deaths among the elderly with ICU infections
Revista Brasileira de Enfermagem. 2017;70(4):733-739
Abstract
RESEARCHDeaths among the elderly with ICU infections
Revista Brasileira de Enfermagem. 2017;70(4):733-739
DOI 10.1590/0034-7167-2016-0611
Views0See moreABSTRACT
Objective:
to evaluate the clinical outcome of elderly patients admitted to intensive care units who had nosocomial infection, correlating the findings with sociodemographic and clinical variables.
Method:
descriptive research, performed with 308 elderly patients. The collection was made from medical records and covers the years 2012 to 2015. Uni-/bivariate analyses were performed.
Results:
a statistical association was found between the clinical outcome types and the variables age, length of stay, presence of previous comorbidities, main diagnosis, respiratory and urinary tract infections, use of central venous and indwelling urinary catheters, mechanical ventilation, and tracheostomy. The survival curve showed higher mortality among the elderly from the age of 80 on.
Conclusion:
the clinical outcome of the elderly who acquire infection in the intensive care unit is influenced by sociodemographic and clinical variables that increase mortality rates.
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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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