Harmful Events Research Articles

Modeling pH and Temperature Effects as Climatic Hazards in Vibrio Vulnificus and Vibrio Parahaemolyticus Planktonic Growth and Biofilm Formation.

Climate-induced stressors, such as changes in temperature, salinity, and pH, contribute to the emergence of infectious diseases. These changes alter geographical constraint, resulting in increased Vibrio spread, exposure, and infection rates, thus facilitating greater Vibrio-human interactions. Multiple efforts have been developed to predict Vibrio exposure and raise awareness of health risks, but most models only use temperature and salinity as prediction factors. This study aimed to better understand the potential effects of temperature and pH on V. vulnificus and V. parahaemolyticus planktonic and biofilm growth. Vibrio strains were grown in triplicate at 25°, 30°, and 37°C in 96 well plates containing Modified Seawater Yeast Extract modified with CaCl2 at pH's ranging from 5 to 9.6. AMiGA software was used to model growth curves using Gaussian process regression. The effects of temperature and pH were evaluated using randomized complete block analysis of variance, and the growth rates of V. parahaemolyticus and V. vulnificus were modeled using the interpolation fit on the MatLab Curve Fitting Toolbox. Different optimal conditions involving temperature and pH were observed for planktonic and biofilm Vibrio growth within- and between-species. This study showed that temperature and pH factors significantly affect Vibrio planktonic growth rates and V. parahaemolyticus biofilm formation. Therefore, pH effects must be added to the Vibrio growth modeling efforts to better predict Vibrio risk in estuarine and coastal zones that can potentially experience the cooccurrence of Vibrio and harmful algal bloom outbreak events.

Paediatric harmful adverse drug events (PHADE).

It is well established that adverse drug events are frequent in paediatric hospital practice. The objective of this study is to systematically quantify and report the incidence of harmful adverse drug events across our institution and to identify predominant medications and error types. We prospectively compiled a validated medication safety database for paediatric inpatients within our institution over a three-and-a-half-year period. All incidences of apparent patient harm relating to medication error were investigated and analyzed to determine veracity, severity of harm, phase of medication process, error type, causative medication, and contributory factors enabling each event. We identified 59 harmful adverse drug events, with an overall rate of 15.5 per 105 patient bed days. Most events occurred during administration (n = 27) and prescribing (n = 26) phases. Almost half of all harm (49%) was associated with opioids; a broad range of medication classes accounted for other harm. Harmful events occurred in 7.3 per 105 administrations of morphine and 13.3 per 105 administrations of hydromorphone. Wrong dose was the most frequently encountered error type. This is the first study to quantify harmful adverse drug events in paediatric hospital practice. Our prospective analysis and compilation of harmful medication errors in paediatric hospital practice, reported with denominators of opioid administrations, and patient bed days, is a new standard for comparison in the long-discussed problem of paediatric harmful adverse drug events. By focusing on identified problematic drugs, error types, and contributory factors, we identify opportunities for interventions, error prevention and harm reduction.

Limiting Factors in Implementing Pharmacovigilance Principles in the Elderly.

The overarching aim of pharmacovigilance is to ensure the safe and effective usage of medication across the population and optimise medicines through holistic considerations. However, within the heterogeneous elderly population, several unique factors are at play, limiting the ability of clinicians to fulfil this aim. A matured physiology influencing the response and effects of drugs, increased polypharmacy enabling drug-drug interactions, and greater consumption of concurrent herbal medicines predispose patients to harmful drug events. This increasingly multimorbid subpopulation requires complex pharmaceutical regimens encouraging inappropriate prescribing and medicine non-adherence leading to suboptimal therapy. Furthermore, restrictive practices in clinical trials commonly exclude elderly patients creating disparities from expected findings within a real-world setting. These issues create an environment where elderly patients are at a heightened risk of adverse drug events and clinicians are forced to make significant decisions from limited information. With projections showing that this demographic will continue growing in size, the true burden of these limiting factors is yet to be realised.

Using climate reanalysis and remote sensing-derived data to create the basis for predicting the occurrence of algal blooms, harmful algal blooms and toxic events in Santa Catarina, Brazil

This study aimed to form a basis for future predictive modeling efforts in support of the harmful algal blooms (HAB) surveillance program currently in force in the Brazilian State of Santa Catarina (SC). Data from monitoring toxin-producing algae were merged with both meteorological and oceanographic data and analyzed. Data from four sources were used in this study: climate reanalysis (air temperature, pressure, cloud cover, precipitation, radiation, U and V winds); remote sensing (chlorophyll concentration and sea surface temperature); Oceanic Niño Index; and HAB monitoring data (phytoplankton counts and toxin levels in shellfish samples obtained from 39 points located in shellfish farms distributed along the SC coastline). This study analyzed the period from 2007-01-01 to 2019-12-31 (7035 records in the HAB database) and used descriptive, bivariate and multivariate analyses to draw correlations among environmental parameters and the occurrence of algal blooms (AB), HAB and toxic events. Dinophysis spp. AB were the most registered type of event and tended to occur during the late autumn and winter months. These events were associated with high atmospheric pressure, predominance of westerly and southerly winds, low solar radiation and low sea and air temperature. An inverted pattern was observed for Pseudo-nitzschia spp. AB, which were mostly registered during the summer and early autumn months. These results give evidence that the patterns of occurrence of highly prevalent toxin-producing microalgae reported worldwide, such as the Dinophysis AB during the summer, differ along the coast of SC. Our findings also show that meteorological data, such as wind direction and speed, atmospheric pressure, solar radiation and air temperature, might all be key predictive modeling input parameters, whereas remote sensing estimates of chlorophyll, which are currently used as a proxy for the occurrence of AB, seem to be a poor predictor of HAB in this geographic area.

Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence

BackgroundOpen Disclosure (OD) is open and timely communication about harmful events arising from health care with those affected. It is an entitlement of service-users and an aspect of their recovery, as well as an important dimension of service safety improvement. Recently, OD in maternity care in the English National Health Service has become a pressing public issue, with policymakers promoting multiple interventions to manage the financial and reputational costs of communication failures. There is limited research to understand how OD works and its effects in different contexts.MethodsRealist literature screening, data extraction, and retroductive theorisation involving two advisory stakeholder groups. Data relevant to families, clinicians, and services were mapped to theorise the relationships between contexts, mechanisms, and outcomes. From these maps, key aspects for successful OD were identified.ResultsAfter realist quality appraisal, 38 documents were included in the synthesis (22 academic, 2 training guidance, and 14 policy report). 135 explanatory accounts were identified from the included documents (with n = 41 relevant to families; n = 37 relevant to staff; and n = 37 relevant to services). These were theorised as five key mechanism sets: (a) meaningful acknowledgement of harm, (b) opportunity for family involvement in reviews and investigations, (c) possibilities for families and staff to make sense of what happened, (d) specialist skills and psychological safety of clinicians, and (e) families and staff knowing that improvements are happening. Three key contextual factors were identified: (a) the configuration of the incident (how and when identified and classified as more or less severe); (b) national or state drivers, such as polices, regulations, and schemes, designed to promote OD; and (c) the organisational context within which these these drivers are recieived and negotiated.ConclusionsThis is the first review to theorise how OD works, for whom, in what circumstances, and why. We identify and examine from the secondary data the five key mechanisms for successful OD and the three contextual factors that influence this. The next study stage will use interview and ethnographic data to test, deepen, or overturn our five hypothesised programme theories to explain what is required to strengthen OD in maternity services.

Forecasting Prorocentrum minimum blooms in the Chesapeake Bay using empirical habitat models

Aquaculturists, local beach managers, and other stakeholders require forecasts of harmful biotic events, so they can assess and respond to health threats when harmful algal blooms (HABs) are present. Based on this need, we are developing empirical habitat suitability models for a variety of Chesapeake Bay HABs to forecast their occurrence based on a set of physical-biogeochemical environmental conditions, and start with the dinoflagellate Prorocentrum minimum (also known as P. cordatum).To identify an optimal set of environmental variables to forecast P. minimum blooms, we first assumed a linear relationship between the environmental variables and the inverse of the logistic function used to forecast the likelihood of bloom presence, and repeated the method using more than 16,000 combinations of variables. By comparing goodness-of-fit, we found water temperature, salinity, pH, solar irradiance, and total organic nitrogen represented the most suitable set of variables. The resulting algorithm forecasted P. minimum blooms with an overall accuracy of 78%, though with a significant variability ~ 30-90% depending on region and season. To understand this variability and improve model performance, we incorporated nonlinear effects into the model by implementing a generalized additive model. Even without considering interactions between the five variables used to train the model, this yielded an increase in overall model accuracy (~ 81%) due to the model’s ability to refine the regions in which P. minimum blooms occurred. Including nonlinear interactions increased the overall model accuracy even further (~ 85%) by accounting for seasonality in the interaction between solar irradiance and water temperature. Our findings suggest that the influence of predictors of these blooms change in time and space, and that model complexity impacts the model performance and our interpretation of the driving factors causing P. minimum blooms. Apart from their forecasting potential, our results may be particularly useful when constructing explicit relationships between environmental conditions and P. minimum presence in mechanistic models.

INVESTIGATING BLOOD LACTATE CONCENTRATION AS A PROGNOSTIC INDICATOR FOR BIRDS PRESENTING WITH BREVETOXICOSIS: 2020-2021.

Large blooms of the dinoflagellate Karenia brevis cause annual harmful algal bloom events, or "red tides" on Florida's Gulf Coast. Each year, the Clinic for the Rehabilitation of Wildlife (CROW) is presented with hundreds of cases of aquatic birds that exhibit neurologic clinical signs due to brevetoxicosis. Double-crested cormorants (Phalacrocorax auratus) are the most common species seen, and typically present with a combination of ataxia, head tremors, knuckling, and/or lagophthalmos. Blood lactate levels are known to increase in mammals for a variety of reasons, including stress, hypoxia, sepsis, and trauma, but there is limited literature on blood lactate values in avian species. The objective of this study was to determine the prognostic value of blood lactate concentration on successful rehabilitation and release of birds presenting with clinical signs consistent with brevetoxicosis. Blood lactate levels were collected on intake, the morning after presentation and initial therapy, and prior to disposition (release or euthanasia) from 194 birds (including 98 cormorants) representing 17 species during the 2020-2021 red tide season. Overall, mean blood lactate at intake, the morning after intake, and predisposition was 2.9, 2.8, and 3.2 mmol/L, respectively, for released birds across all species (2.9, 2.9, and 3.2 mmol/L for released cormorants); 3.4, 3.4, and 6.5 mmol/L for birds that died (4.0, 3.5, and 7.9 mmol/L for cormorants that died); and 3.1, 3.5, and 4.7 mmol/L for birds that were euthanized (3.5, 4.7, and 4.9 mmol/L for cormorants that were euthanized). On average, birds that died or were euthanized had an elevated lactate at all time points as compared to those that were released, but these results were not statistically significant (P = 0.13). These results indicate that blood lactate levels do not appear to be useful as a prognostic indicator for successful release of birds, including double-crested cormorants, affected by brevetoxicosis.

MASCC guideline: cannabis for cancer-related pain and risk of harms and adverse events

Approximately 18% of patients with cancer use cannabis at one time as palliation or treatment for their cancer. We performed a systematic review of randomized cannabis cancer trials to establish a guideline for its use in pain and to summarize the risk of harm and adverse events when used for any indication in cancer patients. A systematic review of randomized trials with or without meta-analysis was carried out from MEDLINE, CCTR, Embase, and PsychINFO. The search involved randomized trials of cannabis in cancer patients. The search ended on November 12, 2021. The Jadad grading system was used for grading quality. Inclusion criteria for articles were randomized trials or systematic reviews of randomized trials of cannabinoids versus either placebo or active comparator explicitly in adult patients with cancer. Thirty-four systematic reviews and randomized trials met the eligibility criteria for cancer pain. Seven were randomized trials involving patients with cancer pain. Two trials had positive primary endpoints, which could not be reproduced in similarly designed trials. High-quality systematic reviews with meta-analyses found little evidence that cannabinoids are an effective adjuvant or analgesic to cancer pain. Seven systematic reviews and randomized trials related to harms and adverse events were included. There was inconsistent evidence about the types and levels of harm patients may experience when using cannabinoids. The MASCC panel recommends against the use of cannabinoids as an adjuvant analgesic for cancer pain and suggests that the potential risk of harm and adverse events be carefully considered for all cancer patients, particularly with treatment with a checkpoint inhibitor.

Evidence-based Standard Operating Procedures FoR the Prevention and Management of Sodium Hypochlorite Accidents in Dentistry.

This article aims to reduce harm and improve patient safety in dentistry by providing evidence-based guidance on the prevention, recognition, management, and reporting of sodium hypochlorite injuries occurring in the course of endodontic dental treatment. In contrast to previous publications all types of sodium hypochlorite harm and near-harm events in the dental setting are considered, to offer the reader an all-encompassing clinical guide for reference.

Hazard-informed optimization of seismic networks for earthquake early warning—the case of the Lower Rhine Embayment (western Germany)

Earthquake early warning (EEW) systems can serve as a viable solution to protect specific hazard‐prone targets (major cities or critical infrastructure) against harmful seismic events. Using the example of the Lower Rhine Embayment (western Germany), we present a novel approach for evaluating and optimizing seismic networks for EEW purposes. The network optimization is applied to simulated earthquake scenarios from a hazard-compatible stochastic catalog, which represents a realization of the seismicity in the target area over a given period of time. We propose a densification of the existing network in the area by pre-selecting a number of potential sites with an optimal station configuration using a microgenetic algorithm, minimizing an appropriate cost function associated with the network layout. We show that the new decentralized network significantly improves the warning time and the accuracy of the warnings for levels of shaking for threshold levels of at least 0.02 g. Although the accuracy of the alerts for other cities outside the target area varies depending on their location, we demonstrate that the updated network layout will also improve the warning times for neighboring cities.

Edukasi Pasien Dan Keluarga Terkait Keselamatan Pasien Di RSU. Melati Perbaungan Kabupaten Serdang Bedagai

Patient safety is a major global issue. The losses caused by not paying attention to patient safety are quite large. Many patients experience unintentional harmful events from treatment at Health Care Facilities. Nurses as a profession at the front line of service must be responsible for patient safety. Therefore, it is necessary to deal with this problem, one of which is education. The aim of this service is to provide education about patient safety in the hospital environment, both patients and families. The methods used are lectures, discussions and evaluations. The results obtained after educating all participants understood patient safety in the hospital environment. It is recommended that this education be carried out consistently, so that it can reduce unexpected events for patients and families.

Use of virtual reality technology in chainsaw operations, education and training

AbstractWood harvesting operations represent one of the industrial sectors with the highest risk of accidents at work. In semi-mechanized logging operations, the great majority of accidents generally occur using chainsaws during tree felling. Unfortunately, these situations frequently cause serious injuries and even the deaths of workers. In numerous cases, the accidents occurred to people who were badly trained and inexperienced, with a short employment history. One solution to reduce these harmful events is to support workers employed in this sector with training applications. This paper presents a description of a research and training programme for operating with chainsaws in tree felling operations using a Virtual Reality (VR) application called ForestVRoom. This innovative education method was compared with the traditional theoretical lesson based on a slide show. The results of the training were verified through a statistical analysis of questionnaires administered to a sample of 45 students in undergraduate and master’s degree programmes at the School of Agriculture and Forestry at the University of Florence. We have shown that the combination of traditional didactics and symmetrical collaborative VR leads to an increase in knowledge and especially in the ability to understand situations in a real forest site. VR is a useful teaching tool that can complement conventional training methods because of its potential to provide an immersive and attractive experience that facilitates learning and recognition of situations in forest sites.

L’état antérieur : quelle incidence pour l’adulte, quelle incidence chez l’enfant ?

IntroductionSearching for a previous state is a common act in all medical disciplines, it corresponds to what appears in clear in any medical or social record: the prior medical history. The history is a time marker and an indicator of a possible symptomatological evolution or the risks incurred regardless of the medical specialty concerned. When they are searched for with an indemnity purpose, they are named prior state. MethodologyThe author draws on his experience of the contradictory expertise of victims (adult or child) terrorist attacks and on the analysis of the Dintilhac mission and missions emanating from CIVI (commission d’indemnisation des victimes d’infraction) and limits the study to psychic injuries during an attack. Objectives and ResultsAn assessment requested as part of a legal process is intended to assess the sequelae attributable to a fact, a harmful event (assault, attack) and the damages resulting from it. It is then necessary to check if there was a previous state in order to determine the impact of the harmful facts on the sequelae state. Based on clinical cases, the author describes the specificities of the psychiatric and psychopathological reasoning on which the expert relies depending on whether the previous condition was revealed before the attack or whether it was aggravated or revealed by the attack. ConclusionFor the psychiatrist, there is a global analysis to be carried out on what represents the previous state in the life course of the victim, the meaning it ascribes to him, and a more specific, medical aspect, which concerns the nature of the previous state.

Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: A randomized controlled trial.

Aim To assess the efficacy of pain neuroscience education combined with physiotherapy for the management of migraine.Background Physiotherapy can significantly reduce the frequency of migraine, but the evidence is based only on a few studies. Pain neuroscience education might pose a promising treatment, as it addresses migraine as a chronic pain disease.Methods In this non-blinded randomized controlled trial, migraine patients received physiotherapy + pain neuroscience education or physiotherapy alone, preceded by a three-month waiting period. Primary outcomes were frequency of headache (with and without migraine features), frequency of migraine and associated disability.Results Eighty-two participants were randomized and analyzed. Both groups showed a decrease of headache frequency (p = 0.02, d = 0.46) at post-treatment (physiotherapy: 0.77 days, 95%CI: -0.75 to 2.29 and physiotherapy + pain neuroscience education: 1.25 days, 95%CI: -0.05 to 2.55) and at follow-up (physiotherapy: 1.93, 95%CI: 0.07 to 3.78 and physiotherapy + pain neuroscience education: 3.48 days, 95%CI: 1.89 to 5.06), with no difference between groups (p = 0.26, d = 0.26). Migraine frequency was reduced significantly in the physiotherapy + pain neuroscience education group, and not in the physiotherapy group, at post-treatment (1.28 days, 95%CI: 0.34 to 2.22, p = 0.004) and follow-up (3.05 days, 95%CI: 1.98 to 5.06, p < 0.0001), with a difference between groups at follow-up (2.06 days, p = 0.003). Migraine-related disability decreased significantly in both groups (physiotherapy: 19.8, physiotherapy + pain neuroscience education: 24.0 points, p < 0.001, d = 1.15) at follow-up, with no difference between groups (p = 0.583). Secondary outcomes demonstrated a significant effect of time with no interaction between time and group. No harm or adverse events were observed during the study.Conclusion In comparison to physiotherapy alone, pain neuroscience education combined with physiotherapy can further reduce the frequency of migraine, but had no additional effect on general headache frequency or migraine-related disability.Trial Registration The study was pre-registered at the German Clinical Trials Register (DRKS00020804).

Metabolic Imaging and Molecular Biology Reveal the Interplay between Lipid Metabolism and DHA-Induced Modulation of Redox Homeostasis in RPE Cells.

Diabetes-induced oxidative stress induces the development of vascular complications, which are significant causes of morbidity and mortality in diabetic patients. Among these, diabetic retinopathy (DR) is often caused by functional changes in the blood-retinal barrier (BRB) due to harmful oxidative stress events in lipids, proteins, and DNA. Docosahexaenoic acid (DHA) has a potential therapeutic effect against hyperglycemia-induced oxidative damage and apoptotic pathways in the main constituents of BRB, retinal pigment epithelium cells (ARPE-19). Effective antioxidant response elicited by DHA is driven by the activation of the Nrf2/Nqo1 signaling cascade, which leads to the formation of NADH, a reductive agent found in the cytoplasm. Nrf2 also induces the expression of genes encoding enzymes involved in lipid metabolism. This study, therefore, aims at investigating the modulation of lipid metabolism induced by high-glucose (HG) on ARPE-19 cells through the integration of metabolic imaging and molecular biology to provide a comprehensive functional and molecular characterization of the mechanisms activated in the disease, as well the therapeutic role of DHA. This study shows that HG augments RPE metabolic processes by enhancing lipid metabolism, from fatty acid uptake and turnover to lipid biosynthesis and β-oxidation. DHA exerts its beneficial effect by ameliorating lipid metabolism and reducing the increased ROS production under HG conditions. This investigation may provide novel insight for formulating novel treatments for DR by targeting lipid metabolism pathways.

The accuracy of the Global Trigger Tool is higher for the identification of adverse events of greater harm: a diagnostic test study.

Global Trigger Tool (GTT) of the Institute for Healthcare Improvement (IHI) has been used as a measurement strategy for patient safety by several institutions and national programs. Although the greater ability of the GTT to identify adverse events (AEs) compared to other methods has already been demonstrated, there are few data on its accuracy, and studies suggest lower sensitivity for minor AEs. This study aimed to assess the accuracy of the GTT for identifying AEs in adult inpatients for all AEs and for the subgroup of AEs with greater harm to the patient, classified as F-I on the IHI-GTT adapted version of the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index for Categorizing Errors. In this diagnostic test study, GTT is the index test and identification of AEs (yes/no) represents the condition of interest. Due to the lack of a gold standard test, a composite reference standard method was developed. Reference standard method combined real-time (during hospitalizations) and retrospective search of medical records and administrative data for screening criteria and AEs. Both tests were applied to a random sample of 211 hospitalizations of adult inpatients during October-November 2016 in a large public hospital in Belo Horizonte, Brazil. The accuracy of the GTT was evaluated using sensitivity, specificity, and global accuracy. A total of 176 AEs were identified in 67 admissions using reference standard method and 129 AEs in 76 admissions using GTT, resulting in rates of 126 and 93 AEs/1000 patient-days, respectively. Sensitivity, specificity, and global accuracy of the GTT for the identification of individual AEs were, respectively, 0.41 (95% confidence interval [CI] 0.34; 0.49), 0.68 (95% CI 0.60; 0.74), and 0.54 (95% CI 0.49; 0.60) for all AEs, regardless of the harm categorization, and 0.85 (95% CI 0.72; 0.93), 0.88 (95% CI 0.82; 0.92), and 0.87 (95% CI 0.82; 0.91) for the subgroup of AEs categorized as harm F-I. Among the main AEs missed by the GTT are AEs related to nursing care, such as those related to peripheral venous access and gastric/enteric catheters. GTT proved to be a valid method for identifying AEs in adult inpatients. Its accuracy increases when minor harm AEs are not counted. Among the main AEs missed by the GTT are those related to nursing care. Therefore, the GTT should be used in conjunction with other measurement strategies to achieve results that are representative of the quality profile of the care provided and, thus, guide the best improvement strategies.

Economic Proof-Testing Intervals for E/E/Pe Safety-Related System with Harmful Risk

E/E/PE safety-related systems play an important role in ensuring the functional safety especially for the safety-critical systems. In fact, the E/E/PE safety-related systems are widely implemented in several types of systems, such as automotive and chemical plant control systems, for the safe operation of them. In the operation of the systems, proof-testing, which is known as scheduled periodic inspections or maintenance activities, is conducted for maintaining certain level of safety integrity required to the E/E/PE safety-related system. However, the proof-testing needs a lot of time and cost for checking and proofing whether the safety-related system satisfies the safety requirement in operation. We discuss economic strategies for supporting design of proof-testing interval by focusing on the trade-off relationship between the maintenance cost and the risk at harmful event occurrence.

Phase II study comparing nasal pressure monitoring with capnography during invasive endoscopic procedures: a single-center, single-arm trial

Nasal pressure signal is commonly used to evaluate obstructive sleep apnea. This study aimed to assess its safety for respiratory monitoring during sedation. A total of 45 adult patients undergoing sedation with propofol and fentanyl for invasive endoscopic procedures were enrolled. While both nasal pressure and capnograph signals were continuously recorded, only the nasal pressure signal was displayed. The primary outcome was the incidence of oxygen desaturation below 90%. The secondary outcomes were the ability to predict the desaturation and incidence of harmful events and false alarms, defined as an apnea waveform lasting more than 3 min without desaturation. Of the 45 participants, 43 completed the study. At least one desaturation event occurred in 12 patients (27.9%; 95% confidence interval 15.3–43.7%). In these 12 patients, more than half of the desaturation events were predictable in 9 patients by capnography and 11 patients by nasal pressure monitoring (p = 0.59). In the 43 patients, false alarms were detected in 7 patients with capnography and 11 patients with nasal pressure monitoring (p = 0.427). Harmful events unrelated to nasal pressure monitoring occurred in 2 patients. Nasal pressure monitoring is safe and possibly useful for respiratory monitoring despite false alarms during sedation.

The State of Play on COVID-19 Vaccination in Pregnant and Breastfeeding Women: Recommendations, Legal Protection, Ethical Issues and Controversies in Italy.

To date, extensive research has been conducted on vaccination against COVID-19 during pregnancy to verify the safety and efficacy of the vaccines, despite the fact that pregnant women were excluded from the initial clinical trials. The ever-increasing number of scientific publications has confirmed the absence of biological mechanisms associating mRNA vaccines with adverse effects in pregnancy and breastfeeding, although few studies have been carried out on their effect on fertility. While the Italian legal system provides for maternity protection measures and indemnity for vaccination damages pursuant to law no. 210/1992, it is not exempt from controversy. This contribution describes the state of play on COVID-19 vaccination in pregnant and lactating women, including: current recommendations for pregnant and lactating women; ethical issues related to vaccination hesitancy among pregnant women; the legislative paradox whereby sanctions may be imposed on women in certain professional categories who refuse vaccination because they are pregnant; and the possible legal consequences in the event of harm to the unborn child due to vaccination. All of this is considered in accordance with the principles of medical ethics, taking into account the national legislation.

CONSUMER BEHAVIOR IN LIFE INSURANCE PLAN: A PHILIPPINE STRATEGIC ANALYSIS

Studying consumer behavior in purchasing life insurance plan is important to marketeers, consumers and also to society. The human life is the most valuable asset, and the most crucial sort of insurance is life insurance, which offers financial security to an individual and his family in the event of unforeseeable risks or harm. The advent of global pandemic led to an avenue where preparedness for life preservation is of great importance. Consumer behavior around life insurance products is evolving quickly. The descriptive-based study was chosen with the goal of examining the demographic profile of life insurance plan holders and identify the different factors that affect the consumer’s decision in purchasing life insurance plan. These include, but not limited to, social factors, values of the Filipino family, psychological factors, income impact and marketing initiative of insurance companies. In the paper, various insurance-related issues have been covered. The study was conducted in the Province of Laguna, with a sample size of 40 respondents through online distribution of questionnaires, employing snowball sampling. Furthermore, the study analyzed the relationship between the different factors that affect consumer’s behavior to purchase policies in relation to the purchaser’s demographic profile.