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.
