Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Kuwahara R [original query] |
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The economic burden of asthma in the United States, 2008 - 2013
Nurmagambetov T , Kuwahara R , Garbe P . Ann Am Thorac Soc 2018 15 (3) 348-356 RATIONALE: Asthma is a chronic disease that affects quality of life, productivity at work and school, healthcare use, and can result in death. Measuring the current economic burden of asthma provides important information on the impact of asthma on society. This information can be used to make informed decisions about allocation of limited public health resources. OBJECTIVES: In this paper, we provide a comprehensive approach to estimate current prevalence, medical costs, cost of absenteeism (missed work and schooldays) and mortality attributable to asthma from a national perspective. In addition, we estimate the association of incremental medical cost of asthma with several important factors, including race/ethnicity, education, poverty, and insurance status. METHODS: The primary source of data was the 2008-2013 household component of the Medical Expenditure Panel Survey. We defined treated asthma as the presence of at least one medical or pharmaceutical encounter or claim associated with asthma. For the main analysis, we applied two-part regression models to estimate asthma-related annual per-person incremental medical costs and negative binomial models to estimate absenteeism associated with asthma. RESULTS: Out of 213,994 people in the pooled sample, 10,237 persons had treated asthma (prevalence = 4.8%). The annual per-capita incremental medical cost of asthma was $3,266 (in 2015 US dollars): $1,830 was attributable to prescription medication, $640 to office visits, $529 to hospitalizations, $176 to hospital-based outpatient visits, and $105 to emergency room visits. For certain groups, the per-person incremental medical cost of asthma differed from that of the population average, namely, $2,145 for uninsured persons and $3.581 for those living below the poverty line. During 2008-2013, asthma was responsible for $3 billion in losses from missed work and school days, $29 billion from asthma-related mortality, and $50.3 billion in medical costs. All combined, the total cost of asthma in the U.S. based on the pooled sample amounted to $81.9 billion in 2013. CONCLUSION: Asthma places a significant economic burden on the United States with a total cost of asthma, including costs incurred by absenteeism and mortality, of $81.9 billion in 2013. |
Through a culturally competent lens: Why the program evaluation standards matter
Gill S , Kuwahara R , Wilce M . Health Promot Pract 2016 17 (1) 5-8 Program evaluation is an important tool for all health professionals as it enables us to learn what works, what does not, and how we can make improvements. In this article, we describe how both program staff and evaluators can use the program evaluation standards to ensure their work is culturally competent and stakeholder driven. When public health programs and their evaluations are responsive to culture and context, and they include meaningful-not token-stakeholder engagement, we produce better evaluations that are more likely to yield useful findings and lead to more effective programs. Effective programs are culturally competent programs that benefit communities in meaningful, respectful ways. |
Evaluation of the informed consent process of a multicenter tuberculosis treatment trial
Chapman KN , Pevzner E , Mangan JM , Breese P , Lamunu D , Shrestha-Kuwahara R , Nakibali JG , Goldberg SV . AJOB Empir Bioeth 2015 6 (4) 31-43 BACKGROUND: Ethical principles obligate researchers to maximize study participants’ comprehension during the informed consent process for clinical trials. A pilot evaluation of the consent process was conducted during an international clinical trial of treatment for pulmonary tuberculosis to assess the feasibility of conducting an evaluation in a larger population and to guide these future efforts. METHODS: Study staff administered an informed consent assessment tool (ICAT) to a convenience sample of trial participants, measuring comprehension of consent components as derived from the Common Rule and FDA Title 21 Part 50, and satisfaction with the process. Participating site staff completed a consent process questionnaire about consent practices at their respective sites and provided improvement recommendations. ICAT scores and corresponding practices were compared where both were completed. RESULTS: ICATs (n = 54) were submitted from one site in Spain (n = 10), one in Uganda (n = 30), and five in the United States (n = 14). Participants were primarily male (76%), born in Africa (n = 31, 57%), and had a median age of 27 years (interquartile range [IQR]: 24–42). Median ICAT scores were 80% (IQR: 67–93) for comprehension and 89% (IQR: 78–100) for satisfaction. Ugandan participants scored higher than participants from other sites on comprehension (87% vs. 64%) and satisfaction (100% vs. 78%). Staff from 14 sites completed consent process questionnaires. Median ICAT scores for comprehension and satisfaction were higher at sites that utilized visual aids. Practice recommendations included shorter forms, simpler documents, and supplementary materials. CONCLUSIONS: Participants achieved high levels (≥80%) of comprehension and satisfaction with their current consent processes. Higher ICAT scores at one site suggest an additional evaluation may identify approaches to improve comprehension and satisfaction in future trials. Through this pilot evaluation, complexities and challenges were identified in obtaining consent in a large, international multicenter trial and provided insights for a more robust assessment of the consent process in future trials. |
Latent tuberculous infection in the United States and Canada: who completes treatment and why?
Hirsch-Moverman Y , Shrestha-Kuwahara R , Bethel J , Blumberg HM , Venkatappa TK , Horsburgh CR , Colson PW . Int J Tuberc Lung Dis 2015 19 (1) 31-8 OBJECTIVES: To assess latent tuberculous infection (LTBI) treatment completion rates in a large prospective US/Canada multisite cohort and identify associated risk factors. METHODS: This prospective cohort study assessed factors associated with LTBI treatment completion through interviews with persons who initiated treatment at 12 sites. Interviews were conducted at treatment initiation and completion/cessation. Participants received usual care according to each clinic's procedure. Multivariable models were constructed based on stepwise assessment of potential predictors and interactions. RESULTS: Of 1515 participants initiating LTBI treatment, 1323 had information available on treatment completion; 617 (46.6%) completed treatment. Baseline predictors of completion included male sex, foreign birth, not thinking it would be a problem to take anti-tuberculosis medication, and having health insurance. Participants in stable housing who received monthly appointment reminders were more likely to complete treatment than those without stable housing or without monthly reminders. End-of-treatment predictors of non-completion included severe symptoms and the inconvenience of clinic/pharmacy schedules, barriers to care and changes of residence. Common reasons for treatment non-completion were patient concerns about tolerability/toxicity, appointment conflicts, low prioritization of TB, and forgetfulness. CONCLUSIONS: Less than half of treatment initiators completed treatment in our multisite study. Addressing tangible issues such as not having health insurance, toxicity concerns, and clinic accessibility could help to improve treatment completion rates. |
Latent TB infection treatment acceptance and completion in the United States and Canada
Horsburgh Jr CR , Goldberg S , Bethel J , Chen S , Colson PW , Hirsch-Moverman Y , Hughes S , Shrestha-Kuwahara R , Sterling TR , Wall K , Weinfurter P . Chest 2010 137 (2) 401-9 BACKGROUND: Treatment of latent TB infection (LTBI) is essential for preventing TB in North America, but acceptance and completion of this treatment have not been systematically assessed. METHODS: We performed a retrospective, randomized two-stage cross-sectional survey of treatment and completion of LTBI at public and private clinics in 19 regions of the United States and Canada in 2002. RESULTS: At 32 clinics that both performed tuberculin skin testing and offered treatment, 123 (17.1%; 95% CI, 14.5%-20.0%) of 720 subjects tested and offered treatment declined. Employees at health-care facilities were more likely to decline (odds ratio [OR], 4.74; 95% CI, 1.75-12.9; P = .003), whereas those in contact with a patient with TB were less likely to decline (OR, 0.19; 95% CI, 0.07-0.50; P = .001). At 68 clinics starting treatment regardless of where skin testing was performed, 1,045 (52.7%; 95% CI, 48.5%-56.8%) of 1,994 people starting treatment failed to complete the recommended course. Risk factors for failure to complete included starting the 9-month isoniazid regimen (OR, 2.08; 95% CI, 1.23-3.57), residence in a congregate setting (nursing home, shelter, or jail; OR, 2.94; 95% CI, 1.58-5.56), injection drug use (OR, 2.13; 95% CI, 1.04-4.35), age >or= 15 years (OR, 1.49; 95% CI, 1.14-1.94), and employment at a health-care facility (1.37; 95% CI, 1.00-1.85). CONCLUSIONS: Fewer than half of the people starting treatment of LTBI completed therapy. Shorter regimens and interventions targeting residents of congregate settings, injection drug users, and employees of health-care facilities are needed to increase completion. |
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