Agricultural Migrants' Health and Ability to Access Care: A Case Study in Southern Italy.

Although a large amount of research exists about migration into the European Union (EU) and the role of migrants in European society, relatively little information is available on the health status of migrants after arriving in the EU. This is particularly true in the case of the most marginalised migrants, migrants from sub-Saharan Africa, who work as itinerant laborers harvesting fruits and vegetables in southern Italy. This study analyzes demographic and health data gathered by a non-governmental organization-run primary healthcare clinic in order to understand the challenges these migrants face when trying to maintain their health. Results show that their health suffers greatly due to substandard living and working conditions, partially due to the fact that these individuals experience many barriers when trying to access care from the national health system. The health status of this population cannot improve without broad reforms to the welfare system and the agricultural sector. Government action is needed to ensure that such individuals are not denied their basic human rights and freedoms, including the right to health.

Relationship Between Viremia and Specific Organ Damage in Ebola Patients: A Cohort Study.

Background: Pathogenesis of Ebola virus disease remains poorly understood. We used concomitant determination of routine laboratory biomarkers and Ebola viremia to explore the potential role of viral replication in specific organ damage. Methods: We recruited patients with detectable Ebola viremia admitted to the EMERGENCY Organizzazione Non Governativa Organizzazione Non Lucrativa di Utilità Sociale (ONG ONLUS) Ebola Treatment Center in Sierra Leone. Repeated measure of Ebola viremia, alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), activated prothrombin time (aPTT), international normalized ratio (INR), creatinine, and blood urea nitrogen (BUN) were recorded. Patients were followed up from admission until death or discharge. Results: One hundred patients (49 survivors and 51 nonsurvivors) were included in the analysis. Unadjusted analysis to compare survivors and nonsurvivors provided evidence that all biomarkers were significantly above the normal range and that the extent of these abnormalities was generally higher in nonsurvivors than in survivors. Multivariable mixed-effects models provided strong evidence for a biological gradient (suggestive of a direct role in organ damage) between the viremia levels and either ALT, AST, CPK LDH, aPTT, and INR. In contrast, no direct linear association was found between viremia and either creatinine, BUN, or bilirubin. Conclusions: This study provides evidence to support that Ebola virus may have a direct role in muscular damage and imbalance of the coagulation system. We did not find strong evidence suggestive of a direct role of Ebola virus in kidney damage. The role of the virus in liver damage remains unclear, but our evidence suggests that acute severe liver injury is not a typical feature of Ebola virus disease.

Changes in decision-making among Italian nurses and nursing students over the last 15 years.

AIMS AND OBJECTIVES: The study aimed at identifying the cognitive strategies used by nurses and nursing students in using information for clinical decision-making and comparing such abilities retrospectively, over the past 15 years. BACKGROUND: Within the context of Italian healthcare professions, a process of cultural role development has been ongoing for several years, in the wake of normative and institutional changes. However, the ability to use information for clinical nursing decision-making has been little studied. DESIGN: Three independent observational studies, with convenience samples of Italian clinical nurses and nursing students recruited at three time-points (1997, 2007, 2012). METHODS: The total sample consisted of 2855 subjects (1406 Nurses and 1449 Nursing Students). Nurses from various clinical realities were subdivided into two classes (less or more than 10 years of experience). Data were collected according to Jenkins' 'Clinical Decision Making in Nursing Scale'. RESULTS: A trend of decreasing skills in information strategies emerged in both nurses and nursing students from 1997-2012. All subjects totalled values in the lowest class (0-130) of the Clinical Decision Making in Nursing Scale of final scoring. Particularly evident were the decreased scores for nursing students from 1997 to 2007-2012. Comparing nurses with nursing students, the former had significantly higher scores. Comparing experienced nurses with novices, the former again had significantly higher scores. Interestingly, in 1997, nursing students had higher scores than nurses, although this result was not confirmed for the other 2 years. CONCLUSIONS: Results showed consistently decreased competence in the use of information skills, particularly among nursing students. RELEVANCE TO CLINICAL PRACTICE: All transformations in training in university-level teaching of nursing show that decision-making skills are continually and significantly worsening. These results are of special interest in view of changes in professional and educational systems.

Blood kinetics of Ebola virus in survivors and nonsurvivors.

BACKGROUND: Infection with Ebola virus (EBOV) results in a life-threatening disease, with reported mortality rates between 50%-70%. The factors that determine patient survival are poorly understood; however, clinical observations indicate that EBOV viremia may be associated with fatal outcome. We conducted a study of the kinetics of Zaire EBOV viremia in patients with EBOV disease (EVD) who were managed at an Ebola Treatment Centre in Sierra Leone during the recent West African outbreak. METHODS: Data from 84 EVD patients (38 survivors, 46 nonsurvivors) were analyzed, and EBOV viremia was quantified between 2 and 13 days after symptom onset. Time since symptom onset and clinical outcome were used as independent variables to compare EBOV viral kinetics in survivors and nonsurvivors. RESULTS: In all patients, EBOV viremia kinetics was a quadratic function of time; however, EBOV viremia was 0.94 logarithm (log) copies per ml (cp/ml) (P = 0.011) higher in nonsurvivors than in survivors from day 2 after the onset of symptoms. Survivors reached peak viremia levels at an earlier time after symptom onset than nonsurvivors (day 5 versus day 7) and had lower mean peak viremia levels compared with nonsurvivors (7.46 log cp/ml; 95% CI, 7.17-7.76 vs. 8.60 log cp/ml; 95% CI, 8.27-8.93). Before reaching peak values, EBOV viremia similarly increased both in survivors and nonsurvivors; however, the decay of viremia after the peak was much stronger in survivors than in nonsurvivors. CONCLUSION: Our results demonstrate that plasma concentrations of EBOV are markedly different between survivors and nonsurvivors at very early time points after symptom onset and may be predicative of outcome. Further studies focused on the early phase of the disease will be required to identify the causal and prognostic factors that determine patient outcome. FUNDING: Italian Ministry of Health; Italian Ministry of Foreign Affairs; EMERGENCY's private donations; and Royal Engineers for DFID-UK.