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ABSTRACTBackgroundModern slavery is a complex global health problem that includes forced labor exploitation. An ecological systems perspective is needed to understand how contextual upstream and midstream factors contribute to labor exploitation, and how disruptive societal challenges, such as infectious disease pandemics, may exacerbate established pathways leading to exploitation. Accumulation of familial and societal risk factors likely heightens vulnerability; for instance, economic precarity for an individual interacts with poor livelihood options and lack of social welfare supports increasing their likelihood of accepting exploitative labor. However, few frameworks exist that account for the accumulation of and interdependence between risk factors at different levels and across contexts.ObjectiveUsing an ecological systems framework, we review literature on the pathways leading to labor exploitation, with the aim of developing a conceptual model grounded in existing research. Next, we discuss how pathways in this conceptual model are likely exacerbated by the COVID-19 pandemic. This conceptual model can guide future research to detect modifiable factors and strategic points of intervention.MethodsA critical review of research articles and gray literature was performed with a primary focus on sub-Saharan Africa. The review utilized various scholarly databases to identify perspectives from multiple disciplines and to more fully account for complex processes linked to labor exploitation.ResultsA conceptual model of these pathways was developed that emphasizes established determinants and risk factors for labor exploitation in sub-Saharan Africa. The model highlights how the COVID-19 pandemic may have exacerbated these pathways.ConclusionsFuture studies should carefully examine the direct and indirect pathways, accumulation of and interactions between factors, and specific external and personal stressors. Interdisciplinary research on multilevel interventions is needed to guide solutions to prevent the persistent problem of labor exploitation.

Background Traditional Chinese medicine (TCM) offers various treatment modalities guided by TCM diagnoses. In the United States, acupuncture is a commonly employed TCM method for treating a variety of chronic illnesses. Three systematic reviews have been reported recently, reaching differing conclusions about the efficacy of acupuncture for the treatment of fibromyalgia (FM). Among the FM acupuncture studies considered in these reviews, none used TCM diagnosis as an inclusion/exclusion criterion or adjusted treatment based on TCM diagnosis. Overlooking TCM diagnosis may be a reason for such disparate results.Primary study objective To obtain TCM diagnoses in a sample of women meeting 1990 American College of Rheumatology criteria for FM who were recruited for a yoga study and to investigate whether there is significant variability.Methods/design Two TCM practitioners conducted baseline TCM diagnostic examinations on 56 women with FM. A consensus diagnosis was reached based on standardised history, palpation and examination. Canonical discriminate analysis identified two baseline items which predicted TCM diagnosis.Setting School of Nursing, Oregon Health & Science University.Participants Women, ages 23–75, with FM recruited to a yoga intervention studyResults Three primary TCM diagnoses were found in the population: Qi and Blood Deficiency (46.4%, CI 33.0% to 60.36%), Qi and Blood Stagnation (26.8%, CI 15.8% to 40.3%), and Liver Qi Stagnation (19.6%, CI 10.2% to 32.4%).Conclusion It is likely that previous studies of FM were treating a heterogeneous study population where variable results might be expected. Future acupuncture studies should either control for TCM diagnosis or consider its usefulness as an inclusion/exclusion criterion.

Hypothesis Studies indicate that menopausal symptoms are relieved by acupuncture. Additional studies have suggested that acupuncture may affect heart rate variability (HRV). This paper reports a pilot study that investigated whether menopausal symptoms responded to acupuncture, and if changes in the spectral analysis of HRV, either suppression of low frequency or augmentation of high frequency bands, corresponded with symptom report.Methods/interventions 12 healthy menopausal subjects were enrolled in this feasibility study. At baseline, subjects were experiencing moderately distressing menopausal symptoms, scoring at least 22 of a possible 44 points on the Menopausal Rating Scale. 10 traditional Chinese medicine-based, protocol acupuncture treatments were administered over a 4 week period, three times a week for 2 weeks, followed by twice a week for 2 weeks.Outcome measures Menopausal Rating Scale questionnaire, 11 menopausal symptoms were evaluated on a zero to four severity scale via self-administered daily checklist for 4 weeks. Dynamic measures of HRV (autoregressive model) were captured before, during and after acupuncture at each session. Spectral analysis of the heart rate was used to compute power in the low frequency and high frequency bands, and their ratio.Results All subjects complied fully with the protocol without any reported adverse events. While all 11 symptoms showed significant improvement, and one HRV measure changed, on average over the study period, there was essentially no support for a relationship between HRV, menopausal symptom report and acupuncture intervention.

In the promotion of moderate physical activity it is increasingly argued that a supportive physical environment is a key factor, and that local government is ideally placed to play an important role. This study reports on the factors that led one local government to take such a leading role. A semi-structured interview was conducted to find out why a chief executive officer of a local government decided that the creation of supportive environments for physical activity was the core business of council. The results show that key ingredients were that local government should take a strategic rather than an operational focus on the issue, that there should be open organisational structures to allow the various functions of local government to work together, and that there must be appropriate leadership. The findings suggest ways for engaging local government as a key partner in promoting supportive environments that are consistent withliterature on policy, organisational structure and leadership theory.

Patients with long-standing extensive ulcerative colitis have an increased risk of colorectal cancer compared with the general population, and the carcinoma is frequently preceded by dysplasia. Molecular markers such as Ki-67, DPC-4, and DYS nuclear matrix proteins may potentially be useful for further refining the diagnosis of dysplasia, or may even eventually provide an alternative method of predicting colorectal cancer. If DYS nuclear matrix proteins prove to be reliably restricted to dysplasia and cancer, their identification in tissues or even serum could be immensely useful. Clinical studies provide further support to the increasingly prevalent recommendation that any dysplasia warrants colectomy. Chemopreventive methods, such as supplementation with folic acid, may help reduce the incidence of neoplasia, but more studies are needed.

Sclerosing sweat-duct carcinoma or malignant syringoma is a rare eyelid tumor. The authors report the first patient with sclerosing sweat-duct carcinoma involving the upper eyelid and present its immunohistochemical and ultrastructural features. The clinical features and the histopathologic and ultrastructural findings that distinguish this tumor from its benign counterparts are discussed. Sclerosing sweat-duct carcinomas are slow growing but locally invasive neoplasms that have a propensity to recur. Wide and deep surgical excision with frozen section evaluation of margins is recommended.

While there is evidence that omeprazole may induce changes in parietal cells, the effect of acid suppression on parietal cells in humans is poorly documented. This study was undertaken to evaluate the effects of omeprazole in human parietal cells over time. The light microscopic morphology of parietal cells in gastric biopsies from 17 patients on omeprazole were compared with those from 13 patients on ranitidine and 20 patients on no acid-lowering medication. Light microscopic and ultrastructural morphology of parietal cells was also evaluated in an additional 14 patients before and after omeprazole administration. Objective measurements of parietal cell height, mass and number were analyzed using analyses of variance. Electron microscopy was used to evaluate parietal cell enlargement. Twenty-five of 31 biopsies from patients on omeprazole, 1 of 13 from patients on ranitidine, and 0 of 20 from patients on neither drug showed parietal cell enlargement. Parietal cell height, mass, and number were increased in omeprazole-treated patients compared with ranitidine-treated patients and those on neither drug, and with the group also evaluated prior to beginning omeprazole treatment. Parietal cell height and mass were increased in patients on omeprazole longer than 12 months compared with biopsies from patients on the drug for less than 12 months. Resin-embedded sections and electron microscopy showed enlarged parietal cells with prominence of cytoplasmic tubulovesicles with sparse secretory canaliculi. Parietal cell hypertrophy and hyperplasia develops in patients on chronic omeprazole therapy; this can be recognized on routine examination of histologic sections. These morphologic changes increase with duration of therapy.

Disease of the terminal ileum can be diagnosed by ileocolonoscopy or barium radiography. We compared the diagnostic accuracy in the terminal ileum of ileocolonoscopy and small-bowel meal with pneumocolon.

This study examined 96 women early childhood educators' death anxiety and their comfort in discussing death with preschool children. Ninety percent believed it was important to be able to discuss death with young children, but only 32 percent felt prepared to do so. liachers' death anxiety scores were significantly correlated with comfort with dealing with death in the classroom (R = .30). Death anxiety was significantly related to teachers' training in children's understanding of death. No other academic or personal experience factors were significantly related to death anxiety or comfort. However, there was an overall pattern for anxiety and comfort scores to be higher for subjects with the greatest academic and personal experiences in death and dying. Suggestions for teacher education and future investigations are presented.

Many sexual abuse prevention programs originally designed for school children are inappropriately used with preschool children. Programs used with young children need to take into consideration their unique learning abilities. This paper uses a developmentally appropriate practice framework as a guide in helping early childhood professionals evaluate sexual abuse prevention programs.

The article presents information related to the prevention of Urinary Tract Infections (UTIs). These infections are common in women. But, herbs with diuretic properties can easily cleanse the kidneys. UTIs are most commonly caused from bacteria moving from the rectum or vagina to the urethra and bladder.

The article focuses on the link between poor diet and the prevalence of digestive problems among Canadian children. Most Canadians consume what is called the Standard American Diet (SAD), which is composed of carbohydrates, processed foods, and chemical additives, thus, lacking the necessary nutrients found in fruits and vegetables. The children are commonly affected in the SAD diet which results to digestive problems like constipation, digestive enzyme inadequacy, and parasitic conditions.

The article focuses on the benefits of herbal chelation in reducing heavy metal toxicity. Herbal heavy metal cleanses are an effective natural method for removing heavy metals. These cleanses remove heavy metals through a process known as chelation. Its binding nature results in some vitamins and minerals being removed from the body during a cleanse. INSET: How are we exposed?.

The article provides answers from readers of the magazine to a question regarding the important question they ever asked themselves.

No relevant conflicts of interest to declare.

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The article provides information about heartburn and its remedy. Also known as acid indigestion or acid reflux, heartburn is an irritation of the esophagus caused by acid that goes up from the stomach. A discussion on how this acid is formed is then presented. Moreover, its treatment will include digestive enzymes, ellagic acid from raspberries, and gastric mucin.

The article provides information about the functions of liver and the means to clean it. Liver is considered as a vital organ next to the skin. It plays an important role in making cholesterol, bile and blood proteins. It is recommended to use supportive herbs that stimulate the production of bile when cleansing the liver. INSET: Liver helpers.