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Background: The Addressing Reproductive Coercion in Health Settings (ARCHES) intervention trains existing providers to address reproductive coercion (RC) and intimate partner violence (IPV) within routine family planning counseling. This study evaluated the effectiveness of a single ARCHES counseling session as adapted for use with abortion clients in Bangladesh. Methods: In this cluster-randomized controlled trial conducted between January 2019 and January 2021, health facilities with an abortion clinic with infrastructure for private counseling and onsite violence support services were eligible. Six facilities in Bangladesh met inclusion criteria, and matched pairs randomization with parallel assignment and a 1:1 allocation ratio was used to randomize three facilities to ARCHES and three facilities to control, which implemented standard counseling. Blinding was not possible as providers in intervention facilities participated in a three-day ARCHES training. Participants were abortion clients aged 18–49 years who could provide safe recontact information and be interviewed privately. The primary outcome was past three-month modern contraceptive use without interruption or interference. The trial was registered on clinicaltrials.gov (NCT03539315) on 29 May 2018. Findings: A total of 1492 intervention participants and 1237 control participants were enrolled. Available data were analyzed at each follow-up period: 1331 intervention and 1069 control participants at the three-month follow-up, and 1269 intervention and 1050 control participants at the twelve-month follow-up. ARCHES was associated with higher likelihood of modern contraceptive use at the three-month follow-up (adjusted RR = 1.08, 95% CI: 1.06–1.10) and the twelve-month follow-up (adjusted RR = 1.06, 95% CI: 1.02–1.10). ARCHES was also associated with decreased incident pregnancy, decreased IPV, and increased knowledge of IPV support services. Interpretation: The ARCHES intervention is effective in increasing post-abortion modern contraceptive use and decreasing incident pregnancy and IPV among abortion clients in Bangladesh. Implementation of ARCHES should be considered in facilities with sufficient privacy for counseling. Funding: Society of Family Planning (#SFPRF11-07) and Ipas.

This study was undertaken to evaluate the effect of a reproductive empowerment contraceptive counselling intervention (ARCHES) adapted to private clinics in Nairobi, Kenya on proximal outcomes of contraceptive use and covert use, self-efficacy, awareness and use of intimate partner violence (IPV) survivor services, and attitudes justifying reproductive coercion (RC) and IPV. We conducted a cluster-controlled trial among female family planning patients (N = 659) in six private clinics non-randomly assigned to ARCHES or control in and around Nairobi, Kenya. Patients completed interviews immediately before (baseline) and after (exit) treatment and at three- and six-month follow-up. We use inverse probability by treatment weighting (IPTW) applied to difference-in-differences marginal structural models to estimate the treatment effect using a modified intent-to-treat approach. After IPTW, women receiving ARCHES contraceptive counselling, relative to controls, were more likely to receive a contraceptive method at exit (86% vs. 75%, p

BackgroundAbortions are restricted in Bangladesh, but menstrual regulation is an approved alternative, defined as a procedure of regulating the menstrual cycle when menstruation is absent for a short duration. Use of contraception after menstrual regulation can reduce subsequent unintended pregnancy, but in Bangladesh, the contraceptive method mix is dominated by short-term methods, which have higher discontinuation and failure rates. Mobile phones are a channel via which menstrual regulation clients could be offered contraceptive support after leaving the clinic. ObjectiveThis study aimed to support the development of a mobile phone intervention to support postmenstrual regulation family planning use in Bangladesh. It explored what family planning information women want to receive after having a menstrual regulation procedure, whether they would like to receive this information via their mobile phone, and if so, what their preferences are for the way in which it is delivered. MethodsWe conducted participatory interviews with 24 menstrual regulation clients in Dhaka and Sylhet divisions in Bangladesh. Women were recruited from facilities in urban and peri-urban areas, which included public sector clinics supported by Ipas, an international nongovernmental organization (NGO), and NGO clinics run by Marie Stopes. Main themes covered in the interviews were factors affecting the use of contraception, what information and support women want after their menstrual regulation procedure, how respondents would prefer to receive information about contraception, and other key issues for mobile health (mHealth) interventions, such as language and privacy. As part of the in-depth interviews, women were shown and played 6 different messages about contraception on the research assistant’s phone, which they were given to operate, and were then asked to give feedback. ResultsWomen were open to both receiving messages about family planning methods on their mobile phones and talking to a counselor about family planning methods over the phone after their menstrual regulation. Women most commonly wanted information about the contraceptive method they were currently using and wanted this information to be tailored to their particular needs. Women preferred voice messages to text and liked the interactive voice message format. When asked to repeat and identify the main points of the messages, women demonstrated good understanding of the content. Women did not seem too concerned with privacy or with others reading the messages and welcomed including their husbands in speaking to a counselor. ConclusionsThis study found that menstrual regulation clients are very interested in receiving information on their phones to support family planning use and wanted more information about the method of contraception they were using. Participatory voicemail was the preferred modality.

Helping students recognize the value of humanistic inquiry can be challenging, especially in required courses. This essay presents a solution: an assignment in which students were asked to pitch one of the required readings to Netflix for adaptation. Through close readings of student responses and an analysis of the "so what" component in a later literary analysis essay, I argue that this nontraditional assignment helped students develop disciplinary skills while articulating disciplinary value. This easily adaptable assignment can help instructors increase student motivation, particularly in courses that fulfill departmental and general education requirements.

Only 13% of older Canadians achieve weekly physical activity (PA) recommendations suggesting that health promotion efforts are warranted. Tai Chi (TC) is a martial art identified as an accessible form of PA for older adults. While research has supported TC's ability to enhance health among those with chronic conditions, no studies have investigated healthy older adults who are experienced in TC practice. To uncover avenues to enhance PA rates and adherence, the study purpose was to explore qualitatively, the perspectives of experienced, healthy older adult TC practitioners. Older adults who identified as healthy and had been practicing TC for at least 1 year were recruited from a community-based program in Northwestern Ontario, Canada. Semi-structured interviews, observations, and field notes were collected and analyzed using deductive and inductive content analysis. Eleven participants (Mean age = 64.9 years; male, n = 8) with an average of 13.6 years TC experience were enrolled. Analysis revealed five themes with associated subthemes including: reasons for joining (e.g., becoming active); participant principles related to TC and aging (e.g., being kind to an aging body); barriers to practice (e.g., class size); facilitators for practice (e.g., energy from softness), and group dynamics (e.g., delivery format). Findings suggest that in this population, TC is gentle and holistic, and facilitators to practice outweigh the barriers. Researchers and health care providers should adopt similar program characteristics (e.g., group-based format, supportive instructors, facilitated social network) when seeking to promote PA in older adults. Keywords: Tai Chi; exercise adherence; group dynamics; qualitative research, Introduction Adults over the age of 50 comprise roughly 37% of the Canadian population (Statistics Canada, 2020), and this cohort is projected to grow at a rapid rate in the [...]

Simple Summary: Historically, there have been very few reports of elevated thyroid hormone (hyperthyroidism) due to thyroid dysfunction in equid species (horses, mules, donkeys, zebras). Hyperthyroidism is a relatively common problem in cats and humans. Increased appetite, weight loss and muscle wasting, elevated heart rate and elevated blood pressure are common clinical signs in these species. In the few case reports of hyperthyroid horses, they often present with weight loss and increased appetite, but there have not been any documented cardiac changes (elevated heart rate, heart murmur, elevated blood pressure) in these patients. The mule investigated in this case report presented with a persistently elevated heart rate and systolic murmur. Cardiac imaging revealed structural changes consistent with those seen in other hyperthyroid mammals. This case report documents the diagnosis, treatment and management and provides long-term follow up of endocrine and cardiac disease in a mule with primary hyperthyroidism. Primary hyperthyroidism is a rarely diagnosed endocrinopathy in equids and there have been no previous reports of structural and functional cardiac changes associated with hyperthyroidism in these species. This case report investigates a 20-year-old mule gelding that presented for a three-month history of thin body condition despite polyphagia, with a heart murmur and elevated free and total thyroid hormone concentrations. On presentation, physical exam revealed a body condition score of two out of nine, persistent tachycardia, pansystolic heart murmur and firm bilateral ventral proximal cervical masses. Bloodwork confirmed markedly elevated free T4, total T4 and T3 concentrations. Echocardiogram demonstrated left ventricular concentric hypertrophy with increased ventricular and atrial systolic function. Bilateral thyroidectomy was performed under standing sedation without complications. Histopathology demonstrated adenocarcinoma of the left thyroid gland and multiple adenomas with osseous metaplasia within the right thyroid. The mule was supplemented with levothyroxine sodium two weeks post-op after a thyroid panel demonstrated undetectable concentrations. Polyphagia resolved following surgery and the mule began gaining weight. Echocardiographic changes improved but did not resolve at two years post-operative. Continued bi-annual follow up and monitoring of thyroid levels was recommended. This case represents the first documentation of hemodynamically relevant cardiac remodeling in an equid associated with primary hyperthyroidism. [ABSTRACT FROM AUTHOR]

Media coverage of the Paralympic Games can affect how athletes with impairment and disability sport are perceived by the public. Researchers investigating media representations of disability sport have focused on how Paralympic athletes and disability sport are represented by the media. Limited research, however, has examined how Paralympic athletes perceive these representations of themselves and the meanings they attribute to such representations. The purpose of this study was to examine how Paralympic athletes make meaning of discourses of disability within Paralympic coverage. This involved semi-structured photo-elicitation interviews with eight Canadian Paralympic athletes. A reflexive thematic analysis (RTA) was used to analyze the data utilizing Foucault's notions of discourse, power, and technologies of the self. The findings demonstrate that Paralympic athletes made meaning of the discourses of disability within Paralympic media coverage by drawing on their lived and media experiences. Athletes with more media experience articulated problematizations of dominant discourses of disability in Paralympic media coverage and engagement in technologies of the self. Knowledge generated from this study offers media personnel an informed understanding of how Paralympic athletes understand representations of disability and disability sport. This knowledge may offer insight and inform future media approaches of disability sport and the Paralympic Games. [ABSTRACT FROM AUTHOR]