Category: Healthy Lifestyle

  • Healthy Lifestyle Benefits Heart After Cancer, Too

    Healthy Lifestyle Benefits Heart After Cancer, Too

    Dec. 29, 2021 — We know a wholesome life style can assistance reduce wellness issues — which include most cancers, coronary heart disorder, and style 2 diabetic issues — but new exploration shows it could also decreased the threat for heart condition and diabetes in folks who already have experienced cancer.

    In a big study posted in JACC: CardioOncology, researchers located that healthy dwelling noticeably lowered the risk of cancer, cardiovascular disease, and type 2 diabetic issues in a balanced inhabitants, and also lowered the threat of heart illness and sort 2 diabetic issues (T2D) in people with a history of cancer.

    “These findings emphasize the added benefits of adopting a combination of healthful behavioral tactics in cutting down the hazard for CVD [heart disease] and T2D problems among the clients with and devoid of widespread cancer,” said the researchers, led by Zhi Cao of Tianjin Healthcare University’s College of General public Health in Tiagnjin, China.

    Healthful residing was outlined by 5 factors: not cigarette smoking, assembly guidelines for physical action, pursuing a healthier diet program, average liquor use, and average sleep period.

    That mentioned, the relationship to alcohol usage as part of a balanced life-style need to be taken with warning, suggests  Erin D. Michos, MD, an associate professor of medicine and epidemiology and affiliate director of preventive cardiology at Johns Hopkins College of Drugs in Baltimore, who also co-authored an editorial revealed with the analyze.

    Alcoholic beverages — even reasonable use — is a hazard element for numerous cancers, as perfectly as for atrial fibrillation, or an irregular heart rhythm, she says.

    “Its use is not endorsed as a preventive method by the American Coronary heart Affiliation or the American Modern society of Medical Oncology.”

    The scientists examined the impression of healthier residing on 432,000 persons ages 40 to 70 decades who had been enrolled in the United kingdom BioBank, a database of genetic and overall health info from fifty percent a million people in the U.K., concerning April 2006 and December 2010.

    “The authors looked at a pretty huge and nicely-established cohort with the United kingdom BioBank, which is a definitely phenomenal resource,” says Stephen Juraschek, MD,  research director at the Hypertension Centre at Beth Israel Deaconess Medical Heart in Boston. “But [the results] are largely confirmatory with what we know about these wholesome life style recommendations.”

    He states the next methods need to be to obtain out how to roll out healthier lifestyle steps to the typical populace.

    “How do we make improvements to procedures to market more healthy taking in and much healthier food alternatives in the supply chain, or to guarantee folks are significantly less sedentary?” he suggests. “What can we do culturally to encourage those people kinds of behaviors?”

  • Healthy Lifestyle Tied to Less CVD, Diabetes, Even With Cancer

    Healthy Lifestyle Tied to Less CVD, Diabetes, Even With Cancer

    Cardiometabolic disease, defined as cardiovascular illness (CVD) or style 2 diabetic issues (T2D), is the major comorbidity in patients with cancer. But new study is linking healthful life style with equally the avoidance of new cancer and the diminished chance for cardiometabolic sickness amid individuals with former cancer. 

    The analyze, carried out by Zhi Cao, MSc, from the Faculty of Community Wellbeing, Tianjin Health care University, Tianjin, China, and colleagues, confirmed that wholesome dwelling appreciably mitigated the chance for incident cancer, cardiovascular disease, and form 2 diabetic issues in a healthier populace, and lowered the chance for CVD and TD2 in all those who formulated cancer or experienced a history of cancer.

    “These conclusions spotlight the rewards of adopting a blend of healthier behavioral procedures in decreasing the threat for CVD and T2D problems amongst patients with and without the need of widespread cancer,” the scientists conclude.

    Benefits of the population-based, observational examine ended up printed in JACC: CardioOncology.

    “I consider this research was unique in that it examined the bidirectional interaction among cancer and CVD,” said Erin D. Michos, MD, affiliate professor of medicine and epidemiology and associate director of preventive cardiology at the Ciccarone Middle for the Prevention of Coronary heart Illness at the Johns Hopkins University School of Medicine in Baltimore, Maryland, who coauthored an editorial accompanying the paper.

    Though prior experiments have examined the hazard of incident most cancers and incident CVD related with life style elements, Michos stated the investigators went one step more to analyze the risk of CVD between individuals following a cancer diagnosis or all those with a prior record of most cancers. “Even immediately after a most cancers prognosis, following a wholesome way of life has continued advantages,” she said.

    The researchers examined the affect of healthful living on 432,000 folks involving the ages of 40 and 70 who ended up enrolled in the Uk Biobank involving April 2006 and December 2010.  The research consisted of two cohorts, like those people with new cancers and individuals with previous diagnoses.

    The balanced lifestyle index (HLI) was defined by five components: not cigarette smoking, meeting the advisable guidelines for bodily exercise, following a healthy diet program, reasonable alcohol use, and average sleep period.

    In all those devoid of prior cancer, the researchers identified that each and every one-stage increment in HLI was linked with an 8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} reduction in new incident most cancers (hazard ratio [HR] .92 95{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} CI, .91-.93). More than 15 yrs, 6.38{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and 4.18{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of these individuals with most cancers formulated CVD or T2D, respectively. Healthful way of life mitigated the risk of transition from most cancers to CVD or T2D with HRs for every one particular-place increment in the HLI of .90 (95{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} CI, .86-.94) and .84 (95{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} CI, .79-.89), respectively.

    In cancer survivors, just about every a single-issue increment in HLI was connected with a 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} lower chance for CVD (HR .90 95{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} CI, .87-.93) and a 13{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} reduction in T2D (HR .87 95{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} CI, .83-.91).  

    “The authors looked at a pretty significant and very well-proven cohort with the Uk Biobank, which is a seriously phenomenal source,” claimed Stephen Juraschek, MD, PhD, assistant professor, Harvard Health care School and analysis director at the Hypertension Heart at the Beth Israel Deaconess Professional medical Middle in Boston, Massachusetts. “But [the results] are mainly confirmatory with what we know about these healthier lifestyle tips.”

    Michos states 1 limitation was that the wellness associations indicated could not be right attributed to the elements in the HLI rating. For case in point, those people adhering to a healthy lifestyle could have been inclined to undertaking other health and fitness-trying to find behaviors previously, this kind of as visiting a healthcare supplier for preventive screening, complying with routine health and fitness routine maintenance, and taking preventive prescription drugs.

    She claims yet another weakness was the connection to liquor consumption as a balanced lifestyle aspect. “Alcohol is a hazard factor for several cancers, even average alcoholic beverages use…[and] liquor is a risk factor for atrial fibrillation,” she stated. “Its use is not endorsed as a preventive method by the American Coronary heart Affiliation or the American Society of Medical Oncology.

    The analyze effects also joined a wholesome life-style with an improved possibility for prostate most cancers and melanoma, which the authors felt was due to the chance of far more prostate cancer screenings foremost to prognosis and far more UV exposure from outdoor things to do.

    Offered that life style things have been only obtained at baseline, not accounting for alterations around time, the examine authors be aware that long run study ought to “study the effect of the life-style trajectory on CVD and T2D in people with most cancers.”

    With all the present evidence about the benefits of a healthy way of life, Jurascheck claims further investigate really should middle on how to roll out much healthier interventions to the general inhabitants.

    “How do we improve policies to endorse healthier having and healthier food stuff selections in the provide chain, or to make sure persons are much less sedentary?” he mentioned. “What can we do culturally to market those types of behaviors?”

    Much more work is also essential to determine therapies that will strengthen both cardiovascular overall health and cancer outcomes, maybe by concentrating on inflammation, which is a shared mechanistic explanation for the overlap of the two disorders, notes Michos. “There is a crucial function of a healthful life-style for avoidance of equally health conditions,” she explained.

    The demo was supported by the Countrywide Natural Science Foundation of China. The authors disclose no conflict of interest appropriate to the contents of this paper.

    JACC: CardioOncology, Vol 3 No. 5, 2021 December 2021, Summary. Editorial.

    For extra information, abide by Medscape on Fb, Twitter, Instagram, and YouTube.

  • 10 Lessons We’ve Learned About Eating Well

    10 Lessons We’ve Learned About Eating Well

    As 2021 arrived to a near, we appeared back again on our reporting on diet program and nourishment to glean strategies we could bring into a new yr. Below are 10 results to keep in mind subsequent time you head to the supermarket or to the kitchen.

    In October, the American Coronary heart Affiliation launched new nutritional tips to boost the hearts and well being of Individuals of all ages and lifestyle circumstances. Instead of issuing a laundry list of “thou shalt not eats,” the committee centered on how persons could make lifelong alterations, taking into account each individual individual’s likes and dislikes as properly as ethnic and cultural tactics and life circumstances. “For case in point, somewhat than urging individuals to skip pasta due to the fact it is a refined carbohydrate, a far more effective message may be to explain to people to eat it the regular Italian way, as a compact very first-course part,” Jane Brody defined.

    As people grappled with greater stages of anxiety, depression and nervousness in the course of the pandemic, lots of turned to their most loved comfort meals: ice product, pastries, pizza, hamburgers. But reports in an emerging industry of investigate acknowledged as dietary psychiatry, which seems to be at the relationship concerning eating plan and psychological wellness, advise that the sugar-laden and significant-fats food items we typically crave when we are stressed or frustrated, as comforting as they could seem to be, are the minimum possible to reward our psychological health and fitness. Full foodstuff such as veggies, fruit, fish, eggs, nuts and seeds, beans and legumes and fermented foodstuff like yogurt could be a better bet.

    “The plan that consuming specified foods could boost brain overall health, much the way it can encourage coronary heart well being, could possibly appear to be like popular sense,” Anahad O’Connor wrote in his story on the analysis. “But historically, diet investigate has concentrated mostly on how the foods we take in impact our bodily overall health, instead than our psychological health.”

    Espresso is beloved by several, but its wellbeing benefits have usually been named into issue. The latest assessments this year of the wellness effects of coffee and caffeine, even so, were reassuring. Their usage has been joined to a decreased threat of all forms of illnesses, which include Parkinson’s condition, heart illness, Variety 2 diabetes, gallstones, melancholy, suicide, cirrhosis, liver cancer, melanoma and prostate cancer.

    Researchers know that the trillions of bacteria and other microbes that are living in our guts participate in an critical part in wellbeing, influencing our hazard of establishing weight problems, coronary heart disorder, Form 2 diabetes and a huge array of other conditions. In 2021, a huge intercontinental examine located that the composition of these microorganisms, collectively acknowledged as our microbiomes, is mainly formed by what we eat. Scientists learned that a diet regime rich in nutrient-dense, whole foodstuff supported the growth of helpful microbes that promoted very good wellbeing. Having a food plan full of hugely processed meals with extra sugars, salt and other additives had the reverse effect, selling gut microbes that were connected to even worse cardiovascular and metabolic wellness.

    Potato chips, ice cream, pizza and much more harmful food items go on to dominate the American diet, even with being linked to being overweight, heart disorder, Variety 2 diabetes and other health and fitness complications. “They are low-cost and handy, and engineered to taste great. They are aggressively marketed by the food stuff sector,” Mr. O’Connor described in a story about new investigation on no matter whether these meals are not just tempting, but addictive. The idea has sparked controversy between researchers, he stated. One review located that specific foods were being specifically most likely to elicit “addictive-like” eating behaviors, such as extreme cravings, a loss of command, and an incapability to cut again despite dealing with unsafe repercussions and a powerful desire to prevent feeding on them. But other gurus pointed out that these foodstuff do not result in an altered point out of intellect, a hallmark of addictive substances.

    Unsweetened carbonated h2o is a better preference than soda or fruit juice, Christina Caron documented, but it likely shouldn’t be your principal source of water. Seltzer has the opportunity to be erosive to your enamel, gurus informed her, and carbonated drinks can add to gas and bloating, Ms. Caron wrote.

    Exceptional components like entire body dimensions, out of doors temperature and how challenging you’re respiratory and sweating will decide how much water you need, an pro told Alice Callahan for her story on what it really suggests to “stay hydrated.” “For most youthful, balanced persons, the very best way to continue to be hydrated is simply to drink when you’re thirsty,” she acquired. “Those who are more mature, in their 70s and 80s, might need to have to pay back additional focus to getting enough fluids for the reason that the thirst sensation can reduce with age.”

    Yogurt, kimchi and kombucha have extended been nutritional staples in several sections of the earth. But this 12 months, as Mr. O’Connor noted, experts found that these fermented foods could alter the make-up of the trillions of microorganisms, viruses and fungi that inhabit our intestinal tracts, collectively regarded as the intestine microbiome. They may perhaps also guide to decrease concentrations of overall body-extensive swelling, which experts progressively url to a variety of health conditions tied to growing old.

    Acid reflux is between the most frequent wellbeing grievances of American older people, and may possibly have turn out to be even extra widespread in the wake of pandemic-related strain and body weight gain. Jane Brody included new investigate that confirmed that individuals who adhered to 5 key life-style attributes — like exercising and adhering to a Mediterranean-model diet program, featuring fruits and veggies, fish, poultry and entire grains — were a lot more most likely to ward off distress from the most persistent and most likely really serious variety of reflux.

    A study to start with released in July identified that flavonoids, the chemical substances that give plant food items their shiny shades, may well aid curb the discouraging forgetfulness and delicate confusion that more mature persons usually complain about with advancing age. Further more stick to-up would be needed to ascertain irrespective of whether foods could possibly have an impact on the threat of building dementia, and there are also broader policy issues at participate in, making it difficult for everybody to access contemporary fruits and veggies, Nicholas Bakalar described. But, specialists agreed these are foods you need to be ingesting for mind health and fitness.

  • Nursing graduate shares her journey to a healthy lifestyle – UofSC News & Events

    Nursing graduate shares her journey to a healthy lifestyle – UofSC News & Events



    Gabs Amster grew up in a property where healthy food items and training have been not component of
    her every day existence. By the time she was 15, she weighed 210 lbs, was bullied by her
    friends and struggled with self-confidence

    She understood she had to enhance her actual physical and psychological health and create a new regime.
    She commenced taking in clear foods and going to the gym, the place she walked — and sooner or later
    ran — 5 miles three to five occasions a week. Inspired by her hard get the job done, her loved ones began
    incorporating healthier foods into their diet plans and started accompanying her to the
    gymnasium.

    “My psychological condition improved significantly when I became more healthy,” says Amster, who is
    from Charlotte. “I started off loving who I was and turned a new, confident particular person.”

    At the University of South Carolina Faculty of Nursing, Amster has made use of her individual
    transformation journey to join and empathize with lots of of her people. Immediately after graduation
    in December, she will start off her career as a registered nurse at Lake Norman Regional
    Healthcare Heart in Charlotte on the important treatment device.

    “I want to share my story and be the inspiration for anyone to obtain their self confidence
    to execute a target,” claims Amster.

    Amster remained steadfast in her determination to individuals health and fitness goals in higher school and
    into college or university. When the pandemic hit, new issues arose — fitness centers closed, routines
    were being disrupted — and then Amster contracted COVID-19.

    “I keep in mind remaining so out of breath and not able to even wander to my toilet 6 toes away
    with no feeling like I would move out,” claims Amster. After COVID, Amster found it
    hard to locate a new health and fitness plan. “It’s been tough with all of the outdoors
    road blocks, but I want to established a excellent instance for my individuals. So, I am nevertheless again on
    a new journey.  This time, much less for bodyweight decline, and additional for balanced dwelling.”

    I want to share my tale and be the inspiration for another person to locate their self-confidence
    to achieve a aim.

    Gabs Amster, University of Nursing graduate

    Amster has located methods to hook up with her patients by being open with her wellness transformation. During
    her junior yr, whilst doing work as an ultrasound tech, she courageously shared her
    story with an emotional affected person.

    “My client came in with peripheral vascular condition and was around 300 kilos. As I
    was scanning, he noticed I was owning challenges because of to his excess weight, and he began to
    cry,” Amster claims. “I confirmed him photographs of myself in significant faculty and talked to him
    about my journey. I shared that he could make optimistic modifications, much too.”

    As Amster enters the upcoming chapter of her nursing occupation as an ICU nurse, she is familiar with
    she will be confronted with new issues, but also new possibilities to link and aid
    sufferers.

    “I experience a feeling of electricity and dignity in my profession selection as a nurse and the hundreds
    of persons I will assistance,” she states.


    Share this Tale! Enable close friends in your social community know what you are looking at about


  • Stroke: Reduce risk by not smoking, moderate intake of alcohol, healthy BMI, exercise

    Stroke: Reduce risk by not smoking, moderate intake of alcohol, healthy BMI, exercise

    The Stroke Association warns that the catastrophic celebration takes place each 5 minutes in the British isles, but the faster a person gets treatment method for a stroke, the significantly less destruction is probably to occur. If you suspect you or another person else is owning a stroke, mobile phone 999 instantly and question for an ambulance.

    Investigate posted in the BMJ says that “lifestyle is a lot extra crucial than most physicians suppose”.

    It notes that in the USlHealth Gurus examine and the Nurses’ Wellness Research, weak lifestyle options accounted for a lot more than 50 percent of strokes.

    It reads: “Participants who realized all five nutritious life-style choices—not using tobacco, reasonable intake of alcohol, a physique mass index <25, daily exercise for 30 min and a healthy diet score in the top 40 percent, had an 80 percent reduction of stroke compared with participants who achieved none.”

    It adds that in a study in Swedish women, all five choices reduced the risk of stroke by 60 percent.

    READ MORE: Omicron variant: Three ‘uncomfortable’ signs showing up in the triple jabbed – doctor

    The Mayo Clinic says that “knowing your stroke risk factors, following your doctor’s recommendations and adopting a healthy lifestyle” are the best steps you can take to prevent a stroke.

    The health site adds that if you’ve had a stroke or a transient ischemic attack, there are measures which might help prevent another stroke.

    “The follow-up care you receive in the hospital and afterward also may play a role,” it notes.

    In general, healthy lifestyle recommendations include controlling high blood pressure, and healthy lifestyle changes and medications are often used to treat high blood pressure.

    DON’T MISS: 

    The National Heart, Lung, and Blood Institute (NHLBI) says anxiety, depression, and high stress levels are all risk factors.

    It adds: “Working long hours and not having much contact with friends, family, or others outside the home are also linked with higher risk of stroke.”

    There are also a number of risk factors, including unhealthy lifestyle habits, such as eating unhealthy foods, not getting regular physical activity, drinking alcohol, and using illegal drugs such as cocaine.

    The signs and symptoms of a stroke vary from person to person, but usually begin suddenly.

    The main stroke symptoms include changes to the face. Your face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have drooped.

    Signs may also occur on the arms – “the person may not be able to lift both arms and keep them there because of weakness or numbness in one arm”, says the NHS.

    Their speech may be slurred or garbled, “or the person may not be able to talk at all despite appearing to be awake” and “they may also have problems understanding what you’re saying to them”, adds the health body.

    Call 999 immediately if you notice any of these signs or symptoms.

    The NHS states: “As different parts of your brain control different parts of your body, your symptoms will depend on the part of your brain affected and the extent of the damage.”

    The health body adds: “If you have been diagnosed with a condition known to increase your risk of stroke, ensuring the condition is well controlled is also important for helping prevent strokes.”

    It notes: “Even if the symptoms disappear while you’re waiting for the ambulance to arrive, an assessment in a hospital should still be done.

    “You should be referred to see a specialist within 24 hours of the start of your symptoms.”

  • New evidence shows the importance of healthy lifestyle programs in pregnancy

    New evidence shows the importance of healthy lifestyle programs in pregnancy

    pregnancy exercise
    Credit score: Unsplash/CC0 Public Domain

    Wholesome way of living plans in being pregnant aid mums to reach much healthier pregnancies and improve wellness results Monash University analysis shows.

    The systematic review integrated 34,546 pregnancies and highlighted that supporting mums-to-be with a structured, nutritious way of life program that gives structured, proof-primarily based health and fitness information, tips and direction from pros about balanced having and actual physical activity for the duration of this priority lifetime phase, can help realize a much healthier being pregnant and significantly improves being pregnant complications.

    This also has a cost-preserving gain for hospitals and the wellness care program, ensuing in significantly less high priced interventions this sort of as caesarean sections and much less admissions for infants to neonatal intense treatment units. This has the possible to help you save our method up to $AUD0.5B for every year.

    Most mums know they require added nutritional intake in being pregnant, but the idea of “eating for two” and “resting up” no lengthier stands them in good stead. All over 50 {fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of all expecting gals in made nations around the world and increasingly in creating nations, struggle to balance dietary intake and bodily exercise, attaining earlier mentioned the balanced recommended body weight in being pregnant.

    This boosts the danger of issues together with gestational diabetic issues, significant blood tension, premature start, unnecessary cesarean sections and also provides lengthy-phrase well being dangers for females and their small children.

    The study also showed that balanced way of life programs are efficient for all mums no matter of what excess weight they enter being pregnant and aim on supporting a healthy life-style and don’t focus on excess weight and are a effective device in supporting mums to be the healthiest they can in pregnancy.

    The findings had been revealed currently in the intercontinental journal JAMA Inner Medication.

    The examine, led by Professor Helena Teede, Director of the Monash Centre for Wellbeing Study and Implementation (MCHRI) at Monash College, and endocrinologist at Monash Health, said: “We have lengthy acknowledged the significance of a healthier life style in being pregnant, but this world proof highlights the crucial need to have for these interventions to be obtainable during routine being pregnant treatment and the effects they can have on strengthening health and fitness results.

    “Furnishing means and fat monitoring by itself was not sufficient to increase results for mums and infants. Only when structured diet plan and physical action aid plans were being sent, did we see the overall health advantages.”

    Dr. Cheryce Harrison, senior creator and co-guide of the Healthful Way of living Stream at MCHRI, reported: “With funding by now secured from the Victorian Federal government, we are actively performing to see these evidence-dependent systems, delivered by focused qualified wellness professionals, out there and built-in into plan treatment for all expecting girls.

    “We are now performing with the Govt to ensure countrywide guidelines replicate this most effective exercise proof and are aiming to make these systems accessible to Australian gals, no make a difference exactly where they reside, and to access being pregnant treatment.”

    Ideal-Me, a wholesome life style system sent by overall health professionals, features assist, health and fitness facts, information and direction for pregnant women’s bodily and mental health and fitness and wellbeing from preconception, being pregnant to immediately after birth. Led by Dr. Harrison, this has supported 250 ladies and was hugely valued by all individuals.

    Prue Cummings, a initial-time mum to now 8-week-old Henry, joined the Best-Me program pre-conception.

    “I observed Exceptional-Me pretty supportive. It truly is an possibility to chat, and a space to talk to all my inquiries, with the self-confidence that I was acquiring the ideal well being advice. This was definitely important to me,” she claimed.

    “It is a one-prevent-shop to fully grasp natural vitamins, vaccinations, wholesome foodstuff and exercising. It gave me all the hints and suggestions and was in general really useful. My being pregnant with Henry was a really fantastic and healthful pregnancy, and I am grateful for a incredibly healthful toddler.”


    Eating plan and life-style throughout being pregnant linked to modifications in infants’ DNA


    Additional info:
    Helena J. Teede et al, Association of Antenatal Diet and Physical Activity–Based Interventions With Gestational Pounds Attain and Being pregnant Results, JAMA Inside Drugs (2021). DOI: 10.1001/jamainternmed.2021.6373

    Supplied by
    Monash University


    Quotation:
    New evidence reveals the great importance of wholesome lifestyle programs in pregnancy (2021, December 22)
    retrieved 29 December 2021
    from https://medicalxpress.com/information/2021-12-proof-significance-healthy-life-style-pregnancy.html

    This document is matter to copyright. Apart from any fair dealing for the reason of private review or investigation, no
    element may be reproduced without the penned permission. The content material is supplied for info reasons only.