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18.11.2020 – The Conversation

Massive project on African DNA sets out to close the knowledge gap on mental illness
DNA chain (Image by licensed under the Creative Commons Attribution-Share Alike 4.0 International)

In July 2009, a woman brought her husband to the hospital where our colleagues work in western Kenya. She reported that for several years he had been behaving abnormally, sleeping poorly, hearing voices that no one else could hear, and believing that people were talking about him and plotting to harm him.

She was seeking help because he was no longer able to work. The man was admitted to the inpatient Mental Health Unit and diagnosed with schizophrenia.

Then the man’s daughter came to visit him. Her clothes and her hair were dishevelled. She described people plotting against her and giving her dirty looks when she walked in the street. She said she was having trouble sleeping. The clinicians looked at each other with apprehension: Might she have schizophrenia too?

Ultimately, the daughter and four more members of the family were diagnosed with schizophrenia. While having six members of the same family diagnosed with schizophrenia is unusual, it has long been recognised that mental disorders can run in families. And often members of such families differ in their symptoms.

For reasons that we are just beginning to understand, one family member might be diagnosed with schizophrenia and another with bipolar disorder or depression. In Eldoret, Kenya, where this health facility is located, it is not unusual to have two or three relatives receiving care for mental illnesses.

Such an occurrence is not unique. Research has found that severe mental illness is influenced by genes more than by any other risk factor. And genes are emerging as important clues for new treatments.

But research on the genetic basis of mental illness has so far largely excluded populations that are not of European heritage. That means that this Kenyan family, and other people of African descent, might not benefit from the new biological insights into mental illness.

To help remedy this problem in psychiatric research, researchers from the United States and four countries in Africa are working together to study the genetics of schizophrenia and bipolar disorder. They are drawn from the Harvard T.H. Chan School of Public Health and the Broad Institute of MIT in the US, Moi University and KEMRI-Wellcome Trust in Kenya, Makerere University in Uganda and Addis Ababa University in Ethiopia. Rounding out southern Africa is the team from the University of Cape Town.

The initiative aims to do something that has never been done on this scale before: recruit 35,000 people in Ethiopia, Kenya, South Africa and Uganda to answer questions about their health, lifestyle and mental illness, and donate two teaspoons of saliva for DNA testing.

Diversity problem

The finding that severe and chronic mental illnesses tend to cluster in families has spurred efforts to understand the genetic differences between people with these illnesses and those without. By looking at DNA and untangling what is going awry in the brain to cause these mental disorders, we hope to spur the creation of new medications to treat these debilitating illnesses and reduce the suffering that comes with them.

Unfortunately, recent efforts to study the genetics of a number of illnesses have what many of us are calling a “diversity problem.” Most of the work in human genetics so far has focused on people of Northern European descent, skewing the data in a way that makes it less useful to the majority of people in the world.

The world is perilously close to an era of “white-people-only DNA tests.” In existing databases, 78% of the DNA data comes from people of European ancestries, who make up only about 16% of the world’s population.

One of the main issues presented by this diversity problem is that any solutions (including new medications) are likely to work best for the people whose DNA the research was based on – people of European descent. In fact, most residents in a diverse city like the US city of Boston, made up of white, black, Hispanic and Asian people among others, may not benefit the way they could from research efforts emanating from only a section of the world’s population.

Potential targets for new medicines

Our large collaborative effort in Africa is called Neuropsychiatric Genetics of African Populations-Psychosis, “NeuroGAP-Psychosis” for short.

With the data collected from the 35,000 people recruited for the project we will be looking for important, clinically relevant genetic differences that might be found in people of African descent and may be less common in people of European descent.

The information could lead to potential targets for new medicines that will help people of African descent and likely people of all ancestries around the globe due to the way human populations originated in Africa and migrated to other continents.

In truth, genetics research cannot be done effectively in a narrow slice of humanity. Our hope is that the genetic data found in the NeuroGAP-Psychosis study, and in similar studies underway in Mexico, China, Japan, Finland and many other countries, will be combined to help solve the mystery of the causes of schizophrenia and bipolar disorder.

Our greatest wish? To see better treatments reach all people suffering from severe mental illness, whether they are in western Kenya or in Boston.

18.11.2020 – Global Voices Online

Moldovans elect their first female president
President-elect of Moldova Maia Sandu in a November 12 campaign video (Image by Maia Sandu’s Facebook page)

Maia Sandu beat Igor Dodon in Sunday’s runoff vote

Maia Sandu is set to become Moldova’s first female president after winning a landslide victory in Sunday’s election.

According to preliminary figures from Moldova’s Central Electoral Commission (CEC), Sandu took 57.7 percent of the vote compared to 42.3 percent for the incumbent Igor Dodon. Sandu, a former World Bank economist, ran on an anti-corruption platform, draw investment to one of Europe’s poorest countries, reform the judicial system and bring transparency to its scandal-ridden politics.

This was their second duel. Dodon, who is affiliated with the Party of Socialists (PSRM) became president in 2016, narrowly beating Sandu with a five percent lead. Dodon, who flaunts his pro-Moscow credentials, promised “stability” and sang the praises of closer economic ties with Moscow. Sandu, who also leads the Action and Solidarity Party (PAS), is regarded as more pro-European.

Foreign observers generally regard all Moldovan elections as geopolitical, even civilisational, choices between Russia and Europe. But for many voters, the priority is economic. In any case, the country is deeply entwined with both — Moldova does most of its trade with the EU, with which it signed an association agreement in 2014. Meanwhile, Russian soldiers and Russian money guarantee the status quo in Transnistria, a self-proclaimed republic occupying a sliver of land on the left bank of the River Dniester.

Hundreds of thousands of Moldovans have headed East and increasingly West in search of the economic prospects their country cannot offer them. In a country with one of the world’s highest rates of depopulation, citizens abroad have an inordinate clout during elections.

Sandu received over 948,000 votes; the highest number cast for any presidential candidate in Moldova’s history. Many of these voters were Moldovans abroad — particularly in the EU. The following scenes at a polling station in Germany indicate that emigres are not ambivalent towards politics back home:

Their engagement has been newly charged by the scale of Moldova’s recent political turmoil.

In 2014, a billion dollars was siphoned out of three local banks with the connivance of influential politicians. The scandal enraged public opinion and led to the downfall of former Prime Minister Vlad Filat, one of the country’s most powerful men. From then on, Moldova’s politics was dominated by the oligarch Vlad Plahotniuc. A succession of nominally pro-European coalition governments led by Plahotniuc’s Democratic Party (DPM) faced off against the pro-Russian PSRM and a group of anti-Plahotniuc but pro-European parties, one of which was led by Sandu. By 2018 the EU had declared Moldova a state “captured by oligarchic interests”.

After inconclusive parliamentary elections last spring, Plahotniuc’s rule collapsed and he fled the country, leaving the PSRM and Sandu to form a unity government for “de-oligarchisation”. Sandu served as prime minister for a few months, before that government too fell last November at the hands of a no-confidence vote by the PSRM and some of the DPM’s remaining MPs.

A second term for Dodon could have been a chance for the PSRM to consolidate its already considerable influence over Moldovan politics.

If Sandu’s election is an obstacle to that goal, it may not be an insurmountable one. With a few exceptions — such as appointing the prime minister and calling national referendums — Moldova’s presidency is largely a ceremonial office. However, it is a prominent position and allows the holder to set the tenor of political debate. If these gestures clash with government policy, the president can quickly become a real headache for governments of the day, as the DPM-led coalition discovered after Dodon’s election.

“The victory of Maia Sandu represents a double revenge — for the ousted government in 2019 and for the lost elections in 2016. The success of Sandu should not be in any case assumed as an absolute support for her political agenda. A big share of voters like and support her and the party that stands behind her. But a smaller segment has voted against Igor Dodon and like other leaders than Sandu, like Renato Usatîi or Ilan Shor”, explains Dionis Cenusa, a Moldovan political analyst and researcher at the Institute of Political Studies at the Justus-Liebig University in Giessen.

“So, in a nutshell, the votes for Maia Sandu is the run-off is not equal to her real popularity at the moment. This should not mean that things can change if her presidency obtains good results“, Cenusa told GlobalVoices.

Therefore Sandu’s support came from a diverse group, including her competitors from the first round, the liberal and centre-right politicians Andrei Năstase and Dorin Chirtoacă, whose politics are associated with unification with neighbouring Romania, a position widely loathed by pro-Russian voters.

This time, they were joined by an unlikely ally. Renato Usatîi, mayor of Moldova’s second largest city Bălți, took ten percent of the vote in the first round. Usatîi heads Our Party, a pro-Russian populist opposition grouping whose base somewhat overlaps with Dodon’s electorate. But when Usatîi did not make it through to the second round, he called on his supporters to vote “against Dodon”.

Along with the looming threat of COVID-19, Usatîi‘s participation strongly distinguished this vote from the presidential race in 2016. But much remained the same — particularly the candidates’ talking points.

Both campaigns accused the other of corruption. Prominent PSRM politician Bogdan Țîrdea suggested that Sandu’s allies and leading independent media were the agents of the billionaire philanthropist George Soros, while Sandu’s campaign drew attention to a surreptitiously recorded meeting in June 2019 between Dodon and Plahotniuc.

Dodon’s campaign materials played some very real concerns among Moldovan voters about “optimisation”, the shrinking of the state sector which Sandu’s style of politics has advocated. However, the dominant tone was one of a culture war: flyers suggested that Sandu’s election would downgrade the status of the Russian language in Moldova, forbid public celebration of the Soviet Union’s defeat of Nazi Germany, and undermine Orthodox Christian values by legalising same-sex marriage. They proclaimed: “Moldova has something to lose!”

These compelled Sandu to release a Russian-language Facebook video on November 12 in which she dismissed each of these accusations.

Dodon has alleged large-scale electoral fraud, but accepted the election result. He now has no other choice: on November 16, Russian President Vladimir Putin congratulated Sandu on her election victory.

In recent interviews with Russian media, such as TV Rain, Sandu has reiterated her desire to preserve strong ties with Russia, even while breathing new life into the 2014 association agreement with the EU. Her key priority with Moscow, she says, is to restore Moldovan exports to Russia, which have been impeded due to poor relations in recent years.

Vladimir Soloviev, a former Moldova correspondent for the Russian daily Kommersant, writes for Carnegie Moscow that the Kremlin might even be able to find a common language with Sandu. The journalist suggests that Russia may have rested on its laurels in recent years, content to sit back as successive unpopular pro-European governments damaged the EU’s credibility with ordinary Moldovans. But as Moscow invested its hopes in one politician, he remarks, Brussels had embarked on a wider programme to regain that trust, repairing roads and rebuilding schools. And despite the apparent assistance of Kremlin spin doctors in assisting Dodon, a vague appeal against change was not appealing enough.

The symbolism of Sandu’s victory is not trivial, particularly given that she has faced sexist language, attempts to spread falsehoods about her personal life, and criticism from religious figures for being unmarried into her 40s. The hope is that Moldova’s first female president can set a new tenor on equality in public life, which the office’s symbolism of the position will certainly allow her.

Crucially, the role will also allow Sandu to call for snap parliamentary elections, which she has already stated is a priority. The stakes will then be even higher.

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Dietrich Bonhoeffer

We must act and dare the appropiateness and not whatever comes to our mind not floating in the likelihood but grasp the reality as brave as we can be freedom lies in action not in the absence of mind obedience knows the essence of good and satisfies it, freedom dares to act and returns God the ultimate judgment of what is right and what is wrong, Obedience performs blindly but Freedom is wide awake Freedom wants to know why, Obedience has its hands tied, Freedom is inventive obedient man respects God’s commands and by virtu of his Freedom, he creats new commands. Both Obedience and Freedom come true in responsability (Dietrich Bonhoeffer)

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