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To adapt the provider version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity.
There is a growing need to measure and explore the impact of various characteristics of health care systems on the quality of primary care. It would provide the best evidence for policy makers if these evaluations come from both the demand and supply sides of the health care sector. Comparatively more researchers have studied primary care quality from the consumer perspective than from the provider’s perspective. This study aims at the latter.
Our study translated and adapted the PCAT provider version (PCAT PE) into a Vietnamese version, after which a cross-sectional survey was conducted to examine the feasibility, internal consistency and validity of the Vietnamese PCAT provider version (VN PCAT PE). All general doctors working at 152 commune health centres in Thua Thien Hue province had been selected to participate in the survey.
The VN PCAT PE is an instrument for evaluation of primary care in Vietnam with 116 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. From the translation and cultural adaptation stage, two items were combined, two items were removed and one item was added. Six other items were excluded due to problems in item-total correlations. All items have a low non-response or ‘don’t know/don’t remember’ response rate, and there were no floor or ceiling effects. All scales had a Cronbach’s alpha above 0.80, except for the Coordination scale, which still was above the minimum level of 0.70.
The VN PCAT PE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the provider perspective.
Epidemiological evidence indicates that high consumption of tomatoes and tomato-based products reduces the risk of chronic diseases such as CVD and cancer. Such potential benefits are often ascribed to high concentrations of lycopene present in tomato products. Mainly from the results of in vitro studies, potential biological mechanisms by which carotenoids could protect against heart disease and cancer have been suggested. These include cholesterol reduction, inhibition of oxidation processes, modulation of inflammatory markers, enhanced intercellular communication, inhibition of tumourigenesis and induction of apoptosis, metabolism to retinoids and antiangiogenic effects. However, with regard to CVD, results from intervention studies gave mixed results. Over fifty human intervention trials with lycopene supplements or tomato-based products have been conducted to date, the majority being underpowered. Many showed some beneficial effects but mostly on non-established cardiovascular risk markers such as lipid peroxidation, DNA oxidative damage, platelet activation and inflammatory markers. Only a few studies showed improvement in lipid profiles, C reactive protein and blood pressure. However, recent findings indicate that lycopene could exert cardiovascular protection by lowering HDL-associated inflammation, as well as by modulating HDL functionality towards an antiatherogenic phenotype. Furthermore, in vitro studies indicate that lycopene could modulate T lymphocyte activity, which would also inhibit atherogenic processes and confer cardiovascular protection. These findings also suggest that HDL functionality deserves further consideration as a potential early marker for CVD risk, modifiable by dietary factors such as lycopene.
Observations of submillimeter lines of CO, HCO+, HCN and their isotopes from circumstellar disks around low-mass pre-main sequence stars can be used to set constraints on the temperature and density distributions in these disks. The lines considered here originate from levels with higher excitation temperatures and critical densities than studied before (CO 6–5, HCO+ and HCN 4–3), and are combined with interferometer data on lower excitation lines. We discuss the results for two disks, i.e., those around LkCa 15 and TW Hya. We find that the TW Hya disk has a warm surface layer and agrees well with a flaring disk geometry, while the LkCa 15 disk is cooler and can be described by either dust-settling in a flared disk or a flatter disk overall. The densities are well described by disk models in the literature.
We present the results of a study of the evolution of the gas and dust in disks around T Tauri, Herbig Ae and Vega-like stars. We observed the two lowest rotational lines of H2 with the ISO-SWS as well as 12CO 3–2 and 13CO 3–2 with the JCMT, and CO 6–5 with the CSO. The H2 lines trace the warm (∽ 100 K) inner region whereas the CO lines probe the colder outer disks. Substantial amounts of H2 have been detected toward T Tauri and Herbig Ae stars, and, surprisingly, also around three Vega-like objects (49 Cet, HD 135344 and β Pictoris). In contrast with previous conclusions derived from CO data, a significant mass of warm gas is found to persist up to ages of several tens of Myrs, suggesting that slow formation of gas-rich giant planets is possible.
The effects of fish oil (FO) supplementation on glycaemic control are unclear, and positive effects may occur only when the phospholipid content of tissue membranes exceeds 14 % as n-3 PUFA. Subjects (n 36, thirty-three completed) were paired based on metabolic parameters and allocated into a parallel double-blind randomised trial with one of each pair offered daily either 6 g of FO (3·9 g n-3 PUFA) or 6 g of maize oil (MO) for 9 months. Hyperinsulinaemic–euglycaemic–euaminoacidaemic (HIEGEAA) clamps (with [6,6 2H2 glucose]) were performed at the start and end of the intervention. Endogenous glucose production (EGP) and whole-body protein turnover (WBPT) were each measured after an overnight fast. The primary outcome involved the effect of oil type on insulin sensitivity related to glycaemic control. The secondary outcome involved the effect of oil type on WBPT. Subjects on FO (n 16) had increased erythrocyte n-3 PUFA concentrations >14 %, whereas subjects on MO (n 17) had unaltered n-3 PUFA concentrations at 9 %. Type of oil had no effect on fasting EGP, insulin sensitivity or total glucose disposal during the HIEGEAA clamp. In contrast, under insulin-stimulated conditions, total protein disposal (P=0·007) and endogenous WBPT (P=0·001) were both increased with FO. In an associated pilot study (n 4, three completed), although n-3 PUFA in erythrocyte membranes increased to >14 % with the FO supplement, the enrichment in muscle membranes remained lower (8 %; P<0·001). In conclusion, long-term supplementation with FO, at amounts near the safety limits set by regulatory authorities in Europe and the USA, did not alter glycaemic control but did have an impact on WBPT.
High consumption of whole-grain food such as oats is associated with a reduced risk of CVD and type 2 diabetes. The present study aimed to systematically review the literature describing long-term intervention studies that investigated the effects of oats or oat bran on CVD risk factors. The literature search was conducted using Embase, Medline and the Cochrane library, which identified 654 potential articles. Seventy-six articles describing sixty-nine studies met the inclusion criteria. Most studies lacked statistical power to detect a significant effect of oats on any of the risk factors considered: 59 % of studies had less than thirty subjects in the oat intervention group. Out of sixty-four studies that assessed systemic lipid markers, thirty-seven (58 %) and thirty-four (49 %) showed a significant reduction in total cholesterol (2–19 % reduction) and LDL-cholesterol (4–23 % reduction) respectively, mostly in hypercholesterolaemic subjects. Few studies (three and five, respectively) described significant effects on HDL-cholesterol and TAG concentrations. Only three out of twenty-five studies found a reduction in blood pressure after oat consumption. None of the few studies that measured markers of insulin sensitivity and inflammation found any effect after long-term oat consumption. Long-term dietary intake of oats or oat bran has a beneficial effect on blood cholesterol. However, there is no evidence that it favourably modulates insulin sensitivity. It is still unclear whether increased oat consumption significantly affects other risk markers for CVD risk, and comprehensive, adequately powered and controlled intervention trials are required to address this question.
Whole-grain foods such as oats may protect against colorectal cancer and have benefits on inflammatory bowel disease and coeliac disease. The present study aimed to systematically review the literature describing intervention studies that investigated the effects of oats or oat bran on risk factors for bowel disease. A literature search was conducted using Embase, Medline and the Cochrane library, which identified 654 potential articles. Thirty-eight articles describing twenty-nine studies met the inclusion criteria. Two studies carried out in participants with a history of colorectal adenomas found no effects of increased oat-bran intake on indirect risk makers for colorectal cancer. One of two interventions with oat bran in patients with ulcerative colitis showed small improvements in the patients' conditions. Most of the eleven studies carried out in adults with coeliac disease showed no negative effects of uncontaminated oat consumption. The fourteen studies carried out in volunteers with no history of bowel disease suggest that oats or oat bran can significantly increase stool weight and decrease constipation, but there is a lack of evidence to support a specific effect of oats on bowel function compared with other cereals. A long-term dietary intake of oats or oat bran could benefit inflammatory bowel disorders, but this remains to be proven. A protective effect on colorectal adenoma and cancer incidence has not yet been convincingly shown. The majority of patients with coeliac disease could consume up to 100 g/d of uncontaminated oats, which would increase the acceptability of, and adherence to, a gluten-free diet.
Studying the inner regions of protoplanetary disks (1-10 AU) is of importance to understand the formation of planets and the accretion process feeding the forming central star. Herbig AeBe stars are bright enough to be routinely observed by Near IR interferometers. The data for the fainter T Tauri stars is much more sparse. In this contribution we present the results of our ongoing survey at the VLTI. We used the PIONIER combiner that allows the simultaneous use of 4 telescopes, yielding 6 baselines and 3 independent closure phases at once. PIONIER's integrated optics technology makes it a sensitive instrument. We have observed 22 T Tauri stars so far, the largest survey for T Tauri stars to this date.
Our results demonstrate the very significant contribution of an extended component to the interferometric signal. The extended component is different from source to source and the data, with several baselines, offer a way to improve our knowledge of the disk geometry and/or composition. These results validate an earlier study by Pinte et al. 2008 and show that the dust inner radii of T Tauri disks now appear to be in better agreement with the expected position of the dust sublimation radius, contrary to previous claims.
The close environment of Herbig stars starts to be revealed step by step and it appears to be quite complex. Many physical phenomena interplay: the dust sublimation causing a puffed-up inner rim, a dusty halo, a dusty wind or an inner gaseous component. To investigate more deeply these regions, getting images at the first Astronomical Unit scale is necessary. This has become possible with near infrared instruments on the VLTI. We have developed a new imaging method adapted to young stellar objects where we process separately the stellar component from the rest of the image to reveal the environment by using the spectral differences between these two components. We present the result of this method on the first imaging survey of Herbig stars carried out by PIONIER on the VLTI.
We summarize the first results from the Herschel Open time Key Program GaS in Protoplanetary Systems (GASPS, P.I.W. Dent). GASPS aims to determine the gas and dust content of ~240 planet-forming discs with ages 1–30 Myrs in a systematic fashion. Photometry in the far-IR and low-resolution spectroscopy of the fine-structure emissions of OI and CII are obtained with the PACS instrument on board the European space telescope Herschel. Initial modelling of the Herschel and complementary observations of the classical T Tauri star TW Hya and of the Herbig Ae star HD 169142 are presented.