RESUMO Objetivo: Traduzir e adaptar transculturalmente para o português do Brasil o instrumento Pediatric Confusion Assessment Method for the Intensive Care Unit para detecção de delirium em unidades de terapia intensiva pediátrica, incluindo algoritmo e instruções. Métodos: Utilizou-se a abordagem universalista para tradução e adaptação transcultural de instrumentos de aferição em saúde. Um grupo de especialistas em terapia intensiva pediátrica avaliou as equivalências conceitual e de itens. Em seguida, a avaliação da equivalência semântica consistiu de tradução do inglês para o português por dois tradutores independentes; conciliação em uma única versão; retradução por um nativo de língua inglesa; e consenso de seis especialistas quanto à compreensão de linguagem e de conteúdo, por meio de respostas do tipo Likert e Índice de Validade de Conteúdo. Finalmente, avaliou-se a equivalência operacional, aplicando-se um pré-teste em 30 pacientes. Resultados: A retradução foi aprovada pelos autores originais. As medianas das respostas do consenso variaram de boa a excelente, exceto na característica "início agudo" das instruções. Itens com Índice de Validade de Conteúdo baixo, relativos às características "início agudo" e "pensamento desorganizado", foram adaptados. No pré-teste, a expressão "acene com a cabeça" foi modificada para "balance a cabeça", para melhor compreensão. Não houve necessidade de outros ajustes, resultando na versão final para o português do Brasil. Conclusão: A versão brasileira do Pediatric Confusion Assessment Method for the Intensive Care Unit foi obtida segundo as recomendações internacionais, podendo ser utilizada no Brasil para o diagnóstico de delirium em crianças graves com 5 anos de idade ou mais, sem atraso de desenvolvimento cognitivo.

ABSTRACT Objective: To undertake the translation and cross-cultural adaption into Brazilian Portuguese of the Pediatric Confusion Assessment Method for the Intensive Care Unit for the detection of delirium in pediatric intensive care units, including the algorithm and instructions. Methods: A universalist approach for the translation and cross-cultural adaptation of health measurement instruments was used. A group of pediatric critical care specialists assessed conceptual and item equivalences. Semantic equivalence was evaluated by means of a translation from English to Portuguese by two independent translators; reconciliation into a single version; back-translation by a native English speaker; and consensus among six experts with respect to language and content understanding by means of Likert scale responses and the Content Validity Index. Finally, operational equivalence was assessed by applying a pre-test to 30 patients. Results: The back-translation was approved by the original authors. The medians of the expert consensus responses varied between good and excellent, except for the feature "acute onset" of the instructions. Items with a low Content Validity Index for the features "acute onset" and "disorganized thinking" were adapted. In the pre-test, the expression "signal with your head" was modified into "nod your head" for better understanding. No further adjustments were necessary, resulting in the final version for Brazilian Portuguese. Conclusion: The Brazilian version of the Pediatric Confusion Assessment Method for the Intensive Care Unit was generated in agreement with the international recommendations and can be used in Brazil for the diagnosis of delirium in critically ill children 5 years of age or above and with no developmental cognitive disabilities.

Abstract: Throughout various decentralization and social reforms in Mexico, state governments have increasingly developed their own social programs. However, there is scant research on the amounts of resources invested in those programs. This article focuses on the participation of state governments in implementing their own social policy, specifically in their investment in social programs. In particular, the main purpose of this research is to identify the most important factors related to the allocation of budgetary resources for social programs by state governments. To do this, this study conducts a quantitative analysis to better understand the allocation of resources to social programs in 32 states of Mexico, according to data reported by the Initiative for Strengthening Institutions of Social Programs (IPRO), from 2009 to 2013. The results of this study suggest that the percentage of extreme state poverty, state per capita gdp, and the occurrence of the electoral year in the state are factors that affect the amount of annual budget allocations of state programs. Although revenue decentralization reported by state governments, among other things, report to have more financial resources to spend, there is no evidence that the availability of these resources translates into a larger budget for social programs, as reported by the information system aforementioned.

Resumen: En el contexto de distintos procesos de descentralización y reforma social, la participación de los gobiernos estales en el desarrollo de programas sociales propios se ha incrementado en México. Sin embargo, la magnitud y los determinantes de la inversión en dichos programas han sido poco estudiados. Este trabajo se centra en la participación de los gobiernos estatales en política social, específicamente, en su inversión en programas sociales. En particular, el propósito central de este artículo es identificar algunos de los factores más importantes relacionados con la asignación de recursos presupuestales para programas sociales por parte de los gobiernos estatales. Para ello, este estudio realiza un análisis cuantitativo del presupuesto asignado a programas sociales de las 32 entidades federativas de México, según los datos reportados por el sistema de información de programas sociales de la Iniciativa para el Fortalecimiento de la Institucionalidad de los Programas Sociales (IPRO) de 2009 a 2013. Los resultados de este estudio sugieren que el porcentaje de pobreza extrema estatal, el producto interno bruto (PIB) per cápita estatal y la ocurrencia de año electoral en el estado, son factores que inciden el monto del presupuesto anual asignado a los programas sociales estatales. Sin embargo, la descentralización ha reportado para los gobiernos estatales, entre otras cosas, más recursos financieros para gastar, no hay evidencia de que la disponibilidad de dichos recursos se traduzca en mayor presupuesto para los programas sociales, como los que registra el sistema de información antes mencionado.

The vast majority of the 1-2 million malaria associated deaths that occur each year are due to anemia and cerebral malaria (the attachment of erythrocytes containing mature forms of Plasmodium falciparum to the endothelial cells that line the vascular beds of the brain). A "model" system"for the study of cerebral malaria employs amelanotic melanoma cells as the "target"cells in an vitro cytoadherence assay. Using this model system we determined that the optimum pH for adherence is 6.6 to 6.8, that high concentrations of Ca²* (50mM) result in increased levels of binding, and that the type of buffer used influences adherence (Bis Tris > MOPS > HEPES > PIPES). We also observed that the ability of infected erythrocytes to cytoadhere varied from (erythrocyte) donor to donor. We have produced murine monoclonal antibodies against P. falciparum-infected red cells which recognized modified forms of human band 3; these inhibit the adherence of infected erythrocytes to melanoma cells in a doso responsive fashion. Antimalarials (chloroquine, quinacrine, mefloquine, artemisinin), on the other hand, affected adherence in an indirect fashion i.e. since cytoadherence is due, in part to the presence of knobs on the surface of the infected erythrocyte, and knob formation is dependent on intracellular parasite growth, when plasmodial development is inhibited so is knob production, and consequently adherence is ablated.