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ORIGINAL ARTICLE12-04-2023
Sepsis and COVID-19: outcomes in young adults in intensive care
Revista Brasileira de Enfermagem. 2023;76(6):e20230037
Abstract
ORIGINAL ARTICLESepsis and COVID-19: outcomes in young adults in intensive care
Revista Brasileira de Enfermagem. 2023;76(6):e20230037
DOI 10.1590/0034-7167-2023-0037
Views0See moreABSTRACT
Objective:
to verify sepsis incidence among young adults admitted to intensive care due to COVID-19 and to analyze its association with demographic, clinical and outcome variables.
Methods:
a quantitative, longitudinal, retrospective and analytical study, consisting of 58 adults aged 20 to 40 years in intensive care for SARS-CoV-2. It was carried out in a university hospital, from March 2020 to December 2021, with data collected from electronic medical records.
Results:
sepsis incidence was 65%. Sepsis was associated with acute kidney injury, use of vasoactive drugs and mechanical ventilation, being admitted to the emergency room, severity according to the Simplified Acute Physiology Score III and bacterial pulmonary co-infection, the latter being the most frequent etiology for sepsis.
Conclusions:
there was a high sepsis incidence, with 42% of deaths, which points to the importance of investing in preventive measures, especially in relation to bacterial pulmonary coinfections.
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ORIGINAL ARTICLE12-04-2023
Clinical simulation scenarios for the planning and management of infusion therapy by nurses
Revista Brasileira de Enfermagem. 2023;76(6):e20230019
Abstract
ORIGINAL ARTICLEClinical simulation scenarios for the planning and management of infusion therapy by nurses
Revista Brasileira de Enfermagem. 2023;76(6):e20230019
DOI 10.1590/0034-7167-2023-0019
Views0ABSTRACT
Objective:
to build, evaluate and test two clinical simulation scenarios for the planning and management of infusion therapy by nurses.
Methods:
methodological study, with construction of scenarios based on the NLN Jeffries Simulation Theory and the theoretical model Vessel Health Preservation; evaluation of the scenario design by judges, with calculation of the Modified Kappa Coefficient (MKC); testing scenarios with the target audience. Results: scenarios built for: 1. Patient assessment and vascular device selection; and 2. Identification and management of deep vein thrombosis. In the evaluation by judges, testing of validated scenarios in relation to educational practices and simulation design, the items evaluated presented MKC values ≥ 0.74.
Conclusion:
two evidence-based scenarios related to infusion therapy were constructed, with high levels of agreement among judges regarding their design. In testing with nurses, good results were obtained regarding the design and structuring of educational practice.
Keywords:Educational MeasurementNursing EducationPatient Care PlanningSimulation TrainingVascular Access DevicesSee more -
Sleep quality of nurses who worked in coping with COVID-19: an integrative review
Revista Brasileira de Enfermagem. 2023;76(6):e20230007
Abstract
Sleep quality of nurses who worked in coping with COVID-19: an integrative review
Revista Brasileira de Enfermagem. 2023;76(6):e20230007
DOI 10.1590/0034-7167-2023-0007
Views0See moreABSTRACT
Objective:
to analyze sleep quality of nurses who worked coping with COVID-19 in scientific evidence.
Methods:
an integrative review, carried out in seven databases, including studies between December 2021 and June 2022, without language restrictions. The sample consisted of 15 primary studies.
Results:
nurses working in hospital, intensive care, outpatient care and teaching institutions constitute a vulnerable group for sleep disorders: latency, duration, efficiency and quality. The disorders identified involved insomnia at varying levels of severity: daytime dysfunction and morning sleepiness. Night work and low capacity for self-care were determinants of impaired sleep patterns.
Final considerations:
the COVID-19 pandemic contributed to greater vulnerability of nurses to changes in sleep, requiring strategies for risk management and well-being promotion.
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ORIGINAL ARTICLE12-04-2023
Work and Mental Distress among Nurses in the Amazon Region of Brazil during the COVID-19 Pandemic
Revista Brasileira de Enfermagem. 2023;76(6):e20220792
Abstract
ORIGINAL ARTICLEWork and Mental Distress among Nurses in the Amazon Region of Brazil during the COVID-19 Pandemic
Revista Brasileira de Enfermagem. 2023;76(6):e20220792
DOI 10.1590/0034-7167-2022-0792
Views0See moreABSTRACT
Objective:
To assess the relationship between psychopathological symptoms and the social, clinical, and occupational profile of nurses in the Amazon region of Brazil during the COVID-19 pandemic.
Methods:
A descriptive cross-sectional online study was conducted in 2020 with 261 nurses. The Symptom Assessment Scale-40 was utilized.
Results:
The presence of pre-existing conditions before the pandemic was associated with psychotism (p=0.044). Experiencing constraints and/or violence at work during the pandemic was associated with somatization (p=0.025), and working hours were associated with anxiety (p=0.025). Nurses predominantly exhibited symptoms related to fear (33.7%), tension (34.5%), and a sense that something is wrong in the mind (22.6%).
Conclusions:
A significant association was observed between working hours and anxiety symptoms, the experience of constraints and/or violence at work during the COVID-19 pandemic and somatization symptoms, as well as between pre-existing conditions and psychotism symptoms related to COVID-19.
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ORIGINAL ARTICLE12-04-2023
Sexual behavior according to undergraduate students: perspective of cross-cultural nursing and intersectional framing
Revista Brasileira de Enfermagem. 2023;76(6):e20220786
Abstract
ORIGINAL ARTICLESexual behavior according to undergraduate students: perspective of cross-cultural nursing and intersectional framing
Revista Brasileira de Enfermagem. 2023;76(6):e20220786
DOI 10.1590/0034-7167-2022-0786
Views0ABSTRACT
Objective:
to discuss undergraduate students’ sexual behavior from the perspective of social markers and cross-cultural care proposed by Madeleine Leininger.
Methods:
descriptive-exploratory qualitative research, with a theoretical-philosophical foundation in the Transcultural Theory. Convenience sample was composed of 57 young people from two universities in Rio de Janeiro. The focus groups’ content were analyzed lexically using the IRAMUTEQ software.
Results:
four classes emerged: Young people’s sexual scripts: between the fear of an unplanned pregnancy and the risk of exposure to sexually transmitted infections; Affective relationships: trust in steady sexual partners, apparent sense of security and disuse of condoms; Sexual practices, gender and cultural determinants: distinction in men’s and women’s role; Sexual partnerships, negotiation of condom use and vulnerability to sexually transmitted infections.
Final considerations:
challenges are perceived for the attention to undergraduate students’ sexual health, who verbalized risky sexual behaviors due to sociocultural vulnerabilities.
Keywords:Cross-Cultural NursingIntersectional FramingSexual BehaviorSexually Transmitted InfectionsYoung AdultSee more -
ORIGINAL ARTICLE12-04-2023
Hospital discharge planning in care transition of patients with chronic noncommunicable diseases
Revista Brasileira de Enfermagem. 2023;76(6):e20220772
Abstract
ORIGINAL ARTICLEHospital discharge planning in care transition of patients with chronic noncommunicable diseases
Revista Brasileira de Enfermagem. 2023;76(6):e20220772
DOI 10.1590/0034-7167-2022-0772
Views0ABSTRACT
Objective:
to analyze care transition in hospital discharge planning for patients with chronic noncommunicable diseases.
Method:
a qualitative study, based on the Care Transitions Intervention theoretical model, with four pillars of intervention, to ensure a safe transition. Twelve professionals participated in a public hospital in the countryside of São Paulo. Data were collected through observation, document analysis and semi-structured interviews.
Results:
there was a commitment of a multidisciplinary team to comprehensive care and involvement of family members in patient care. The documents facilitated communication between professionals and/or levels of care. However, the lack of time to prepare for discharge can lead to fragmented care, impairing communication and jeopardizing a safe transition.
Final considerations:
they were shown to be important elements in discharge planning composition, aiming to ensure a safe care transition, team participation with nurses as main actors, early discharge planning and family involvement.
Keywords:Continuity of Patient CareNurse's RolePatient DischargePatient-Centered CareProcess AssessmentTransitional CareSee more -
ORIGINAL ARTICLE12-04-2023
Psychometric Properties of an Instrument for Assessing University Administrators’ Knowledge on Gender-Based Violence
Revista Brasileira de Enfermagem. 2023;76(6):e20220770
Abstract
ORIGINAL ARTICLEPsychometric Properties of an Instrument for Assessing University Administrators’ Knowledge on Gender-Based Violence
Revista Brasileira de Enfermagem. 2023;76(6):e20220770
DOI 10.1590/0034-7167-2022-0770
Views0ABSTRACT
Objective:
To evaluate the factorial structure of the instrument measuring university administrators’ knowledge of gender-based violence.
Methods:
This cross-sectional methodological study was conducted from August to November 2020 with 101 university administrators. Data on demographic and functional characteristics were collected, and the “QUEST VBG UNIV” instrument was applied. Descriptive analysis was performed, the structure of the questionnaire was assessed using exploratory factor analysis (EFA), and the stability of the factors was verified through ORION and FDI tests.
Results:
Of the original 38 items across the 4 sections of the questionnaire, 19 were retained within 2 factors, with appropriate factor loadings. Factor 1 had an explained variance of 15.69%, and Factor 2 had an explained variance of 9.10%. The reliability was deemed satisfactory (ORION > 0.900, FDI > 0.900).
Conclusions:
The questionnaire presented a valid and reliable factorial structure for measuring knowledge about gender-based violence, thereby representing a suitable option for situational assessments in universities.
Keywords:Factor AnalysisGender-Based ViolencePsychometricsStatisticalValidation StudyWorkplace violenceSee more
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RESEARCH01-01-2017
Violence against children and adolescents: the perspective of Primary Health Care
Revista Brasileira de Enfermagem. 2017;70(3):511-518
Abstract
RESEARCHViolence against children and adolescents: the perspective of Primary Health Care
Revista Brasileira de Enfermagem. 2017;70(3):511-518
DOI 10.1590/0034-7167-2016-0471
Views0See moreABSTRACT
Objective:
To analyze the care provided by Basic Health Units (BHU) to families involved in domestic intrafamily violence against children and adolescents.
Method:
Qualitative research, based on the Paradigm of Complexity. Data collection was performed with 41 professionals through focus groups and semi-structured interviews.
Results:
The following categories emerged from data analysis: ‘Everything comes here’, which reflects the legitimate place of BHUs for the population and the actions taken to build care for families; and ‘We only do what is really necessary’, which brings the look to violence still based on the positivist and biomedical paradigm.
Final considerations:
The model of understanding and construction of work processes in the BHU is structured in the aforementioned paradigm. Nurses have the possibility to become agents of change, both in professionals’ training and in the care thought and provided to communities.
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RESEARCH01-01-2017
Integrality of care: challenges for the nurse practice
Revista Brasileira de Enfermagem. 2017;70(3):504-510
Abstract
RESEARCHIntegrality of care: challenges for the nurse practice
Revista Brasileira de Enfermagem. 2017;70(3):504-510
DOI 10.1590/0034-7167-2016-0380
Views0See moreABSTRACT
Objective:
to understand the role of the nurse in the collegiate management model of a teaching hospital, in the integrality of care perspective.
Method:
a single case study with multiple units of analysis, with the theoretical proposition “integrality of care is a result of the care offered to the user by multiple professionals, including the nurse”. Data were obtained in a functional unit of a teaching hospital through interviews with 13 nurses in a non-participant observation and document analysis.
Results:
from the analytical categories emerged subcategories that allowed understanding that the nurse promotes integrality of care through nursing management, team work and integration of services.
Final considerations:
the theoretical proposition was confirmed and it was verified that the nursing management focus on attending to health care needs and is a strategy to provide integrality of care.
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RESEARCH01-01-2017
Low completion rate of hepatitis B vaccination in female sex workers
Revista Brasileira de Enfermagem. 2017;70(3):489-494
Abstract
RESEARCHLow completion rate of hepatitis B vaccination in female sex workers
Revista Brasileira de Enfermagem. 2017;70(3):489-494
DOI 10.1590/0034-7167-2016-0567
Views0See moreABSTRACT
Objective:
to assess predictive factors for noncompletion of the hepatitis B vaccination schedule in female sex workers in the city of Teresina, Northeastern Brazil.
Method:
402 women were interviewed and, for those who did not wish to visit specialized sites, or did not know their hepatitis B vaccination status, the vaccine was offered at their workplaces. Bi- and multivariate analyses were performed to identify potential predictors for noncompletion of the vaccination schedule.
Results:
of the 284 women eligible for vaccination, 258 (90.8%) received the second dose, 157/258 (60.8%) and 68/258 (26.3%) received the second and third doses, respectively. Working at clubs and consuming illicit drugs were predictors for noncompletion of the vaccination schedule.
Conclusion:
the high acceptability of the vaccine’s first dose, associated with low completion rates of the vaccination schedule in sex workers, shows the need for more persuasive strategies that go beyond offering the vaccine at their workplaces.
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RESEARCH01-01-2017
Cost of nursing most frequent procedures performed on severely burned patients
Revista Brasileira de Enfermagem. 2017;70(3):481-488
Abstract
RESEARCHCost of nursing most frequent procedures performed on severely burned patients
Revista Brasileira de Enfermagem. 2017;70(3):481-488
DOI 10.1590/0034-7167-2015-0034
Views0See moreABSTRACT
Objective:
to identify the mean direct cost (MDC) of the most frequent procedures performed by nursing professionals on severely burned patients in an Intensive Care Unit.
Method:
exploratory-descriptive quantitative single-case study. The MDC was calculated by multiplying time (timed) spent by nursing professionals in the performance of the procedures by the unit cost of direct labor, and adding the costs of material and medicine/solutions.
Results:
a MDC of US$ 0.65 (SD=0.36) was obtained for “vital signs monitoring”; US$ 10.00 (SD=24.23) for “intravenous drug administration”; US$ 5.90 (SD=2.75) for “measurement of diuresis”; US$ 0.93 (SD=0.42) for “capillary blood glucose monitoring”; and US$ 99.75 (SD=129.55) for “bandaging”.
Conclusion:
the knowledge developed can support managerial decision-making, contribute to the efficiency distribution of the resources involved and, when possible, provide cost-containment or cost-minimization strategies without impairing the quality of nursing care.
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RESEARCH01-01-2017
Nursing Activities Score and Acute Kidney Injury
Revista Brasileira de Enfermagem. 2017;70(3):475-480
Abstract
RESEARCHNursing Activities Score and Acute Kidney Injury
Revista Brasileira de Enfermagem. 2017;70(3):475-480
DOI 10.1590/0034-7167-2016-0266
Views0See moreABSTRACT
Objective:
to evaluate the nursing workload in intensive care patients with acute kidney injury (AKI).
Method:
A quantitative study, conducted in an intensive care unit, from April to August of 2015. The Nursing Activities Score (NAS) and Kidney Disease Improving Global Outcomes (KDIGO) were used to measure nursing workload and to classify the stage of AKI, respectively.
Results:
A total of 190 patients were included. Patients who developed AKI (44.2%) had higher NAS when compared to those without AKI (43.7% vs 40.7%), p <0.001. Patients with stage 1, 2 and 3 AKI showed higher NAS than those without AKI. A relationship was identified between stage 2 and 3 with those without AKI (p = 0.002 and p <0.001).
Conclusion:
The NAS was associated with the presence of AKI, the score increased with the progression of the stages, and it was associated with AKI, stage 2 and 3.
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RESEARCH01-01-2017
Nursing appointment and cardiometabolic control of diabetics: a randomized clinical trial
Revista Brasileira de Enfermagem. 2017;70(3):468-474
Abstract
RESEARCHNursing appointment and cardiometabolic control of diabetics: a randomized clinical trial
Revista Brasileira de Enfermagem. 2017;70(3):468-474
DOI 10.1590/0034-7167-2016-0352
Views0See moreABSTRACT
Objective:
to verify the effect of nursing appointment on cardiometabolic profile of people with Diabetes Mellitus type 2.
Method:
randomized controlled trial, developed with 134 individuals chosen for two groups: intervention and control. The intervention consisted of three nursing appointments alternated bimonthly, with two phone calls, over five months. The control group received usual care offered by the Health Unit. Data were collected through semi-structured interviews before and after the intervention, in addition to conducting laboratory tests.
Results:
after the intervention, a significant difference was shown in the amount of glycated hemoglobin (p = 0.006) and in the systolic blood pressure (p = 0.031), which were higher in the control group.
Conclusion:
besides being low-cost and easy to develop on the monitoring routine of people with diabetes, the intervention performed influenced positively the biochemical profile.
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RESEARCH01-01-2017
Terms of the specialized nursing language for the care of ostomates
Revista Brasileira de Enfermagem. 2017;70(3):461-467
Abstract
RESEARCHTerms of the specialized nursing language for the care of ostomates
Revista Brasileira de Enfermagem. 2017;70(3):461-467
DOI 10.1590/0034-7167-2015-0058
Views0See moreABSTRACT
Objectives:
to identify terms of the specialized nursing language for the care of ostomates from the literature of the area, and to map the identified terms with terms of the International Classification for Nursing Practice (ICNP®).
Method:
descriptive study of quantitative approach guided by the guidelines for the elaboration of terminology subsets of the ICNP®. The terms were collected in 49 scientific articles, extracted using a computational tool, selected according to the relevance for the theme, and normalized and mapped with the ICNP®.
Results:
20,668 terms were extracted. The standardization process resulted in 425 relevant terms (151 were constant in ICNP® and 274 were not contained in ICNP®), of which 154 were similar, 19 were more comprehensive, 50 were more restricted, and 51 were not in concordance.
Conclusion:
the use of standardized language can minimize the ambiguities and redundancies identified in the mapping. The existence of terms not in concordance with the ICNP® reinforces the need for constant updating of this classification.
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RESEARCH01-01-2017
Validation of an instrument regarding nursing intervention in patients in vasoactive therapy
Revista Brasileira de Enfermagem. 2017;70(3):453-460
Abstract
RESEARCHValidation of an instrument regarding nursing intervention in patients in vasoactive therapy
Revista Brasileira de Enfermagem. 2017;70(3):453-460
DOI 10.1590/0034-7167-2016-0254
Views0See moreABSTRACT
Objective:
to validate the content of a Standard Operational Procedure, regarding nursing interventions in emergency patients treated with vasoactive drugs.
Method:
methodological study, carried out from December 2015 to January 2016. Content validity was determined by 16 experts (13 nurses, 2 pharmacists and one biomedical scientist), who judged it through a four-point Likert scale. The items were evaluated in terms of: feasibility, objectivity, simplicity, clearness, pertinence and accuracy. The Content Validity Index was applied, accepting the value ≥ 0.90.
Results:
two rounds of evaluation were required to achieve the minimum index. The items were reviewed regarding writing, dilution, indication and replacement interval. The instrument was validated with 33 items and with total Content Validity Index of 0.99.
Conclusion:
the instrument was considered appropriate, fractionally and globally, for nursing care for the patient treated with vasoactive drugs in emergency, in a safe and reliable way.
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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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