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ORIGINAL ARTICLE12-16-2024
Complexities of nursing in healthcare waste management in hospitals
Revista Brasileira de Enfermagem. 2024;77(6):e20230391
Abstract
ORIGINAL ARTICLEComplexities of nursing in healthcare waste management in hospitals
Revista Brasileira de Enfermagem. 2024;77(6):e20230391
DOI 10.1590/0034-7167-2023-0391
Views0See moreABSTRACT
Objectives:
to understand how healthcare waste management is developed by nursing professionals in hospitals.
Methods:
qualitative research, whose theoretical and methodological frameworks were Complexity Theory and Grounded Theory. Thirty-two nursing professionals from a public hospital in Rio de Janeiro participated in the study. Semi-structured interviews were used.
Results:
nursing affects healthcare waste management multidimensionally. Shortage of materials and work overload were identified as factors that influence professionals’ decision-making and increase the risk of improper waste disposal. The lack of knowledge on the subject also influences nursing practice. However, professionals value actions related to hazardous waste.
Final Considerations:
nursing professionals recognize themselves in healthcare waste management and understand the need to develop systemic awareness for sustainable practice.
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ORIGINAL ARTICLE12-16-2024
Predisposing factors for symptoms of anxiety, depression, and insomnia in university students
Revista Brasileira de Enfermagem. 2024;77(6):e20230387
Abstract
ORIGINAL ARTICLEPredisposing factors for symptoms of anxiety, depression, and insomnia in university students
Revista Brasileira de Enfermagem. 2024;77(6):e20230387
DOI 10.1590/0034-7167-2023-0387
Views0See moreABSTRACT
Objectives:
to characterize the sociodemographic and psychological aspects of university students who sought psychiatric care at a Student Support Center of a Federal University and to analyze associations between mental health issues and predisposing factors.
Methods:
a retrospective analysis of 103 medical records was conducted. The statistical analysis consisted of two steps: a descriptive analysis and a predictive analysis using the Logistic Regression Model.
Results:
the majority of the students were female. Symptoms of anxiety, depression, and insomnia were the main reasons for seeking care. Students who reported having emotional difficulties that negatively impacted their studies and those who had undergone some form of health treatment showed a higher probability of experiencing anxiety symptoms. Notable correlations were found between anxiety and emotional difficulties, depression and diarrhea, and insomnia and a sedentary lifestyle.
Conclusions:
symptoms of anxiety, depression, and insomnia led students to seek psychiatric care at the university. Understanding the predisposing factors for mental health issues in university students can inform care strategies and promote academic success.
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ORIGINAL ARTICLE12-16-2024
Educational technology to empower patients as participants in their care
Revista Brasileira de Enfermagem. 2024;77(6):e20230359
Abstract
ORIGINAL ARTICLEEducational technology to empower patients as participants in their care
Revista Brasileira de Enfermagem. 2024;77(6):e20230359
DOI 10.1590/0034-7167-2023-0359
Views0See moreABSTRACT
Objectives:
to build and validate an educational technology to empower patients as participants in their own care.
Methods:
methodological study to develop an educational technology based on the elaboration, validation, and evaluation that were carried out in five stages at a teaching hospital in Amazonas. The study was carried out from 2019 to 2022, with the participation of 19 judges specialized in patient safety and 72 patients admitted to the hospital’s medical and surgical clinics, the study setting.
Results:
the agreement between the judges obtained an overall index of 0.85, being considered validated. The overall analysis of the booklet obtained an assessment of the level of agreement above 85%.
Final Considerations:
the educational technology presented here was validated and suitable for promoting patient/professional rapprochement and consolidating health care in a way that increases the patient’s ability to contribute to their treatment and prevent the occurrence of adverse events.
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REVIEW12-16-2024
Strategies for expanding vaccination coverage in children in Brazil: systematic literature review
Revista Brasileira de Enfermagem. 2024;77(6):e20230343
Abstract
REVIEWStrategies for expanding vaccination coverage in children in Brazil: systematic literature review
Revista Brasileira de Enfermagem. 2024;77(6):e20230343
DOI 10.1590/0034-7167-2023-0343
Views0See moreABSTRACT
Objectives:
to identify the strategies found in the literature for increasing vaccination coverage among children in Brazil. It is justified mainly by the current scenario of falling vaccination coverage.
Methods:
systematic literature review. The search was carried out in the Pubmed (MEDLINE), Embase and Scopus databases, following the PRISMA guidelines.
Results:
initially, 4,824 results were returned. In the end, 6 studies were included for narrative synthesis using the SWiM methodology. Of these, 50% dealt with studies related to the Bolsa Família Program (PBF). The others explored strategies for approaching parents directly, Rapid Vaccination Monitoring (MRV) and the Community Health Agents Program (PACS). The PBF did not guarantee compliance with the conditionality of keeping vaccinations up to date. The MRV and PACS are effective strategies, especially because they allow active search for absentees.
Conclusions:
we conclude that more publications are needed on strategies to increase vaccination coverage among children in Brazil.
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ORIGINAL ARTICLE12-16-2024
The nursing practice environment and hospital sociotechnical complexity: a mixed-methods study
Revista Brasileira de Enfermagem. 2024;77(6):e20230315
Abstract
ORIGINAL ARTICLEThe nursing practice environment and hospital sociotechnical complexity: a mixed-methods study
Revista Brasileira de Enfermagem. 2024;77(6):e20230315
DOI 10.1590/0034-7167-2023-0315
Views1See moreABSTRACT
Objectives:
to analyze the relationship between the nursing practice environment and hospital sociotechnical complexity as perceived by nurses.
Methods:
a sequential explanatory mixed-methods study was conducted in a hospital in southern Brazil. The Brazilian version of the Practice Environment Scale-Nursing Work Index and the Complexity Characterization Questionnaire were administered to 132 nurses. Subsequently, semi-structured interviews were conducted with 18 participants, and the data were subjected to thematic analysis. Data integration was achieved through a connection approach.
Results:
the nursing practice environment was found to be favorable, except in the subscale concerning Staffing and Resource Adequacy, where complexity was present in the activities. The three emerging categories explained human and technical aspects related to complexity in the practice environment, quality of care, and patient safety. Unexpected variability was inversely correlated with the practice environment.
Conclusions:
the study results indicate a relationship between these constructs, with implications for the quality and the safety of care.
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ORIGINAL ARTICLE12-16-2024
Factors associated with maternal well-being during childbirth among postpartum women in Minas Gerais
Revista Brasileira de Enfermagem. 2024;77(6):e20230304
Abstract
ORIGINAL ARTICLEFactors associated with maternal well-being during childbirth among postpartum women in Minas Gerais
Revista Brasileira de Enfermagem. 2024;77(6):e20230304
DOI 10.1590/0034-7167-2023-0304
Views0See moreABSTRACT
Objectives:
to analyze the factors associated with maternal well-being during childbirth among postpartum women in Minas Gerais.
Methods:
a cross-sectional study nested within a cohort was conducted with postpartum women in a municipality of Minas Gerais. The Maternal Well-being in Childbirth Scale 2 was used. The prevalence of maternal well-being during childbirth was estimated. The magnitude of the association between maternal distress and care practices was estimated using the Prevalence Ratio (PR), applying Poisson regression.
Results:
a total of 183 postpartum women aged between 15 and 46 years participated, with 26.2%, 27.9%, and 45.9% reporting excellent, adequate, and poor well-being during childbirth care, respectively. Maternal distress was more prevalent among women who underwent cesarean sections (PR = 1.60) and those who did not receive breastfeeding information (PR = 1.59).
Conclusions:
a high prevalence of maternal distress during childbirth was observed, associated with cesarean delivery and the lack of breastfeeding information.
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ORIGINAL ARTICLE12-16-2024
Prevalence and factors associated with musculoskeletal pain among hospital cleaning staff
Revista Brasileira de Enfermagem. 2024;77(6):e20230237
Abstract
ORIGINAL ARTICLEPrevalence and factors associated with musculoskeletal pain among hospital cleaning staff
Revista Brasileira de Enfermagem. 2024;77(6):e20230237
DOI 10.1590/0034-7167-2023-0237
Views0RESUMO
Objetivos:
verificar a prevalência e os fatores associados à dor musculoesquelética em trabalhadores do serviço hospitalar de limpeza.
Métodos:
estudo transversal, realizado com trabalhadores de limpeza de um hospital de ensino do Sul do Brasil. Utilizaram-se questionário com variáveis sociodemográficas, laborais e de saúde, o Nordic Musculoskeletal Questionnaire e o Diagrama de Corlett e Manenica. Realizou-se análise bivariada.
Resultados:
participaram 149 trabalhadores. Prevaleceu dor musculoesquelética na coluna lombar no último ano (65,8%) e últimos sete dias (42,3%). Constataram-se associações entre automedicação e dor na parte inferior das costas (p=0,020) e ombros (p=0,026); sedentarismo, oito horas de sono diárias e dor nos tornozelos (p=0,041) e pés (p=0,039); ex-tabagismo, uso de medicamento e dor nos punhos (p=0,015) e mãos (p=0,004).
Conclusões:
prevaleceram lombalgias associadas a hábitos de saúde e vida. Um programa de educação em saúde e recomendações de melhorias nos processos de trabalho podem minimizar a exposição à dor musculoesquelética.
Keywords:Dor MusculoesqueléticaSaúde do TrabalhadorServiço Hospitalar de LimpezaServiços HospitalaresTranstornos Traumáticos CumulativosSee more
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EDITORIAL01-01-2017
Fundamentos e práticas do cuidar em Enfermagem Gerontológica
Revista Brasileira de Enfermagem. 2017;70(4):671-672
Abstract
EDITORIALFundamentos e práticas do cuidar em Enfermagem Gerontológica
Revista Brasileira de Enfermagem. 2017;70(4):671-672
DOI 10.1590/0034-7167.2017700401
Views0As intensas transformações sociais, econômicas, políticas, culturais, ambientais, epidemiológicas e demográficas, em conjunto com as aceleradas inovações tecnológicas, têm afetado significativamente a vida em sociedade, exigindo que as pessoas reflitam sobre as próprias concepções da natureza humana. Esse contexto de transformações tem estimulado os indivíduos a valorizar os avanços tecnológicos e a construção de relações […]See more -
EDITORIAL01-01-2017
Fundamentals and practice of care in Gerontological Nursing
Revista Brasileira de Enfermagem. 2017;70(4):671-672
Abstract
EDITORIALFundamentals and practice of care in Gerontological Nursing
Revista Brasileira de Enfermagem. 2017;70(4):671-672
DOI 10.1590/0034-7167.2017700401
Views0Intense social, economic, political, cultural, environmental, epidemiological, and demographical transformations, coupled with accelerated technological innovation, have significantly affected life in society, requiring people to reflect about the conceptions of human nature itself. This context of transformation has incentivized individuals to value technological advances and the construction of more autonomous, global, and unstable human relationships, outlining […]See more -
The importance of empathy in health and nursing care
Revista Brasileira de Enfermagem. 2017;70(3):669-670
Abstract
The importance of empathy in health and nursing care
Revista Brasileira de Enfermagem. 2017;70(3):669-670
DOI 10.1590/0034-7167-2016-0032
Views0“In her book “Cultivating Empathy”(), Kathleen Stephany, psychologist and professor at the College of Health Sciences at Douglas College, writes about empathy, which she considers to be the basis of effective communication and one of the most important skills to be developed by human beings. Empathy is the ability to put oneself in the place […]See more -
REFLECTION01-01-2017
Clinical reasoning in nursing: teaching strategies and assessment tools
Revista Brasileira de Enfermagem. 2017;70(3):662-668
Abstract
REFLECTIONClinical reasoning in nursing: teaching strategies and assessment tools
Revista Brasileira de Enfermagem. 2017;70(3):662-668
DOI 10.1590/0034-7167-2016-0509
Views0See moreABSTRACT
Objective:
To present the concept and development of teaching strategies and the assessment tools regarding clinical reasoning for accurate practice.
Method:
This is a theoretical reflection based on scientific studies.
Results:
Comprehension of the essential concepts of the thought process and its articulation with the different teaching strategies and the assessment tools which has allowed presenting ways to improve the process of diagnostic or therapeutic clinical reasoning.
Conclusion:
The use of new strategies and assessment tools should be encouraged in order to contribute to the development of skills that lead to safe and effective decision making.
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REFLECTION01-01-2017
Continuing education in health from the perspective of Augustine of Hippo
Revista Brasileira de Enfermagem. 2017;70(3):656-661
Abstract
REFLECTIONContinuing education in health from the perspective of Augustine of Hippo
Revista Brasileira de Enfermagem. 2017;70(3):656-661
DOI 10.1590/0034-7167-2016-0484
Views0See moreABSTRACT
Objective:
To reflect about continuing education from the perspective of Augustine of Hippo and his theories based on the construction of knowledge and the learning process.
Method:
This is a theoretical reflection study whose aim is to propose dimensions of analysis, emphasizing the history and challenges of continuing education. Such dimensions analyze the production of knowledge in Augustinian pedagogy, its historical aspects and its close relationship with lifelong education in health professions.
Results:
The results show the difficulty of continuing education to reach adequate importance in health services, and that of academia in appropriating the thoughts of renowned philosophers such as Augustine. This is a result of ignorance about the convergence of these principles and their relevance.
Final considerations:
Continuing education and Augustinian pedagogy walk hand in hand in terms of care, meeting the needs that originate from practice and that are reflected in it, challenging isolated knowledge and putting different areas of knowledge to work together.
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REVIEW01-01-2017
Influence of hormonal contraceptives and the occurrence of stroke: integrative review
Revista Brasileira de Enfermagem. 2017;70(3):647-655
Abstract
REVIEWInfluence of hormonal contraceptives and the occurrence of stroke: integrative review
Revista Brasileira de Enfermagem. 2017;70(3):647-655
DOI 10.1590/0034-7167-2016-0056
Views0See moreABSTRACT
Objective:
To identify scientific evidence regarding the influence of hormonal contraceptive use and the occurrence of stroke.
Method:
Integrative review of the literature, through database search using the descriptors “contraceptive agents“, “contraceptive devices“, “contraceptives, Oral” and “Stroke”. Original studies in Portuguese, Spanish and English, published in full and available online were included. Studies that did not answer our guiding questions and duplicated studies were excluded.
Results:
Women using combined oral contraceptives have higher risk of stroke, even with a lower hormonal dosage and different types of progestogen, regardless of the duration of use. The use of contraceptives associated with smoking, hypertension, migraine, hypercholesterolemia, obesity and sedentary lifestyle increases the chance of stroke. Contraceptive patch and vaginal ring are associated to increased risk.
Conclusion:
Use of combined hormonal contraceptives, except for the injectable and the transdermal ones, increases the chance of occurrence of the event. Progestogen-only contraceptives were considered safe.
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RESEARCH01-01-2017
Health Conditions and Memory Performance: a study with older adult women
Revista Brasileira de Enfermagem. 2017;70(3):640-646
Abstract
RESEARCHHealth Conditions and Memory Performance: a study with older adult women
Revista Brasileira de Enfermagem. 2017;70(3):640-646
DOI 10.1590/0034-7167-2016-0529
Views0See moreABSTRACT
Objective:
to verify the correlation between health condition and memory performance of older adult women in the community.
Method:
Analytical cross-sectional study developed with 28 older adult women living in Cuiabá-MT. They answered the Mini-Mental State Examination (MMSE), and a shortened Geriatric Depression Scale (GDS-15) to screen for dementia and depression symptoms. Memory skills were assessed through Rey Auditory Verbal Learning Test (RAVLT).
Results:
The mean age was 66.36 years and 75% of the participants had educational level higher than 7 years. The MMSE mean score was 28.45. The correlations found were: educational level and immediate memory (r = 0.49; p = 0.008); delayed recall and immediate memory (r = 0.71; p < 0.001); memory recognition and immediate memory (r = 0.43; p = 0.021) and recognition memory with delayed recall (r = 0.47; p = 0.012).
Conclusion:
High scores in the MMSE and a satisfactory health perception among the participants were evident. There was no correlation between memory performance and health perception.
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RESEARCH01-01-2017
Comprehension of the education handout and health literacy of pacemaker users
Revista Brasileira de Enfermagem. 2017;70(3):633-639
Abstract
RESEARCHComprehension of the education handout and health literacy of pacemaker users
Revista Brasileira de Enfermagem. 2017;70(3):633-639
DOI 10.1590/0034-7167-2016-0336
Views0See moreABSTRACT
Objective:
To verify the comprehension of the education handout and the level of Functional Health Literacy of individuals with cardiac pacemaker (PM) and whether there is correlation between the comprehension and Functional Health Literacy (FHL).
Method:
Cross-sectional study with 63 individuals with PM who answered to comprehension tests of the handout, literacy assessment (SAHLPA-50) and cognition (MMSE). Measurements of dispersion, Pearson correlation and multiple linear regression were calculated.
Results:
Most women, study time ≤ 9 years, 66.21 (average age) presented no cognitive changes. An adequate literacy level was evidenced in 50.8% individuals with PM and satisfactory comprehension of the handout. No correlation was identified between FHL, handout comprehension, age, years of study and cognition.
Conclusion:
The handout comprehension assessed by individuals with appropriate FHL indicated that it can be a printed material suitable for use, aiming to improve care process and knowledge of individuals with PM.
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RESEARCH06-01-2015
Perceptions of adolescent students about drugs
Revista Brasileira de Enfermagem. 2015;68(3):517-523
Abstract
RESEARCHPerceptions 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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RESEARCH06-01-2015
Cognitive stimulation for older people with Alzheimer’s disease performed by the caregiver
Revista Brasileira de Enfermagem. 2015;68(3):510-516
Abstract
RESEARCHCognitive 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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RESEARCH06-01-2015
Anxiety and spirituality in university students: a cross-sectional study
Revista Brasileira de Enfermagem. 2015;68(3):504-509
Abstract
RESEARCHAnxiety 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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RESEARCH06-01-2015
Nursing guidance on bed baths to reduce anxiety
Revista Brasileira de Enfermagem. 2015;68(3):497-503
Abstract
RESEARCHNursing 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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RESEARCH06-01-2015
Body language in health care: a contribution to nursing communication
Revista Brasileira de Enfermagem. 2015;68(3):490-496
Abstract
RESEARCHBody 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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RESEARCH06-01-2015
Health promotion in supplementary health care: outsourcing, microregulation and implications for care
Revista Brasileira de Enfermagem. 2015;68(3):482-489
Abstract
RESEARCHHealth 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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RESEARCH06-01-2015
Gateway to the diagnosis of tuberculosis among elders in Brazilian municipalities
Revista Brasileira de Enfermagem. 2015;68(3):467-473
Abstract
RESEARCHGateway 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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