Candida auris, a drug-resistant fungus that health officials hoped to contain is now in more than half the states, according to a new research paper.A deadly fungus that is considered an urgent public health threat by the Centers for Disease Control and Prevention spread at an “alarming rate” during the pandemic, the C.D.C. said on Monday.The fungus, called Candida auris, preys primarily on older people with weakened immune systems and is particularly dangerous because it resists treatment by common antifungal medications. C. auris was first reported in the United States in 2016, showing up most notably in New York and Illinois, where public health officials hoped they could contain it by rigorous screening and infection control in long-term care facilities and nursing homes.But over the course of 2021, state and local health departments around the country reported 1,474 clinical cases, more than a 200 percent increase over 476 cases in 2019.The surge represents a “dramatic increase” in case load and transmission of C. auris, according to a research paper published Monday in the Annals of Medicine and compiled by researchers at the C.D.C. The fungus is now in half the states, many with just a handful of cases, but with higher concentrations in California, Nevada, Texas and Florida. The new paper did not include caseloads from 2022. However, a C.D.C. website that tracks the spread of the fungus shows that there were 2,377 infections reported last year, another sharp increase. Dr. Meghan Lyman, a medical officer in the mycotic diseases branch of the C.D.C., said that the agency did not have a good sense of how many deaths to attribute to the fungus. The reason is that people who become infected are also dealing with multiple other health challenges, so C. auris can be both a cause of death or something that, along with other poor-health factors, hastens it. It is likely that the coronavirus pandemic worsened the spread of C. auris, C.D.C. officials said. With attention focused on Covid-19, less emphasis was put on screening for C. auris. Also, the fungus tends to cling to nursing gowns, gloves and other personal protective gear that, under ideal conditions, would be changed frequently but that were reused during pandemic because of supply shortages. C. auris can also attach to ventilators or other medical equipment“We were worried what would happen during Covid,” Dr. Lyman said. She characterized the spread as “concerning but not surprising.”C. auris is not a particular threat to young healthy people, whose immune systems can fight it off, but can be transported on skin and clothing. The fungus commonly strikes older patients, particularly those who have many visits or prolonged visits to health care facilities, where it can be hard to clean or eradicate. The challenge in treating C. auris stems from the fact that it can be resistant to antifungal medications. During 2020, the research paper found, 86 percent of the germ samples tested by the C.D.C.’s Antimicrobial Resistance Laboratory Network were resistant to a class of drugs known as Azoles. More concerning to health officials is that 1.2 percent were resistant that year to a frontline treatment class of drugs called echinocandins. If resistance to echinocandins becomes more common as the germ evolves, C. auris could become extremely difficult, if not impossible, to treat, health officials said. Dr. Lyman also said that the news is not all bad. Intensive efforts to stop the spread of the germ in New York and Illinois appear to have been effective in containing C. auris within the health care systems in those states — even as the bug rooted elsewhere. “It’s not a hopeless situation,” Dr. Lyman said.

911 dispatchers are buried under an avalanche of false, automated distress calls from skiers and other Apple device owners who are very much alive.FRISCO, Colo. — On a recent sunny Sunday morning, following a night of fluffy snowfall, tens of thousands of skiers flocked to the resorts of Summit County. Just minutes after the lift lines opened, sirens began blaring in the 911 emergency service center, where four staff members were taking calls and dispatching help.Each jarring alert was a new incoming call, heralding a possible car crash, heart attack or other life-threatening situation. Often, the phone operators heard a chilling sound at the far end of the line: silence, perhaps from a caller too incapacitated to respond.At 9:07 a.m., one dispatcher, Eric Betts, responded to such a call. From the map on one of the seven monitors on his desk, he could see that the distress call originated from a slope at the Arapahoe Basin Ski Area. Mr. Betts tried calling back. A man picked up.“Do you have an emergency?” Mr. Betts asked. No, the man said, he was skiing — safely, happily, unharmed. Slightly annoyed, he added, “For the last three days, my watch has been dialing 911.”Winter has brought a decent amount of snowfall to the region’s ski resorts, and with it an avalanche of false emergency calls. Virtually all of them have been placed by Apple Watches or iPhone 14s under the mistaken impression that their owners have been debilitated in collisions.As of September, these devices have come equipped with technology meant to detect car crashes and alert 911 dispatchers. It is a more sensitive upgrade to software on Apple devices, now several years old, that can detect when a user falls and then dial for help. But the latest innovation appears to send the device into overdrive: It keeps mistaking skiers, and some other fitness enthusiasts, for car-wreck victims.Lately, emergency call centers in some ski regions have been inundated with inadvertent, automated calls, dozens or more a week. Phone operators often must put other calls, including real emergencies, on hold to clarify whether the latest siren has been prompted by a human at risk or an overzealous device.“My whole day is managing crash notifications,” said Trina Dummer, interim director of Summit County’s emergency services, which received 185 such calls in the week from Jan. 13 to Jan. 22. (In winters past, the typical call volume on a busy day was roughly half that.) Ms. Dummer said that the onslaught was threatening to desensitize dispatchers and divert limited resources from true emergencies.“Apple needs to put in their own call center if this is a feature they want,” she said.Trina Dummer, interim director of Summit County’s emergency services. “My whole day is managing crash notifications,” she said.Theo Stroomer for The New York TimesDavid Benson, one of Summit County’s 911 dispatchers.Theo Stroomer for The New York TimesHer call center and others have alerted Apple to the issue. In mid-January, the company sent four representatives to observe Ms. Dummer and her team for a day; she said they had plenty of examples to show off.In a written statement, Alex Kirschner, an Apple spokesman, said, “We have been aware that in some specific scenarios these features have triggered emergency services when a user didn’t experience a severe car crash or hard fall.” The company noted that when a crash is detected, the watch buzzes and sends a loud warning alerting the user that a call is being placed to 911, and it provides 10 seconds in which to cancel the call.Apple also said that updates to the software late last year had been intended to “optimize” the technology and reduce the number of false calls. Mr. Kirschner added, “Crash Detection and Fall Detection are designed to get users help when they need it most, and it has already contributed to saving several lives.”Apple maintains a collection of incidents in which the two technologies have come to the rescue. In one case, an Apple Watch alerted the authorities after a driver in Indianapolis had crashed into a telephone pole and the device dialed for assistance. In another, a watch called for help after a New Jersey man fell down a steep cliff while hiking.In Colorado, call dispatchers had trouble recalling an instance in which a watch had saved a skier in distress. (Ms. Dummer added that her team had “very rarely” received false 911 calls from other companies’ devices, such as Android phones.)The problem extends beyond skiers. “My watch regularly thinks I’ve had an accident,” said Stacey Torman, who works for Salesforce in London and teaches spin classes there. She might be safely on the bike, exhorting her class to ramp up the energy, or waving her arms to congratulate them, when her Apple Watch senses danger.“I want to celebrate, but my watch really doesn’t want me to celebrate,” she said. Oh great, she thinks, “now my watch thinks I’m dead.”Recently she fell while racing to catch a bus in the rain. “I went down hard, really hard,” she said. Her watch did not call 911, however. “When I did actually fall running for the bus?” she said. “Crickets.”Skiers and snowboarders at the Breckenridge Ski Resort on a recent Sunday.Theo Stroomer for The New York TimesJeff Fitch, a rookie dispatch supervisor, taking a call at the Summit County 911 Center.Theo Stroomer for The New York TimesJon Baron, who works in real estate in Golden, Colo., has an Apple Watch that has twice dialed the authorities. Once, he was at an amusement park playing the strongman game, in which the goal is to hit a lever with a hammer firmly enough to ring a bell. Mr. Baron swung, the bell rang, his wife and children seemed duly impressed — until “my watch started making this noise like an air-raid siren,” he said.“I was trying to show I was physically able, which I thought I’d demonstrated fairly aptly, but my watch thought different,” he added.Another time, Mr. Baron was in the Tampa airport when the intercom summoned him to a white paging telephone. An emergency services operator at the other end told him his device had dialed 911 for help. Was he OK? “I’m doing all right,” he said he had told the operator. “But I have a plane to catch.”Apple introduced fall detection technology in 2018 after developing an algorithm based on the trajectory of a wrist wearing a watch and acceleration at time of impact. Its crash-detection technology, introduced in September, was tested in crash tests and labs on iPhones and Apple Watches.But something about the way skiers accelerate and stop, or jostle, seems to set the technology on edge. And skiers, in helmets and layers of clothing, often do not to detect the warning, so they may not cancel the call or respond to the 911 dispatcher.“A lot of people don’t feel it or hear it,” said Brett Loeb, emergency services communications director in Pitkin County, Colo., home to Aspen Mountain. Or, he proposed, even when they feel the vibration, “they think, ‘I don’t want to answer my phone right now — I’m having a great time; my phone is killing my buzz.’”He noted that Aspen Mountain had recently posted signs at lift lines and ticket offices alerting Apple Watch and iPhone 14 users to the problem and encouraging them to upgrade to the latest software version or disable the service, to “prevent unnecessary trips to the slopes” by 911-dispatched ambulances.“I’m struggling to get my daily job done,” Sgt. Mark Watson said. “I don’t have all day to do Apple products.”Theo Stroomer for The New York TimesMr. Fitch, in training, fielding a 911 call.Theo Stroomer for The New York TimesAt the Summit County call center on Sunday morning, Ms. Dummer was training a rookie dispatch supervisor, Jeff Fitch, to field 911 calls, while Mr. Betts and another dispatcher, David Benson, handled the overflow and communicated with ambulances and the police.The siren went off, and Mr. Fitch picked up the call. “911,” he said into his headset. “Hello?” A monitor displayed the caller’s location on the ski slope; another displayed the caller’s number. Mr. Fitch leaned forward into the silence: “Hello?”The watch calls kept coming; the siren kept blaring. Amid it all, Ms. Dummer and Mr. Fitch fielded a genuine distress call from a 78-year-old driver who was having trouble breathing. Traffic was bad, hindering ambulance access, and the dispatch team was calling two nearby counties for help.Just before noon, Mark Watson, a sergeant with the sheriff’s office, walked into the dispatch room looking glum. “This is not a good day,” he said.Ordinarily, he had other duties, including patrolling the backcountry on snowmobile, but the ghost calls had kept him at his desk. Whenever the 911 operators were unable to reach the owner of the watch or phone, the case was referred to Sergeant Watson, who would try calling and sending a text; if he didn’t hear back, he forwarded the issue to the ski patrol.So far that day, Sergeant Watson had fielded seven referrals from 911, four of which he forwarded to the ski patrol. He turned to Ms. Dummer: How many crash-detection calls had come in overall? Eleven, she said, out of 30 calls total.“I wanted to check the numbers,” he said. “I was writing a letter to Apple.” He described his basic message to the company: “I’m struggling to get my daily job done. I don’t have all day to do Apple products.”In Grand County, home to a busy mountain called Winter Park, Sheriff Brett Schroetlin decided in late December to devote less attention to the crash-detection calls. Now if a 911 operator receives one from the slopes and no one is on the other end of the line, they know to ignore the call; no more referrals or follow-ups. None of the ghost calls so far have been real emergencies, Sheriff Schroetlin reasoned, and he couldn’t afford to waste limited resources. Besides, he said, there was a better technology: human beings.“It’s rare that someone falls on the mountain and there’s not a passer-by,” he said. “We’re hoping to get an actual 911 call from the person or someone on the scene.”

Studies indicate that dialectical behavior therapy offers greater benefits than more generalized therapy. But treatment is intensive, and expensive.Parents seeking therapy for teenagers who self-harm or suffer from anxiety, depression or suicidal thoughts face an imposing thicket of treatment options and acronyms: cognitive behavioral therapy (C.B.T.), parent management training (P.M.T.), collaborate assessment and management of suicidality (CAMS), acceptance and commitment therapy (ACT) and others.Each approach can benefit a particular subset of people. But for teenagers at acute risk for self-harm and suicide, health experts and researchers increasingly point to dialectical behavior therapy, or D.B.T., as an effective treatment.“As of this moment, it’s probably the best tool we have,” said Michele Berk, a child and adolescent psychiatrist at Stanford University.In a 2018 study in the Journal of the American Medical Association, Dr. Berk and her colleagues found that D.B.T. led to sharper drops in suicidal attempts and self-harm among adolescents than a more generalized therapy did. A 2014 study by researchers in Norway found a similar effect, noting that the therapy also has a relatively low dropout rate, and concluded that “it is indeed possible for adolescents to be engaged, retained, and treated” using D.B.T. The therapy is also identified as a key evidence-based treatment by the American Academy of Pediatrics. If anything, Dr. Berk said, D.B.T. “is not available enough.”How D.B.T. worksDialectical behavior therapy is a subset of cognitive behavioral therapy, which aims to reframe a person’s thoughts and behavior. D.B.T. focuses initially on behavior and raw emotion, helping the individual surmount moments of crisis and understand what prompted the behavior in the first place.D.B.T. is intensive. The fullest version of the program, which can take six months to a year to complete, has four components: individual therapy for the teenager; group therapy; training for teenagers and their parents to teach emotional regulation, and phone access to a therapist to help during a crisis.The initial step is to teach a patient to recognize the feelings in the body when dangerous impulses arise, like “a lump in the throat, racing pulse, tense shoulders,” said Jill Rathus, a psychologist practicing in Long Island. In the 1990s, Dr. Rathus was part of a team that adapted the adult version of D.B.T. for use by adolescents and their families.Patients then learn to put those feelings into words. It is vital, Dr. Rathus said, to “put language” to a physical and emotional experience; this engages parts of the brain, like the prefrontal cortex, that help regulate emotions. In young people, these brain regions are not fully developed and can easily become overwhelmed.The next step is to learn to lower the arousal state with specific, often simple techniques: splashing the face with cold water, doing brief but intense exercise, putting an ice pack on the eyes — to “tip the body chemistry,” in the language of D.B.T.Jill Rathus, a psychologist in Great Neck, N.Y. “The mistake parents make, even well-meaning and loving parents, is to minimize the feelings,” she said. Gabby Jones for The New York TimesThe overwhelmed brainThe intensive nature of D.B.T. reflects the difficulty of the challenge it confronts: regulating the emotions of teenagers who are so overwhelmed that they struggle to reason. At that age, Dr. Rathus said, the adolescent brain is often not developed enough to process the flood of incoming news and social information.“The brain just goes into overload, flooded with high emotional arousal,” Dr. Rathus said, “and you can’t learn anything new, can’t process incoming information and so suggestions of what to do or to try just bounce right off you.”This is why teenagers appear to their parents to be unable to hear suggestions for curbing their dangerous impulses, no matter how well-intended or compassionate the delivery, Dr. Rathus noted. Some adolescents are unable to start D.B.T. without a medication, like an antidepressant or anti-anxiety drug, to calm the brain enough for treatment to take hold.Tips for Parents to Help Their Struggling TeensCard 1 of 6Tips for Parents to Help Their Struggling TeensAre you concerned for your teen?

It’s all fun and games till you strain your Achilles’ tendon, herniate a disc or do a face-plant in the Kitchen.During a recent pickleball match, Nish Nadaraja, 50, made a quick lunge for the ball. It was just a few feet away, but Mr. Nadaraja, an entrepreneur in Northern California, said he felt his feet tangle and he began falling to the pavement “in slow motion.” He still hoped to brace himself with his knees and make a play with his paddle.Nope. “I face-planted,” he said.The pain was mild and Mr. Nadaraja played through it, although his wife (and doubles opponent) thought he should have rested. “I did need antibiotics,” he conceded.It was another wound stemming from a national sensation that shares a name with a snack or a sandwich topping but that is proving a bit more hazardous than sometimes advertised. As a flock of middle-aged players migrate from tennis or start fresh with an easy-to-learn sport, the aches are defying the game’s low-impact reputation.Pickleball injuries were on the rise even before the pandemic. One analysis, published in 2019 in The Journal of Emergency Medicine, estimated that there were 19,000 pickleball injuries in 2017, with 90 percent of them affecting people 50 and older.Part Ping-Pong, tennis, badminton and chess, pickleball involves hitting a whiffle-ball-like sphere with a paddle over a net. The game, which is highly social, is typically played as doubles in a small space like a mini tennis court and requires little running. There’s even a small area near the net known invitingly as the Kitchen. What could go wrong?“Achilles’ strains or tears, shoulder problems, rotator cuff injuries, lower back problems such as disc injuries, muscle strains,” said Noe Sariban, a pickleball instructor, former pro player and physical therapist who markets himself as the Pickleball Doctor. And, of course, there’s lateral epicondylitis, commonly known as tennis elbow — now pickleball elbow.“Pickleball kind of sounds like a game with a silly name, but it’s a sport,” Mr. Sariban said. “It’s no bocce ball.”Nish Nadaraja, an entrepreneur in Northern California, recently face-planted during a pickleball match.Christie Hemm Klok for The New York TimesThe number of injuries “grew rapidly” from 2010 to 2019, according to an analysis of emergency-room visits related to pickleball published last year in the journal Injury Epidemiology. The article focused on injuries among people over 60 because players in that demographic accounted for 85 percent of the visits, the study found. The most common injuries were sprains, strains and fractures.The study found that by 2018 the number of emergency-room visits related to pickleball among people 60 and older equaled the number for tennis. Many pickleball players are older; the average age is 38, but half of all “core” players — meaning devotees — are 55 and above, according to USA Pickleball, which calls itself the sport’s governing body. In general, older bodies are more likely than younger ones to have existing strains, which are easily amplified.The Growing Appeal of PickleballA mash-up of tennis, badminton and Ping-Pong, this sport has long enjoyed a cult following. Now, it is going mainstream.Pandemic Pastime: Pickleball began soaring in popularity in recent years; the search for new activities during the coronavirus pandemic turned many people into “picklers.”A Business Opportunity: The growing sport has lured investors eager to cash in on its popularity, opening courts and adding food and other entertainment options.A Tennis Player’s Perspective: A Times columnist who grew up playing competitive tennis on Seattle courts took up a paddle to see what all the fuss was about.Married, With a Side of Pickleball: Couples are marrying on pickleball courts, hosting games at their receptions and finding other ways to incorporate the sport into their nuptials.But pickleball is deceptively demanding at any age. It involves quick stops and starts, and lots of lunging and twisting, said Dr. Neil Roth, an orthopedist in Westchester County, N.Y. Overhead shots tear at shoulder joints. And on a small court the effort seems innocuous, so players tend to reach or bend to make a play that is harder on the body than it looks. In tennis, a new player might not think to chase down a distant ball, whereas in pickleball the temptation is greater to bend, reach, charge.This month, Dr. Roth met with a 53-year-old patient who was experiencing excruciating pain when he lifted his right arm over his head. The injury, from pickleball, turned out to be a labrum tear, a condition that Dr. Roth saw quite often when he worked for the Los Angeles Dodgers and the California Angels; he has also treated cases caused by tennis and swimming.“You’re absolutely not just sitting around hitting the ball,” Dr. Roth said of pickleball. Players are engaging the “long muscles of the lower legs, the gastrocs, the quads and the hamstrings,” he added.Stops and starts lead to slips. That helps explain why the largest share of emergency-room injuries identified in the 2021 study fell (as it were) into a category that researchers labeled Slip/Trip/Fall/Dive.Injuries can include “Achilles’ strains or tears, shoulder problems, rotator cuff injuries, lower back problems such as disc injuries, muscle strains,” Noe Sariban, a pickleball instructor, said.Christie Hemm Klok for The New York Times“Most of it is from tripping,” said Dr. Amy Fenoglio, a hand and upper-extremity surgeon at the University of Colorado, where she has seen a surge in pickleball-related wrist fractures in the past 18 months.Then there’s the Kitchen. Its official name is the nonvolley zone, a seven-foot strip in front of the net on both sides. (An official pickleball court is 44 feet long and 20 feet wide.) Players are not allowed to step foot in the Kitchen, so when a ball heads there a player might bend forward to return a “dink,” a cunning shot that hops over the net and lands in the opponent’s Kitchen.Mr. Sariban knows the risks firsthand. A former junior college basketball player, he was in a small professional pickleball tournament in January 2018 — perfect Southern California day, a $200 gift certificate for the winner — when he found himself at the edge of the Kitchen.“I’m reaching to hit a routine rolling volley, one I’ve hit a million times,” he said. “I hit the ball and I feel my back lock up, and in my head I go, ‘Uh-oh.” Within minutes, he had to lie down on the court. “I could barely walk,” he said, adding, “I sat in the car and my wife had to swing my legs around” and into the passenger well. He had herniated two discs. “I thought I was never going to play a sport ever again in my life,” he said.Since then Mr. Sariban has become conscientious about stretching, and he teaches players at his clinics to do the same, which includes warming up without a paddle before any hitting starts. “It is amazing to me how no one warms up,” he said. “I’ve taught in a lot of states, and it’s the same thing everywhere. Pickleball players are notorious about not warming up.”Mr. Sariban and other pickleball experts note that the risk of injury isn’t higher than in other sports, but that the perception of risk is lower. And the risks should not discourage participation, say die-hards like Debbie Landa, a tech entrepreneur in her early 50s in San Francisco. Like many, Ms. Landa has taken up pickleball during the pandemic; she now plays five days a week. Among her mentors, she said, was an 82-year-old woman in Palm Springs “who motivated me everyday.”Ms. Landa has had various pickleball afflictions — pickleball elbow, sore hips — but those come with the sport, she said. The real pains, she said, are the nasty players who “get too aggressive and angry.”“I tell them: ‘You’ve got to loosen up. You’re playing pickleball — you’re playing a game called pickleball!’” she said.

Researchers have long used imaging technology to try to understand mental-health ailments. But with relatively few participants, such studies may not be producing valid findings.For two decades, researchers have used brain-imaging technology to try to identify how the structure and function of a person’s brain connects to a range of mental-health ailments, from anxiety and depression to suicidal tendencies.But a new paper, published Wednesday in Nature, calls into question whether much of this research is actually yielding valid findings. Many such studies, the paper’s authors found, tend to include fewer than two dozen participants, far shy of the number needed to generate reliable results.“You need thousands of individuals,” said Scott Marek, a psychiatric researcher at the Washington University School of Medicine in St. Louis and an author of the paper. He described the finding as a “gut punch” for the typical studies that use imaging to try to better understand mental health.Studies that use magnetic-resonance imaging technology commonly temper their conclusions with a cautionary statement noting the small sample size. But enlisting participants can be time-consuming and expensive, ranging from $600 to $2,000 an hour, said Dr. Nico Dosenbach, a neurologist at Washington University School of Medicine and another author on the paper. The median number of subjects in mental-health-related studies that use brain imaging is around 23, he added.But the Nature paper demonstrates that the data drawn from just two dozen subjects is generally insufficient to be reliable and can in fact yield “massively inflated” findings,” Dr. Dosenbach said.For their analysis, the researchers examined three of the largest studies using brain-imaging technology to reach conclusions about brain structure and mental health. All three studies are ongoing: the Human Connectome Project, which has 1,200 participants; the Adolescent Brain Cognitive Development, or A.B.C.D., study, with 12,000 participants; and the U.K. Biobank study, with 35,700 participants.The authors of the Nature paper looked at subsets of data within those three studies to determine whether smaller slices were misleading or “reproducible,” meaning that the findings could be considered scientifically valid.For instance, the A.B.C.D. study looks, among other things, at whether thickness of the brain’s gray matter can be correlated to mental health and problem-solving ability. The authors of the Nature paper looked at small subsets within the big study and found that the subsets produced results that were unreliable when compared with the results yielded by the full data set.On the other hand, the authors found, when results were generated from sample sizes involving several thousand subjects, the findings were similar to those from the full data set.The authors ran millions of calculations by using different sample sizes and the hundreds of brain regions explored in the various major studies. Time and again, the researchers found that subsets of data from fewer than several thousand people did not produce results consistent with those of the full data set.Dr. Marek said that the paper’s findings “absolutely” applied beyond mental health. Other fields, like genomics and cancer research, have had their own reckonings with the limits of small sample sizes and have tried to correct course, he noted.“My hunch this is much more about population science than it is about any one of those fields,” he said.

A new C.D.C. study underscored the mental health issues facing teenagers in the past few years.During the pandemic, emergency rooms across the country reported an increase in visits from teenage girls dealing with eating and other disorders, including anxiety, depression and stress, according to new data from the Centers for Disease Control and Prevention.The report provides new detail about the kinds of mental health issues affecting a generation of adolescents.Mental health experts hypothesize that the pandemic prompted some youth to feel isolated, lonely and out-of-control. Some coped by seeking to have control over their own behavior, said Emily Pluhar, a pediatric psychologist at Boston Children’s Hospital and instructor at Harvard Medical School.“You take a very vulnerable group and put on a global pandemic,” she said. “The eating disorders are out of control.”In the C.D.C. study, the agency said that the proportion of eating disorder visits doubled among teenage girls, set off by pandemic-related risk factors, like the “lack of structure in daily routine, emotional distress and changes in food availability.”The agency said that the increase in tic disorders was “atypical,” as these disorders often present earlier, and are more common in boys. But the C.D.C., reinforcing speculation from other clinicians and researchers, said that some teenage girls may be developing tics after seeing the phenomenon spread widely on social media, notably on TikTok.“Stress of the pandemic or exposure to severe tics, highlighted on social media platforms, might be associated with increases in visits with tics and tic-like behavior among adolescent females,” the C.D.C. wrote.In a related report, the C.D.C. also said on Friday that the increase in visits for mental health issues occurred as emergency rooms reported sharp declines overall in visits during the pandemic. As compared with 2019, overall visits fell by 51 percent in 2020 and by 22 percent in 2021, declines that the agency attributed in part to families delaying care, and a drop in physical injuries from activities like swimming and running.There was a decline in overall emergency room visits for mental health conditions among all youths, up to age 17. Increases occurred for particular maladies and, particularly among teenage girls.More broadly, the surge in adolescent mental health distress appears to have intensified during the pandemic, but it began earlier. Emergency room visits among youths related to depression, anxiety and similar issues rose by 28 percent from 2007 to 2018, according to another report by the surgeon general.In its report on Friday, the C.D.C. said that mental health-related emergency room visits for teenage boys fell in both 2020 and 2021 as compared with 2019. But the C.D.C. also reported that the data was nuanced and that the visitation patterns for boys, as well as girls, depended on specific mental health condition and time period.“These sex differences might represent differences in need, recognition and health care-seeking behavior,” the C.D.C. wrote.For teenage girls, weekly emergency room visits rose for eating and tic disorders during 2020; and for those conditions and obsessive compulsive disorders in 2021. During January of 2022, the C.D.C. said there also was an increase in anxiety, trauma and stress-related issues.

By now, the Omicron wave of the coronavirus has crested in much of the United States. But the size the wave, which broke records for national cases and hospitalizations, has given regulators and scientists an opportunity to better assess vaccine efficacy in children aged 6 months to 4 years old, Dr. Scott Gottlieb, a former commissioner of the Food and Drug Administration, said on Sunday.Dr. Gottlieb, who sits on the board of the vaccine-maker Pfizer, said that he hopes key data expected on Friday will shed additional light on whether the federal government should grant emergency authorization for two doses of Pfizer-BioNTech’s vaccine for children in this age group.“We now have an opportunity to look at a much richer data set,” Dr. Gottlieb, said on CBS’s “Face The Nation.” He did not specify what that data would reveal. Still, he emphasized that the toll Omicron took on children in particular gave Pfizer a stronger basis for comparison of those given vaccines and those not.“Some got infected, hopefully some didn’t,” he said of the test group. “I think that’s what the data package is going to show, and I think it’s going to give a much clearer picture of” the vaccine’s efficacy against Omicron.He said that the newer data will help illuminate results that had been less rich before the full Omicron wave had crested.At the urging of the federal government, Pfizer and its partner BioNTech applied last week for authorization for two doses of its vaccine to children aged 4 and younger.But results released in December did not show the hoped-for immune response in children aged 2 to 4. Children 6 months to 2 years old showed a comparable response to that of older teenagers and young adults.The disappointing finding has led the companies to test a third shot in young children, but those results will not available for a few weeks. Still, in hopes of getting a jump start on the vaccination effort, the F.D.A. urged the companies to apply for authorization of two doses while everyone awaits data on the third dose.The thinking is that if two doses are authorized and given, then children would be prepared for a third dose if and when research demonstrates that three shots prove fully effective.That three doses will work is the working presumption of Pfizer and of some experts. Critics have argued that this strategy is short-circuiting the research process and that there is not yet clear evidence that a third dose will be make up for the inadequacies of two doses.The Coronavirus Pandemic: Key Things to KnowCard 1 of 4The state of the virus in the U.S.

The United States surgeon general on Tuesday warned that young people are facing “devastating” mental health effects as a result of the challenges experienced by their generation, including the coronavirus pandemic.The message came as part of a rare public advisory from the nation’s top physician, Dr. Vivek H. Murthy, in a 53-page report noting that the pandemic intensified mental health issues that were already widespread by the spring of 2020.The report cited significant increases in self-reports of depression, anxiety and emergency-room visits for mental health challenges. In the United States, emergency room visits for suicide attempts rose 51 percent for adolescent girls in early 2021 as compared to the same period in 2019. The figure rose 4 percent for boys.Globally, symptoms of anxiety and depression doubled during the pandemic, the report noted. But mental health issues were already on the rise in the United States, with emergency room visits related to depression, anxiety and related issues up 28 percent from 2007 to 2018.The reasons are complex and not yet definitive. Adolescent brain chemistry and relationships with friends and family are important factors, the report noted, as is a fast-paced media culture, which can leave some young minds feeling helpless.“Young people are bombarded with messages through the media and popular culture that erode their sense of self-worth — telling them they are not good-looking enough, popular enough, smart enough or rich enough,” Dr. Murthy wrote in the report. “That comes as progress on legitimate, and distressing, issues like climate change, income inequality, racial injustice, the opioid epidemic and gun violence feels too slow.”The surgeon general’s advisory adds to a growing number of calls for attention and action around adolescent mental health. In October, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association joined to declare “a national emergency” in youth mental health.Although blame for adolescent distress is often pinned on social media, the research suggests that screen time alone does not account for crisis. Rather, social media and other online activities act more to amplify an adolescent’s existing mental state, causing some to feel more distress and others to experience enhanced feelings of connection.Bonnie Nagel, a pediatric neuropsychologist at Oregon Health & Science University who treats and studies adolescents, said that online interactions appear not to satisfy core needs for connection.Recent research she co-authored shows that loneliness is a key predictor in feelings of depression and suicidal ideation.“I don’t think it is genuine human connection when talking to somebody with a fake façade online,” Dr. Nagel said.At the same time, screen time may be displacing activities known to be vital to physical and mental health, including sleep, exercise and in-person activity, research shows. The current generation of youth express heightened levels of loneliness — more than any other age group — despite spending countless hours connected over media.Authorities and scientists widely acknowledge that there has been insufficient research into the underlying causes. Dr. Murthy’s advisory calls for more resources to be devoted to understanding and addressing mental health challenges, and it urges a greater appreciation of mental health as a key factor in overall health.“This is a moment to demand change,” the report concludes.

The agency had faced a Sept. 9 deadline to decide whether the products could stay on the market but said it needed more time to review evidence.The Food and Drug Administration on Thursday put off a long-anticipated ruling on whether Juul Labs and other major e-cigarette companies could continue to sell their products in the United States.The companies are at the center of a review of the vaping industry that the agency has been conducting for the past year. The F.D.A. said on Thursday that it had so far denied the applications of 946,000 flavored e-cigarette products to remain on the market, mostly made by small companies.No e-cigarettes have been approved through the application process, an agency official said.“The F.D.A. is committed to completing the review of the remaining products as quickly as possible,” the agency said in a statement Thursday afternoon.The F.D.A. had earlier signaled that it would rule on the larger companies by Thursday, one year after applications to stay on the market were due. Many public health experts had hoped a ruling on the market leaders would clarify the conditions under which companies could operate.“They still haven’t made any of the tough decisions,” said Eric Lindblom, a tobacco policy expert at the Georgetown University Law Center. “I expected a little bit more, and I’m not an optimist.”In a response to the agency’s move, Juul said in a statement that it “respects the central role of the F.D.A.” in concluding a “thorough” review of its applications.Advocates of e-cigarettes see the products as a way to wean smokers from traditional cigarettes, which are more toxic, while critics say they are just another nicotine delivery system and one that is luring young people to the drug.Juul, the market leader, whose sleek devices led to a surge in vaping among teenagers who had never smoked, has been at the center of the debate. By pushing back its decision on the company, the F.D.A. appears to be delaying a larger decision about whether the agency sees these devices as creating more harm than good.The F.D.A. is considering applications for e-cigarette products from around 500 companies, many of them small. Companies have to show that their vaping products are less harmful than traditional cigarettes, and that their usefulness in helping smokers quit outweighs the risk that some people will start using nicotine through the products.Matthew Myers, president of the Campaign for Tobacco-Free Kids, said that the F.D.A.’s inaction on Juul and other companies could bring additional court action. “The decisions the F.D.A. still has to make are more important than the ones they’ve made already,” Mr. Myers said. “If they don’t commit to making them promptly, then we have no choice but to ask a court to intervene.”While overall smoking rates have fallen sharply since the mid-1960s, smoking remains the leading cause of preventable death in the United States, contributing to the deaths of nearly half a million Americans each year. E-cigarettes, which deliver vaporized nicotine without many of the carcinogens inhaled with combustible cigarettes, have been marketed as a safer alternative despite unsettled science about their broader public health impact.Since e-cigarettes came on the market in the United States in the mid-2000s, youth vaping has increased steadily. By 2019, more than 27 percent of high school students reported in surveys that they vaped. That figure dropped to less than 20 percent during the coronavirus pandemic, which experts said could partly reflect the fact that teenagers were isolated and less likely to use social drugs.The fate of Juul and other market leaders also is part of a larger conversation about the best way to further discourage cigarette use. Some experts believe the most effective step would be to limit the amount of nicotine levels in traditional cigarettes, making them less appealing. Juul initially pitched itself as a foe of Big Tobacco. But in December 2018, the company sold a 35 percent stake to Altria, one of the world’s largest cigarette companies, for $12.8 billion.Critics have argued that Juul’s initial marketing campaigns and flavors like cool cucumber and crème brûlée lured a new generation of young people to nicotine, many of whom became addicted.The company recently agreed to pay $40 million to settle a lawsuit with the State of North Carolina over its marketing practices, allowing Juul to avoid public testimony from aggrieved teenagers and families. The company still faces thousands of other lawsuits.Juul officials have long said that the company never sought a youth market. They have argued that Juul has taken aggressive steps to discourage youth use, including suspending its advertising in the United States.Under pressure from the F.D.A., the company pulled almost all its flavors from the market in 2019. It has since submitted applications for only menthol- and tobacco-flavored products. It is seeking approval for its nicotine pods in two strengths: 5 percent, which is equivalent to the nicotine in an average pack of cigarettes, and 3 percent.As part of its request to gain approval for its nicotine pods, Juul filed a 125,000-page application to the F.D.A., making the case that its products have public health benefits. Research that the company funded has suggested that the devices can be effective at helping smokers quit. A study that began with 55,000 adult Juul users found that 58 percent of the 17,000 smokers who stayed in the study had stopped smoking at 12 months. Another 22 percent continued to smoke both e-cigarettes and traditional ones but cut their cigarette smoking by at least half.Several major health organizations — the American Heart Association, the American Lung Association, the American Academy of Pediatrics and the American Cancer Society Cancer Action Network — have asked the F.D.A. to reject Juul’s application.On Thursday, the American Heart Association said that it was disappointed by the F.D.A.’s inaction on big companies like Juul, which the heart association said “has targeted our nation’s teens for years and contributed to the epidemic of tobacco use among youth.”

At the height of the pandemic, doctors and nurses made furious efforts to protect themselves with gowns and masks and scrambled to save the lives of the severely ill Covid-19 patients with ventilators.But these efforts, among other life saving measures, had a side effect: drug-resistant infections have increased in hospitals.The development, reported on Thursday by the Centers for Disease Control and Prevention, came about in part because drug-resistant bacteria thrived on reused protective equipment, intravenous lines and medical equipment like ventilators.Drug-resistant infections have in recent years become a gnawing, sometimes deadly, problem. The threat has grown as various germs — notably bacteria and fungi — have mutated and developed defenses that allow them to resist medications and thrive; the germs prey in particular on older patients and the immunocompromised, limiting drug options to counter infections or, in extreme cases, leaving no effective treatments.Immense efforts have been made in recent years to slow the growth of these noxious microbes that, increasingly, resist treatment by various classes of medicines. In the second half of 2020, though, “sometimes these efforts went terribly wrong,” with so much focus on stopping transmission of Covid-19, according to a commentary that accompanies the new study by the C.D.C. The authors wrote that the practices best known to stop the spread of drug-resistant infections were ignored or subverted in the face of a larger threat.Drug-resistant bloodstream infections at hospitals rose 47 percent in the last three months of 2020 compared to the same period a year earlier. That was a sharp change in momentum. In the first three months of 2020, such infections had fallen nearly 12 percent compared to the same period a year earlier, reflecting heightened efforts at the time to stop the spread.Similar trends showed up with regard to infections traced to ventilators, which rose 45 percent in the fourth quarter of 2020 over the previous year. During the same period, infections from one bacterium — methicillin-resistant Staphylococcus aureus, or MRSA —rose 34 percent after having fallen in the first quarter of 2020 as compared to the same period a year earlier.