PubMed · 15680449
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Jason Gardosi. GRIT: concern about external validity.. https://doi.org/10.1016/s0140-6736(05)17821-0
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Measurement of development is often less precise than that of height and weight. Developmental scores are typically based on passing one or more developmental markers, but do not have interval scale so calculating differences between scores can be nonsensical. Age-specific standardized scores are sometimes used, but fail to have a common metric that allows comparison of developmental scores across age. The goal of this study is to develop a quantitative developmental score (D-score) with improved measurement characteristics. The basic assumption of the D-score is the existence of a common continuous scale for the development. Scores of 2151 children between 0 and 2 years on a Dutch developmental instrument were analysed. Application of the Rasch Model resulted in excellent reliability and satisfactory fit. This indicates that the new quantitative D-score succeeds in representing outcomes of the instrument on a common interval scale. Age-conditional reference values for the D-score were derived by means of the LMS method. The definition of the D-scores is not specific to age, so the D-score of a measured person can be compared to the D-score of another person of a different age. Difference scores between sessions can be used to evaluate developmental velocity on the individual level. To our knowledge this is the first developmental scale for children with such properties.
OBJECTIVE: To evaluate the effects of Sure Start local programmes (SSLPs) on children and their families. To assess whether variations in the effectiveness of SSLPs are due to differences in implementation. DESIGN: Quasi-experimental cross sectional study using interviews with mothers and cognitive assessment of children aged 36 months who speak English. SETTING: Socially deprived communities in England: 150 communities with ongoing SSLPs and 50 comparison communities. PARTICIPANTS: Mothers of 12,575 children aged 9 months and 3927 children aged 36 months in SSLP areas; mothers of 1509 children aged 9 months and 1101 children aged 36 months in comparison communities. OUTCOME MEASURES: Mothers' reports of community services and local area, family functioning and parenting skills, child health and development, and verbal ability at 36 months. RESULTS: Differences between SSLP areas and comparison areas were limited, small, and varied by degree of social deprivation. SSLPs had beneficial effects on non-teenage mothers (better parenting, better social functioning in children) and adverse effects on children of teenage mothers (poorer social functioning) and children of single parents or parents who did not work (lower verbal ability). SSLPs led by health services were slightly more effective than other SSLPs. CONCLUSION: SSLPs seem to benefit relatively less socially deprived parents (who have greater personal resources) and their children but seem to have an adverse effect on the most disadvantaged children. Programmes led by health services seem to be more effective than programmes led by other agencies.
BACKGROUND: The long term outcome of children entered into neonatal trials of high frequency oscillatory ventilation (HFOV) or conventional ventilation (CV) has been rarely studied. OBJECTIVE: To evaluate respiratory and neurodevelopmental outcomes for children entered into the United Kingdom Oscillation Study, which was designed to evaluate these outcomes. METHODS: Surviving infants were followed until 2 years of age corrected for prematurity. Study forms were completed by local paediatricians at routine assessments, and parents were asked to complete a validated neurodevelopmental questionnaire. RESULTS: Paediatricians' forms were returned for 73% of the 585 surviving infants. Respiratory symptoms were common in all infants, and 41% had received inhaled medication. Mode of ventilation had no effect on frequency of any symptoms. At 24 months of age, severe neurodevelopmental disability was present in 9% and other disabilities in 38% of children, but the prevalence of disability was similar in children who received HFOV or CV (relative risk 0.93; 95% confidence interval 0.74 to 1.16). The prevalence of disability did not vary by gestational age, but boys were more likely to have overall disability. Developmental scores were unaffected by mode of ventilation (relative risk 1.13; 95% confidence interval 0.78 to 1.63) and were lower in infants born before 26 weeks gestation compared with babies born at 26-28 weeks. CONCLUSIONS: Initial mode of ventilation in very preterm infants has no impact on respiratory or neurodevelopmental morbidity at 2 years. HFOV and CV appear equally effective for the early treatment of respiratory distress syndrome.