Medical Students Knowledge, Attitudes, and Perceptions Regarding the Affordable Care Act and Other Health Policy Issues

ABSTRACT BACKGROUND: Very little is known regarding medical student's attitudes and knowledge on the Affordable Care Act (ACA) and if they are willing to engage in its implementation as part of their future professional obligations. OBJECTIVE: To characterize medical students' views on and knowledge of the ACA and assess correlates of these views. DESIGN: A link to an IRB-approved online survey was emailed directly to students through their university-affiliated email addresses. Cross-sectional survey. PARTICIPANTS: 5,340 medical students enrolled at eight geographically diverse U.S. medical schools (overall response rate 2,761/5,340 [52%]). MAIN MEASURES: We measured students' levels of agreement with 4 questions targeting ACA viewpoints and ability to answer 9 knowledge-based questions regarding the ACA. Students also had the opportunity to answer 2 open-ended questions to give their opinions on positive and negative aspects of the ACA. KEY RESULTS: The majority of respondents indicated understanding of the ACA (75.3%), support for its enactment (62.8%), and a professional obligation to assist with implementation of the ACA (56.1%). The mean number of correct answers on the knowledge-based questions was 6.9±1.3 out of a possible 9 points. Those who anticipated going into a surgical or procedure- based specialty were less likely to support the legislation (OR=0.6 (0.4-0.7), OR=0.4 (0.3-0.6)), less likely to indicate a professional obligation to implement the ACA (OR= 0.7 (0.6-0.9), OR=0.7 (0.5-0.96)), and more likely to have negative expectations (OR=1.9 (1.5-2.6), OR=2.3 (1.6-3.5)) when compared to those who plan to go into a medical or primary care specialty. Those who identified themselves as political moderates, politically liberal, and those with an above average knowledge score were more likely to indicate support for the ACA (OR=5.7 (4.1-7.9), OR= 35.1 (25.4-48.5), OR= 1.7 (1.4-2.1)) and a professional obligation toward implementation of the ACA (OR=1.9 (1.4-2.5), OR=4.7 (3.6-6.0), OR=1.2 (1.02-1.5))1 Positive comments regarding the ACA from the quantitative section, showed themes focused on appreciation for increased access to care, focus on primary care, coverage for pre-existing conditions, and allowing children to stay on parents' insurance plans until 26 years of age. Negative comments focused on lack of tort reform to lessen the burden of malpractice suits on physicians, no identifiable plan to alleviate physician shortage or reduce physicians' educational debt, and concerns about the economic implications of expanding Medicaid provisions. CONCLUSIONS: This study is one of the first national studies addressing medical students' knowledge and views on the ACA. The majority of student respondents support the ACA. We found that support towards the ACA was highest among students who anticipate a future career in a medical specialty, self-identify as political moderates and liberals, or had an above average knowledge score of the ACA. Strong support of the ACA by future physicians suggests they are willing to be involved with health care reform measures and health policy which may lead to improving access to care for many Americans. However, ongoing input from future physicians is critical as many of them have positive and negative opinions or possibly no opinion (lack of interest or knowledge) on the ACA that may ultimately affect individual health care practices. KEYWORDS: Medical students; Health care reform; Affordable Care Act; Survey.Master of Public Healt

Gaining a “Foothold” on the Diagnosis of Leishmaniasis

Pediatric refugees and immigrants may present with unusual diagnoses due to their extensive migration and potential harsh conditions in travel. Trauma and family separation add to the difficulty of obtaining a history of exposures. We report a case of one of the more commonly neglected tropical diseases, Leishmaniasis. A 15-year-old male refugee patient presented to the hospital with ulcerative lesions to his legs. His migration history was extensive, starting in Central Africa with travel to South America, followed by migration through Central America to Texas. The patient developed ulcerative lesions on his legs, and he was brought to the children’s hospital by his refugee organization, where the diagnosis was ultimately confirmed as Leishmaniasis. Providers should become familiar with tropical diseases that refugees, as well as local populations, may acquire from travel. Specifically, pediatricians should become familiar with the more prevalent “neglected” tropical diseases as recommended by the World Health Organization

Low Prevalence of Chlamydia trachomatis Infection in Non-Urban Pregnant Women in Vellore, S. India

Objective: To determine the prevalence and risk factors for Chlamydia trachomatis (CT) infection in pregnant women and the rate of transmission of CT to infants. Methods: Pregnant women ($28 weeks gestation) in Vellore, South India were approached for enrollment from April 2009 to January 2010. After informed consent was obtained, women completed a socio-demographic, prenatal, and sexual history questionnaire. Endocervical samples collected at delivery were examined for CT by a rapid enzyme test and nucleic acid amplification test (NAAT). Neonatal nasopharyngeal and conjunctival swabs were collected for NAAT testing. Results: Overall, 1198 women were enrolled and 799 (67%) endocervical samples were collected at birth. Analyses were completed on 784 participants with available rapid and NAAT results. The mean age of women was 25.8 years (range 18– 39 yrs) and 22 % (95 % CI: 19.7–24.4%) were primigravida. All women enrolled were married; one reported.one sexual partner; and six reported prior STI. We found 71 positive rapid CT tests and 1/784 (0.1%; 95 % CI: 0–0.38%) true positive CT infection using NAAT. Conclusions: To our knowledge, this is the largest study on CT prevalence amongst healthy pregnant mothers in southern India, and it documents a very low prevalence with NAAT. Many false positive results were noted using the rapid test. Thes

Common Childhood Bacterial Infections

Children with infectious diseases are commonly encountered in primary care settings. Identification of the subset of patients with bacterial infections is key in guiding the best possible management. Clinicians frequently care for children with infections of the upper respiratory tract, including acute otitis media, otitis externa, sinusitis, and pharyngitis. Conjunctivitis is not an uncommon reason for office visits. Bacterial pneumonia, urinary tract infections, and gastroenteritis are regularly seen. Over the last decade, a growing number of children have had infections of the skin and soft tissue, driven by the increased prevalence of infections caused by methicillin-resistant Staphylococcus aureus. The following review addresses the epidemiology and risk factors for specific infections and examines the clinical presentation and selection of appropriate diagnostic methods in such conditions. Methods to prevent these bacterial infections and recommendations for follow-up are suggested. Management of these infections requires that antimicrobial agents be used in a judicious manner in the outpatient setting. Such antibiotic therapy is recommended using both available clinical evidence and review of disease-specific treatment guidelines

Common Childhood Bacterial Infections

Children with infectious diseases are commonly encountered in primary care settings. Identification of the subset of patients with bacterial infections is key in guiding the best possible management. Clinicians frequently care for children with infections of the upper respiratory tract, including acute otitis media, otitis externa, sinusitis, and pharyngitis. Conjunctivitis is not an uncommon reason for office visits. Bacterial pneumonia, urinary tract infections, and gastroenteritis are regularly seen. Over the last decade, a growing number of children have had infections of the skin and soft tissue, driven by the increased prevalence of infections caused by methicillin-resistant Staphylococcus aureus. The following review addresses the epidemiology and risk factors for specific infections and examines the clinical presentation and selection of appropriate diagnostic methods in such conditions. Methods to prevent these bacterial infections and recommendations for follow-up are suggested. Management of these infections requires that antimicrobial agents be used in a judicious manner in the outpatient setting. Such antibiotic therapy is recommended using both available clinical evidence and review of disease-specific treatment guidelines

CT Prevalence Studies in India.

<p>This table shows a review on Indian data which show a wide variation in CT prevalence and methods of laboratory confirmation.</p

Study Flow Chart.

<p>April 2009 to January 2010, 7955 women delivered during the recruitment period. 1198 (88%) women were enrolled; 799 endocervical samples from the 1198 enrolled subjects were collected and data on 784 participants with both RDT and NAAT results are reported.</p

Baseline characteristics of Enrolled Mothers, Enrolled Tested mothers, and Enrolled and not Tested.

*<p>(50Rs = 1 USD).</p><p>This table shows that tested mothers were significantly older, multiparous, and higher socio-economic group compared to untested mothers (p = 0.03, p = <0.0001, and p = 0.03; respectively).</p

Neonate Characteristics.

<p>There were 768 newborn specimens (NP and conjunctival) obtained from the neonates of the 784 enrolled mothers who had both NAAT and RDT results reported. This table describes the neonatal characteristics.</p