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ObjectiveTo evaluate construct validity of the contraception-focused "Preference-aligned Fertility Management" (PFM) Index, a new person-centered and rights-based outcome measure, in Nigeria and Uganda.Study designWe analyzed survey data from convenience samples of new users of contraception and non-users of contraception in Uganda and users of contraception in Nigeria. PFM Index scores were calculated by combining two indicators: Indicator 1 assessing alignment between desire to use contraception and actual use; Indicator 2 evaluating whether users' current methods are desired. We developed a nomological network of related constructs and conducted bivariable logistic regressions, predicting odds of PFM associated with each variable.Results71.3% of contraception users in Nigeria, 99.2% of new users in Uganda, and 42.9% of non-users in Uganda were practicing contraception-focused PFM. In Nigeria, high Women's and Girls' Empowerment in Sexual and Reproductive Health Index scores and permission to visit a health center were significantly associated with higher odds of contraception-focused PFM (OR=2.72; 95%CI=1.01-7.31, OR=2.64; 95%CI=1.04-6.73, respectively). In Uganda, women's and partner's secondary school education were significantly associated with higher odds of contraception-focused PFM (OR=2.58; 95%CI=1.58-4.24, 2.01; 95%CI=1.54-2.62, respectively); as were concordance with partner's desired number of children, recent experience of gender-based violence, and satisfaction with what (if anything) one is doing to prevent pregnancy (OR=1.48; 95%CI=1.30-1.69, OR=2.33; 95%CI=1.52-3.56, OR=4.44; 95%CI=2.77-7.12, respectively).ConclusionsThe contraception-focused PFM Index demonstrated construct validity in Nigeria and Uganda. PFM and other new measures of self-defined need contribute to the paradigm shift underway to align contraception indicators with human rights principles.

INTRODUCTION: Presbyopia, difficulty in seeing close-ups, affects a billion people globally. Mobile financial services (MFS) have been mandated since January 2021 for Bangladesh government social safety net payments, including old age allowance (OAA) and widow allowance (WA). We report the protocol for the Transforming Households with Refraction and Innovative Financial Technology randomised trial assessing the impact on the use of online banking of providing presbyopic safety net beneficiaries with reading glasses, and brief smartphone and mobile banking app training. METHODS AND ANALYSES: Eligible participants (n=484) are OAA (men aged 65-70 years; women aged 62-70) or WA recipients (women aged 48-60) with presbyopia as their only vision problem, passing a smartphone-based test of numeracy, cognition and dexterity, and not currently owning a smartphone or independently using MFS. All participants receive smartphones loaded with a mobile banking app and a transaction-tracking app and are randomised 1:1 to receive immediate free near-vision glasses and half-day training for smartphone and banking app use (intervention), or glasses and training 12 months later (control). The primary outcome is the mean quarterly number of mobile bank transactions over the 12-month follow-up period, comparing study groups, with and without adjustment. Secondary outcomes include food security, healthcare access and social connectedness. ETHICS AND DISSEMINATION: The protocol was approved by ethics committees at Queens University Belfast (reference #MHLS22_69) and BRAC James P Grant School of Public Health (reference #IRB-21 August22-028). The trial is conducted in accordance with the Declaration of Helsinki and national regulations in Bangladesh, and results will be published in open-access, peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05510687; ClinicalTrials.gov.

Implementing self-injection (SI) of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) is a key self-care strategy for sexual and reproductive health, but SI uptake remains low, and assertions about the potential of SI to increase women's control over contraceptive use lack evidence. We sought to qualitatively explore how women with diverse contraceptive experiences-including those with and without experience using SI-view the benefits and challenges of SI as compared to other methods. We conducted 241 in-depth interviews with women across four sub-Saharan African countries and found alignment between the perceived and experienced benefits of SI across our diverse sample. Through the benefits of privacy, easier access, and self-management, we found SI can promote greater control over the contraceptive experience by facilitating a woman's ability to act on her preferences and control who is involved in or aware of her contraceptive use. Interviews revealed SI's potential is, however, constrained by inherent limitations in the method; for example, it is often not private or accessible enough and many fear injecting themselves. SI has the most potential when implemented with programmatic solutions that mitigate challenges women experience or anticipate and allow more women to benefit from the privacy, easier access, and self-management that SI offers.

Rare coding variants that substantially affect function provide insights into the biology of a gene1-3. However, ascertaining the frequency of such variants requires large sample sizes4-8. Here we present a catalogue of human protein-coding variation, derived from exome sequencing of 983,578 individuals across diverse populations. In total, 23% of the Regeneron Genetics Center Million Exome (RGC-ME) data come from individuals of African, East Asian, Indigenous American, Middle Eastern and South Asian ancestry. The catalogue includes more than 10.4 million missense and 1.1 million predicted loss-of-function (pLOF) variants. We identify individuals with rare biallelic pLOF variants in 4,848 genes, 1,751 of which have not been previously reported. From precise quantitative estimates of selection against heterozygous loss of function (LOF), we identify 3,988 LOF-intolerant genes, including 86 that were previously assessed as tolerant and 1,153 that lack established disease annotation. We also define regions of missense depletion at high resolution. Notably, 1,482 genes have regions that are depleted of missense variants despite being tolerant of pLOF variants. Finally, we estimate that 3% of individuals have a clinically actionable genetic variant, and that 11,773 variants reported in ClinVar with unknown significance are likely to be deleterious cryptic splice sites. To facilitate variant interpretation and genetics-informed precision medicine, we make this resource of coding variation from the RGC-ME dataset publicly accessible through a variant allele frequency browser.

Abstract Objective Niger has among the highest rates of child marriage and lowest rates of modern contraceptive use in the world. This study analyzes the association between contraceptive decision-making and contraceptive use among married adolescent girls in rural Niger, including multiple assessments of decision-making and consideration of overt vs. covert contraceptive use. Methods We analyzed cross-sectional survey data collected from married adolescent females (n = 823) participating in the third round of data collection (October–November 2019) for the cluster-randomized controlled trial of a family planning intervention study. Contraceptive decision-making measures assessed participants’ (a) participation in contraceptive decision-making, (b) final say in decision-making in case of spousal disagreement, and (c) satisfaction with participation in decision-making. Outcomes include contraceptive use ever categorized based on whether use was overt (with husband’s knowledge) or covert (without husband’s knowledge). Adjusted multinomial logistic regression models were used to test the associations between each decision-making item and each type of contraceptive use. Results Over half of participants reported ever using a contraceptive (59%) and that their husbands were the sole decision-makers regarding contraceptive use (60%). Adolescents’ participation in decision-making was negatively associated with overt contraceptive use (ARRR = 0.41; 95%CI = 0.19–0.91) and positively associated with covert contraceptive use (ARRR = 8.76; 95%CI = 2.45–31.30). Women reporting joint decision-making were more likely to report covert use vs. no use (ARRR = 3.20; 95%CI = 1.14–8.99). Women having final say in contraceptive decision-making in case of disagreements were more likely to report covert contraceptive use over no use (ARRR = 9.14; 95%CI = 3.17–26.40). Women’s satisfaction with decision-making was positively associated with contraceptive use ever (AOR = 2.72; 95%CI = 1.80–4.16), and overt (ARRR = 2.68; 95%CI = 1.75–4.01) and covert contraceptive use (ARRR = 10.9; 95%CI = 2.16–54.80). Conclusion Male control over decision-making and female satisfaction with decision-making are associated with greater contraceptive use. Findings indicate that women’s control over decision-making, and its relation to contraceptive use, is complex and requires more nuanced understanding for married adolescents.

Naveen Kumar Challa, Waleed M Alghamdi, Muhammed S Alluwimi, Saleh Alshammeri Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraidah, AlQassim, Saudi ArabiaCorrespondence: Naveen Kumar Challa, Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraidah, AlQassim, Saudi Arabia, Tel +966531177518, Email N.challa@qu.edu.saAim: To assess and compare subclinical alterations in superficial capillary plexus vessel density (SCPVD) and retinal layers thickness in the macular region between individuals with type 2 diabetes mellitus (DM) and healthy controls.Methods: Swept-source OCT images were obtained from 29 control subjects and 24 diabetic subjects. Macular thickness (MT), retinal nerve fiber layer (RNFL) thickness, and ganglion cell layer (GCL) thickness were measured in the central macula and four quadrants of macular region using a 6.0 × 6.0 mm radial macular scan centered on the fovea. OCTA acquisition included a 3.0 × 3.0 mm macular scan for the foveal avascular zone (FAZ) and a 4.5 × 4.5 mm macular scan for SCPVD. The FAZ was manually mapped at the SCP on OCTA images.Results: In diabetic subjects, the superficial capillary plexus vessel density (SCPVD) was significantly lower in both the central (P = 0.04) and inferior (P = 0.01) regions compared to the control group. Additionally, diabetic patients showed a significant reduction in temporal macular thickness (MT) and thinning of the ganglion cell layer (GCL) in all three quadrants except in the central and inferior macula (P < 0.05). There was also significant thinning of the superior macular retinal nerve fiber layer (RNFL) in diabetics compared to controls (P = 0.02). While the foveal avascular zone (FAZ) was larger in diabetic subjects, this difference was not statistically significant (P = 0.78). Duration of diabetes has shown a significantly high positive correlation (r = 0.77, P < 0.01) with superior macular VD.Conclusion: The findings of this study suggest that the diabetic macula experiences significant ganglion cell layer (GCL) thinning and reduced superficial capillary plexus (SCP) vascular density even before the onset of clinical retinopathy. Swept-source OCT proves to be an essential tool for detecting these early changes in diabetic patients.Keywords: tomography, age, RNFL, SCPVD, FAZ, diabetes mellitus

Background: Osteoarthritis of the knee joint (OAK) represents a leading cause of pain, functional limitation, and diminished quality of life, particularly among older adults. The association between metabolic syndrome (MetS) and OAK is of growing interest due to the potential impact of MetS components on joint health. While evidence suggests that MetS and its components may influence the development of osteoarthritis (OA), the specific relationship between MetS and the likelihood of progressing to a stage of OAK that requires Total knee replacement (TKA) remains underexplored. Aim: This study aimed to evaluate the association between osteoarthritis of the knee joint (OAK) and metabolic syndrome (MetS) and to know whether the presence of MetS (or its components) increases the risk of OAK requiring Total knee replacement (TKA). Methodology: It is a cross-sectional study that includes patients (males and females) above 50. Data collection was done including demographic details, medical history, physical examinations, and laboratory tests. OAK (≥grade 2 Kellgren-Lawrence) and severe OAK (≥grade 3 Kellgren-Lawrence) were evaluated based on radiological findings. Statistical Analysis: Mean, standard deviation, frequencies, and percentages were calculated for baseline characteristics. To analyze the association between qualitative factors and MetS, the Chi-Square test was used. For comparing quantitative factors, the unpaired t-test was employed. A P value of less than 0.05 was considered statistically significant. Results: The study involved 107 primary osteoarthritis patients categorized into cases (N = 57), requiring TKA, and controls (N = 50), not requiring TKA. MetS was significantly more prevalent among cases than controls, with 68.4% of cases and 36% of controls testing positive for MetS (P = 0.001). The odds of having MetS were 3.9 times higher in the cases compared to the controls. Conclusion: The results of our research could shed light on how MetS affects the onset and course of OAK, guiding primary care and prevention measures. It might also emphasize how critical it is to treat MetS symptoms to lessen the severity of OAK. Understanding whether MetS or its components are linked to an increased risk of TKA could provide crucial insights into preventive and therapeutic strategies for managing severe OAK.