Nhớ 'một câu nhịn chín câu lành', người Việt sẽ không hung dữ
Hơn nhau không phải ở nắm đấm mà là ở khả năng học tập, làm việc, chia sẻ, thương yêu, tử tế với ḿnh, với người trong mối quan hệ với cuộc sống xung quanh!
Hạ cẳng tay, thượng cẳng chân sau khi va chạm giao thông - Ảnh do bạn đọc cung cấp
Cách đây mấy bữa, trên đường đi làm về, tôi thấy một đám đông ở Hàng Xanh (Q.B́nh Thạnh, TP.HCM), nghĩ là có kẹt xe. Tới gần mới phát hiện là vừa có vụ va quẹt và hai tài xế đang căi nhau, người đi đường ngang qua ai cũng lắc đầu.
Chuyện va quẹt trên phố đông như Sài G̣n giờ tan tầm là chuyện cơm bữa, nếu cảm thông và chia sẻ được th́ có lẽ người ta sẽ nhẹ nhàng cho qua, tôi nghĩ vậy!
Môi trường nhiều mầm mống bạo lực
Thường người ta sẽ nổi nóng khi gặp một chuyện bất như ư nào đó, như vừa bị sếp la, ra cổng cơ quan bảo vệ đùa một câu, liền sân si. Nỗi buồn, sự bực bội là thứ năng lượng chi phối hành xử khiến người ta không thể kiềm chế được cơn tức dâng lên, lây sang người khác.
V́ vậy, có người dễ nổi nóng đă cảnh báo: "Thấy tôi ‘khó ở’ là tránh xa xa giùm, không ăn mắng ráng chịu". Theo đó, người nóng lâu ngày họ cũng biết tính khí của ḿnh nên có "chống chỉ định" chuyện nói đùa, tiếp xúc lúc họ đang không vui, căng thẳng. Thực ra, khi quá mệt mỏi, phiền muộn trong ḷng, ta không c̣n giữ được ḿnh.
Có người bạn của tôi b́nh thường hiền queo, ai nói ǵ cũng cười. Bỗng một ngày, tôi hỏi "sao buồn dữ rứa?" lại bị bạn nạt cho một câu nghe chưng hửng. Trời, bạn ḿnh đây sao? Mới đầu tôi phản ứng vậy, nhưng chợt dừng lại v́ nhớ ra, đây không phải là bản chất của bạn. Có thể bạn đang có một nỗi niềm, áp lực từ cuộc sống, gia đ́nh, t́nh yêu hoặc bản thân đang trải qua bệnh tật, sự cố…
Ai cũng có lúc nóng giận, nếu ḿnh hiểu th́ sẽ không khiến ngọn lửa trong họ cháy phừng. Tôi im lặng và không bỏ mặc, cuối cùng cũng nghe được thổ lộ từ bạn. Bạn bị nhiều áp lực trong công việc: sếp chèn ép, đồng nghiệp t́m cách chơi khăm, lương không cao, phải chật vật trang trải cuộc sống…
Tất nhiên, nhiều người khó khăn hơn nhưng họ không nổi nóng. Đó là tính cách và sức chịu đựng của từng người. Sự nóng tính là một thói quen được huấn tập hằng ngày theo nguyên lư:
"Thói quen tạo nên tính cách, tính cách tạo nên số phận".
V́ thế, các chuyên gia tâm lư khi chia sẻ với tôi về thói vũ phu của chồng vẫn thường lưu ư, có thể anh ấy từng bị bạo hành lúc nhỏ, từng sống gần những gia đ́nh lớn tiếng, ồn ào đánh căi nhau như cơm bữa.
Sự tác động của cuộc sống xung quanh lên tính cách con người theo hướng đó được ông bà xưa đúc kết rằng "gần mực th́ đen". Cái đen đó cần có thời gian thanh lọc để dần trắng, nhưng nếu vẫn tiếp tục nuôi dưỡng trong môi trường đen hơn th́ sẽ đen đậm hơn.
Ngày nay các văn hóa phẩm mang tính bạo lực vẫn đầy rẫy trên mạng và tồn tại trong cuộc sống, giải trí của nhiều người: từ game online đến phim ảnh. Thường ngày tiếp xúc với sự đánh đấm, máu me trong các "thức ăn tinh thần" đó khiến năo quen với những "mùi vị" của bạo lực, từ đó hành xử theo.
Những kẻ "giang hồ mạng" được ngưỡng mộ và thu tiền trăm triệu cũng chính là một "h́nh tượng" khiến người ta thay đổi suy nghĩ: cần ǵ học hành, tử tế, chỉ cần có "số má" là có thể lên đời.
Môi trường bên ngoài đă vậy, trong nhà trường, gia đ́nh cũng đầy mầm mống bạo lực, tránh sao người trẻ không hoang mang và hành xử theo cách tương tự. Đây mới là điều đáng lo, và người lớn muốn thay đổi không khí bạo lực lan tràn th́ chính bản thân phải nỗ lực để ứng xử nhẹ nhàng với nhau trước.
Nhẫn để yêu thương
Không thể có kết cục tốt với những người nóng nảy. Nhân vật Trương Phi trong Tam Quốc Chí là h́nh mẫu của nóng tính dẫn đến hư sự và mang họa sát thân. Ai cũng nóng nảy trong hành xử th́ chiến tranh sẽ nổ ra, thương vong là tất yếu.
Một câu nói đùa cũng thành chuyện lớn v́ con người ta quá nóng, quá hung dữ; đi nhậu lo hát karaoke cũng bị đánh chết th́… ôi thôi, cuộc sống quá kinh khủng. Pháp luật cần nghiêm minh để trừng trị việc vô cớ đánh, giết người nhưng đó là xử lư phần ngọn, c̣n cái gốc vẫn là giáo dục.
Làm sao để con người có thể chậm lại để phân tích kỹ hơn từng câu nói, từng biểu hiện của người khác, trong đó có thân nhân, bạn bè ḿnh để không chụp mũ rồi hành xử như người điên, người say?
Sống thiền hay b́nh tĩnh sống, sống chậm, sống có chánh niệm… là những cách sống theo tinh thần "nhẫn để yêu thương". Đầu tiên là thương ḿnh. Một người chỉ được người khác tin tưởng, nể trọng và giao việc khi có sự chín chắn, điềm tĩnh trong xử lư. Như vậy, người sống có lư trí, điềm tĩnh chính là cách sống lợi lạc tự thân.
C̣n cái lợi cho người xung quanh, nhất là người thân - thương th́ cũng dễ dàng để thấy. Con cái sẽ học được nhiều điều hay ho từ bố mẹ có cách sống nhẹ nhàng, t́nh cảm. Đó mới là gia tài quư giá để lại cho con.
Hành xử nóng tính dẫn tới hư việc, hại người th́ ṿng lao lư chờ ḿnh là chắc chắn. Một khi đă gây ra sự cố mới hối th́ đâu c̣n kịp. Nhiều người b́nh luận thiếu niên 16 tuổi rút dao đâm chết người nhắc ḿnh chuyện chạy xe chính là "anh hùng rơm", chứng tỏ với bạn gái nhưng rồi được ǵ sau lần ra tay đó? Tù tội và có thể mất luôn bạn gái.
Ai đợi và ai chấp nhận một người giết người làm người yêu, người chồng, người cha tương lai?
Thực ra, sân si - ai cũng có. Cái chính là cách quản lư năng lương tiêu cực đó để những năng lượng tích cực phát triển. Để làm được điều đó, phải xây dựng lối sống nhân văn từ chính mỗi gia đ́nh, người lớn dạy trẻ nhẫn nhịn để an lành như ông bà ḿnh nhắc "một câu nhịn chín câu lành".
Cleveland Clinic releases fourth installment of Alzheimer's Disease Drug Pipeline Report
Despite several high profile failures, Alzheimer's drug development continues with a diverse pipeline beyond amyloid
Cleveland Clinic
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Cleveland Clinic's fourth annual analysis of Alzheimer's disease drug development found that the pipeline has grown in the number and variety of agents being tested over the past year, while highlighting several advances in the field including new clinical trial designs, more detailed criteria for making a research diagnosis, and an increased use of biological tests reflecting of the disease.
Based on the federal website ClinicalTrials.gov, the paper, Alzheimer's disease drug development: pipeline 2019, is Cleveland Clinic's fourth review of Alzheimer's disease drug development and appears as a July featured article in Alzheimer's & Dementia: Translational Research & Clinical Trials Interventions (TRCI), an open access journal of the Alzheimer's Association.
"Improvements to clinical trial design and new guidelines for a research diagnosis of Alzheimer's disease have allowed for accuracy in studies and precision in the staging of Alzheimer's disease, which are increasingly important in drug development," said Jeffrey Cummings, M.D., ScD, director emeritus of Cleveland Clinic Lou Ruvo Center for Brain Health, director of the Center for Neurodegeneration and Translational Neuroscience and research professor at the University of Nevada, Las Vegas department of Brain Health. "This progress is a result of key collaborations amongst stakeholders and has elevated us to an unprecedented stage of drug development. We've never seen more funding, more agents or more diversity in the pipeline."
At a time when scientists are now reexamining the role of therapies targeting amyloid, this year's pipeline shows a trend toward a more diverse approach in attacking Alzheimer's disease. These agents include, anti-tau, neuroprotective, anti-inflammatory, regenerative (stem cells) and metabolic interventions. Additional trends include a variety of approaches to deep brain stimulation as well as ribonucleic acid (RNA)-based therapies.
"It's been really disappointing to see these last couple of clinical trials fail. We were worried that this would have a devastating impact on Alzheimer's drug development, but when we surveyed the landscape, we were encouraged to see more, not fewer agents being developed," said Aaron Ritter, M.D., director of clinical trials at Cleveland Clinic Lou Ruvo Center for Brain Health. "Every drug failure is an opportunity for learning, and it is our hope that through this paper, the public will see the importance of clinical trial participation. The bottom line is that as the pipeline grows, so does the number of people needed to test these medications."
Drs. Cummings and Ritter, along with fellow authors Garam Lee, Pharma.D., a clinical research pharmacist at Cleveland Clinic Lou Ruvo Center for Brain Health; Marwan Sabbagh, M.D., director of Cleveland Clinic Lou Ruvo Center for Brain Health; and Kate Zhong, M.D., CEO of CNS Innovations examined all clinical trials from 2018 to 2019 to uncover the diversity in the pipeline as well as innovations utilized in current trials such as designs, outcomes, populations and biomarkers.
The authors note that several new clinical trial designs - including futility analyses and adaptive trial designs, as seen in the development of cancer and diabetes medications - increase the speed and sophistication of conducting Alzheimer's disease clinical trials. Another important trend in the field is a move toward testing medications in people either minimally effected or even before the onset of symptoms.
Several Alzheimer's prevention studies enrolling people based on their genetic predisposition to Alzheimer's disease are now being conducted. Moving forward, the authors' specific areas of interest include repurposed agents, immunotherapies, and novel mechanisms of action (MOA).
'Flash mob' study puts clinical decision rules for ACS to the test
A nationwide flash-mob study for suspected Acute Coronary Syndrome
American Academy of Family Physicians
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A novel "flash mob" study finds that, in emergency care, acute coronary syndrome cannot be safely ruled out using the Marburg Heart Score or the family physicians' clinical assessment. In a period of only two weeks, researchers at Maastricht University collected data on 258 ACS-suspected patients by mobilizing one in five family physicians throughout the Netherlands to participate in the study. This mobilization was done by enlisting ambassadors among the FP community in the Netherlands who then spread the word through traditional professional and social networks. The study found that among 243 patients receiving a final diagnosis, 45 (18.5%) were diagnosed with acute coronary syndrome. Sensitivity for the FP rating was 86.7% and sensitivity for the MHS was 94.4%. While large, prospective studies can be time consuming and costly, this innovative "flash mob" method of research, named after the large-scale public collaborations/gatherings driven by social media, allowed for the fast investigation of one simple question on a large scale in a short timeframe.
Many still uninsured after Affordable Care Act Implementation
Following uninsured patients through Medicaid expansion: Ambulatory care use and diagnosed conditions
American Academy of Family Physicians
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In community health centers in Medicaid expansion states, among established patients who were uninsured prior to the Affordable Care Act, many remained uninsured after implementation of the Obama-era law. Using electronic health record data across 11 Medicaid expansion states, an Oregon Health & Science University study tracking uninsured patients before and after the implementation of the ACA found that 21% of those patients remained continuously uninsured, 15% gained Medicaid, 12% gained other insurance, and 51% did not visit their Community Health Center post ACA implementation. The 21% who remained uninsured were largely Hispanic and spoke Spanish as their primary language, indicating both a language and potential legal barrier to enrollment in the ACA. These uninsured patients continued to have frequent healthcare visits and the majority had at least one health condition that would require continuous care. The results of this study point to a need for additional funding to support the needs of Community Health Centers serving the uninsured.
Redesign of opioid medication management shows impact in rural clinics
Team-based clinic redesign of opioid medication management in primary care: Effect on opioid prescribing
American Academy of Family Physicians
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In rural practice, a system redesign resulted in declines in the proportion of patients on high dose opioids and the number of patients receiving opioids. The "Six Building Blocks," a team-based redesign of opioid medication management within smaller practice settings addressing policy changes, patient agreements, patient tracking, in-clinic support, and success metrics, was implemented in 20 clinic locations across eastern Washington and central Idaho. Among patients aged 21 years and over, there was a 2.2% decline in patients receiving high dose opioids over a period of 15 months, compared to a 1.3% decline in the control group. Similarly, a 14% decline was observed in the total number of patients receiving opioids in the intervention clinics compared to a 4.8% control group decline. The results indicate that efforts to redesign care by primary care teams, guided by the Six Building Blocks framework, can improve opioid prescribing practices and possibly reduce dependency.
Metformin could lower risk of dementia in African Americans with type 2 diabetes
American Academy of Family Physicians
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A large observational cohort study examining male veterans aged over 50 years with type 2 diabetes found that metformin use was associated with a significantly lower risk of dementia in African American patients. The study included data from 73,500 patients who received care through the Veteran's Health Administration from 2000-2015 and were diabetes- and dementia-free at baseline and who subsequently developed type 2 diabetes and began treatment with either metformin or sulfonylurea. Cox proportional hazards models, using propensity scores and inverse probability treatment to balance confounding factors, were computed to measure the association of both drugs and incident dementia across race and age groups. For African American patients aged 50-64 years, the hazard ratio for developing dementia was 0.60 (CI, 0.45-0.81), and for African American patients aged 65-74 years, the hazard ratio was 0.71 (CI, 0.53-0.94). The study showed modest to no association between metformin and lower risk for dementia in white patients 65-74 and no association in other age groups. The present results may point to a novel approach for reducing dementia risk in African Americans with type 2 diabetes mellitus.
Diabetes patients experiencing empathy from PCPs have lower risk of mortality
American Academy of Family Physicians
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A United Kingdom study designed to examine the association between primary care practitioner empathy and incidence of cardiovascular disease and all-cause mortality among type 2 diabetes patients found that those patients experiencing greater empathy in the year following their diagnosis saw beneficial long-term clinical outcomes. Using the consultation and relational empathy (CARE) questionnaire, which measures patients' experience of care with a focus on empathy, a numerical score for 628 participants from 49 general practices in East Anglia, UK, was computed 12 months after diagnosis. Those patients reporting better experiences of empathy had a lower risk (40-50%) of all-cause mortality over the subsequent 10 years compared with those reporting low practitioner empathy. While medicine moves increasingly towards precision, target-driven health care and technology-based assessment models, these findings suggest that interpersonal, empathic care may be an important determinant in the risk of mortality.
Study confirms disparities in triple-negative breast cancer diagnoses
Georgia State University
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IMAGE: Women of color and young women may face elevated risks of developing triple-negative breast cancers, a type of cancer that spreads more quickly than most other types and doesn't respond... view more
Credit: Georgia State
Women of color and young women may face elevated risks of developing triple-negative breast cancers, a type of cancer that spreads more quickly than most other types and doesn't respond well to hormone or targeted therapies, a study published in CANCER, a peer-reviewed journal of the American Cancer Society, shows.
Previous U.S. studies have found racial disparities in triple-negative breast cancer diagnoses, but few have looked beyond the scope of one state. To conduct a larger study, researchers in the Georgia State University School of Public Health analyzed all breast cancer cases diagnosed during 2010-14 from the United States Cancer Statistics database, a surveillance system of cancer registries with data representing 99 percent of the U.S. population.
The team identified more than 1.15 million cases of breast cancer, with triple-negative cases accounting for about 8.4 percent of all cases. The researchers uncovered a significant incidence of triple-negative breast cancer for women of color, specifically non-Hispanic black women, and for younger women.
Compared with non-Hispanic white women, non-Hispanic black women and Hispanic women had higher odds of being diagnosed with triple-negative breast cancer, respectively. More than 21 percent of non-Hispanic black women were diagnosed with triple-negative breast cancer, compared with less than 11 percent for all other types of breast cancer. Women younger than 40 years of age had twice the odds of being diagnosed with triple-negative breast cancer than women aged 50-64 years. Also, among women who were diagnosed with breast cancer, those diagnosed at late stages were 69 percent more likely to have triple-negative cancer than other types.
"Our results demonstrate that African American women of younger age are more likely to be diagnosed with triple negative breast cancer than younger women of other ethnicities," said Dora Il'yasova, epidemiologist and associate professor in the School of Public Health at Georgia State.
Because of the aggressive nature of triple-negative breast cancer and the lack of therapeutic options, it is important to know which individuals face a higher risk and what factors may influence this risk, the researchers noted.
"Until we have evidence of what environmental and genetic components contribute to this risk, it is imperative that women know their familial history of breast cancer, discuss that with their physicians and follow screening recommendations," said Lia Scott, lead researcher, recent doctoral graduate of the Georgia State University School of Public Health (Ph.D. '18), and current Steven M. Teutsch Prevention Effectiveness Fellow with the Centers for Disease Control and Prevention Division of Cancer Prevention & Control. "We hope that this update on the epidemiology of triple-negative breast cancer can provide a basis to further explore contributing factors in future research."
According to the American Cancer Society, most breast cancers are mainly classified by three proteins that can affect the cancer's growth: the estrogen hormone receptor, the progesterone hormone receptor and the human epidermal growth factor receptor 2 (HER2). Triple-negative breast cancer does not have any of the receptors, making it difficult to identify what is fueling the cancer's growth. Doctors have fewer options for targeted treatment to destroy these cancer cells. Chemotherapy is still an effective option for treating this cancer and reducing the risk of its return.
Study: New cars are safer, but women most likely to suffer injury
University of Virginia
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IMAGE: The Center for Applied Biomechanics is crash-testing an industry-standard dummy that is designed to represent a 5th percentile female (5 feet tall, weighing 110 pounds). These tests will help evaluate... view more
Credit: UVA Center for Applied Biomechanics
Cars built in the last decade have been shown to be safer than older models, including in the most common types of crashes - frontal collisions. However, a new study conducted by researchers at the University of Virginia's Center for Applied Biomechanics shows that women wearing seat belts are significantly more likely to suffer injury than their male counterparts.
Belted female auto occupants have 73% greater odds of being seriously injured in frontal car crashes compared to belted males (after controlling for collision severity, occupant age, stature, body mass index and vehicle model year). The difference in risk is greatest for injury to the lower extremities, but also occurs with several other types of injury.
"Until we understand the fundamental biomechanical factors that contribute to increased risk for females, we'll be limited in our ability to close the risk gap," said Jason Forman, a principal scientist with the Center for Applied Biomechanics. "This will take substantial effort, and in my view the National Highway Traffic Safety Administration does not have the resources needed to address this issue."
Additionally, vehicle occupants age 66 and older continue to be particularly susceptible to thoracic injury, likely resulting from increased fragility of the ribcage with advanced age.
The good news is that newer automobiles have tended to exhibit a decreased risk of injury overall. Specifically, risk has decreased for skull fractures, cervical spine injury and abdominal injury. Injury risks to the knee-thigh-hip region and the ankle are also significantly reduced. The risk of sternum fractures and serious rib fractures, however, has not been significantly reduced.
The study, published this week in the journal Traffic Injury Prevention, is an analysis of crash and injury data compiled from the National Automotive Sampling System Crashworthiness Data System for the years 1998 to 2015. These data come from a sample of police-reported crashes in the U.S.
"For belted occupants in frontal collisions, substantial reductions in injury risk have been realized in many body regions in recent years," Forman said. "These results provide insight into where advances in the field have made gains in occupant protection, and what injury types and risk factors remain to be addressed."
This study focused on frontal-impact crashes with belted occupants, aged 13 and older. The data included nearly 23,000 front-end crashes involving more than 31,000 occupants, and a nearly equal number of females and males. Pregnant women who were past the first trimester were not included.
'Traffic light' food labels reduce calories purchased in hospital cafeteria
Massachusetts General Hospital
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BOSTON - A new study by Massachusetts General Hospital (MGH) investigators released today in JAMA Network Open, a publication of the Journal of the American Medical Association, showed that labeling food choices in a hospital cafeteria with simple "traffic-light" symbols indicating their relative health value was associated with a reduction in calories purchased by employees, and that the dietary changes were sustained over two years.
In the program, green labels indicated the healthiest foods, yellow labels indicated less healthy foods, and red the least healthy based on positive and negative criteria, including whether the main ingredient was fruit, vegetable, whole grain, and so forth, and the amount of saturated fat.
Researchers used employee ID numbers to track the purchases of 5,695 employees buying food at MGH cafeterias. After establishing a three-month baseline period, the researchers tracked purchases made after the labels were added and again after product-placement changes made healthier choices more accessible. The interventions remained in place at MGH cafeterias, and the study analyzed data over two years after the traffic-light labels were first introduced.
The researchers found that the proportion of green-labeled foods purchased increased while the proportion of the least healthy foods purchased decreased.
The current study, a retrospective analysis using newly available item-level calorie data, associated the labeling with a reduction in calories over the two-year period studied and found that the biggest calorie decreases were seen in red-labeled food purchases. "So that indicates that not only were employees' consuming fewer calories at work," said lead author Anne N. Thorndike, MD, MPH, "but also that they were improving the quality of the calories they were purchasing."
For employees who visited the cafeterias most frequently, the estimated reduction in calories equated to a weight loss of up to 2 kg (4.4 pounds) over time. However, Thorndike stressed, "this is not a weight loss program." Data show that people gain an average of one to two pounds per year. "If a program like this could help guarantee that every adult maintained a steady weight rather than continuing to gain," she said, "we could start to reverse the obesity epidemic."
Prior research evaluating the impact of food labeling interventions on calories purchased has been either lab-based or cross-sectional, assessing a single food or meal choice. "The difference with our study is that it looked at real-world purchases by employees over several months," said Thorndike.
A third of the nearly 150 million Americans who are employed are obese, and the prevalence of obesity is increasing across all industries, including healthcare. Obesity and diet-related diseases such as diabetes and cardiovascular disease reportedly contribute to higher absenteeism and lower productivity as well as to approximately $200 billion in healthcare costs nationwide. Employees frequently acquire meals at work, and a recent nationally representative household survey found that workplace food was high in calories from saturated fat and sugars, often consisting of items such as pizza, regular soft drinks, cookies, and brownies. Effective strategies for reducing nonnutritive energy intake during the workday could help address the rising prevalence of obesity in the United States and worldwide.
"More workplaces should be doing these kind of interventions," Thorndike said. "Wellness programs typically end after a certain period, but programs like this, that people are exposed to every day when they go to work, become part of the workplace culture. That's how you get people to make long-term changes."
Thorndike believes the labels helped employees to make the healthier choices they wanted to make. "A red label is a reminder that something is not healthy at the time you're about to make the purchase," she said. "The labels are for people who are trying to make a healthy choice but don't have time to look at the nutrition-facts panel. They want something quick and easy so they can make the choice and get back to work."
July/August 2019 Annals of Family Medicine tip sheet
American Academy of Family Physicians
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Diabetes Patients Experiencing Empathy From Primary Care Practitioners Have Lower Risk of Mortality
A United Kingdom study designed to examine the association between primary care practitioner empathy and incidence of cardiovascular disease and all-cause mortality among type 2 diabetes patients found that those patients experiencing greater empathy in the year following their diagnosis saw beneficial long-term clinical outcomes. Using the consultation and relational empathy (CARE) questionnaire, which measures patients' experience of care with a focus on empathy, a numerical score for 628 participants from 49 general practices in East Anglia, UK, was computed 12 months after diagnosis. Those patients reporting better experiences of empathy had a lower risk (40-50%) of all-cause mortality over the subsequent 10 years compared with those reporting low practitioner empathy. While medicine moves increasingly towards precision, target-driven health care and technology-based assessment models, these findings suggest that interpersonal, empathic care may be an important determinant in the risk of mortality.
Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study
Hajira Dambha-Miller, MRCGP, PhD et al
University of Cambridge, United Kingdom http://www.annfammed.org/content/17/4/311
Metformin Could Lower Risk of Dementia in African Americans With Type 2 Diabetes
A large observational cohort study examining male veterans aged over 50 years with type 2 diabetes found that metformin use was associated with a significantly lower risk of dementia in African American patients. The study included data from 73,500 patients who received care through the Veteran's Health Administration from 2000-2015 and were diabetes- and dementia-free at baseline and who subsequently developed type 2 diabetes and began treatment with either metformin or sulfonylurea. Cox proportional hazards models, using propensity scores and inverse probability treatment to balance confounding factors, were computed to measure the association of both drugs and incident dementia across race and age groups. For African American patients aged 50-64 years, the hazard ratio for developing dementia was 0.60 (CI, 0.45-0.81), and for African American patients aged 65-74 years, the hazard ratio was 0.71 (CI, 0.53-0.94). The study showed modest to no association between metformin and lower risk for dementia in white patients 65-74 and no association in other age groups. The present results may point to a novel approach for reducing dementia risk in African Americans with type 2 diabetes mellitus.
Association Between Metformin Initiation and Incident Dementia Among African American and White Veterans Health Administration Patients
Jeffrey F. Scherrer, PhD, et al
Saint Louis University, St. Louis, Missouri http://www.annfammed.org/content/17/4/352
Redesign of Opioid Medication Management Shows Impact in Rural Clinics
In rural practice, a system redesign resulted in declines in the proportion of patients on high dose opioids and the number of patients receiving opioids. The "Six Building Blocks," a team-based redesign of opioid medication management within smaller practice settings addressing policy changes, patient agreements, patient tracking, in-clinic support, and success metrics, was implemented in 20 clinic locations across eastern Washington and central Idaho. Among patients aged 21 years and over, there was a 2.2% decline in patients receiving high dose opioids over a period of 15 months, compared to a 1.3% decline in the control group. Similarly, a 14% decline was observed in the total number of patients receiving opioids in the intervention clinics compared to a 4.8% control group decline. The results indicate that efforts to redesign care by primary care teams, guided by the Six Building Blocks framework, can improve opioid prescribing practices and possibly reduce dependency.
Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing
Michael L. Parchman, MD, MPH, et al
Kaiser Permanente Washington Health Research Institute, Seattle http://www.annfammed.org/content/17/4/319
Shingles vaccine safely prevents outbreaks among stem cell transplant patients
The study could offer hope to others with severely compromised immune systems
Duke University Medical Center
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DURHAM, N.C. - A newer form of shingles vaccine reduced outbreaks of the painful rash among patients who were transplanted with their own stem cells, according to a study led by a Duke Health researcher and published today in JAMA.
The vaccine appears to offer protection from one of the most common and painful side effects of cell therapy and shows promise for patients with immune-compromising conditions.
Using a non-live form of the herpes zoster virus that causes shingles, the researchers tested vaccination among people whose immune systems are wiped out during hematopoietic stem cell transplantation (HSCT). HSCT patients are especially prone to bouts of shingles, which is caused by reactivation of the latent varicella-zoster virus that also causes chicken pox.
The outbreak results in red, painful, burning blisters and rash, typically on one side of the body and often occurs in older adults or people with weakened immune systems. In some cases, shingles causes excruciating and long-lasting neurologic pain.
"This trial is important because it demonstrates that the vaccine works in severely immunosuppressed patients," said oncologist Keith Sullivan, M.D., the James B. Wyngaarden Professor of Medicine at Duke. "That suggests it could also work with others whose immune systems are not normal -- including patients with HIV, breast cancer and auto-immune conditions."
Sullivan and colleagues at 167 centers in 28 countries enrolled more than 1,800 transplant recipients. Half were randomly assigned to received two vaccine doses shortly after transplant and half received placebo.
At a median follow-up of 21 months, the vaccine group had 30 cases of shingles per 1,000 person-years compared to 94 cases per 1,000 person-years among patients receiving placebo injections.
The vaccine also apparently reduced the incidence of painful post-therapeutic neuralgia, shingles-related hospitalizations and complications and duration of pain.
"Among HSCT patients, a shingles outbreak is often more feared than the transplant itself, and I've had patients tell me they'd undergo two transplants before facing another episode of shingles," Sullivan said. "It's hugely gratifying, and a welcome surprise, to see such a strong immune response among this study population."
In UK's third largest city intervention program helps reduce childhood obesity
Bar-Ilan University
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IMAGE: Graph depicting the steady decline in the rate of obesity in Leeds from 2009-2017 as compared to cities like Leeds, and England as a whole. view more
Credit: Bar-Ilan University
Childhood obesity has reached epidemic proportions, affecting children's health and wellbeing and leading to obesity, heart disease, diabetes and cancer later in life. The number of children with obesity continues to rise globally, particularly for children living in poverty.
Leeds, England's third largest city, has bucked the global trend and seen a significant fall in obesity, according to a recent study published in the journal Pediatric Obesity by Prof. Mary Rudolf, Head of the Department of Population Health at the Azrieli Faculty of Medicine of Bar-Ilan University. Furthermore, the largest decrease in obesity occurred among the city's poorest and most disadvantaged children.
Prof. Rudolf conducted her research on the growth measurements of children in England from 2009 to 2017. She found that, unlike England as a whole and comparable cities, the numbers of obese children in Leeds fell by 6.4%. "We used nationally collected data in our study, so it was very obvious that something different was happening in Leeds," she says.
Next week Prof. Rudolf will present the findings of her study to the Food and Health Forum at the British Parliament. This cross-party forum meets regularly and advises Parliament on how the health of the nation can be improved.
The decline in obesity coincided with a strategy introduced by the city in 2009 which aimed to tackle the obesity epidemic through focusing on families with preschool children in the poorest areas of Leeds. At its heart was HENRY - Health Exercise Nutrition for the Really Young -- an intervention developed by Prof. Rudolf and colleagues for children under the age of five. HENRY, which has been widely adopted in the UK over the past ten years, offers a range of programs and trains health and community practitioners to work in innovative ways to help parents provide their families with a healthier start in life.
In Israel, where Prof. Rudolf is now based, one in five children are obese or overweight by the time they start first grade, rising to one in three by seventh grade. In an effort to address the problem, the Israel Ministry of Health brought HENRY to Israel in 2014. A team of four professionals was sent to Oxford to learn the approach, and subsequently trained nurses, dieticians and social workers who worked directly with families that participated in the program, and in particular specialists in early childhood. Training was also provided to parents participating in the program. HENRY has been translated into Hebrew and Arabic and has been piloted in a variety of disadvantaged towns, such as Safed, Kiryat Yam, Daliyat al-Karmel, Ussefiya, Baqa al-Gharbiyye, Ramle, Jerusalem, Yeruham, and Dimona.
Known in Israel as Efshari bari mishpachti ("A Healthy Family is Possible") the program has been tailored to families with children under the age of three, and is under evaluation by Prof. Orna Baron-Epel, of the University of Haifa. Results show that group work with parents was particularly successful in changing family lifestyle. Plans are now being considered to extend the program to the nation's kupot holim (healthcare service providers).
Prof. Rudolf says it remains to be seen whether Israeli cities can be as successful as Leeds in tackling the problem of child obesity, but when society invests in early childhood, it gets the best returns for doing so. "If we are going to make a difference we must start at a young age, before the onset of obesity. This can reduce the impact of poor lifestyle later on," concludes Rudolf, who was born in London and worked in Leeds before moving to Israel in 2012.
Scientists discover previously unknown subtypes of liver cells in health and disease
Max Planck Institute of Immunobiology and Epigenetics
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IMAGE: Single cells were isolated from liver tissue derived from 9 different patients to perform single-cell RNA-sequencing. After applying computational single-cell analysis methods, a human liver cell atlas, or cell type... view more
Credit: MPI of Immunobiology and Epigenetics, Freiburg, Grün
The liver is one of the largest and most versatile organs of the human body. It turns sugars, proteins, and fats from our food into substances useful for the body and releases them to the cells. In addition to its role in human metabolism, the liver is an immunological organ, which is indispensable for detoxifying the blood. Most strikingly, the liver is the only internal organ that can regenerate back to its full size with only 25% of its original mass.
Liver diseases are one of the biggest health problems in the world and a leading cause of death. Only in Germany, at least five million patients are suffering from fatty liver disease, liver cancer, or hepatitis. Despite the immense importance of the liver for human health, the diversity of individual liver cell types and the associated molecular and cellular processes in both healthy and diseased tissue have not yet been fully investigated.
Scientists from the Max Planck Institute of Immunobiology and Epigenetics in Freiburg and colleagues from the University of Strasbourg are now presenting a comprehensive cell atlas of the human liver published in the science journal Nature. Using what is known as single-cell RNA sequencing, the researchers led by Max Planck Group Leader Dominic Grün and in cooperation with the Baumert Lab succeeded in creating a detailed map of the cell populations in the healthy human liver. Based on the analysis of 10000 cells from nine human donors, the cell atlas maps all important liver cell types, including hepatocytes, the major metabolic cells of the liver, endothelial cells lining the blood vessels, liver resident macrophages and other immune cell types, as well as bile duct cells and liver epithelial progenitors. With this data, it is possible to capture the diversity of cell types and cell states at an unprecedented resolution and to understand how they change during development or upon disease progression.
The cell's fingerprint
The researchers also discovered an astonishing diversity among individual cells of the alleged same cell type. They found new subtypes of hepatocytes, endothelial cells, and macrophages, which, although hardly different in their morphological appearance, have discrete gene expression profiles. These discoveries were made possible by the significant progress of experimental and computational single-cell analysis methods, which enable cells to be examined at high resolution.
In single-cell RNA sequencing, the organ tissue to be investigated is dissociated into individual cells; these cells are then isolated and sequenced separately. The sequencing is used to determine how many messenger RNA molecules (mRNA) of each gene are present in the cell. "The messenger RNA transmits the blueprints stored in the DNA to the protein factories. By measuring which RNA molecules are present in a cell at a certain point in time, we can identify which genes are active. This gives us a kind of fingerprint that provides us with a comprehensive insight into the very nature of each cell. This enables us to understand which functions the cell performs, how it is regulated and also what happens when diseases develop," explains Dominic Grün.
The data obtained in this way are not only extremely extensive, but also very complex since the RNA molecules of thousands of genes in thousands of cells have to be quantified and interpreted simultaneously. In recent years, Dominic Grün has developed tailor-made algorithms helping him and his team to characterize the different cell types and understand their developmental pathways.
Identifying progenitors of liver cells
Using such fingerprints of cells, the Freiburg researchers also identified previously unknown properties of a subpopulation of bile duct cells. Bile ducts run through the entire liver to transport bile to the gallbladder. "Our data show that cells within this rare subpopulation are precursor cells or progenitors. They are not only able to form organoids, which is a marked characteristic of stem cells, but also have the potential to develop into different cell types," explains Nadim Aizarani, the first author of the study. These progenitor cells either differentiate into hepatocytes or bile duct cells when cultivated in a culture medium. The Max Planck researchers are convinced that this precursor cell population plays an important role in liver regeneration and could also be involved in the development of liver diseases or tumors.
The cell atlas and the method of single-cell RNA-sequencing, therefore, have great potential for cancer therapy. Current approaches to analyze diseased tissue, such as tumor tissue, only provided an average value of the concentration of active genes for the entire tissue sample and thus only an average view of the tumor's molecular profile. "The contribution of rare cell types or even individual cells is lost in this average value. Although it is perhaps precisely these few cells that determine whether a tissue is healthy or degenerates into cancer," explains Dominic Grün.
But single-cell sequencing, on the other hand, captures the molecular signature of each healthy or diseased cell in the sample to be examined. The comparison with reference data from healthy tissue enables scientists to target the disease-causing molecular properties of tumor cells and may help to develop improved treatment options in the future.
The Freiburg and Strasbourg researchers demonstrate in their newest study that the cell atlas of the human liver will be an essential reference database for liver cancer research. They compared the data of healthy tissue from the cell atlas with cells from hepatocellular carcinoma, the most common form of primary liver cancer. The comparison enabled conclusions to be drawn, e.g. the identification of new tumor cell markers and perturbed gene activity patterns of different cell types within the tumor. "I think that research into cancer using single-cell sequencing will help to improve the diagnosis and eventually the treatment of tumors even further. In the future, we will not only be able to uncover possible interactions between different cell types in tumors. It will also be possible to observe these interactions as the disease progresses," says Dominic Grün.
The researchers are convinced that their cell atlas of the human liver and the developed methods have laid an important foundation within biomedicine, which will advance the research and understanding of liver diseases on the molecular level to possibly create new therapeutic strategies against liver diseases in the future.
Impaired learning linked to family history of Alzheimer's
A large internet-based study suggests that adults with a close relative with Alzheimer's disease have learning impairments that may be worsened by diabetes or genetics
eLife
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Adults with a first-degree relative with Alzheimer's disease perform more poorly on online paired-learning tasks than adults without such a family history, and this impairment appears to be exacerbated by having diabetes or a genetic variation in the apolipoprotein E (APOE) gene linked to the disease.
The findings, published on Tuesday in eLife, may help identify people who have increased risk for developing Alzheimer's disease and could uncover new ways to delay or prevent the disease.
"Identifying factors that reduce or eliminate the effect of a family history of Alzheimer's disease is particularly crucial since there is currently no cure or effective disease-slowing treatments," says lead author Joshua Talboom, PhD, a Postdoctoral Fellow at the Translational Genomics Research Institute in Arizona, US.
Having a family history of Alzheimer's disease is a well-known risk factor for developing the condition, but the effects on learning and memory throughout a person's life are less clear. Some studies have been conducted in this area, but most have been too small to draw significant conclusions.
To enable a larger study, Talboom and colleagues created an easy-to-use website, http://www.mindcrowd.org, that participants could log on to and complete a memory test. Participants were asked to learn 12-word pairs and were then tested on their ability to complete the missing half of the pair when presented with one of the words.
The 59,571 individuals who participated were also asked to answer questions about their sex, education, age, language, country and health, including a question about whether one of their parents or siblings had been diagnosed with Alzheimer's disease. Those with a family history of Alzheimer's were able to match about two and one-half fewer word pairs than individuals without a family history. Having diabetes appeared to compound the learning impairments seen in individuals with a family history.
A subset of 742 participants who had a close relative with Alzheimer's submitted a sample of dried blood or saliva that the researchers tested for a genetic variation in the APOE gene linked to the disease. "The APOE genotype is an important genetic factor that influences memory, and we found that those with the variation performed worse on the memory test than those without the variation," Talboom explains.
Some characteristics, however, appeared to protect against memory and learning impairments in people with a family history of Alzheimer's disease. Participants with higher levels of education experience less of a decline in scores on the learning and memory test than people with lower levels of education, even when they have a family history of the disease. Women also appear to fair better despite having Alzheimer's disease risk factors.
"Our study supports the importance of living a healthy lifestyle, properly treating diseases such as diabetes, and building learning and memory reserve through education to reduce the cognitive decline associated with Alzheimer's disease risk factors," concludes senior author Matthew Huentelman, Professor of Neurogenomics at the Translational Genomics Research Institute, Arizona.
The Zika epidemic in Cuba, reflected by imported cases in Barcelona
A study confirms the key role of imported disease clinics in the surveillance and prevention of arboviral diseases in Europe
Barcelona Institute for Global Health (ISGlobal)
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IMAGE: Returning travellers may introduce infectious diseases such as Zika into non-endemic regions. view more
Credit: Ross Parmly / Unsplash
Travellers returning to Barcelona mirrored the 2017 Zika outbreak in Cuba, according to a study led by the Hospital Clínic of Barcelona and the Barcelona Institute for Global Health, an institution supported by "la Caixa".
Zika virus spread throughout Latin America between 2015 and 2016, followed by a decrease in the number of new cases. Cuba, however, was one of the last countries to report cases: the first autochthonous case was confirmed in March 2016, and recent data indicate that an outbreak with over 600 reported cases occurred mid-2017 in Cienfuegos.
This outbreak was reflected in a study initiated by Hospital Clinic in 2016, with the aim of detecting imported cases of Zika and other mosquito-borne viral diseases (which are part of arboviral diseases). Over a period of almost three years, the Tropical Medicine Service detected 42 imported cases of Zika. While in 2016, Zika-infected travellers had visited different countries in Latin America and the Caribbean, the cases diagnosed from ends of 2017 onwards only came from Cuba. "These cases could reflect an absence of herd immunity in the Cuban population, as well as the possibility of it being one of the last places in America with ongoing virus transmission," explains Alex Almuedo, first author of the study.
For Jose Muñoz, study coordinator, ISGlobal researcher and Head of the Tropical Medicine Service at the Hospital Clínic, these results underscore the need to consider possible Zika infection among travellers returning from Cuba." Only in 2016, more than one million European travellers visited the island.
"It is also important to note that 70% of the travellers that got infected with Zika did not seek advice before their trip," adds Muñoz, highlighting that the imported diseases clinics are "a key element to survey and prevent the introduction of these diseases in non-endemic regions."
Mission: detect autochthonous transmission of arboviral diseases
Along this line, the study AVATAR (Autochthonous arboVirAl Transmisión bARcelona) will be launched this season in collaboration with the Barcelona Public Health Agency and the Instituto de Salud Carlos III, to evaluate the possibility of silent autochthonous transmission in Barcelona of dengue, chikungunya and Zika - viral diseases that can be transmitted by a vector present in the region: Aedes albopictus, also known as tiger mosquito.
Targeting men, seasonal workers could be key to tackling residual cases, study suggests
Johns Hopkins University Bloomberg School of Public Health
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New research led by the Johns Hopkins Center for Communication Programs, Ifakara Health Institute and the Zanzibar Malaria Elimination Program suggests that a better understanding of human behavior at night - when malaria mosquitoes are biting - could be key to preventing lingering cases. The Center for Communication Programs (CCP) is based at the Johns Hopkins Bloomberg School of Public Health.
The new study, published July 1 in Malaria Journal, found that targeting men who work and socialize outside the home in the evenings and travelers and seasonal workers who may bring malaria to the islands from mainland Tanzania could accelerate elimination of the disease.
Zanzibar has maintained malaria prevalence below one percent for the past decade, but elimination of the deadly mosquito-borne disease remains elusive, despite the widespread use of insecticide-treated bed nets and indoor spraying.
"We've seen such great progress, but it's hard to eliminate the remaining cases," says CCP's April Monroe, PhD, who led the research. "It's the typical last mile problem: Sometimes the hardest part of the journey comes at the end. To get there, we need to focus our attention now on human behavior, instead of solely on mosquito behavior as we did in the past."
The World Health Organization estimates that between 2000 and 2015, the rate of new malaria cases declined by 37 percent globally and malaria deaths fell by 60 percent, with 6.2 million lives saved. Three quarters of those gains can be attributed to interventions such as insecticide-treated bed nets and indoor spraying for mosquitoes.
But those interventions are only designed to work indoors.
For the study, Monroe and her colleagues analyzed data from 62 in-depth interviews with community members and leaders conducted in December 2016 and April/May 2017. The researchers also looked at data from night time observation of routine community activities, such as buying and selling at local shops, watching television in public spaces and socializing in small groups, as well as large-scale community events such as weddings and religious ceremonies.
The researchers found little evidence of people using protection against mosquitoes outdoors. "Participants reported that topical repellants were not widely available in the community and were only sold at shops in town," the authors noted.
As one woman who was interviewed remarked, "When you are outside, you really can't wear the bed nets, can you?"
In low-transmission settings like Zanzibar, children under five are no longer considered the population most at risk for malaria infection. They are sleeping under their nets and are typically at home or near home after dark. It is men who are often outside at night, whether working or socializing, which could put them at higher risk.
Zanzibar is made up of a series of islands in the Indian Ocean off the coast of Tanzania, where transmission of malaria is more common. Travelers from the mainland are understood to bring many of the malaria cases found in Zanzibar with them. When a mosquito bites a person infected with the parasite, it infects the mosquito which can then transmit the disease to someone else.
Seasonal workers from mainland Tanzania come to Zanzibar for a variety of reasons, including to work in the fields from planting to harvest time and they often do not have mosquito nets. Some communities in Zanzibar have instituted a process by which newcomers register with community leaders who can connect them with testing for malaria (and treatment, if need be) as well as to offer malaria prevention information. Monroe says these community-designed systems could be scaled up in other areas of Zanzibar.
There is a great opportunity to explore the use of mosquito control tools beyond nets and spraying alongside social and behavior change interventions to help address these identified gaps in malaria prevention that occur after dark, she says.
"Building on these existing systems to target interventions should be explored so as to limit both local and imported malaria cases," the authors note.
"Human behaviour and residual malaria transmission in Zanzibar: findings from in-depth interviews and direct observation of community events" was written by April Monroe, Kimberly Mihayo, Fredros Okumu, Marceline Finda, Sarah Moore, Hannah Koenker, Matthew Lynch, Faiza Abbas, Abdullah Ali, George Greer and Steven Harvey.
How the mosquito immune system fights off the malaria parasite
Iowa State University
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IMAGE: An Iowa State University scientist identifies mosquito species with the help of a microscope. A recent study from ISU entomologists describes the immune responses mosquitoes have to the parasite that... view more
Credit: Iowa State University News Service
AMES, Iowa - A new study from Iowa State University entomologists describes how mosquitoes fight off parasites that cause malaria, a disease that sickens millions of people every year.
The study, published recently in the scientific journal Proceedings of the National Academy of Sciences, shows how the mosquito immune system combats malaria parasites at multiple stages of development. A better understanding of the mosquito immune response could lay the groundwork for future research to combat the transmission of malaria, said Ryan Smith, assistant professor of entomology and lead author of the study.
Roughly 219 million cases of malaria, a disease transmitted to humans by the bite of infected mosquitoes, occurred worldwide in 2017, according to the Centers for Disease Control and Prevention. Most cases are concentrated in tropical and subtropical climates such as sub-Saharan Africa and South Asia. The disease resulted in 435,000 deaths in 2017, according to the CDC.
Mosquitoes are required to transmit malaria, acquiring malaria parasites by biting an infected person, then transmitting the disease weeks later after the parasite has completed development in the mosquito. The new study focused on how the mosquito immune system responds to the parasite.
"Mosquitoes are generally pretty good at killing off the parasite," Smith said. "We wanted to figure out the mechanisms and pathways that make that happen."
The researchers treated mosquitoes with a chemical that depleted their immune cells, which are needed to defend the mosquito against pathogens. The experiments showed that malaria parasites survived at greater rates in mosquitoes when the immune cells were depleted. The research also illuminated how these immune cells promoted different "waves" of the mosquito immune response targeting distinct stages of malaria parasites in the mosquito host.
Smith, who also leads the ISU Medical Entomology Laboratory, said the findings increase the understanding of a complement-like pathway that is involved in the initial recognition and killing of parasites, similar to that found in mammals. The work also implicates phenoloxidases, an insect-specific immune response, in causing a secondary immune response directed at later stages of the malaria parasite, he said.
Understanding these immune responses could lead to opportunities to eliminate malaria parasites in the mosquito, thus reducing the transmission of malaria. For instance, Smith said scientists could use genetic approaches to make mosquitoes resistant to malaria parasites. Introducing mosquitoes with enhanced immunity in endemic areas of malaria could significantly reduce human malaria cases.
"There are more steps required to validate that kind of approach, but we think this study lays a foundation for those future experiments," Smith said.
Nguyễn Bá Chổi (Danlambao) - Một trong những “sự cố” nổi cộm trong quần chúng nhân dân mấy ngày qua là chuyện có hay không cái Quốc tịch Mỹ của “bà” gái rượu của ngài đương kim thủ tướng nước CHXHCNCC. Một bên “sư” (nguyên) Viện trưởng Viện Hồ Chí Minh “nói phải”, một bên “văi” Thanh Phượng “nói không”. Biết nghe ai bây giờ, không quan trọng; vấn đề là: Cớ sao người ta phải “ầm ỷ lên” về cái Quốc tịch Mỹ, mà quên đi cái “mối tội đầu” của nó, là cái Quốc dịch Việt Nam.
Nói đến “Quốc Dịch Việt Nam” là “nói đến”... đố ai không mắc bệnh tâm thần bại năo lại không nghĩ ra ngay đó là Cộng Sản. V́, chỉ sau khi cậu Cu Côn ra đi “t́m đường cứu nước”, cu-bác mới vác về nước cái cái dịch họa tai ương khủng khiếp chưa từng xảy ra, hoành hành khắp cả tổ quốc giang san.
Thực vậy. Trải qua chiều dài lịch sử hơn 4000 năm, dân Việt đă chịu bao nhiêu thứ ôn dịch: dịch đậu mùa, dịch thổ tả, dịch hạch, vân vân..., nhưng chẳng mấy ai bỏ xứ mà đi, mà nếu có đi lánh dịch, th́ chỉ là tạm thời, chờ khi cơn dịch qua đi, người ta lại trở lại quê hương cũ, về mái nhà xưa.
“Phải đợi đến” cơn quốc dịch Cộng Sản, nạn nhân mới không dám nghĩ tới ngày quay về, v́ nó kinh hoàng, khủng khiếp quá, di họa lại khôn lường; so với nó, dịch Thổ Tả, dịch Hạch Háng, dịch Đậu Mùa... chỉ là ba thứ lẻ tẻ, phường bát nháo, nhỏ như con... ghẻ ngứa “ngồi buồn găi háng dái lăn tăn”.
“Động thái” bỏ của nợ (CS) chạy lấy người không phải mới bắt đầu từ ngày đảng ta “đổi mới tư duy”, bỏ Đồng Rúp của “Thành tŕ Cách Mạng Vô Sản” để núp Đồng Đô của “ Đế quốc Tư Bản đầu sỏ, con đỉa hai ṿi; một ṿi hút máu nhân dân Mỹ, một ṿi vươn ra hút máu người nước ngoài trong đó có Miền Nam Việt Nam”, nhưng đă bắt đầu từ thời kỳ toàn dân đang kháng chiến chống thực dân Pháp, nhiều người sau khi “phát hiện” sớm cái mặt con vai-rớt /virus Cộng Sản, đă “dinh Tề”, tức về thành. Thà ở với thực dân bóc lột c̣n hơn sống chung với con khỉ đột gian ác trong rừng.
Rồi khi vai-rớt CS lan truyền lên nửa nước, dân Miền Bắc, trừ những người “điếc không sợ súng”, ai cũng sợ mắc dịch, đă t́m đường vượt tuyến, thoát được triệu người, xuống Miền Nam là nơi mà chúa vai-rớt nói đồng bào “bị Mỹ Ngụy ḱm kẹp, bóc lột thấu xương”.
Tuy “bị Mỹ Ngụy ḱm kẹp, bóc lột thấu xương”, người dân Miền Nam không ai xin “xuất khẩu lao động” ở nước ngoài cả; không có con gái nhà ai tự lột quần áo, xú x́ ḿnh hết trơn, rồi đứng xếp hàng “tự nhiên như người Hà Nội”, để cho ba anh Đài Loan, Đại Hàn ế vợ sang ngắm nghía cân đo đong đếm tuyển chọn làm vợ - có khi là vợ cho tập thể cả nhà người ta bên xứ lạ; không có ai đi du học rồi ở luôn lại nước ngoài, ngoại trừ mấy chàng v́ lư do duy nhất là sợ về nước phải đi lính. Như bây giờ!
Tuy “bị Mỹ Ngụy ḱm kẹp, bóc lột thấu xương”, cái quốc tịch Mỹ chỉ là điều xa lạ, nào có ai nghĩ đến chuyện bỏ nước mà đi, dù là đi Mỹ thời đó được mệnh danh là “thiên đàng hạ giới”.
Lại “phải đợi đến” khi vai-rớt CS “đại thắng mùa xuân”, đ̣i “khuân” luôn gịng máu Việt Miền Nam c̣n lại, người dân Việt mới nghĩ đến chuyện chẳng đặng đừng là bỏ nước mà đi. Đi với bất cứ giá nào; trong đó cái giá trước mắt là làm mồi cho cá, mồi cho hải tặc, mồi cho rừng thiêng nước độc cùng thú dữ. Thà hơn là làm mồi cho vai-rớt ôn dịch CS hoành hành. Cũng xin đừng trách người ra đi sao lại liều ḿnh như thế, v́ ngay cả cột đèn nó c̣n đ̣i, nếu rút chân lên được, nó cũng đi thôi.
Bốn mươi năm quốc dịch đang khiến cho ḍng người xếp hàng trước Sứ quán Mỹ để xin chiếu khán nhập cảnh nước “thằng Mỹ cút” ngày càng dài. Từ đó suy ra, h́nh chụp cái visa made in USA của Ếch cô nương-cục cưng của Ếch Thủ tướng- chỉ là chuyện nhỏ, so với con gái nguyên TBT đảng Vai- rớt- CS Đỗ Mười, cháu của cựu ngài Thủ tướng - Hoàng-Trường-Sa- là-của-Chai-Na- Phạm-Văn-Đồng vân vân đang bám vào đất Mỹ ma hút máu... ai bây giờ...
Nhớ lời Đức Giê-Su dạy, “Con người sống không chỉ bằng bánh, mà c̣n bằng lời Chúa”, người Việt ly hương như Chổi đây nhận ra, bản thân ḿnh không chỉ sống bằng “bơ sữa Mỹ”, mà c̣n sống bằng sợi khói lam chiều trên mái nhà quê hương Việt Nam.
Người Việt mang quốc tịch Mỹ, có chăng cùng v́ cái nạn Quốc dịch Việt Nam, mà thủ phạm chính không ai khác hơn là bác Hồ và băng đảng của “ông cụ”.
Quét sạch nó đi, trách nhiệm chính không phải nơi người phu cầm chổi quét đường, mà trước hết ở bậc sĩ phu; đương nhiên là không thuộc hàng “Viện trưởng Viện Hồ Chí Minh” như mấy ngài “GS. TS”... Sùng, Tùng, Kháng.
Câu chuyện xảy ra vào cuối triều đại nhà Minh đầu nhà Thanh tại thôn Ngơa Gia Điếm cách Bắc Kinh khoảng hơn mười dặm.
Trong thôn này có một gia đ́nh rất giàu, mọi người thường gọi là “Tiền viên ngoại”. Ở cách nhà họ khoảng hai dặm có một gia đ́nh nông dân họ Lư, mọi người thường gọi là “Lư lăo nhị”. Lư lăo nhị là người biết làm một chút các công việc xây dựng, cho nên ông thường xuyên đến nhà Tiền viên ngoại để làm các việc đó cho gia đ́nh này. Mỗi lần Lư lăo nhị đến làm việc nhà Tiền viên ngoại, Tiền gia đều trả cho ông không ít tiền công. Bởi v́ hai nhà thường xuyên qua lại nên Tiền gia coi Lư lăo nhị là Lư đệ (em trai), c̣n Lư lăo nhị gọi Tiền gia là Tiền đại ca (anh trai).
Một năm nọ, cả nhà Tiền viên ngoại đều phải đến phía nam làm việc trong thời gian mấy tháng mới trở về. Tiền viên ngoại cho gọi Lư lăo nhị đến nói chuyện: “Lư đệ! Hai gia đ́nh chúng ta có mối quan hệ tốt đẹp, ta nay gọi đệ đến là có chút việc muốn nhờ, không biết là Lư đệ có giúp được không?”
Lư đệ nói: “Tiền đại ca, đại ca có việc ǵ cứ việc nói, nếu là việc đệ có thể xử lư được th́ nhất định sẽ cố gắng làm.”
Tiền viên ngoại nói: “Ta có một lượng lớn rượu quư, chỉ sợ người ngoài lấy trộm mất, muốn chuyển đến nhà đệ để đệ trông coi giúp, không biết ư đệ thế nào?”
Lư đệ nói: “Đại ca à, đệ c̣n tưởng việc ǵ to tát, đại ca cứ yên tâm đi đi, khi nào đại ca trở về đệ sẽ trả lại nguyên vẹn.”
Thế là, Tiền viên ngoại cho người làm đưa đến nhà Lư lăo nhị 30 ṿ rượu quư, Lư lăo nhị đem chúng cất giữ trong một pḥng trống ở phía tây rồi khóa chặt cửa lại.
Loáng một cái mà đă hai tháng trôi qua, gia đ́nh nhà Tiền viên ngoại đi mà không thấy có tin tức ǵ về báo về.
Một hôm, Lư lăo nhị nhớ ra Tiền viên ngoại có gửi ba chục ṿ rượu quư liền mở cửa pḥng để xem xem một chút. Khi ông mở cửa pḥng ra xem, thấy ba mươi ṿ rượu đều dùng một loại giấy đặc biệt dán miệng, trên thân ṿ rượu c̣n dán giấy màu hồng, trên đó đều ghi một chữ rất đậm “Rượu”. Lư lăo nhị dùng hai tay nhấc một ṿ rượu lên rồi lắc qua lắc lại nhưng lại thấy không có mùi vị ǵ. Ông ta thầm nghĩ: “Ṿ rượu này dù dán kín miệng rồi th́ vẫn có thể ngửi thấy mùi rượu chứ”. Hai tay ông ta lại lắc lắc nhưng cũng không nghe thấy âm thanh của rượu, cuối cùng ông ta quyết định mở một ṿ rượu ra xem. Nhưng thứ mà được đổ ra lại khiến ông ta vô cùng kinh ngạc, đâu có phải rượu, toàn là bạc trắng. Ông ta bắt đầu mở hết cả 30 ṿ rượu ra, và đếm được đúng 3000 lượng bạc trắng. Lăo nhị nghĩ: “Đây đúng là tiền trên trời rơi xuống…!” Nh́n thấy số bạc này, Lư lăo nhị nổi ḷng tham, ông ta nghĩ hết cách để số bạc này biến thành của ḿnh. Cuối cùng, Lăo nhị nghĩ ra một chiêu thâm hiểm là đi ra ngoài mua rất nhiều rượu ngon về rồi rót đầy vào các ṿ rượu kia, sau đó dán kín lại như lúc ban đầu, c̣n số bạc đó ông ta đem chôn hết xuống phần đất trong nhà.
Mấy tháng sau, gia đ́nh Tiền viên ngoại trở về, Lư lăo nhị liền mang 30 ṿ rượu kia trả lại. Khi Lư lăo nhị vừa đi khỏi, Tiền viên ngoại mở các ṿ rượu ra xem xét, nào ngờ tất cả bạc trắng đă biến thành rượu trắng. Tiền viên ngoại hiểu rơ: “Vậy là toàn bộ số tiền tích góp cả đời ḿnh đă bị Lư lăo nhị chiếm hết”. Ông cũng có ư định đến cửa quan để tố cáo Lư lăo nhị nhưng lại nghĩ: “Ta lúc trước đă nói với Lư lăo nhị toàn bộ các ṿ này là rượu, nên việc ông ta trả lại rượu th́ không kiện ǵ được”. Việc này quả thực khiến ông đành phải ngậm bồ ḥn mà im lặng, có nỗi khổ mà không nói được ra. Tiền viên ngoại từ đó vừa nén giận vừa nén uất ức trong ḷng, không quá nửa năm sau th́ chết.
Lư lăo nhị thấy Tiền viên ngoại đă chết, không có người t́m ông ta đ̣i lại nên liền dùng số tiền đó chi tiêu cho gia đ́nh. Ông ta mua một ngôi nhà rất lớn, lại cưới thêm mấy bà vợ bé, quả thật là: “Khi xưa nghèo hèn th́ vắng vẻ, hôm nay th́ đông đúc như trảy hội”.
Một hôm, Lư nhị đang nằm ngủ th́ mơ: Ông đang ở trong pḥng uống trà, đột nhiên cánh cửa mở ra, một người từ bên ngoài đi vào, ông ta nh́n kỹ th́ ra là Tiền viên ngoại. Tiền viên ngoại trên vai có mang một cái bao rồi nh́n ông ta cười ha hả nói: “Ta đến để đ̣i nợ đây!”. Lư lăo nhị đột nhiên tỉnh giấc, toàn thân toát mồ hôi.
Đúng lúc ấy, một nữ hầu đến nói với ông ta: “Xin chúc mừng lăo gia, phu nhân đă sinh cho ngài một công tử rất bụ bẫm ạ!”
Đây vốn là một chuyện tốt, nhưng nghĩ đến giấc mộng vừa rồi, Lăo nhị thấy bất ổn trong ḷng, ông luôn nghĩ đứa con trai vừa ra đời có liên quan ǵ đó đến giấc mộng kia. V́ thế, ông ta luôn cảnh giác với đứa con này. Thế nhưng, đứa con này lại hiếu thuận với cha một cách lạ thường. Đến tuổi tới trường, Lư nhị nhờ mấy thầy giáo dạy cho cậu, đứa trẻ này cái ǵ cũng học rất nhanh, thứ ǵ đă học qua là dường như không quên. Lăo nhị cũng từng khoe với mọi người con trai ông là một đứa bé kỳ tài, tương lai có thể thi đỗ làm quan. Sau một thời gian dài, giấc mộng kia cũng dần dần đi vào quên lăng.
Năm đó con trai của Lư nhị gia tṛn 18 tuổi và đi vào kinh dự thi. Quả nhiên, cậu ta thi đỗ, làm quan thất phẩm. Gia đ́nh Lăo nhị treo đèn đỏ khắp nơi, ai nấy đều vui mừng khôn xiết, bạn bè người thân đều đến chúc mừng. Trong bữa tiệc có một người nói: “Thời buổi này nhiều người dùng tiền mua quan, ta thấy nhà Lư huynh cũng không thiếu tiền, chi bằng tốn chút tiền mua cho con trai chức quan to hơn một chút, nếu như huynh bằng ḷng, ta có thể dẫn huynh đến gặp một người giúp huynh.” Tất cả mọi người đang ngồi dự tiệc đều cho đó là ư kiến hay. Lư nhị nghĩ: “Đứa con trai duy nhất của ḿnh tài hoa hơn người, làm quan thất phẩm th́ quá là uổng phí, mua một chức quan to hơn cũng được.” Thế là, Lư nhị bỏ ra một số tiền rất lớn để mua một chức quan cho con trai ḿnh.
Mấy tháng sau, Tể tướng quả thực đă phong cho con trai Lư nhị làm quan tứ phẩm. Đây cũng là một việc vui mừng, Lư gia lại tổ chức một buổi tiệc chúc mừng. Nhiều quan lại và bà mai mối đều có lời ngỏ ư, nhưng cậu ta không đồng ư một ai mà chỉ chọn thiên kim tiểu thư của một vị quan lớn trong triều đ́nh. Thế là Lư nhị đành phải bỏ ra một số tiền lớn để nhờ bà mối làm mai giúp, sau khi bỏ ra rất nhiều tiền th́ nhà gái cũng đồng ư, nhưng họ lại yêu cầu một lễ hỏi thật lớn. Không có cách nào khác, Lăo nhị đành phải thuận theo, cuối cùng th́ mọi việc cũng xong xuôi.
Ngày đón dâu cũng đă định xong, chỉ c̣n vài ngày nữa là tới, Lư nhị trong ḷng vô cùng vui mừng phấn khởi. Buổi tối hôm đó, ông ta sau khi uống mấy chén rượu rồi đi ngủ th́ giấc mơ của 18 năm trước lại hiện ra trước mắt ông: Tiền viên ngoại cười ha hả nói với ông ta: “Ngươi thiếu ta một khoản nợ, ta lấy lại trong 18 năm, cuối cùng cũng phải trở về rồi, c̣n mang theo một chút tiền lăi nữa!”,
Tiền viên ngoại vừa nói xong c̣n đưa tay vỗ vỗ vào chiếc bao khoác trên vai, quả thật cái bao khi ông ta mang đến trong giấc mơ trước là rỗng mà bây giờ đă phồng to rồi. Tiền viên ngoại c̣n nói tiếp: “Khoản nợ đă lấy xong rồi, ta cũng nên đi thôi!” Lư nhị giật ḿnh bừng tỉnh. Đúng lúc ấy, một người hầu hớt hải chạy vào: “Lăo gia, không hay rồi, công tử bị bệnh rồi, ông mau đi xem đi!”
Lư nhị vội vàng đến pḥng con trai xem xét, không ngờ con trai của ông ta đă bị chết rồi. Lư lăo nhị ngồi phịch xuống đất, mọi chuyện ông đều hiểu rơ: “Hóa ra Tiền viên ngoại gửi hồn làm con trai ḿnh để đến đ̣i nợ ḿnh.”
Ông hồi tưởng lại mọi chuyện, từ khi con trai sinh ra, đi học, đi thi, mua quan, đính hôn… th́ cũng tiêu hết không kém ba ngh́n hai trăm lượng bạc, ông ngẫm: “Thảo nào Tiền viên ngoại trước khi đi c̣n nói là mang theo chút tiền lăi.”
Từ đó về sau, Lư nhị cả người cả của đều không c̣n ǵ cả, hàng ngày ngồi bên lề đường ăn xin và kể lại chuyện ḿnh lừa gạt hại người nhằm khuyên bảo mọi người đừng làm việc thất đức, trái lương tâm bởi v́ việc thiếu nợ người ta là đều phải trả. Nhưng mọi người đều cho rằng Lư lăo nhị đă bị điên rồi…
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