New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

The Quality of Neighbourhood Facilities and Their Effect on Social Trust in Salak Selatan New Village, Kuala Lumpur

This study investigated neighbourhood amenities as socio-spatial settings within which relationships of trust are built through the passage of daily activities. It examined the effect of satisfaction towards neighbourhood facilities on social trust in one of Malaysia's urban villages: Salak South New Village in Kuala Lumpur. Data from 335 survey respondents were analysed using the MANOVA method to determine the influence of neighbourhood facilities satisfaction on social trust. To achieve the aim of this study, five independent variables (IVs) of satisfaction with provided selected neighbourhood facilities were considered: basic utilities, commercial facilities, health facilities, police service and public transport, while two dependent variables (DV) of communal trust and leadership trust were identified that constitute social trust. The findings reveal that satisfaction towards neighbourhood facilities significantly influenced social trust among the respondents. Multivariate analysis showed commercial facilities as the most influential in determining social trust, followed by public transport, health facilities, basic utilities, and finally police service. Therefore, improving neighbourhood facilities and amenities will enhance the satisfaction of residents and accordingly increase social trust. In other words, unmaintained and underdeveloped facilities lessen social trust in a community via resident dissatisfaction. This necessitates engagement of stakeholders including urban planners, local authorities and the residents themselves in the planning process and village development to ensure that the residents will be satisfied with changes for better neighbourhood facilities and social trust is sustained.Abstrak. Makalah ini mempelajari keberadaan fasilitas lingkungan dalam konteks sosio-spasial yang menjadi tempat terbangunnya hubungan kepercayaan melalui perjalanan aktivitas sehari-hari. Makalah ini menguji pengaruh kepuasan terhadap fasilitas lingkungan pada kepercayaan sosial di salah satu desa perkotaan Malaysia - Desa Baru Selatan Salak, di Kuala Lumpur. Data dari 335 responden dianalisis menggunakan metode MANOVA untuk menjelaskan pengaruh kepuasan fasilitas lingkungan terhadap kepercayaan sosial. Untuk mencapai tujuan penelitian ini, ditentukan lima variabel independen (IV) yang dapat mewakili kepuasan terhadap penyediaan fasilitas lingkungan yang dipilih: utilitas dasar, fasilitas komersial, fasilitas kesehatan, layanan polisi dan angkutan umum; sedangkan dua variabel dependen (DV):Kepercayaan komunal dan kepercayaan kepemimpinan diidetifikasi sebagai yang merupakankepercayaan sosial Hasil penelitian mengungkapkan bahwa kepuasan terhadap fasilitas lingkungan berpengaruh secara signifikan terhadap kepercayaan sosial di kalangan responden. Analisis multivariat menunjukkan fasilitas komersial sebagai yang paling berpengaruh dalam menentukan kepercayaan sosial; diikuti oleh angkutan umum, fasilitas kesehatan, utilitas dasar, dan terakhir layanan polisi. Oleh karena itu, peningkatan fasilitas dan amenitas lingkungan akan meningkatkan kepuasan penghuni dan karenanya meningkatkan kepercayaan sosial. Dengan kata lain, fasilitas yang tidak terawat dan terbelakang mengurangi kepercayaan sosial dalam masyarakat melalui ketidakpuasan warga. Hal ini membutuhkan keterlibatan pemangku kepentingan termasuk perencana kota, pemerintah daerah dan warga sendiri dalam proses perencanaan dan pembangunan desa untuk memastikan bahwa penduduk desa puas dengan perubahan untuk fasilitas lingkungan yang lebih baik dan kepercayaan sosial dipertahankan.Kata kunci. Kepercayaan sosial, Kepuasan fasilitas, Kelurahan, Ruang lingkungan, Kuala Lumpur

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used