ABSTRACT Objective To develop and validate a high-risk predictive model that identifies, at least, one common adverse event in older population: early readmission (up to 30 days after discharge), long hospital stays (10 days or more) or in-hospital deaths. Methods This was a retrospective cohort study including patients aged 60 years or older (n=340) admitted at a 630-beds tertiary hospital, located in the city of São Paulo, Brazil. A predictive model of high-risk indication was developed by analyzing logistical regression models. This model prognostic capacity was assessed by measuring accuracy, sensitivity, specificity, and positive and negative predictive values. Areas under the receiver operating characteristic curve with 95% confidence intervals were also obtained to assess the discriminatory power of the model. Internal validation of the prognostic model was performed in a separate sample (n=168). Results Statistically significant predictors were identified, such as current Barthel Index, number of medications in use, presence of diabetes mellitus, difficulty chewing or swallowing, extensive surgery, and dementia. The study observed discrimination model acceptance in the construction sample 0.77 (95% confidence interval: 0.71-0.83) and good calibration. The characteristics of the validation samples were similar, and the receiver operating characteristic curve area was 0.687 (95% confidence interval: 0.598-0.776). We could assess an older patient’s adverse health events during hospitalization after admission. Conclusion A predictive model with acceptable discrimination was obtained, with satisfactory results for early readmission (30 days), long hospital stays (10 days), or in-hospital death.

RESUMO Buscou-se identificar na literatura os principais obstáculos e dificuldades enfrentadas por pessoas surdas quanto ao acesso à saúde. Trata-se de uma revisão integrativa de literatura, considerando estudos publicados entre 2006 e 2016, utilizando combinações de descritores controlados. As bases de dados virtuais utilizadas foram: LILACS, PUBMED e SciELO, incluindo artigos publicados em Inglês, Português e Espanhol. A amostra final foi composta por 24 artigos, selecionados após análise dos títulos, resumos e textos na íntegra. Os estudos selecionados foram categorizados quanto às principais temáticas e dificuldades enfrentadas pela comunidade surda, sendo principalmente relacionadas à barreira comunicacional existente entre ouvintes e surdos. Tal fato culmina em interferências na relação profissional-paciente, compreensão deficitária das pessoas surdas quanto ao processo saúde-doença e as dificuldades de integração da pessoa surda na comunidade. Na maioria dos estudos analisados, evidenciou-se que as dificuldades enfrentadas pelas pessoas surdas quando buscam atendimento em saúde são ligadas à comunicação, bem como desconhecimento de Língua Brasileira de Sinais (LIBRAS) por grande parte dos profissionais de saúde. Além disso, também há a necessidade de familiar ou intérprete presente durante a consulta e a falta de compreensão de grande parte da comunidade surda como sujeitos bilíngues e multiculturais.

ABSTRACT The main obstacles faced by deaf people in access to healthcare services were investigated in the literature. This is an integrative literature review, considering studies published between 2006 and 2016, using combinations of controlled descriptors. The virtual databases used were: LILACS, PUBMED and SciELO, including articles published in English, Portuguese and Spanish. The final sample was composed of 24 articles, selected after analysis of titles, abstracts and full texts. The elected studies were categorized according to themes and to the presented difficulties, mainly concerning communication obstacles between deaf and normally hearing people. This fact interferes on the doctor-patient relationship, producing a poor understanding by the deaf community about the health-disease process and causing a challenging integration of those people in the society. The majority of the analyzed studies indicated that the main obstacles faced by the deaf regarding the access to healthcare services are communication related, especially the healthcare professionals unfamiliarity with the Brazilian Sign Language (LIBRAS). In addition, there is also the need for a family member or interpreter to be present during the consultation. Furthermore, the lack of perception on the hearing society part, of the deaf community as bilingual and multicultural subjects, was verified.

Ideal biocompatible polymers must show a mimetic superstructure with biological supra-organization. Collagen-rich structures like tendons and ligaments are materials with various levels of order, from molecules to bundles of fibers, which affect their biomechanical properties and cellular interactions. Poly-benzyl-L-glutamate (PBLG) displaying helicity was used here to test the development of wave-like structures as those occurring in collagen fibers. Birefringence of PBLG under various crystallization conditions was studied with a lambda/4 compensator according to Sénarmont. Qualitative observations were plainly sufficient to conclude that the PBLG fibrils were supra-organized helically as a chiral object. During crystallization stretched PBLG formed a helical superstructure with characteristic striation resembling waves (crimp). Supported by optical anisotropy findings, a twisted grain boundary liquid crystal type is proposed as a transition phase in the formation of the PBLG chiral object. A similarity with the wavy organization (crimp) of collagen bundles is proposed.

A fluorescencia natural devida à presença de corpos de lipofuscina foi pesquisada em miócitos cardíacos de camundongos adultos jovens tratados com oxamniquine. O objetivo foi buscar uma evidência de indução de envelhecimento celular precoce, com base em dados prévios de acentuação poliploidia, promovida pela droga. Comparando o miocárdio dos camundongos tratados com animais contrôle jovens e velhos, não foi observada a presença de lipofuscina nos seus miócitos. Isto possivelmente se deva a um não comprometimento da eficiência das lipases lisossomiais apesar da acentuação do fenômeno de poliploidização induzida pela droga.

The autofluorescence due to lipofuscin bodies was investigated in cardiac miocytes of young adult mice treated with oxamniquine. The aim was to detect evidence for a cell aging process promoted by the drug, taking into account previous findings on the enhancement of polyploidy in this material. However, as no lipofuscin was observed in these cells, when compared to young and old control animals, it is assumed that the efficiency of the lysosome lipases in the heart miocytes of the treated mice is not affected by the drug induced polyploidy enhancement.