MARIA INES BAPTISTELLA NEMES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
32 resultados
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- Comunicação profissional-paciente e cuidado: avaliação de uma intervenção para adesão ao tratamento de HIV/Aids(2013) BELLENZANI, Renata; NEMES, Maria Ines Baptistella; PAIVA, VeraInterventions to improve HIV/AIDS treatment adherence are often based on cognitive approaches of the health professional-patient communication and health behaviors. From a social-constructionist perspective of professional-patient communication and treatment experiences, it was assessed the implementation process of an individual psychosocial intervention, consisting of 4 encounters and informed by the conceptual frameworks of Vulnerability and Human Rights in the psychosocial dimension of Care. Taking all 16 encounters (4 encounters with each participant), the implementation process was considered ""moderately developed."" Difficulties were encountered to develop dialogic conversations and decode meanings regarding the lack of adherence in social situations integrated with interpersonal and sociocultural scenarios. Despite the predominance of guidelines and motivational incentives for patients, there were also dialogic moments of co-understanding difficulties in adherence in its different meanings in medication intake scenes. This approach to care proves to be productive to enhance adherence practices.
- Avaliação de serviços de Atenção Básica em municípios de pequeno e médio porte no estado de São Paulo: resultados da primeira aplicação do instrumento QualiAB(2014) CASTANHEIRA, Elen Rose Lodeiro; NEMES, Maria Ines Battistella; ZARILI, Thais Fernanda Tortorelli; SANINE, Patrícia Rodrigues; CORRENTE, José EduardoThe QualiAB questionnaire involves 65 indicators of health care organization and management. In its first application in 2007, QualiAB was answered by 598 Primary Health Care services from 115 municipalities in the state of São Paulo. The mean performance was 64% of desirable standards. Clustering according to K-means produced three quality groups. Family Health Units and facilities located in municipalities under 50,000 inhabitants were more likely to belong to the best quality group. Focusing on how to organize local health care procedures, QualiAB readily supports professionals and can be included in quality improvement initiatives addressing all levels of management.
- Profile of the cohort of people being treated for HIV infection in the SUS, Brazil, 2015-2018(2023) SATO, Ana Paula Sayuri; NEMES, Maria Ines Battistella; ALVES, Ana Maroso; SOUZA, Evelyn Lima de; SANTOS, Barbara dos Reis; NUNES, Luceime Olivia; SANTOS, Angelica Carreira dos; KUMOW, Aline; NASCIMENTO, Felipe Parra doOBJECTIVE: To build an integrated database of individual and service data from the cohort of people who started antiretroviral therapy (ART), from 2015 to 2018, in Brazil. METHODS: Open cohort study that includes people aged 15 years or older who started ART from 2015 to 2018, with follow-up in services of the Brazilian Unified Health System (SUS), and who responded to the 2016/2017 Qualiaids national survey. The source of individual data was the related HIV database, derived from the probabilistic linkage between data from the SUS systems of diagnostic information, medication, tests, and deaths. The data source for the services was the services' response database to the Qualiaids survey. After analysis of consistency and exclusions, the database of individuals was deterministically related to the database of services. RESULTS: The cohort comprised 132,540 people monitored in 941 SUS services. Of these services, 59% are located in the Southeast region and 49% followed 51 to 500 cohort participants. The average performance of organization and management of patient care ranged from 29% to 75%. Most of the cohort participants are male, black and mixed, aged between 20 and 39 years old, and have between 4 and 11 years of schooling. Median baseline T-CD4 was 419 cells/mm3, 6% had an episode of tuberculosis, and 2% died of HIV disease. CONCLUSION: For the first time in Brazil, this cohort provides the opportunity for a joint analysis of individual factors and services in the production of positive and negative clinical outcomes of HIV treatment.
- Evaluation of outpatient services in the Brazilian Unified National Health System for persons living with HIV: a comparison of 2007 and 2010(2018) LOCH, Ana Paula; NEMES, Maria Ines Battistella; SANTOS, Maria Altenfelder; ALVES, Ana Maroso; MELCHIOR, Regina; BASSO, Caritas Relva; CARACIOLO, Joselita Maria de Magalhaes; ALVES, Maria Teresa Seabra Soares de Britto e; CASTANHEIRA, Elen Rose Lodeiro; CARVALHO, Wania Maria do Espirito Santo; KEHRIG, Ruth Terezinha; MONROE, Aline AparecidaHealth services play a crucial role in reaching the 90-90-90 target of controlling the HIV epidemic. This study evaluates the organization of Brazilian health services in improving, monitoring, and retention in HIV care and adherence support. Percentage variation (PV) was used to compare the responses by services to an evaluation questionnaire on organizational quality (Qualiaids) in 2007 and 2010. The study analyzed the 419 services that completed the questionnaire in 2007 (83.1% of respondents) and 2010 (63.6%). Management actions of retention and support although increased in the period, but remained at low rates, for example: systematic meetings for case discussion (32.7% in 2010; PV = 19.8%) and recording of missed medical appointments (35.3%; PV = 36.8%). Patient care actions related to adherence to ART remained largely exclusive to the attending physician. The supply of funds and resources from the Federal Government (medicines and specific HIV tests) remained high for the vast majority of the services (similar to 90%). It will not be possible to achieve a significant decrease in HIV transmission as long as retention in treatment is not a priority in all the health services.
- ASSESSMENT OF PHYSICAL IMPAIRMENTS IN LEPROSY PATIENTS: A COMPARISON BETWEEN THE WORLD HEALTH ORGANIZATION (WHO) DISABILITY GRADE AND THE EYE-HAND-FOOT SCORE(2011) RAPOSO, Marcos Tulio; CAMINHA, Ana Virginia de Queiroz; HEUKELBACH, Jorg; SANCHEZ-GONZALEZ, Miguel Angel; MEDEIROS, Jovany Luis Alves de; NEMES, Maria Ines BattistellaThis cross-sectional study assessed the grade of physical impairments in 61 individuals with leprosy receiving multidrug therapy (MDT) under the Brazilian Unified Health System (SUS), and residing in Campina Grande, Paraiba State, Brazil. Impairments were assessed using the disability grade (DG) standardized by the WHO, and the EHF score (Eye-Hand-Foot sum of impairment scores). Impairments were detected in 25 (41%) of the subjects. A total of 14(23%) patients scored DG 1, while 11(18%) were assigned DG 2. The EHF score ranged from 1 to 10 points in the group of patients with physical impairments, with a mean score of 3.6 points. The majority of individuals with impairments were affected in at least two sites. We conclude that the EHF score showed overlapping impairments in the segments examined and may be more appropriate than the DG classification system for describing the degree of physical impairment of leprosy patients.
- Development and validation of the WebAd-Q Questionnaire to monitor adherence to HIV therapy(2018) VALE, Felipe Campos; SANTA-HELENA, Ernani Tiaraju de; SANTOS, Maria Altenfelder; CARVALHO, Wania Maria do Espirito Santo; MENEZES, Paulo Rossi; BASSO, Caritas Relva; SILVA, Mariliza Henrique; ALVES, Ana Maroso; NEMES, Maria Ines BattistellaOBJECTIVE To present the development and validation of the WebAd-Q Questionnaire, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/AIDS centers in Brazil. METHODS The WebAd-Q is an electronic questionnaire that has three questions about the use of antiretrovirals in the last week. It was constructed from interviews and focus groups with 38 patients. Its validity was tested in a study with a sample of 90 adult patients on antiretroviral therapy for at least three months. We used electronic monitoring bottles, pill counting, and self-report interview to compare adherence. The WebAd-Q was answered on the sixtieth day, twice, with at least one hour of interval. The viral load of the patients was obtained from the service records. We have analyzed the agreement between the answers to the WebAd-Q, the associations, and the correlations with viral load and performance compared to other measures of adherence. RESULTS Among the invited patients, 74 (82.2%) answered the WebAd-Q. No difficulties were reported to answer the questionnaire. The average answer time was 5 min 47 sec. The set of three questions of the WebAd-Q obtained agreement of 89.8%, with Kappa of 0.77 (95%CI 0.61–0.94). The non-adherence answers of the WebAd-Q were associated with detectable viral load. We obtained moderate viral load correlations with the non-adherence scale according to the WebAd-Q. For the three questions of the WebAd-Q, patients with non-adherence answers were also reported as less adherent according to the other measures of adherence. CONCLUSIONS The WebAd-Q answered all the issues considered relevant in the validation of questionnaires, was well understood by patients, was associated with viral load, and obtained good agreement and good performance compared to the other measures. The feasibility analysis of its implementation still depends on a national study on its applicability.
- CARE TO INCARCERTAED PEOPLE WITH HIV/AIDS: LITERATURE REVIEW(2020) BOSSONARIO, Pedro Augusto; SAITA, Nanci Michele; ANDRADE, Rubia Laine de Paula; SANTOS, Glauber Palha dos; NEMES, Maria Inês Battistella; MONROE, Aline AparecidaABSTRACT Objective: to describe health care provided to people living with HIV/AIDS in the penitentiary system. Method: a narrative review of the literature that considered publications from 2012 to 2017. The bibliographic survey was performed using controlled descriptors and keywords in the LILACS, PubMed, Embase, Cinahl and Scopus databases. Result: a total of 215 studies were retrieved that went through three selection stages, including nine. These were grouped according to the areas: HIV prevention, HIV testing and diagnosis, HIV treatment, and articulation between Health Services in addressing HIV. Conclusion: prisons have the capacity to offer quality health care to persons deprived of their liberty living with HIV, through health promotion and prevention of the HIV virus, as well as early diagnosis and adherence to treatment.
- Vulnerability factors associated with HIV/AIDS hospitalizations: a case-control study(2020) LOPES, Livia Maria; ANDRADE, Rubia Laine de Paula; ARAKAWA, Tiemi; MAGNABOSCO, Gabriela Tavares; NEMES, Maria Ines Battistella; RUFFINO NETTO, Antonio; MONROE, Aline AparecidaObjectives: to identify the association between HIV/AIDS hospitalizations and factors that integrate individual, social, and programmatic vulnerabilities. Methods: a case-control study conducted in 2014 in a municipality in the state of Sao Paulo.""Cases"" included people living with HIV (PLHIV) hospitalized and ""control"" those who were outpatients. Interviews were conducted using a tool with sociodemographic variables, clinical characteristics and other vulnerabilities. Data were analyzed by conditional logistic regression. Results: fifty-six cases and 112 control participated. Risk factors for HIV hospitalization were: unemployed and retired individuals; homeless people; non-antiretroviral users; individuals who did not regularly attend returns. Access to social workers was a protective factor for hospitalization. Conclusions: this research contributed to measure the social, individual and programmatic vulnerabilities that interfere with HIV worsening and, consequently, unfavorable outcome such as hospitalization.
- A re-emergência da epidemia de aids no Brasil: desafios e perspectivas para o seu enfrentamento(2015) GRANGEIRO, Alexandre; CASTANHEIRA, Elen Rose; NEMES, Maria Inês Battistella
- Grade 2 disabilities in leprosy patients from Brazil: Need for follow-up after completion of multidrug therapy(2018) RAPOSO, Marcos Tulio; REIS, Martha Cerqueira; CAMINHA, Ana Virginia de Queiroz; HEUKELBACH, Jorg; PARKER, Lucy Anne; PASTOR-VALERO, Maria; NEMES, Maria Ines BattistellaBackground Leprosy continues to be a public health problem in many countries. Difficulties faced by health services include late diagnosis, under-reporting of new cases, adequate monitoring of disabilities and treatment. Furthermore, systematic follow-up after completion of treatment is important, when new disabilities may occur, or existing disabilities may get worse. The objective of the present study was to determine the prevalence of leprosy-associated grade 2 disabilities (G2D) after completion of multidrug therapy (MDT) and to identify factors associated with G2D. Methods We performed a cross-sectional study of 222 leprosy cases registered in Vitoria da Conquista, Bahia state, Brazil from 2001-2014. We performed a clinical examination of the study participants and collected socio-economic and clinical information by interview. We identified factors associated with grade 2 disability (G2D) using logistic regression. Results In total, 38 (17.1%) participants were diagnosed with G2D, and 106 (47.7%) with grade 1 disabilities (G1D). The following independent factors were significantly associated with G2D: occurrence of leprosy reaction (adjusted OR = 2.5; 95% CI = 1.09-5.77), thickening and/or tenderness of one or more nerve trunks (adjusted OR = 3.0; CI = 1.13-8.01) and unemployment (adjusted OR = 7.17; CI = 2.44-21.07). Conclusions This study shows that physical disabilities remain after completion of MDT and frequently occur in an endemic area in Brazil. Finding new ways to reduce the burden of disability are urgently needed, and may include systematic follow-up of patients after treatment completion combined with evidence-based preventative measures.