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DM&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3</span></a> Contudo&#44; tamb&#233;m devem ser desenvolvidas estrat&#233;gias para impedir a hipoglicemia noturna recorrente grave&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;5</span></a> Nesse sentido&#44; o manejo di&#225;rio do DM1 apresenta in&#250;meros desafios para o atingimento de controle metab&#243;lico satisfat&#243;rio&#44; pois exige tratamento complexo por meio de v&#225;rias inje&#231;&#245;es de insulina&#44; automonitoramento frequente da glicemia&#44; um cronograma rigoroso das refei&#231;&#245;es&#44; exerc&#237;cio f&#237;sico regular e contato frequente com profissionais da sa&#250;de&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7</span></a> todos os quais podem afetar a qualidade de vida dos pacientes&#44; principalmente de crian&#231;as e adolescentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Na &#250;ltima d&#233;cada&#44; o interesse na qualidade de vida relacionada &#224; sa&#250;de &#40;QVRS&#41; aumentou significativamente e se tornou uma medida de resultado essencial em ensaios cl&#237;nicos e avalia&#231;&#245;es de servi&#231;os de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Os v&#225;rios aspectos de sa&#250;de abordados pelas quest&#245;es de QVRS s&#227;o espec&#237;ficos de cada est&#225;gio do desenvolvimento cognitivo nas crian&#231;as e pode revelar problemas que at&#233; mesmo os pais n&#227;o percebem&#46; Assim&#44; um instrumento de avalia&#231;&#227;o padronizada da QVRS seria muito &#250;til para detectar preocupa&#231;&#245;es f&#237;sicas e emocionais das perspectivas das crian&#231;as e dos cuidadores&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Para ser &#250;til na pr&#225;tica cl&#237;nica&#44; os question&#225;rios da QVRS devem atender aos seguintes crit&#233;rios&#58; a&#41; devem ser breves&#44; com confiabilidade e validade para fornecer informa&#231;&#245;es adequadas n&#227;o enviesadas&#59; b&#41; devem ser projetados para pais e filhos e f&#225;ceis de interpretar e pontuar&#59; e c&#41; devem ser sens&#237;veis a mudan&#231;as repentinas nas atitudes dos pacientes&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> A falta de um instrumento efetivo para avaliar a QVRS em crian&#231;as abaixo de 11 anos motivou Varni et al&#46; a desenvolverem o <span class="elsevierStyleItalic">Pediatric Quality of Life Inventory</span> &#40;<span class="elsevierStyleItalic">PedsQL&#8482;</span>&#41;&#44; que inclui uma escala gen&#233;rica para doen&#231;as cr&#244;nicas &#40;PedsQL&#8482; 4&#46;0 <span class="elsevierStyleItalic">Generic Core Scales</span>&#41; e uma escala espec&#237;fica para determinadas doen&#231;as&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> inclusive uma escala de QVRS para crian&#231;as e adolescentes com DM1 entre dois e 18 anos e seus pais ou cuidadores&#44; chamada de <span class="elsevierStyleItalic">Pediatric Quality of Life Inventory</span><span class="elsevierStyleSup">TM</span> 3&#46;0 <span class="elsevierStyleItalic">Diabetes Module</span> &#40;<span class="elsevierStyleItalic">PedsQL&#8482; 3&#46;0 Diabetes Module</span>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#8208;16</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Os objetivos deste estudo foram criar uma vers&#227;o traduzida em portugu&#234;s &#40;Brasil&#41; que seja conceitualmente equivalente &#224; vers&#227;o original americana<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> e de f&#225;cil entendimento e validar linguisticamente o instrumento em uma popula&#231;&#227;o pedi&#225;trica brasileira com DM1&#44; tornar poss&#237;vel a avalia&#231;&#227;o da qualidade de vida especificamente relacionada a essa doen&#231;a&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">O PedsQL&#8482; 3&#46;0 &#233; composto de question&#225;rios de autorrelato sobre qualidade de vida das crian&#231;as&#47;adolescentes nas faixas de 5&#8208;7&#44; 8&#8208;12 e 13&#8208;18 anos&#44; associados a question&#225;rios que avaliam sua qualidade de vida a partir das perspectivas dos pais&#47;cuidadores &#40;relato dos pais&#41;&#44; e esses tamb&#233;m respondem question&#225;rios sobre as crian&#231;as na faixa de 2&#8208;4 anos&#46; Cada question&#225;rio cont&#233;m 28 itens classificados em cinco dom&#237;nios ou subescalas&#44; como segue&#58; 1&#46; Sintomas de diabetes &#40;11 itens&#41;&#59; 2&#46; Barreiras ao tratamento &#40;quatro itens&#41;&#59; 3&#46; Ades&#227;o ao tratamento &#40;sete itens&#41;&#59; 4&#46; Preocupa&#231;&#227;o &#40;tr&#234;s itens&#41;&#59; e 5&#46; Comunica&#231;&#227;o &#40;tr&#234;s itens&#41;&#46; As instru&#231;&#245;es iniciais pedem que os entrevistados indiquem em que medida cada item foi problem&#225;tico durante o m&#234;s anterior em uma escala de cinco pontos &#40;0 &#61; nunca foi um problema&#59; 1 &#61; quase nunca &#233; um problema&#59; 2 &#61; &#224;s vezes &#233; um problema&#59; 3 <span class="elsevierStyleItalic">&#61;</span> normalmente &#233; um problema&#59; 4 &#61; sempre &#233; um problema&#41;&#46; Os itens foram ent&#227;o pontuados de forma reversa e transformados linearmente para uma escala Likert com intervalor de 0&#8208;100 &#40;0 &#61; 100&#44; 1 &#61; 75&#44; 2 &#61; 30&#44; 3 &#61; 25&#44; 4 &#61; 0&#41;&#44; para que os maiores escores indiquem melhor QVRS&#46; O question&#225;rio para crian&#231;as entre cinco e sete anos cont&#233;m tr&#234;s escolhas para cada item&#44; especificamente as respostas &#8220;nunca &#233; um problema para voc&#234;&#8221; &#40;0 &#61; 100&#41;&#44; &#8220;&#224;s vezes &#233; um problema para voc&#234;&#8221; &#40;2 &#61; 50&#41; e &#8220;um problema muito grande para voc&#234;&#8221; &#40;4 &#61; 0&#41; que s&#227;o associadas a uma escala facial composta de um sorriso&#44; express&#227;o normal ou rosto franzido&#44; respectivamente&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A tradu&#231;&#227;o transcultural do instrumento seguiu o m&#233;todo de tradu&#231;&#227;o e vers&#227;o<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">17&#44;18</span></a> em colabora&#231;&#227;o pr&#243;xima com o Instituto de Pesquisa Mapi em Lyon&#44; Fran&#231;a&#44; e com o consentimento do autor&#44; Dr&#46; J&#46;W&#46; Varni&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> A tradu&#231;&#227;o incluiu as seguintes fases&#58;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Fase 1</span><p id="par0040" class="elsevierStylePara elsevierViewall">As tradu&#231;&#245;es independentes da vers&#227;o original do ingl&#234;s &#40;Estados Unidos&#41; &#40;idioma de origem&#41; para portugu&#234;s &#40;Brasil&#41; &#40;idioma&#8208;alvo&#41; foram feitas por dois tradutores profissionais locais &#40;MMP e BFL&#41;&#44; cujo idioma nativo &#233; o portugu&#234;s &#40;Brasil&#41;&#46; As duas vers&#245;es foram discutidas pelos tradutores e pesquisadores para obter concord&#226;ncia em uma &#250;nica vers&#227;o do question&#225;rio&#44; que deve ser conceitualmente equivalente ao question&#225;rio original&#44; usar um idioma coloquial e simples&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Fase 2</span><p id="par0045" class="elsevierStylePara elsevierViewall">A vers&#227;o em portugu&#234;s foi ent&#227;o vertida para o ingl&#234;s &#40;Estados Unidos&#41; por um tradutor bil&#237;ngue &#40;EA&#41;&#44; cujo idioma nativo &#233; o ingl&#234;s&#46; O instrumento original foi comparado com a vers&#227;o durante uma reuni&#227;o entre o tradutor e os pesquisadores para detectar equ&#237;vocos&#44; erros de tradu&#231;&#227;o e imprecis&#245;es na vers&#227;o produzida na Fase 1&#46; Um relat&#243;rio foi enviado para o grupo&#44; liderado pelo Dr&#46; J&#46;W&#46; Varni&#44; que criou o PedsQL<span class="elsevierStyleSup">TM</span> original&#59; eles n&#227;o sugeriram altera&#231;&#227;o&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Fase 3</span><p id="par0050" class="elsevierStylePara elsevierViewall">De acordo com a entrevista cognitiva padr&#227;o do <span class="elsevierStyleItalic">PedsQL&#8482; 3&#46;0 Diabetes Module</span>&#44;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;19</span></a> a vers&#227;o traduzida foi administrada aos grupos de pacientes de cada faixa et&#225;ria e seus pais&#47;cuidadores&#46; O objetivo dessa fase foi determinar se o question&#225;rio traduzido foi aceito&#44; se usou linguagem simples&#44; foi de f&#225;cil entendimento e manteve os significados dos termos em ingl&#234;s &#40;Estados Unidos&#41;&#46; Al&#233;m disso&#44; foi determinado o tempo necess&#225;rio para conclus&#227;o do question&#225;rio&#46; As entrevistas com as crian&#231;as foram feitas separadamente &#40;em diferentes salas&#41; das de seus pais&#46; O n&#250;mero de entrevistados por faixa et&#225;ria foi 2&#8208;4 anos &#40;n &#61; 4&#41;&#44; 5&#8208;7 anos &#40;n &#61; 4&#41;&#44; 8&#8208;12 anos &#40;n &#61; 5&#41; e 13&#8208;18 anos &#40;n &#61; 5&#41;&#46; Os question&#225;rios foram respondidos em aproximadamente 15 minutos por paciente&#47;pai&#44; exceto na faixa de 5&#8208;7 anos&#44; que exigiu 15 a 20 minutos para conclus&#227;o&#46; Isso porque&#44; para cada pergunta&#44; a crian&#231;a tinha de escolher uma express&#227;o que indicasse o grau de dificuldade do respectivo item&#46; Em todas as faixas et&#225;rias&#44; os entrevistados n&#227;o sabiam o significado de &#8220;cart&#227;o de identifica&#231;&#227;o&#8221;&#44; um pequeno cart&#227;o que cont&#233;m informa&#231;&#245;es sobre o tratamento de hipoglicemia&#44; medicamentos usados&#44; n&#250;meros de emerg&#234;ncia e de &#8220;carboidrato de a&#231;&#227;o r&#225;pida&#8221; &#40;itens 5 e 6 do dom&#237;nio Ades&#227;o ao tratamento&#41;&#46; Foi produzido um relat&#243;rio em ingl&#234;s e&#44; ap&#243;s uma an&#225;lise adicional&#44; o Dr&#46; J&#46;W&#46; Varni sugeriu incluir exemplos de carboidratos de a&#231;&#227;o r&#225;pida e mostrar um cart&#227;o de identifica&#231;&#227;o&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Dessa forma&#44; a vers&#227;o final em portugu&#234;s foi a cria&#231;&#227;o e proje&#231;&#227;o do PedsQLTM 3&#46;0 M&#243;dulo Diabetes&#46; Para valid&#225;&#8208;lo &#40;Fase 4 &#8211; Teste de campo&#41;&#44; os pacientes regularmente vistos na Cl&#237;nica Ambulatorial de Diabetes do Instituto da Crian&#231;a do Hospital das Cl&#237;nicas da Faculdade de Medicina da Universidade de S&#227;o Paulo &#40;HCFMUSP&#41;&#44; Cl&#237;nica de Endocrinologia e Metabologia &#8211; Unidade de Diabetes e pr&#225;ticas privadas e tamb&#233;m pacientes que participaram voluntariamente de atividades coordenadas pela Associa&#231;&#227;o de Diabetes Juvenil &#8211; S&#227;o Paulo foram convidados a responder os question&#225;rios de agosto de 2014 a fevereiro de 2017&#46; Foram inclu&#237;dos os pacientes na faixa de 2&#8208;18 anos&#44; diagnosticados com DM1 no m&#237;nimo um ano antes do estudo e acompanhados por pelo menos um dos pais ou cuidador na consulta cl&#237;nica&#46; Os crit&#233;rios de exclus&#227;o foram presen&#231;a de comorbidades f&#237;sicas e&#47;ou mentais e necessidade de dose de insulina di&#225;ria abaixo de 9&#44;5 U&#47;kg&#47;dia&#46; Outros dados coletados inclu&#237;ram idade no diagn&#243;stico&#44; dura&#231;&#227;o do DM1 e n&#237;veis de hemoglobina glicada &#40;HbA1c&#41;&#44; que foram quantificados com o m&#233;todo CLAE Variant II &#40;Bio&#8208;Rad&#174;&#44; SP&#44; Brasil&#41; no momento em que o instrumento foi administrado&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Os question&#225;rios foram respondidos pelas crian&#231;as&#47;adolescentes e seus pais&#47;cuidadores separadamente no dia de uma consulta m&#233;dica &#40;fase de teste&#41; e readministrados ap&#243;s um intervalo de 15 dias a tr&#234;s meses &#40;fase de reteste&#41;&#46; O pesquisador administrou pessoalmente os question&#225;rios nas crian&#231;as na faixa de 5&#8208;7 anos e em indiv&#237;duos analfabetos&#44; ao passo que as crian&#231;as com mais de oito anos&#44; adolescentes e adultos responderam o question&#225;rio na sala de espera&#44; sem interfer&#234;ncia do pesquisador&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A confiabilidade da vers&#227;o brasileira foi avaliada com as an&#225;lises de consist&#234;ncia interna&#44; confiabilidade entre os observadores &#40;teste&#8208;reteste&#41; e validade concorrente&#44; que foi avaliada por meio de&#58; a&#41; associa&#231;&#245;es entre os escores desse instrumento e das de um question&#225;rio gen&#233;rico de qualidade de vida pedi&#225;trica anteriormente traduzido e validado no Brasil &#91;PedsQL<span class="elsevierStyleSup">TM</span> Question&#225;rio pedi&#225;trico sobre qualidade de vida Vers&#227;o 4&#46;0 &#8211; Portugu&#234;s &#40;Brasil&#41;&#93;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&#59; b&#41; correla&#231;&#227;o entre o escore total do PedsQL&#8482; 3&#46;0 e os n&#237;veis de HbA1c dos pacientes&#59; e c&#41; correla&#231;&#245;es entre os escores obtidos no autorrelato dos pacientes &#40;5&#8208;18 anos&#41; e as escalas de relato dos pais&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pelo Comit&#234; de &#201;tica para a An&#225;lise de Projetos de Pesquisa &#40;n&#176; 555659&#41;&#46; Os pacientes e seus parentes&#47;cuidadores foram informados sobre os objetivos do estudo e pedimos que eles lessem e assinassem os formul&#225;rios de consentimento informado&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lise estat&#237;stica</span><p id="par0075" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica descritiva foi usada para caracteriza&#231;&#227;o cl&#237;nica e laboratorial dos pacientes e para an&#225;lise do escore total no PedsQL&#8482; 3&#46;0 e suas subescalas&#46; A consist&#234;ncia interna &#40;correla&#231;&#227;o entre itens&#41; foi avaliada com o coeficiente alfa de Cronbach&#58;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> um valor alfa &#62; 0&#44;7 &#233; aceit&#225;vel&#44; um valor alfa &#62; 0&#44;81 &#233; bom e um valor alfa &#62; 0&#44;91 &#233; excelente&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> As escalas de confiabilidade &#8805; 0&#44;70 s&#227;o recomendadas para compara&#231;&#245;es entre os grupos de pacientes&#44; ao passo que aquelas com crit&#233;rio de confiabilidade de 0&#44;90 s&#227;o recomendadas para an&#225;lise dos escores dos pacientes individuais&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12&#44;13&#44;22</span></a> A confiabilidade entre os observadores e a validade concorrente foram avaliadas com o teste de correla&#231;&#227;o de Pearson&#46; O grau de correla&#231;&#227;o &#40;r&#41; entre as vari&#225;veis foi designado como pequeno &#40;0&#44;3&#8208;0&#44;49&#41;&#44; m&#233;dio &#40;0&#44;5&#8208;0&#44;7&#41; ou grande &#40;&#62; 0&#44;7&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> Todas as an&#225;lises foram feitas com o Pacote Estat&#237;stico para as Ci&#234;ncias Sociais &#40;SPSS&#41; &#40;IBM SPSS Estat&#237;stica para Windows&#44; Vers&#227;o 20&#46;0&#46; NY&#44; EUA&#41;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> e o n&#237;vel de relev&#226;ncia estat&#237;stica adotado foi p &#60; 0&#44;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Dos 127 participantes eleg&#237;veis&#44; 83 pacientes &#40;5&#8208;18 anos&#41; e 108 pais&#47;cuidadores &#40;2&#8208;18 anos&#41; responderam todas as perguntas do instrumento nas fases de teste e reteste&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> mostra a distribui&#231;&#227;o da popula&#231;&#227;o estudada&#44; de acordo com a faixa et&#225;ria&#44; caracter&#237;sticas cl&#237;nicas e n&#237;vel m&#233;dio de HbA1c&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Entre os pais&#47;cuidadores que preencheram o instrumento &#40;n &#61; 108&#41;&#44; 34&#44;3&#37; estavam na faixa de 31&#8208;40 anos e 31&#44;5&#37; estavam na faixa de 41&#8208;50 anos&#46; A m&#227;es foram predominantes &#40;88&#44;9&#37;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">As an&#225;lises descritivas do escore total e escores das subescalas do &#40;fases de teste&#8208;reteste&#41; e do PedsQL<span class="elsevierStyleSup">TM</span> Question&#225;rio pedi&#225;trico sobre qualidade de vida Vers&#227;o 4&#46;0 &#8211; Portugu&#234;s &#40;Brasil&#41; da popula&#231;&#227;o estudada s&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Confiabilidade de consist&#234;ncia interna</span><p id="par0095" class="elsevierStylePara elsevierViewall">O coeficiente alfa de Cronbach do PedsQL<span class="elsevierStyleSup">TM</span> 3&#46;0 M&#243;dulo Diabetes traduzido na &#237;ntegra foi 0&#44;85 para crian&#231;as&#47;adolescentes e 0&#44;82 para seus pais&#47;cuidadores &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Em uma an&#225;lise separada das subescalas&#44; foram obtidos os seguintes coeficientes&#58; sintomas de diabetes &#40;&#945;<span class="elsevierStyleInf">crian&#231;as</span> &#61; 0&#44;76&#59; &#945;<span class="elsevierStyleInf">pais</span> &#61; 0&#44;77&#41;&#59; preocupa&#231;&#227;o &#40;&#945;<span class="elsevierStyleInf">crian&#231;as</span> &#61; 0&#44;72&#59; &#945;<span class="elsevierStyleInf">pais</span> 0&#44;82&#41;&#59; comunica&#231;&#227;o &#40;&#945;<span class="elsevierStyleInf">crian&#231;as</span> &#61; 0&#44;79&#59; &#945;<span class="elsevierStyleInf">pais</span> &#61; 0&#44;82&#41;&#59; ades&#227;o ao tratamento &#40;&#945;<span class="elsevierStyleInf">crian&#231;as</span> &#61; 0&#44;71&#59; &#945;<span class="elsevierStyleInf">pais</span> &#61; 0&#44;68&#41;&#59; e barreiras ao tratamento &#40;&#945;<span class="elsevierStyleInf">crian&#231;as</span> &#61; 0&#44;58&#59; &#945;<span class="elsevierStyleInf">pais</span> &#61; 0&#44;54&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confiabilidade entre observadores</span><p id="par0100" class="elsevierStylePara elsevierViewall">Durante as fases de teste e reteste &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#44; para o grupo de pais&#47;cuidadores &#40;2&#8208;4 anos&#41;&#44; houve uma correla&#231;&#227;o significativa entre os escores totais &#40;r &#61; 0&#44;72&#59; p &#60; 0&#44;001&#41; e todos os escores das subescalas &#40;r &#61; 0&#44;62&#8208;0&#44;83&#59; p &#60; 0&#44;001&#41;&#44; exceto no dom&#237;nio comunica&#231;&#227;o &#40;r &#61; 0&#44;28&#59; p &#61; 0&#44;180&#41;&#44; ao passo que os na faixa de 5&#8208;18 anos apresentaram uma correla&#231;&#227;o positiva &#40;0&#44;52&#8208;0&#44;71&#59; p &#60; 0&#44;001&#41; entre todos os escores&#46; Houve ainda uma correla&#231;&#227;o positiva entre as escalas de autorrelato dos pacientes &#40;0&#44;52&#8208;0&#44;61&#59; p &#60; 0&#44;001&#41; nas duas fases&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Validade concorrente</span><p id="par0105" class="elsevierStylePara elsevierViewall">Em compara&#231;&#227;o com os escores totais no PedsQL&#8482; 3&#46;0 e PedsQL<span class="elsevierStyleSup">TM</span> Question&#225;rio pedi&#225;trico sobre qualidade de vida Vers&#227;o 4&#46;0 &#8211; Portugu&#234;s &#40;Brasil&#41;&#44; foi observada uma correla&#231;&#227;o positiva significativa entre as escalas de relato dos pais das crian&#231;as na faixa de 2&#8208;4 e 5&#8208;18 anos &#40;r &#61; 0&#44;48 e 0&#44;55&#44; respectivamente&#59; p &#61; 0&#44;016 e p &#60; 0&#44;001&#41;&#44; bem como entre as escalas de autorrelato dos pacientes &#40;r &#61; 0&#44;56&#59; p &#60; 0&#44;001&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Houve uma correla&#231;&#227;o positiva significativa entre os escores totais das escalas de relato dos pais e do autorrelato dos pacientes &#40;5&#8208;18 anos&#41; &#40;r &#61; 0&#44;40&#59; p &#60; 0&#44;001&#41; e nas subescalas sintomas de diabetes &#40;r &#61; 0&#44;43&#59; p &#60; 0&#44;001&#41;&#44; barreiras de tratamento &#40;r &#61; 0&#44;38&#59; p &#60; 0&#44;001&#41; e comunica&#231;&#227;o &#40;r &#61; 0&#44;42&#59; p &#60; 0&#44;001&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Por outro lado&#44; nessa amostra populacional&#44; n&#227;o houve correla&#231;&#227;o significativa entre o controle glic&#234;mico&#44; com base no n&#237;vel de HbA1c&#44; e os escores totais obtidos nos relatos dos pais&#8208;crian&#231;as &#40;r &#61; &#8208;0&#44;08 a &#8208;0&#44;23&#59; p &#62; 0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#8208;C&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discuss&#227;o</span><p id="par0120" class="elsevierStylePara elsevierViewall">Ap&#243;s as mudan&#231;as feitas na segunda vers&#227;o traduzida do <span class="elsevierStyleItalic">PedsQL&#8482; 3&#46;0 Diabetes Module</span>&#44; o novo instrumento&#44; agora chamado PedsQL<span class="elsevierStyleSup">TM</span> 3&#46;0 M&#243;dulo Diabetes&#44; mostrou linguagem simples e foi facilmente entendido pela popula&#231;&#227;o estudada&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Os escores obtidos por nossa amostra de crian&#231;as e adolescentes brasileiros com DM1 foram menores do que os obtidos em estudos no Kuwait&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> na It&#225;lia<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> e na Gr&#233;cia<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> e semelhantes aos obtidos em um estudo no Ir&#227;&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Adicionalmente&#44; o escore total nos question&#225;rios respondidos pelos pais&#47;cuidadores foi menor do que nos question&#225;rios respondidos pelas crian&#231;as&#47;adolescentes&#44; conforme tamb&#233;m observado em outros estudos&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;25</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">A confiabilidade interna da escala total do question&#225;rio traduzido &#40;&#945;<span class="elsevierStyleInf">crian&#231;as</span> &#61; 0&#44;85&#59; &#945;<span class="elsevierStyleInf">pais</span> &#61; 0&#44;82&#41; ficou acima do m&#237;nimo recomendado &#40;&#945; &#61; 0&#44;70&#41; para compara&#231;&#227;o entre os grupos<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;22</span></a> e ultrapassou os valores encontrados nas vers&#245;es grega&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> italiana<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> e ar&#225;bica&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> Na an&#225;lise de cada subescala individualmente&#44; os dom&#237;nios ades&#227;o ao tratamento &#40;&#945; &#61; 0&#44;71&#41; e preocupa&#231;&#227;o &#40;&#945; &#61; 0&#44;72&#41; nos question&#225;rios para crian&#231;as&#47;adolescentes &#40;5&#8208;18 anos&#41; mostraram coeficientes maiores do que os dom&#237;nios nas vers&#245;es americana<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> e italiana<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> originais&#46; Contudo&#44; os dom&#237;nios barreiras ao tratamento nos dois question&#225;rios e ades&#227;o ao tratamento no question&#225;rio dos pais mostraram coeficientes abaixo de 0&#44;70&#44; o que sugere que a validade do intervalo do <span class="elsevierStyleItalic">PedsQL</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">TM</span></span><span class="elsevierStyleItalic">3&#46;0 Diabetes Module</span> depende de sua totalidade&#44; n&#227;o possibilita&#44; assim&#44; uma aplica&#231;&#227;o fragmentada de suas subescalas&#46; Essa tend&#234;ncia tamb&#233;m foi observada na vers&#227;o original<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> e nas tradu&#231;&#245;es grega&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> italiana<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> e persa&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">A confiabilidade entre os observadores foi moderada em todas as faixas et&#225;rias&#46; Os resultados sugerem uma estimativa da confiabilidade adequada do instrumento traduzido&#44; mesmo que seja destacado que esse achado pode ter sido influenciado por fatores externos&#44; como vari&#225;veis relacionadas &#224; doen&#231;a em si e seu tratamento&#44; bem como as condi&#231;&#245;es socioecon&#244;micas e culturais da popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;20</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">No processo de valida&#231;&#227;o concorrente&#44; houve uma correla&#231;&#227;o pequena a m&#233;dia entre o PedsQL<span class="elsevierStyleSup">TM</span> 3&#46;0 M&#243;dulo Diabetes e o question&#225;rio gen&#233;rico&#44; conforme tamb&#233;m observado em outras vers&#245;es&#44;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;25</span></a> exceto a vers&#227;o original americana&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> Apesar de os dois question&#225;rios avaliarem o constructo &#8220;qualidade de vida&#8221;&#44; seus itens abordam diferentes contextos da doen&#231;a cr&#244;nica&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Em especial&#44; o instrumento gen&#233;rico foca na capacidade f&#237;sica e no funcionamento escolar&#44; que normalmente n&#227;o apresenta problemas para crian&#231;as e adolescentes com DM1&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">No presente estudo&#44; houve uma pequena associa&#231;&#227;o positiva entre as escalas de autorrelato dos pacientes e relato dos pais para os dois escores totais &#40;r &#61; 0&#44;40&#41; e a maior parte escores das subescalas &#40;sintomas de diabetes&#44; barreiras ao tratamento e comunica&#231;&#227;o&#44; r &#61; 0&#44;38&#8208;0&#44;43&#41;&#46; A vers&#227;o original do instrumento<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> &#40;r &#61; 0&#44;28&#8208;0&#44;47&#41; e as vers&#245;es italiana<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> &#40;r &#61; 0&#44;28&#8208;0&#44;54&#41; e grega<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> &#40;r &#61; 0&#44;47&#8208;0&#44;62&#41; mostraram correla&#231;&#245;es m&#233;dias na maior parte dos dom&#237;nios&#46; Essas varia&#231;&#245;es corroboram a import&#226;ncia de n&#227;o apenas avaliar as perspectivas das crian&#231;as&#47;adolescentes&#44; mas tamb&#233;m das de seus respectivos pais&#47;cuidadores&#44; pois&#44; mesmo se diferentes&#44; elas representam aspectos adicionais da avalia&#231;&#227;o da QVRS pedi&#225;trica&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;16</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Apesar de correla&#231;&#245;es negativas de baixa e m&#233;dia intensidade terem sido observadas entre HbA1c e a vers&#227;o original americana do question&#225;rio&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> outros estudos&#44; como o nosso&#44; n&#227;o encontraram essa associa&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Em geral&#44; os escores de qualidade de vida tendem a estar correlacionados de forma modesta aos resultados cl&#237;nicos&#44; sugerem que os resultados cl&#237;nicos e humanos s&#227;o relativamente independentes&#44; ou seja&#44; eles medem dom&#237;nios diferentes e provavelmente complementares&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Por sua vez&#44; os resultados de estudos rec&#233;m&#8208;publicados<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a> sugerem que um melhor controle metab&#243;lico est&#225; associado a melhor QVRS em crian&#231;as e adolescentes com DM1&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Os principais pontos fortes deste estudo s&#227;o a inclus&#227;o de crian&#231;as e adolescentes na faixa de dois a 18 anos&#44; a confirma&#231;&#227;o da confiabilidade interna da vers&#227;o traduzida&#44; a correla&#231;&#227;o positiva com outro question&#225;rio j&#225; validado para o Brasil e&#44; por fim&#44; o fato de ser o primeiro instrumento que pode ser usado para avaliar a QVRS especificamente em uma popula&#231;&#227;o pedi&#225;trica &#40;dois a 18 anos&#41; com MD1 no idioma portugu&#234;s &#40;Brasil&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Contudo&#44; algumas limita&#231;&#245;es do estudo devem ser mencionadas&#58; o tamanho relativamente pequeno da amostra&#44; o uso predominante de um &#250;nico centro terci&#225;rio e a falta de uma an&#225;lise de fatores que possibilitaria uma avalia&#231;&#227;o de se todos os itens do instrumento medem uma &#250;nica dimens&#227;o&#46; Por outro lado&#44; o estudo de valida&#231;&#227;o original<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> e os das vers&#245;es em outros idiomas<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;25&#44;26</span></a> inclu&#237;ram um n&#250;mero semelhante de pacientes&#44; conforme este estudo&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; constatou&#8208;se que o PedsQL<span class="elsevierStyleSup">TM</span> 3&#46;0 M&#243;dulo Diabetes foi facilmente entendido e rapidamente respondido pelas crian&#231;as e adolescentes em uma ampla faixa et&#225;ria&#46; O c&#225;lculo dos escores pelo pesquisador tamb&#233;m foi simples&#44; o que facilitou seu uso na pesquisa cl&#237;nica&#46; O grupo de pais e cuidadores viu o instrumento como uma importante forma de expressar suas preocupa&#231;&#245;es e necessidades com rela&#231;&#227;o &#224; doen&#231;a cr&#244;nica de seus filhos&#46; As an&#225;lises feitas confirmaram que o instrumento tem propriedades psicom&#233;tricas necess&#225;rias para a confiabilidade e validade e&#44; assim&#44; &#233; aplic&#225;vel em crian&#231;as&#47;adolescentes brasileiros com DM1 e seus cuidadores&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflitos de interesse</span><p id="par0170" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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            1 => "Qualidade de vida"
            2 => "<span class="elsevierStyleItalic">Diabetes mellitus</span> tipo 1"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of the present study was to create a translated version of the Pediatric Quality of Life Inventory&#8482; 3&#46;0 Diabetes Module &#40;PedsQL&#8482; 3&#46;0 Diabetes Module&#41; in Brazilian Portuguese that was conceptually equivalent to the original American English version and to linguistically validate it in a Brazilian pediatric population with type 1 diabetes mellitus and their parents or caregivers&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The instrument was translated&#44; back&#8208;translated&#44; and then administered to 83 children&#47;adolescents &#40;5&#8211;18 years&#41; with type 1 diabetes mellitus and their family members and to 25 parents&#47;caregivers of patients aged between 2 and 4 years&#46; The final translated version was tested for reliability by analyzing internal consistency&#44; intraobserver &#40;test&#8211;retest&#41; reliability&#44; and concurrent validity&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cronbach&#39;s alpha coefficient for the total score of the questionnaires of children&#47;adolescents &#40;<span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;85&#41; and their parents &#40;<span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;82&#41; was above the recommended minimum of 0&#46;70 for group comparisons&#46; Intraobserver reliability and concurrent validity exhibited a significant positive correlation &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; indicating the reliability of the translated instrument&#46; A moderate but significant positive correlation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;40&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; was demonstrated between the total scores of patient self&#8208;report and parent proxy&#8208;report scales&#46; There was no significant correlation between glycated hemoglobin &#40;HbA1c&#41; levels and the respective scores in the questionnaires answered by patients and their parents&#47;caregivers&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The analysis of the translated version of the PedsQL&#8482; 3&#46;0 Diabetes Module revealed adequate psychometric characteristics with respect to reliability and validity following administration to a sample of Brazilian children&#47;adolescents with type 1 diabetes mellitus and their caregivers&#46;</p></span>"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Produzir uma vers&#227;o do question&#225;rio <span class="elsevierStyleItalic">Pediatric Quality of Life Inventory</span>&#8482; <span class="elsevierStyleItalic">3&#46;0 Diabetes Module</span> &#40;<span class="elsevierStyleItalic">PedsQL&#8482; 3&#46;0 Diabetes Module</span>&#41; para a l&#237;ngua portuguesa do Brasil&#44; que fosse conceitualmente equivalente &#224; vers&#227;o original em ingl&#234;s&#44; e proceder &#224; sua valida&#231;&#227;o lingu&#237;stica numa popula&#231;&#227;o pedi&#225;trica brasileira portadora de <span class="elsevierStyleItalic">diabetes mellitus</span> tipo 1 &#40;DM1&#41; e seus pais ou cuidadores&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A tradu&#231;&#227;o do instrumento foi feita pela metodologia de tradu&#231;&#227;o&#8208;tradu&#231;&#227;o reversa&#44; foi aplicado a 83 crian&#231;as&#47;adolescentes &#40;5&#8208;18 anos&#41; portadores de <span class="elsevierStyleItalic">diabetes mellitus</span> tipo 1 com seus parentes e a 25 pais&#47;cuidadores de pacientes entre 2 e 4 anos de idade&#46; A confiabilidade da vers&#227;o traduzida foi avaliada pelas seguintes an&#225;lises&#58; consist&#234;ncia interna&#44; confiabilidade teste&#8208;reteste e validade concorrente&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O coeficiente alfa de Cronbach para a pontua&#231;&#227;o total do question&#225;rio das crian&#231;as&#47;adolescentes &#40;&#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;85&#41; e seus pais &#40;&#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;82&#41; excedeu o m&#237;nimo recomendado 0&#44;70 para compara&#231;&#227;o entre grupos&#46; Na confiabilidade intraobservador e validade concorrente observou&#8208;se correla&#231;&#227;o positiva e estatisticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; indicou a fidedignidade do instrumento traduzido&#46; Na compara&#231;&#227;o entre os escores totais obtidos por pais&#47;cuidadores e crian&#231;as&#47;adolescentes&#44; houve uma correla&#231;&#227;o positiva&#44; pequena&#44; mas significativa &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;40&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; N&#227;o houve correla&#231;&#245;es estatisticamente significativas entre os n&#237;veis de hemoglobina glicada e os escores obtidos nos question&#225;rios respondidos pelos pacientes e seus pais&#47;cuidadores&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">As an&#225;lises do instrumento PedsQL&#8482; 3&#46;0 M&#243;dulo Diabetes demonstraram propriedades psicom&#233;tricas adequadas em termos de confiabilidade e validade quando aplicado nessa amostra de crian&#231;as&#47;adolescentes brasileiros portadores de DM tipo 1 e seus cuidadores&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Como citar este artigo&#58; Garcia LF&#44; Manna TD&#44; Passone CG&#44; Oliveira LS&#46; Translation and validation of Pediatric Quality of Life Inventory&#8482; 3&#46;0 Diabetes Module &#40;PedsQL&#8482; 3&#46;0 Diabetes Module&#41; in Brazil&#8208;Portuguese language&#46; J Pediatr &#40;Rio J&#41;&#46; 2018&#59;94&#58;680&#8211;8&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Trabalho apresentado na Universidade de S&#227;o Paulo &#40;USP&#41;&#44; Faculdade de Medicina&#44; S&#227;o Paulo&#44; SP&#44; Brasil&#59; para obten&#231;&#227;o de mestrado em um Programa de Pediatria&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1118
            "Ancho" => 3535
            "Tamanyo" => 179636
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Correla&#231;&#227;o entre o escore total do PedsQL<span class="elsevierStyleSup">TM</span> M&#243;dulo Diabetes e HbA1c na popula&#231;&#227;o estudada&#58; A&#41; crian&#231;as&#47;adolescentes &#40;5&#8208;18 anos&#41;&#59; B&#41; pais&#47;cuidadores &#40;2&#8208;4 anos&#41;&#59; C&#41; pais&#47;cuidadores &#40;5&#8208;18 anos&#41;&#46;</p>"
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        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas da popula&#231;&#227;o estudada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexo &#40;Feminino&#47;Masculino&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#47;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Faixa et&#225;ria</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#8208;4 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#8208;7 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>8&#8208;12 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>13&#8208;18 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Idade no acometimento de diabetes &#40;anos&#41; &#40;m&#233;dia</span> &#177; DP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;40&#177;3&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Dura&#231;&#227;o do diabetes &#40;anos&#41;</span> &#40;m&#233;dia &#177; DP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;14&#177;4&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">HbA1c</span> &#40;m&#233;dia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#8208;4 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#8208;7 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>8&#8208;12 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>13&#8208;18 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Lacuna temporal entre teste e reteste &#40;dias&#41;</span> &#40;m&#233;dia &#177; DP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#44;68&#177;19&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>15&#8208;45 dias &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>46&#8208;75 dias &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>76&#8208;90 dias &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
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        "descripcion" => array:1 [
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        ]
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Escala&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&#233;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&#237;nimo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&#225;ximo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&#233;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&#237;nimo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&#225;ximo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleBold">PedsQL</span><span class="elsevierStyleSup"><span class="elsevierStyleBold">TM</span></span><span class="elsevierStyleBold">3&#46;0 M&#243;dulo Diabetes</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Autorrelato da crian&#231;as</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sintomas de diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Barreiras ao tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ades&#227;o ao tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Preocupa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Comunica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Escore total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Relato dos pais</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sintomas de diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Barreiras ao tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ades&#227;o ao tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Preocupa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Comunica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Escore total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleBold">PedsQL</span><span class="elsevierStyleSup"><span class="elsevierStyleBold">TM</span></span><span class="elsevierStyleBold">Question&#225;rio pedi&#225;trico sobre qualidade de vida vers&#227;o 4&#46;0 &#8211; Portugu&#234;s &#40;Brasil&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Autorrelato da crian&#231;as</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sa&#250;de f&#237;sica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Funcionamento emocional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Funcionamento social&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Funcionamento escolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Escore total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#44;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Relato dos pais</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sa&#250;de f&#237;sica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Funcionamento emocional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Funcionamento social&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Funcionamento escolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Escore total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">An&#225;lises descritivas das escalas do PedsQL<span class="elsevierStyleSup">TM</span> 3&#46;0 M&#243;dulo Diabetes &#40;fases de teste&#8208;reteste&#41; e do PedsQL<span class="elsevierStyleSup">TM</span> Question&#225;rio pedi&#225;trico sobre qualidade de vida vers&#227;o 4&#46;0 &#8211; Portugu&#234;s &#40;Brasil&#41; na amostra estudada</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">&#945;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Autorrelato das crian&#231;as &#40;5&#8208;18 anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sintomas de diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Barreiras ao tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ades&#227;o ao tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Preocupa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Comunica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Relato dos pais &#40;2&#8208;4 anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sintomas de diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Barreiras ao tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ades&#227;o ao tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Preocupa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Comunica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Escore total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Preocupa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Comunica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;66&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Relato dos pais &#40;2&#8208;18 anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sintomas de diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Comunica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Escore total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  """
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          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Consist&#234;ncia interna &#40;coeficiente alfa de Cronbach&#41; e correla&#231;&#227;o entre as fases de teste&#8208;reteste para o PedsQL<span class="elsevierStyleSup">TM</span> 3&#46;0 M&#243;dulo Diabetes de pais&#47;cuidadores &#40;2&#8208;18 anos&#41; e crian&#231;as&#47;adolescentes &#40;5&#8208;18 anos&#41;</p>"
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      "titulo" => "Refer&#234;ncias"
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        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0155"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                            1 => "L&#46; Guariguata"
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                  "host" => array:1 [
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                      "doi" => "10.1016/j.diabres.2013.11.005"
                      "Revista" => array:6 [
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                        "volumen" => "103"
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            1 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of intensive treatment of diabetes on the development and progression of long&#8208;term complications in insulin&#8208;dependent diabetes mellitus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            3 => "J&#46; Lachin"
                            4 => "P&#46; Cleary"
                            5 => "O&#46; Crofford"
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                  "host" => array:1 [
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                      "titulo" => "Diabetes Control and Complications Trial &#40;DCCT&#41;&#47;Epidemiology of Diabetes Interventions and Complications &#40;EDIC&#41; Research Group&#46; Beneficial effects of intensive therapy of diabetes during adolescence&#58; outcomes after the conclusion of the diabetes control and complications trial &#40;DCCT&#41;"
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                            3 => "D&#46; Goldstein"
                            4 => "J&#46; Malone"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Rewers"
                            1 => "K&#46; Pillay"
                            2 => "C&#46; de Beaufort"
                            3 => "M&#46;E&#46; Craig"
                            4 => "R&#46; Hanas"
                            5 => "C&#46;L&#46; Acerini"
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                      "doi" => "10.1111/pedi.12190"
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                        "paginaFinal" => "114"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25182311"
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                  "contribucion" => array:1 [
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                      "titulo" => "11&#46; Children and adolescents"
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                            0 => "American Diabetes Association"
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                      "doi" => "10.2337/dc16-S014"
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                        "tituloSerie" => "Diabetes Care"
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                        "paginaInicial" => "S86"
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                      "titulo" => "Metabolic control and quality of life self&#8208;assessment in adolescents with IDDM"
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                          "etal" => false
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                        "tituloSerie" => "Diabetes Care"
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                      "titulo" => "Coping&#44; self&#8208;management and adaptation in adolescents with type 1 diabetes"
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                            2 => "R&#46; Whittemore"
                            3 => "S&#46; Jeon"
                            4 => "K&#46; Murphy"
                            5 => "A&#46; Delamater"
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