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We examined factors associated with and reasons for perceived susceptibility to COVID-19 among urban and rural adults in Alabama. We surveyed 575 eligible participants’ engagement in preventive behaviors, concern about COVID-19 in their communities, perceived susceptibility to the virus, and reasons for susceptibility across three response options (Yes, No, and Don’t Know/Not Sure). Bivariate analyses compared characteristics by level of perceived susceptibility to COVID-19. A multinomial logistic regression model evaluated the association of demographics, health insurance coverage, and chronic illness status with perceived susceptibility. Participants’ race, gender, and educational attainment were significantly associated with perceived susceptibility to COVID-19. African Americans and males had higher odds of responding ‘No’, compared to ‘Yes’ and ‘Don’t Know/Not Sure’ than Whites and females. Participants with a high school education and lower had higher odds of responding ‘Don’t Know/Not Sure’ versus ‘Yes’ compared to those with college or higher education. Those unconcerned about COVID-19 in their community had higher odds of responding ‘No’ (OR = 2.51, CI 1.35–4.68) and ‘Don’t Know/Not Sure’ (OR = 2.51, CI 1.26–4.99) versus ‘Yes’, as compared to those who were concerned. Possibility of exposure at work was the most frequent reasons for perceiving themselves susceptible to COVID-19, engagement in recommended preventive measures was the most frequent reason among respondents who indicated ‘No’, and uncertainty/perception that everyone is at risk was the most frequent reason among the ones who indicated ‘Don’t Know/Not Sure’. Results indicate that tailored efforts to heighten perceived susceptibility to COVID-19 among specific demographics are needed.

Aim Less than half of all patients with Crohn's disease remain in remission with long‐term use of azathioprine. Our aim was to assess the efficacy of Artesunate and Curcumin in maintaining remission in patients with Crohn's disease, who had ongoing evidence of disease activity despite taking azathioprine. Methods Patients with Crohn's disease being treated with azathioprine for at least 3 months but still had mild to moderate Crohn's disease (CDAI 150–450) were included. Patients were randomized into four blocks of 10 patients each in a 2 × 2 factorial design to receive artesunate 200 mg PO daily for 2 weeks and/or curcumin 200 mg PO daily for 3 months or placebo. Harvey–Bradshaw Index, CDAI, and fecal calprotectin were measured at baseline, 1 week, 1 month, 3 months, and 6 months. Results Forty patients were recruited and randomized into the study. Both Artesunate and Curcumin were well tolerated with no adverse effects. The Harvey–Bradshaw Index statistically differed across the treatment groups at 6 months (p = 0.047), there were no significant group differences in the post hoc pairwise analysis. The differences in CDAI from baseline to 6 months were statistically significant in Artesunate + Curcumin (p = 0.0098) and Curcumin + Placebo (p = 0.0431) groups. Similarly, statistically significant differences were observed between Baseline and 6 months for the Harvey–Bradshaw Index in the Artesunate + Curcumin (p = 0.0070) and Curcumin + Placebo (p = 0.0138) groups. Conclusion A combination of artesunate and curcumin in patients with ongoing inflammatory activity appears to be effective as measured by CDAI and Harvey–Bradshaw Index.

This study examines major cancer sites among the population of Gandhinagar district, India during the year 2009-2011. To study leading cancer incidents and mortality and their age distribution in both sexes in Gandhinagar district. Primary data were collected from various sources and entered in computer and analyzed. Quality checks were done, and duplicate cases were eliminated. For mortality data, death registration units were contacted. Total 2360 incident cases (1374 males and 986 females) and 736 mortality cases (464 males and 272 females) were recorded during the year 2009-2011 in Gandhinagar district. Among males, the leadings sites were mouth, tongue, lung, esophagus, hypopharynx, and larynx, whereas in females they were breast, cervix, ovary, mouth, tongue and myeloid leukemia. Majority of cases were found in the age group of 35-64 years and the proportion in male and female in this age group was 62.51% and 71.05%, respectively. The study helps to understand the possible cancer patterns in Gandhinagar district. Foremost causes of cancer in leading sites in males were tobacco related, and the proportion of cancers associated with tobacco was 53% in our study. It highlights the possibility of easy and early detection of cancers, especially by oral cancer screening in the population. Further, the findings highlight the need of cancer cervix and breast screening among the women at regular intervals through camp approach in the community, as these are the most common sites (40% of female cancers).

Abstract Background Ultrasensitive ctDNA assays are emerging as a prognostic marker in various tumor types including in renal cell carcinoma (RCC). Pembrolizumab is currently approved for intermediate and high-risk, surgically resected RCC patients based on a survival benefit of approximately 5% at 48 months. There are no currently established biomarkers for treatment selection. We examine a tumor informed MRD-guided approach to the assignment of adjuvant immunotherapy in an ambispective cohort. Methods The study was conducted with Institutional Review Board (IRB) approval and obtained informed consent from all prospective participants. Key inclusion criteria included age ≥18 years, clear cell RCC of intermediate to high-risk of recurrence, no prior systemic therapy, Eastern Cooperative Oncology Group (ECOG) performance status 0–2, and availability of tumor sample for development of a tumor informed ctDNA MRD probe. M1 NED(No Evidence of Disease) was an exclusion criteria. In the prospective cohort, patients were assigned to receive pembrolizumab (400 mg q6 weeks or 200 mg q3 weeks) by intravenous infusion only if found to be ctDNA positive within a MRD surveillance window (<120 days from surgery). A minimum of one MRD test was required but more were allowed. In the retrospective cohort, only patients meeting prospective inclusion criteria and treated concordant to MRD with pembrolizumab were included. Data was analyzed for a period of 1/12/2023 - 2/23/2025. The primary and secondary endpoints were 1-year DFS and OS with an MRD guided approach respectively. Results 35 patients have been accrued (7 prospective, 28 retrospective), with a median follow up of 11 months. All patients were evaluable for radiologic progression. A median of 3 MRD tests were performed within the 12-week post-surgical eligibility window (range 1–4). 5 patients were MRD positive (14.28%), of which 3 have had recurred at the time of data cutoff. Among 30 patients who were MRD negative 2 patients progressed at followup (NPV = 93%). MRD guided therapy was associated with a 1-year DFS rate of 85.7% (95% CI: 69.7% – 93.4%) and MRD positivity was associated strongly with relapse risk HR 9.48 95%CI (1.58-57.00), P = .014 [Fig 1]. The median disease free survival in patients who tested positive for MRD was 5.6 months (95% CI 4.5–9.7 months). Median DFS was not reached in MRD negative patients. OS follow-up was not mature as no deaths were recorded in the study period. Conclusions This analysis of an intermediate-high risk RCC population treated based on serial postoperative MRD monitoring suggests that intensive MRD monitoring may be a valuable approach to better tailor adjuvant therapy for intermediate to high-risk RCC patients

Although low back pain is a common medical condition that often progresses to become a chronic problem, little is known about the likelihood of recovery from chronic low back pain (CLBP). This study aimed to measure the risk of recovery from CLBP based on low back pain intensity and back-related functioning measures reported by participants within a pain research registry over 12 months of observation and to consider the implications for osteopathic medicine. A total of 740 participants with CLBP in the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation in the United States were studied between April 2016 and October 2021. Inception cohorts for pain recovery and functional recovery were assembled from the participants who did not meet the recovery criteria at registry enrollment. The pain recovery criterion was having a score of ≤1/10 on a numerical rating scale for low back pain intensity, and the functional recovery criterion was having a score of ≤4/24 on the Roland-Morris Disability Questionnaire. A total of 737 and 692 participants were included in the inception cohorts for pain recovery and functional recovery, respectively. Participants provided follow-up data at quarterly encounters over 12 months to determine if they achieved and maintained a pain or functional recovery from CLBP over the entire period of observation. Logistic regression was utilized to identify factors associated with recovery. The mean age of the participants at baseline was 52.9 years (SD, 13.1 years) and 551 (74.5%) were female. No participant reported a pain recovery that was maintained over all four quarterly encounters, whereas 16 participants (2.3%; 95% CI, 1.2-3.4%) maintained a functional recovery. Having high levels of pain self-efficacy (OR, 17.50; 95% CI, 2.30-133.23; p=0.006) and being Hispanic (OR, 3.55; 95% CI, 1.11-11.37; p=0.03) were associated with functional recovery, and high levels of pain catastrophizing (OR, 0.15; 95% CI, 0.03-0.65; p=0.01) and having chronic widespread pain (OR, 0.23; 95% CI, 0.08-0.66; p=0.007) were inversely associated with functional recovery. The findings for pain self-efficacy and Hispanic ethnicity remained significant in the multivariate analysis that adjusted for potential confounders. The absence of pain recovery and the low likelihood of functional recovery observed in our study suggests that osteopathic physicians should embrace a biopsychosocial approach to CLBP management and work with patients to set realistic expectations based on more pragmatic outcome measures, such as those that address health-related quality of life. The findings also suggest the potential importance of patient education and counseling to enhance pain self-efficacy.

Purpose: This study was conducted to determine the feasibility of providing an eHealth intervention for health-related quality of life (HRQOL) to facilitate patient self-management. Methods: A randomized controlled trial was conducted from 2019–2020 within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation. Eligible patients included those with chronic low back pain and a SPADE (sleep disturbance, pain interference with activities, anxiety, depression, and low energy/fatigue) cluster score ≥ 55 based on the relevant scales from the Patient-Reported Outcomes Measurement Information System instrument with 29 items (PROMIS-29). Patients were randomized to the eHealth treatment group, which received a tailored HRQOL report and interpretation guide, or to a wait-list control group. The primary outcome was change in the SPADE cluster score, including its five component scales, over 3 months. Secondary outcomes were changes in low back pain intensity and back-related disability. Treatment effects were measured using the standardized mean difference (SMD) in change scores between groups. The eHealth intervention was also assessed by a survey of the experimental treatment group 1 month following randomization. Results: A total of 102 patients were randomized, including 52 in the eHealth treatment group and 50 in the wait-list control group, and 100 (98%) completed the trial. A majority of patients agreed that the HRQOL report was easy to understand (86%), provided new information (79%), and took actions to read or learn more about self-management approaches to improve their HRQOL (77%). Although the eHealth intervention met the criteria for a small treatment effect in improving the overall SPADE cluster score (SMD = 0.24; p= 0.23) and anxiety (SMD = 0.24; p = 0.23), and for a small-to-medium treatment effect in improving depression (SMD = 0.37; p = 0.06) and back-related disability (SMD = 0.36; p = 0.07), none of these results achieved statistical significance because of limited sample size. Conclusion: Given the feasibility of rapid online deployment, low cost, and low risk of adverse events, this eHealth intervention for HRQOL may be useful for patients with chronic pain during the COVID-19 pandemic.

Background The COVID-19 pandemic involved business closures (e.g., gyms), social distancing policies, and prolonged stressful situations that may have impacted engagement in health behaviors. Our study assessed changes in cancer-related health behaviors during the pandemic, specifically physical activity, fruit/vegetable intake, smoking/tobacco use, and alcohol consumption. Methods Eight cancer centers administered mailed/web-based/telephone surveys between June 2020 and March 2021. Surveys assessed demographics, perceptions on social distancing, and self-reported changes of behaviors (less/same/more) associated with cancer prevention or risk, e.g., physical activity, fruit/vegetable intake, tobacco/smoking use, and alcohol consumption. Descriptive analyses and logistic regression models assessed association of variables with behavior change. Results Most of the 21,911 respondents reported adhering to at least 4(of 5) social distancing measures (72%) and indicated social distancing was very/somewhat important to prevent the spread of COVID-19 (91%). 35% of respondents reported less physical activity, 11% reported less fruit/vegetable intake, 27% reported more smoking/tobacco use (among those who used tobacco/smoking products in past 30 days), and 23% reported more alcohol consumption (among those who reported at least 1 drink in past 30 days) than before the pandemic. Urban residence, younger age, female gender, and worse general health were associated with less physical activity, less fruit/vegetable intake, more smoking/tobacco use, and more alcohol intake. Higher educational attainment was associated with less physical activity and fruit/vegetable intake and more alcohol consumption. Reporting social distancing as important and adhering to more COVID-19 safety practices were associated with less physical activity and more alcohol consumption. Conclusion Our findings suggest that certain demographics and those who adhered to social distancing measures were more likely to self-report unfavorable changes in health behaviors during the pandemic. Future studies should examine if the behaviors returned to baseline following relief from pandemic restrictions, and if these behavior changes are associated with increased cancer incidence and mortality.