What to Watch Out For on the Next Leg of Taylor Swift’s Eras Tour

Taylor Swift is back by popular demand. The North American leg of her historically popular Eras Tour ended alongside the summer: Her last tour date was Aug. 27 in Mexico City. After a little break, she’s starting up again on Nov. 9, this time in South America, starting in Buenos Aires.

There, roughly 240 fans have been systematically taking turns camping out in four tents outside of the Estadio River Plate, some since June. According to Pitchfork, an internal spreadsheet keeps track of how many hours individuals have spent in a tent, which raises the chances of being one of the first fans in line.

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In June, the group’s rules leaked online and went viral. They contain such requirements as: No one under 18 is allowed, two people minimum and three people maximum per night, and you must spend at least one night per month in the tent. Some Swifties even offer to log hours in the tent on behalf of people in other provinces who can’t be there in person—for a price.

Filtraron la lista de requisitos para estar en las capas que esperan a Taylor Swift
Ni para laburar te piden tanto 💀☠️☠️ pic.twitter.com/4BwofjZa73

— ElBuni (@therealbuni) June 8, 2023

Where the record-breaking Eras Tour is headed next

After her trio of sold-out shows in Buenos Aires, Swift will perform from Nov. 17-19 at the Estádio Olímpico Nilton Santos in Rio de Janeiro and from Nov. 24-26 at Allianz Parque in São Paulo. After a winter break, February will take her to Tokyo, Melbourne, and Sydney, while March will see her in Singapore. 

Summer 2024 will see Swift take the Eras Tour through Europe, including stops in Paris, Stockholm, Lisbon, Dublin, and London. A second North American leg will begin next October, in Toronto. 

The Eras Tour has become known for Swift revealing “surprise songs.” At each show, she sings  two surprise acoustic versions of often lesser-known tracks. Of roughly 161 options, Swift has played 106 songs. That’s 17 from Red (Taylor’s Version), 15 from Speak Now (Taylor’s Version), 14 from Fearless (Taylor’s Version), 10 from Taylor Swift, 11 from 1989, 9 from Midnights, 7 from evermore, 9 from Lover, 6 from folklore, and 7 from Reputation. 

The next leg of the tour will likely see Swift perform some of the more than 50 songs on the list. And at the last show on the first U.S. leg of her tour, Swift announced that she would be releasing the re-recorded “Taylor’s Version” of 1989, so the new songs “from the vault,” that almost made the original cut and are now available, are eligible as surprise tracks.

Read More: The Staggering Economic Impact of Taylor Swift’s Eras Tour

After 56 shows each, Swift has surpassed Beyoncé as having the highest-grossing concert tour by a woman. The former has grossed $780 million so far, while the latter grossed $579.8 million. Taylor Swift: The Eras Tour movie, which came out on Oct. 13, smashed records, making more than $230 million worldwide.

And Travis Kelce—a Kansas City Chiefs tight end and Swift’s new beau—may or may not be coming along to South America with her. Kelce alluded to potentially heading “somewhere sunny” for the weekend on New Heights with Jason and Travis Kelce, his podcast with his brother, a center for the Philadelphia Eagles.

source https://time.com/6333509/taylor-swift-eras-tour-cities-songs/

Fargo Season 5 Is a Sharp, Darkly Hilarious Return to Form

Minnesota homemaker Dot Lyon (Juno Temple) has a nice, quiet life. Her husband (David Rysdahl) worships her. Their preteen daughter (Sienna King) is Dot’s whole world. The only apparent obstacle to her happiness is a haughty mother-in-law (Jennifer Jason Leigh), who happens to own America’s largest debt collection agency—and is convinced that Dot’s motives for marrying her boy were less than pure. Then one day, a pair of thugs show up at the Lyons’ doorstep to drag Dot back to a painful past that she never disclosed to her family. She doesn’t go quietly.

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So begins the fifth season of FX’s Coen Brothers-inspired crime anthology Fargo, premiering Nov. 21. As a follow-up to Season 4’s ambitious yet cluttered, 1950s-set exploration of American identity, which aired in 2020, it’s a tighter, funnier, but equally dark return to form for creator Noah Hawley. This time, gender and class are the battlefields on which the show’s eternal war of good vs. evil are fought.

Set in the portentous, pre-pandemic and pre-Jan. 6 autumn of 2019, the season is crawling with law-enforcement types connected to Dot’s case who become avatars for different visions of justice. Fargo’s stalwart good cops include a pragmatic officer from Minnesota (Richa Moorjani) and her fairness-obsessed North Dakota counterpart (Lamorne Morris). A stiff pair of FBI agents worship at the altar of rules. Best—and worst—of all, Jon Hamm plays the pompous, violent, virulently misogynistic “constitutional sheriff” Roy Tillman, whose certainty that he has the authority to mete out divine justice allows him to run his squad like his own personal mafia.

Along with a wonderfully deranged soundtrack (Nightmare Before Christmas fans, prepare yourselves for Easter eggs galore) and reliably gorgeous cinematography, this smartly cast menagerie of oddballs makes Fargo a pleasure to watch. Ted Lasso alum Temple’s signature effervescence conceals a steely tenacity. Leigh drips cynicism and condescension, and has her own convenient theories on justice. The police, she explains to one officer, exist “to separate those who have money, class, intellect from those who don’t.” Hamm is her perfect foil, all macho bluster. He gets some of the most audaciously baroque dialogue in the series’ history—which is saying a lot—and never squanders a line. Approached by colleagues as he bathes in a capacious outdoor bathtub, Roy drawls: “Does my discussing matters of state in moist repose bother you?”

If you’re looking for contemporary political resonance, you’ll surely find it in the inevitable negotiations between Leigh’s billionaire girlboss elitist and Hamm’s Bible-thumping, he-man populist over the fate of one poor, desperate woman. But, as the spookily ageless self-described nihilist in a kilt (Sam Spruell) lurking at the story’s margins suggests, this is a parable, not a hot take. In bringing so many mutually exclusive perspectives to bear on Dot’s traditionally male quest to defend herself and her family, Hawley has more elemental questions in mind.

source https://time.com/6333438/fargo-season-5-review/

Robbie Williams Confronts His Darkest Moments in New Netflix Documentary

It’s hard to overstate the influence of pop star Robbie Williams at the height of his career. He dominated British music charts and tabloids—proving to be the ultimate entertainer both on and off the stage. Having left school without any qualifications, Williams was just 16-years-old in 1990 when he landed a spot in Take That, which went on to become one of the U.K.’s most successful boy bands. Fans were devastated when Williams left the group in 1995, after his bandmates and management took issue with his partying habits. They were even more bereft a year later, when the remaining four members of Take That announced the band was splitting. (The Samaritans set up a special helpline for the distraught fanbase, largely made up of teenage girls.) The phenomenon of Take That was arguably the 90s’ version of Beatlemania. The fans were “obsessive,” Williams notes.

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While the public fully expected Take That’s lead singer and songwriter Gary Barlow to become the breakout star after the band broke up, it was Williams who took center stage as a solo artist, thanks to his game-changing 1997 track “Angels.” The song elevated his career, cementing his front-man status and introducing him to a global audience (though his international appeal never quite took off in the United States). Williams was considered by many to be the bad boy of pop. A firm fixture in the tabloids, he was often pictured leaving parties in a bleary-eyed state. He had high-profile relationships with All Saints singer Nicole Appleton, who went on to marry Oasis’ Liam Gallagher, and Spice Girls’ Geri Halliwell. However, behind all of the hit singles, headlines, and bravado, Williams was struggling to find a sense of peace and purpose. Plagued by self-doubt, the former boybander battled addiction and depression.

Williams’ highest highs and lowest lows come into focus in the new Netflix documentary series Robbie Williams. Out Nov. 8, the series features the pop star taking viewers through his memories of his time in the spotlight. 

The four-part series, shot in 2022, takes us to Williams’ palatial Los Angeles home that he shares with his wife Ayda and their four children, who he heralds as being his saving grace. Aside from a few scenes where he’s pictured walking the grounds of his idyllic mansion in a Gucci cardigan, the singer spends the majority of the time lying in bed with his laptop, wearing a black vest top and briefs. “If I’m not on stage, I’m in bed,” Williams says, explaining the unorthodox location to director Joe Pearlman, the man behind other hit music documentaries such as Lewis Capaldi: How I’m Feeling Now. Williams watches behind-the-scenes footage and video blogs from his decades-long career, often grimacing as he’s confronted with moments he’s long sought to forget.

The “Let Me Entertain You” singer’s duality is prevalent throughout the documentary. He’s renowned for being an extrovert, yet admits he is “instinctively a loner.” He is often completely unguarded about his vulnerabilities. Reflecting on the era where his addiction to drugs and alcohol worsened, he reveals “there was a sense of… it would be best if I sort of passed away.” At other times, in the old footage especially, he comes off as arrogant and detached from reality. We witness Williams grapple with a desire to be “normal,” while acknowledging that he hasn’t truly lived a “normal” life since he was 16. “Nobody graduates from childhood fame well balanced,” the musician reasons. 

Williams’ most conflicting relationships—with Take That, the British press, and with himself—form the crux of the story. Here’s what the documentary reveals about the most impactful relationships in his life and career.

Take That

In footage from the early ‘90s, Williams can be seen as an energetic teenager dancing alongside his bandmates. But the cracks soon started to show, as Williams rebelled against the polished image that had been created to represent the band. He also started to clash with lead singer Gary Barlow, who he felt was prioritized by the band’s management. Largely fueled by Williams, the rivalry went on for years. The singer often called out his former bandmate on stage and in interviews, sometimes going so far as to issue cruel jibes about Barlow’s appearance. In one moment of the documentary series, Williams looks back at footage from the ‘90s, as his daughter Teddy (born Theodora) makes one of her welcome interruptions. With the bluntness only a child can get away with, she quizzes her dad about his feelings on Take That, asking: “Who did you hate the most and why?” Without much hesitation, William admits: “I disliked Gary the most… I wanted to make him pay by having the career he was supposed to have.” He later confesses to feeling regret over how he treated Barlow during those years.

After reuniting in 2005, Take That pulled off an impressive comeback, topping the British charts once more and enjoying a critically-acclaimed tour. Williams, then at a low-point in his professional career, watched from afar. Although his memories from his early years in Take That had been “sullied” by how unhappy he was behind the scenes, he later yearned for that sense of brotherhood on stage. In 2009, when Williams battled with his mental health and low confidence as he attempted to make a solo comeback, he turned to his old bandmates. He rejoined the group for an album and a tour in 2010, before leaving once again in 2014. It was a full-circle moment for the singer, who had spent years actively separating himself from the “ex-boybander” label.

Guy Chambers

Take That’s split is not the only band break-up Williams encountered in his career. When the singer was struggling to find his solo voice in the industry, he teamed up with Guy Chambers, who became his musical director and co-writer. He refers to Chambers as one half of the “Robbie Williams band.” It’s easy to view Chambers as the Bernie Taupin to Williams’ Elton John. The duo collaborated on all of Williams’ biggest hits, including “Angels,” “Rock DJ,” “Millennium,” and “Let Me Entertain You.” Chambers features in much of the footage that Williams revisits in his documentary. Their friendship and brotherhood transcended beyond the studio, as we witness them traveling the world together. In Episode 2, during a prominent video filmed in 2000, the duo are seen enjoying a holiday in the South of France with their respective partners. Chambers is with his wife Emma, and Williams is with former Spice Girls member Geri Halliwell. Although we’ve already watched a whole episode’s worth of footage at this point, Williams admits that this holiday is the first time we’ve seen him truly happy.

But their harmonious bond fractured over time, and by 2002, Williams had decided that there was no longer a professional future for him and Chambers. “I needed full control, as much as possible,” he says, reflecting on his decision to cut Chambers from any future albums. “I was done with him.” Williams is cut-throat about the union ending, in an attitude that mirrors his reaction to his split from Take That and makes you wonder if, back then, he viewed people as disposable. It’s another instance of Williams’ dual nature, as he cherished the brotherly bond he shared with Chambers, yet desperately sought to prove that he could go it entirely alone.

The British press

Williams’ fractured, career-defining relationship with the British media is explored throughout the documentary. The invasive nature of the paparazzi, in particular, grated on Williams. Recalling his “confusing relationship” with Geri Halliwell, he says the intrusive nature of the press and the heightened interest in their union had a detrimental impact. Williams recalls being bewildered by how the paparazzi always managed to find them, noting that he was once informed by a photographer that Halliwell was orchestrating the paparazzi shots herself. Although Williams now says he doesn’t believe that to be true, he did at the time, and it wasn’t long before he and Halliwell parted ways.

“Robbie Williams is a crime against music” and “Robbie’s a loser” are just some of the brutal headlines revisited in the documentary. Among the historical footage, the singer can be seen phoning British tabloid newspaper The Sun to confront them over a “Stroppy Williams” story they had published. The singer’s push-and-pull relationship with the press reached its height in 2006, when he was lambasted for releasing a rap song, “Rudebox.” The change in direction was not well received, and Williams believes the British press’ poor reaction to the song negatively impacted the public and, in turn, his record sales.

In 1999, Williams tried to “break America” but was unsuccessful in his efforts. His “cheeky” British humor and his tendency to flash his bum on stage didn’t translate well with American audiences. At the time, this was a devastating loss to the record company who had invested so much in Williams’ attempt at success across the Atlantic. But Williams was later grateful for remaining a relative unknown in the U.S., reveling in regaining his anonymity when he moved to Los Angeles in the early 00s. Williams recalls being filled with a sense of dread when he returned to the U.K. on tour. “It represents hatred and a lack of safety,” he says. “I am divorced from the land that was once mine and I’m deeply, deeply affected by it.”

In spite of all this, Williams still craved the acceptance and approval of the British press. In footage from his 2009 comeback, he excitedly tells the camera that an article about his return to music is “number two on the BBC’s most read” stories. The media’s acceptance, and fame in general, appears to be another drug that Williams struggled to resist.

Addiction and mental health

Williams had a long and hard road battling addiction before getting sober during an ultimatum trip to rehab in 2007, organized by his increasingly concerned management who had witnessed him relapsing. “I’m a want monster, I want everything,” Williams states, before reeling off the drugs he used to indulge in or, as he calls them, his “greatest hits.” The singer’s addictions initially took a strong hold over him when he was 19. Newly divorced from Take That, Williams admits to “ingesting everything I could get my hands on.” As he jostled with the trauma brought about by transitioning from boyhood to manhood in front of the public’s glare, he soon came to rely on drugs and alcohol as a crutch. 

In one enlightening moment, the singer recognises that the attributes that made him an addict are the same ones that made him a renowned showman. His “let’s see how far we can take this” attitude had both a positive and negative impact on his life and career.

Having been diagnosed with depression in his early 20s, Williams went on to experience what he describes as a “nervous, mental breakdown.” Although he was considered to be a cheeky chappy in the press, the musician struggled with depressive episodes which, at the height of his troubles, impacted his ability to perform, preventing him from doing the thing he believes he was born to do.

The man in the mirror

The experience of watching the Netflix documentary means seeing Williams get in his own way time and time again, a cycle revealed to be something only he could break. While the singer voices the impact of the press’ brutal criticism, it soon becomes apparent that Williams’ biggest critic is himself. Early on in the documentary, he alludes to his disordered eating. Reflecting on his first trip to rehab as a young twenty-something, Williams says the experience became more of a “weight loss camp” for him, admitting he was only eating a banana a day at the time. His body image issues are not directly brought up again, but they are visible in Williams’ self-loathing thoughts and taunts. Throughout the documentary, in both old and new footage, the singer refers to himself as “fat” and “fatty.” It’s always presented in a jovial, throwaway manner, but the sinister feeling behind it is clear for anyone who’s paying attention.

Over the years, Williams struggled with finding a sense of self-worth and purpose, at one point asking “am I enough?” He chased success, thinking it would amount to happiness, and although it worked for a short while, it wasn’t a sustainable or healthy way of living. 

As the series shows, the singer managed to find some much-need balance after creating an identity outside of fame by becoming a father and husband. After meeting Ayda Field, a former American actor, in 2007, Williams embarked on a serious relationship with her after exiting rehab. “I guess the God-shaped hole has been filled with four kids and a wife,” he says in the closing moments of the documentary, sharing that he’s on his way to “being really, really happy.” Still very much a work in progress, like us all, Williams signs off the documentary from a place of hard-earned tranquility. Having confronted his darkest moments on tape, Williams has made peace with his former self and is focused on what the future holds.

source https://time.com/6332204/robbie-williams-netflix-documentary-revelations/

Ozempic Can’t Fix America’s Obesity Crisis

What is obesity?

Some people will tell you it’s a fancy word for being fat; others might say it’s a slur that pathologizes bigger bodies. And yet others will insist it’s a moral failing—one of laziness and poor willpower.

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For the past decade, however, the medical community has recognized that obesity is a chronic disease, much like cancer, diabetes, and high blood pressure. Obesity triples the risk of hospitalization due to COVID-19, is linked with hundreds of medical complications, and accounts for 4 million preventable deaths every year.

Obesity is also heterogeneous, with manifold different causes, clinical presentations, and responses to treatment. The astronomical rise of GLP-1 drugs such as Ozempic, Wegovy, and Mounjaro has glossed over such nuance, with bold promises that medication is the “holy grail,” “silver bullet,” and “miracle” to the obesity problem, a one-size-fits-all solution. If only it were that simple.

The truth is that Ozempic can’t solve the obesity crisis in America. Although medication can help some individuals lose weight, obesity is not a simple disease of inactivity or overeating. A myriad of factors, including genetics, mental health, socioeconomic status, and environmental influences, contribute to the development and progression of this disease. As such, how patients present inside the clinic varies widely, from a mutation in the MC4R gene being linked to an 18% higher odds of obesity to some antipsychotic medications causing 75-125 pounds of weight gain. While GLP-1 drugs could help many of these patients, they also target only one factor—hormonal imbalances— and can’t solve for all the other problems.

This overly reductionist approach is mirrored in the diagnostic criteria for obesity—a body mass index (BMI) of 30 or higher—because patients can be perfectly metabolically healthy above this cutoff, or develop obesity-related comorbidities within the “normal” range. In fact, designed for white European men, BMI underestimates obesity among Hispanic and Asian Americans while overestimating it among Black Americans, so the American Medical Association has asked doctors to de-emphasize the use of this flawed, discriminatory measure.

A Lancet Commission of 60 international experts from high, middle, and low-income countries is currently working to redefine obesity, moving away from a height- and weight-based metric to a clinical diagnosis rooted in specific signs and symptoms.

Beyond these complexities in origin and diagnostic criteria, patients with obesity also respond differently to treatment. On average, the GLP-1 drug Wegovy helped patients reduce their body weight by 16%; in other words, a 300-pound person might have lost 50 pounds. But some patients in this New England Journal of Medicine study only lost 5% of body weight while others lost up to 30%. This variability highlights the importance of individualized treatment plans to address patients’ unique needs instead of relying on any one drug.

Read More: Should We End Obesity?

With the current state of obesity care, however, that’s nearly impossible. In the U.S., there are 115 million people living with this disease, but just over 100 doctors who are fellowship-trained in obesity. Since 2003, federal law has also prohibited Medicare from covering obesity medications because they are seen as “lifestyle” drugs instead of real medicine. Correspondingly, our research shows that only 1% of eligible patients get treated with anti-obesity drugs, with most simply relegated to following the oft-quoted advice of eating less and moving more. While diet and exercise are certainly important, the most effective treatments for obesity are interdisciplinary, where this regimen is combined with behavioral therapy, medication treatment, and sometimes metabolic and bariatric surgery.

With so few doctors to help so many Americans in need, it’s no surprise that diet scams and products preying on people’s insecurities have filled the void — the U.S. weight loss market is estimated at $160 billion in 2023. When we similarly treat GLP-1 drugs as the proverbial magic bullet, we open this genuine medical advance to spurious critiques and attack campaigns. For example, the widely reported critique that patients gain weight when they stop taking GLP-1s only matters if they are seen as an obesity “cure.” After all, for insulin and hypertension drugs, it’s hardly news that glucose and blood pressure shoot back up when you discontinue medication.

With obesity costing the U.S. $1.7 trillion, or 9% of our GDP, we need to celebrate progress against this chronic disease and how GLP-1 drugs can help some patients live longer, healthier lives while also significantly reducing healthcare costs. But we must also recognize that much work remains to be done, from promoting social empathy to training more specialty physicians to implementing policies that ensure affordability and access to treatment. Although drugs like Ozempic, Wegovy, and Mounjaro holds great promise, it is not the panacea the media has made them out to be, and we must resist the temptation to oversimplify the issue.

Instead, let us celebrate the potential of GLP-1s as part of a comprehensive, individualized, and compassionate approach to treating obesity—one that not only considers individual’s unique needs and circumstances but also focuses on improving overall health and well-being.

source https://time.com/6332910/ozempic-americas-obesity-crisis/

The Whole World Is at Risk for ‘Compassion Fatigue’

After serving in the Vietnam War, Charles Figley became interested in the concept of trauma—not only the lasting psychological wounds that people experienced after living through traumatic events themselves, but also how their loved ones often came to share those burdens. “Simply being a member of a family and caring deeply about its members makes us emotionally vulnerable to the catastrophes which impact them,” he wrote in 1983.

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At the time, Figley—who now runs the Tulane University Traumatology Institute—called these trickle-down effects “secondary traumatic stress reactions.” Today, however, he often uses the term “compassion fatigue” to refer to the emotional and physical exhaustion that sometimes afflicts people who are exposed to others’ trauma.

In the nearly 50 years since Figley began researching these concepts, compassion fatigue has been primarily studied among people in “caring professions” like health care and social work, who are routinely exposed to pain on the job. But Figley’s early work, on how ordinary people can be infected by the trauma of others, is becoming increasingly prescient at a time when just about everyone is near-constantly exposed to content about war, violence, death, and injustice on the news, internet, and social media.

Indeed, it now seems that “anyone can experience compassion fatigue,” says Briana Smith, a Ph.D. student at the Tulane University School of Medicine who works with Figley.

Michelle Trent, executive director of The Compass Center, a nonprofit counseling center in South Dakota focused on trauma healing and prevention, saw that firsthand in 2020. Many of her clients were struggling not only with issues in their personal lives, but also with the emotional drain of living through the COVID-19 pandemic, the racial justice movements following George Floyd’s death, and other societal stressors. “Our clients were coming in just saying, ‘We can’t watch the news anymore. We can’t do this anymore,’” she says. “That’s really when it came to our radar.”

Figley’s research suggests people who develop compassion fatigue may experience symptoms similar to those of PTSD, including trouble sleeping; becoming triggered by difficult emotions or memories; and changes in personality, mood, or affect. It can also manifest as emotional numbness, with the sufferer becoming desensitized to the experiences of others and struggling to connect with patients, colleagues, or loved ones.

Gabriela Murza, an assistant professor at Utah State University who educates people in the surrounding community about public-health topics including compassion fatigue, says feeling overwhelmed can also be part of it. “When someone has compassion fatigue, they will feel like there’s a lot happening and they don’t know where to start and they don’t know what to do, so sometimes they will turn off their emotions,” she says.

Figley says health care workers are the “most obvious” people at risk due to the nature of their professions. But Smith’s research with Figley suggests it’s not just a workplace phenomenon. She is studying compassion fatigue among volunteers, including people who provide household care for family members and people who volunteer with emergency services, and has found that they may be even more susceptible than professionals—in part because they’re sometimes thrust into difficult work without extensive training, and in part because they tend to have a personal tie to their chosen cause, which amplifies their emotional reactions.

Regular people may, similarly, be more likely to experience compassion fatigue if they personally identify with an issue in the news or that a loved one is experiencing. Someone of Middle Eastern descent, for example, might be especially affected by images of the current war in Gaza and Israel, Smith says.

Triggers vary from person to person, Trent says, so there’s no way to know for sure what will cause compassion fatigue. But she says it’s important to monitor how you’re feeling during stressful or emotionally taxing times. If you don’t feel like yourself or are reacting more strongly than usual to difficult situations—perhaps by snapping at others or growing angry when you’re usually level-headed—you may be experiencing compassion fatigue.

If that’s the case, taking a break from difficult news and social media is a good first step, Trent says, though she notes that there’s a difference between ignoring a situation and taking purposeful time to recharge. She recommends using your break for personal wellness—moving, getting good sleep, spending time outdoors—and connecting with people in your community to remind yourself of “the good in humanity.”

Doing so may help counter some of the overwhelming feelings that accompany compassion fatigue, Murza says. There’s often no clear way for an individual to help in an issue with global consequences, which can cause people to withdraw. But “there might be an organization in your city where you can volunteer…to make a difference for people experiencing loss or tragedy,” Murza says.

Social connection is, in general, a balm for compassion fatigue, Smith adds. Studies suggest confiding in people who relate to your feelings, such as coworkers or fellow volunteers, can help, she says. Finding a therapist to speak with can also be beneficial, Trent says.

“Compassion is like a tank of gas,” Trent says. “At some point, if you don’t replenish it, then you’re on empty.”

source https://time.com/6332107/compassion-fatigue-risk/

How Stress Affects Your Heart Health

For many people, stress is part of everyday life. The demands of work, family, and other quotidian pressures can leave one feeling angry, agitated, anxious, downtrodden, or burned out.

While these kinds of day-to-day challenges are often described as mild forms of stress, the reality is that some people will experience them more often and more significantly than others. And there’s mounting evidence linking these and other forms of stress to heart-related health problems.

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“We know from several studies in different populations that emotional and psychological stress is associated with an increased likelihood of developing and dying of cardiovascular disease,” says Dr. Beth Cohen, a stress researcher and professor of medicine at the University of California, San Francisco. 

For example, research on stress in the workplace has found that people who are under regular strain or who work long hours are up to 40% more likely than their less-taxed counterparts to eventually develop heart disease or stroke. “There are also studies looking at what we call perceived stress, which is the amount of stress a person reports feeling, regardless of cause,” Cohen says. There again, research has found that people who report feeling a lot of stress are at elevated risk for cardiovascular problems down the road.  

Meanwhile, some of Cohen’s work has examined the health effects of stress that stem from deeply traumatic experiences—such as those related to military combat service or interpersonal violence. She says post-traumatic stress disorder (PTSD) and other stress-related disorders are associated with increased cardiovascular disease risks. 

But while stress appears to be a major risk factor for heart trouble, there’s a lot about the relationship between stress and heart health that experts are still sorting out. For example, how much stress is too much? “Not all challenging or stressful situations are unhealthy,” Cohen says. “Short-term stress in specific situations, such as working to overcome a difficulty, may actually be beneficial.” Another lingering question: Does stress itself damage the heart, or does stress lead to other things (smoking, poor sleep, an unhealthy diet) that cause the bulk of the harm? These are the types of questions that science has not fully answered.

Untangling the exact relationship between stress and health problems—including heart disease, but also other stress-related conditions such as Type 2 diabetes—is now the goal of research teams across the world. They’ve made progress in showing how stress may change a person—both inside and out—in ways that could contribute to heart trouble.

Read More: Feeling Off? It Could Be ‘Ambient’ Stress

Defining stress

In order to understand the negative effects of stress, medical researchers must first define what it means to be “stressed.” That’s easier said than done. 

“There’s the lay-person idea of stress, but defining it more scientifically is challenging,” says Dr. Ian Kronish, an associate professor of medicine and associate director of the Center for Behavioral Cardiovascular Health at Columbia University in New York. 

For example, some researchers have defined stress as “[a]ny physical or psychological stimuli that disrupt homeostasis.” By this broad definition, watching a suspenseful TV show or hurrying to an appointment are both forms of stress. Both are likely to raise a person’s heart rate and blood pressure in measurable ways. But most experts, like laypeople, recognize that these fleeting periods of stress probably aren’t the kinds that contribute to heart problems.

Another definition of stress is one that encompasses experiences or events that lead to unhelpful changes within the body’s stress-response system. It’s these disruptive forms of stress, Kronish says, that may contribute to heart disease and other health issues. These forms of stress are often sorted into two types: acute stress and chronic stress. 

Acute stressors are experiences that lead to very intense activation of the body’s fight-or-flight response. “These are events where the demands of the situation outstrip a person’s resources to handle them,” Kronish says. “Living through a major disaster, whether from natural causes or something like a terrorist event, could be the kind of acute stress that leads to disruptions within these internal systems.” Chronic stress, meanwhile, refers to stressful experiences that may not pose an immediate threat to someone’s health, but that happen regularly and persist for long periods of time. Working in a hectic and draining profession is one example of a chronic stressor that, over time, could lead to perturbations of the body’s stress-response system.

While acute and chronic stress may seem like straightforward concepts, nailing down when and how they harm a person’s health is difficult. Different people will respond to the same stressful situation in different ways; not all veterans with combat experience develop PTSD, and not all people who work in demanding professions develop adverse health effects. There’s also evidence that other lifestyle or environmental factors—such as a person’s exercise habits, their diet, and their social relationships—can help determine whether stress leads to health problems. “When I try to draw this out for people, it ends up looking like a big spider web of connections,” Cohen says. “All of these other things that are important to a person’s psychological and cardiovascular health may affect how they’re impacted by stress.”

It has also been a challenge for researchers to measure stress. “With stress, we don’t have something like blood pressure where I can sit you down and measure it and know exactly what it means,” Cohen says. Likewise, when someone with a history of stress develops heart trouble, there is currently no way for experts to determine whether stress caused that person’s health problems. “We don’t have a test that can tell whether your heart has been impacted negatively by stress,” Kronish says. 

In an effort to address these and other gaps, researchers have focused much of their attention on mapping out the underlying connections between stress and health. That work has revealed how acute and chronic stress may contribute to heart trouble, diabetes, and other health problems. 

The stress-heart connection

The human body reacts to stress in predictable ways. Blood pressure and heart rate increase, while breathing becomes shallow and rapid. Muscles grow tense and blood sugar levels rise. Alertness and attention sharpen. This all happens because stress-related hormones are circulating throughout the brain and body, ramping up activity in the sympathetic nervous system (SNS) and preparing the entire organism to respond to any potential threats. While SNS activation is the kind of stress a person can feel, a lot more is going on inside them. In fact, stress affects the operation of every organ and system in the body, including the immune system. 

All of this is normal and healthy. The body is made to manage stress, and, typically, it will recover from periods of stress without any lingering ill-effects. But in those situations when a stressful event is very severe, or when stress lingers for long periods of time, changes may occur that threaten the heart. “Increases in blood pressure, which can be initiated by stress, will increase pressure on the walls of blood vessels, and can therefore lead to cardiovascular damage,” says Dr. Amgad Makaryus, a cardiologist and professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health in New York. 

The effect stress has on blood pressure is just one of many theorized ways that stress may lead to heart trouble. “With stress, it’s difficult to pinpoint the exact way it’s doing damage, but we know one of the end products of stress is inflammation,” Makaryus says. While stress usually leads to temporary increases in inflammatory activity, chronic stress can produce persistent low-grade inflammation. This sort of simmering, all-the-time inflammation has been tied to heart disease, but also to Type 2 diabetes, depression, and other illnesses of the mind and body.

While there’s good evidence supporting the theory that too much stress damages the body via heightened inflammation and other forms of internal dysregulation, experts say there are still a lot of details to be worked out. “The field is still trying to untangle the various biological and behavioral pathways that may connect stress and cardiovascular health,” Kronish notes. His group has spent a lot of time looking at the ways stress changes a person’s behavior in ways that may lead to health problems. He says stress motivates some people to take better care of themselves, but it can also lead people to forgo exercise and social gatherings, to smoke or drink more than they otherwise would, and to adopt other habits that imperil their health. “Sleep is another pathway that might connect stress to poor cardiovascular outcomes,” he says. There’s evidence that stressed people tend to sleep poorly, and a persistent lack of sleep has been associated with a wide assortment of health problems. 

Untangling all these different stress-related harms—both the biological and the behavioral—is no easy task. They’re likely all interconnected. “People talk a lot about a dysregulated stress system, but my sense is it’s a more complicated story,” Kronish says. “There are so many factors to tease apart.”

Read More: How COVID-19 Changes the Heart—Even After the Virus Is Gone

How to reduce your risks

Stress appears to threaten the heart in numerous ways. Safeguarding the heart from that assault may require a multi-pronged defensive strategy, experts agree. “People hear that stress is bad for the heart, and so they should do things to reduce stress,” Kronish says. “But the truth is we don’t have a grand slam stress-reducing intervention that we know will protect the heart from stress in all people.”

For example, psychotherapy has shown promise for the reduction of both stress and its attendant heart risks, and Cohen recommends it for people with PTSD and other stress-related mental health conditions, such as anxiety, depression, and trouble sleeping. But the evidence supporting its protective benefits for the heart is inconsistent. “Some trials have looked at psychotherapy and stress reduction techniques,” she says. “They’ve consistently led to better mental health outcomes, but they’ve had mixed evidence in terms of whether they reduce heart disease risk.”

Meanwhile, Makaryus says medication-based treatments aren’t the answer—at least not yet. “Medications are a big part of cardiovascular disease treatment, but we don’t have an easy pill that will solve this,” he says of stress-related heart trouble. “I think the key is prevention.”

It may not be surprising, but he and others say the time-tested elements of a healthy lifestyle—regular exercise, a proper diet, good sleep, and time spent with friends—can help a person recover from stress and reduce their risks for stress-related health problems. “Many people deal with stress by connecting with family and friends, or connecting with a spiritual group,” Cohen says. Leaning on other people for support—as opposed to isolating yourself and dealing with stress on your own—seems to be one of the best ways to reduce its harms, she says. 

For many of us, stress is inescapable. But we all have the power to eat better, exercise, and engage in other healthy activities that appear to help limit the harms of stress. “There are mysteries left to unravel,” Cohen adds, “but we already know many ways how to preserve and protect cardiovascular health.” 

source https://time.com/6332877/stress-affects-heart-health/

Gun Injuries to Children Have Soared. So Have Their Impacts

Firearms have accounted for the deaths of more American children than any other cause since 2020. The true damage guns inflict on children is larger still, as demonstrated by a new study showing that emergency-room visits for children injured by firearms nearly doubled during the pandemic.

In a survey of nine U.S. hospitals, a team led by Dr. Jennifer Hoffman, a pediatric emergency medicine physician at Lurie Children’s Hospital of Chicago, found that pediatric emergency room visits due to gun shots increased from 694 in the years before the pandemic to 1,210 during the pandemic, a 74% increase, according to data from 2017 through 2022. During that time, the death rate among gun victims age 18 and under nearly doubled as well, from 3.1% to 6.1% of all children injured by firearms.

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That increase was apparent to physicians who worked in emergency rooms throughout the pandemic, Hoffman says. But for the first time in decades, she and other researchers able to secure federal funding to study what they were seeing, thanks to a longtime freeze on grants supporting research on gun violence that was only lifted in 2020. Hoffman’s study is one of two published yesterday (Nov. 6) that help reveal the full extent of the problems gun violence poses to American kids, their families, and the health care economy.

An increase in child firearm injuries early on in the pandemic was initially thought to be the direct result of a wave of firearm purchases during lockdown, combined with heightened emotions and the dramatic changes to Americans’ daily routines, Hoffman says. “We hoped that as the daily impact of the pandemic decreased, that we would see a decline in firearm injuries,” she says. “But instead, we saw that the elevated levels of visits persisted and remain significantly elevated.”

Hoffman also found that gunshot-related pediatric emergency room visits increased only among Black and Hispanic youth, indicating what she calls “a widening of the disparities” that existed between these groups and their white peers before the pandemic.

The data, published Nov. 6 in the journal Pediatrics, doesn’t offer many other clues about the possible origins of this alarming trend. Firearm injuries are sorted into three types in hospital reporting and billing systems: Accidental injuries, often the result of improper gun storage and curious kids; self-inflicted injuries, most the results of suicide attempts; and assault injuries. This simple categorization can easily miss a lot of nuance that could be helpful for researchers, explains Hoffman. Clear early-pandemic factors, like increased gun buying, poor teen mental health, and rising community violence levels, respectively, seem to be easy explanations for rising numbers of incidents in each injury category, but it’s likely that there are many more unknown causes at play. The proportions of injury categories stayed fairly constant over time, says Hoffman, which makes it even harder to point to any one cause of increased injury.

Read More: Raising Children in America Means Living in Fear That They’ll Be Shot

This data is still important to have, since research on gun violence tends to focus on fatalities, says Dr. Zirui Song, an associate professor of health care policy and medicine at Harvard Medical School. “What is often forgotten is the much larger number of people in America each year who sustain firearm injuries but are able to survive,” he says. Song’s own work, including a study also released yesterday, takes a more expansive look at the impacts of firearm injuries in children by analyzing the consequences for those around them.

His paper in Health Affairs demonstrates what he calls the “shared family trauma” that occurs when a child is injured or killed by gunfire, which includes a more than 30% increase in psychiatric disorders among the parents of survivors. 

Siblings of victims, too, are deeply affected. Although some family members rely on mental health services more often after a child is injured or killed, Song found that routine medical care often fell by the wayside for the siblings and mothers of survivors, with a decrease of between 5% to 14% for various visits and procedures. “This doesn’t necessarily mean that siblings were unharmed or sitting at home and just okay with it,” says Song, who has cared for the families of victims as an internal medicine physician at Massachusetts General Hospital. Instead, he believes it’s more likely a reflection of trauma remaining so unaddressed that it prevents families from engaging with care altogether.

Song also found that in the first year after being injured, health care spending for young survivors went up an average of $34,884, an economic burden shouldered almost entirely by insurers and employers, and one that he hopes continues to be highlighted in conversations about protecting children. (Song’s study included only families with employer-sponsored insurance, and he hopes to replicate it with families insured by public programs like Medicaid.) “So often in the healthcare system, moral arguments don’t move the needle on something,” he says. “In this case, children dying from firearm injuries have not moved the needle, but often dollars do. Gun violence is not only a medical issue and a public health issue, but it is increasingly an economic issue for our country.”

If it feels like researchers are trying to account for all sides of the issue at once, it’s because they’ve been left with little other choice, says Hoffman. They’re rushing to fill the gap left by years of growing gun ownership without the resources to track it. With papers like Hoffman’s and Song’s, researchers are still putting together an initial picture of gun violence today. “We’re decades behind where we should be and understanding why these increases are occurring and what we can do about them,” she says. The same, then, goes for the extent of their impact.

source https://time.com/6332323/gun-injuries-in-children-have-doubled-so-have-their-impacts/