Izzeldin Abuelaish

CHX10 mutations cause non-syndromic microphthalmia/ anophthalmia in Arab and Jewish kindreds.

Microphthalmia/anophthalmia is a clinically heterogeneous disorder of eye formation, ranging from small size of a single eye to complete bilateral absence of ocular tissues. The genetic defect underlying isolated autosomal recessive microphthalmia/anophthalmia is yet unclear. We studied four families (two of Arab origin, one of Bedouin origin, and one of Persian-Jewish origin) with autosomal recessive microphthalmia/anophthalmia and no associated eye anomalies, and one Syrian–Jewish family with associated colobomas. Assuming a founder effect in each of the families, we performed homozygosity mapping using polymorphic markers adjacent to human homologues of genes known to be associated with eye absence in various species, namely EYA1, EYA2, EYA3, SIX4, SIX6, PAX6 and CHX10. No association was found with EYA1, EYA2, EYA3, SIX6 or PAX6. In two families, linkage analysis was consistent with possible association with SIX4, but no mutations were found in the coding region of the gene or its flanking intron sequences. In three of the five families, linkage analysis followed by sequencing demonstrated that affected individuals in each family were homozygous for a different CHX10 aberration: a mutation in the CVC domain and a deletion of the homeobox domain were found in two Arab families, and a mutation in the donor-acceptor site in the first intron in the Syrian-Jewish family. There was phenotypic variation between families having different mutations, but no significant phenotypic variation within each family. It has been previously shown that mutations in a particular nucleotide in CHX10 are associated with an autosomal recessive syndrome of microphthalmia/anophthalmia with iris colobomas and cataracts in two families. We now show that different mutations in other domains of the same gene underlie isolated microphthalmia/anophthalmia.

A pilot with computer-assisted psychosocial risk –assessment for refugees

BackgroundRefugees experience multiple health and social needs. This requires an integrated approach to care in the countries of resettlement, including Canada. Perhaps, interactive eHealth tools could build bridges between medical and social care in a timely manner. The authors developed and piloted a multi-risk Computer-assisted Psychosocial Risk Assessment (CaPRA) tool for Afghan refugees visiting a community health center. The iPad based CaPRA survey was completed by the patients in their own language before seeing the medical practitioner. The computer then generated individualized feedback for the patient and provider with suggestions about available services.MethodsA pilot randomized trial was conducted with adult Afghan refugees who could read Dari/Farsi or English language. Consenting patients were randomly assigned to the CaPRA (intervention) or usual care (control) group. All patients completed a paper-pencil exit survey. The primary outcome was patient intention to see a psychosocial counselor. The secondary outcomes were patient acceptance of the tool and visit satisfaction.ResultsOut of 199 approached patients, 64 were eligible and 50 consented and one withdrew (CaPRA = 25; usual care = 24). On average, participants were 37.6 years of age and had lived 3.4 years in Canada. Seventy-two percent of participants in CaPRA group had intention to visit a psychosocial counselor, compared to 46 % in usual care group [X2 (1)=3.47, p = 0.06]. On a 5-point scale, CaPRA group participants agreed with the benefits of the tool (mean = 4) and were ‘unsure’ about possible barriers to interact with the clinicians (mean = 2.8) or to privacy of information (mean = 2.8) in CaPRA mediated visits. On a 5-point scale, the two groups were alike in patient satisfaction (mean = 4.3).ConclusionThe studied eHealth tool offers a promising model to integrate medical and social care to address the health and settlement needs of refugees. The tool’s potential is discussed in relation to implications for healthcare practice. The study should be replicated with a larger sample to generalize the results while controlling for potential confounders.

Positivity Ratio Links Self-control Skills to Physical Aggression and Happiness in Young Palestinians Living in Gaza

The study examined a potential underlying mechanism through which self-control skills (SCSs) may predict more happiness on the one hand and less hostility, anger and peer aggression on the other hand in an understudied sample of 744 Palestinian youngsters (Grades 8–12) from the Gaza Strip, a military conflict area. The hypothesized model was confirmed: self-reported SCS linked with happiness through positivity ratio as a mediator; SCS linked with physical aggression through the association of positivity ratio with hostility, and anger; and anger mediated the link between hostility and physical aggression. Additional analyses showed that girls scored higher than boys in SCS and boys scored higher than girls on positivity ratio, happiness, hostility, anger, and physical aggression. The study highlights the importance of imparting SCS to increase positivity ratio, so that, despite exposure to extreme adversity, youngsters in Gaza and elsewhere may experience not only less aggression but also more happiness.

Genomic epidemiology of meticillin-resistant Staphylococcus aureus ST22 widespread in communities of the Gaza Strip, 2009

Background Remarkably high carriage prevalence of a community-associated meticillin-resistant Staphylococcus aureus (MRSA) strain of sequence type (ST) 22 in the Gaza strip was reported in 2012. This strain is linked to the pandemic hospital-associated EMRSA-15. The origin and evolutionary history of ST22 in Gaza communities and the genomic elements contributing to its widespread predominance are unknown. Methods: We generated high-quality draft genomes of 61 ST22 isolates from Gaza communities and, along with 175 ST22 genomes from global sources, reconstructed the ST22 phylogeny and examined genotypes unique to the Gaza isolates. Results: The Gaza isolates do not exhibit a close relationship with hospital-associated ST22 isolates, but rather with a basal population from which EMRSA-15 emerged. There were two separate resistance acquisitions by the same MSSA lineage, followed by diversification of other genetic determinants. Nearly all isolates in the two distinct clades, one characterised by staphylococcal cassette chromosome mec (SCCmec) IVa and the other by SCCmec V and MSSA isolates, contain the toxic shock syndrome toxin-1 gene. Discussion: The genomic diversity of Gaza ST22 isolates is not consistent with recent emergence in the region. The results indicate that two divergent Gaza clones evolved separately from susceptible isolates. Researchers should not assume that isolates identified as ST22 in the community are examples of EMRSA-15 that have escaped their healthcare roots. Future surveillance of MRSA is essential to the understanding of ST22 evolutionary dynamics and to aid efforts to slow the further spread of this lineage.

The Flint water contamination crisis: the corrosion of positive peace and human decency

The human body is 70% water and people need two or three litres of it per day to remain hydrated (Mayo Clinic 2016). The United States has made it a priority to have one of the safest public drinking water supplies in the world (CDC 2014). So why did a severe water contamination crisis occur in Flint, Michigan between 2014 and 2017. Indeed, lead contamination prevails in many other communities besides Flint. Moreover, this public health emergency is manmade – a consequence of government neglect and carelessness. It represents a government’s ‘cost-saving’ decision to switch the Flint municipal water system to a new and less safe water source. As a result, lead leached into Flint’s water system, poisoning residents – mainly poor, African-American and under the age of five (Hanna-Attisha et al. 2016). What are the driving forces behind this crisis? Positive peace is defined as ‘the attitudes, institutions and structures which create and sustain peaceful societies.’ (The Institute for Economics and Peace 2015). It requires a well-functioning government, the equitable distribution of resources and the free flow of information. The Flint water contamination is an invisible act of what Johan Galtung calls ‘structural violence,’ (Galtung 1969) carried out by government officials against a poor and ethnically distinct community. To achieve reconciliation in Flint, it is necessary to uncover the truth behind the crisis. We argue that health professionals, including public health workers, have a moral duty, not only to prevent and treat disease, but also to address the ‘upstream factors’ of ill health and conflict and to advocate for social justice and peace.

Hatred-a public health issue

Hatred may be defined as a ‘negative emotion that motivates and may lead to negative behaviours with severe consequences’ (Halperin 2008). Though these sentiments might accompany it, hatred is not synonymous with extreme dislike, aversion, resentment, anger, or rage. Hatred includes an intense and chronic feeling, a judgment (of its object as ‘bad, immoral, dangerous’ (Navarro, Marchena, and Inmaculada 2013)), and a tendency, desire, or intention to be violent, often to the extreme of destroying its object. Most alarmingly, hatred involves the dehumanisation of the other (Halperin 2008; Harris and Fiske 2009; Sternberg 2005), which serves as a gateway through which moral barriers can be removed and violence can be perpetrated. From a peace studies point of view, hatred might be seen as a prime and extreme, enabler of direct, structural and cultural violence. As such, when contextualised within conflict, hatred may manifest as massive violence, mass murder, and genocide. Whether it engenders widespread physical, psychological, or political violence, each will result inevitably, in equally widespread health consequences. Many of the current violent civil or civil-military conflicts across the globe are either based on, or fuelled by, hatred. Hatred self-perpetuates, usually through cycles of hatred and counter-hatred, violence and counter-violence (sometimes as revenge) (Figure 1).

The Palestinian–Israeli conflict: a disease for which root causes must be acknowledged and treated

Abstract Fourth of June 2017 marks a half century of the Six Day War, three decades post the first Intifada, seven decades post the Palestinian Nakba (catastrophe), the 70th anniversary of Israeli Independence, and one century post the Balfour Declaration. Both Palestinians and Israelis remain occupied. Five million Palestinians remain sick with hopelessness and despair rendered by years of subjugation. Israelis are stuck, occupied by their historical narrative and transcendental fears. Over two decades have passed since the Oslo accords, which both Israelis and Palestinians hoped might be a historic turning point. This was supposed to put an end to the chronic disease of protracted conflict, allowing Palestinians to enjoy freedom in an independent state side by side to Israel and Israelis to live within peaceful, secure borders with the respect of the international community. Palestinians were ready to give up 78% of their land. Free Palestine would be in the remaining 22%, with East Jerusalem as the capital and a satisfactory solution to the Right of Return. The patient’s diagnosis and seeking therapy has been delayed by greed, ignorance, ideology, violence and fear. Accurate diagnosis is needed to successfully heal the wounds and cure this chronic disease.

No voy a odiar. Viaje de un médico de Gaza en el camino a la paz y la dignidad humana

This story is a necessary lesson against hatred and revenge, says Elie Wiesel, Nobel Peace Prize Laurate, about a Palestinian who has lived through half a century of horror and destruction in Gaza. After losing his three daughters in January 2009 during an Israeli incursion into Gaza Strip, Dr. Abuelaish said: “If I could know that my daughters were the last sacrifice on the road to peace between Palestinians andIsraelis, then I would accept their loss”.

Closing the global gender gap

Today, sex-based inequalities and inequities shape how individuals are disproportionately exposed to adverse determinants of health. Our sex can determine how well or ill we become, and if or how our health care needs are acknowledged and met. The underlying reasons for this disparity are complex and diverse, shaped by how sex and sexual customs interact within varying political and social contexts. Discriminatory values, norms and behaviours, different exposures and disease vulnerability, and health system and health research biases all interact to result in sexbased inequities in health outcomes. Conversely, ill health, in and of itself, can also negatively influence social and economic outcomes. The World Economic Forum has developed a framework, the Global Gender Gap Index, to measure sex-based disparities among countries and to track these disparities over time. The framework outlines and examines inequities between men and women in four broad categories: economic participation and opportunity; educational attainment; health and survival; and political empowerment. These four “pillars” are considered essential in recognising the importance of the role of women in society and in diminishing the gaps between the sexes. According to this framework, no country has, as yet, achieved sex equity in all of these four categories, although some countries (eg, Scandinavian countries) are getting close to achieving this goal. The framework also highlights that high-income countries often have fewer sex-based inequities than low-income countries. It is well known that, generally speaking, women in low-income countries fare far worse in terms of health outcomes, and are more likely to experience death during youth and adolescence than those in high-income countries. Maternal mortality exemplifies this, with the vast majority of maternal mortality occurring in low-income countries with weak institutional (including health) structures. Why has no country in the world achieved sex-based equity? Is inequity between the sexes not an abuse of human rights? It is imperative that action be taken, and I would argue that the most fundamental action required is to provide all women with the opportunity of education. Educating women has been shown not only to improve health, but also to decrease population growth, decrease child mortality, decrease child marriages and increase the participation of women in the labour force — all of which lead to faster economic growth and decreased poverty. Education is the key to building community capacity, as it provides individuals with the knowledge to participate in society. Education is also the key to resolving conflict, locally, regionally and globally, as it has also been shown that less conflict occurs in societies where women have higher economic and social status. Globally, there have been strong efforts to ensure access to primary education for all children. World Bank Group data show that, in 1999, 105.6 million children were identified as out-of-school children (ie, not enrolled in primary school); 58% of these were girls and 42% were boys. By 2009, the number of out-of-school children had decreased to 67 million; 52% of these were girls. Education is lacking in many regions in the world, so this global gap is much larger in specific regions of conflict or low-income countries. For example, in Afghanistan, 2009 data from the World Bank Group show that the expected years of schooling for a child vary greatly by sex. Boys are in school for an average of 11.2 years; girls, 6.8 years. From a global perspective, sub-Saharan Africa is home to half of the world’s out-of-school girls, and South Asia to a quarter. Nigeria, Pakistan and India, the three countries with the most out-of-school children, are recognised for their poor treatment of women. We need to ask why women are treated as second-class citizens in terms of access to health care and education in developing countries. A global effort is needed to change this pattern, to change the societal view of women, with the goal of promoting equal access to education for girls. Our path forward, as men and women, is to complement each other, not to compete; to create a balance and harmony in relations, not to strengthen one over the other; for all to be strong, and to eradicate domination. Collective efforts are needed from us all, because no one person or group can do everything. Men’s participation, awareness and engagement in this goal will be vital. A global society of freedom, justice and peace will not be achieved unless all human needs are met. Closing the global gender gap