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The US Preventive Services Task Force (USPSTF) Draft Recommendation statement on Menopausal Hormone Therapy: Primary Prevention for Chronic Diseases, released in May 2017, perpetuates a major disconnect between the primary population affected, women within roughly 10 years of menopause, and the data cited. Furthermore, major elements of the evidence relied upon have been misinterpreted or misstated, particularly in regard to coronary heart disease and breast cancer, for which there is no statistically significant evidence of harm. As currently drafted, the recommendations reiterate the USPSTF statements of 2012, 2005 and 2002, and will perpetuate egregious harm to the public health. In an attempt to avoid that outcome and to facilitate a return to rational discourse regarding menopausal hormone therapy, an ad hoc group of experts in menopausal health submitted this comprehensive response to the USPSTF. [ABSTRACT FROM AUTHOR]

Agricultural production responds to social, political, economic, environmental, and technological drivers that influence producers' decisions and shape the individual systems through modification of management practices, crop and livestock mix, and marketing strategy. We use an interview and discussion approach with producer panels to examine production systems in the eastern United States and explore key drivers impacting their unique characteristics and development. The internal social driver that values the farming lifestyle is a principle factor that leads people to choose farming. Irrespective of location, farming is first and foremost a lifestyle choice. The choice of type of production system is partly a lifestyle preference and partly influenced by other external factors, including economic and environmental elements. A second principle driver is economic, arising from a need to make a living, and tempers the internal social driver. Economic return is partially a function of the marketability of products. Marketing channels are dependent on social drivers, including education of producers and consumers, community support and community values. Farmers in the Northeast are able to take a more active role in determining contract terms than those in the Southeast, and are also more aggressive in developing new markets. Development of local markets and community support strengthens the link between farmers and consumers, and reinforces the economic sustainability of Northeastern production systems. With decreased reliance on external risk reduction approaches, Northeastern producers bear greater risk, but also have greater flexibility in altering the crop and livestock mix and are better able to respond to consumer demand. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to evaluate the efficacy and safety of 3 dosages of Esclim, delivering 0.025 mg, 0.050 mg, or 0.100 mg 17beta-estradiol per 24 hours, in the treatment of moderate to severe vasomotor symptoms.Study Design: In this double-blind, placebo-controlled, parallel-group, multicenter trial, 196 highly symptomatic menopausal women received 12 weeks of continuous unopposed treatment with 1 of the 3 dosages of Esclim or a matching placebo patch.Results: The reduction in frequency of moderate to severe vasomotor symptoms was statistically significant compared with placebo (P <.05) from week 2 onward in the Esclim 50 and 100 groups and from week 3 onward in the Esclim 25 group. Symptom severity was also reduced. Estrogen-related adverse events, particularly metrorrhagia and endometrial hyperplasia, were less frequent in the Esclim 25 group than in the higher-dosage groups.Conclusion: All 3 dosages of Esclim were effective in the treatment of vasomotor symptoms. The efficacy and safety of Esclim 25 indicate a good risk-benefit ratio. [ABSTRACT FROM AUTHOR]

Objective: --To describe the epidemiology of foodborne disease outbreaks in nursing homes and to identify where preventive efforts might be focused.Data Sources: --Reports by state and local health departments of foodborne disease outbreaks occurring from January 1, 1975, through December 31, 1987.Study Selection: --Foodborne disease outbreaks reported to the Centers for Disease Control, Atlanta, Ga, on standard investigation forms.Data Extraction: --Each foodborne disease outbreak report was examined by an epidemiologist or statistician. Outbreaks were considered to have a known pathogen if confirmed by laboratory tests, and a known vehicle when an epidemiologic investigation implicated a specific food item.Data Synthesis: --From 1975 through 1987, 26 states reported 115 outbreaks of foodborne disease in nursing homes, causing illness in 4944 persons and death in 51. These outbreaks represented 2% of all reported foodborne disease outbreaks and 19% of outbreak-associated deaths in this period. Of 52 outbreaks with a known cause, Salmonella was the most frequently reported pathogen, accounting for 52% of outbreaks and 81% of deaths. Salmonella enteritidis outbreaks accounted for 56% of the Salmonella-associated deaths since 1981. The implicated food vehicles in S enteritidis outbreaks were made with eggs or prepared with equipment contaminated with eggs. Staphylococcal foodborne disease was the next most commonly identified cause, accounting for 23% of outbreaks.Conclusions: --Since the elderly are at high risk for serious morbidity from foodborne disease, nursing homes should practice careful food handling, preparation, and storage procedures; provide education for food handlers; and have active infection control programs to rapidly detect and control outbreaks of foodborne disease. [ABSTRACT FROM AUTHOR]

Background: As part of a program to develop a novel estradiol-releasing contraceptive vaginal ring (CVR), we evaluated the pharmacokinetic (PK) profile of CVRs releasing segesterone acetate (Nestorone® (NES)) combined with one of three different estradiol (E 2 ) doses., Study Design: A prospective, double-blind, randomized, multi-centered study to evaluate a 90-day CVR releasing NES [200mcg/day] plus E 2 , either 10mcg/day, 20mcg/day, or 40mcg/day in healthy reproductive-age women with regular cycles. Participants provided blood samples twice weekly for NES and E 2 levels during the first 60 days (ring 1) and the last 30 days (ring 2) of use. A subset underwent formal PK assessments at ring initiation, ring exchange (limited PK), and study completion., Results: The main study enrolled 197 women; 22 participated in the PK substudy. Baseline characteristics between the main and PK participants were comparable, with an average BMI of 25.8 kg/m 2 (SD 4.3). In the PK substudy, all three rings showed similar NES PK: mean area under the curve (AUC (0-72) ) 34,181 pg*day/mL; concentration maximum (C max ) 918 pg/mL; time to maximum concentration (T max ) 3.5 h. For E 2, the C max occurred at 2 h, and was significantly higher with the 20 mcg/day ring (mean 390 pg/mL); 10 mcg/day, 189 pg/mL, p=.003; 40 mcg/day, 189 pg/mL, p<.001), and declined rapidly to≤50 pg/mL for all doses by 24 h. For all subjects, the median E 2 levels remained under 35 pg/mL during treatment., Conclusion: PK parameters of NES were not affected when paired with different doses of E 2 , but E 2 levels from all three doses were lower than anticipated and no dose response was observed., Implications: While these novel estradiol-releasing combination contraceptive vaginal rings provided sustained release of contraceptive levels of Nestorone over 90 days, the E 2 levels achieved were not consistent with bone protection, and a dose-response was not observed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

New contraceptive modalities that are being introduced into the US marketplace reflect many changes in the delivery of existing steroidal products. These products are available now not only as oral medications but also as transdermal, intravaginal, intrauterine, and implantable or injectable devices. Each of these has its own unique profile and enhances the ability of consumers to pick and choose the product that is most acceptable to them. However, development of new barrier contraceptives, particularly those that have the potential to reduce the heterosexual transmission of HIV or to reduce a bacterial infection such as Chlamydia or Neisseria gonorrhea, continues to be moving forward in clinical trials. These products can have a lower efficacy compared with the steroidal products but, because of their other benefits, may be of significant medical use.

There are new choices for Medicare beneficiaries, and individuals may be confused about what is available to them. Home care providers who understand these choices can be valuable resources to clients as well as to colleagues.

Listeria methods research at the U.S. Department of Agriculture, Eastern Regional Research Center, has concentrated on 2 areas during the past year. The first was development of techniques for assessing isolation methods for their ability to detect sublethally stressed cells. It appears that a number of widely used media do not accurately detect Listeria that have been injured by thermal processing or acidification. The second was development of improved plating media. One, modified Vogel-Johnson agar, shows promise; it is highly selective and quantitative, and eliminates the need to select colonies on the basis of a blue color when illuminated with reflected light.

The incidence of acute episodes of intestinal infectious diseases in the United States was estimated through analysis of community-based studies and national interview surveys. Their differing results were reconciled by adjusting the study population age distributions in the community-based studies, by excluding those cases that also showed respiratory symptoms, and by accounting for structural differences in the surveys. The reconciliation process provided an estimate of 99 million acute cases of either vomiting or diarrhea, or both, each year in this country, half of which involved more than a full day of restricted activity. The analysis was limited to cases of acute gastrointestinal diseases with vomiting or diarrhea but without respiratory symptoms. Physicians were consulted for 8.2 million illnesses; 250,000 of these required hospitalization. In 1985, hospitalizations incurred $560 million in medical costs and $200 million in lost productivity. Nonhospitalized cases (7.9 million) for which physicians were consulted incurred $690 million in medical costs and $2.06 billion in lost productivity. More than 90 million cases for which no physician was consulted cost an estimated $19.5 billion in lost productivity. The estimates excluded such costs as death, pain and suffering, lost leisure time, financial losses to food establishments, and legal expenses. According to these estimates, medical costs and lost productivity from acute intestinal infectious diseases amount to a minimum of about $23 billion a year in the United States.