Internal medicine physician job satisfaction in rural Montana and Northern Wyoming- a qualitative analysis

Background: Shortage of physicians in rural areas within the USA is an ongoing issue. There are limited data about why internal medicine physicians ('internists') practice in rural areas throughout the USA. We explored reasons why internists chose rural practice locations in Montana and Northern Wyoming, and reasons for overall job satisfaction in these areas. Methods: We used the phenomenological method of qualitative analysis for the study. The principal investigator (RR) conducted and voice recorded 17 semi-structured interviews, throughout Montana and two counties in Northern Wyoming. The voice recordings were transcribed and analyzed according to thematic analysis. Results: Four main themes emerged, outlining why internists chose to practice in rural areas, and why internists reported overall job satisfaction. The main reason internists reported for choosing rural practices was a rural background or the appeal of rural lifestyle. Reasons reported for overall job satisfaction by internists in rural areas included wide breadth of practice, flexibility of rural practice model and the work environment and administrative support for practice. Conclusion: Despite shortages of health care providers in rural areas, a number of internists show ongoing commitment to practicing in these areas. Hopefully, our study will help rural practices, hospitals and residency programs in Montana and Northern Wyoming with future hiring decisions

Infectious diseases among foreign prisoners: results of a hospital-based management model in Palermo

Foreign prisoners have a high vulnerability in terms of morbidity and access to care in overcrowded Italian prisons. This paper presents and comments on the management model of infectious diseases in foreign prisoners at our outpatient clinic, in order to describe a model of management for these conditions. Overall, 133 subjects (mean age 35.5 years) from 29 countries were followed for a period of 15 years. The most commonly represented area of origin (54.1%) was the Maghreb region. HCV infection (40.6%), HIV (22.5%), HBV (9.8%) and co-infection (15%, HIV/HCV or HIV/HBV) were observed. Ten subjects had tuberculosis, and only 30% of them were compliant with the treatment. Only 46.3% of HCV mono-infected patients completed the entire diagnostic process and even a lower percentage (37%) of them took treatment regularly. 90% of HBV mono-infected patients and 84% of those HIV mono- and co-infected completed the diagnostic workout. 77% of patients in each group took therapy regularly. Overall, the results show limited effectiveness. Therefore, it would be necessary to improve communication between healthcare professionals and correctional systems. Moreover, it appears urgent to reduce overcrowding in prisons to limit morbidity in prisoners

Tuberculosis among Migrant Populations in Sicily: A Field Report

Background. In the EU, tuberculosis (TB) mainly affects vulnerable people, including migrants. From 2014 to 2017, we have estimated the frequency of both tuberculosis and latent tuberculosis infection (LTBI) among the migrant population hosted in 41 reception centers in western Sicily (ITaCA network). Materials and Methods. All migrants were consecutively recruited for the screening of TB infection with physical examination and TST in 1,020 migrants and with IGRA in the others 2,690. The screening was carried out 4–8 weeks after landing in Sicily. For all migrants with a positive screening test, chest X-ray and smear examination were performed. LTBI was defined by positivity of TST or IGRA with negative X-ray chest, clinical, and smear examination. Active TB was defined by radiological and/or clinical and/or sputum positivity in a patient with a TST or IGRA positivity. Results. We evaluated a total of 3,710 migrants, of which 89% came from Sub-Saharan countries; 2,811 were males, 899 were females, with a median age of 22 years (IQR: 18–25). TB infection was diagnosed in 501 persons (13.5%) of which 440 (11.8%) had LTBI and 61 had active TB (1.6%): 1 had lymph node TB, 1 had intestinal TB, and 59 had pulmonary TB (38 sputum smear positive TB; no drug-resistant TB were observed). Conclusions. TB screening is critical to early diagnosis and treatment