Category Archives: Uncategorized

WEEKLY HEALTH UPDATE from your Napa Chiropractor, 5-24-2021

Health Alert: Obesity Linked to Higher Healthcare Costs. A review of health records concerning nearly
180,000 adults and children found that healthcare costs are nearly $1,900 higher per year for obese individuals,
with the cost increasing $235 a year with each unit increase in body mass index. PLOS ONE, March 2021
Diet: Processed Meat May Increase Risk of Dementia. According to a study that included data on close to
500,000 adults, consuming a 25-gram serving of processed meat each day is associated with a 44% increased
risk for developing dementia later in life. Lead researcher Dr. Huifeng Zhang writes, “Worldwide, the
prevalence of dementia is increasing and diet as a modifiable factor could play a role… Our research adds to the
growing body of evidence linking processed meat consumption to increased risk of a range of non-transmissible
diseases.” American Journal of Clinical Nutrition, March 2021
Exercise: All Physical Activity Seems to Help Against Depression. Using data from the European Health
Interview Survey, researchers report that regularly engaging in physical activity of any kind—recreational,
active commuting, or work—can help reduce the risk and severity of depressive symptoms.
Depression and Anxiety, April 2021
Chiropractic: Low Back Pain Common with Hip Impingement. Examinations of 158 patients with
femoroacetabular (hip) impingement revealed that three in five also suffer from clinically significant low back
pain, and that increased disability in one location is associated with greater disability in the other. The findings
suggest that clinicians should evaluate both the hip and low back pain of patients presenting with either
complaint. Doctors of chiropractic are skilled in the evaluation and management of musculoskeletal conditions
such as low back pain and hip impingement. PM&R, February 2021
Mental Attitude: Mental Health Issues Common in Future Healthcare Professionals. Questionnaires
completed by 449 students pursuing a degree in the health sciences revealed that 65% are stressed, 85.1% are
anxious, and 51.4% are depressed.
International Journal of Environmental Research and Public Health, March 2021
Wellness/Prevention: Tips to Help Prevent Diabetes. To reduce one’s risk for type 2 diabetes, the American
Diabetes Association recommends the following: get more physical activity, get plenty of fiber, go for more
whole grains, lose extra weight, avoid fad diets, make healthier food choices, and get regular checkups to
monitor blood sugar levels, especially if you’re overweight. American Diabetes Association, April 2021
Quote: “Knowing yourself is the beginning of all wisdom.” ~ Aristotle

I found that Dr. Joe Megna is one of the best chiropractors I have found in the Napa region.

WEEKLY HEALTH UPDATE from your Napa Chiropractor, 5-17-2021

Health Alert: E-Cigarettes Increase Risk for Lung Disease. An analysis of data from the Behavioral Risk
Factor Surveillance System revealed that e-cigarette usage is associated with a 26% increased risk for asthma
and a 44% elevated risk for chronic obstructive pulmonary disease (COPD).
Tobacco Induced Diseases, April 2021
Diet: Nuts Are Good for the Heart. Experts from the Mayo Clinic note that regularly eating nuts can improve
low-density lipoprotein (bad cholesterol) levels; make arteries healthier; reduce the risk for blood clots; and
lower levels of inflammatory markers in the blood that are associated with heart disease.
Mayo Clinic News Network, March 2021
Exercise: Exercise Is Good for the Brain. Reduced blood flow to the brain and stiffer blood vessels in the
neck are often seen in patients with mild-cognitive impairment (MCI) and dementia. In a recent experiment that
included 70 older men and women with MCI, researchers observed that participants who engaged in a brisk
walk exercise program experienced improved blood flow to the brain, as well as increased blood vessel
flexibility in the neck. Study leader Dr. Rong Zhang writes, “This [study] is part of a growing body of evidence
linking exercise with brain health… We’ve shown for the first time in a randomized trial in these older adults
that exercise gets more blood flowing to your brain.” Journal of Alzheimer’s Disease, March 2021
Chiropractic: Acute Back Pain Can Become Chronic Back Pain. A review of records involving 5,233
patients who sought treatment for acute low back pain revealed that 32% went on to develop chronic low back
pain. Further analysis suggests the following are associated with an increased risk for progression to chronic
low back pain: obesity, smoking, severe disability, depression/anxiety, and a prescription of opioids within the
first 21 days. JAMA Network Open, February 2021
Mental Attitude: Vitamin B7 May Be Important for Mental Health. Assessments completed by 7,387 adults
revealed that a high intake of biotin, also known as vitamin B7, is associated with a lower risk for depression,
anxiety, and stress. Dietary sources of biotin include eggs, legumes, nuts/seeds, liver, sweet potatoes,
mushrooms, bananas, broccoli, and avocados. Journal of Affective Disorders, March 2021
Wellness/Prevention: Reduce Parkinson’s Risk? The current research suggests that regular exercise and a
nutrient-rich diet are two lifestyle choices that may reduce an individual’s risk for Parkinson’s disease.
Journal of Parkinson’s Disease, March 2021
Quote: “The noblest pleasure is the joy of understanding.” ~ Leonardo da Vinci

I found that Dr. Joe Megna is one of the best chiropractors I have found in the Napa region.

WEEKLY HEALTH UPDATE from your Napa Chiropractor, 5-10-2021

Health Alert: Sleep Apnea Can Affect the Autonomic Nervous System. A review of data from 71 studies
suggests that obstructive sleep apnea can affect autonomic nervous system functions related to relaxation,
digestion, stress response, and heart rate. The authors of the review speculate this may be the mechanism by
which sleep apnea increases the risk for cardiovascular disease. Sleep Medicine Reviews, March 2021
Diet: Poor Diet is Bad for Brain and Gums. New research suggests that consuming a pro-inflammatory
diet—an eating pattern characterized by a high intake of red and processed meat, high-fat dairy products, and
refined grains—is associated with an elevated risk for both periodontitis and cognitive dysfunction.
Nutrients, March 2021
Exercise: Avoid Uninterrupted Sedentary Time. Past research has shown that prolonged periods of sedentary
behavior can lead to the accumulation of biomarkers in the blood that are associated with an elevated risk for
cardiovascular disease. In this study, researchers found that breaking up sessions of sedentary activity every 15
minutes with just a small amount of physical activity of any intensity can counteract much of the negative
effects of prolonged inactivity. Scandinavian Journal of Medicine and Science in Sports, April 2021
Chiropractic: Manual Therapy Effective and Safe for Cervicogenic Cephalic Syndrome. Cervicogenic
cephalic syndrome is a condition characterized by headaches and dizziness caused by dysfunction in the neck.
A recent literature review found that manual therapies, such as those provided by doctors of chiropractic, are a
safe and effective treatment option for patients with cervicogenic cephalic syndrome. Medicine, February 2021
Mental Attitude: Suicide Risk Elevated Among Nurses. Using data from the National Violent Death
Reporting System, researchers report that individuals in the nursing profession have an 18% increased risk for
suicide compared with the general population. The authors of the study note that further research is necessary to
gain a greater understanding of why nurses are at elevated risk for suicide and to identify interventions to
address the issue. JAMA Psychiatry, April 2021
Wellness/Prevention: Take Microbreaks to Stay Sharp at Work. Microbreaks are short timeouts from work
functions that usually involve activities like getting a snack, chatting with co-workers, stretching, or doing a
crossword puzzle that can help workers maintain their energy levels and stay productive throughout the day.
Journal of Applied Psychology, March 2021
Quote: “We come. We go. And in between we try to understand.” ~ Rod Steiger

I found that Dr. Joe Megna is one of the best chiropractors I have found in the Napa region.

WEEKLY HEALTH UPDATE from your Napa Chiropractor, 5-3-2021

Health Alert: Secondhand Smoke Puts Kids at Risk for Hospitalization. New research suggests that
children from smoking households are more likely to visit an urgent care center or be admitted to a hospital than
kids from smoke-free homes. Lead author Dr. Ashley Merianos notes, “Despite major progress in tobacco
control, about four in ten children remain exposed to tobacco smoke… This exposure places developing
children at higher risk for many health problems, including respiratory illnesses such as asthma, bronchiolitis
and pneumonia.” PLOS ONE, March 2021
Diet: Slow Down at Mealtime. Using data from two ongoing studies, researchers report that individuals
identified as fast eaters tend to consume more calories per meal and are more likely to gain weight over time
than slower eaters. Clinical Obesity, January 2021
Exercise: Exercise May Slow Cognitive Decline in Parkinson’s Patients. Among a group of 173 patients
with early Parkinson’s disease, researchers observed that those with a sedentary lifestyle experienced a greater
decline in cognitive function over the following two years than participants who regularly exercise.
Neurology, March 2021
Chiropractic: Manipulation for Treatment of Lumbar Disk Herniation. A study that included 67 lumbar
disk herniation patients revealed that six spinal manipulative therapy treatments spread over two weeks not only
resulted in improvements in pain and function, but also in the curvature of the lumbar spine. Spinal
manipulation is the primary form of treatment utilized by doctors of chiropractic for musculoskeletal conditions
of the spine. China Journal of Orthopeadics and Traumatology, January 2021
Mental Attitude: Teens Who Are Online a Lot Are More Likely to Become Cyberbullies. A survey of 428
adolescents revealed that teenagers spend an average of seven hours a day online. Additionally, the more time a
teen is on the Internet each day, the greater the chance they will engage in cyberbullying behaviors.
Journal of Child and Adolescent Counseling, March 2021
Wellness/Prevention: Vitamin D Deficiency Too Common in Hip Fracture Patients. Blood tests collected
from 268 brittle hip fracture patients revealed that almost 90% were vitamin D deficient, and half of these
individuals were severely deficient. Because vitamin D is important for healthy bones, the findings suggest that
improving vitamin D status in the elderly could reduce their risk for serious hip fracture.
Orthopedic Surgery, March 2021
Quote: “May you live every day of your life.” ~ Jonathan Swift

I found that Dr. Joe Megna is one of the best chiropractors I have found in the Napa region.

WEEKLY HEALTH UPDATE from your Napa Chiropractor, 4-26-2021

Health Alert: Painful Diabetic Peripheral Neuropathy and Low Vitamin D? Painful peripheral neuropathy
is a common long-term complication in patients with type 2 diabetes. An analysis of blood samples from 483
type 2 diabetics revealed that those with painful diabetic peripheral neuropathy were three times more likely to
have severe vitamin D deficiency, leading researchers to suggest that low vitamin D status may be a risk factor
for the condition. Frontiers in Nutrition, March 2021
Diet: Cocoa Flavanols Boost Memory? In a recent clinical trial involving 211 healthy middle-aged and older
adults, researchers observed that participants provided with a cocoa flavanol supplement for twelve weeks
performed better on a list-learning task than members of a placebo group. Scientific Reports, February 2021
Exercise: Exercise Provides Mental Health Benefits for Those with Prostate Cancer. New research
suggests that both resistance training and aerobic exercise are effective for reducing anxiety and depression in
prostate cancer patients undergoing androgen deprivation therapy.
Prostate Cancer and Prostatic Diseases, February 2021
Chiropractic: Manual Therapy Aids in Management of Neck Pain. Among a group of 60 patients with neck
pain, researchers observed that those treated with the combination of manual therapies and physiotherapy
modalities experienced greater improvements in pain and disability than patients treated with physiotherapy
alone. Doctors of chiropractic often address neck pain with a multimodal approach that may include manual
therapies, modalities, exercises, and nutritional recommendations.
Journal of Pakistan Medical Association, January 2021
Mental Attitude: Academic Performance and ADHD. Researchers monitored the academic progress of 400
university students and found that those with attention-deficit/hyperactivity disorder (ADHD) had about a half
grade lower GPA than students without the condition. Additionally, students with ADHD were less likely to
graduate. The finding suggests that students with ADHD may need greater academic support to help them
succeed in school. Journal of Clinical Child & Adolescent Psychology, February 2021
Wellness/Prevention: How to Prevent Falls in the Winter Months. American Bone Health offers the
following tips to help you stay on your feet when presented with snowy, icy, or wet surfaces: wear shoes with
good traction, dress warm, be careful getting out of your car, don’t rush, pay attention to surfaces, stay alert for
black ice, and keep your driveway and walkways clear. American Bone Health, March 2021
Quote: “Truth is the cry of all, but the game of few.” ~ George Berkeley

I found that Dr. Joe Megna is one of the best chiropractors I have found in the Napa region.

WEEKLY HEALTH UPDATE from your Napa Chiropractor, 4-19-2021

Health Alert: Lack of Sleep Raises Dementia Risk. Using data from the National Health and Aging Trends
Study, researchers estimate that older adults who sleep five or fewer hours a night are two times more likely to
be diagnosed with dementia or die in the following five years than participants who sleep an average of seven to
eight hours a night. Aging, February 2021
Diet: Mediterranean Diet Linked to Reduced Obesity Risk. A review of data from 143 studies concluded
that the Mediterranean diet—an eating pattern focused on eating fruits, vegetables, nuts, fish, olive oil, and
whole grains while avoiding red and processed meats, dairy, saturated fats, and refined sugars—is associated
with a reduced risk for obesity in adults. Public Health Nutrition, February 2021
Exercise: Home Gym Essentials. Fitness experts from Self magazine recommend the following essential items
for building an affordable home gym: an exercise mat, resistance bands, kettlebells, dumbbells, a full-length
mirror, a jump rope, and a gym ball. Self, March 2021
Chiropractic: Spinal Manipulation for Tension-Type Headaches. Tension-type headache patients treated
with the combination of spinal manipulation and exercise experienced greater improvements with respect to
headache frequency and severity than those treated with either myofascial release of the suboccipital muscles or
exercise alone. Doctors of chiropractic commonly use a combination of spinal manipulation and specific
exercises when managing patients with tension-type and other forms of headache.
Complementary Therapies in Clinical Practice, January 2021
Mental Attitude: Early Life Mental Health Issues Can Affect Physical Health in Adulthood. An analysis
of long-term health data concerning over 1,000 individuals whom researchers monitored for several decades
revealed that participants with a history of anxiety, depression, and other mental health issues as children
experienced sharper declines in sensory, motor, and mental function as they aged. The findings suggest that
improving the mental health of kids and teens may provide life-long benefits. JAMA Psychiatry, February 2021
Wellness/Prevention: Health & Wellness Tips for All. The Guadalupe Regional Medical Center offers
several small tips for improving one’s health and wellness: schedule a wellness check and stick to it, get yearly
eye exams, eat at least one fruit and vegetable at every meal, spend one entire day on you, schedule regular
dental exams and cleanings, drink at least two glasses of water per day, give up soft drinks, and get physically
active. Guadalupe Regional Medical Center, March 2021
Quote: “Fast is fine, but accuracy is everything.” ~ Wyatt Earp

I found that Dr. Joe Megna is one of the best chiropractors I have found in the Napa region.

WEEKLY HEALTH UPDATE from your Napa Chiropractor, 4-12-2021

Health Alert: Chronic Heartburn Increased Risk for Some Cancers. Gastroesophageal reflux disease
(GERD) occurs when the stomach contents, especially acid, leak into the esophagus. In a review of data
concerning a half-million middle aged and older adults, those with GERD had nearly a two-times increased risk
for cancers of the larynx and esophagus. Cancer, February 2021
Diet: Dietary Pattern that Benefits the Heart and Mind. The current research suggests that a diet rich in
fruits and vegetables, particularly berries and leafy greens, with a limited intake of saturated fat and animal
products is associated with a reduced risk of neurocognitive decline and healthy function of the left ventricle of
the heart. British Journal of Nutrition, February 2021
Exercise: Getting Physically Active and Sitting Less Reduces Diabetes Risk. An analysis of accelerometer
data and blood samples collected from 660 seniors revealed that the combination of regular moderate-tovigorous physical activity and less sedentary time is associated with improved glucose metabolism, which may
lower the risk for type 2 diabetes. Translational Sports Medicine, February 2021
Chiropractic: Exercise to Address Increased Thoracic Kyphosis Benefits Neck Region. Thoracic
hyperkyphosis is a term used to describe an exaggerated curvature of the upper back, which can affect the
muscles and soft tissues in the neck, leading to cervical pain and disability. A study that included 24 thoracic
hyperkyphosis patients revealed that corrective exercises were more effective for improving sagittal posture,
cervical muscle strength and endurance, and cross-sectional area of the deep cervical muscles than traditional
resistance training and physical therapy. Doctors of chiropractic often utilize a combination of manual therapies
and corrective exercises to address abnormal spinal curvature. Scientific Reports, February 2021
Mental Attitude: Work Performance Poor for “Night Owls.” Following a review of long-term lifestyle and
health data concerning over 12,000 adults, researchers report that about 1 in 10 individuals habitually stay up
too late and they tend to underperform at work in comparison with their peers who get sufficient sleep each
night. Occupational & Environmental Medicine, February 2021
Wellness/Prevention: Risk Factors for Poor Quality Sleep. Questionnaires completed by 1,300 middle-age
adults revealed that one-in-ten regularly experience poor quality sleep. Risk factors for poor sleep quality
include poor diet, excessive stress, chronic back pain, chronic respiratory disease, and depression.
Preventative Medicine Reports, December 2020
Quote: “Dreams come true; without that possibility, nature would not incite us to have them.” ~ John Updike

I found that Dr. Joe Megna is one of the best chiropractors I have found in the Napa region.

WEEKLY HEALTH UPDATE from your Napa Chiropractor, 4-5-2021

Health Alert: Vaping Marijuana May Pose More Serious Risk to Teen Lungs. A survey of nearly 15,000
teenagers revealed that those who vaped marijuana products were more likely to experience symptoms of lung
injury, such as wheezing, than their peers who vaped nicotine products or smoked either cigarettes or marijuana.
Journal of Adolescent Health, March 2021
Diet: Fish May Cut Frailty Risk. Frailty is a condition characterized by weakness, slowness, physical
inactivity, self-reported exhaustion, and unintentional weight loss. An analysis of data from the Kyoto
University Rheumatoid Arthritis Management. Alliance (KURAMA) cohort suggests that eating fish twice a
week is associated with a reduced risk for frailty in older adults. Scientific Reports, March 2021
Exercise: Golfing Offers Benefits for Those with Parkinson’s. Past research has shown that exercise can
improve balance and mobility in patients with moderate Parkinson’s disease. A new study found that
Parkinson’s patients who golfed for one hour twice a week experienced similar benefits as patients in a Tai Chi
group. However, those in the golfing group were nearly three times more likely to continue exercise in that
manner at the conclusion of the study. American Academy of Neurology, April 2021
Chiropractic: Restoring Cervical Lordosis Reduces Neck Pain and More. Treatment to restore cervical
lordosis and correct anterior head translation in 110 athletes with chronic nonspecific neck pain resulted in
improvements in pain, disability, autonomic nervous system function, and cervical sensorimotor control.
Doctors of chiropractic often use a multimodal approach to improve cervical posture in patients with chronic
neck pain. Journal of Athletic Training, February 2021
Mental Attitude: Social Media Time Tied to Suicide Risk Among Teen Girls. Researchers tracked social
media habits of nearly 500 teenage girls and found that those who spent two or more hours per day on social
media at age 13 and increased their use over time had an elevated risk for suicide over the following decade.
Journal of Youth and Adolescence, February 2021
Wellness/Prevention: Don’t Skip a Mammogram. A study that looked at health data concerning more than
549,000 women found that those who showed up for their two routine screening exams before their breast
cancer diagnosis were 50% less likely to die from the disease during the next decade than women who missed
their mammograms. Radiology, March 2021
Quote: “Your world is a living expression of how you are using and have used your mind.” ~ Earl Nightingale

I found that Dr. Joe Megna is one of the best chiropractors I have found in the Napa region.

WEEKLY HEALTH UPDATE from your Napa Chiropractor,3-29-2021

Health Alert: Mono May Raise Depression Risk. Following a review of data concerning 1.4 million adults born
between 1977 and 2005, researchers report that individuals with a history of infectious mononucleosis as children or
teenagers have up to a 40% elevated risk for depression in young adulthood.
Brain, Behavior, & Immunity, February 2021
Diet: Just One Salad a Week Benefits Oral Cancer Patients. Among 150 patients with oral cancer, researchers
observed that those who consumed at least one salad a week experienced slower cancer progression and had a higher
likelihood of surviving the disease. Nutrients, January 2021
Exercise: Take a Rest Day? Active individuals who suffer from persistent muscle pain or soreness, an inability to
finish a workout routine, or continued sluggishness following a workout are likely in need of a day off from the gym.
Rest days can offer the following benefits: reduces muscle pain and soreness, helps repair and build muscles,
replenishes the body’s energy stores, prevents injury, and allows the mind to rest.
Medical News Today, January 2021
Chiropractic: Nursing Students Suffer Work-Related Musculoskeletal Disorders. Questionnaires completed by
125 nursing students revealed that 104 (~83%) had musculoskeletal pain or discomfort in at least one body region,
most often in the lower back, neck, and shoulders. The findings reveal that undergraduate nursing students are at
greater risk of musculoskeletal disorders and there is a need for greater prevention and treatment options for this
group of students. Doctors of chiropractic are trained to diagnose and treat these disorders, often with a combination
of manual therapies, specific exercises, and ergonomic guidance. Health SA, December 2020
Mental Attitude: How Divorce Can Harm Kids. Interviews conducted with over 550 kids, ages 9 to 18, revealed
that exposure to conflict predicted a child’s fear that one or both parents would abandon them. Furthermore, children
who reported higher fear of being abandoned were more likely to report more mental health issues nearly a year
later. Based on the findings, the lead author says that parents need to make sure that their children know that even
though they are separated or divorced, they will continue to care for them to help reduce any fears of abandonment.
Child Development, January 2021
Wellness/Prevention: Should I Get a Calcium-Score Test? A non-contrast coronary calcium CT scan is used to
help detect calcium deposits in atherosclerotic plaque in the coronary arteries. The greater the buildup of calcium, the
higher one’s risk for future cardiovascular events. Doctors recommend this test for patients with the following traits:
family or personal history of coronary artery disease; males over age 45 and females over the age of 55; history of
smoking, high cholesterol, diabetes, or high blood pressure; excess weight; and inactivity.
Cleveland Clinic, February 2021
Quote: “Most folks are as happy as they make up their minds to be.” ~ Abraham Lincoln

I found that Dr. Joe Megna is one of the best chiropractors I have found in the Napa region.

WEEKLY HEALTH UPDATE from your Napa Chiropractor, 3-22-2021

Health Alert: Air Pollution Can Affect Cognitive Function. Cognitive assessments completed by over 500
individuals at various stages of life revealed that those who grew up in areas with greater exposure to air pollution
experienced more severe cognitive decline than participants from less polluted neighborhoods. Lead author Dr. Tom
Russ writes, “For the first time we have shown the effect that exposure to air pollution very early in life could have
on the brain many decades later. This is the first step towards understanding the harmful effects of air pollution on
the brain and could help reduce the risk of dementia for future generations.”
Journal of Alzheimer’s Disease, February 2021
Diet: Bleeding Gums and Vitamin C. An analysis of 15 clinical trials found that low vitamin C status is associated
with bleeding of the gums, gingival bleeding, bleeding in the eye, or retinal hemorrhaging. Investigators also found
that increasing daily vitamin C intake helped people with low vitamin C plasma levels reverse these bleeding issues.
Nutrition Reviews, February 2021
Exercise: How to Make Exercise a Daily Habit. Harvard University offers the following tips to help make exercise
a daily habit: piece your workout together, such as getting 10 minutes in the morning, noon, and night; exercise with
a friend; take a walk during lunch; use a pedometer to keep track of steps and record daily totals; turn off the TV,
computer, and smartphone to reduce sitting time; break up sedentary time with stretching breaks; sign up for a
fitness class; and plan exercise into your daily schedule. Harvard University, February 2021
Chiropractic: Age and Low Back Pain Can Impair Balance. Proprioception is the body’s ability to sense where
its various parts are in relation to one another for purposes of movement and balance. Examinations of 151 adults of
varying ages with or without chronic low back pain revealed that chronic low back pain and advancing age are both
risk factors for reduced proprioception. Doctors of chiropractic are trained to diagnose and manage low back
conditions and provide exercise training to improve their joint position sense.
Frontiers in Neurology, December 2020
Mental Attitude: Social Media Addiction Can Reduce Quality of Life. A survey of 390 university students
revealed that about 1 in 5 (21.5%) met the criteria for social media addiction. Further analysis showed that these
individuals also had an elevated risk for poor sleep, poor academic performance, low levels of life satisfaction, and
depression. Frontiers in Public Health, January 2021
Wellness/Prevention: Working Outdoors May Lower Risk of Breast Cancer. New research suggests that women
who spend more of their working hours outdoors in the sun have a 17% lower risk for breast cancer after age 50.
Occupational & Environmental Medicine, February 2021
Quote: “I have never met a man so ignorant that I couldn’t learn something from him.” ~ Galileo Galilei

I found that Dr. Joe Megna is one of the best chiropractors I have found in the Napa region.