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Postgraduate education in gerontology is now widespread within European universities, but, even so, such developments remain very uneven. This paper outlines the variety of provision by describing Master's programmes in a sample of countries: England, Scotland, Finland, and Spain. These programmes illustrate some of the common problems: lack of funding for students, limited availability of academic staff, and reliance on a small core of dedicated teachers. They exhibit many strengths, including the breadth of curricula, high academic standards, high calibre and varied backgrounds of the students, the value of the qualification in employment, and meeting the demands of an ageing Europe. At the same time, these courses are faced with important issues about their sustainability. This paper argues that the demand for generalist courses such as gerontology taught Master's may fall in the coming years due to a combination of factors, such as employers' unwillingness to allow day release and demands by older people themselves for treatment and care by specialists. Generalist courses, this paper argues, may only survive in the biggest and best universities serving large populations and in cities able to attract overseas students. (Contains 1 note.)

Objective: In children born small for gestational age (SGA), the relationship between growth hormone (GH) treatment and insulin resistance (IR) has only been investigated for a short period, necessitating a longer observation period. This study aimed to evaluate the long‐term (10 years) effect of GH to SGA‐children on IR and safety during treatment. Design: This was a multicenter observational study. Patients: SGA‐children who received GH treatment in Spain (stratified by Tanner‐stage and age at GH onset [two groups: ≤6 years old or >6 years old]). Measurements: The analysed variables (yearly measures) included auxologic, metabolic (insulin‐like growth factor‐1 (IGF‐1), height velocity [HV], weight and homeostatic model assessment‐IR [HOMA‐IR]) and safety data. Data were collected prospectively (since the study approval: 2007) and retrospectively (since the initiation of GH treatment: 2005–2007). Results: A total of 389 SGA children (369 Tanner‐I) were recruited from 27 centres. The mean age (standard deviation) of the children at GH treatment onset was 7.2 (2.8) years old. IGF‐1 (standard deviation score [SDS]) and HOMA‐IR values tended to increase until the sixth year of GH‐treatment, with significant differences being observed only during the first year, while these remained stable in the later years (within normal ranges). Height (SDS) increased significantly (basal: −3.0; tenth year: −1.13), and the maximum HV (SDS) occurred during the first year (2.75 ± 2.39). Conclusions: HOMA‐IR values increased significantly in SGA‐children during the first year of GH‐treatment, remained stable and were within normal ranges in all cases. Our 10‐year data suggests that long‐term GH treatment does not promote IR and is well‐tolerated, safe and effective. [ABSTRACT FROM AUTHOR]

1) Analizar la implementación de los modelos de atención multidisciplinar en pacientes con artritis psoriásica (APs), y 2) definir estándares de calidad de mínimos y de excelencia. Se envió una encuesta a profesionales que ya realizan atención multidisciplinar o están en vías preguntando por: 1) tipo de modelo de abordaje multidisciplinar, y 2) grado, prioridad y facilidad de la implementación de los estándares de calidad de estructura, proceso y resultado. En 6 reuniones regionales se presentaron y discutieron los resultados de la encuesta, tanto a nivel nacional como regional, y se definió la prioridad definitiva de los estándares de calidad. En una reunión de grupo nominal, 11 expertos (reumatólogos y dermatólogos) analizaron los resultados de la encuesta y las reuniones regionales. Con ello definieron qué estándares de calidad son actualmente de mínimos y cuáles de excelencia. Los modelos de atención multidisciplinar conjunto y paralelo son los más implementados, y los de los estándares de calidad es muy variable: en los de estructura varía del 22 al 74%, en los de proceso del 17 al 54% y en los de resultado del 2 al 28%. De los 25 estándares de calidad originales, 9 se consideran solo de mínimos, 4 de excelencia y 12 tienen definidos unos criterios para ser de mínimos y otros para la excelencia. La definición de estándares de calidad de mínimos y de excelencia ayudará en la consecución del objetivo de la atención multidisciplinar para pacientes con APs, que es la mejor asistencia sanitaria posible. 1) To analyze the implementation of multidisciplinary care models in psoriatic arthritis (PsA) patients, 2) To define minimum and excellent standards of care. A survey was sent to clinicians who already performed multidisciplinary care or were in the process of undertaking it, asking: 1) Type of multidisciplinary care model implemented; 2) Degree, priority and feasibility of the implementation of quality standards in the structure, process and result for care. In 6 regional meetings the results of the survey were presented and discussed, and the ultimate priority of quality standards for care was defined. At a nominal meeting group, 11 experts (rheumatologists and dermatologists) analyzed the results of the survey and the regional meetings. With this information, they defined which standards of care are currently considered as minimum and which are excellent. The simultaneous and parallel models of multidisciplinary care are those most widely implemented, but the implementation of quality standards is highly variable. In terms of structure it ranges from 22% to 74%, in those related to process from 17% to 54% and in the results from 2% to 28%. Of the 25 original quality standards for care, 9 were considered only minimum, 4 were excellent and 12 defined criteria for minimum level and others for excellence. The definition of minimum and excellent quality standards for care will help achieve the goal of multidisciplinary care for patients with PAs, which is the best healthcare possible. [ABSTRACT FROM AUTHOR]

To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients. [ABSTRACT FROM AUTHOR]

Introduction. The Asthma Control QuestionnaireTM (ACQ) was developed to assess asthma control. The objective of this study is to determine the cut-off points that best differentiate between several types of asthma control in three versions of the ACQ used in clinical practice. Materials and methods. It appears 607 adult asthmatic patients (61% female) were recruited from 43 outpatient clinics in Spain. Once the patients were stratified by severity of asthma, they were then evaluated in an epidemiological study. To determine the optimum cut-off points, the area under the receiver operating characteristics (ROC) curve, as well as sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively), was calculated for each version of the ACQ (ACQ-FEV1 (forced expiratory volume in the first second), ACQ-PEF (peak expiratory flow), and ACQ-wLF (without lung function)). Results. The optimal cut-off for ACQ-FEV1 was 1.14 (the sum of 8 points/7 items), for ACQ-PEF 1.28 (the sum of 9 points/7 items), and for ACQ-wLF 0.83 (the sum of 5 points/6 items), and the percentage of correctly classified patients was 76.5%, 77.3%, and 77.2%, respectively. A comparison of ROCs obtained from the three versions of the ACQ shows that ACQ-wLF had a significantly greater area under the curves (AUC) ( p = .004) than ACQ-FEV1. Patients were considered as having some control if their ACQ-FEV1 score fell between 1.14 and 1.57, if ACQ-PEF values were between 1.28 and 1.57, or if ACQ-wLF scores ranged between 0.83 and 1.5. Conclusions. Our study, which was carried out in a manner which more closely reflects clinical practice, reveals differences in cut-offs used to define well-controlled asthma among three versions of the ACQ. [ABSTRACT FROM AUTHOR]

• Thin-only could reduce the likelihood of active crown fires and spread in the midterm. • For low and moderate intensities, fuel moisture surpassed wind speed effect on fire severity. • Thin-only has a minor influence on the reduction of fire severity and soil protection. • Surface fuel reduction is needed to increase thin-only efficiency. Fuel hazard reduction is an essential component of pine plantation management. In NW Spain, plantation managers assume that thin-only reduces the potential fire behavior and effects by decreasing the quantity and continuity of canopy fuels. Nevertheless, thin-only can alter additional variables than control fire behavior and effects such as surface fuel availability and microclimate conditions. Moreover, the duration of thinning effects could vary and be species-specific. We present an approach linking field-measured fuel variables to well-established models for assessing the mid-term effects (six years) of thin-only on potential fire behaviour and severity and ability of burned stands to protect soil against erosion. Field variables were obtained from 41 thinning trials installed in stands of P. pinaster (22 locations) and P. radiata (19 locations). Canopy fuel load and canopy bulk density were still significantly lower in treated sample plots for both species six years after treatments, whereas total and fine understory fuel loads were slightly but significantly larger in thinned plots in P. pinaster. In a simulation process, different fire danger scenarios were considered through two fire-related weather variables: the 10-m open wind speed and the fine dead fuel moisture content. Results showed that thin-only could significantly reduce the likelihood of active crown fire and its rate of spread for both species, particularly in P. pinaster, while passive crown fire probability increased. The potential fire severity, in terms of crown scorch height, scorch volume and tree mortality, hardly worsened by thinning. For fireline intensities lower than 4000 kW m−1, dead fuel moisture content effect on fire severity surpassed the wind speed influence. Moreover, protection of soil against erosion improved only slightly when thinning was previously carried out. The results of the study reveal that, in the mid-term, it is unlikely that thin-only, without intervention in the surface fuels, may have a marked influence on the reduction of the severity of a subsequent fire. The results also highlight the need of a comprehensive assessment of the effects of thin-only on both the whole fuel complex and microclimatic variables for obtaining realistic results. [ABSTRACT FROM AUTHOR]

Red clover (Trifolium pratense L.) is a highly adaptable forage crop for temperate livestock agriculture. Genetic variation can be identified, via molecular techniques, and used to assess diversity among populations that may otherwise be indistinguishable. Here we have used genotyping by sequencing (GBS) to determine the genetic variation and population structure in red clover natural populations from Europe and Asia, and varieties or synthetic populations. Cluster analysis differentiated the collection into four large regional groups: Asia, Iberia, UK, and Central Europe. The five varieties clustered with the geographical area from which they were derived. Two methods (BayeScan and Samβada) were used to search for outlier loci indicating signatures of selection. A total of 60 loci were identified by both methods, but no specific genomic region was highlighted. The rate of decay in linkage disequilibrium was fast, and no significant evidence of any bottlenecks was found. Phenotypic analysis showed that a more prostrate and spreading growth habit was predominantly found among populations from Iberia and the UK. A genome wide association study identified a single nucleotide polymorphism (SNP) located in a homologue of the VEG2 gene from pea, associated with flowering time. The identification of genetic variation within the natural populations is likely to be useful for enhancing the breeding of red clover in the future.

Objective: 1) To analyze the implementation of multidisciplinary care models in psoriatic arthritis (PsA) patients, 2) To define minimum and excellent standards of care., Methods: A survey was sent to clinicians who already performed multidisciplinary care or were in the process of undertaking it, asking: 1) Type of multidisciplinary care model implemented; 2) Degree, priority and feasibility of the implementation of quality standards in the structure, process and result for care. In 6 regional meetings the results of the survey were presented and discussed, and the ultimate priority of quality standards for care was defined. At a nominal meeting group, 11 experts (rheumatologists and dermatologists) analyzed the results of the survey and the regional meetings. With this information, they defined which standards of care are currently considered as minimum and which are excellent., Results: The simultaneous and parallel models of multidisciplinary care are those most widely implemented, but the implementation of quality standards is highly variable. In terms of structure it ranges from 22% to 74%, in those related to process from 17% to 54% and in the results from 2% to 28%. Of the 25 original quality standards for care, 9 were considered only minimum, 4 were excellent and 12 defined criteria for minimum level and others for excellence., Conclusions: The definition of minimum and excellent quality standards for care will help achieve the goal of multidisciplinary care for patients with PAs, which is the best healthcare possible., (Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Various different factors have led to the accumulation of biomass in forest soils in the Mediterranean-climate region in the last few decades, thus exacerbating the effects of wildfires. Although prescribed burning is used to decrease the fuel load and reduce the currency of mega-wildfires, the impacts on soil organic matter (SOM) and nutrient cycling, and therefore on forest ecosystem sustainability, are uncertain. The present study was designed to cover a range of conditions and therefore to assess the variability in the responses in similar geographical areas. Three prescribed burning treatments producing different levels of soil burn severity were conducted in two different types of forests (Pinus nigra and Pinus pinaster) and one (previously treated by prescribed burning) shrubland ecosystem (Cytisus oromediterraneus), all characterized by different fuel loads and depths of soil organic layer, in Central Spain. After the treatments, the SOM content, its thermal properties, and the distribution of Phosphorus (P) forms ( 31 P NMR spectroscopy) were measured in the soil organic layer and mineral soils (0-2 cm depth), and the results were related to the temperatures reached. The prescribed burning les to low-moderate perturbations in SOM quality and Carbon (C) and P dynamics. The organic P, which in the unburnt plots represented 70% of the extractable P, was greatly depleted (by 56 and 95% with respect the initials values). This effect was concurrent with decreases in the most thermolabile SOM fractions, suggesting that organic P is readily mineralized, even at relatively low temperatures. Release of large amounts of soluble orthophosphate may occur when the prescribed burning leads to a high level of soil burn severity. The findings show that prescribed burning treatments should be planned carefully in order to prevent long-term perturbation of C and P cycling., (Copyright © 2018. Published by Elsevier Ltd.)

Objetive: To describe (structure, processes) of the multidisciplinary care models in psoriatic arthritis (PsA) in Spain, as well as barriers and facilitators of their implementation., Methods: A qualitative study was performed following structured interviews with 24 professionals (12 rheumatologists, 12 dermatologists who provide multidisciplinary care for patients with PsA). We collected data related to the hospital, department, population and multidisciplinary care model (type, physical and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision- making, research and education, clinical sessions, development and planning of the model, advantages and disadvantages of the model, barriers and facilitators in the implementation of the model. The models characteristics are described., Results: We analyzed 12 multidisciplinary care models in PsA, with at least 1-2 years of experience, and 3 subtypes of models, face-to-face, parallel, and preferential circuit. All are adapted to the hospital and professionals characteristics. A proper implementation planning is essential. The involvement and empathy between professionals and an access and well-defined referral criteria are important facilitators in the implementation of a model. The management of agendas and data collection to measure the multidisciplinary care models health outcomes are the main barriers., Conclusions: There are different multidisciplinary care models in PsA that can improve patient outcomes, system efficiency and collaboration between specialists., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)