Toward a New Definition of Unmet Need for Contraception

The current definition of unmet need for contraception assumes that all women who are using a method have a met need. We argue that without taking into account the level of satisfaction with a method, many women are classified as having a met need, when in fact they have an unmet need. They are using a method that does not meet their preferences, either because it causes side effects they find untenable or has other characteristics they do not like. Given the large number of contraceptive episodes that end in discontinuation, reportedly often due to the experience of side effects, we argue that the current definition of unmet need undercounts the number of women with a true unmet need for contraception as it misses the many women who are using a method that does not meet their preferences. We suggest the addition of satisfaction questions in national surveys such as the Demographic and Health Surveys to more fully assess the level of true met need for contraception.     

Recommended Immunological Strategies to Screen for Botulinum Neurotoxin-Containing Samples

Botulinum neurotoxins (BoNTs) cause the life-threatening neurological illness botulism in humans and animals and are divided into seven serotypes (BoNT/A–G), of which serotypes A, B, E, and F cause the disease in humans. BoNTs are classified as “category A” bioterrorism threat agents and are relevant in the context of the Biological Weapons Convention. An international proficiency test (PT) was conducted to evaluate detection, quantification and discrimination capabilities of 23 expert laboratories from the health, food and security areas. Here we describe three immunological strategies that proved to be successful for the detection and quantification of BoNT/A, B, and E considering the restricted sample volume (1 mL) distributed. To analyze the samples qualitatively and quantitatively, the first strategy was based on sensitive immunoenzymatic and immunochromatographic assays for fast qualitative and quantitative analyses. In the second approach, a bead-based suspension array was used for screening followed by conventional ELISA for quantification. In the third approach, an ELISA plate format assay was used for serotype specific immunodetection of BoNT-cleaved substrates, detecting the activity of the light chain, rather than the toxin protein. The results provide guidance for further steps in quality assurance and highlight problems to address in the future.