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To identify existing controversies in the routine management of patients with T2D and to contrast them with the latest scientific evidence and clinical guidelines, in order to help optimize and homogenize the treatment of patients with T2D in Primary Care (PC) in Spain.240 family doctors responded to an online questionnaire about the management of 6 patient profiles with T2D of increasing complexity.The main drivers for the antihyperglycemic treatment choice are an HbA1c10% and the presence of cardiovascular disease (CVD), although in evolved patients, the estimated glomerular filtration rate and the risk of hypoglycemia become more relevant. In newly diagnosed patients with an HbA1c9%, treatment is still initiated with monotherapy (24%). In patients not controlled with metformin, dipeptidyl peptidase 4 inhibitors (DPP4-I, 54%) or sodium-glucose cotransporter 2 inhibitors (SGLT2-I, 39%) are usually added. On the other hand, type1 glucagon-like peptide receptor agonists (GLP1-RA) are mainly associated with obese patients with T2D. In patients not controlled with metformin+sulfonylurea (SU), SU replacement is preferred to adding a third antihyperglycemic agent to background therapy (77% vs. 23%).T2D treatment in PC is still focused on HbA1c reduction and treatment safety. Thus, DPP4-I are widely used. SGLT2-I are usually preferred for patients with T2D and CVD and GLP1-RA for patients with T2D and obesity, although their use in PC is low.

IntroductionLarge granular lymphocyte (LGL) leukaemia is considered a mature T-cell or natural killer (NK) cell neoplasm, characterised by a clonal proliferation of LGL.AimsTo analyse the characteristics and to establish (if possible) the prognostic parameters of these patients diagnosed in a single centre: University Hospital of Donostia.MethodsWe retrospectively studied data about 308 patients with LGL leukaemia diagnosed in our centre.ResultsThe frequency of T-LGL leukaemia and chronic lymphoproliferative disorder of NK cells was 89% and 6.8% respectively, and no aggressive NK-LGL leukaemia was seen in our population. The median age at diagnosis was 65.7 years and male-to-female ratio was 1.08. 59% of our patients were asymptomatic at the time of diagnosis. Most patients presented lymphocytosis and 63.6% more than 20% LGLs in the peripheral blood count, but it has to be taken into account that these results may be influenced by the selection bias of our study, as we recognised these patients as ‘alarms of the laboratory analysers’. Neutropenia was the most common cytopenia, and autoimmune disorders were described in 16.5% of the patients. Only 12 patients (3.9%) required treatment, a much lower percentage that the one reported in the literature, and this is consistent with the fact that patients were less symptomatic than in other series, as we expected. The 5-year and 15-year overall survival was 92% and 87%, respectively.ConclusionsOur patients may represent the even more benign end of the spectrum of clonal T LGL and NK proliferations.

Decades of research have established that racial ethnic minority, low-income, and/or non-English speaking children with autism spectrum disorder (ASD) are diagnosed later than white children, and their families experience greater difficulty accessing services in the USA. Delayed access to timely diagnosis and early intervention may impact child outcomes and family quality of life. Despite their cognition of these disparities and their significant impact on the lives of those affected, explanations for the barriers experienced by underserved families are elusive, likely due to the complex interaction between structural and family factors. This study used qualitative methods to gather family and provider perspectives of perceived barriers and facilitators to obtaining an ASD diagnosis and accessing ASD-related services for underserved families. Themes from focus groups and interviews with families from three cultural groups (black, Hispanic/Latino, and Korean) and three primary languages (English, Korean, and Spanish) highlight specific barriers related to family, community, and systemic challenges as well as facilitators to accessing care for these populations. Family experiences are expanded upon with viewpoints from the providers who work with them. Recommendations are made for reducing disparities in the existing ASD service system including increasing professional, family, and community education; increasing culturally responsive care; improving provider-family partnerships; and addressing practical challenges to service access.

research-article2017 AUT0010.1177/1362361317692950AutismEditorial Editorial Toward a more collaborative research culture: Extending translational science from research to community and back again Rigorous research addressing complicated questions tradi- tionally requires controlled and complex scientific infra- structure with a strong emphasis on internal validity. This research often is conducted uni-directionally (from researcher to communities) and yields results years after the study starts (Bohland et al., 2009; Fiks et al., 2015; Landsverk et al., 2011). In many ways, this method is anti- thetical to rapid discoveries that are valid and meaningful for families and other community stakeholders (Pellicano et al., 2014; Stadnick et al., 2013). Autism research, like other areas of science, has typi- cally followed this traditional, unidirectional research pipe- line from basic science to intervention development, then to efficacy research, and finally to attempts at dissemina- tion and implementation (see the black shapes in Figure 1 adapted from Landsverk et al., 2011). This often slow pro- cess has led community stakeholders to criticize scientists for conducting fragmented research that is disconnected from the community needs. This criticism has led to recom- mendations for a more comprehensive research plan that integrates stakeholders at all phases of inquiry to ensure goals from basic science to implementation stages are uni- fied and meaningful to the community. Specifically, there have been calls for bi-directional knowledge exchange that involves active collaboration and partnership between researchers and community stakeholders at both basic and applied levels (Addis, 2002; Beutler et al., 1995; Wells et al., 2004). One promising method of ensuring the rele- vance of research to all stakeholders, expediting translation to community settings, and increasing innovation at all lev- els of science is through the use of participatory or collabo- rative models between researchers and stakeholders (Brookman-Frazee et al., 2012a). Treatment researchers in autism spectrum disorder (ASD) have begun to use community-based participatory research strategies to facilitate effective use of evidence- based interventions in community service settings (Brookman-Frazee et al., 2015; Drahota et al., 2016). Examples of this type of research can be seen in early inter- vention (Stahmer et al., 2016), schools (Locke et al., 2014; Mandell, 2016; Stahmer et al., 2012), and community men- tal and behavioral health settings (Brookman-Frazee et al., 2012a; Drahota et al., 2012). These projects have relied on bi-directional collaboration between applied researchers Autism 2017, Vol. 21(3) 259­–261 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav https://doi.org/10.1177/1362361317692950 DOI: journals.sagepub.com/home/aut Figure 1. Traditional research pipeline with recommended stakeholder collaboration. and community stakeholders to adapt intervention and training methods to increase effective implementation and sustainment of evidence-based strategies in the community. By utilizing methods that facilitate the collaboration between community and academic partners (Drahota et al., 2016), these projects have been highly productive in terms of building community capacity for effective services and improving clinical outcomes. However, these methods have, thus far, been limited primarily to intervention trans- lation and have not been used further up the research pipe- line in basic research. Some first steps are being made in animal model research, where basic researchers have started to collabo- rate with clinical experts in autism to develop mouse behavioral assays relevant to human behavior (Crawley, 2007). Similarly, basic science results are being interpreted for clinical relevance (Kim et al., 2016). This work has been conducted with applied researchers translating rele- vant clinical information for basic scientists. Some early collaborative efforts have also led to promising methods of measuring child-level brain-related outcomes that may offer innovative ways to detect intervention effects that may not be detected by standard behavioral measurements

a b s t r a c t Objectives: To analyze the factorial structure of a new instrument to assess the quality of the family context (Etxadi-Gangoiti Scale) in a sample from the Gipuzkoa cohort of the Environment and Childhood (Infancia y Medio Ambiente (INMA)) study. Methods: Families in a sample of 433 two-year-old children were assessed in a home visit with subsequent analysis of the factorial structure and psychometric properties of the data. Results: An exploratory factorial analysis (principal axis factoring and varimax rotation) and a con“rm- atory factorial analysis were carried out; partial con“rmation of the original factorial structure of the instrument was obtained, which revealed the following factorial structures. Subscale (1): promotion of cognitive and linguistic development, social skills, psychomotor skills, and pretend play and imita- tion; subscale (2): promotion of independence and self-esteem, provision of optimal frustration, social and emotional quality of the relationship, and absence of physical punishment; subscale (3): paternal involvement, low exposure to family con”ict, low frequency of family con”ict, relationship with the extended family, social support, diversity of experiences, low frequency of stressful events, and low parental perception of stress. Discussion: The structure of the original instrument structure was partially con“rmed, which was attributed to the characteristics of the sample. We stress the importance of the variability obtained in the evaluation of the families, as well as of adequate indicators of reliability in such evaluation. The new instrument could be used in public health to identify de“cient family contexts and to design preventive interventions focused on parenting skills.

Background: Prenatal exposure to air pollutants has recently been identified as a potential risk factor for neuropsychological impairment. Objectives: To assess whether prenatal exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2) and benzene were associated with impaired development in infants during their second year of life. Methods: Regression analyses, based on 438 mother–child pairs, were performed to estimate the association between mother exposure to air pollutants during pregnancy and neurodevelopment of the child. The average exposure to PM2.5, NO2 and benzene over the whole pregnancy was calculated for each woman. During the second year of life, infant neuropsychological development was assessed using the Bayley Scales of Infant Development. Regression analyses were performed to estimate the association between exposure and outcomes, accounting for potential confounders. Results: We estimated that a 1 μg/m3 increase during pregnancy in the average levels of PM2.5 was associated with a −1.14 point decrease in motor score (90% CI: −1.75; −0.53) and that a 1 μg/m3 increase of NO2 exposure was associated with a −0.29 point decrease in mental score (90% CI: −0.47; −0.11). Benzene did not show any significant association with development. Considering women living closer (≤100 m) to metal processing activities, we found that motor scores decreased by −3.20 (90% CI: −5.18; −1.21) for PM2.5 and −0.51 (−0.89; −0.13) for NO2, while mental score decreased by −2.71 (90% CI: −4.69; −0.74) for PM2.5, and −0.41 (9% CI: −0.76; −0.06) for NO2. Conclusions: Our findings suggest that prenatal residential exposure to PM2.5 and NO2 adversely affects infant motor and cognitive developments. This negative effect could be higher in the proximity of metal processing plants. Keywords: Cognitive development, Psychomotor development, Particle matter, PM2.5

Iodine supplementation during pregnancy is a common practice in developed countries. However, scant evidence is available regarding the safety and effectiveness of maternal iodine supplementation with regard to child neuropsychological development. We previously reported an inverse association between iodine supplementation and the psychomotor development of infants in a birth cohort from Valencia, Spain. In the present study, we assessed this association in a wider sample of mother and child pairs from 3 other regions in Spain. Neuropsychological development was assessed using the Bayley Scales of Infant Development in 1,519 infants (median age, 16 months) between 2006 and 2009. In multivariate analyses, maternal consumption of 150 mu g/day or more of iodine from supplements was related to a 1.5-fold increase in the odds of a psychomotor score less than 85 (95% confidence interval: 0.8, 2.9) and to a 1.7-fold increase in the odds of a mental score less than 85 (95% confidence interval: 0.9, 3.0). Findings previously reported in the Valencia cohort were only partially verified. The results of the present study suggest that, at least in these regions, iodine supplementation does not improve infant neuropsychological development at 1 year of age. Further research is needed on the risks and benefits of supplementary iodine for both maternal thyroid function and child neurodevelopment.

Polychlorinated biphenyls (PCB), hexachlorobenzene (HCB), and dichlorodiphenyl dichloroethylene (pp′DDE) are persistent, bioaccumulative, and toxic environmental pollutants with potential neurotoxic effects. Despite a growing body of studies investigating the health effects associated with these compounds, their specific effects on early neuropsychological development remain unclear. We investigated such neuropsychological effects in a population-based birth cohort based in three regions in Spain (Sabadell, Gipuzkoa, and Valencia) derived from the INMA [Environment and Childhood] Project. The main analyses in this report were based on 1391 mother–child pairs with complete information on maternal levels of organochlorine compounds and child neuropsychological assessment (Bayley Scales of Infant Development) at age 14 months. We found that prenatal PCB exposure, particularly to congeners 138 and 153, resulted in impairment of psychomotor development (coefficient=−1.24, 95% confidence interval=−2.41, −0.07), but found no evidence for effects on cognitive development. Prenatal exposure to pp′DDE or HCB was not associated with early neuropsychological development. The negative effects of exposure to PCBs on early psychomotor development suggest that the potential neurotoxic effects of these compounds may be evident even at low doses. Keywords: Child development, Organochlorine compounds, Polychlorinated biphenyls, Hexachlorobenzene, Dichlorodiphenyl dichloroethylene, Neuropsychology

Background: A wide range of neuropsychological development outcomes in children are currently measured in a large number of birth cohort and child cohort studies. Methods: We summarized neuropsychological development assessment protocols from a number of birth cohort studies, reviews and specific books on child neuropsychology into a unifying conceptual framework. Results: We suggest that neuropsychological development can be differentiated into two levels, i.e. functional and clinical. The functional level includes the skills, abilities, capacities and knowledge acquired during maturation of the brain as a result of the development of neural networks. It can be further divided into cognitive, psychomotor and social-emotional development subdomains. The clinical level includes the assessment of neurodevelopmental disorders or the presence of symptoms (subclinical symptomatology) of these disorders in populations under investigation in environmental epidemiology studies. Conclusions: Through explicit recognition of these levels of outcomes, and in using this framework, epidemiologists will be better able to design research through the informed selection of individual levels of outcomes. The framework also serves to standardize disparate terminologies across this field and allows for pooling of epidemiological data on neuropsychological endpoints where essentially similar levels of outcomes have been analyzed using different tests.