Evidências de validade e fidedignidade da Escala Internacional de Inteligência Leiter-R para crianças dos 6 aos 8 anos

This study verified psychometric parameters of the Leiter-R, a nonverbal intelligence scale. The scale wasadministered to 213 children between 6 and 8 years. Exploratory factor analysis and confirmatory indexes showed adequacy fora two factor structure according to the original version. Moderate and high correlations between test-retest measures indicatedthe stability of the test scores. The values of Kuder-Richardson and Spearman-Brown coefficients varied between subtestsaccording to the age of the children. In all age groups the highest values were observed for the subtests Sequential Order andRepeated Patterns. Significant increase in scores occurred only from 6 to 7 and 8 years. Evidence of convergent validity wasobtained between the Leiter-R with the WISC-III and the Raven Colored Progressive Matrices.Este estudo verificou os parâmetros psicométricos da escala não-verbal de inteligência Leiter-R. Esta foi administrada em 213 crianças com idade entre 6 e 8 anos. Análise fatorial exploratória e índices de ajustes confirmatórios mostraram adequação da estrutura interna para dois fatores conforme a versão original do instrumento. Foi verificada estabilidade temporal, com correlações de magnitude moderada a alta entre teste e re-teste. Coeficientes de Kuder-Richardson e Spearman-Brown variaram entre os subtestes em função das diferentes idades. Maiores valores foram observados nos subtestes Sequências e Padrões Repetidos para todas as idades. Aumento significativo dos escores ocorreu apenas dos 6 para os 7 e 8 anos. Foram verificadas evidências de validade convergente com a WISC-III e as Matrizes Progressivas Coloridas de Raven

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years