Background:Obesity is a growing public health crisis in the United States, with over 70% of adults classified as overweight or obese. It has been associated with multiple health conditions, including at least 13 types of cancer. Despite this, awareness of the obesity-cancer link remains low, with only 53% of Americans aware of it as of 2019. Understanding the epidemiology of obesity-related cancers is critical, particularly in high-obesity states like Oklahoma. Objective:To assess the incidence and trends of obesity-related cancers in Oklahoma, focusing on demographic, geographic, and socioeconomic disparities. Methods:Articles were selected through a structured literature search and narratively summarized by key study characteristics and results. We used data from the Oklahoma Central Cancer Registry (OCCR) from 1999 to 2022, identifying cases based on CDC-defined obesity-related cancers. Age-adjusted incidence rates (AAIR) were calculated per 100,000 population, using the 2000 U.S. standard population. Temporal trends were assessed using Joinpoint regression. Spatial analysis was conducted using Global and Local Moran's I statistics. Demographic and socioeconomic data were linked using U.S. Census and Rural-Urban Continuum Codes (RUCC). Results:Between 2018-2022, 44,304 Oklahomans were diagnosed with obesity-related cancers, representing 39% of all cancer cases. Rates were higher in women (AAIR: 243.0) than men (AAIR: 127.0), with notable variation by race, insurance type, rurality, and poverty level. American Indian/Alaska Native populations had the highest incidence. Breast, colorectal, and kidney cancers comprised most cases. Geographic clustering was evident, particularly in southeastern Oklahoma. Conclusion:Obesity-related cancers constitute a significant proportion of the cancer burden in Oklahoma. Disparities by sex, race, socioeconomic status, and geography underscore the need for targeted prevention and education strategies. Public awareness campaigns and health policy interventions addressing obesity may help reduce cancer incidence in high-risk populations.
Background:Despite declining national smoking rates, Oklahoma continues to experience high tobacco use, particularly among groups such as American Indian/Alaska Native (AI/AN) and rural populations. Cigarette smoking is a leading cause of cancer, and tobacco-related cancer incidence remains a significant public health concern in Oklahoma. Methods:Articles were selected through a structured literature search and narratively summarized by key study characteristics and results. We then analyzed tobacco-related cancer incidence data from the Oklahoma Central Cancer Registry (1999-2022), focusing on cancers identified by the CDC as tobacco-related. Rates were age-adjusted to the 2000 US standard population. We assessed trends using Joinpoint regression and stratified findings by age, sex, race/ethnicity, rurality, and insurance status. Results:Between 2018 and 2022, 48,552 tobacco-related cancer cases were reported in Oklahoma, comprising 42% of all cancers. The age-adjusted incidence rate (AAIR) was 278.0 per 100,000. Males (253.5) had higher rates than females (161.3). The highest AAIR was among NH AI/AN individuals (257.5), with 52% of their cancers tobacco-related. Lung, colorectal, and kidney cancers were the most common tobacco-related cancers. Rural areas had higher incidence rates than their urban counterparts. Tobacco-related cancer rates declined over time (APC -0.55%, p < 0.0001), while non-tobacco-related cancer rates slightly increased. A weak positive correlation (r2 = 0.29) was found between county-level smoking prevalence in 2010 and cancer incidence a decade later. Conclusions:Tobacco-related cancers remain prevalent in Oklahoma, especially among males, rural, and AI/AN populations. Although incidence is declining, disparities persist. These findings underscore the ongoing need for targeted tobacco control efforts to address inequities and reduce cancer burden.
Background:Chronic low back pain is the most prevalent chronic pain condition worldwide, accounting for 15-20% of physician visits and costing billions of dollars. Without adequate treatment, it can lead to substance use disorder and increased risk of suicide. Current treatments include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, surgery, and non-pharmacological adjuncts. Evidence suggests cognitive behavioral therapy (CBT) as adjunctive therapy can improve patient commitment to treatment but not pain intensity. However, CBT is limited due to availability, location and shortage of trained personnel. Virtual reality (VR) has been growing in interest in providing affordable, digital, home-based, and self-directed CBT to address the psychosocial aspect of pain. Methods:We searched the literature for meta-analysis, randomized control trials (RCT), and systemic reviews using the PubMed database with the terms virtual reality and chronic low back pain. Results:The review identified 31 studies. Six were chosen that were applicable to our clinical questions, one systematic review, two meta-analysis and three RCTs. The RCTs showed that virtual reality can improve pain in patients with chronic lower back pain as an effective adjunctive to pharmacological and surgical intervention. The systemic review and meta-analysis also concluded that VR is beneficial in pain management however, due to inconsistent results and the multifactorial aspect of chronic pain. Conclusions:Thus further research is required. The number of randomized trials, evidence on long-term application, and the efficacy of self-directed versus guided VR treatment limit our understanding of this topic.
Background:The pandemic caused by the novel Coronavirus 2019 (COVID-19) overwhelmed healthcare systems with emergency department (ED) and hospital overcrowding. Our hospital system was able to discharge a subset of COVID-19 patients home with remote patient monitoring (RPM) and home oxygen (HO2ME) if needed, which opened up beds for the more critical patients. The objective of this study was to review the all-cause 30-day mortality and admission rates for patients chosen for our program, and to additionally examine the financial impact. Methods:This was a retrospective cohort study of ED patients who were included if they tested positive for SARS-CoV-2 RNA on nasopharyngeal swab and received emergency care for COVID-19 at any INTEGRIS facility during 10/27/2020-9/8/2021. For the primary statistical analysis, descriptive statistics were calculated and reported as medians with interquartile ranges. For the purpose of financial analysis, we filtered a subset of insured patients who were sent home with oxygen. Results:490 patients were enrolled with a median age of 62 and median body mass index (BMI) of 31. Of the 490 patients, 151 patients (31%) met requirements for home oxygen and were discharged with oxygen. Over a median enrollment time of 15 days, patients discharged from the emergency department on the RPM program were observed to have an all-cause 30-day mortality rate of 3.2% (95% Cl, 1.8%-5.2%). The observed rate of all-cause hospital admission within 30 days was 17%. The financial analysis revealed savings to insurance companies. Conclusions:This study demonstrated that rapidly deploying a RPM program for patients with acute COVID-19 infection allowed our health system to safely care for patients in their homes. The program opened hospital beds for more severe and critically ill COVID-19 patients who necessitated more intense monitoring and inpatient care, while simultaneously observing low 30-day all-cause mortality and hospital admission rates.
The American Cancer Society estimated 1.9 million diagnosed cancer cases and 608,570 cancer deaths in 2021 in the US; for Oklahoma, they estimated 22,820 cases and 8,610 deaths. This project aimed to demonstrate a method to systematically describe cancer in an accurate and visually attractive, yet simple to make, interpolated map using ZIP Code level registry data, as it is the smallest area unit with high accuracy using inverse distance weighting. We describe a process of creating smoothed maps with an appropriate, well-described, simple, replicable method. These smoothed maps display low (cold) or high (hot) areas of incidence rates of: (a) all cancer combined, (b) colorectal cancer and lung cancer rates by gender, (c) female breast cancer, and (d) prostate cancer, by ZIP Codes for Oklahoma from 2013-2017. The methods we present in this paper provide an effective visualization to pinpoint low (cold) or high (hot) areas of cancer incidence.
Clinical Question:In patients with osteoarthritis, is curcumin, compared to placebo, effective in reducing pain? Answer:Yes. Studies have shown that curcumin extract has benefit in treating osteoarthritic pain, compared to placebo. It is reasonable to use curcumin in addition to traditional osteoarthritis treatments, as studies show it has a low side effect profile. However, a greater number of studies as well as larger studies are needed to definitively recommend curcumin, especially as a replacement for more traditional therapies. Level of Evidence of the Answer:B.
Background –:The Region 6 South Central Public Health Training Center conducts needs assessments to inform the development of online trainings tailored to the HRSA Region 6 health and public health workforce. The purpose of this study was to assess Oklahoma's Community Health Representative (CHR) / Community Health Worker (CHW) workforce characteristics, current trainings, and training needs to guide the development of online trainings. Methods –:This survey-based needs assessment for health and public health workforce training needs asked about alternative job titles, top three health issues addressed, roles played, skills used, current trainings, and training needs. Descriptive statistical analysis provided insights about CHRs/CHWs. The Fisher's exact test was used to compare frequency of responses between CHRs and CHWs, with p-values <0.05 considered significant. We analyzed qualitative data by using a modified content analysis. Results –:Fifty-one self-identified CHRs/CHWs in Oklahoma participated in the 2019 regional health and public health training needs assessment. Most CHRs/CHWs were female and identified as "frontline public health workers." Respondents reported a range of educational attainment and diverse job titles. CHRs worked at tribal health or public health organizations primarily in rural areas. Most CHWs worked in urban areas and were employed by state and local health departments or community-based organizations. CHRs/CHWs had a broad spectrum of roles and skills, with required trainings reflecting various organizational needs. CHRs/CHWs expressed strong interest in receiving additional trainings via multiple delivery formats. Discussion and Conclusions –:Oklahoma's CHRs/CHWs would benefit from and utilize workforce development, including trainings on a broad spectrum of roles and skills in multiple delivery formats. Potential employers and funders across the state would benefit from education on CHRs/CHWs as a workforce, team-integration, and sustainable funding.
BACKGROUND:Multiple studies have been conducted investigating the use of sterile vs non-sterile gloves. The aim of this Clin-IQ is to determine whether there is a clinically significant difference in the rate of infections in relation to the use of sterile vs non-sterile gloves for joint injections. CONCLUSIONS:Multiple studies have shown no appreciable difference in outcomes using sterile vs clean gloves for a variety of clinical applications including joint injections.
Background –:Diabetes, a leading cause of morbidity and mortality in the United States, disproportionally affects minority populations. In 2015, Hispanics, the largest minority in the country, had the third highest rate of diabetes prevalence and the third highest age-adjusted rate of diabetes-related mortality. Substantial progress in understanding diabetes disparities nationally and in many areas of the country has been made. However, little is known about diabetes and related mortality among Hispanics in Oklahoma, which is known as a Hispanic "new Settlement" state due to the relatively recent and substantial growth of this population. Methods –:We used Oklahoma Behavioral and Risk Factor Surveillance Survey data (2011-2016) to calculate population estimates of diabetes prevalence and selected sociodemographic characteristics for Hispanic and Non-Hispanic adults in the state. We used Oklahoma Death Registry data to estimate diabetes-related mortality rates for Hispanic and Non-Hispanic adults for the same five-year period. We examined differences in diabetes prevalence and diabetes-related mortality across selected sociodemographic characteristics. Results –:Hispanics are the largest minority group in Oklahoma. Spanish is the most common non-English language spoken in the state. Hispanics are younger, poorer, less educated and experience less access to health care compared to other populations in Oklahoma. While Hispanics had the fifth highest reported diabetes prevalence rate during the five-year period examined, they had the third highest diabetes-related mortality rate in the state. Discussion and Conclusions –:There is a need for community engagement and basic and applied research to help identify and reduce diabetes disparities in the growing Hispanic population in Oklahoma.
CLINICAL QUESTION:Does utilization of electronic cigarettes facilitate smoking cessation compared to other interventions? AUTHORS:Sarah Wolf MD, PGY-1; Senushi O'Sullivan MD, PGY-2;Roselynn Dean MD, PGY-3; Tomas Owens MD. FACULTY MENTOR:Tomas Owens, MD. RESIDENCY PROGRAM:Integris Great Plains Family Medicine Residency Program, Oklahoma City, Oklahoma. ANSWER:Debatable. With conflicting data and some evidence of e-cigarettes leading to on-going nicotine use, there is not a clear benefit to utilizing e-cigarettes for smoking cessation. LEVEL OF EVIDENCE FOR THE ANSWER:B. SEARCH TERMS:smoking cessation, electronic cigarettes, e-cigarettes. DATE SEARCH WAS CONCLUDED:24 April 2019 Inclusion and Exclusion Criteria. INCLUSION CRITERIA:Studies directly comparing smoking cessation with utilization of electronic cigarettes compared to control group. EXCLUSION CRITERIA:Studies that were systematic reviews, published since 2015, and studies comparing smoking cessation with anything other than electronic cigarettes.
CLINICAL QUESTION:In adults with lumbar spinal stenosis, do epidural injections (anesthetics with or without steroids) provide long term improvement in pain and functionality?ANSWER:Yes.Studies show that anesthetic epidural injections provide long term and short term improvement in pain and functionality in patients with lumbar spinal stenosis. Studies do not show good evidence addition of steroids can add any benefit in the improvement in pain and functionality.LEVEL OF EVIDENCE OF THE ANSWER:A.SEARCH TERMS:Lumbar spinal stenosis, long term, pain, epidural injections.LIMITS:Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, meta-analysis, adults age 18 or more, publication dates 2015 to now.DATE SEARCH WAS CONDUCTED:October 13, 2018.INCLUSION AND EXCLUSIONS CRITERIA:Inclusion Criteria:Recent published systematic reviews, randomized controlled trials, meta-analyses; adults with lumbar spinal stenosis, treatment with epidural injections.EXCLUSION CRITERIA:Studies older than 5 years, children, adolescents less than 18 years of age, just lower back pain or radiculopathy but not specifically spinal stenosis.
The annual influenza vaccine is universally recommended by the CDC for individuals greater than six months of age. However, unlike the other 16 routinely recommended vaccines, influenza vaccination is annual and developed based on circulating strains that are constantly modifying the primary immune targets, the hemagglutinin and neuraminidase receptors. Given the variation in these critical receptors, the need to predict changes in the protein structure, and the necessity of such frequent immunizations it is reasonable to question the annual vaccinations efficacy, especially in otherwise healthy adults. This article will review literature on inactivated influenza vaccine efficacy on preventing infection, decreasing hospitalizations and pneumonia, and mortality.
Clostridium difficile colitis infection is an opportunistic infection with as high as an estimated 30,000 deaths and 4.8 million dollars in healthcare costs recorded in 2011. The most common risk factor for infection is antibiotic therapy. Studies reviewed consisting of a meta-analysis of 19 randomized clinical trials demonstrate a beneficial effect of probiotics in preventing CDCI with the highest efficacy noted when initiated within 2 days of antibiotics. However, variations in dosing, initiation and species of probiotic have unknown effects in study results. The most significant correlation noted was the decreased incidence of CDCI by almost 50% when adjusting for timing of probiotic administration nearer to the first dose of antibiotics. The adverse effects of probiotics across studies were similar when comparing control and experimental groups.
This chapter discusses how the Entrenchment-and-Conventionalization Model explains language change. First, it is emphasized that not only innovation and variation, but also the frequency of repetition can serve as important triggers of change. Conventionalization and entrenchment processes can interact and be influenced by numerous forces in many ways, resulting in various small-scale processes of language change, which can stop, change direction, or even become reversed. This insight serves as a basis for the systematic description of nine basic modules of change which differ in the ways in which they are triggered and controlled by processes and forces. Large-scale pathways of change such as grammaticalization, lexicalization, pragmaticalization, context-induced change, or colloquialization and standardization are all explained by reference to these modules. The system is applied in a case study on the history of do-periphrasis.
IMPORTANCE:Nonalcoholic fatty liver disease (NAFLD) is rapidly evolving into one of the most common pediatric liver diseases and currently is the most common cause for liver transplantation in young adults. Therefore, early recognition of risk factors, disease prevention, and diagnosis during childhood is paramount for effective management. OBJECTIVE:The primary objective of this review is to discuss updated recommendations for screening, diagnosis and management of NAFLD. The secondary objective is to review the extent and impact of pediatric NAFLD in Oklahoma through our center's participation in a multi-center prospective study. EVIDENCE REVIEW:We reviewed updated guidelines from the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), the approach used in our clinic and data from a multi-center collaboration on NAFLD, known as TARGET-NASH. FINDINGS:Our review highlights that obese and Hispanic children are at greatest risk for developing NAFLD. Screening with ALT should be considered between ages 9-11 years for children with BMI more than the 95th percentile. Liver biopsy is the gold standard for diagnosis of NAFLD and currently lifestyle modification is the only effective therapy for management of NAFLD. CONCLUSION AND RELEVANCE:All obese children, especially those who are Hispanics or have a family history of NAFLD should be considered for screening with serum ALT between the ages of 9 and 11 years. Children with ALT values that are elevated more than twice the upper limit of normal for more than 3 months must be referred to pediatric hepatology for timely evaluation.
IMPORTANCE:Oklahoma ranked 43rd in the 2017 America's Health Rankings largely due to health behaviors such as adult obesity, lack of physical activity and smoking. Oklahoma children also suffer from adverse childhood experiences that contribute to poor health outcomes. Community engagement, a process that involves people affiliated by geographic location and shared interest working together to address issues affecting community wellbeing, is a common model that has had some success in Oklahoma communities addressing child health. OBSERVATIONS:Factors that contribute to poor health in Oklahoma include not only health behaviors such as obesity and smoking, but also lack of access to care created by a lack of health insurance and primary care providers, compounded by the largely rural nature of the state. The National Institutes of Health is committed to funding research aimed at improving the health of rural and disadvantaged populations. Historically, these populations are difficult to reach and may not be interested in the national health research initiatives, but rather want to focus on health issues important to their communities. CONCLUSIONS AND RELEVANCE:In this article we discuss some of Oklahoma's most pressing pediatric health needs, community engagement efforts to address these issues and a newly funded NIH grant at OUHSC aimed at supporting and learning from these efforts.
BACKGROUND:The prevalence of childhood obesity continues to be a major public health problem. Nearly one-third of children in the United States can be classified as overweight or obese, which is particularly concerning given that obesity is associated with a number of physical and mental health problems. Past studies have examined childhood obesity and psychological symptoms using samples of referred children who have already been identified as overweight or obese, leaving out children who are classified as underweight or healthy weight. This study aims to bridge this gap in the literature by evaluating differences in psychological symptoms among children who fall within all weight ranges within primary care. METHODS:Data was obtained from a systematic chart review using EMR (Electronic Medical Record) for children ages 6 to 16 years from two primary care health clinics. Differences between weight groups regarding reported internalizing and externalizing symptoms were evaluated utilizing data from the Pediatric Behavioral Health Screen (PBHS). RESULTS:Significant overall psychological symptoms (internalizing and externalizing) were endorsed for 13.2% of the sample (p > .01). Chi-Square analyses determined that the relationship between internalizing symptoms and weight category were significant. Specifically, children who were classified as overweight or obese were more likely to report significant internalizing symptoms than underweight or healthy weight children. CONCLUSIONS:Children who fall into the overweight and obese weight categories may need to be screened for psychological symptoms and referred for mental health services following overweight/obese classification in primary care.
Neonatal abstinence syndrome from opioids (NAS-O) is a multisystem disorder resulting in neurological and gastrointestinal symptoms from the abrupt discontinuation of chronic fetal exposure to opioids. Increasing opioid use during pregnancy has led to a five-fold increase in NAS-O nationally over the past decade. Several knowledge gaps in our experiences with opioid-exposed neonates have been identified: 1) universal maternal screening; 2) diagnostic tools for newborn abstinence syndrome; 3) optimal treatment protocols; and 4) long-term neurodevelopmental effects of fetal opioid exposure. This review article gives a broad overview of the issues associated with screening, diagnosis, and management of opioid exposure in newborns as well as the issues with collecting accurate outcomes data to monitor efforts aimed at curbing opioid exposure in children and NAS-O. Data specific to Oklahoma is provided, when available.
ObjectiveGeographic access to primary care can be a barrier to receiving appropriate preventative services. Oklahoma has been identified as having relatively few primary care providers per capita to care for its population compared to the US. The goal of this analysis was to identify the areas in Oklahoma with significant concentrations of children under five, no pediatrician within reasonable driving distance, and whether other primary care providers are present.MethodsThe 2016 American Community Survey was used to estimate the total population of children under five years of age for each Census Block Group in Oklahoma. Access was defined as a thirty-minute drive time radius computed around each child's imputed location. The National Provider Identifier database was used to identify and locate pediatricians, family medicine physicians, and mid-level providers in Oklahoma. Areas of high concentrations of children with no pediatrician access were identified and non-pediatrician provider locations were superimposed.ResultsOf the estimated 265,818 children under five in Oklahoma, approximately 7% were outside of a thirty-minute drive from a pediatrician. These children are concentrated in northwestern and southeastern Oklahoma, with several smaller additional groupings. There are multiple non-pediatrician primary care providers operating in many of these areas.ConclusionThere are areas in the state where a paucity of pediatricians and high concentrations of young children lend themselves to collaborations using technology and education to improve the care of children.
