Bayley-III Scales of Infant and Toddler Development: Transcultural Adaptation and Psychometric Properties

Escalas con evidencia de la validez/fiabilidad son importantes para la evaluación del desarrollo infantil. En Brasil, faltan instrumentos estandardizados/normalizados para la evaluación en la primera infancia. Este estudio investigó las propiedades psicométricas de las Bayley Scales of Infant and Toddler Development-III, traducida y adaptada al portugués. Se evaluaron 207 niños (12-42 meses). Evidencias de validez convergente se observaron entre Bayley-III con: Escala de Desarrollo Motor de Peabody 2, Escala de Inteligencia Internacional Leiter-R, Lista de Evaluación de Vocabulario y Prueba de Vocabulario Expresivo Imágenes Peabody. El análisis factorial exploratorio indicó un componente que explica el 86% de la varianza, corroborado por buenos índices de ajuste en el análisis factorial confirmatorio. Bayley-III mostró buena consistencia interna, con coeficientes alfa de 0,90. La adecuación de las propiedades psicométricas puede contribuir al avance de la investigación en el contexto nacional en el área de evaluación del desarrollo infantil.Escalas com evidências de validade e precisão são importantes para avaliação do desenvolvimento infantil. No Brasil, há escassez de instrumentos padronizados e normatizados para a primeira infância. Este estudo investigou as propriedades psicométricas da Bayley Scales of Infant and Toddler Development, terceira edição (Bayley-III) que foi traduzida, adaptada para o português e testada com 207 crianças (12-42 meses). Evidências de validade convergente foram observadas entre a Bayley-III e: Peabody Developmental Motor Scale-2, Escala Internacional de Inteligência Leiter-R, Lista de Avaliação de Vocabulário Expressivo e Teste de Vocabulário por Imagens-Peabody. Análise fatorial exploratória indicou componente que explica 86% da variância, corroborado por bons índices de ajustes na análise fatorial confirmatória. A Bayley-III apresentou boa consistência interna com coeficientes alfa a partir de 0,90 e boa estabilidade teste-reteste apenas para a escala motora fina. Estas adequadas propriedades psicométricas podem contribuir para o avanço nas pesquisas em contexto nacional na área de avaliação do desenvolvimento infantil.Scales with evidence of validity and reliability are important to evaluate child development. In Brazil, there is a lack of standardized instruments to evaluate young children. This study investigated the psychometric properties of the Bayley Scales of Infant Development, Third Edition (Bayley-III). It was translated into Brazilian Portuguese, culturally adapted and tested on 207 children (12-42 months of age). Evidence of convergent validity was obtained from correlations of the Bayley-III with the: Peabody Developmental Motor Scale 2, Leiter International Performance Scale-R, Expressive Vocabulary Assessment List and Peabody Picture Vocabulary Test. Exploratory factor analyses showed a single component explaining 86% of the variance, supported by goodness-of-fit indexes in confirmatory factor analysis. The Bailey-III demonstrated good internal consistency with alpha coefficients greater than or equal to .90 and stability for fine motor scale only. These robust psychometric properties support the use of this tool in future national studies on child development

Translation, cultural adaptation and validity evidences of Bayley Scales III of infant development in the population of Barueri, São Paulo

Introdução: Sabe-se que, no universo acadêmico e clínico, há uma carência de instrumentos de avaliação do desenvolvimento infantil validados para nossa população. A busca de instrumentos com evidência de utilidade clínica e de pesquisa é crucial, considerando que os resultados dos testes são parte de uma avaliação abrangente do diagnóstico do desenvolvimento infantil. As Escalas Bayley III, aplicadas em crianças de 16 dias a 42 meses de idade, são reconhecidas como um dos melhores instrumentos para a avaliação do desenvolvimento infantil. O objetivo deste estudo foi realizar a tradução, adaptação transcultural e buscar evidências de validade por mudanças desenvolvimentais e por padrões de convergência de crianças de 12 a 42 meses de idade. Método: A tradução e a adaptação transcultural foram realizadas a partir das diretrizes propostas pelo Internation Test Commission. Foram seguidos os seguintes passos: tradução, duas revisões, adaptação cultural, teste piloto e revisão produzindo uma versão final do instrumento nos três domínios. Essa versão brasileira obteve a aprovação da editora americana que detém os direitos autorais e comerciais do instrumento, estando atualmente disponível para uso. A amostra do estudo foi de 207 crianças de 12 a 42 mese de idade de creches públicas do município de Barueri (SP). Resultados: análises descritivas mostraram validade por mudanças desenvolvimentais, visto que o desempenho da amostra dos participantes avaliados pelas Escalas Bayley III foi sensível à idade. Padrões de convergência foram confirmados por meio de correlações positivas e significantes entre os escores das Escalas Bayley III e os instrumentos Peabody Developmental Motor Scale (domínios motor grosso e fino), Leiter International Performance Scale-Revised (cognitivo), Lista de Avaliação de Vocabulário Expressivo (linguagem expressiva) e Teste de Vocabulário por Imagens Peabody (linguagem receptiva). Conclusões: os resultados da pesquisa sugerem boa adequação dos parâmetros psicométricos buscados para a versão brasileira das Escalas Bayley III, atestando a qualidade do instrumento.Introduction: It is known that in the academic and clinical training, there is a lack of validated assessment tools in child development for the Brazilian population. The search of instruments with evidence of clinical utility and research is crucial considering that the test results are part of a comprehensive evaluation of the diagnosis of child development. Bayley Scales III, applied to children of 16 days to 42 months old, are recognized as one of the best instruments for the assessment of child development. The aim of this study was to perform the translation, cultural adaptation and search for evidences of validity for developmental changes and convergence patterns of 12-42 months children. Method: The translation and cultural adaptation were accomplished based on the guidelines proposed by the Internation Test Commission. The following steps were the guidelines of this study: translation, it two reading, cultural adaptation, pilot test and review producing a final version of the instrument in all three domains. The Brazilian version obtained approval from U.S. publisher that owns the copyright and trade instrument; they are currently available for use. The study sample were 207 children between 12 and 42 months old at public daycare centers of Barueri, SP. Results: Descriptive analyzes showed validity for developmental changes, since the performance of the sample of participants assessed by the Bayley Scales III was sensitive to age. Patterns of convergence were confirmed through significant and positive correlations between the scores of the Bayley Scales III and the Peabody Developmental Motor Scale instruments (fine and gross motor domains), Leiter International Performance Scale-Revised (cognitive), Assessment List of Expressive Vocabulary (expressive language) and Peabody Picture Vocabulary Test (receptive language). Conclusion: The results of the research suggest good fit on psychometric parameters searched for the Brazilian version of the Bayley Scales III, attesting to the quality of the instrument.Fundo Mackenzie de Pesquis

Follow-up of premature children with high risk for growth and development delay: a multiprofessional assessment

Objective: To describe the activities of a multiprofessional outpatient clinic performed by neonatologist, physiatrist, physical therapist, occupational therapist, speech therapist, audiologist and psychologist, who evaluated the development of premature newborns. Methods: Twenty children born at a tertiary-care hospital (São Paulo, Brazil), between April 2006 and April 2007, with birth weight below 1250 g or less than 32 weeks of gestation, were evaluated. The multiprofessional evaluation included assessment of development using the Bayley III scale, at the corrected age of 3, 6, 9, 12, 18 and 24 months. Results: The mean gestation age at birth was 28.8 weeks; mean birth weight was 1055 g. The mean maternal age was 35 years and the mean length of stay of neonates was 46.3 days. Fifteen percent of children presented impaired sensory motor skills, 20% had hearing abnormalities and 10% motor alterations. Bayley III showed alterations in the communication area in 10% of subjects and in the motor area in 10% of individuals. The parents were oriented to stimulate the child or a specific intervention was suggested. The major development delay was observed between 6 and 18 months of age and the development was improved at 24 months of age. Conclusions: Most children evaluated had improved growth and development at 24 corrected-age months. Further studies with a larger sample are recommended, as well as the possibility to follow this population group up till the primary school

Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial

Background The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50\ue2\u80\u9375 years with type 2 diabetes inadequately controlled with metformin monotherapy (2\ue2\u80\u933 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15\ue2\u80\u9345 mg) or a sulfonylurea (5\ue2\u80\u9315 mg glibenclamide, 2\ue2\u80\u936 mg glimepiride, or 30\ue2\u80\u93120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57\uc2\ub73 months. The primary outcome occurred in 105 patients (1\uc2\ub75 per 100 person-years) who were given pioglitazone and 108 (1\uc2\ub75 per 100 person-years) who were given sulfonylureas (hazard ratio 0\uc2\ub796, 95% CI 0\uc2\ub774\ue2\u80\u931\uc2\ub726, p=0\uc2\ub779). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0\uc2\ub70001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups. Interpretation In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events. Funding Italian Medicines Agency, Diabete Ricerca, and Italian Diabetes Society