Creating and Implementing a Community Engagement Strategy for the 2022-2027 Illinois Comprehensive Cancer Control Plan Through an Academic-State Public Health Department Partnership

INTRODUCTION

Comprehensive cancer control (CCC) plans are state-level blueprints that identify regional cancer priorities and health equity strategies. Coalitions are encouraged to engage with community members, advocacy groups, people representing multiple sectors, and working partners throughout the development process. We describe the community and legislative engagement strategy developed and implemented during 2020-2022 for the 2022-2027 Illinois CCC plan.

METHODS

The engagement strategies were grounded in theory and evidence-based tools and resources. It was developed and implemented by coalition members representing the state health department and an academic partner, with feedback from the larger coalition. The strategy included a statewide town hall, 8 focus groups, and raising awareness of the plan among state policy makers.

RESULTS

A total of 112 people participated in the town hall and focus groups, including 40 (36%) cancer survivors, 31 (28%) cancer caregivers, and 18 (16%) Latino and 26 (23%) African American residents. Fourteen of 53 (26%) focus group participants identified as rural. Participants identified drivers of cancer disparities (eg, lack of a comprehensive health insurance system, discrimination, transportation access) and funding and policy priorities. Illinois House Resolution 0675, the Illinois Cancer Control Plan, was passed in March 2022.

CONCLUSION

The expertise and voices of community members affected by cancer can be documented and reflected in CCC plans. CCC plans can be brought to the attention of policy makers. Other coalitions working on state plans may consider replicating our strategy. Ultimately, CCC plans should reflect health equity principles and prioritize eliminating cancer disparities.

First-Year Resident Perceptions of Virtual Interviewing

Background and Objectives: Virtual interviews (VI) for residency programs present a relatively new paradigm for recruitment. To date, studies have been small, largely descriptive, and focused on surgical and subspecialty areas. The purpose of the study was to assess residents’ perceptions about their VI experience and to compare those in primary care versus non-primary care specialties. Methods: An electronic survey was sent to 35 designated institutional officials in Illinois with a resulting snowball sample to assess first-year residents’ perceptions of their virtual interviewing experience. A total of 82 postgraduate year-1 residents responded to the survey. We used descriptive analysis and χ2 tests to analyze results. Results: Respondents were mostly female (52.4%), White (79%), non-Hispanic (76%), attending a university residency program (76.3%), and in a primary care specialty (61.7%). In general, most respondents (54.8%-75.3%) felt their VI accurately portrayed their residency program experience. Resident morale, resident-faculty camaraderie, and educational opportunities were perceived as being best portrayed in the VI. Compared to non-primary care residents, primary care residents felt that their program’s VI more accurately portrayed the patient population served (P=.0184), resident morale in the program (P=.0038), and the overall residency experience (P=.0102). Still, 25.7% of respondents felt they were not accurately represented in the VI. Conclusions: Respondents reported that the VI portrays the residency experience fairly well, yet there is opportunity to improve the overall experience. The more difficult experiences to convey (morale, camaraderie, and the overall resident experience) may be areas in which primary care programs are outpacing other training programs.

COVID-19 Vaccine Attitudes and Barriers among Unvaccinated Residents in Rural Northern/Central Illinois

Background

Rural communities have lower COVID-19 vaccine uptake and poorer health outcomes compared to non-rural communities, including in rural, northern/central Illinois. Understanding community perceptions about vaccination is critical for developing targeted responses to improve vaccine uptake in rural communities and meet global vaccination targets.

Purpose

This study examines COVID-19 vaccine attitudes and barriers as well as the impact of COVID-19 on specific health behaviors of residents in rural northern/central Illinois to inform efforts to increase vaccine uptake.

Methods

In collaboration with community partners and local health departments, we conducted a 54-item, English-language, online questionnaire from Feb 11 to March 22, 2021; the questionnaire included the COVID behavioral questionnaire scale (CoBQ), as well as questions on intention to vaccinate, vaccination attitudes, and barriers to vaccine access. Descriptive and bivariate analyses assessed participant differences based on intention to vaccinate.

Results

Most unvaccinated survey respondents (n = 121) were White (89.3%) and female (78.5%), with an average age of 52.3±14.1 years. Lack of intention to vaccinate was negatively associated with trust in the science behind vaccine development (P = .040), belief in the safety of the vaccine (P = .005) and belief that the vaccine was needed (P=.050). CoBQ scores of respondents who intended to get vaccinated differed significantly from those who did not (P<.001), showing a greater negative impact of COVID-19 on engaging in health behaviors for vaccine-hesitant participants.

Conclusion

Study findings show mistrust of science and lack of confidence in vaccine safety are barriers to vaccination in rural northern Illinois residents. Similar results have been reported in low- and middle-income countries.

Mayer-Rokitansky-Küster-Hauser syndrome - case studies, methods of treatment and the future prospects of human uterus transplantation

OBJECTIVE

We aimed to present patients with the Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) coming from one center and presenting all the possibilities of its treatment, at the forefront with the uterine transplantation.

PATIENTS AND METHODS

The presented work is an example of different types of MRKH syndrome diagnosed in 25 women who were diagnosed in the Department of Gynecological Endocrinology due to the primary amenorrhea from 01/2001 to 06/2018.

RESULTS

Patients suffering from MRKH syndrome are capable of having genetic offspring but are unable to give birth to their own child, due to an absence of the uterus, blindly terminated vagina, and normal ovaries. Patients suffering from this syndrome have the opportunity to receive treatment in accordance with their current needs. However, there are many medical, technical, and ethical limitations in achieving the most important therapeutic target: uterine transplantation and childbirth.

CONCLUSIONS

Until a few years ago, patients with an absolute uterine factor of infertility, including women with MRKH syndrome, had a real choice of only two equally controversial options giving a chance for motherhood - surrogacy and adoption. However, modern transplantation has shown that a third option - a uterine transplant - exists and is available.

The correlation between the concentration of hepcidin in serum and the occurrence of insulin resistance and hyperandrogenemia in women with polycystic ovary syndrome

OBJECTIVE

Scarce clinical and experimental studies suggest that hepcidin can be a protein participating in the development of metabolic disorders, while its synthesis and concentration in the circulation outside of the iron metabolism parameters can be influenced by hormones. The aim of the present study was to determine the correlation between the concentration of hepcidin in serum and the occurrence of insulin resistance and hyperandrogenemia in women with PCOS.

PATIENTS AND METHODS

Five groups of women with PCOS were divided based on: correct body mass (17 without hyperandrogenemia and insulin resistance - G1; 17 with hyperandrogenemia and without insulin resistance - G2; 11 without hyperandrogenemia and with insulin resistance - G3; 10 with hyperandrogenemia and insulin resistance - G4), metabolic and hormonal parameters and selected markers of iron metabolism.

RESULTS

Serum glucose levels were significantly higher in the group G3 than G1 and in the group G4 than G1 and G2. Serum insulin levels and HOMA-IR values were significantly higher in the groups G3 and G4 than G1 and G2. Serum androstenedione levels were significantly higher in the group G2 than G1 and G3 than G2. Serum transferrin levels were significantly lower in the group G1 than in the reaming study groups.

CONCLUSIONS

It has been demonstrated that insulin resistance and hyperandrogenemia appear to be the factors decreasing the concentration of transferrin circulation, but not the remaining parameters of the iron metabolism in the studied women. No relationship between the concentration of hepcidin circulation and other studied parameters of the iron metabolism and the parameters of the carbohydrate metabolism was discovered. Androstenedione can stimulate hepcidin synthesis in women with PCOS with correct body mass.

The effect of abdominal obesity in patients with polycystic ovary syndrome on metabolic parameters

OBJECTIVE

Polycystic ovarian syndrome and obesity contribute to the metabolic complications for women of reproductive age. The aim of present study was to analyze the effect of abdominal obesity expressed using waist/hip ratio (WHR) in patients with polycystic ovary syndrome on metabolic parameters.

PATIENTS AND METHODS

The study included 659 women with PCOS with WHR <0.8 and ≥0.8 aged between 17 and 44 years. Patients were tested for follicular stimulating hormone, luteinizing hormone, 17-beta-estradiol, dehydroepiandrosterone sulfate, androstenedione, sex hormone binding globulin, and total lipid profile during the follicular phase (within 3 and 5 days of their menstrual cycle). Also, fasting glucose and insulin concentrations, and after, oral-glucose glucose administration, were determinate. De Ritis and Castelli index I and II were calculated.

RESULTS

Women with WHR ≥0.8 had higher concentration of glucose and  insulin (both fasting and after 120 min of oral administration of 75 g glucose), as well as HOMA-IR value, than women with WHR value < 0.8. Also, abdominal obesity disorders hormonal parameters. Higher free androgen index and lower concentration of sex hormone binding globulin and dehydroepiandrosterone sulfate were found in female with WHR ≥ 0.8. Follicular stimulating hormone, luteinizing hormone, androstenedione, and 17-beta-estradiol, were on similar level in both groups. Elevation in triglycerides, total cholesterol, and low-density lipoprotein levels, as well as decrease in high density lipoprotein level in serum of women with WHR value ≥ 0.8, were found when compared to women with WHR < 0.8. A statistically significant correlation was found between WHR value and glucose, insulin, sex hormone binding globulin, free androgen index and lipid profile parameters.

CONCLUSIONS

Abdominal obesity causes additional disorders in metabolic and hormonal parameters in PCOS women, which confirmed changes in analyzed parameters between PCOS women with WHR < 0.8 and WHR ≥ 0.8 and statistically significant correlations between WHR value and analyzed parameters.

Thyroid disorders in polycystic ovary syndrome

OBJECTIVE

Thyroid disorders, especially Hashimoto's thyroiditis (HT), are observed significantly more often in patients with polycystic ovary syndrome (PCOS) than in the general population - approximately 27% and 8%, respectively. This is extremely important in young women, because both disorders are connected with fertility problems. As HT and PCOS occur together, fertility problems may become a serious clinical issue in these patients.

MATERIALS AND METHODS

A systematic literature review in PubMed of PCOS- and HT-related articles in English, published until December 2015 was conducted.

RESULTS

The reasons for joint prevalence still remain unclear. Genetic and autoimmune backgrounds are recognized to be possible common etiological factors. Three genetic polymorphisms have been described to play a role in PCOS as well as in HT. They are polymorphism of the gene for fibrillin 3 (FBN3) regulating the activity of transforming growth factor-b (TGF-b) and regulatory T cell levels, gonadotropin-releasing hormone receptor (GnRHR) polymorphism and CYP1B1 polymorphism standing for estradiol hydroxylation. High estrogen-to-progesterone ratios owing to anovulatory cycles, as well as high estrogen levels during prenatal life, disrupt development of the thymus and its function in maintaining immune tolerance, and are suspected to enhance autoimmune response in PCOS. Vitamin D deficiency could be also involved in the pathogenesis of HT and PCOS.

CONCLUSIONS

The above-mentioned common etiological factors associated with fertility problems in HT and PCOS require further research.

Spiral CT: use in the evaluation of chest masses in the critically ill neonate

The radiologic evaluation of neonatal chest masses may be carried out with a number of different imaging modalities, each with distinct advantages and disadvantages. While it is necessary clinically to rapidly and accurately diagnose these lesions, this may be difficult when the neonate is critically ill. We report the use of spiral (helical) CT (SCT) scanning with reconstructed images to diagnose chest masses in two critically ill neonates undergoing oscillating ventilation. We describe the technique used to image the masses and compare this technique with other available imaging modalities.

Three-dimensional computed tomographic angiography in the preoperative evaluation of cerebrovascular lesions

Although three-dimensional computed tomographic angiography was developed as a screening tool for use in patients with suspected cerebrovascular disease, this imaging modality has also proven to be of value in surgical planning for patients with large or unusual vascular lesions of the brain. The three-dimensional images generated by this technique yield valuable information regarding the size and configuration of intracranial aneurysms and vascular malformations, the presence and extent of intra-aneurysmal thrombus, the relationship of the vascular lesion to other cerebrovascular or skeletal structures, aneurysm wall thickness, and the presence and orientation of an aneurysm neck. The use of three-dimensional computed tomographic angiography in representative cases of patients with large or unusual cerebrovascular lesions is presented. It has been our experience that this imaging modality displays anatomical information that is not readily available from standard, intra-arterial angiography, provides better detail for surgical planning than magnetic resonance angiography, and is less expensive than either of these other imaging modalities.

Three-dimensional computerized tomography angiography in the diagnosis of cerebrovascular disease

Computer-generated three-dimensional reconstruction of the intracranial vascular system obtained by contrast-enhanced computerized tomography (CT) has been used in the diagnosis of 20 patients with known or suspected intracranial cerebrovascular disease. This technique allows visualization of the intracranial vasculature without exposing patients to the risks associated with intra-arterial angiography. The color prints and videotape images generated have been used to diagnose the presence of intracranial aneurysms, arteriovenous malformations, and venous angiomas. They have also been used to rule out structural abnormalities in patients with suspected intracranial vascular pathology and to screen patients with a strong family history of intracranial aneurysm. In 11 patients who underwent both three-dimensional CT angiography and intra-arterial angiography, the diagnostic correlation was 100%. No complications from the procedures or from incorrect diagnosis have been encountered. Although this technique requires further development and clinical evaluation, the authors' early experience with three-dimensional CT angiography suggests that this may become a valuable tool in the diagnosis of patients with cerebrovascular disease.