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The disproportionate toll that COVID-19 took on people with diabetes continues today

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theconversation.com – Jamie Hartmann-Boyce, Assistant Professor of Promotion and Policy, UMass Amherst, UMass Amherst – 2024-06-06 07:43:06
Hundreds of millions of people worldwide have diabetes.
Halfpoint Images/Moment via Getty Images

Jamie Hartmann-Boyce, UMass Amherst

At the start of the pandemic, many people living with diabetes were wondering what COVID-19 meant for them. Diabetes was already known to put people at higher risks from other infectious diseases, including flu. Would it be the same with COVID-19? At the time, all scientists could do was make educated guesses.

In 2024, things look very different. A great deal more research is available, as well as effective vaccines, and life has in many ways returned to something like normal.

COVID-19 hasn't disappeared, however, and for the more than 400 million people living with diabetes worldwide, very real risks and impacts from the pandemic remain.

I specialize in drawing on and combining existing evidence to inform health policy across a range of areas. I've been studying COVID-19 and diabetes since the start of the pandemic and have experienced firsthand some of the many ways in which COVID-19 has affected people with diabetes. I've lived with Type 1 diabetes for the past 30 years. And at the start of the pandemic, I had a lot of questions about what COVID-19 meant for me.

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Among the recommendations: Eat whole grains, vegetables and whole fruits instead of juices.

Diabetes types defined

Diabetes is characterized by having higher than normal blood sugars. Different types of diabetes create this condition in varying ways.

Type 1 diabetes occurs when your body attacks the cells that produce insulin.

Insulin is the hormone that converts sugar into energy – without it, sugar remains in the blood, and the body is deprived of the energy it needs. Type 1 diabetes can be treated only by injecting insulin and is irreversible. If left untreated, Type 1 diabetes is fatal. There is no cure. No one knows for sure why some people get Type 1 diabetes and others don't.

By contrast, in Type 2 diabetes – by far the most common type – your body is still producing insulin but is less able to use it. People are more likely to get Type 2 diabetes if they are living with obesity. But people who aren't obese can also get Type 2 diabetes, and many people living with obesity never get diabetes.

Type 2 diabetes often runs in families. It can be treated in a range of ways. This includes weight loss for people living with obesity, changes to diet and exercise, and medications. In some cases, Type 2 diabetes can be reversed.

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Type 1 diabetes is most likely to start in childhood or adolescence, and Type 2 diabetes is most likely to start later in life. However, older people can develop Type 1 diabetes, and children can develop Type 2.

There are other types of diabetes, too. Gestational diabetes develops in pregnancy and goes away after giving birth. As with Type 2 diabetes, the body is still making insulin but is less able to use it.

In general, diabetes is on the rise, with most of this being driven by Type 2. By 2050, it's estimated that 1.3 billion people will be living with diabetes worldwide.

Diabetes can damage many parts of your body, including your eyes, heart, blood vessels, nervous system, feet and kidneys. Blood sugar management and regular checkups can help reduce these risks.

Diabetes and COVID-19

In a 2023 study, my colleagues and I reviewed a wide body of literature to examine the extent to which people with diabetes were at increased risk from COVID-19, and whether some people with diabetes were at greater risk than others.

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Overall, we found that people with diabetes were about twice as likely to get seriously sick with COVID-19 than people without diabetes. Evidence also consistently showed that people with diabetes were more likely to die from COVID-19 than people without diabetes.

Some people with diabetes appeared to be at greater risk than others. The higher people's blood sugar levels were before or during COVID-19 infection, the worse their outcomes were likely to be. In addition, risks generally seemed higher for people with Type 1 diabetes and people who used insulin.

There are several potential explanations. We know that having higher blood sugar levels makes it harder for people's bodies to fight infections. On average, blood sugar levels are higher in people with Type 1 than Type 2 diabetes. Infection can make blood sugar levels harder to manage.

People with Type 1 diabetes also tend to have lived with diabetes longer than people with Type 2 diabetes, and that might mean their bodies are less able to fight COVID-19 because of diabetes complications – for example, damage to their heart and kidneys.

Twenty percent of Americans with diabetes don't know they have the disease.

Pandemic disruptions

The pandemic triggered wide-scale disruptions for people living with diabetes. Many found it harder to make appointments with their health care providers. Some found it harder to access their medications. For many people, diet and physical activity were disrupted, too.

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We did a wide-ranging, systematic review of 139 studies in more than a million people to examine the impact of pandemic disruptions on people with diabetes. Evidence showed that people were more likely to die from diabetes during the pandemic than before it and were more likely to lose sight because of diabetes during the pandemic than before. People with diabetes need regular eye checkups to help protect their sight; these checkups often didn't happen during the pandemic, and people's vision suffered as a result.

We also found that young people with diabetes fared particularly badly. Children and adolescents with Type 1 diabetes were more likely to be admitted to the hospital with a life-threatening condition called diabetic ketoacidosis, which is when your blood turns toxic because you don't have enough insulin in your body.

Admissions to pediatric intensive care units for diabetes were higher during the pandemic than prior. It might be that people delayed seeking care, or were unable to access care, because of pandemic disruptions. That could mean that by the time young people with diabetes made it to a hospital, they were already really, really sick.

Looking forward

There is still plenty of reason for optimism, though. COVID-19 vaccines have markedly decreased the chances of dying or getting really sick from COVID-19, and in many countries, people living with diabetes have been prioritized for vaccines.

There are also developments in diabetes care. Improved diabetes management, whether it be through technologies such as insulin pumps or continuous glucose monitors, behavior changes or medications, can help reduce risk from COVID-19 and other infections.

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Weight loss drugs may also play a role in diabetes prevention, but it's still too early to say for sure.

Time will tell what the long-lasting impacts of the pandemic will be. Diabetes complications can often develop many years down the line, so researchers like me may see more people suffering complications from diabetes five to 10 years from now as a result of challenges with diabetes management during the pandemic.

Regular monitoring, particularly of the groups most affected by the pandemic, is likely to help. Caught early, many diabetes complications can be successfully treated.

My team found that among people living with diabetes, women, young people and people from racial and ethnic minority groups were most likely to suffer ill effects from the pandemic. These are groups who may be more likely to struggle to access care, with insulin prices and access remaining a particularly critical issue.

Efforts to make insulin and health care more accessible can help improve diabetes outcomes before, during and after pandemics.The Conversation

Jamie Hartmann-Boyce, Assistant Professor of Health Promotion and Policy, UMass Amherst, UMass Amherst

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This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Conversation

Surgeon general’s call for warning labels on social media underscores concerns for teen mental health

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theconversation.com – Emily Hemendinger, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical Campus – 2024-06-21 07:27:16
Calls to action for regulating social media have fallen flat with Congress.
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Emily Hemendinger, University of Colorado Anschutz Medical Campus

Amid growing concerns over the effects of social media on teen mental , on June 17, 2024, U.S. Surgeon General Vivek Murthy called for warning labels to be added to social media platforms, similar to surgeon general warnings on cigarettes and alcohol.

Murphy's warning cited research showing that teens who use more than three hours of social media a day face double the risk of mental health problems.

This comes a year after Murphy issued a major public advisory over the links between social media and youth mental health.

As a specialist in eating disorders and anxiety, I regularly work with clients who experience eating disorder symptoms, self-esteem issues and anxiety related to social media.

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I also have firsthand experience with this topic: I am 16 years post-recovery from an eating disorder, and as a teenager, I grew up when people were beginning to widely use social media. In my view, the impact of social media on mental health, especially on diet and exercise patterns, cannot simply be mitigated with a warning label. However, it is an important starting point for raising awareness of the harms of social media.

The U.S. surgeon general wrote in The New York Times that ‘the mental health crisis among young people is an emergency — and social media has emerged as an important contributor.'

Links, associations and causal effects

Experts have long suspected that social media may be playing a role in the growing mental health crisis in young people. However, the surgeon general's 2023 warning was one of the first government warnings supported by robust research.

Critics of the call for warning labels argue that it oversimplifies a complex issue and that limiting social media access in any way would do more harm than good. Some supporters feel that it is a step in the right direction and far less restrictive than trying to start with more widespread privacy regulations.

And so far, calls for action over regulating social media have fallen flat.

Researchers are limited to only studying associations, which make causal links difficult to establish. But there are numerous studies that do show a relationship between viewing media and worsened self-esteem, body image and mental health.

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Additionally, there is scientific data that has shown the effectiveness of including warning labels to deter use of substances such as tobacco and alcohol.

However, the strategy of warning labels has been used for eating disorder content and digitally altered images on the internet, with mixed results. These studies showed that the warning labels do not reduce the negative impact of the media on body image. Some of the research even found that the warning labels might increase body and appearance comparisons, which are thought to be key reasons why social media can be harmful to self-esteem.

Potential harms

Research shows that images of beauty as depicted in movies, social media, television and magazines can lead to mental illness, issues with disordered eating and body image dissatisfaction.

Body dissatisfaction among children and adolescents is commonplace and has been linked to decreased quality of life, worsened mood and unhealthy eating habits.

The mental health of adolescents and teens has been declining for the past decade, and the COVID-19 pandemic contributed to worsening youth mental health and brought it into the spotlight. As the mental health crisis surges, researchers have been taking a close look at the role of social media in these increasing mental health concerns.

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The pros and cons of social media

About 95% of children and adolescents in the U.S. between the ages of 10 and 17 are using social media almost constantly. A 2023 study found that teens spend about five hours per day on social media.

Research has shown that social media can be beneficial for finding community support. However, studies have also shown that the use of social media contributes to social comparisons, unrealistic expectations and negative mental health effects.

In addition, those who have preexisting mental health conditions tend to spend more time on social media. People in that category are more likely to self-objectify and internalize the thin body ideal. Women and people with preexisting body image concerns are more likely than others to feel worse about their bodies and themselves after they spend time on social media.

A breeding ground for eating disorders?

A recent review found that, as with mass media, the use of social media is a risk factor for the development of an eating disorder, body image dissatisfaction and disordered eating. In this review, social media use was shown to contribute to negative self-esteem, social comparisons, decreased emotional regulation and idealized self-presentation that negatively influenced body image.

Another study, called the Dove Self-Esteem Project, published in April 2023, found that 9 in 10 children and adolescents ages 10 to 17 are exposed to toxic beauty content on social media, and 1 in 2 say that this has an impact on their mental health.

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Researchers have also found that increased time at home during the pandemic led to more social media use by young people and therefore more exposure to toxic body image and dieting social media content.

While social media alone will not cause eating disorders, societal beliefs about beauty, which are amplified by social media, can contribute to the development of eating disorders.

According to a report from the Centers for Disease Control and Prevention, 42% of high school students say they feel ‘persistently sad' and ‘hopeless.'

‘Thinspo' and ‘fitspo'

Toxic beauty standards online include the normalization of cosmetic and surgical procedures and pro-eating-disorder content, which promotes and romanticizes eating disorders. For instance, social media sites have promoted trends such as “thinspo,” which is focused on the thin ideal, and “fitspo,” which perpetuates the belief of there being a perfect body that can be achieved with dieting, supplements and excessive exercise.

Research has shown that social media content encouraging “clean eating” or following a diet based on pseudoscientific claims can lead to obsessive behavior around food. These unfounded “wellness” posts can lead to weight cycling, yo-yo dieting, chronic stress, body dissatisfaction and higher likelihood of muscular and thin-ideal internalization.

Some social media posts feature pro-eating-disorder content, which directly or indirectly encourages disordered eating. Other posts promote deliberate manipulation of one's body, using harmful quotes such as “nothing tastes as good as thin feels.” These posts provide a false sense of connection, allowing users to bond over a shared goal of losing weight, altering their appearance and continuing patterns of disordered eating.

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While young people can often recognize and understand toxic beauty advice's effects on their self-esteem, they may still continue to engage with this content. This is in part because friends, influencers and social media algorithms encourage people to follow certain accounts.

Phone-free zones

Small steps at home to cut down on social media consumption can also make a difference. Parents and caregivers can create phone-free periods for the family. Examples of this include putting phones away while the family watches a movie together or during mealtimes.

Adults can also help by modeling healthy social media behaviors and encouraging children and adolescents to focus on building connections and engaging in valued activities.

Mindful social media consumption is another helpful approach. This requires recognizing what one is feeling during social media scrolling. If spending time on social media makes you feel worse about yourself or seems to be causing mood changes in your child, it may be time to change how you or your child interact with social media.

This is an updated version of an article originally published on June 7, 2023.The Conversation

Emily Hemendinger, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical Campus

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The Conversation

Making art is a uniquely human act, and one that provides a wellspring of health benefits

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theconversation.com – Girija Kaimal, Professor of Art Therapy Research, Drexel University – 2024-06-20 07:24:22
The act of creating art serves as exercise for the brain and is integral to physical and mental .
hzechphotography/Moment via Getty Images

Girija Kaimal, Drexel University

When you think about the word “art,” what comes to mind? A child's artwork pinned to the fridge? A favorite artist whose work always inspires? Abstract art that is hard to understand?

Each of these assumes that making art is something that other people do, such as children or “those with talent.”

However, as I explain in my book “The Expressive Instinct,” art is intrinsic to human evolution and history. Just as sports or workouts exercise the body, creating art exercises the imagination and is essential to mental as well as physical well-being.

I am a professor of art therapy who studies how creative self-expression affects physical and emotional health. In our clinical research studies, my colleagues and I are finding that any form of creative self-expression – including drawing, painting, fiber arts, woodworking or photography – can reduce stress, improve mood and increase self-confidence.

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As a sickly child who needed to stay home from school a lot, I found that making art helped me cope. Today, creating art is my sanctuary. I use it as a sounding board to better understand myself and a way to recharge and learn from the challenges of life.

A bookmark covered in purple, white and yellow flowers sits on an open book.
Bookmark made with wildflowers and ink drawing, created by Girija Kaimal. ‘My aim here was to capture the beauty of nature and the work of the human hand.'
Girija Kaimal

The uniquely human attribute of creativity

Although everyone has their own concept of what defines art, one thing is universally true: Creativity is a defining feature of the human species.

How so? Well, human brains are not computers processing data. They are biological prediction machines that perceive the environment through memories and the senses, with the capacity to use that information to imagine plausible future scenarios.

These inherent predictive and imaginative capacities are the wellspring of humanity's abilities to survive and thrive – because self-expression is a safety valve that helps us cope with uncertainty. No one truly knows the future; they must live each day not sure of what will happen tomorrow. Art can help us all practice this imaginative muscle in a useful way.

In our study examining brain activity while using virtual reality tools to create 3-D digital artwork, my team demonstrated that creative expression is a natural state of being. The brain naturally uses fewer cognitive resources to be expressive and creative, compared with the brain power needed to do a rote task that requires conscious effort.

Seemingly ordinary everyday activities can provide opportunities to tap into one's natural creativity and imagination: whipping up a meal from leftovers, figuring out an alternate route to work, dancing a little jig in response to hearing a song, or planting and tending a garden.

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We have repeatedly found in our studies that even a single session of real and honest self-expression can improve self-confidence and reduce feelings of stress, anxiety and burnout.

This is partly because creativity activates reward pathways in the brain. Using our hands and bodies to express ourselves activates dopamine pathways and helps us feel good. Dopamine is a neural messenger that is associated with feeling a sense of hope, accomplishment or reward. Our brains are wired to secrete feel-good hormones whenever we move, create something or engage in any type of expressive activity.

Tapping into the creative resources within is one of the most underrated seeds of well-being in the world.

By comparison, bottling up or denying these feelings can cause distress, anxiety and fear because we have not processed and expressed them. This is probably one of the reasons why every community around the world has its own creative and expressive practices. Even our ancestors in Indigenous communities all around the world intuitively knew that self-expression was essential to emotional health and social connection.

Being unable to share our lives, keeping secrets and feeling isolated and lonely tend to worsen our health. To our brains, social isolation feels like a chronic disease because it interprets this loneliness and inability to express as a threat to survival.

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Since creative expression can engage the senses, it can also be a body workout: a sensual as well as emotional and cognitive experience. Being active in expression – be it art, music, dance, drama, writing, culinary arts or working with nature – imparts a sense of confidence and hope that challenges can be navigated and overcome.

A hand-drawn color portrait
Portrait artwork by Laila Ahuja, in progress.
Laila Ahuja

The role of art therapy

Given the integral role of art in our lives, it makes sense that making art can help people manage transitions, adversity and trauma, such as the stresses of puberty, the death of a loved one or experiencing a serious illness.

According to a global study, 1 in 2 people will experience a mental-health-related challenge in their lifetime, whether from life's challenges, genetic predispositions or a combination of the two.

This is where art therapy can come in. Art therapy is a regulated mental health profession in which clinical psychotherapists with extensive clinical training offer psychotherapy to patients with diagnosed mental health needs.

The origins of art therapy go back to attempts to treat soldiers struggling with post-traumatic stress during the 20th century's two world wars. Today there is evidence that traumatic experiences tend to be stored as sounds, images and physical sensations in the brain. When someone lacks the words to process these experiences through traditional talk therapy, art therapy can provide an indirect way to express and externalize those feelings and memories.

The process of making art can help people process feelings that they aren't able to put into words.

One of art therapy's unique strengths is that it provides nonverbal ways of communicating, processing and eventually managing the symptoms of post-traumatic stress disorder, or PTSD. In fact, in a recent study, my team has found that a personal history of trauma is related to how people react to evocative images. Images of distress and pain resonate with us when we have known similar kinds of distress ourselves. This implies that our life stories make us sensitized to distress in others and even personalize it more.

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Creative self-expression is especially relevant in coping with trauma because it provides an outlet through which a person can regain a sense of agency and control.

A brightly colored stem of orange and yellow flowers with green leaves sits on a notebook page with handwritten description behind it.
Botanical notes artwork made by 12-year-old self-taught artist Laila Ahuja as part of a summer exercise to practice drawing and learn about different flowers around the world.
Laila Ahuja

How to bring creativity into daily life

For those new to exploring art as a creative pursuit or for well-being reasons, engaging in creative activities begins with letting go of unrealistic expectations. Being creative isn't about becoming a famous artist or even a mediocre one. It is about allowing ourselves to flex the creative muscle that we all have and enjoying all the sensory and emotional aspects of imagining.

Next, think about activities that made you feel free to explore when you were a child. Did you like singing, playing in the outdoors, dancing, making up pretend plays, or writing little tales? Allow yourself to indulge in any and all of these creative pursuits that made you feel relaxed and joyful.

A cultural tradition, tinkering with electronics, making a gift for someone or simply paying attention to everyday beauty – any of these can be a creative activity. And just like any muscle, the more you exercise it, the stronger it becomes. Over time, you will notice yourself getting more confident and adventurous in your creative practices.

Whatever it is, make time for this creative pursuit every week – which is possibly the hardest step of them all. If it seems “unimportant” compared with the demands of daily life, such as work or family, try thinking of it as another form of sustenance.

Remember that creativity is just as critical to human health as eating nutritious meals or getting exercise and good rest. So as the Latin saying goes: “Plene vivere.” Live fully.

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A square box with the words 'Art & Science Collide' and a drawing of a lightbulb with its wire filament in the shape of a brain, surrounded by a circle.
Art & Science Collide series.

This article is part of Art & Science Collide, a series examining the intersections between art and science.
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Art and science entwined: This course explores the long, interrelated history of two ways of seeing the world The Conversation

Girija Kaimal, Professor of Art Therapy Research, Drexel University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

Boost your immune system with this centuries-old health hack: Vaccines

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theconversation.com – Aimee Pugh Bernard, Assistant Professor of Immunology and Microbiology, University of Colorado Anschutz Medical Campus – 2024-06-20 07:24:38

When it comes to vaccines and immune , the results aren't too good to be true.

Jena Ardell/Moment via Getty Images

Aimee Pugh Bernard, University of Colorado Anschutz Medical Campus and David Higgins, University of Colorado Anschutz Medical Campus

There are a dizzying number of tips, hacks and recommendations on how to stay healthy, from dietary supplements to what color of clothes promotes optimal wellness. Some of these tips are helpful and based on good evidence, while others are not.

However, one of the easiest, most effective and safest ways to stay healthy is rarely mentioned: vaccination.

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We are a preventive medicine physician and an immunologist who want people to live the healthiest lives possible. Among the many research-backed ways to live healthier, we encourage people to eat well, exercise regularly, get good sleep and care for their mental health.

And when it comes to your immune system, nothing can replace the essential role vaccines play in promoting whole health. The protection that vaccines provide is an irreplaceable part of living the healthiest lifestyle possible.

Vaccines are essential to health

Some healthy people think they don't need a vaccine. But your immune system needs more than just a healthy lifestyle to protect your body when vaccine-preventable diseases come knocking on the door.

Imagine the cells of your immune system as athletes preparing for the Olympics. Just as athletes undergo rigorous and specialized training to meet every possible challenge they might face in their event, immune cells need to be primed and ready to fight off every pathogenic challenge you encounter.

Vaccines expose your immune cells to inactivated versions of a pathogen, providing them with practice sessions to recognize and combat the real threat with speed and precision. Vaccines ensure that your immune cells are at their peak performance when faced with the actual infection. Just as well-trained athletes can tackle their competition with skill and confidence, vaccinated immune cells can swiftly and effectively protect your body from diseases.

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If a person is unvaccinated and exposed to a disease they haven't encountered before, their immune cells are unprepared and must play catch-up to fight the pathogen. This leaves your body vulnerable to severe disease.

Without vaccination, even young, healthy people are vulnerable to diseases like the flu.

Even people at the pinnacle of health can unnecessarily suffer from vaccine-preventable diseases because their immune systems might not have been well-trained. Take the story of Austin Booth, a healthy and athletic 17-year-old who was not vaccinated for influenza. Just days after he started to feel ill, he died of the disease.

For healthy people, vaccination can reduce the risk of death from influenza by two-thirds. When people choose to skip vaccines recommended as an essential part of their overall health, there is a greater chance of serious complications or death from a vaccine-preventable disease, regardless of how healthy they may be. These people are playing a potentially life-altering and deadly game of chance.

Vaccine-preventable diseases are still common. In the U.S., hundreds of thousands of adults are hospitalized and thousands die every year from vaccine-preventable diseases such as influenza, pneumococcal pneumonia, respiratory syncytial virus (RSV) and COVID-19. And tens of thousands of adults develop cancer every year from vaccine-preventable diseases such as HPV.

Vaccines are the safest immune health hack

Many of the trendiest health hacks have little to no evidence of improving health. Some are even dangerous. But vaccines are one of the most tested and proven ways to stay healthy.

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Vaccines have been used for centuries. In the past 50 years, they have saved an estimated 154 million lives worldwide. Mathematical models estimate that a 25-year-old now has a 35% greater chance of living to their next birthday thanks to vaccines alone.

Smiling person rolling up sleeve to show bandaid on upper arm that reads 'fight flu'

Vaccines are a tried and true way to improve your health.

CDC/Robin Spratling

Not only are vaccines effective, but they are also safe. Yes, vaccines can come with mild and limited side effects – who hasn't felt a little sluggish or bumped their sore arm after getting vaccinated? More severe vaccine side effects are extremely rare. If you have concerns, talk to your doctor. As opposed to dietary supplements, trendy health hacks and even many over-the-counter medications, there are robust systems in place to test and monitor the safety and effectiveness of vaccines.

Of all the tips available to improve your health, one recommendation is clear: Even healthy, fit people need recommended vaccines to stay healthy and live well.The Conversation

Aimee Pugh Bernard, Assistant Professor of Immunology and Microbiology, University of Colorado Anschutz Medical Campus and David Higgins, Research fellow, Instructor of Pediatrics, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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