Publisher Health

Older adults with more harmful than healthy bacteria in their gums are more likely to have evidence for amyloid beta — a key biomarker for Alzheimer’s disease — in their cerebrospinal fluid (CSF), according to new research from NYU College of Dentistry and Weill Cornell Medicine. However, this imbalance in oral bacteria was not associated with another Alzheimer’s biomarker called tau.
The study, published in the journal Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, adds to the growing evidence of a connection between periodontal disease (gum disease) and Alzheimer’s. Periodontal disease — which affects 70 percent of adults 65 and older, according to CDC estimates — is characterized by chronic and systemic inflammation, with pockets between the teeth and gums enlarging and harboring bacteria.
“To our knowledge, this is the first study showing an association between the imbalanced bacterial community found under the gumline and a CSF biomarker of Alzheimer’s disease in cognitively normal older adults,” said Angela Kamer, DDS, PhD, associate professor of periodontology and implant dentistry at NYU College of Dentistry and the study’s lead author. “The mouth is home to both harmful bacteria that promote inflammation and healthy, protective bacteria. We found that having evidence for brain amyloid was associated with increased harmful and decreased beneficial bacteria.”
Alzheimer’s disease is characterized by two hallmark proteins in the brain: amyloid beta, which clumps together to form plaques and is believed to be the first protein deposited in the brain as Alzheimer’s develops, and tau, which builds up in nerve cells and forms tangles.
“The mechanisms by which levels of brain amyloid accumulate and are associated with Alzheimer’s pathology are complex and only partially understood. The present study adds support to the understanding that proinflammatory diseases disrupt the clearance of amyloid from the brain, as retention of amyloid in the brain can be estimated from CSF levels,” said the study’s senior author Mony J. de Leon, EdD, professor of neuroscience in radiology and director of the Brain Health Imaging Institute at Weill Cornell Medicine. “Amyloid changes are often observed decades before tau pathology or the symptoms of Alzheimer’s disease are detected.”
The researchers studied 48 healthy, cognitively normal adults ages 65 and older. Participants underwent oral examinations to collect bacterial samples from under the gumline, and lumbar puncture was used to obtain CSF in order to determine the levels of amyloid beta and tau. To estimate the brain’s expression of Alzheimer’s proteins, the researchers looked for lower levels of amyloid beta (which translate to higher brain amyloid levels) and higher levels of tau (which reflect higher brain tangle accumulations) in the CSF.
Analyzing the bacterial DNA of the samples taken from beneath the gumline under the guidance of NYU College of Dentistry microbiologist Deepak Saxena, PhD, the researchers quantified bacteria known to be harmful to oral health (e.g. Prevotella, Porphyromonas, Fretibacterium) and pro-oral health bacteria (e.g. Corynebacterium, Actinomyces, Capnocytophaga).
The results showed that individuals with an imbalance in bacteria, with a ratio favoring harmful to healthy bacteria, were more likely to have the Alzheimer’s signature of reduced CSF amyloid levels. The researchers hypothesize that because high levels of healthy bacteria help maintain bacterial balance and decrease inflammation, they may be protective against Alzheimer’s.
“Our results show the importance of the overall oral microbiome — not only of the role of ‘bad’ bacteria, but also ‘good’ bacteria — in modulating amyloid levels,” said Kamer. “These findings suggest that multiple oral bacteria are involved in the expression of amyloid lesions.”
The researchers did not find an association between gum bacteria and tau levels in this study, so it remains unknown whether tau lesions will develop later or if the subjects will develop the symptoms of Alzheimer’s. The researchers plan to conduct a longitudinal study and a clinical trial to test if improving gum health — through “deep cleanings” to remove deposits of plaque and tartar from under the gumline — can modify brain amyloid and prevent Alzheimer’s disease.
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Testing how well “good” cholesterol particles reduce inflammation may help predict who is at heightened risk to develop cardiovascular disease caused by narrowed arteries, according to research published today in the American Heart Association’s flagship journal Circulation.
Assessing levels of high-density lipoprotein (HDL) cholesterol, known as “good cholesterol,” are already a standard part of formulas used to predict cardiovascular risk. A new test of the anti-inflammatory function of HDL seems to provide additional information that is independent of the quantity of HDL. If the results are confirmed in broader populations and a test developed for clinical use, adding anti-inflammatory capacity to risk scores may improve risk prediction and help people take steps to protect themselves against heart disease.
“HDL are very complex particles with anti-atherosclerotic functions that are not reflected by measuring just the cholesterol quantity,” said senior study author Uwe J.F. Tietge, M.D., Ph.D., professor and head of the division of clinical chemistry at the Karolinska Institute in Stockholm, Sweden. “Atherosclerosis [plaque build-up in the arteries] underlying cardiovascular disease is increasingly recognized as a disease with a strong inflammatory component, and a central biological function of HDL is to decrease inflammation.”
This study is the first to test whether better anti-inflammatory function of HDL particles protects against heart attacks and other serious heart-related events.
Participants included 680 white adults (average age of 59, 70% male) living in the Netherlands who were part of a large population study that began in 1997. All were healthy when they enrolled in the study. From the larger study participants were identified who’d had a first cardiovascular disease event before the end of the study follow-up. HDL particles were analyzed in 340 people who experienced a first fatal or non-fatal heart attack, were diagnosed with heart problems caused by narrowed heart arteries (ischemic heart disease) or who required a procedure to open clogged coronary arteries during the median 10.5-year follow-up period. These participants were matched to a control group of 340 people of the same age (within 5 years), sex, smoking status and HDL cholesterol levels who had no cardiovascular events during follow-up.
Several lab tests were performed for all participants at enrollment, including measuring the ability of isolated HDL particles to decrease the inflammatory response of endothelial cells lining blood vessels (called the anti-inflammatory capacity). Researchers also measured C-reactive protein, a substance that rises when there is more inflammation throughout the body, and cholesterol efflux capacity, a laboratory assessment of how efficiently HDL can remove cholesterol from cells that resemble those found in plaque.
The researchers found: HDL anti-inflammatory capacity was significantly higher in people who remained healthy (31.6%) than in those who experienced a cardiovascular event (27%); The association of anti-inflammatory capacity with cardiovascular events was independent of the established biomarkers of HDL cholesterol and C-reactive protein levels, and was also independent of cholesterol efflux capacity; For every 22% increase in the ability of HDL particles to suppress inflammation in endothelial cells, participants were 23% less likely to have a cardiovascular event during the next decade; The amount of protection from increased HDL anti-inflammatory capacity was higher in women than in men; and Risk prediction was improved by adding HDL anti-inflammatory capacity to the Framingham Risk Score, or by replacing HDL cholesterol levels with this new measure of HDL function.”By using a novel research tool, our results provide strong support for the concept that plaque buildup in the arteries has an inflammatory component, and that the biological properties of HDL particles have clinical relevance to cardiovascular disease risk prediction,” said Tietge.
Although the results raise intriguing possibilities for improved screening, the results must be confirmed in different populations. In addition, a simpler and hopefully automated test for anti-inflammatory capacity should be developed first, researchers said.
“The HDL cholesterol level is a good, established, simple and cost-efficient CVD risk biomarker. Our results, however, demonstrate that the anti-inflammatory capacity or assays looking at HDL function in general have the potential to provide clinically relevant information beyond the static HDL cholesterol measurements that are currently used,” Tietge said.
The findings also raise the possibility that medications to improve HDL anti-inflammatory capacity may be developed and used to lower heart disease risk.
Study limitations to be considered include that the study population was white and genetically similar, thus results are not generalizable to other race and ethnic groups. In addition, the researchers did not include stroke incidence in their analysis so conclusions cannot be drawn about HDL and stroke.
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Respiratory disease increased markedly following one of Iceland’s largest volcanic eruptions, a new study has found.
And the findings could have significant implications for actions taken to protect the health of the 800 million people globally living near active volcanoes. Indeed, only last month (March), lava burst through a crack in Iceland’s Mount Fagradalsfjall in the first eruption of its type in more than 800 years.
The new research, led by the University of Leeds and the University of Iceland, examined the health impacts of pollution caused by the Holuhraun lava eruption in 2014-2015.
It shows that following exposure to emissions that changed chemically from gas to fine particles, incidents of respiratory disease in Iceland rose by almost a quarter, and the incidence of asthma medication dispensing by a fifth.
The findings, published today (10:00 GMT 12 April) in Nature Communications, highlight the need for decision-making authorities to prepare for health issues associated with returning emissions — known as mature plumes — in the days immediately following volcanic eruptions.
The report’s co-lead author is Dr Evgenia Ilyinskaya, from the University of Leeds’ School of Earth and Environment.

Scientists from Queen Mary University of London, funded by the charity Brain Tumour Research, have found a new way to starve cancerous brain tumour cells of energy in order to prevent further growth.
The pre-clinical research in human tissue samples, human cell lines and mice could lead to changes in the way that some children with medulloblastoma are treated in the future, if the findings are confirmed in human clinical trials.
Medulloblastoma is the most common high-grade brain tumour in children. Some 70 are diagnosed in the UK each year. Survival rate is 70 per cent for those whose tumour has not spread but it is almost always fatal in cases of recurrent tumour.
The research, published in the high impact journal Nature Communications, looks at inositol hexaphosphate (IP6), a naturally occurring compound present in almost all plants and animals, and showed how it inhibits medulloblastoma and can be combined with chemotherapy to kill tumour cells.
Lead researcher Professor Silvia Marino from the Brain Tumour Research Centre of Excellence at Queen Mary University of London said: “Medulloblastoma occurs in four distinct subgroups (WNT, SHH, G3 and G4). Despite our growing knowledge of the molecular differences between these subgroups, current options are surgery together with radiotherapy and/or chemotherapy for all patients. We desperately need to understand the key molecular events driving tumour growth in each subgroup to design new, less toxic, targeted treatments.”
“G4 medulloblastoma is the least understood of all subgroups, despite being the most common and associated with poor prognosis. We have identified a novel way that this type of medulloblastoma is able to adapt its metabolism and grow uncontrollably. Significantly, we have also shown how this energy supply can be blocked. These exciting results bring hope of developing new targeted treatments for patients with this aggressive paediatric brain tumour.”
Normal cells are able to switch specific genes on and off as required to control their growth. Known as epigenetics, this process can be disrupted in cancer, leading to over production of specific proteins that contribute to the development and growth of a tumour.

The US and Europe should pay a quarter of the cost each to vaccinate poorer nations, a former UK prime minister has claimed.Gordon Brown said the G7 and other wealthier nations “should pay their share” to help parts of Africa and Asia.He said it should not be left to a “whip round” to deal with a “disease that has got be to be brought under control”.

Many Americans increased their alcohol intake during the pandemic, with women and parents of young children disproportionately affected.For most of her life, Andrea Carbone, a 51-year-old paralegal living in Florida, wasn’t a big drinker. But when the pandemic struck, she worried constantly about her job, her health and the safety of her children.While many people were able to work from home last year, Ms. Carbone, was required to go into the office. Some mornings she would cry in her car as she drove along deserted roads and highways to get to her office in downtown Tampa, which looked, she said, “like a ghost town.”As her stress levels soared, so did her alcohol intake. Before the pandemic, Ms. Carbone would have a glass of red wine with dinner most nights. But by May, her intake had climbed substantially. “I noticed I was having a glass of wine as soon as I got home, then a glass with dinner, then we’d sit down to watch TV and I’d have another glass or two,” she said. “By the end of the night I was drinking a bottle.”Ms. Carbone is far from alone. The widespread fear, frustration and social isolation surrounding the tumultuous events of the past year — the pandemic, civil unrest, political upheaval — caused stress levels to skyrocket, with many people increasing their alcohol intake. Women and parents of young children seem to have been hit particularly hard. A nationwide survey commissioned by the American Psychological Association in February found that one in four adults reported drinking more this past year to manage their stress. That rate more than doubled among those who had children between the ages of 5 and 7.Another study published in JAMA Network Open in October found that Americans increased the frequency of their alcohol consumption by 14 percent compared to a year earlier. But the same study found a 41 percent increase in the number of days on which women drank heavily, defined as having four or more drinks in a couple of hours.“Women have disproportionately left the labor force entirely compared to men; they have disproportionately taken on the work around the house, the child care, and the child’s education,” said Michael S. Pollard, the lead author of the JAMA study and a senior sociologist at the RAND Corporation. “So, it stands to reason that women would increase their alcohol use disproportionately as well.”The psychological damage from the past year has caused sharp declines in physical health, including widespread weight gain and disruptions in sleep. Hospitals around the country have reported an increase in admissions for hepatitis, cirrhosis, liver failure and other forms of alcohol-related diseases. Almost no group has been spared.Driftwood Recovery, an addiction and mental health rehabilitation center in Texas, has had so many requests for treatment this past year that it has a two-month waiting list. Vanessa Kennedy, Driftwood’s director of psychology, said that many of her clients are parents who started drinking heavily as they struggled to balance their day jobs with home-schooling and other parental responsibilities.“They’re used to having their kids go off happily to school and having an experienced teacher teach their children while they go to work and focus on performing well and providing financial support for their family,” said Dr. Kennedy. “Their work roles are conflicting with their parenting roles, and it’s been difficult for them to create space and do those things well.”Dr. Kennedy has treated a wide range of patients who turned to excessive drinking this past year. Some lost their jobs or shuttered their businesses, which left them without daily structure and the means to provide for their families. Others were college students who felt socially disconnected when they were sent home to do virtual schooling, or older adults who drank because they were depressed that they could not see their loved ones or hug their grandchildren.Before last year, Gordon Mueller, a retiree who lives in Rochester, N.Y., rarely consumed more than one or two drinks a day. But when the pandemic struck and the economy and stock market stumbled, Mr. Mueller was consumed by anxiety as he followed the news and worried about his retirement account. As Mr. Mueller sheltered in place at home with his wife, his alcohol intake escalated to seven drinks a day: vodka cocktails in the afternoon, wine with dinner, and a whisky nightcap before bed. “We had no idea if we were going to financially get through this thing, let alone get sick and potentially die,” he said. “It was just a lot of fear and boredom. Those were the two emotions.”Ms. Carbone now uses an app to track her alcohol intake and has at least two “dry” days a week.Zack Wittman for The New York TimesBut many people have found novel ways to rein in their drinking. In December, Mr. Mueller turned to Moderation Management, an online community that helps people who want to cut back on their drinking but not necessarily abstain. He started attending Zoom calls with other members and using the organization’s private Facebook group to learn tips and advice to reduce his drinking. Then, in January, he decided to give up alcohol for a while to see how he would feel.“I’m happy to say that I haven’t had a drink this year, and I feel a lot better: I sleep better, and I can get more things done,” he said. “The nice thing about this moderation group is that it’s not an all-or-nothing ‘You can never drink again or you’re a failed alcoholic’ approach.”In Tampa, Ms. Carbone started using a popular app called Cutback Coach, which helps people track their alcohol intake and set goals and reminders so they can develop healthier drinking habits. Using the app, Ms. Carbone makes a plan for how much she will drink each week. The app tracks her daily intake, sends her notifications about her goals, and updates her on her progress, including all the calories she avoided and the money she saved by drinking less. She now has at least two “dry” days per week and has cut her drinking in half.“Seeing the progress that I’ve made makes me feel good and makes me keep doing it,” she said. “I sleep a lot better. I wake up less at night. I wake up feeling less sluggish, less tired, and I’ve been going to the gym more regularly, whereas before I couldn’t drag myself there.”For people who want to reduce their drinking, here are some simple tips that might help.Try PrecommitmentRather than relying on willpower alone, make a plan every Sunday to limit your drinking to a specific amount each day of the week and stick to it. This is a tactic known as precommitment, which Cutback Coach uses to help its thousands of members. The idea behind it is that you increase your chances of success by committing to a plan and restricting your ability to back out later on. Some other examples of precommitment are deciding not to keep junk food in your house and encouraging yourself to exercise by scheduling a workout with a friend. Studies show that precommitment is an effective way to change behavior.Find Social SupportTalk to your spouse, a friend or a family member about your plan to drink less. They can hold you accountable and help you find healthier ways to manage your stress. Make a plan to go for a walk with your friend or partner at the end of the day, for example, instead of opening a bottle. “You might find that you have a buddy who says, ‘why don’t we go play tennis or do something else to unwind after work,’” said Dr. Kennedy. “There are a lot of benefits to trying healthy activities instead of the wine.”Create ObstaclesSet up rules to slow your drinking. Mary Reid, the executive director of Moderation Management, follows a simple rule that helps her avoid drinking heavily: Each glass of wine she drinks has to last at least one hour. “My strongest tool is timing my drinks,” she said. “We always tell new members that we do have stop buttons, but we just ignore them.” Dr. Kennedy at Driftwood employs a similar rule. She tells people to alternate every alcoholic drink they have with a glass of water.Change Your RoutineSome people drink more out of habit than an actual desire for alcohol. Try substituting sparkling water or another beverage for your usual drink. Mr. Mueller used to have a cocktail every night while watching the evening news. But when he cut back on alcohol, he switched to drinking a cup of tea or nonalcoholic beer while watching the news and realized he just needed a beverage to sip. “Now I still have a glass in my hand but it doesn’t have alcohol,” he said. “It’s almost like having a glass in your hand is the habit and not the alcohol.”

“This crisis affects more or less everyone, and poetry can help us process difficult feelings like loss, sadness, anger, lack of hope.”Many, perhaps most, of us have spent this past year struggling to find ways to mourn the losses, weather the stresses and revive the pleasures stolen by the Covid-19 pandemic. We’ve monitored Zoom funerals, weddings, graduations, christenings, bar and bat mitzvahs, alternately laughing and weeping at inanimate screens as we tried to make sense of a world turned upside down.But I wonder how many have turned to poetry as a source of comfort, release, connection, understanding, inspiration and acceptance. This being National Poetry Month, there’s no better time than the present to do so.One person who has long valued poetry as both a personal and professional aid is Dr. Norman Rosenthal, a psychiatrist in Rockville, Md., who pioneered the use of light therapy for seasonal affective disorder. A clinical professor of psychiatry at Georgetown Medical School, Dr. Rosenthal said he has used poems as a therapeutic assistant, with rewarding results among his patients.“I have loved poetry ever since I was able to read, and it has been a personal source of comfort and solace to me at different times in my life,” he told me. “As a therapist, I have collected poems along the way that I thought had the power to heal, inspire or, at the very least, bring joy.”Now anyone can access and benefit from the short poems he has found to be so therapeutic and the soul-restoring messages he has gleaned from them. Dr. Rosenthal has compiled them in a new book, “PoetryRx: How 50 Inspiring Poems Can Heal and Bring Joy to Your Life,” complete with helpful takeaways and discussions of the circumstances under which they were written. (The book will be published next month by Gildan Media.)While we herald vaccines as potential saviors from the threat of a devastating virus, Dr. Rosenthal said, “Poetry can serve as a vaccine for the soul.” In a world that is so marred by loss and deprived of pleasure, he believes poetry can help fill in the gaps, offering a brief retreat from a troubled world and hope for a better future.For Margaret Shryer, a Minnesota great-grandmother, poetry has been like a good friend, a reliable source of inspiration and consolation that has helped her remain sane during the many Covid months mostly confined to her apartment in a senior residence.“Poetry generally picks me up,” she told me. “There’s a nugget of truth in every poem, and I flip through them to find ones that resonate with me and will get me going. I read them aloud. Every time you go back to a poem, you read it with a different set of ears. To people who think they don’t like poetry or understand it, I say ‘What about lyrics? That song you love? That’s poetry.’ Some of the most moving poetry can be found in lyrics.”I used to believe that poetry did not “speak” to me, but I now see how wrong I was. I lived for 44 years with a husband, a lyricist, whose beautifully crafted, heartfelt lyrics touched my every fiber and continue to uplift and inspire me a decade after his death. The special beauty of Dr. Rosenthal’s book for me is his discussion of what each poem is saying, what the poet was likely feeling and often how the poems helped him personally, as when he left his birth family in South Africa for a rewarding career in the United States.Amanda Gorman’s inspired and inspiring poem that stole the show at President Biden’s inauguration in January has shown millions of Americans the emotional and social power of poetry and, I hope, prompted them to use it themselves.On her blog, Diana Raab, a psychologist, poet and author in Santa Barbara, wrote that “poetry can help us feel as if we’re part of a larger picture and not just living in our isolated little world. Writing and reading poetry can be a springboard for growth, healing and transformation. Poets help us see a slice of the world in a way we might not have in the past.”Dr. Rafael Campo, a poet and physician at Harvard Medical School, believes poetry can also help doctors become better providers, fostering empathy with their patients and bearing witness to our common humanity, which he considers essential to healing. As he put it in a TEDxCambridge talk in June 2019, “When we hear rhythmic language and recite poetry, our bodies translate crude sensory data into nuanced knowing — feeling becomes meaning.”According to Dr. Robert S. Carroll, a psychiatrist affiliated with the University of California, Los Angeles, Medical Center, poetry can give people a way to talk about subjects that are taboo, like death and dying, and provide healing, growth and transformation.Referring to the pandemic, Dr. Rosenthal said, “This crisis affects more or less everyone, and poetry can help us process difficult feelings like loss, sadness, anger, lack of hope. Although not everyone has a gift for writing poetry, all of us can benefit from the thoughts so many poets have beautifully expressed.”Indeed, the book’s first section features the poem “One Art” by Elizabeth Bishop, about loss that can comfort those who are suffering. She wrote:Even losing you (the joking voice, a gestureI love) I shan’t have lied. It’s evidentthe art of losing’s not too hard to masterthough it may look like (Write it!) like disaster.“When people are devastated by loss they should be allowed to feel and express their pain,” Dr. Rosenthal said in an interview. “They should be offered support and compassion, not urged to move on. You can’t force closure. If people want closure, they’ll do it in their own time.”Closure was not a state cherished by Edna St. Vincent Millay, who wrote that“Time does not bring relief; you all have liedWho told me time would ease me of my pain!”However, Dr. Rosenthal pointed out that for most people, time does bring relief, despite what his friend Kay Redfield Jamison wrote in her memoir “An Unquiet Mind.” For her, relief “took its own, and not terribly sweet, time in doing so.”Poems, I now realize, thanks to Dr. Rosenthal, can be a literary panacea for the pandemic. They let us know that we are not alone, that others before us have survived devastating loss and desolation and that we can be uplifted by the imagery and cadence of the written and spoken word.

“This crisis affects more or less everyone, and poetry can help us process difficult feelings like loss, sadness, anger, lack of hope.”Many, perhaps most, of us have spent this past year struggling to find ways to mourn the losses, weather the stresses and revive the pleasures stolen by the Covid-19 pandemic. We’ve monitored Zoom funerals, weddings, graduations, christenings, bar and bat mitzvahs, alternately laughing and weeping at inanimate screens as we tried to make sense of a world turned upside down.But I wonder how many have turned to poetry as a source of comfort, release, connection, understanding, inspiration and acceptance. This being National Poetry Month, there’s no better time than the present to do so.One person who has long valued poetry as both a personal and professional aid is Dr. Norman Rosenthal, a psychiatrist in Rockville, Md., who pioneered the use of light therapy for seasonal affective disorder. A clinical professor of psychiatry at Georgetown Medical School, Dr. Rosenthal said he has used poems as a therapeutic assistant, with rewarding results among his patients.“I have loved poetry ever since I was able to read, and it has been a personal source of comfort and solace to me at different times in my life,” he told me. “As a therapist, I have collected poems along the way that I thought had the power to heal, inspire or, at the very least, bring joy.”Now anyone can access and benefit from the short poems he has found to be so therapeutic and the soul-restoring messages he has gleaned from them. Dr. Rosenthal has compiled them in a new book, “PoetryRx: How 50 Inspiring Poems Can Heal and Bring Joy to Your Life,” complete with helpful takeaways and discussions of the circumstances under which they were written. (The book will be published next month by Gildan Media.)While we herald vaccines as potential saviors from the threat of a devastating virus, Dr. Rosenthal said, “Poetry can serve as a vaccine for the soul.” In a world that is so marred by loss and deprived of pleasure, he believes poetry can help fill in the gaps, offering a brief retreat from a troubled world and hope for a better future.For Margaret Shryer, a Minnesota great-grandmother, poetry has been like a good friend, a reliable source of inspiration and consolation that has helped her remain sane during the many Covid months mostly confined to her apartment in a senior residence.“Poetry generally picks me up,” she told me. “There’s a nugget of truth in every poem, and I flip through them to find ones that resonate with me and will get me going. I read them aloud. Every time you go back to a poem, you read it with a different set of ears. To people who think they don’t like poetry or understand it, I say ‘What about lyrics? That song you love? That’s poetry.’ Some of the most moving poetry can be found in lyrics.”I used to believe that poetry did not “speak” to me, but I now see how wrong I was. I lived for 44 years with a husband, a lyricist, whose beautifully crafted, heartfelt lyrics touched my every fiber and continue to uplift and inspire me a decade after his death. The special beauty of Dr. Rosenthal’s book for me is his discussion of what each poem is saying, what the poet was likely feeling and often how the poems helped him personally, as when he left his birth family in South Africa for a rewarding career in the United States.Amanda Gorman’s inspired and inspiring poem that stole the show at President Biden’s inauguration in January has shown millions of Americans the emotional and social power of poetry and, I hope, prompted them to use it themselves.On her blog, Diana Raab, a psychologist, poet and author in Santa Barbara, wrote that “poetry can help us feel as if we’re part of a larger picture and not just living in our isolated little world. Writing and reading poetry can be a springboard for growth, healing and transformation. Poets help us see a slice of the world in a way we might not have in the past.”Dr. Rafael Campo, a poet and physician at Harvard Medical School, believes poetry can also help doctors become better providers, fostering empathy with their patients and bearing witness to our common humanity, which he considers essential to healing. As he put it in a TEDxCambridge talk in June 2019, “When we hear rhythmic language and recite poetry, our bodies translate crude sensory data into nuanced knowing — feeling becomes meaning.”According to Dr. Robert S. Carroll, a psychiatrist affiliated with the University of California, Los Angeles, Medical Center, poetry can give people a way to talk about subjects that are taboo, like death and dying, and provide healing, growth and transformation.Referring to the pandemic, Dr. Rosenthal said, “This crisis affects more or less everyone, and poetry can help us process difficult feelings like loss, sadness, anger, lack of hope. Although not everyone has a gift for writing poetry, all of us can benefit from the thoughts so many poets have beautifully expressed.”Indeed, the book’s first section features the poem “One Art” by Elizabeth Bishop, about loss that can comfort those who are suffering. She wrote:Even losing you (the joking voice, a gestureI love) I shan’t have lied. It’s evidentthe art of losing’s not too hard to masterthough it may look like (Write it!) like disaster.“When people are devastated by loss they should be allowed to feel and express their pain,” Dr. Rosenthal said in an interview. “They should be offered support and compassion, not urged to move on. You can’t force closure. If people want closure, they’ll do it in their own time.”Closure was not a state cherished by Edna St. Vincent Millay, who wrote that“Time does not bring relief; you all have liedWho told me time would ease me of my pain!”However, Dr. Rosenthal pointed out that for most people, time does bring relief, despite what his friend Kay Redfield Jamison wrote in her memoir “An Unquiet Mind.” For her, relief “took its own, and not terribly sweet, time in doing so.”Poems, I now realize, thanks to Dr. Rosenthal, can be a literary panacea for the pandemic. They let us know that we are not alone, that others before us have survived devastating loss and desolation and that we can be uplifted by the imagery and cadence of the written and spoken word.

In powering through discomfort, I became inured to it — until I figured out how to acknowledge what I actually wanted.This article is part of a series on resilience in troubled times — what we can learn about it from history and personal experiences.“You are miserable,” my boss said, as I murmured in faint protest. “Every day you come in here with that grumpy face, and you make me look at it.” Despite the harsh words, her tone was laced with love and concern. And she was right: The job was not a fit.I was a talent agent at a huge Hollywood agency in my 20s, representing emerging comedy actors. My role was to make my clients’ dreams come true. I loved that part — spotting talent, and getting them started on their journeys to fame and fortune — and I’m certain they would tell you now that I was good at it. But that was the only part that worked for me.I didn’t enjoy the stuff that was supposed to be fun. One partner noticed I was spending too little on my expenses, instead of schmoozing. After a movie premiere, I got a talking-to for going straight to my seat instead of walking the red carpet with the cast, a ritual that made me want to evaporate, every time.“There are parts of the job you clearly find icky,” my boss continued, as she watched me curl into a nauseated ball on her love seat. “But you have to think about whether you can tolerate them, in order to enjoy the parts you like.”Mental health professionals like to say that we’re all floating around the world like little rubber bands: We encounter a challenge, which makes us stretch, grow and bounce back. That’s how resilience is meant to work.But that all assumes that hard times end. What if there’s always something else? What if you go through a year as relentless as this last one has been for so many of us: illness, death, home-schooling, job losses, systems crumbling left and right? An entire year of hobbling around with two flat tires but only one spare, praying for an uneventful day or two, until the next tire blows?What happens is that you get used to it — something with which I am all too familiar. Tolerating things I didn’t enjoy was, for a long time, my superpower, one I had cultivated after an eventful childhood. By many metrics my upbringing was blissful: boundless love, laughter, globe-trotting adventures. But I also know change and trauma, having moved over 30 times over three decades, across a childhood punctuated by dramatic loss, including violent conflict in my homeland, Kashmir, and the death of my beloved grandfather. My little rubber band eventually settled, taut and brittle, seemingly forever. In powering through the discomfort of constant change, I became inured to it.Resilience without any waning period, turned into endurance, and I became adept at snuffing out my own vulnerability and discomfort before I even felt it. I grew into someone who could live anywhere, befriend anyone, be anyone, do anything — the harder, the better.And it was these exact qualities that garnered praise. “You don’t have to worry about her,” people told my parents, and everyone swelled with pride. If no one understood me, I’d learn a new language. If my accent was a barrier, then — poof! — all of a sudden, I sounded American. If my bank balance was negative $900 one month, I’d figure out how to reverse it.I chased the high of conquering things that seemed impossible, which led me to the entertainment industry. Cracking the codes to its impenetrable world made me think I was winning, then thriving, until those conversations with my boss began to shatter that perception. I realized I had a dream job — it just wasn’t mine.When she suggested that I could be happier, that I could envision the right life for me and go get it, my mind was blank. I had been ignoring my feelings in favor of crossing off the next goal, through college, law school, a prestigious job. My itinerant childhood wired me to pursue stability above all, but what were my dreams? “Don’t you want to write some books, maybe have a couple kids?” she said, casually, and I froze. It sounded perfect. But the idea of actively seeking happiness was terrifying. What if I failed?I had spent so long buffeted by the waves of external events that once they went quiet I didn’t know what to do. Technically, a lifetime of endurance had convinced that me I was so tough that I could handle anything. But I didn’t want to. So for the first time, I allowed myself to say so. I didn’t know if there was a professional pursuit that might make me happier, but that one was worth seeking.I knew only that my true love was reading, and writers. I knew words on a page made me happy, and I went looking for more of that feeling. The joy I felt discussing ideas, helping mold those ideas into a script, then onscreen, became my new pursuit. It suddenly felt so silly, so luxurious, not to be in pure survival mode — to have made the space to think about what was good for me.I got into producing, and had a baby. But soon I felt that old dissatisfaction creep in again, the one that I was making other people’s dreams come true but not my own. And this time I trusted my feelings enough not to ignore them. This wasn’t the kind of challenge I was meant to power through; it was one that called for looking clearly within myself. The pleasure I derived from work had successfully chipped away at the hard shell of my endurance, and let happiness into the cracks, shining a light on the malaise nudging its way out. But still, I couldn’t admit what I wanted.So I spent some time flailing about, groaning, wishing out loud that the world — someone, anyone — would tell me what to do next. After months of this charade, my husband, a professional writer, steered me into listing five people whose careers I admired. That was easy. “They’re all writers,” he said. “Do you think that means anything?”Reading brought me such transcendent joy, who was I to think I might bring that same joy to other people? It seemed insane, at the time, like deciding to be God. I just couldn’t. “Of course you could,” he said. And the new me, the one who was learning that life could be celebrated rather than just tolerated, decided to try.So I wrote and wrote, thinking: if it’s bad, no one will ever see it; if it’s good, it might change my life. I started with a lot of disjointed, maudlin blog entries. As they became less terrible, I pitched and wrote an advice column for people wanting to break into entertainment. I wrote a short film, funded by my last producing paycheck, and shot it in our home. That got me an agent, and sold my first TV show, and kicked off a screenwriting career. Last year, during the pandemic, I wrote some essays. Those essays allowed me to sell the book I’m writing now.Ever an immigrant, it’s still difficult for me to say out loud that my dreams are taking shape, without my old self disassociating. “Are you insane? If you talk about it, it’ll all crumble away!” the disassociated me screams, even now. She’s maddening, but I ignore her. I have finally figured out what is good for me: to sit in a sunny room, by myself, typing these words. No pushy colleagues. No schmoozing. No stiff upper lip, while I wait for a happier time that might never come.And I’m still tough; this last year has reminded me of that. But my rubber band hasn’t snapped or frayed. I know it’s not stuck, and this won’t last forever. I have some other settings now: content, delighted, disappointed, anxious. One might even call them feelings. Feelings I’m marinating in as I write this book. If it works, it might change my life. If it doesn’t? Well, I’ll bounce back.Priyanka Mattoo is a Los Angeles-based writer and filmmaker. She is working on “Sixteen Kitchens,” a memoir-in-essays from Knopf.

El síndrome MIS-C puede afectar a los menores semanas después de infectarse con el coronavirus. Los expertos, tras publicarse el mayor estudio realizado en Estados Unidos sobre la afección, recomiendan a los pediatras estar atentos.Muchos niños y adolescentes que desarrollaron el misterioso síndrome inflamatorio que puede manifestarse varias semanas después de contraer el coronavirus nunca tuvieron los síntomas clásicos de COVID-19 al momento de su infección, según el estudio de casos más grande hasta ahora en Estados Unidos.El estudio, dirigido por investigadores de los Centros para el Control y la Prevención de Enfermedades (CDC, por su sigla en inglés), encontró que en más de 1000 casos en los que se disponía de información sobre si se habían enfermado por su COVID-19 inicial, el 75 por ciento de los pacientes no experimentaron tales síntomas. Sin embargo, de dos a cinco semanas después, se enfermaron lo suficiente como para ser hospitalizados por la afección, llamada síndrome inflamatorio multisistémico pediátrico (MIS-C, por su sigla en inglés), que puede afectar diversos órganos, especialmente el corazón.El estudio, publicado el 6 de abril en JAMA Pediatrics, afirmó que “se cree que la mayoría de las enfermedades MIS-C son el resultado de casos leves o asintomáticos de COVID-19” seguidos de una respuesta hiperinflamatoria que parece ocurrir cuando los cuerpos de los pacientes han producido su nivel máximo de anticuerpos contra el virus. Los expertos aún no saben por qué algunos jóvenes, y una cantidad menor de adultos, responden de esta manera.“Eso significa que los pediatras de atención primaria deben tener un alto índice de sospecha de esto porque la covid es muy frecuente en la sociedad y los niños a menudo tienen una enfermedad asintomática en su infección inicial de covid”, afirmó Jennifer Blumenthal, intensivista pediátrica y especialista en enfermedades infecciosas pediátricas del Hospital para Niños de Boston, quien no estuvo involucrada en el estudio.Los investigadores evaluaron 1733 de los 2090 casos del síndrome en personas de 20 años o menos que habían sido reportados a los CDC hasta enero.Los resultados muestran que, aunque el síndrome es poco común, puede ser grave. Los datos de los CDC solo incluyeron pacientes que fueron hospitalizados. Más del 90 por ciento de estas personas jóvenes experimentaron síntomas que involucraron al menos cuatro sistemas de órganos y el 58 por ciento necesitó tratamiento en unidades de cuidados intensivos.Muchos experimentaron problemas cardiacos importantes: más de la mitad desarrolló baja presión arterial, el 37 por ciento desarrolló choque cardiogénico y el 31 por ciento experimentó una disfunción cardiaca relacionada con la incapacidad del corazón para bombear de forma adecuada. El estudio afirmó que un porcentaje significativamente mayor de pacientes que no habían tenido síntomas de COVID-19 experimentaron estos problemas cardiacos, en comparación con aquellos que sí tuvieron síntomas iniciales de coronavirus. Un porcentaje mayor de pacientes que al principio fueron asintomáticos también terminaron en unidades de cuidados intensivos (UCI).“Incluso la gran mayoría de los niños con casos graves de MIS-C que estuvieron en la UCI, no tuvieron una enfermedad previa que pudieran reconocer”, afirmó Roberta DeBiasi, jefa del departamento de enfermedades infecciosas del Children’s National Hospital en Washington D. C., quien no participó en la investigación.El estudio proporcionó la imagen demográfica y geográfica más detallada del síndrome hasta la fecha. Alrededor del 34 por ciento de los pacientes eran negros y el 37 por ciento eran hispanos, lo que refleja la forma en que el coronavirus ha afectado desproporcionadamente a los miembros de esas comunidades. A medida que avanzaba la pandemia, escribieron los autores, aumentó la proporción de pacientes de raza blanca, que representaban el 20 por ciento de todos los casos. Las personas de origen asiático representaban poco más del uno por ciento de los pacientes.En general, casi el 58 por ciento de los pacientes eran hombres, pero la proporción no era la misma en todas las edades. En el grupo más joven —recién nacidos hasta los 4 años— el número de niños y niñas era prácticamente igual, y la proporción entre hombres y mujeres aumentaba en los grupos de mayor edad hasta que la proporción llegaba a más de dos en el grupo de 18 a 20 años.La gran mayoría de los pacientes (casi el 86 por ciento) eran menores de 15 años. El estudio reveló que los menores de 5 años tuvieron el menor riesgo de desarrollar complicaciones cardiacas graves y fueron menos propensos a necesitar cuidados intensivos. Los pacientes de 10 años o más tuvieron una probabilidad mucho mayor de desarrollar problemas como choque cardiogénico, presión arterial baja y miocarditis (inflamación del músculo cardiaco).“Creo que es parecido a lo que vimos con la covid, donde los niños mayores parecían tener enfermedades más graves”, dijo DeBiasi. “Y eso se debe a que lo que en realidad enferma a las personas de la covid es su aspecto inflamatorio, así que quizás estos niños mayores, por diversas razones, produjeron más inflamación en la covid inicial o en el MIS-C”.Aun así, un número significativo de los pacientes más jóvenes desarrollaron problemas cardiacos. En el grupo entre recién nacidos hasta niños de 4 años, el 36 por ciento tuvo baja presión arterial, 25 por ciento tuvo choque cardiogénico y el 44 por ciento recibió tratamiento en la UCI.Pacientes de todas las edades en el estudio experimentaron casi la misma incidencia de algunos de los problemas cardiacos menos comunes relacionados con el síndrome, como aneurismas coronarios y acumulación de líquido. Los niños de 14 años o menos fueron más propensos a tener sarpullido y enrojecimiento de los ojos, mientras que los mayores de 14 tuvieron mayores probabilidades de desarrollar dolor en el pecho, dificultad para respirar y tos. Cerca de dos tercios de todos los pacientes se vieron afectados por dolores abdominales y vómito.Se registraron 24 muertes, repartidas en todos los grupos de edad. No hubo información en el estudio sobre si los pacientes tenían afecciones médicas subyacentes, pero los médicos e investigadores informaron que las personas jóvenes con MIS-C por lo general estuvieron previamente sanas y tenían muchas más probabilidades de estar sanas que el número relativamente pequeño de jóvenes que padecieron enfermedades graves de las infecciones iniciales de covid.De los 1075 pacientes de los que se tenía información sobre la enfermedad de covid inicial, solo 265 mostraron síntomas en ese momento. Eran más propensos a ser mayores: su edad promedio fue de 11 años, mientras que la edad promedio de aquellos con infecciones de covid asintomáticas fue de 8. Sin embargo, eso podría deberse a que “los niños más pequeños no pueden expresar sus preocupaciones con la misma eficiencia”, aseguró Blumenthal, quien coescribió una editorial sobre el estudio.“En realidad no sabemos si en efecto hay menos sintomatología en la población muy joven”, concluyó.Tampoco están claras las razones que subyacen al hallazgo del estudio de que en la primera oleada de MIS-C, del 1 de marzo al 1 de julio de 2020, los jóvenes eran más propensos a algunas de las complicaciones cardíacas más graves. DeBiasi dijo que eso no coincidía con la experiencia de su hospital, donde “los niños estaban más enfermos en la segunda ola”.El estudio documentó dos oleadas de casos de MIS-C que siguieron a los aumentos de los casos generales de coronavirus durante un mes o más. “El tercer pico más reciente de la pandemia de COVID-19 parece estar conduciendo a otro pico de MIS-C que quizá implique a comunidades urbanas y rurales”, escribieron los autores.El estudio descubrió que la mayoría de los estados en los que la tasa de casos de MIS-C por población era más alta se encontraban en el noreste, donde se produjo el primer aumento de casos, y en el sur. Por el contrario, la mayoría de los estados con altas tasas de niños con COVID-19 por población, pero con bajas tasas de MIS-C, se encontraban en el Medio Oeste y el Oeste. Aunque la concentración de casos se extendió de las grandes ciudades a los pueblos más pequeños con el tiempo, no fue tan pronunciada como las tendencias generales de la pandemia, dijeron los autores.Blumenthal dijo que ese patrón geográfico podría reflejar que la “comprensión de las complicaciones de la enfermedad” no había alcanzado su prevalencia en las distintas regiones o que muchos estados con tasas más bajas de MIS-C tienen poblaciones menos diversas étnicamente. “También podría tratarse de algo relacionado con la propia covid, aunque no lo sabemos”, dijo. “En este momento, no sabemos nada sobre cómo las variantes afectan necesariamente a los niños”.El estudio representó solo los criterios más estrictos sobre MIS-C, al excluir unos 350 casos notificados que cumplían la definición del síndrome de los CDC pero tenían una prueba de anticuerpos negativa o presentaban principalmente síntomas respiratorios. DeBiasi dijo que también hay muchos casos probables de MIS-C que no se comunican a los CDC porque no cumplen todos los criterios oficiales.“Estos probables niños con MIS-C, en la vida real, son un montón de niños”, dijo. Además, aunque hasta ahora se ha centrado en los casos graves, “hay todo un grupo de niños que en realidad pueden tener MIS-C leve”.Si una comunidad ha experimentado un aumento reciente de coronavirus, entonces “solo porque el niño diga: ‘Nunca he tenido covid o mis padres nunca lo han tenido’, eso no significa que el niño que tienes delante no tenga MIS-C”, dijo DeBiasi. “Si tu ciudad tiene covid, prepárate”.Pam Belluck es una reportera de ciencia y salud cuyos galardones incluyen un Premio Pulitzer compartido en 2015 y el premio Nellie Bly a la mejor historia de primera plana. Es autora de Island Practice, un libro sobre un doctor peculiar. @PamBelluck