Kalpana Ramiah - Academia.edu (original) (raw)

Papers by Kalpana Ramiah

Public Health Reports, May 1, 2004

Annals of Surgical Oncology

Advances in breast cancer screening and systemic therapies have been credited with profound impro... more Advances in breast cancer screening and systemic therapies have been credited with profound improvements in breast cancer outcomes; indeed, 5-year relative survival rate approaches 91% in the USA (U.S. National Institutes of Health NCI. SEER Training Modules, Breast). While breast cancer mortality has been declining, oncologic outcomes have not improved equally among all races and ethnicities. Many factors have been implicated in breast cancer disparities; chief among them is limited access to care which contributes to lower rates of timely screening mammography and, once diagnosed with breast cancer, lower rates of receipt of guideline concordant care (Wu, Lund, Kimmick GG et al. in J Clin Oncol 30(2):142–150, 2012). Hospitals with a safety-net mission, such as the essential hospitals, historically have been dedicated to providing high-quality care to all populations and have eagerly embraced the role of caring for the most vulnerable and working to eliminate health disparities. In this article, we review landmark articles that have evaluated the role safety-net hospitals have played in providing equitable breast cancer care including to those patients who face significant social and economic challenges.

Annals of Surgical Oncology

Advances in breast cancer screening and systemic therapies have been credited with profound impro... more Advances in breast cancer screening and systemic therapies have been credited with profound improvements in breast cancer outcomes; the relative rate approaches

Objective: This study examines risk perceptions, nutrition practices, and physical activity among... more Objective: This study examines risk perceptions, nutrition practices, and physical activity among ever pregnant South Asian American women, and explores differences by history of GDM, a significant risk factor for the development of type 2 diabetes. Methods: The Diabetes Prevention Study (DPS) recruited a convenience sample of South Asian adults living in the metropolitan Washington DC region. Specific eligibility criteria included English proficiency; having at least one child between the ages of 5 and 15; no current diagnosis of type 2 diabetes mellitus (T2DM); and having a family history of T2DM. The present study utilizes a subset of the DPS dataset and includes 109 ever pregnant women, including 58% with a history of GDM. Results: Mean scores for perceptions of risk showed that both worry and personal control are slightly greater than "neutral" with 3.5 out 5. Therefore, women worry about T2DM yet also perceive personal control for their risk. 40.2% of all respondents use ghee (clarified butter) to cook meals and 41.7% re-use cooking oil. 35% of respondents report no physical activity in an average week. Only 39.8% of women meet the recommended guidelines for adults in the US There are no significant differences between women with or without a history of GDM for nutrition practices and physical activity. Conclusions: This study adds to the literature on GDM and missed opportunities for the prevention of future T2DM. Future research ought to explore knowledge levels on T2DM during and after pregnancy, as well as what types of intervenetions would be effective and acceptable to South Asian women.

NAM Perspectives, 2020

In this paper, we emphasize and explore health equity as an integral component of a culture of pa... more In this paper, we emphasize and explore health equity as an integral component of a culture of patient and family engaged care (PFEC), rather than an isolated or peripheral outcome. To examine the role of PFEC in addressing health inequities, we build on the 2017 NAM Perspectives discussion paper "Harnessing Evidence and Experience to Change Culture: A Guiding Framework for Patient and Family Engaged Care." Informed by both scientific evidence and the lived experience of patients, their care partners, practitioners, and health system leaders, the paper by Frampton et al. introduced a novel Guiding Framework that delineates critical elements that work together to co-create a culture of PFEC, while also depicting a logical sequencing for implementation that facilitates progressive change and improvement toward the Quadruple Aim outcomes of better culture, better care, better health, and lower costs. In this paper, the authors highlight the need to integrate addressing health and health care disparities and improving health equity as core components of the framework to ensure the culture and policy changes necessary to meaningfully engage patients, health system staff, families, and communities. AUTHOR'S NOTE This paper was written prior to the emergence of the COVID-19 pandemic, which has caused widespread stresses to health care systems and social conditions that affect health. The authors feel that the key messages of this paper, notably the need for detailed data collection on health disparities and implementation of policies designed to ameliorate those inequities, in conjunction with continued partnership with patients and their families, are especially relevant as methods and mechanisms of the provision of health care and protection of health change. BOX 1 | Definitions and Terms Health Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity [117]. Health Equity Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This concept requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care [19]. Health Care Equity Health care equity means providing care that does not vary in quality by personal characteristics such as ethnicity, race, gender, geographic location, socioeconomic status, or other identity [62]. Health Disparities Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population [78]. Health Care Disparities Health care disparities are the differences in the preventive, diagnostic, or treatment services offered to people with similar health conditions [60]. Social Determinants of Health Social determinants of health include the conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks [106]. Population Health Population health is defined as the health outcomes of a group of individuals including the distribution of such outcomes of these individuals. This approach to health aims to improve the health of an entire human population [65]. Health Literacy Health literacy is the alignment of available and accurate health information and services in a society with people's capacities to find, understand, and use health information and services for informed decisions and actions. Health numeracy-the ability to understand and work with numbers-is an important part of this skill [79,95].

Background/Significance: There is a paucity of data on perceptions of health needs for the South ... more Background/Significance: There is a paucity of data on perceptions of health needs for the South Asian population in the United States. Although community based organizations focused on South Asians exist around the country, it is still unclear whether these organizations prioritize health issues in the same way as South Asians themselves. A groundbreaking study, Project SAHNA (South Asian Health Needs Assessment) examined health related perceptions, and behaviors amongst a sample of South Asians living in the Washington, DC metropolitan area. Data from Project SAHNA coupled with a recent study of community-based organizations (CBOs) around the country will assist in identifying gaps and common needs as perceived by both organizations and individuals. Methods: The statistical analysis approached for Project SAHNA and understanding the impact of CBOs on South Asians was a combination of quantitative and qualitative research using an on-line survey and paper/pencil surveys and an on-l...

The MPH Core Competency Project was initiated in 2004, directed by staff and consultants of the A... more The MPH Core Competency Project was initiated in 2004, directed by staff and consultants of the Association of Schools of Public Health (ASPH). The purpose of the project was to identify a set of competencies that every MPH graduate should possess in the five core disciplines, plus public health biology, and a set of interdisciplinary cross-cutting areas. One of the core areas was biostatistics. The author of this paper chaired the Biostatistics Competency Workgroup, made up of academicians and practitioners, and many members of the APHA Statistics Section served on one of the workgroups in the three-round Delphi process used to focus the competencies. The process used for the biostatistics competencies involved the collection of candidate competencies from workgroup members. The chair and one of the workgroup members organized the set of candidate competencies into a set of 30 competencies. These were submitted for the first round of the Delphi where workgroup members were asked to...

Health, 2012

Objective: This study examines risk perceptions, nutrition practices, and physical activity among... more Objective: This study examines risk perceptions, nutrition practices, and physical activity among ever pregnant South Asian American women, and explores differences by history of GDM, a significant risk factor for the development of type 2 diabetes. Methods: The Diabetes Prevention Study (DPS) recruited a convenience sample of South Asian adults living in the metropolitan Washington DC region. Specific eligibility criteria included English proficiency; having at least one child between the ages of 5 and 15; no current diagnosis of type 2 diabetes mellitus (T2DM); and having a family history of T2DM. The present study utilizes a subset of the DPS dataset and includes 109 ever pregnant women, including 58% with a history of GDM. Results: Mean scores for perceptions of risk showed that both worry and personal control are slightly greater than "neutral" with 3.5 out 5. Therefore, women worry about T2DM yet also perceive personal control for their risk. 40.2% of all respondents use ghee (clarified butter) to cook meals and 41.7% re-use cooking oil. 35% of respondents report no physical activity in an average week. Only 39.8% of women meet the recommended guidelines for adults in the US There are no significant differences between women with or without a history of GDM for nutrition practices and physical activity. Conclusions: This study adds to the literature on GDM and missed opportunities for the prevention of future T2DM. Future research ought to explore knowledge levels on T2DM during and after pregnancy, as well as what types of intervenetions would be effective and acceptable to South Asian women.

Public health reports (Washington, D.C. : 1974)

Public health reports (Washington, D.C. : 1974)

During this meeting, the participants developed a strategic set of recommendations for ASPH to co... more During this meeting, the participants developed a strategic set of recommendations for ASPH to continue to advance the study of tobacco control in public health through research and education/training programs. The meeting focused on sustaining and further developing tobacco-related research and education/ training programs. All four issues were addressed in depth through valuable discussion and exchange and reflected in the nine areas of focus. Recommendations for advocacy for future funding for SPH in tobacco control included developing collaborative relationships with ASPH partners, organizations, and institutions with complementary objectives (state departments of health, third party payors, etc). Priorities for sustaining and further developing research and education/training programs within SPH included developing a focus on particular research areas (e.g., special populations, economic issues, dissemination and translational issues), building on existing knowledge, and attemp...

Health, 2012

Community based organizations play a vital role in the health of communities in the United States... more Community based organizations play a vital role in the health of communities in the United States, particularly among immigrant and minority populations. Yet the gap between the needs of the community and the health issues that are being addressed remains quite large. This qualitative assessment provides a brief summary of community-based organizations in the US that focus on health issues specifically addressing the needs of south Asian Americans. In addition, this assessment explores the health needs of the South Asian American community living in the Washington DC metropolitan region, the fifth largest densely populated city in the US of South Asian Americans. While the report provides an array of organizations serving this population, the question of how effective can community-based organizations be if they can not prioritize their needs based on the community's needs still remains.

Infection Control & Hospital Epidemiology, 2014

Objective.To understand the prevalence of multidrug-resistant organism (MDRO) infections among nu... more Objective.To understand the prevalence of multidrug-resistant organism (MDRO) infections among nursing home (NH) residents and the potential for their spread between NHs and acute care hospitals (ACHs).Methods.Descriptive analyses of MDRO infections among NH residents using all NH residents in the Long-Term Care Minimum Data Set (MDS) 3.0 between October 1, 2010 and December 31, 2011.Results.Analysis of MDS data revealed a very high volume of bidirectional patient flow between NHs and ACHs, indicating the need to study MDRO infections in NHs as well as in hospitals. A total of 4.24% of NH residents had an active MDRO diagnosis on at least 1 MDS assessment during the study period. This rate significantly varied by sex, age, urban/rural status, and state. Approximately 2% of NH discharges to ACHs involved a resident with an active diagnosis of infection due to MDROs. Conversely, 1.8% of NH admissions from an ACH involved a patient with an active diagnosis of infection due to MDROs. Am...

Public Health Reports, 2004

Journal of Immigrant and Minority Health, 2012

Limited data and research is available on the health issues faced by the South Asian population, ... more Limited data and research is available on the health issues faced by the South Asian population, especially for those living in the Washington, DC metropolitan area. Online and in-person surveys were administered to a convenience sample (n = 709) of South Asians living in the metropolitan Washington DC region. The survey gathered information on socio-demographics and acculturation; health care access and utilization; sources of health information; perceptions of community health; physical activity and smoking. While over 70 % of participants had a routine physical exam in the last 12 months, foreign born and less acculturated adults were less likely to have had a routine visit in the last 12 months. Internet (76.9 %) and physicians (76.1 %) are key sources of health information for South Asians. Only 29 % of South Asians are engaging in the recommended amount of physical activity per week. The results of this study provide guidance for future work in addressing the health and well-being of South Asian communities in the United States.

Journal of Health Communication, 2013

When a new patient education program is being considered for adoption by a public health agency, ... more When a new patient education program is being considered for adoption by a public health agency, it is essential to determine provider perceptions of its acceptability for routine use. In 2007, the West Virginia Bureau of Public Health Perinatal Program, Right From The Start (RFTS), decided to adopt the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Program. RFTS is a statewide perinatal home visitation initiative delivered by designated care coordinators (DCCs). The authors developed the SCRIPT Adoption Scale (SAS) in the absence of a valid instrument to assess the perceived attributes of a tobacco treatment innovation among the RFTS DCC population. They evaluated the validity of the five constructs of the Rogers' Diffusion of Innovations model in an organization (relative advantage, compatibility, complexity, observability, and trialability) to predict SCRIPT use. After reviewing the literature and developing draft SAS forms, 2 expert panel reviews established the face and content validity of a 43-item SAS. It was administered to 90% (85/90) of the RFTS DCC population. Psychometric analyses confirmed the validity and reliability of a 28-item scale. All 28 items had factor loadings greater than 0.40 (range = 0.43-0.81). All SAS subscales were strongly correlated, r = 0.51 to 0.97, supporting the convergent validity of a 5-factor SAS. There was a significant association between the DCC SAS score and DCC SCRIPT Program Implementation Index supporting the SAS convergent (construct) validity (r = 0.38). The SAS internal consistencyr = 0.93 and stabilityr = 0.76. Although 2 specific subscales need to be improved, the SAS can be adapted by prenatal care programs to measure the attributes of adoption of new, evidence-based patient education and counseling methods.

American Journal of Public Health, 2008

Core competencies have been used to redefine curricula across the major health professions in rec... more Core competencies have been used to redefine curricula across the major health professions in recent decades. In 2006, the Association of Schools of Public Health identified core competencies for the master of public health degree in graduate schools and programs of public health. We provide an overview of the model development process and a listing of 12 core domains and 119 competencies that can serve as a resource for faculty and students for enhancing the quality and accountability of graduate public health education and training. The primary vision for the initiative is the graduation of professionals who are more fully prepared for the many challenges and opportunities in public health in the forthcoming decade.

Public health reports (Washington, D.C. : 1974), 2008

Competency-based education for public health professionals has been recommended by the Institute ... more Competency-based education for public health professionals has been recommended by the Institute of Medicine. The Association of Schools of Public Health has developed a set of academic core competencies that it recommends that all Master of Public Health (MPH) students should possess prior to graduation. This article discusses the processes and reasoning used by the workgroup that prepared the epidemiology subset of MPH core competencies that appear in the association's 2006 report. These academic core competencies are complementary to but distinct from the specialist competencies that students should develop in their major field. The authors emphasize the importance of ongoing refinement of the core competency model with participation from both public health academics and public health practitioners.

Public Health Reports, May 1, 2004

Annals of Surgical Oncology

Advances in breast cancer screening and systemic therapies have been credited with profound impro... more Advances in breast cancer screening and systemic therapies have been credited with profound improvements in breast cancer outcomes; indeed, 5-year relative survival rate approaches 91% in the USA (U.S. National Institutes of Health NCI. SEER Training Modules, Breast). While breast cancer mortality has been declining, oncologic outcomes have not improved equally among all races and ethnicities. Many factors have been implicated in breast cancer disparities; chief among them is limited access to care which contributes to lower rates of timely screening mammography and, once diagnosed with breast cancer, lower rates of receipt of guideline concordant care (Wu, Lund, Kimmick GG et al. in J Clin Oncol 30(2):142–150, 2012). Hospitals with a safety-net mission, such as the essential hospitals, historically have been dedicated to providing high-quality care to all populations and have eagerly embraced the role of caring for the most vulnerable and working to eliminate health disparities. In this article, we review landmark articles that have evaluated the role safety-net hospitals have played in providing equitable breast cancer care including to those patients who face significant social and economic challenges.

Annals of Surgical Oncology

Advances in breast cancer screening and systemic therapies have been credited with profound impro... more Advances in breast cancer screening and systemic therapies have been credited with profound improvements in breast cancer outcomes; the relative rate approaches

Objective: This study examines risk perceptions, nutrition practices, and physical activity among... more Objective: This study examines risk perceptions, nutrition practices, and physical activity among ever pregnant South Asian American women, and explores differences by history of GDM, a significant risk factor for the development of type 2 diabetes. Methods: The Diabetes Prevention Study (DPS) recruited a convenience sample of South Asian adults living in the metropolitan Washington DC region. Specific eligibility criteria included English proficiency; having at least one child between the ages of 5 and 15; no current diagnosis of type 2 diabetes mellitus (T2DM); and having a family history of T2DM. The present study utilizes a subset of the DPS dataset and includes 109 ever pregnant women, including 58% with a history of GDM. Results: Mean scores for perceptions of risk showed that both worry and personal control are slightly greater than "neutral" with 3.5 out 5. Therefore, women worry about T2DM yet also perceive personal control for their risk. 40.2% of all respondents use ghee (clarified butter) to cook meals and 41.7% re-use cooking oil. 35% of respondents report no physical activity in an average week. Only 39.8% of women meet the recommended guidelines for adults in the US There are no significant differences between women with or without a history of GDM for nutrition practices and physical activity. Conclusions: This study adds to the literature on GDM and missed opportunities for the prevention of future T2DM. Future research ought to explore knowledge levels on T2DM during and after pregnancy, as well as what types of intervenetions would be effective and acceptable to South Asian women.

NAM Perspectives, 2020

In this paper, we emphasize and explore health equity as an integral component of a culture of pa... more In this paper, we emphasize and explore health equity as an integral component of a culture of patient and family engaged care (PFEC), rather than an isolated or peripheral outcome. To examine the role of PFEC in addressing health inequities, we build on the 2017 NAM Perspectives discussion paper "Harnessing Evidence and Experience to Change Culture: A Guiding Framework for Patient and Family Engaged Care." Informed by both scientific evidence and the lived experience of patients, their care partners, practitioners, and health system leaders, the paper by Frampton et al. introduced a novel Guiding Framework that delineates critical elements that work together to co-create a culture of PFEC, while also depicting a logical sequencing for implementation that facilitates progressive change and improvement toward the Quadruple Aim outcomes of better culture, better care, better health, and lower costs. In this paper, the authors highlight the need to integrate addressing health and health care disparities and improving health equity as core components of the framework to ensure the culture and policy changes necessary to meaningfully engage patients, health system staff, families, and communities. AUTHOR'S NOTE This paper was written prior to the emergence of the COVID-19 pandemic, which has caused widespread stresses to health care systems and social conditions that affect health. The authors feel that the key messages of this paper, notably the need for detailed data collection on health disparities and implementation of policies designed to ameliorate those inequities, in conjunction with continued partnership with patients and their families, are especially relevant as methods and mechanisms of the provision of health care and protection of health change. BOX 1 | Definitions and Terms Health Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity [117]. Health Equity Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This concept requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care [19]. Health Care Equity Health care equity means providing care that does not vary in quality by personal characteristics such as ethnicity, race, gender, geographic location, socioeconomic status, or other identity [62]. Health Disparities Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population [78]. Health Care Disparities Health care disparities are the differences in the preventive, diagnostic, or treatment services offered to people with similar health conditions [60]. Social Determinants of Health Social determinants of health include the conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks [106]. Population Health Population health is defined as the health outcomes of a group of individuals including the distribution of such outcomes of these individuals. This approach to health aims to improve the health of an entire human population [65]. Health Literacy Health literacy is the alignment of available and accurate health information and services in a society with people's capacities to find, understand, and use health information and services for informed decisions and actions. Health numeracy-the ability to understand and work with numbers-is an important part of this skill [79,95].

Background/Significance: There is a paucity of data on perceptions of health needs for the South ... more Background/Significance: There is a paucity of data on perceptions of health needs for the South Asian population in the United States. Although community based organizations focused on South Asians exist around the country, it is still unclear whether these organizations prioritize health issues in the same way as South Asians themselves. A groundbreaking study, Project SAHNA (South Asian Health Needs Assessment) examined health related perceptions, and behaviors amongst a sample of South Asians living in the Washington, DC metropolitan area. Data from Project SAHNA coupled with a recent study of community-based organizations (CBOs) around the country will assist in identifying gaps and common needs as perceived by both organizations and individuals. Methods: The statistical analysis approached for Project SAHNA and understanding the impact of CBOs on South Asians was a combination of quantitative and qualitative research using an on-line survey and paper/pencil surveys and an on-l...

The MPH Core Competency Project was initiated in 2004, directed by staff and consultants of the A... more The MPH Core Competency Project was initiated in 2004, directed by staff and consultants of the Association of Schools of Public Health (ASPH). The purpose of the project was to identify a set of competencies that every MPH graduate should possess in the five core disciplines, plus public health biology, and a set of interdisciplinary cross-cutting areas. One of the core areas was biostatistics. The author of this paper chaired the Biostatistics Competency Workgroup, made up of academicians and practitioners, and many members of the APHA Statistics Section served on one of the workgroups in the three-round Delphi process used to focus the competencies. The process used for the biostatistics competencies involved the collection of candidate competencies from workgroup members. The chair and one of the workgroup members organized the set of candidate competencies into a set of 30 competencies. These were submitted for the first round of the Delphi where workgroup members were asked to...

Health, 2012

Objective: This study examines risk perceptions, nutrition practices, and physical activity among... more Objective: This study examines risk perceptions, nutrition practices, and physical activity among ever pregnant South Asian American women, and explores differences by history of GDM, a significant risk factor for the development of type 2 diabetes. Methods: The Diabetes Prevention Study (DPS) recruited a convenience sample of South Asian adults living in the metropolitan Washington DC region. Specific eligibility criteria included English proficiency; having at least one child between the ages of 5 and 15; no current diagnosis of type 2 diabetes mellitus (T2DM); and having a family history of T2DM. The present study utilizes a subset of the DPS dataset and includes 109 ever pregnant women, including 58% with a history of GDM. Results: Mean scores for perceptions of risk showed that both worry and personal control are slightly greater than "neutral" with 3.5 out 5. Therefore, women worry about T2DM yet also perceive personal control for their risk. 40.2% of all respondents use ghee (clarified butter) to cook meals and 41.7% re-use cooking oil. 35% of respondents report no physical activity in an average week. Only 39.8% of women meet the recommended guidelines for adults in the US There are no significant differences between women with or without a history of GDM for nutrition practices and physical activity. Conclusions: This study adds to the literature on GDM and missed opportunities for the prevention of future T2DM. Future research ought to explore knowledge levels on T2DM during and after pregnancy, as well as what types of intervenetions would be effective and acceptable to South Asian women.

Public health reports (Washington, D.C. : 1974)

Public health reports (Washington, D.C. : 1974)

During this meeting, the participants developed a strategic set of recommendations for ASPH to co... more During this meeting, the participants developed a strategic set of recommendations for ASPH to continue to advance the study of tobacco control in public health through research and education/training programs. The meeting focused on sustaining and further developing tobacco-related research and education/ training programs. All four issues were addressed in depth through valuable discussion and exchange and reflected in the nine areas of focus. Recommendations for advocacy for future funding for SPH in tobacco control included developing collaborative relationships with ASPH partners, organizations, and institutions with complementary objectives (state departments of health, third party payors, etc). Priorities for sustaining and further developing research and education/training programs within SPH included developing a focus on particular research areas (e.g., special populations, economic issues, dissemination and translational issues), building on existing knowledge, and attemp...

Health, 2012

Community based organizations play a vital role in the health of communities in the United States... more Community based organizations play a vital role in the health of communities in the United States, particularly among immigrant and minority populations. Yet the gap between the needs of the community and the health issues that are being addressed remains quite large. This qualitative assessment provides a brief summary of community-based organizations in the US that focus on health issues specifically addressing the needs of south Asian Americans. In addition, this assessment explores the health needs of the South Asian American community living in the Washington DC metropolitan region, the fifth largest densely populated city in the US of South Asian Americans. While the report provides an array of organizations serving this population, the question of how effective can community-based organizations be if they can not prioritize their needs based on the community's needs still remains.

Infection Control & Hospital Epidemiology, 2014

Objective.To understand the prevalence of multidrug-resistant organism (MDRO) infections among nu... more Objective.To understand the prevalence of multidrug-resistant organism (MDRO) infections among nursing home (NH) residents and the potential for their spread between NHs and acute care hospitals (ACHs).Methods.Descriptive analyses of MDRO infections among NH residents using all NH residents in the Long-Term Care Minimum Data Set (MDS) 3.0 between October 1, 2010 and December 31, 2011.Results.Analysis of MDS data revealed a very high volume of bidirectional patient flow between NHs and ACHs, indicating the need to study MDRO infections in NHs as well as in hospitals. A total of 4.24% of NH residents had an active MDRO diagnosis on at least 1 MDS assessment during the study period. This rate significantly varied by sex, age, urban/rural status, and state. Approximately 2% of NH discharges to ACHs involved a resident with an active diagnosis of infection due to MDROs. Conversely, 1.8% of NH admissions from an ACH involved a patient with an active diagnosis of infection due to MDROs. Am...

Public Health Reports, 2004

Journal of Immigrant and Minority Health, 2012

Limited data and research is available on the health issues faced by the South Asian population, ... more Limited data and research is available on the health issues faced by the South Asian population, especially for those living in the Washington, DC metropolitan area. Online and in-person surveys were administered to a convenience sample (n = 709) of South Asians living in the metropolitan Washington DC region. The survey gathered information on socio-demographics and acculturation; health care access and utilization; sources of health information; perceptions of community health; physical activity and smoking. While over 70 % of participants had a routine physical exam in the last 12 months, foreign born and less acculturated adults were less likely to have had a routine visit in the last 12 months. Internet (76.9 %) and physicians (76.1 %) are key sources of health information for South Asians. Only 29 % of South Asians are engaging in the recommended amount of physical activity per week. The results of this study provide guidance for future work in addressing the health and well-being of South Asian communities in the United States.

Journal of Health Communication, 2013

When a new patient education program is being considered for adoption by a public health agency, ... more When a new patient education program is being considered for adoption by a public health agency, it is essential to determine provider perceptions of its acceptability for routine use. In 2007, the West Virginia Bureau of Public Health Perinatal Program, Right From The Start (RFTS), decided to adopt the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Program. RFTS is a statewide perinatal home visitation initiative delivered by designated care coordinators (DCCs). The authors developed the SCRIPT Adoption Scale (SAS) in the absence of a valid instrument to assess the perceived attributes of a tobacco treatment innovation among the RFTS DCC population. They evaluated the validity of the five constructs of the Rogers' Diffusion of Innovations model in an organization (relative advantage, compatibility, complexity, observability, and trialability) to predict SCRIPT use. After reviewing the literature and developing draft SAS forms, 2 expert panel reviews established the face and content validity of a 43-item SAS. It was administered to 90% (85/90) of the RFTS DCC population. Psychometric analyses confirmed the validity and reliability of a 28-item scale. All 28 items had factor loadings greater than 0.40 (range = 0.43-0.81). All SAS subscales were strongly correlated, r = 0.51 to 0.97, supporting the convergent validity of a 5-factor SAS. There was a significant association between the DCC SAS score and DCC SCRIPT Program Implementation Index supporting the SAS convergent (construct) validity (r = 0.38). The SAS internal consistencyr = 0.93 and stabilityr = 0.76. Although 2 specific subscales need to be improved, the SAS can be adapted by prenatal care programs to measure the attributes of adoption of new, evidence-based patient education and counseling methods.

American Journal of Public Health, 2008

Core competencies have been used to redefine curricula across the major health professions in rec... more Core competencies have been used to redefine curricula across the major health professions in recent decades. In 2006, the Association of Schools of Public Health identified core competencies for the master of public health degree in graduate schools and programs of public health. We provide an overview of the model development process and a listing of 12 core domains and 119 competencies that can serve as a resource for faculty and students for enhancing the quality and accountability of graduate public health education and training. The primary vision for the initiative is the graduation of professionals who are more fully prepared for the many challenges and opportunities in public health in the forthcoming decade.

Public health reports (Washington, D.C. : 1974), 2008

Competency-based education for public health professionals has been recommended by the Institute ... more Competency-based education for public health professionals has been recommended by the Institute of Medicine. The Association of Schools of Public Health has developed a set of academic core competencies that it recommends that all Master of Public Health (MPH) students should possess prior to graduation. This article discusses the processes and reasoning used by the workgroup that prepared the epidemiology subset of MPH core competencies that appear in the association's 2006 report. These academic core competencies are complementary to but distinct from the specialist competencies that students should develop in their major field. The authors emphasize the importance of ongoing refinement of the core competency model with participation from both public health academics and public health practitioners.