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Introduction: Menopausal hormone therapy is the most efficacious option for treating vasomotor symptoms, the genitourinary syndrome of menopause, and to prevent fractures and bone loss. However, publication of contradictory evidence about the risks associated with menopausal hormone therapy and changing recommendations created confusion among patients and providers about how best to manage symptoms. Because providers with varying degrees and specialties may take care of midlife women, and there is no specific certification required to offer menopause treatment, The Menopause Society established its competency exam in 2002 to set the standard for menopause care and assist women in locating clinicians who provide optimal menopause-related care. Objective: To identify clinics advertising menopause treatment in Ohio, Michigan, and Pennsylvania and evaluate whether clinics not affiliated with a MSCP-certified provider are more likely to offer guideline-non-concordant treatment compared to clinics affiliated with a MSCP- certified provider. Methods: We performed an internet search to identify clinics providing menopause treatment in Ohio, Michigan, and Pennsylvania. From each clinic's website we abstracted the location, whether the clinic offered guideline-non-concordant treatment (hormone testing, bioidentical "hormone menopause therapy (HRT)", or compounded HRT), whether the clinic advertised that menopausal hormone therapy(MHT) would promote youthful appearance or weight loss, and whether the clinic accepted insurance. We checked clinic personnel against the Menopause Society directory of practitioners to determine if the clinic was affiliated with a MSCP-certified provider. We used Fisher's exact test to evaluate association between affiliation with a MSCP provider and guideline-non-concordant care, inaccurate claims about MHT, and accepting insurance. Our primary outcome was odds of offering hormone testing. Results: We identified 174 clinics (41% in OH, 28% in PA, and 31% in MI). 13% of clinics were affiliated with a MSCP-certified provider. Clinics with a MSCP-certified provider are significantly more less likely to advertise hormone testing (primary outcome, OR = 0.11, 95% confidence interval: 0.02 to 0.39), compounded hormone therapy (OR = 0.06, 95% confidence interval: 0.001 to 0.41), and bioidentical hormone therapy (OR = 0.07, 95% confidence interval: 0.001 to 0.26), compared to clinics without a MSCP-certified provider. MSCP provider-affiliated clinics are also less likely to advertise that hormone replacement therapy will help maintain youth or help with weight loss (Table). Clinics with a MSCP-certified provider are more likely to accept insurance (OR = 7.55, 95% confidence interval: 1.59 to 72.29). Conclusions: Our research has shown that in the states of Ohio, Michigan, and Pennsylvania, MSCP-certified providers were more likely to adhere to the Menopause Society's guidelines and not advertise for compounded or bioidentical hormones, recommend hormone testing, or advertise hormones for a youthful appearance or weight loss. These clinics were also more likely to accept insurance. Providers who work with midlife women should consider obtaining their MSCP certification to remain current with evidence-based practice and make it easier for patients to locate a provider who is following the most up to date guidelines. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: Astellas. [ABSTRACT FROM AUTHOR]

Objective: To identify clinics in Ohio, Michigan, and Pennsylvania that advertise menopause treatment on their website and evaluate whether clinics not affiliated with a Menopause Society Certified Practitioner (MSCP) are more likely to offer guideline-nonconcordant treatment compared to clinics affiliated with an MSCP., Methods: We performed an Internet search to identify clinics advertising on their website menopause treatment in Ohio, Michigan, and Pennsylvania. We checked clinic personnel against The Menopause Society directory of practitioners to determine if the clinic was affiliated with an MSCP., Results: We identified 174 clinics (41% in OH, 28% in PA, and 31% in MI). Thirteen percent of clinics were affiliated with an MSCP. Clinics with an MSCP are significantly less likely to advertise hormone testing (primary outcome; odds ratio [OR], 0.11; 95% confidence interval, 0.02-0.39), compounded hormone therapy (OR, 0.06; 95% confidence interval, 0.001-0.41), and bioidentical hormone therapy (OR, 0.07; 95% confidence interval, 0.001-0.26), compared to clinics without an MSCP-affiliated clinics that are also less likely to advertise that hormone therapy will help maintain youth or help with weight loss., Conclusions: Our pilot study has shown that in the states of Ohio, Michigan, and Pennsylvania, clinics with an MSCP were more likely to advertise on their website an adherence to The Menopause Society's guidelines and not advertise for compounded or bioidentical hormones, recommend hormone testing, or advertise hormones for a youthful appearance or weight loss., Competing Interests: Financial disclosure/conflicts of interest: J.M.M. receives ongoing funding from Astellas and is a consultant to MIM. R.P. receives funding from Astellas and Johnson and Johnson. The other authors have nothing to disclose., (Copyright © 2024 by The Menopause Society.)

The Centers for Disease Control and Prevention (CDC), in coordination with 65 states, cities, and territories, implemented HIV prevention community planning beginning in 1994. This large scale innovation in public health planning has involved tens of thousands of professionals and community residents. Though a single case study, Michigan provides a strong test of the implementation of this national prevention planning model because of the state's decentralized approach to HIV prevention community planning involving several hundred residents. A decentralized approach to community planning promises to maximize participation and the sharing of leadership as well as obstacles to community planning. Here, the CDC Guidance for community planning is contrasted with empirical observation of implementation in Michigan. We conclude that the high expectations for a decentralized approach to HIV prevention community planning can be best achieved when a distinction is drawn between information-seeking tasks and decision-making tasks. We recommend that information-seeking tasks be centrally coordinated, and that decision-making tasks be decentralized, to most fully achieve the potential of HIV prevention community planning.

Knowledge and attitudes related to human immunodeficiency virus (HIV) and the use of the universal precautions recommended by the Centers for Disease Control and Prevention were investigated among 807 State and 2,797 local public health personnel in Michigan in September 1989. Survey results indicated that the majority of respondents were well-informed regarding the major routes of HIV transmission, but many respondents hold misconceptions regarding nonviable routes of transmission and about policies on HIV counseling and testing. Respondents reporting occupational exposure to blood or semen reported inconsistent use of universal precautions. Most respondents believed in providing the same quality of care for those with HIV infection as for noninfected persons. However, 32.4 percent believed that they should have the right to refuse treatment, and 9.4 percent reported that they would not be willing to provide routine public health services to an HIV-infected client. The results of this research suggest that in Michigan, public health personnel are in need of HIV education that focuses on the correction of misconceptions about HIV transmission, counseling, and testing policies; the development of appropriate attitudes toward persons infected with HIV; and the appropriate use of universal precautions. Findings also suggest that inadequate protective equipment is an important barrier to the consistent use of universal precautions.