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Common kinds of air pollution led to changes in teens’ blood pressure, study says | CNN

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CNN
—

Scientists know that air pollution can make it difficult to breathe and may ultimately cause serious health problems like cancer, but a new study shows that it might also have a negative impact on teens’ blood pressure.

Exposure to higher levels of nitrogen dioxide was associated with lower blood pressure in teens, according to the study, published Wednesday in the journal PLOS One. Exposure to particulate matter 2.5, also known as particle pollution, was associated with higher blood pressure.

The researchers say the impact is “considerable.”

Other studies have found a connection between blood pressure changes and pollution, but much of that work focuses on adults. Some research has also found negative associations with pollution exposure and younger children, but little has focused on teens.

Generally, low blood pressure can cause immediate problems like confusion, tiredness, blurred vision and dizziness. High blood pressure in adolescence can lead to a lifetime of health problems including a higher risk of stroke or heart attack. It’s a leading risk factor for premature death worldwide.

The study did not look at whether the teens had symptoms or health effects from the change in blood pressure.

The scientists saw this association between pollution and blood pressure in data from the Determinants of Adolescent Social Well-Being and Health study, which tracks the health of a large and ethnically diverse group of children in London over time.

The researchers took data from more than 3,200 teens and compared their records to their exposures to pollution based on annual pollution levels where they lived.

Nitrogen dioxide pollution is most commonly associated with traffic-related combustion byproducts. Nitrogen may help plants grow, but it can impair a person’s ability to breathe and may cause damage to the human respiratory tract. In this study, the nitrogen was thought to be coming predominantly from diesel traffic.

The particle pollution in the study is so tiny – 1/20th of a width of a human hair – that it can travel past the body’s usual defenses. Instead of being carried out when a person exhales, it can get stuck in the lungs or go into the bloodstream. The particles cause irritation and inflammation and may lead to a whole host of health problems.

Particle pollution can come from forest fires, wood stoves, power plants and coal fires. It can also come from traffic and construction sites.

In this study, the link between pollution exposure and changes in blood pressure was stronger in girls than in boys. The researchers can’t determine why there is a gender difference, but they found that 30% of the female participants got the least amount of exercise among the group and noted that that can have an effect on blood pressure.

“It is thus imperative that air pollution is improved in London to maximise the health benefits of physical exercise in young people,” the study says.

Although the study also can’t pinpoint why teens’ blood pressure changed with pollution exposure, others have found that exposure to air pollution may affect the central nervous system, causing inflammation and damage to the body’s cells. Additionally, exposure to particle pollution can disrupt a person’s circadian rhythms, which could affect blood pressure. Particle pollution exposure may also reduce the kidneys’ ability to excrete sodium during the day, leading to a higher nighttime blood pressure level, the study says.

When it came to nitrogen dioxide pollution, the researchers had previously done a crossover study that involved the blood pressure of 12 healthy teen participants who were exposed to nitrogen oxide from a domestic gas cooker with lit burners. Their blood pressure fell compared with participants exposed to only room air.

In the new study, the associations between pollution and blood pressure were consistent. Body size, socieoecomonic status and ethnicity didn’t change the results.

However, it looks only at teens in London, and only 8% of them were people of color. Those children were exposed to higher levels of pollution than White children, the study found.

Levels of pollution in London are also well above what World Health Organization guidelines suggest is safe for humans. However, the same could be said for most any area in the world. In 2019, 99% of the world’s population lived in places that did not meet WHO’s recommended air quality levels.

Earlier work has shown that pollution can damage a young person’s health and may put them at a higher risk for chronic diseases like heart problems later in life. Studies in adults found that exposure to air pollution can affect blood pressure even within hours of exposure.

Pollution caused 1 in 6 deaths worldwide in 2019 alone, another study found.

Some experts suggest that one way to reduce a teen’s risk of pollution-related health problems is to invest in portable air cleaners with HEPA filters that are highly effective at reducing indoor air pollution. However, the filters can’t remove all of the problem, and experts say communitywide solutions through public policy are what’s needed.

Dr. Panagis Galiatsatos, an assistant professor in pulmonary and critical care medicine at Johns Hopkins Medicine, said research like this is important to generate a hypothesis about what these pollutants are doing to people. Galiatsatos, a volunteer medical spokesperson with the American Lung Association, was not involved with the new study.

“A lot of these air pollutions tend to cluster in economically disadvantaged neighborhoods, so it’s one of the big reasons we want to always keep a close eye on this, as it disproportionately impacts certain populations more than others,” he said.

Blood pressure is an important marker to track for health because it is a surrogate to understand the more complex processes that might be happening in the body.

“My big takeaway is that these toxins clearly seem to have some physiological impact on the cardiovascular system, and any manipulation should be taken into the context of a concern,” Galiatsatos said.

Study co-author Dr. Seeromanie Harding, a professor of social epidemiology at King’s College London, said she hopes it will lead to more research on the topic.

“Given that more than 1 million under 18s live in [London] neighborhoods where air pollution is higher than the recommended health standards,” she said in a news release, “there is an urgent need for more of these studies to gain an in-depth understanding of the threats and opportunities to young people’s development.”

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Don’t serve Girl Scout cookies with a side of shame | CNN

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Editor’s Note: Dr. Katie Hurley, author of “No More Mean Girls: The Secret to Raising Strong, Confident and Compassionate Girls,” is a child and adolescent psychotherapist in Los Angeles. She specializes in work with tweens, teens and young adults.

CNN
—

It’s Girl Scout cookie season again, which means young female entrepreneurs are outside your favorite stores and community centers selling you the latest flavors and old favorites.

While this program that helps girls learn and practice important leadership skills remains the largest girl-led entrepreneurial program in the world, cookie season can also include unwelcome messaging about calorie counting, restricted eating and diet culture.

During the course of the selling season, and even just in a single shift, girls are likely to hear negative comments about weight, body image and disordered eating from both customers and passersby. While many comments are passed off as humor, a seemingly benign joke about needing to exercise more to “earn” a Thin Mint isn’t as innocent as it might seem.

“We know that children can internalize body image concerns as young as 3 to 5 years old, so it’s important to keep in mind how we talk about our bodies and the food we eat in front of children very early on,” said Dr. Nicole Cifra, an attending physician in the division of adolescent medicine at Children’s Hospital of Philadelphia.

“We also know that dieting is a major risk factor for developing an eating disorder, so minimizing talk about diets or restricting certain food groups is beneficial,” she added.

Although a single comment isn’t likely to trigger an eating disorder, repeated exposure to diet talk can have an effect on the thought patterns girls develop around eating and body image.

“There’s a cumulative effect of kids getting these messages directly,” said Oona Hanson, parent coach and founder of the Facebook community, Parenting without Diet Culture. “One individual customer is not solely responsible for internalized messages that lead to disordered eating, but all adults play a role in the messaging kids hear around diet culture and positive body image.”

What might feel like a humorous way to deflect a cookie purchase in the moment could do more harm than anticipated. It’s probably not the only negative commentary the young entrepreneurs hear during a shift. Given that over 200 million boxes of cookies are sold each year, that’s a lot of girls fending off a lot of snarky remarks about bathing suit season or earning the confection through extra workouts or starvation.

If you’re inclined to crack a joke because you just don’t want the cookies, consider taking a moment to engage a Girl Scout in conversation about their business model and where the funds land. This gives these young businesswomen a chance to practice public speaking while sharing what they’re learning. Chances are you might even learn that you can make a cookie donation through the “Cookie Share” program. My family likes to buy some for our home and send some via Cookie Share to United States troops.

Charlotte Markey, author of “The Body Image Book for Girls,” notes that it is nearly impossible to address every negative comment heard in the background of cookie sale booths. “Some of this is so commonplace that if we take every single comment seriously, we spend too much energy on it,” Markey said.

However, there are steps parents, educators and Girl Scout troop leaders can take to mitigate some of this negative messaging so that girls don’t internalize it.

“The best thing that troop leaders and parents can do for their kids is to model their own healthy body image,” said Dr. Cheri Levinson, associate professor in the department of psychological and brain sciences at the University of Louisville and director of the university’s Eating Anxiety Treatment Lab. “It’s also important to talk about all of the good things that bodies do for us — like letting us hug people, dance or pet our pets.”

Practicing gratitude as it relates to our bodies is a powerful way to reframe thinking away from unrealistic expectations or negative thoughts about our bodies and toward being mindful of the many ways our bodies carry us through our days.

Kids are always listening.

“One of the most important things is not to talk negatively about your body or food in front of kids,” Levinson said. When we talk kindly to ourselves, she noted, they learn to do the same.

Balanced eating includes having treats at times and taking the time to enjoy the foods we consume. When adults label foods or eating choices as “good” or “bad” and “healthy” or “unhealthy,” kids get the message some foods are either off-limits or harmful. This can create feelings of shame around eating, particularly when sweets are restricted to these categories.

“One thing troop leaders can do is talk about the joy around food by sharing their favorite combinations of cookies,” Hanson said. “This tips the scales in the direction of creating a balanced relationship with food.”

It might be tempting to ignore the commentary and simply move on, but if girls are hearing diet culture talk, they need to talk about it with a trusted adult.

“I recommend having an open line of communication about these topics. Talking to children about the media they consume or comments they hear from others related to body image can be helpful in giving them a space to process the information they’re receiving,” Cifra said.

One way to do this is to debrief the girls after the shift ends. A troop leader can say, “We heard a few jokes and comments about diets and not eating cookies. I wonder how you felt when you heard those things?” This opens the door to a discussion about negative body comments and how girls can reframe their thinking.

There might be times when an adult has to step in and gently redirect another adult who is making uncomfortable comments, but girls can also take the opportunity to use their voices to stand up to diet talk.

Assertiveness is an essential leadership skill, and countering unwanted commentary with positive messaging is one way to help girls sharpen their skills. Plan ahead to come up with some talking points to use if they encounter any negative messaging. Phrases like “We love our cookies and they only come around once a year!” or “Gift a box to our troops — we know they love our cookies!” change the tone from negative to hopeful while empowering the girls to speak up for a cause they believe in.

Cookie season does only come around once a year, and the dollars earned from these sales go directly back to the local and regional troops to fund activities for the girls throughout the year. Whether you donate the cookies to someone else or pick up a box of favorites to enjoy yourself, your purchase empowers up-and-coming leaders. So go ahead and grab those Thin Mints while you still can.

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For the first time, US task force proposes expanding high blood pressure screening recommendations during pregnancy | CNN

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CNN
—

The US Preventive Services Task Force has released a draft recommendation to screen everyone who is pregnant for hypertensive disorders of pregnancy, by monitoring their blood pressure throughout the pregnancy, and the group is calling attention to racial inequities.

This is the first time the task force has proposed expanding these screening recommendations to include all hypertensive disorders of pregnancy, which are on the rise in the United States.

It means the average person might notice their doctor paying closer attention to their blood pressure measurements during pregnancy, as well as doctors screening not just for preeclampsia but for all disorders related to high blood pressure.

The draft recommendation statement and evidence review were posted online Tuesday for public comment. The statement is consistent with a 2017 statement that recommends screening with blood pressure measurements throughout pregnancy.

It was already recommended for blood pressure measurements to be taken during every prenatal visit, but “the difference is now really highlighting the importance of that – that this is a single approach that is very effective,” said Dr. Esa Davis, a member of the task force and associate professor of medicine at the University of Pittsburgh.

The draft recommendation urges doctors to monitor blood pressure during pregnancy as a “screening tool” for hypertensive disorders, she said, and this may reduce the risk of some hypertensive disorders among moms-to-be going undiagnosed or untreated.

“Since the process of screening and the clinical management is similar for all the hypertensive disorders of pregnancy, we’re broadening looking at screening for all of the hypertensive disorders, so gestational hypertension, preeclampsia, eclampsia,” Davis said.

The US Preventive Services Task Force, created in 1984, is a group of independent volunteer medical experts whose recommendations help guide doctors’ decisions. All recommendations are published on the task force’s website or in a peer-reviewed journal.

To make this most recent draft recommendation, the task force reviewed data on different approaches to screening for hypertensive disorders during pregnancy from studies published between January 2014 and January 2022, and it re-examined earlier research that had been reviewed for former recommendations.

“Screening using blood pressure during pregnancy at every prenatal encounter is a long-standing standard clinical practice that identifies hypertensive disorders of pregnancy; however, morbidity and mortality related to these conditions persists,” the separate Evidence-Based Practice Center, which informed the task force’s draft recommendation, wrote in the evidence review.

“Most pregnant people have their blood pressure taken at some point during pregnancy, and for many, a hypertensive disorder of pregnancy is first diagnosed at the time of delivery,” it wrote. “Diagnoses made late offer less time for evaluation and stabilization and may limit intervention options. Future implementation research is needed to improve access to regular blood pressure measurement earlier in pregnancy and possibly continuing in the weeks following delivery.”

The draft recommendation is a “B recommendation,” meaning the task force recommends that clinicians offer or provide the service, as there is either a high certainty that it’s moderately beneficial or moderate certainty that it’s highly beneficial.

For this particular recommendation, the task force concluded with moderate certainty that screening for hypertensive disorders in pregnancy, with blood pressure measurements, has a substantial net benefit.

Hypertensive disorders in pregnancy appear to be on the rise in the United States.

Data published last year by the US Centers for Disease Control and Prevention shows that, between 2017 and 2019, the prevalence of hypertensive disorders among hospital deliveries increased from 13.3% to 15.9%, affecting at least 1 in 7 deliveries in the hospital during that time period.

Among deaths during delivery in the hospital, 31.6% – about 1 in 3 – had a documented diagnosis code for hypertensive disorder during pregnancy.

Older women, Black women and American Indian and Alaska Native women were at higher risk of hypertensive disorders, according to the data. The disorders were documented in approximately 1 in 3 delivery hospitalizations among women ages 45 to 55.

The prevalence of hypertensive disorders in pregnancy was 20.9% among Black women, 16.4% among American Indian and Alaska Native women, 14.7% among White women, 12.5% among Hispanic women and 9.3% among Asian or Pacific Islander women.

The task force’s new draft recommendation could help raise awareness around those racial disparities and how Black and Native American women are at higher risk, Davis said.

“If this helps to increase awareness to make sure these high-risk groups are screened, that is something that is very, very important about this new recommendation,” she said. “It helps to get more women screened. It puts it more on the radar that they will then not just be screened but have the surveillance and the treatment that is offered based off of that screening.”

Communities of color are at the highest risk for hypertensive disorders during pregnancy, and “it’s very related to social determinants of health and access to care,” said Dr. Ilan Shapiro, chief health correspondent and medical affairs officer for the federally qualified community health center AltaMed Health Services in California. He was not involved with the task force or its draft recommendation.

Social determinants of health refer to the conditions and environments in which people live that can have a significant effect on their access to care, such as their income, housing, safety, and not living near sources for healthy food or easy transportation.

These social determinants of health, Shapiro said, “make a huge difference for the mother and baby.”

Hypertensive disorders during pregnancy can be controlled with regular monitoring during prenatal visits, he said, and the expectant mother would need access to care.

Eating healthy foods and getting regular exercise also can help get high blood pressure under control, and some blood pressure medications are considered safe to use during pregnancy, but patients should consult with their doctor.

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Climate change is contributing to the rise of superbugs, new UN report says | CNN

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CNN
—

Climate change and antimicrobial resistance are two of the greatest threats to global health, according to a new report from the United Nations Environment Programme.

The report, titled “Bracing for Superbugs,” highlights the role of climate change and other environmental factors contributing to the rise of antimicrobial resistance. It was announced Tuesday at the Sixth Meeting of the Global Leaders Group on Antimicrobial Resistance in Barbados.

Antimicrobial resistance or AMR happens when germs such as bacteria, viruses and fungi develop the ability to defeat the medications designed to kill them.

“The development and spread of AMR means that antimicrobials used to prevent and treat infections in humans, animals and plants might turn ineffective, with modern medicine no longer able to treat even mild infections,” the UN Environment Programme said in a news release.

Roughly 5 million deaths worldwide were associated with antimicrobial resistance in 2019, and the annual toll is expected to increase to 10 million by 2050 if steps aren’t taken to stop the spread of antimicrobial resistance, according to the report.

In the US, there are nearly 3 million antimicrobial-resistant infections each year, and more than 35,000 people die as a result, the US Centers for Disease Control and Prevention says.

Antimicrobials are commonly used in cleaning products, plant pesticides and medications to kill and prevent the spread of germs among people, animals and crops.

Drug resistance can develop naturally, but experts say the overuse of antimicrobials in people, animals and food production has accelerated the process. The microorganisms that survive these chemicals are stronger and more powerful, and they can spread their drug-resistant genes to germs that have never been exposed to antimicrobials.

The focus so far has largely been on excessive antimicrobial use, but experts say there is growing evidence that environmental factors play a significant role in the development, transmission and spread of antimicrobial resistance.

“Climate change, pollution, changes in our weather patterns, more rainfall, more closely packed, dense cities and urban areas – all of this facilitates the spread of antibiotic resistance. And I am certain that this is only going to go up with time unless we take relatively drastic measures to curb this,” said Dr. Scott Roberts, an infectious diseases specialist at Yale School of Medicine, who was not involved with the new UN report.

The climate crisis worsens antimicrobial resistance in several ways. Research has shown that increased temperatures increase both the rate of bacterial growth and the rate of the spread of antibiotic-resistant genes between microorganisms.

“As we get a more extreme climate, especially as it warms, the gradients that drive the evolution of resistance will actually accelerate. So, by curbing temperature rises and reducing the extremity of events, we can actually then fundamentally curb the probability of evolving new resistance,” Dr. David Graham, a professor of ecosystems engineering at Newcastle University and one of the UN report’s authors, said at a news conference ahead of the report’s release.

Experts also say severe flooding as a result of climate change can lead to conditions of overcrowding, poor sanitation and increased pollution, which are known to increase infection rates and antimicrobial resistance as human waste, heavy metals and other pollutants in water create favorable conditions for bugs to develop resistance.

“The same drivers that cause environmental degradation are worsening the antimicrobial resistance problem. The impacts of antimicrobial resistance could destroy our health and food systems,” Inger Andersen, the UN Environment Programme’s executive director, said at the news conference.

Environmental pressures are creating bugs that thrive in the human body, which experts say is unusual for some species.

“There’s one hypothesis from a prominent mycologist who suggests that the reason the body’s temperature is 98.6 is because that is the temperature where fungi can’t grow that well. And so, now we’re seeing Candida auris and some of the other new microbes that have come up that really grow quite well – even at temperatures of 98.6 in the human body. And so I think climate change, really selecting for these organisms to adapt to a warmer climate, is going to increase the odds that there’s infection in humans,” Roberts said.

Such opportunistic infections jeopardize medical advancements like joint replacements, organ transplants and chemotherapy – procedures in which patients have a significant risk of infection and require effective antibiotics.

Drug-resistant infections can make treatment difficult or even impossible. Roberts says that resorting to “last-ditch treatments” is “never a good scenario from the patient level because there are reasons we don’t use them up front,” such as organ toxicity and failure.

“When somebody does present with a drug-resistant bacteria or fungus and we really need to rely on one of these last-line antibiotics, it’s usually a challenge to treat from the outset. And so the patients really don’t do as well as a result,” he said. “In rare circumstances, we run out of options entirely, and in that case, there’s really nothing we can do. Fortunately, those cases remain quite rare, but I am certain that with this growing antibiotic resistance problem, we’ll see these increasing frequency over time.”

Experts say that both climate change and antimicrobial resistance have been worsened by and can be improved by human actions. One critical step is to limit antibiotic overuse and misuse.

“Antibiotics and antifungals do not work on viruses, such as colds and the flu. These drugs save lives. But, anytime they are used, they can lead to side effects and antimicrobial resistance,” the UN report’s authors wrote.

The authors also emphasize that the health of people, animals, plants and the environment are closely linked and interdependent, and they call on governments to identify policies to limit antibiotic use in agriculture and reduce environmental pollution.

Finally, experts say, steps to reduce climate change are steps to limit antimicrobial resistance.

“Whatever we can do on an individual level to kind of reduce the impact of climate change, really, that’s kind of only worsening this problem, as well as pollution and urbanization and in dense, crowded areas. Although I know from the individual level that’s a hard thing to change,” Roberts said.

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Alcohol and dementia: Study finds benefits in minimal drinking, but it’s complicated | CNN

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CNN
—

Keeping alcohol consumption to one or two drinks a day lessened the odds of developing dementia, according to a study of nearly 4 million South Koreans.

However, drinking more than two drinks a day increased that risk, according to the study published Monday in the journal JAMA Network Open.

“We found that maintaining mild to moderate alcohol consumption as well as reducing alcohol consumption from a heavy to moderate level were associated with a decreased risk of dementia,” said first author Dr. Keun Hye Jeon, an assistant professor at CHA Gumi Medical Center, CHA University in Gumi, South Korea, in an email.

But don’t rush to the liquor store, experts say.

“This study was well done and is extremely robust with 4 million subjects, but we should be cautious not to over interpret the findings,” said Alzheimer’s researcher Dr. Richard Isaacson, a preventive neurologist at the Institute for Neurodegenerative Diseases of Florida. He was not involved in the new study.

Alcohol use can be a risk factor for breast and other cancers, and consuming too much can contribute to digestive problems, heart and liver disease, hypertension, stroke, and a weak immune system over time, according to the US Centers for Disease Control and Prevention.

There are red flags for Alzheimer’s as well. For example, if a person has one or two copies of the APOE4 gene variant, which raises your risk of developing the mind-wasting disease, drinking is not a good choice, Isaacson said.

“Alcohol has been shown to be harmful for brain outcomes in people with that risk gene — and about 25% of the US population carries one copy of APOE4,” he said.

The new study examined the medical records of people covered by the Korean National Health Insurance Service (NHIS), which provides a free health exam twice a year to insured South Koreans who are 40 and older. In addition to doing various tests, examiners asked about each person’s drinking, smoking and exercise habits.

The study looked at the data collected in 2009 and 2011 and categorized people by their self-reported drinking levels. If a person said they drank less than 15 grams (approximately 0.5 ounces) of alcohol a day, they were considered “mild” drinkers.

In the United States, a standard drink contains 14 grams of alcohol, which is roughly the same as 12 ounces of regular beer, 5 ounces of wine or 1.5 ounces of distilled spirits.

If study participants told doctors they drank 15 to 29.9 grams a day — the equivalent of two standards drinks in the US — the researchers categorized them as “moderate” drinkers. And if people said they drank over 30 grams, or three or more drinks a day, researchers considered them “heavy” drinkers.

Researchers also looked at whether people sustained or changed the amount they drank between 2009 and 2011, Jeon said.

“By measuring alcohol consumption at two time points, we were able to study the relationship between reducing, ceasing, maintaining and increasing alcohol consumption and incident dementia,” he said.

The team then compared that data to medical records in 2018 — seven or eight years later — to see if anyone studied had been diagnosed with dementia.

After adjusting for age, sex, smoking, exercise level and other demographic factors, researchers found people who said they drank at a mild level over time — about a drink a day — were 21% less likely to develop dementia than people who never drank.

People who said they continued to drink at moderate level, or about two drinks a day, were 17% less likely to develop dementia, the study found.

“One has to be cautious when interpreting studies using medical records. They can be fraught with challenges in how diseases are coded and studied,” Isaacson said. “Any anytime you ask people to recall their behaviors, such as drinking, it leaves room for memory errors.”

The positive pattern did not continue as drinking increased. People who drank heavily — three or more drinks a day — were 8% more likely to be diagnosed with dementia, the study found.

If heavy drinkers reduced their drinking over time to a moderate level, their risk of being diagnosed with Alzheimer’s fell by 12%, and the risk of all-cause dementia fell by 8%.

However, people aren’t very good at judging how much alcohol they are drinking, Isaacson said.

“People don’t really monitor their pours of wine, for example,” Isaacson said. “They may think they are drinking a standard-sized glass of wine, but it’s really a glass and a half every time. Drink two of those pours and they’ve had three glasses of wine. That’s no longer mild or moderate consumption.”

In addition, too many people who think they are moderate drinkers do all of their drinking on weekends. Binge drinking is on the rise worldwide, even among adults, studies show.

“If someone downs five drinks on Saturday and Sunday that’s 10 drinks a week so that would qualify as a moderate alcohol intake,” Isaacson said. “To me, that is not that is not the same as having a glass of wine five days a week with a meal, which slows consumption.”

The new study also found that starting to drink at a mild level was associated with a decreased risk of all-cause dementia and Alzheimer’s, “which, to our knowledge, has never been reported in previous studies,” the authors wrote.

However, “none of the existing health guidelines recommends starting alcohol drinking,” Jeon said, adding that since the study was observational, no cause and effect can be determined.

“Our findings regarding a initiation of mild alcohol consumption cannot be directly translated into clinical recommendations, thereby warranting additional studies to confirm these associations further,” Jeon said.

A study published in March 2022 found that just one pint of beer or glass of wine a day can shrink the overall volume of the brain, with the damage increasing as the number of daily drinks rises.

On average, people between 40 and 69 who drank a pint of beer or 6-ounce glass of wine per day for a month had brains that appeared two years older than those who only drank half of a beer, according to that previous study.

“I’ve never personally suggested someone to start drinking moderate amounts of alcohol if they were abstinent,” Isaacson said. “But there’s really not a one-size-fits-all approach towards counseling a patient on alcohol consumption.”

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The virus threat is easing, but US hospitals are still as full as ever | CNN

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CNN
—

At Massachusetts General Hospital in downtown Boston, the hallways of the emergency department are lined with dozens of patients waiting to get a room upstairs.

“Imagine spending days and nights in the hallway under fluorescent lights in the ER next to a trauma bay while [patients] have heart failure, kidney failure or pneumonia,” said Dr. Melissa Mattison, a physician and chief of hospital medicine at Mass General, which is a founding member of Mass General Brigham.

“Everybody’s doing their best, but where do they go to the bathroom? How do they take a shower if they want to clean up? How do they eat? There’s no privacy. It’s just, it’s awful. It’s absolutely awful.”

As of Friday, about 87% of all available hospital beds in the state are in use, and capacity strains have eased little despite a dramatic decrease in the number of people being treated for respiratory illness.

“Every day, our emergency room has a backlog of anywhere between 25 and 100 patients waiting for a bed upstairs. So if today, that number was 25, and two weeks ago, it was 100 – yes, that’s better, but there’s still a long line,” Mattison said. “Maybe the patients aren’t piled like sardines in the ER as much when you only have 35 patients waiting compared to 75. But it’s still not great.”

The winter triple threat of flu, Covid-19 and RSV is easing across the United States, and as in Massachusetts, most states are now reporting low or minimal levels of respiratory illness activity overall.

Nationwide, emergency department visits for the respiratory viruses are a third of what they were a month ago, federal data shows. Flu hospitalizations are nearly as low as they’ve been all season, since October. Hospitalizations for Covid-19 – the last of the three viruses to trend down – have been falling for the past few weeks, and just 4% of hospital beds nationwide are being used by Covid-19 patients.

That’s a dramatic shift from January 2022, when Covid-19 patients were filling most hospital beds amid the early Omicron surge. But hospitals are still about as full as they’ve ever been during the pandemic – at least three-quarters of available beds across the country were in use for all of 2022 – and that doesn’t seem likely to change any time soon.

Hospitals were facing capacity and resource challenges long before the pandemic hit, experts say, in large part because the people who are being admitted are sicker than they were before.

“It’s been a continuing trend over the last decade or so that there’s been this greater acuity of patients inside the hospitals,” said Nancy Foster, vice president for quality and patient safety with the American Hospital Association. “So what you see is this incredibly sick group of people inside of hospitals. If you’re a doctor or nurse or respiratory therapist or pharmacist or any other health professional working inside the hospital, that means it’s always a difficult puzzle you’re trying to solve to help that patient out.”

At Mass General, an emergency department boarder program – which outlines plans for how to cover patients who were waiting for a bed – was well-established years before the pandemic hit, Mattison said.

Hospitals started to report capacity data to the federal government in 2020 under a pandemic requirement, so there’s no federal data to compare to pre-pandemic years.

But Mattison was quick to say her hospital is 99% full now, like it was in 2019 and years before the pandemic. Still, she says, “how long is that waiting list, and who’s on that waiting list? That’s something that’s not reflected in that metric.”

By and large, the mix of patients in hospitals is similar to what it was pre-pandemic, said Aaron Wesolowski, vice president of policy research, analytics and strategy at the American Hospital Association.

As the share of Covid-19 patients drops, it’s perhaps “a breath less stressful” for health care providers who felt frustrated by the lack of tools available to help people as they so desperately wanted to in the early days of the pandemic, Foster said.

In fact, for most categories of care – with infectious disease as a noticeable exception – the number of people seen in inpatient and emergency department settings in 2022 was lower than it was in 2019, Wesolowski said, citing data from Strata, a health care data analytics firm.

A mix of complicating factors were exacerbated during the pandemic, experts say, straining resources more than ever.

“Length of stay is longer because people are needing more acute care. Because of work force pressures, there are not as many people who can be treated in an inpatient setting all at once,” Wesolowski said. “So both things, I think, can be true.”

Samuel Scarpino, director of AI and life sciences at Northeastern University, says it’s a “perfect storm” of issues: Covid-19 and the ongoing infection control measures that hospitals have to keep in place, a backlog of other patients with a delayed need for acute care, and work force burnout three years into a pandemic.

The biggest risk factor in the equation is still Covid-19, he says, not because a new variant will necessarily cause more hospitalizations but because the unpredictability is forcing hospitals to leave more beds open as a buffer just in case.

“The biggest risk is almost certainly the uncertainty associated with what’s coming,” said Scarpino, who was previously vice president at the Rockefeller Foundation’s Pandemic Prevention Institute.

Foster, of the American Hospital Association, says the pandemic emergency declaration has granted a number of flexibilities – such as telehealth – that have helped more patients have options for care that are outside of hospitals.

The federal government has continuously renewed the emergency declaration since January 2020, but it is likely to come to an end in May.

Without it, Foster says, hospitals would probably be even more full than they already are – particularly as alternative options for care outside of the hospital may become more limited again.

“Part of the reason we have the kind of inpatient hospital capacity that we have right now is that we do have a number of flexibilities that were granted to hospitals by [the Centers for Medicare and Medicaid Services] and other federal agencies and the states during Covid that are being used for a wide variety of patients,” she said. “If those were to disappear overnight, we would be struggling to care for the current level of patients.”

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Paging Dr. AI? What ChatGPT and artificial intelligence could mean for the future of medicine | CNN

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CNN
—

Without cracking a single textbook, without spending a day in medical school, the co-author of a preprint study correctly answered enough practice questions that it would have passed the real US Medical Licensing Examination.

But the test-taker wasn’t a member of Mensa or a medical savant; it was the artificial intelligence ChatGPT.

The tool, which was created to answer user questions in a conversational manner, has generated so much buzz that doctors and scientists are trying to determine what its limitations are – and what it could do for health and medicine.

ChatGPT, or Chat Generative Pre-trained Transformer, is a natural language-processing tool driven by artificial intelligence.

The technology, created by San Francisco-based OpenAI and launched in November, is not like a well-spoken search engine. It isn’t even connected to the internet. Rather, a human programmer feeds it a vast amount of online data that’s kept on a server.

It can answer questions even if it has never seen a particular sequence of words before, because ChatGPT’s algorithm is trained to predict what word will come up in a sentence based on the context of what comes before it. It draws on knowledge stored on its server to generate its response.

ChatGPT can also answer followup questions, admit mistakes and reject inappropriate questions, the company says. It’s free to try while its makers are testing it.

Artificial intelligence programs have been around for a while, but this one generated so much interest that medical practices, professional associations and medical journals have created task forces to see how it might be useful and to understand what limitations and ethical concerns it may bring.

Dr. Victor Tseng’s practice, Ansible Health, has set up a task force on the issue. The pulmonologist is a medical director of the California-based group and a co-author of the study in which ChatGPT demonstrated that it could probably pass the medical licensing exam.

Tseng said his colleagues started playing around with ChatGPT last year and were intrigued when it accurately diagnosed pretend patients in hypothetical scenarios.

“We were just so impressed and truly flabbergasted by the eloquence and sort of fluidity of its response that we decided that we should actually bring this into our formal evaluation process and start testing it against the benchmark for medical knowledge,” he said.

That benchmark was the three-part test that US med school graduates have to pass to be licensed to practice medicine. It’s generally considered one of the toughest of any profession because it doesn’t ask straightforward questions with answers that can easily found on the internet.

The exam tests basic science and medical knowledge and case management, but it also assesses clinical reasoning, ethics, critical thinking and problem-solving skills.

The study team used 305 publicly available test questions from the June 2022 sample exam. None of the answers or related context was indexed on Google before January 1, 2022, so they would not be a part of the information on which ChatGPT trained. The study authors removed sample questions that had visuals and graphs, and they started a new chat session for each question they asked.

Students often spend hundreds of hours preparing, and medical schools typically give them time away from class just for that purpose. ChatGPT had to do none of that prep work.

The AI performed at or near passing for all the parts of the exam without any specialized training, showing “a high level of concordance and insight in its explanations,” the study says.

Tseng was impressed.

“There’s a lot of red herrings,” he said. “Googling or trying to even intuitively figure out with an open-book approach is very difficult. It might take hours to answer one question that way. But ChatGPT was able to give an accurate answer about 60% of the time with cogent explanations within five seconds.”

Dr. Alex Mechaber, vice president of the US Medical Licensing Examination at the National Board of Medical Examiners, said ChatGPT’s passing results didn’t surprise him.

“The input material is really largely representative of medical knowledge and the type of multiple-choice questions which AI is most likely to be successful with,” he said.

Mechaber said the board is also testing ChatGPT with the exam. The members are especially interested in the answers the technology got wrong, and they want to understand why.

“I think this technology is really exciting,” he said. “We were also pretty aware and vigilant about the risks that large language models bring in terms of the potential for misinformation, and also potentially having harmful stereotypes and bias.”

He believes that there is potential with the technology.

“I think it’s going to get better and better, and we are excited and want to figure out how do we embrace it and use it in the right ways,” he said.

Already, ChatGPT has entered the discussion around research and publishing.

The results of the medical licensing exam study were even written up with the help of ChatGPT. The technology was originally listed as a co-author of the draft, but Tseng says that when the study is published, ChatGPT will not be listed as an author because it would be a distraction.

Last month, the journal Nature created guidelines that said no such program could be credited as an author because “any attribution of authorship carries with it accountability for the work, and AI tools cannot take such responsibility.”

But an article published Thursday in the journal Radiology was written almost entirely by ChatGPT. It was asked whether it could replace a human medical writer, and the program listed many of its possible uses, including writing study reports, creating documents that patients will read and translating medical information into a variety of languages.

Still, it does have some limitations.

“I think it definitely is going to help, but everything in AI needs guardrails,” said Dr. Linda Moy, the editor of Radiology and a professor of radiology at the NYU Grossman School of Medicine.

She said ChatGPT’s article was pretty accurate, but it made up some references.

One of Moy’s other concerns is that the AI could fabricate data. It’s only as good as the information it’s fed, and with so much inaccurate information available online about things like Covid-19 vaccines, it could use that to generate inaccurate results.

Moy’s colleague Artie Shen, a graduating Ph.D. candidate at NYU’s Center for Data Science, is exploring ChatGPT’s potential as a kind of translator for other AI programs for medical imaging analysis. For years, scientists have studied AI programs from startups and larger operations, like Google, that can recognize complex patterns in imaging data. The hope is that these could provide quantitative assessments that could potentially uncover diseases, possibly more effectively than the human eye.

“AI can give you a very accurate diagnosis, but they will never tell you how they reach this diagnosis,” Shen said. He believes that ChatGPT could work with the other programs to capture its rationale and observations.

“If they can talk, it has the potential to enable those systems to convey their knowledge in the same way as an experienced radiologist,” he said.

Tseng said he ultimately thinks ChatGPT can enhance medical practice in much the same way online medical information has both empowered patients and forced doctors to become better communicators, because they now have to provide insight around what patients read online.

ChatGPT won’t replace doctors. Tseng’s group will continue to test it to learn why it creates certain errors and what other ethical parameters need to be put in place before using it for real. But Tseng thinks it could make the medical profession more accessible. For example, a doctor could ask ChatGPT to simplify complicated medical jargon into language that someone with a seventh-grade education could understand.

“AI is here. The doors are open,” Tseng said. “My fundamental hope is, it will actually make me and make us as physicians and providers better.”

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Pathological lying could finally be getting attention as a mental disorder | CNN

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CNN
—

When Timothy Levine set out to write a book about deception in 2016, he wanted to include a chapter on one of its most extreme forms: pathological lying.

“I just couldn’t find any good research base on this,” said Levine, chair of the Department of Communication Studies at the University of Alabama at Birmingham.

Now, it seems it’s the only thing anyone wants to talk to him about.

“Santos has brought more reporters to me in the last couple of weeks than probably in the last year,” Levine said.

Santos, of course, is US Rep. George Santos, a Republican from Long Island who was recently elected to represent New York’s third congressional district.

In the months since his election, key claims from Santos’ biography – including where he earned his college degree, his employment at Citigroup and Goldman Sachs, an animal rescue group he says he founded and his Jewish religious affiliation – have withered under the scrutiny of reporters and fact-checkers. Now, he says, he doesn’t have a college degree; he wasn’t employed by Citigroup or Goldman Sachs; and the IRS has no record of his animal rescue group. He also says he never claimed to be Jewish, but rather he was “Jew-ish.”

Santos defended himself in media interviews in December, saying that the discrepancies were the result of résumé padding and poor word choices but that he was not a criminal or a fraud.

It’s not clear what is driving Santos’ statements.

But the story has given professionals who study lying in its most extreme forms a rare moment to raise awareness about lying as a mental disorder – one they say has been largely neglected by doctors and therapists.

“It is rare to find a public figure who lies so frequently in such verifiable ways,” says Christian Hart, a psychologist who directs the Human Deception Laboratory at Texas Woman’s University.

Psychiatrists have recognized pathological lying as a mental affliction since the late 1800s, yet experts say it has never been given serious attention, funding or real study. It doesn’t have its own diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the bible of psychiatry. Instead, it is recognized as a feature of other diagnoses, like personality disorders.

As a result, there’s no evidence-based way to treat it, even though many pathological liars say they want help to stop.

The standard approach to treating lying relies on techniques borrowed from cognitive behavioral therapy, which emphasizes understanding and changing thinking patterns. But no one is sure that this is the most effective way to help.

We don’t know necessarily what’s the most effective treatment,” said Drew Curtis, an associate professor of psychology at Angelo State University in Texas who studies pathological lying.

Curtis had someone offer to drive across the country to see him for treatment, which he says he wasn’t able to offer.

“So that’s the heartbreaking side of it for me, as a clinician: people that are wanting to help and can’t have the help,” Curtis said.

Longtime collaborators Curtis and Hart recently published a study laying out evidence to support the inclusion of pathological lying as a standalone diagnosis in the DSM.

Over the years, Hart said, almost 20 people have proposed definitions of pathological lying, but there’s very little overlap between them: “The only truly common feature is that these people lie a lot.”

The first thing to know about pathological or compulsive lying is that it is rare, Levine says. His studies show that most people tell the truth most of the time.

“These really prolific liars are pretty unusual,” said Levine, whose book about deception, “Duped,” was published in 2019.

Which isn’t to say that lying isn’t common. Most people lie sometimes, even daily. In his studies, people lied up to twice a day, on average.

Levine himself regularly lies at the grocery store when workers ask whether he found everything he was looking for. Since the Covid-19 pandemic began, that answer is almost always no, but he says yes anyway.

One of his students worked in a retail clothing store and regularly lied to people who were trying on clothes. Another – a receptionist – lied to cover for a doctor who was always running late.

That’s all pretty normal, Levine said. He believes that honesty is our default mode of communication simply because people have to be honest with each other to work effectively in big groups, something humans do uniquely well in the animal kingdom.

But sticking to the facts isn’t easy for everyone.

In their studies, Hart and Curtis have found that most people tell an average of about one lie a day. That’s pretty normal. Then there are people who lie a lot: about 10 lies a day, on average.

Hart and Curtis call prolific or especially consequential liars – someone like Bernie Madoff, who dupes and defrauds investors, for example – “Big Liars,” which is also the title of their recent book.

Big lying is pretty unusual. Pathological lying is even more rare than that.

Hart thinks he’s only ever interacted with two people that met the classical case study description of pathological lying.

“It was dizzying,” Hart says.

When people start to lie so much that they can’t stop or that it begins to hurt them or people around them, that’s when it becomes abnormal and may need treatment.

“It’s more the clinical category of people who tell excessive amounts of lies that impairs their functioning, causes distress, and poses some risk to themselves or others,” Curtis said, sharing the working definition of pathological lying that he and Hart hope will eventually be included in the DSM.

“What we found, examining all the cases, is that the lying appears to be somewhat compulsive,” Hart said. “That is, they’re lying in situations when a reasonable person probably wouldn’t lie, and it seems like even to their own detriment in many cases.

“It tends to cause dysfunction in their lives,” Hart said, including social, relationship and employment problems.

On some level, pathological liars know they’re lying. When confronted with their lies, they’ll typically admit to their dishonesty.

Lying can also be a feature of other disorders, but Hart says that when they assessed people who met the criteria for pathological lying, they found something interesting.

“It turned out that the majority of them don’t have another psychological disorder. And so it seems like lying is their principal problem,” he said, lending weight to the idea that it deserves to be its own diagnosis.

The American Psychiatric Association, or APA, publishes the DSM and regularly reviews proposals for new diagnoses. Curtis says he has been gathering evidence and is in the process of filling out the paperwork the APA requires to consider whether pathological lying should be a new diagnosis.

As for whether certain professions seem to attract people who lie more than average, Hart says that’s a complicated question.

It’s not that people who lie a lot tend to gravitate to certain jobs. Rather, certain jobs – like sales, for example – probably reward the ability to lie smoothly, and so these professions may be more likely to have a higher concentration of people who lie more than average.

“The evidence we have suggests that politicians aren’t by their nature any more dishonest than the typical person,” Hart said. “However, when people go into politics, there’s pretty good evidence that the most successful politicians are the ones that are more willing to bend the truth” and so they may be the ones more likely to be re-elected.

Only time will tell, how the situation may play out for Santos.

So far, he has resisted calls to step down, saying he intends to serve his term in Congress. This week, though, Santos announced he would step down from any committee assignments while the investigations are ongoing.

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The 4-7-8 method that could help you sleep | CNN

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Editor’s Note: Sign up for the Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.

CNN
—

Falling asleep or coming down from anxiety might never be as easy as 1-2-3, but some experts believe a different set of numbers – 4-7-8 – comes much closer to doing the trick.

The 4-7-8 technique is a relaxation exercise that involves breathing in for four counts, holding that breath for seven counts and exhaling for eight counts, said Dr. Raj Dasgupta, a clinical associate professor of medicine at the University of Southern California’s Keck School of Medicine, via email.

Also known as the “relaxing breath,” 4-7-8 has ancient roots in pranayama, which is the yogic practice of breath regulation, but was popularized by integrative medicine specialist Dr. Andrew Weil in 2015.

“What a lot of sleep difficulties are all about is people who struggle to fall asleep because their mind is buzzing,” said Rebecca Robbins, an instructor in medicine at Harvard Medical School and associate scientist in the division of sleep and circadian disorders at Brigham and Women’s Hospital in Boston. “But exercises like the 4-7-8 technique give you the opportunity to practice being at peace. And that’s exactly what we need to do before we go to bed.”

“It does not ‘put you to sleep,’ but rather it may reduce anxiety to increase likelihood of falling asleep,” said Joshua Tal, a New York state-based clinical psychologist.

READ MORE: Sign up for CNN’s Adulthood, But Better newsletter series. Our seven-part guide wil help you make more informed decisions around personal finance, career, wellness and personal connections.

The 4-7-8 method doesn’t require any equipment or specific setting, but when you’re initially learning the exercise, you should sit with your back straight, according to Weil. Practicing in a calm, quiet place could help, said Robbins. Once you get the hang of it, you can use the technique while lying in bed.

During the entire practice, place the tip of your tongue against the ridge of tissue behind your upper front teeth, as you’ll be exhaling through your mouth around your tongue. Then follow these steps, according to Weil:

Completely exhale through your mouth, making a whoosh sound.
Close your mouth and quietly inhale through your nose to a mental count of four.
Hold your breath for a count of seven.
Exhale through your mouth, making a whoosh sound for a count of eight.
Repeat the process three more times for a total of four breath cycles.

Keeping to the ratio of four, then seven and then eight counts is more important than the time you spend on each phase, according to Weil.

“If you have trouble holding your breath, speed the exercise up but keep the ratio (consistent) for the three phases. With practice you can slow it all down and get used to inhaling and exhaling more and more deeply,” his website advised.

When you’re stressed out, your sympathetic nervous system – responsible for your fight-or-flight response – is overly active, which makes you feel overstimulated and not ready to relax and transition into sleep, Dasgupta said. “An active sympathetic nervous system can cause a fast heart rate as well as rapid and shallow breathing.”

The 4-7-8 breathing practice can help activate your parasympathetic nervous system – responsible for resting and digesting – which reduces sympathetic activity, he added, putting the body in a state more conducive to restful sleep. Activating the parasympathetic system also gives an anxious brain something to focus on besides “why am I not sleeping?” Tal said.

While proponents may swear by the method, more research is needed to establish clearer links between 4-7-8 and sleep and other health benefits, he added.

“There is some evidence that 4-7-8 breathing helps reduce anxious, depressive and insomniac symptoms when comparing pre- and post-intervention, however, there are no large randomized control trials specifically on 4-7-8 breathing to my knowledge,” Tal said. “The research on (the effect of) diaphragmatic breathing on these symptoms in general is spotty, with no clear connection due to the poor quality of the studies.”

A team of researchers based in Thailand studied the immediate effects of 4-7-8 breathing on heart rate and blood pressure among 43 healthy young adults. After participants had these health factors and their fasting blood glucose measured, they performed 4-7-8 breathing for six cycles per set for three sets, interspersed with one minute of normal breathing between each set. Researchers found the technique improved participants’ heart rate and blood pressure, according to a study published in July 2022.

When researchers have observed the effects of breathing techniques like 4-7-8 breathing, they have seen an increase in theta and delta brain waves, which indicate someone is in the parasympathetic state, Robbins said. “Slow breathing like the 4-7-8 technique reduces the risk of cardiovascular disease and type 2 diabetes and improves pulmonary function.”

The 4-7-8 technique is relatively safe, but if you’re a beginner, you could feel a little lightheaded at first, Dasgupta said.

“Normal breathing is a balance between breathing in oxygen and breathing out carbon dioxide. When you upset this balance by exhaling more than you inhale, (it) causes a rapid reduction in carbon dioxide in the body,” he said. “Low carbon dioxide levels lead to narrowing of the blood vessels that supply blood to the brain. This reduction in blood supply to the brain leads to symptoms like lightheadedness. This is why it is often recommended to start slowly and practice three to four cycles at a time until you are comfortable with the technique.”

The more you practice the 4-7-8 technique, the better you’ll become, and the more your body and mind will incorporate it into your usual roster of tools for managing stress and anxiety, Dasgupta said. Some people combine this method with other relaxation practices such as progressive muscle relaxation, yoga, mindfulness or meditation.

Unmanaged stress can rear its head in the form of sleep difficulties, Robbins said. “But when we can manage our stress over the course of the day (and) implement some of these breathing techniques, we can put ourselves in the driver’s seat instead of being victim to events that happen in our lives.”

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‘Groundhog Day’ movie: The Buddhist lifehacker film | CNN

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CNN
—

“It’s not true that life is one damn thing after another – it’s one damn thing over and over.” – Edna St. Vincent Millay

I’ve seen the 1993 film “Groundhog Day” again and again and again, but only once on the big screen, a few years after it was in theaters. It was shown in a packed lecture hall inside Baltimore’s Walters Art Museum, followed by a lecture from a comparative religion scholar who took us through the spiritual meaning and symbolism cleverly packaged in what, on its surface, is a rom-com with a “Twilight Zone” premise.

Even if you haven’t seen the film you still know the basic plot because the term “Groundhog Day” has entered the common vernacular – which alone speaks to its resonance beyond the film itself – as shorthand for repeating the same experience over and over.

But it’s worth seeing, for the first time or the tenth, to witness self-centered weatherman Phil Connors (a role only Bill Murray could master) breaking that cycle through personal redemption. It’s a grand metaphor some scholars see as Buddhist, Christian or secularly philosophical. It’s also directly, practically applicable to how you spend your day today, and everyday.

I think the film is best described as “Buddish,” an adjective coined by the film’s director, Harold Ramis, to sum up his own belief system. His mother-in-law and one of his best friends were devout Zen Buddhists who hooked him onto its precepts. “Memorable, simple, didn’t require articles of faith, but completely humanistic in every way that I valued,” he said in an interview for Chicago magazine in 2008. “So I proselytize it without practicing it.”

And what an entertaining Buddish proselytization “Groundhog Day” is. Like sushi or a Jamba Juice shake, it’s so delicious you barely realize you’re eating raw fish and fruit. That’s the reason for this metaphysical movie’s enduring cult status: a genuinely hilarious film that glimpses the meaning of life.

There are many theories about Phil’s temporal loop (which by one estimate lasted nearly 34 years) and his eventual escape. One sees it as a metaphor for psychotherapy: repeating the stories of one’s past until you have a breakthrough that allows you to dismantle old patterns. Another claims it illustrates a classic economic paradigm.

But the most wisdom-invoking evidence amounts to religious insight and how to most fruitfully spend our precious hours.

One of the central tenets of Buddhism is that we must continue to reincarnate until we find enlightenment. The concept, called samsara, keeps us living out many lives through “various modes of existence” (called gati), some lowly animals and others god-like, as determined by your actions (karma). Once ignorance and ego are destroyed by your actions and awareness, you awaken to the true, interconnected reality, which frees you from the cycle and into heavenly nirvana.

In the film – written by Danny Rubin, a Zen Buddhist, according to Ramis’ DVD commentary of the film – Phil reincarnates each day, but he also transforms his behavior over “time.” He takes self-centered advantage of his unique predicament – robbing bank trucks, stuffing his face with angel food cake, tricking a woman into bed – but eventually perfects the day with creative self-improvement tasks and compassionately helping others. Once he becomes the best possible version of Phil Connors, he is released from his temporal prison, while simultaneously winning the love of his virtuous producer, Rita.

Phil’s plight is not unlike a character from Greek mythology who was doomed to eternally and perpetually push a boulder up a mountain. In his essay “The Myth of Sisyphus,” Albert Camus uses the story to illustrate the absurdity of lives that toil away at meaningless jobs. But Camus says we must find hope, and therefore meaning, in such a plight and he imagines Sisyphus understanding and accepting it.

There’s a similar Buddhist tale of an enlightened monk who climbs a mountain to get a spoonful of snow in order to fill a well at the bottom of the mountain, again and again. Some lessons take a long and seemingly futile amount of time to learn. Buddhist monasticism is itself “Groundhog”-like with the same routine, clothes and daily rituals – for decades of practice.

Yet every moment is still different. Remember what the ancient Greek philosopher Heraclitus said: “No man ever steps in the same river twice, for it’s not the same river and he’s not the same man.” In that sense, Phil doesn’t repeat the same day over and over because one significant thing is different each Groundhog Day: him. He is the one thing that is changing.

What is time anyway? Illusory, says Buddhist dogma, a notion contained in the Zen koan Phil asks as he begins to understand that his own time is not progressing: “What if there is no tomorrow? There wasn’t one today.”

That’s right, woodchuck-chuckers, there is no past or future. There is only now.

The Catholic concept of purgatory, a spiritual realm where souls must linger until they expiate their remaining sins and earn their way into heaven, fits the film’s bill as much as the Buddhist concept samsara. And many references and motifs that recur in the film support the notion that “Groundhog Day” is Christian rather than Buddhist. “These sticky buns are heaven.” “When you stand in the snow you look like an angel.” The groundhog hibernation – rebirth after a death of sorts, and emerging from the sleepy tomb – is reminiscent of Jesus.

There’s even a delightfully blasphemous scene in which Phil declares that he is a god. “I’m not the God … I don’t think,” he wonders aloud as he contemplates how close he comes to the Catholic conception of monotheism. “Maybe he’s not omnipotent. He’s just been around so long he knows everything.” This after he has shouted, like an angry deity, “I make the weather!”

Then there’s the film’s montage with a homeless man whom Phil brushes off early on, patting his pants pockets like he doesn’t have any cash. Later Phil tries to help repeatedly, only to find the man dies every time. It’s the lesson of the Serenity Prayer, written by the theologian Reinhold Niebuhr and later co-opted by Alcoholics Anonymous:

God, grant me the serenity to accept the things I cannot change,

The courage to change the things I can,

And the wisdom to know the difference.

After accepting that he cannot save the old man, Phil turns an optimistic and meaningful corner in the plot and begins living in service to others (catching a falling boy from a tree, saving the mayor from choking etc). It’s this change of direction that allows him to escape purgatory.

Whatever spiritual takeaway the film holds for you, it’s an undeniable call for hope. Phil survives his many attempts at suicide – leaping from a church, dropping a toaster in the tub, driving off a cliff – and is reborn a hopeful, charitable man. Baptized by death and stronger for it on the other side, he tells his television audience: “When Chekhov saw the long winter, he saw a winter bleak and dark and bereft of hope. Yet we know that winter is just another step in the cycle of life.”

Winter is such a great metaphor for the bleakness that precedes rebirth. “I’ll give you a winter prediction,” the weatherman reports in the “hopeless” second act of the film. “It’s gonna be cold, it’s gonna be gray, and it’s gonna last you for the rest of your life.”

But in a more optimistic stage he wakes up one happy morning and surprises a stranger with a hug and a Samuel Coleridge quote: “Winter, slumbering in the open air, wears on its smiling face a dream…of spring.” It’s from the sonnet “Work Without Hope” which contains the famous line “bloom for whom ye may,” which Phil does.

This is the classic hero’s journey. Phil is exiled into an unexpected adventure, despairs, suffers losses, but eventually learns how to overcome his obstacles and hopelessness. By the end of the film, he has managed to become the town hero for all the mitzvah he crams into a single day.

You don’t have to subscribe to Buddhism or Christianity or believe in reincarnation or heaven for this story to be directly applicable to your daily life.

“What would you do if you were stuck in one place and every day was exactly the same, and nothing that you did mattered?” Phil asks a townie, Ralph, in the film.

“That about sums it up for me,” says Ralph.

And who doesn’t relate, at one time or another, for one day, or many years, to that sentiment. It’s Thoreau’s “life of quiet desperation.” It’s Sisyphus. It’s George Bailey pre-epiphany in “It’s a Wonderful Life.”

“I think people place too much emphasis on their careers,” Phil says to Rita. “I wish we could all live in the mountains, at high altitude. That’s where I see myself in five years. How about you?” This sentiment echoes an earlier role in Murray’s career as Larry Darrell in the movie, based on the novel by W. Somerset Maugham, “The Razor’s Edge.” Darrell takes a pilgrimage to find enlightenment with Tibetan monks high in the Himalayas where he observes that, “It’s easy to be a holy man on top of a mountain.”

The rest of us are down here in the valley, where it’s harder. Each day is not that different than the last. We’re on autopilot sometimes. We’re bored. We repeat our bad habits. We are often self-centered and usually under-inspired.

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But something does change every day, even if it’s imperceptible. It’s ourselves. And we can choose how this day will unfold, and how we will slowly evolve. There might even be a “Groundhog Day”-inspired resolution: memorizing French poetry, playing the piano, figuring out how to help others more often. Like Phil, we can utilize creativity and compassion to change a glass-is-half-empty paradigm, to half full. The pursuit of meaning is itself meaningful. And today, as well as everyday, can be your first day of spring.

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