ABSTRACT Purpose To synthesize the relevant scientific information regarding the assessment of language development in prelingually deaf children during their first six years of life, in order to determine whether it is sufficient to confirm the presence of some language development in this population, or if a more integrated approach would be more appropriate. Research strategies A structured review of the relevant scientific literature was carried out in the following databases: PubMed, Lilacs, Ibecs, Trip DataBase, Cochrane library, Clinical Trial and Nice. Selection criteria Systematic reviews, health technology assessments, randomized clinical trials, observational cohorts and case-control studies; including publications of assessments concerning any aspect of language development or any intervention in any language. Evaluations related exclusively to hearing and speech, to central, sudden or transient deafness, to deaf-blindness, to further disabilities or to autism spectrum disorders, were excluded. Data analysis GRADE methodology was used to analyze evidence quality. Results It is possible to evaluate the language development of prelingually deaf children. A moderate quality of evidence was obtained, suggesting that the evaluations’ results are fairly trustworthy, provided that the assessments are conducted within an integrated approach of other linguistic elements. Conclusion The results of the language evaluations must be supported mostly by receptive and expressive language data, and the found evidence can be improved by combining the assessments of the formal linguistic elements of both oral and gestural modalities with the pragmatic components of the communication process.

RESUMEN Objetivo Sintetizar la información científica relevante sobre la evaluación del desarrollo del lenguaje en niños sordos prelocutivos durante los primeros seis años de vida, con el fin de determinar si es suficientes para confirmar la presencia de algún desarrollo de lenguaje en esta población, o si se requiere un enfoque más integral. Estrategia de investigación Se realizó una revisión estructurada de la literatura científica en las siguientes bases de datos: PubMed, Lilacs, Ibecs, Trip DataBase, Cochrane library, Clinical Trial y Nice. Criterios de selección revisiones sistemáticas, evaluaciones de tecnologías sanitarias, ensayos clínicos aleatorizados, estudios observacionales de cohorte y casos - controles; incluyendo publicaciones sobre evaluación de cualquier aspecto del desarrollo de lenguaje, cualquier intervención y en cualquier idioma, se excluyeron si únicamente evalúan audición o habla, sordera central, súbita, transitoria, sordoceguera, con otras discapacidades o con trastornos del espectro autista. Análisis de datos se usó la metodología GRADE para analizar la calidad de la evidencia. Resultados es factible realizar evaluaciones del desarrollo de lenguaje a niños sordos prelocutivos. Se obtiene una calidad de la evidencia moderada que sugiere cierta confianza en los resultados de las evaluaciones, siempre y cuando vengan acompañadas de una apreciación integral de otros elementos lingüísticos. Conclusión los resultados de las evaluaciones de lenguaje deben sostenerse, en mayor medida, en datos sobre el lenguaje receptivo y expresivo, y que cuyas evidencias pueden enriquecerse al adjuntar evaluaciones de elementos lingüísticos formales tanto de la modalidad oral como gestual, y de los componentes pragmáticos de los procesos comunicacionales.

Abstract: The prevailing violence in the global and national scales has also permeated indigenous communities in Mexico, which have been integrating aggressive practices in family traditions since some time ago in their everyday life. Thus, an intervention project has been carried out based on the action research methodology, by means of the Summer Research programs promoted by institutions in a P’urhepecha community. The purpose of this article is to give account for the non-formal educational experience for Peace based on intercultural recreational processes with the above-mentioned indigenous context. Fifty P’urhepecha boys and girls between 6 and 12 years old participated with four Psychology students, two undergraduate students and two Psychology professors. There were four analysis categories: Group integration and participation; respect for rules; education for peace, and intercultural education. Through these categories, the change process became noticeable in the boys and girls participating, as well as in the research team. As a conclusion, intercultural recreational processes like this become useful strategies in the education for peace, not only in the indigenous population, but for everyone involved.

Resumen: La violencia prevaleciente a nivel mundial y nacional ha permeado también las comunidades indígenas en México, cuya vida cotidiana integra prácticas agresivas intrafamiliares desde tiempo atrás. Por ello, en una comunidad p’urhepecha se llevó a cabo un proyecto de intervención basado en la metodología de la investigación-acción a través de los programas de Verano de la Investigación que promueven algunas instituciones. El objetivo de este artículo es dar cuenta de una experiencia de educación para la paz, en modalidad no formal, basada en procesos lúdicos interculturales, en dicho contexto indígena. Participaron 50 niños y niñas p’urhepechas de seis a doce años, además de cuatro estudiantes de Psicología y dos profesoras de la misma carrera. Las categorías de análisis fueron cuatro: integración grupal y participación; respeto a las reglas; educación para la paz; y educación en la interculturalidad. En ellas se evidencia el proceso de cambio de niños y niñas participantes, pero también del equipo investigador. Se concluye que procesos lúdicos interculturales como este constituyen estrategias útiles para la educación para la paz, no solo para el ámbito indígena, sino para todos.

Abstract Intensive livestock systems allow reaching higher productivity, competitiveness and sustainability. The use of agroforestry systems (AFS) would ease the attainment of those systems, although there is no scientific information regarding the behavior of Cynodon nlemfuensis, Tithonia diversifolia and Gliricidia sepium under AFS conditions. Therefore, the objective of this study was to evaluate the forage yield and quality of C. nlemfuensis, T. diversifolia and G. sepium in monoculture and in AFS. The experimental design was completely random and the treatments were: C. nlemfuensis (MCn), T. diversifolia (MTd) and G. sepium (MGs) in monoculture with six repetitions and AFS made up of the same species with five repetitions. The variables were forage yield, leaf:stalk rate, crude protein (CP) and neutral detergent fiber (NDF) content. AFS had the highest global forage yield (11.8 Mg DM ha-1) compared to MCn, MTd and MGs (8.4, 2.7 and 2.1 Mg DM ha-1, respectively). When comparing between systems, the MCn was higher than SACn, SATd was higher than MTd, whereas MGs was similar to SAGs. The forage composition (proportion of leaf and stalk) and the CP and NDF content did not vary between cultivation systems. The use of AFS increases the total forage production, without affecting the forage composition and nutritional quality of the grass.

Resumen Los sistemas ganaderos intensivos permiten alcanzar mayor productividad, competitividad y sostenibilidad. El uso de sistemas agroforestales (SAF) facilitaría el logro de dichos sistemas, pero no hay información científica acerca del comportamiento de Cynodon nlemfuensis, Tithonia diversifolia y Gliricidia sepium bajo las condiciones de SAF. Por lo tanto, el objetivo de este estudio fue evaluar el rendimiento y la calidad forrajera de C. nlemfuensis, T. diversifolia y G. sepium en monocultivo y en SAF. El diseño experimental fue completamente al azar y los tratamientos fueron: C. nlemfuensis (MCn), T. diversifolia (MTd) y G. sepium (MGs) en monocultivo con seis repeticiones y SAF conformado por las mismas especies con cinco repeticiones. Las variables fueron rendimiento de forraje, relación hoja: tallo, contenido de proteína cruda (PC) y fibra detergente neutra (FDN). El SAF tuvo el mayor rendimiento global de forraje (11.8 Mg MS ha-1) respecto a MCn, MTd y MGs (8.4, 2.7 y 2.1 Mg MS ha-1, respectivamente). Al comparar entre sistemas, el MCn fue mayor a SACn, SATd fue mayor a MTd, mientras que MGs fue similar a SAGs. La composición del forraje (proporción de hoja y tallo) y el contenido de PC y FDN no vario entre sistemas del cultivo. El uso del SAF incrementa la producción forrajera total, sin afectar la composición del forraje y la calidad nutritiva de la gramínea.

Resumo O Laboratório de Sensibilidades da Universidade Federal de São Paulo (UNIFESP) é uma tentativa de construir experimentos abertos às alteridades, com ações em diversas superfícies que podem reverberar dentro e fora de seu lugar material. Neste artigo expomos algumas experiências que transversalizam o corpo desvago do Laboratório e suas incidências nos corpos que o compõem e decompõem. Narramos uma experimentação com uma comunidade-corpo, que se modulou em uma performance que nomeamos coletivamente de “Cabeça Dizpensa”. Discutimos, dentre outras, as noções de intervenção e interferência, e um itinerário de problematizações e pequenas narrativas com ecos do laboratório.

Abstract Sensitivities Laboratory at Federal University of São Paulo (UNIFESP) is an attempt of creating experiments that are open to alterities, with actions in many different surfaces which can reverberate into and out of its material place. In this paper, we expose some experiences that transversalize the Laboratory’s diffuse body and their incidences in the bodies that compose and decompose it. We report an experimentation with a community-body, which has shaped into a performance we collectively named “Lo(o)se-Head”. Among others, we bring the discussion of the notions of intervention and interference, as well as an itinerary of questionings and short narratives that bring echoes from the Laboratory.

Abstract Palatal rugae patterns are anatomic structures considered unique to each person. Monozygotic twins present similarities, however, Rugoscopy in particular, may contribute to their individualization for forensic purposes. The aims of this study were: to study the palatal rugae classifications of Briñón; to propose improvements to facilitate use of this method, if pertinent; and to characterize palatal rugae in a sample of Brazilian monozygotic twins and singletons. Precise reproducibility of the two methods of Briñón, from 1982 and 2011, was prevented by poor intra-examiner agreement (70% and 13% respectively). Our proposed improvements to these methods, although preliminary, were associated with better results. The most common palatal rugae patterns were types A, M, and Q. Palatal rugae were confirmed to be unique to each individual, even in monozygotic twins. Furthermore, twins did not exhibit any special patterns that might facilitate their differentiation from singletons.

Abstract: Background: Kawasaki disease (KD) is one of the most common systemic vasculitis in children under 5 years of age. The epidemiology of the disease is not well established in Mexico. The objective of this study was to describe the epidemiology, clinical features and treatment of patients with KD at the Hospital Infantil de Mexico Federico Gomez (HIMFG). Methods: We conducted a retrospective, descriptive and analytical study of patients diagnosed from January 2004 to December 2014 with KD in the HIMFG. Results: We analyzed 204 cases from which 55% were male, with a median age of 32.5 months (6-120) and a rate of hospitalization of 96%. Twenty percent of patients presented incomplete KD. No differences in the somatometric measurements or vitals were reported. The most frequent symptoms were fever, conjunctivitis (89%), oral changes (84%), pharyngitis (88%) and strawberry tongue (83%). We found higher acute phase reactants in the classic presentation. Echocardiographic alterations in 60 patients (29%), of which 12% were ectasia and 11% reported coronary aneurysms. On the other hand, 169 (83%) patients received intravenous immunoglobulin (IVIG), 18 (9%) presented resistance to IVIG, 6 (3%) required corticosteroids, and 2 (1%) infliximab; all received acetylsalicylic acid. Conclusions: There were no important differences between classic and incomplete presentations. The incidence of cardiac alterations is less than previously reported in Mexico, but similar to that of other countries.

Resumen: Introducción: La enfermedad de Kawasaki (EK) es una de las vasculitis sistémicas más comunes en niños menores de 5 años de edad. La epidemiología de la enfermedad no está bien establecida en México. El objetivo de este trabajo fue describir la epidemiología, características clínicas y tratamiento de los pacientes con EK atendidos en el Hospital Infantil de México Federico Gómez (HIMFG). Métodos: Se realizó un estudio retrospectivo, descriptivo y analítico de pacientes diagnosticados con EK en el HIMFG en el periodo comprendido entre enero de 2004 y diciembre de 2014. Resultados: Se analizaron 204 casos, la mayoría de sexo masculino (55%), con mediana de edad de 32.5 meses (6-120) y una tasa de hospitalización del 96%. El 20% de los pacientes presentó EK incompleto. No se reportaron diferencias en la somatometría ni signos vitales. La sintomatología más frecuente fue fiebre, conjuntivitis (89%), cambios orales (84%), faringitis (88%) y lengua en fresa (83%). Se encontraron reactantes de fase aguda más elevados en las presentaciones clásicas. Se reportaron alteraciones ecocardiográficas en 60 pacientes (29%), de las cuales el 12% fueron ectasia y el 11% aneurismas coronarios. Por otro lado, 169 pacientes (83%) recibieron inmunoglobulina intravenosa (IGIV), 18 (9%) resistencia a IGIV, 6 (3%) requirieron corticosteroides y 2 (1%) infliximab; todos recibieron ácido acetilsalicílico. Conclusiones: No se encontraron diferencias importantes entre las presentaciones clásicas e incompletas. La incidencia de alteraciones cardiacas es menor a la reportada previamente en México, pero similar a la de otros países.

Abstract In light of the fact that dentists may be held civilly liable for their practice, it is important to understand the current situation of lawsuits filed against these professionals by studying current legal decisions and the literature. The objective of this study was to analyze the case law of the Court of Justice of São Paulo, Brazil, relative to the profile of patients and professionals, the most commonly involved specialties, the amounts litigated and the court decisions pertaining to civil liability lawsuits against dentists. In an inductive approach, a single researcher screened and collected civil liability rulings by accessing the Court’s website, and following a statistical-descriptive procedure and an indirect observation technique. The most frequently involved specialty was prosthodontics. However, oral and maxillofacial surgery was related to a higher incidence of damages awarded to settle claims and to higher damage amounts. The dentist was found guilty in 44.32% of the cases researched. Pecuniary damages ranged between R$ 485.50 and R$ 12,530.00, and non-pecuniary damages ranged between R$ 2,500.00 and R$ 70,000.00. Most lawsuits were filed by women against male dentists. An increase in the relative number of lawsuits against companies versus individuals was observed.

Background: the World Health Organization (WHO) has intensified its efforts to promote and achieve a rational use of medications to contribute to the individual and social welfare. The Pharmacotherapy Committee is a forum for improving health care services and is also considered an instrument to foster a more efficient and rational use of medication. In Cuba, it has been proven that there is an irrational use of medications, what makes us think that the Pharmacotherapy Committees are not functioning in accordance with the established. Objective: to provide a methodology to Primary Health Care institutions for the correct operation of the Pharmacotherapy Committee Method: we conducted a detailed review of the scientific literature about the aspects related to each section and designed a multidisciplinary group of professional experts from Primary Health Care areas and Pharmacoepidemiology with experience on the topic. The final text was submitted to comments and suggestions and the recommendations were agreed by the consensus among the whole editor group. Results: we obtained a document which was directed to all professional prescribers and those that perform specific tasks for the improvement of the use of medications in Primary Health Care institutions as well as the sanitary managers that should encourage them. The application of this document will result in medical, economic and social benefits once the strategy has been implemented. These benefits should stimulate and promote the activities of such committees to achieve an efficient and rational use of medications. Conclusions: the methodology provided by this document will make the Pharmacotherapy Committees function as discussion forums for a safe, rational and adequate use of medications.

Introducción: la OMS ha intensificado sus esfuerzos por promover y alcanzar un uso racional del medicamento para contribuir al bienestar del individuo y de la sociedad. El comité farmacoterapéutico es un foro para la mejora de la prestación de servicios de salud, es también un instrumento para fomentar un uso más eficaz y racional de los medicamentos. En Cuba se ha comprobado que existen problemas de uso irracional, lo que hace pensar que los comités farmacoterapéuticos no están funcionando según lo establecido. Objetivo: brindar una metodología a las instituciones de la Atención Primaria de Salud para el correcto funcionamiento del comité farmacoterapéutico. Método: se realizó una revisión exhaustiva de la literatura científica sobre los aspectos relacionados con cada apartado, se designó a un grupo multidisciplinario de profesionales expertos, procedentes de las áreas de Atención Primaria de Salud y Farmacoepidemiología con experiencia en el tema. El texto final estuvo sometido a comentarios y sugerencias, las recomendaciones fueron consensuadas por todo el grupo redactor. Resultados: se obtuvo un documento dirigido a los profesionales prescriptores y todos aquellos que realizan las tareas específicas de mejora de uso de medicamentos en las instituciones correspondientes a la Atención Primaria de Salud y a los gestores sanitarios que deben fomentarlas. La aplicación del mismo traerá como consecuencia beneficios médicos, económicos y sociales, una vez implantada la estrategia que estimulen e impulsen la actividad de dichos comité y así lograr un uso eficiente y racional de los medicamentos. Conclusiones: La metodología aportada por este documento hará que los CFT funcionen como foros de discusión para un uso adecuado, racional y seguro de los medicamentos.

Objective: to identify the factors that strengthen and those factors that limit the adequate use of economic assessment as a function of the decision-making process in the Cuban health care system. Methods: there was selected a group of professionals linked to the decision-making process at various contexts of the national health care system. Focal groups for each identified level were organized in addition to making in-depth interviews to chosen managers, physicians, professors and researchers to find their criteria on this issue. Results: practical, methodological and administrative factors that either strengthen or limit the development of economic assessment nationwide were identified. Conclusions: a number of actions were put forward to strengthen the use of economic assessment in health in the decision-making process in Cuba.

Objetivo: identificar cuáles son los factores que fortalecen y los que limitan el adecuado uso de las evaluaciones económicas en función de la toma de decisiones en el contexto sanitario cubano. Métodos: se seleccionó un conjunto de profesionales vinculados a la toma de decisiones en diferentes ámbitos del Sistema Nacional de Salud. Se realizaron grupos focales para cada nivel identificado y entrevistas de profundidad a directivos, médicos, profesores e investigadores escogidos para conocer sus criterios al respecto. Resultados: se encontraron factores de carácter práctico, metodológico y administrativo que fortalecen y otros que limitan el desarrollo de la evaluación económica en el país. Conclusiones: se propone un conjunto de acciones para fortalecer el uso de la evaluación económica en salud en el proceso de toma de decisiones en Cuba.

Objective: to identify the factors that strengthen and those factors that limit the adequate use of economic assessment as a function of the decision-making process in the Cuban health care system. Methods: there was selected a group of professionals linked to the decision-making process at various contexts of the national health care system. Focal groups for each identified level were organized in addition to making in-depth interviews to chosen managers, physicians, professors and researchers to find their criteria on this issue. Results: practical, methodological and administrative factors that either strengthen or limit the development of economic assessment nationwide were identified. Conclusions: a number of actions were put forward to strengthen the use of economic assessment in health in the decision-making process in Cuba.

Objetivo: identificar cuáles son los factores que fortalecen y los que limitan el adecuado uso de las evaluaciones económicas en función de la toma de decisiones en el contexto sanitario cubano. Métodos: se seleccionó un conjunto de profesionales vinculados a la toma de decisiones en diferentes ámbitos del Sistema Nacional de Salud. Se realizaron grupos focales para cada nivel identificado y entrevistas de profundidad a directivos, médicos, profesores e investigadores escogidos para conocer sus criterios al respecto. Resultados: se encontraron factores de carácter práctico, metodológico y administrativo que fortalecen y otros que limitan el desarrollo de la evaluación económica en el país. Conclusiones: se propone un conjunto de acciones para fortalecer el uso de la evaluación económica en salud en el proceso de toma de decisiones en Cuba.

In order to evaluate different methods for the primary isolation of Brucella melitensis in goat milk from infected herds, Ver., 45 female adult goats were randomly selected trough the following criteria: 30 previously vaccinated with Brucella melitensis Rev-1 strain, and 15 never vaccinated. Sample size was estimated by a probabilistic model, with unknown population and 35% known prevalence rate (n = 1 - p / pv); where n corresponds to sample size, p for prevalence rate and v variation coefficient (0.05). All goats selected were sampled three times within a 30 day interval to guarantee Brucella spp. milk shedding. Milk samples were aseptically collected into sterile glass tubes from half udder and were refrigerated at 4°C until they were laboratory processed into the next 24 hours. Milk samples were 10,000 X g centrifuged during 20 minutes, in a refrigerated centrifuge at 4ºC. Farrell and Tripticase Soy Agar (TSA) media, were the isolation culture media selected and both were enriched with bovine fresh serum during their formulation. Both isolation culture media selected were inoculated by duplicate with fat and sediment from centrifuged milk as it is established in the Mexican regulations. The results obtained were statistically evaluated by Chi square (c²). A half of both inoculated isolation culture media was incubated under 5 to 10% carbonic dioxide atmosphere and the other half in aerobic one. From 76% of 135 milk samples obtained, only Brucella melitensis biovar - 1 was isolated using both culture media; however, the majority of isolated field strains were recovered from Farrell culture medium (p<0.05); from milk fat 57% of isolated strains and from milk sediment 67%. Also, the best Brucella melitensis biovar - 1 development (p<0.05) from Farrell culture medium was observed by aerobic atmosphere incubation. It is conclusive that Farrell culture medium is more effective than TSA medium for that purpose, both from the fat and sediment of milk, likewise incubation of the samples in aerobic atmosphere was better and there was more successful development of bacteria.

Con el propósito de evaluar varios métodos para el aislamiento primario de Brucella melitensis a partir de leche procedente de rebaños caprinos infectados se seleccionaron de forma aleatoria 45 cabras bajo los siguientes criterios: 30 vacunadas previamente, con la cepa Rev-1 de Brucella melitensis; y 15 hembras nunca vacunadas. El tamaño de muestra se basó en un modelo probabilístico con población desconocida y con prevalencia conocida de 35% (n = 1 - p / p v); donde, n = tamaño de muestra, p = prevalencia y v = coeficiente de variación (0.05). Todas las cabras seleccionadas se muestrearon por tres ocasiones a intervalos de 30 días entre uno y otro muestreo. Las muestras de leche fueron tomadas en forma aséptica de cada mitad de la ubre, en tubos estériles de cierre hermético y se refrigeraron a 4°C hasta su procesamiento en el laboratorio, dentro de las siguientes 24 horas. Las muestras se centrifugaron por 20 minutos a 10,000 X g a 4°C. y para la siembra, se utilizaron los medios de cultivo de Farrell y de agar de soya tripticaseína (TSA) enriquecidos con suero fresco de bovino. De las muestras de leche centrifugadas, se sembraron por duplicado en cada medio, porciones de grasa y sedimento de acuerdo con técnicas establecidas en la NOM - 041 - ZOO - 1995. Los resultados obtenidos, se evaluaron a través del análisis de datos categóricos (c²). Una mitad de cada uno de los medios empleados, se incubó bajo presión de bióxido de carbono del 5 al 10% y la otra, en aerobiosis. Se recuperó B. melitensis biovar-1 en el 76% de 135 muestras procesadas; y la mayor cantidad de cepas de campo se aislaron a través del medio Farrell (p<0.05); de la grasa, el 57% y del sedimento, el 67%. Además, el mejor desarrollo de las bacterias (p<0.05) en este medio se observó en la incubación bajo atmósfera de aerobiosis. Se concluye que el medio de Farrell fue más eficaz que el de TSA para ese fin, tanto a partir de la grasa de la leche como del sedimento; asimismo, la incubación de las muestras en atmósfera de aerobiosis tuvo un mejor y más exitoso desarrollo de las bacterias.