ABSTRACT: BACKGROUND: Reduction and modification of dietary fats have differing effects on cardiovascular risk factors (such as serum cholesterol), but their effects on important health outcomes are less clear. OBJECTIVE: To assess the effect of reduction and/or modification of dietary fats on mortality, cardiovascular mortality, cardiovascular morbidity and individual outcomes including myocardial infarction, stroke and cancer diagnoses in randomised clinical trials of at least 6 months duration. METHODS: Search methods: For this review update, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase, were searched through to June 2010. References of Included studies and reviews were also checked. Selection criteria: Trials fulfilled the following criteria: 1) randomized with appropriate control group, 2) intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions), 3) not multi factorial, 4) adult humans with or without cardiovascular disease, 5) intervention at least six months, 6) mortality or cardiovascular morbidity data available. Data collection and analysis: Participant numbers experiencing health outcomes in each arm were extracted independently in duplicate and random effects meta-analyses, meta-regression, sub-grouping, sensitivity analyses and funnel plots were performed. MAIN RESULTS: This updated review suggested that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14% (RR 0.86, 95% CI 0.77 to 0.96, 24 comparisons, 65,508 participants of whom 7% had a cardiovascular event, I2 50%). Subgrouping suggested that this reduction in cardiovascular events was seen in studies of fat modification (not reduction - which related directly to the degree of effect on serum total and LDL cholesterol and triglycerides), of at least two years duration and in studies of men (not of women). There were no clear effects of dietary fat changes on total mortality (RR 0.98, 95% CI 0.93 to 1.04, 71,790 participants) or cardiovascular mortality (RR 0.94, 95% CI 0.85 to 1.04, 65,978 participants). This did not alter with sub-grouping or sensitivity analysis. Few studies compared reduced with modified fat diets, so direct comparison was not possible. AUTHORS' CONCLUSIONS: The findings are suggestive of a small but potentially important reduction in cardiovascular risk on modification of dietary fat, but not reduction of total fat, in longer trials. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates. The ideal type of unsaturated fat is unclear.

PROBLEM: The Chinese central government launched the Health System Reform Plan in 2009 to strengthen disease control and health promotion and provide a package of basic public health services. Village doctors receive a modest subsidy for providing public health services associated with the package. Their beliefs about this subsidy and providing public health services could influence the quality and effectiveness of preventive health services and disease surveillance. APPROACH: To understand village doctors'perspectives on the subsidy and their experiences of delivering public health services, we performed 10 focus group discussions with village doctors, 12 in-depth interviews with directors of township health centres and 4 in-depth interviews with directors of county-level Centers for Disease Control and Prevention. LOCAL SETTING: The study was conducted in four counties in central China, two in Hubei province and two in Jiangxi province. RELEVANT CHANGES: Village doctors prioritize medical services but they do their best to manage their time to include public health services. The willingness of township health centre directors and village doctors to provide public health services has improved since the introduction of the package and a minimum subsidy, but village doctors do not find the subsidy to be sufficient remuneration for their efforts. LESSONS LEARNT: Improving the delivery of public health services by village doctors is likely to require an increase in the subsidy, improvement in the supervisory relationship between village clinics and township health centres and the creation of a government pension for village doctors.

SITUACIÓN: En el año 2009, el gobierno central chino puso en marcha el plan de reforma del sistema sanitario con el objetivo de reforzar el control de las enfermedades y fomentar la salud, asà como proporcionar un paquete de servicios básicos de salud pública. Los médicos rurales perciben una modesta subvención por la prestación de los servicios de salud pública relacionados con dicho paquete. Sus opiniones acerca de dicha subvención y la prestación de los servicios de salud pública podrÃan influir en la calidad y la eficacia de los servicios sanitarios preventivos y de la vigilancia de las enfermedades. ENFOQUE: Con objeto de comprender los puntos de vista de los médicos rurales acerca de la subvención y sus experiencias en la prestación de servicios sanitarios, hemos llevado a cabo 10 debates con grupos focales de médicos rurales, 12 entrevistas en detalle con directores de centros de salud municipales y 4 entrevistas en detalle con directores de Centros para el Control y Prevención de las Enfermedades provinciales. MARCO REGIONAL: El estudio se llevó a cabo en cuatro condados del centro de China, dos de ellos en la provincia de Hubei y otros dos en la de Jiangxi. CAMBIOS IMPORTANTES: Los médicos rurales dan prioridad a los servicios médicos, pero hacen todo lo posible por gestionar su tiempo a fin de incluir los servicios de salud pública. La disposición de los directores de los centros sanitarios municipales y de los médicos rurales para prestar los servicios de salud pública ha aumentado desde la introducción del paquete y de la subvención mÃnima, si bien los médicos rurales no consideran que sea una retribución suficiente por sus esfuerzos. LECCIONES APRENDIDAS: Es probable que, para mejorar la prestación de servicios de salud pública por parte de los médicos rurales, sea necesario un aumento de la subvención, una mejora en la relación de supervisión entre las clÃnicas rurales y los centros de salud municipales, asà como la creación de una pensión gubernamental para los médicos rurales.

PROBLÈME: Le gouvernement central chinois a lancé le plan de réforme du système de santé en 2009 pour renforcer la lutte contre les maladies et l'amélioration de la santé, et pour fournir un paquet de services de base en termes de santé publique. Les médecins de village reçoivent une subvention modeste pour offrir des services de santé publique liés à ce paquet. Leurs opinions sur cette subvention et la fourniture de services de santé publique pourraient avoir une influence sur la qualité et l'efficacité des services de santé préventive et sur la surveillance des maladies. APPROCHE: Pour comprendre les perspectives des médecins de village sur la subvention et leur expérience dans le domaine de la fourniture de services de santé publique, nous avons organisé 10 discussions de groupe cible avec des médecins de village, 12 entrevues approfondies avec des directeurs de centres de santé cantonaux et 4 entrevues approfondies avec des directeurs départementaux de centres pour la lutte et la prévention des maladies. ENVIRONNEMENT LOCAL: Létude a été effectuée dans quatre comtés du centre de la Chine, deux dans la province de Hubei et deux dans la province du Jiangxi. CHANGEMENTS SIGNIFICATIFS: Les médecins de village donnent la priorité aux services médicaux, mais ils font de leur mieux pour gérer leur temps de manière à inclure les services de santé publique. La volonté des directeurs de centres de santé cantonaux et des médecins de village d'offrir des services de santé publique s'est accrue depuis l'introduction du paquet et d'une subvention minimale, mais les médecins de village ne considèrent pas que cette subvention constitue une rémunération suffisante pour leurs efforts. LEÇONS TIRÉES: Il est possible que l'amélioration de la fourniture de services de santé publique par les médecins de village nécessite une augmentation de la subvention, l'amélioration de la relation de supervision entre cliniques de village et centres de santé cantonaux et la création d'une pension gouvernementale pour les médecins de village.

The initiative to link habitat and parks across political borders, to form large Transfrontier Conservation Areas (TFCAs), has gained momentum in Africa and the world. TFCAs hold many advantages, one of them being the restoration of habitat connectivity in order to conserve ecosystem functioning. A feasibility study in 2002 highlighted 22 sites as potential TFCAs in southern Africa, and the Peace Parks Foundation is facilitating the implementation of eight of them. This paper describes a methodological framework with which to map remaining large, natural habitat fragments (or remnants) in southern Africa, the distribution, shape and size of which will provide the foundation and stakeholders with information on possible coarse-scale landscape linkages. This framework, which maps remnants, was designed to be transparent, systematic and dynamic to facilitate easy updating as TFCA projects mature, or updated data become available. This is intended to be the first in a series of studies towards developing an integrated, systematic framework for TFCA planning at a sub-continental scale. It does not aim to prioritize remnants or linkages.