A Field Test of the NORMAL Job Aid With Community Health Workers in Kenya to Address Contraceptive-Induced Menstrual Changes.

INTRODUCTION: Concerns about contraceptive-induced menstrual changes (CIMCs) contribute to nonuse and discontinuation of family planning (FP). Current counseling materials inadequately address these concerns. After obtaining initial feedback, we field-tested an adapted version of the NORMAL job aid that guides community health workers on how to counsel women about CIMCs. The field test aimed to help understand how the job aid was used, the challenges faced in using it, and recommendations to improve the job aid. METHODS: Sixteen community health volunteers (CHVs) from 2 subcounties in Kenya were trained on the 2-page job aid and given copies of the job aid to use with clients. Six to 8 weeks after the training, we interviewed the CHVs about their experiences using the job aid. The interviews were audio-recorded, transcribed, and analyzed to identify qualitative themes. RESULTS: All 16 CHVs reported using the job aid each time they counseled. All liked it and said they used it because it gave them new information and made counseling easier. All reported offering the job aid to most clients and that most clients accepted a copy. CHVs noted clients referred their friends and family to them after counseling using the job aid. CHVs said the job aid reduced clients' and their male partners' concerns about CIMCs and helped clients select or switch FP methods. Most CHVs did not have suggestions for improving the job aid. CONCLUSION: The job aid was highly acceptable to the CHVs who participated in this small assessment. According to the CHVs, it increased counseling effectiveness and may help increase uptake and continued use of FP methods directly through counseling or indirectly through diffusion in the community. Though further research is needed in other settings and to quantify its impact, we recommend this promising job aid be adapted for wider use.

Global research and learning agenda for building evidence on contraceptive-induced menstrual changes for research, product development, policies, and programs.

Background: Contraceptive-induced menstrual changes (CIMCs) can affect family planning (FP) users' lives in both positive and negative ways, resulting in both opportunities and consequences. Despite this, and despite the important links between FP and menstrual health (MH), neither field adequately addresses CIMCs, including in research, product development, policies, and programs globally. Methods: In November 2020, a convening of both MH and FP experts reviewed the existing evidence on CIMCs and identified significant gaps in key areas. Results: These gaps led to the establishment of a CIMC Task Force in April 2021 and the development of the Global Research and Learning Agenda: Building Evidence on Contraceptive-Induced Menstrual Changes in Research, Product Development, Policies, and Programs Globally (the CIMC RLA) , which includes four research agendas for (1) measurement, (2) contraceptive research and development (R&D) and biomedical research, (3) social-behavioral and user preferences research, and (4) programmatic research. Conclusions: Guided by the CIMC RLA, researchers, product developers, health care providers, program implementers, advocates, policymakers, and funders are urged to conduct research and implement strategies to address the beneficial and negative effects of CIMCs and support the integration of FP and MH. CIMCs need to be addressed to improve the health and well-being of women, girls, and other people who menstruate and use contraceptives globally. Disclaimer : The views expressed in this article are those of the authors. Publication in Gates Open Research does not imply endorsement by the Gates Foundation.

Effect of the ligand shell composition on the dispersibility and transport of gold nanocrystals in near-critical solvents.

The development of more efficient and environmentally benign methods for the synthesis and manipulation of nanomaterials has been a major focus of research among the scientific community. Supercritical (ScFs) and near-critical fluids (NcFs) offer numerous advantages over conventional solvents for these purposes. Among them, ScFs and NcFs offer dramatic reductions in the volume of organic waste typically generated during advanced material processes with the feasibility of changing a number of physicochemical properties by discrete variations in solvent pressure or temperature. In this work, we study the dispersibility of gold nanocrystals with a 3.7 nm core size stabilized by different ligand shells in NcF ethane and propane over a wide range of densities by fine-tuning the pressure of these fluids. Dispersibility vs density plots are obtained by following the variation in the surface plasmon resonance (SPR) absorption spectra of the nanoparticles. To understand the results obtained in this study, three models are briefly discussed: the total interaction theory, the sedimentation coefficient equation, and the Chrastil method. The dispersibility and behavior of the nanocrystals with variations in fluid density are strongly dependent on the surface chemistry of the nanocrystal and the solvent employed. A correlation between measured dispersibility values and calculated sedimentation coefficients was observed in both compressed solvents. In addition, we successfully applied the Chrastil equation to predict and describe the dispersibility of gold nanocrystals with different shells as a function of density, determining that the reason for the high stabilities of some of the nanocrystal dispersions is the strong solvent-nanocrystal interactions. While NcF propane showed higher nanocrystal dispersibilities, using NcF ethane led to improved tunability of nanoparticle dispersions formed in the pressure range studied. Therefore, with a judicious selection of the fluid, NcFs seem to offer a remarkable advantage over conventional solvents for manipulation of nanomaterials, which could be applied to transport, purification, and separation of nanocrystals.

Advancements toward the greener processing of engineered nanomaterials--effect of core size on the dispersibility and transport of gold nanocrystals in near-critical solvents.

The ability to process and purify engineered nanomaterials using near critical or supercritical fluids (NcFs or ScFs) has enormous potential for the application at various stages of the development of green nanomaterials. The dispersibility of octanethiol-stabilized gold nanocrystals of different core sizes is explored, which were chosen to serve as model nanomaterials of general interest in compressed ethane and propane over a wide range of fluid conditions. Both solvents have enormous potential for the environmentally benign processing and transport of engineered nanomaterials due to their nominal toxicity and high degree of tunability and processability that can essentially eliminate solvent waste. The dispersibility is determined by measuring the absorption spectra of dispersions of various sizes of nanocrystals in NcFs. To better understand the obtained results three models, the total interaction theory, the sedimentation coefficient equation, and the Chrastil method, are discussed. Nanoparticle dispersibility versus density plots are strongly dependent on nanoparticle size and solvent conditions, with the dispersion of larger nanocrystals more dependent on changes of pressure or density at a given temperature. For the range of nanoparticle sizes studied, compressed ethane at 25 degrees C leads to a greater tunability of nanoparticle dispersion when compared with compressed propane at 65 degrees C. For equivalent pressures, compressed propane is found to provide better solubility than ethane due to its higher density. The results quantitatively demonstrate that NcFs can offer pressure-tunable, size-selective control of nanoparticle solvation and transport at easily obtainable temperature and pressure conditions. These capabilities provide clear advantages over conventional solvents and direct application to various nanomaterials processes, such as synthesis, separation, transport, and purification of nanocrystals.