Abordagem de narrativas como método de pesquisa em saúde pública: aproximações conceituais e contribuições da psicanálise / Narrative research in public health: conceptual approximations and contributions from psychoanalysis / Enfoque en narrativas como método de investigación en salud pública: aproximaciones conceptuales y aportaciones del psicoanálisis

Este artigo refere-se à parte de uma pesquisa de doutorado, realizada em hospital de alta complexidade do Sistema Único de Saúde, cujos participantes são os profissionais de saúde. O objetivo deste artigo é analisar o potencial da abordagem das narrativas como método de pesquisa e intervenção nos serviços de saúde, traçando aproximações com a teoria psicanalítica. Sua relevância no campo da Saúde Pública está calcada no reconhecimento do papel do sujeito como agente de mudanças. O texto divide-se em duas partes: na primeira, explora as especificidades do trabalho na área da saúde, o paradigma da saúde pública no que concerne à gestão e possíveis contribuições da clínica ampliada para esse modelo. Na segunda parte, analisa o uso das narrativas como método de pesquisa nesse campo e as aproximações conceituais entre a narrativa em Walter Benjamin e a psicanálise em Freud. Busca na literatura referências sobre experiências análogas que fundamentem a proposta ora realizada e conclui pela importância de, no momento atual, apostar na força germinativa das narrativas como fonte criativa de novas formas de cuidar.(AU)

This article derives from a PhD research conducted with health professionals at a high-complexity public hospital from the Brazilian Unified Health System (SUS). It analyzes the potential of the narrative as a research and intervention method in health services, outlining approximations with psychoanalysis. In the field of Public Health, the narrative approach acknowledges the individual as an agent of change. The text is divided into two parts. The first presents an overview of the peculiarities involved in healthcare, the Public Health paradigm regarding service management and possible contributions from the expanded clinic to this model. The second analyzes the use of narratives as a research method in this field and the conceptual approximations between Benjamin's narrative and Freud's psychoanalysis. It searches the literature for references on similar experiences to support the present proposal and concludes by highlighting the importance of betting on the creative power of narratives as a source for new ways to care.(AU)

Este artículo es parte de una investigación doctoral, realizada con los profesionales de la salud de un hospital de alta complejidad del Sistema Único de Salud de Brasil. Su propósito es analizar el potencial del enfoque en narrativas como método de investigación e intervención en los servicios de salud, esbozando aproximaciones entre las narrativas y la teoría del psicoanálisis. Su relevancia en el campo de la salud pública se basa en el reconocimiento del rol del sujeto como agente de cambio. El texto se divide en dos partes: La primera investiga las especificidades del trabajo en el área de la salud, el paradigma de la salud pública en la gestión de los servicios y las posibles contribuciones de la clínica ampliada a este modelo. En la segunda parte, analiza el uso de narrativas como método de investigación en este campo y las aproximaciones conceptuales entre la narrativa de Walter Benjamin y el psicoanálisis de Freud. Este estudio busca en la literatura referencias sobre experiencias similares que apoyen la propuesta ahora realizada y concluye con la importancia de, en el momento actual, apostar por el poder de las narrativas como fuente creadora de nuevas formas de cuidar.(AU)

Apropriação dos espaços urbanos na infância e na velhice em Brasília (DF) / Occupation of urban spaces in childhood and old age in Brasilia, Brazil / Apropiación de espacios urbanos en la infancia y en la vejez en Brasília, Brasil

Os estudos sobre as relações mútuas entre as pessoas e o ambiente buscam subsidiar melhorias no contexto urbano a partir de métodos e técnicas pautados na compreensão do uso de espaços públicos e privados. A crescente demanda pela promoção de ambientes amigáveis para idosos e crianças nos cenários urbanos direcionou esta pesquisa e elencou dois componentes: o panorama relativo à população local e o arcabouço teórico da psicologia ambiental. Para tanto, buscou-se identificar as principais atividades realizadas por crianças e idosos em seus respectivos locais de moradia. Foram avaliados os principais usos e atividades desses dois grupos, em duas vizinhanças, diferenciando-os de acordo com suas especificidades em termos de demandas individuais e ambientais. As observações sistemáticas a partir da técnica de mapeamento comportamental centrado no lugar (MCCL) ocorreram na cidade de Brasília, Distrito Federal (DF) e permitiram compreender o processo de apropriação dos espaços na infância e na velhice e suas repercussões em termos da congruência pessoa-ambiente. Cada um destes setores organizados a partir de elementos específicos direciona as ações dos participantes para determinados tipos de comportamentos, observados de maneira a compor um roteiro em que a brincadeira (lazer ativo) surge como central na infância e a caminhada (circulação) como mais potente para a população idosa. Os resultados demonstram que o diálogo entre a psicologia ambiental e a ciência do desenvolvimento humano tem sido bastante profícuo e tem contribuído para a compreensão de aspectos da relação pessoa-ambiente em diferentes momentos do ciclo de vida.(AU)

Studies on the mutual relations between people and the environment seek to support improvements in the urban context from methods and techniques based on understanding the use of public and private spaces. The growing demand for the promotion of friendly urban environments for older people and children guided this research, with two notable components: the panorama related to the local population and the theoretical framework of Environmental Psychology. Therefore, we sought to identify the main activities carried out by children and older people in their respective dwellings. The main uses and activities of these two groups were evaluated in two neighborhoods, differentiating them according to their specificities in terms of individual and environmental demands. Systematic observations using the place-centered behavioral mapping technique took place in the city of Brasília, Federal District, and allowed us to understand the process of appropriation of spaces in childhood and old age and its repercussions in terms of person-environment congruence. Each of these sectors, organized from specific elements, directs the participants' actions towards certain types of behavior, observed in order to compose a script in which playing (active leisure) emerges as central in childhood and walking (circulation) as more potent for the older people. The results demonstrated that the dialogue between environmental psychology and the science of human development has been very fruitful and has contributed to the understanding of aspects of the person-environment relationship at different times in the life cycle.(AU)

Los estudios sobre las relaciones mutuas entre las personas y el medio ambiente buscan aportar mejoras en el contexto urbano mediante métodos y técnicas basados en la comprensión del uso de los espacios públicos y privados. La creciente demanda de la promoción de ambientes amigables para las personas mayores y los niños en entornos urbanos guio esta investigación y enumeró dos componentes: el panorama relacionado con la población local y el marco teórico de la Psicología Ambiental. En este contexto, buscamos identificar las principales actividades que realizan los niños y las personas mayores en sus respectivas viviendas. Se evaluaron los principales usos y actividades de estos dos grupos en dos barrios, diferenciándolos según sus especificidades en cuanto a las demandas individuales y ambientales. Las observaciones sistemáticas utilizando la técnica de mapeo conductual centrado en el lugar (MCCL) ocurrieron en la ciudad de Brasília, Distrito Federal (Brasil) y nos permitieron comprender el proceso de apropiación de espacios en la infancia y la vejez y sus repercusiones en la congruencia persona-ambiente. Cada uno de estos sectores, organizados a partir de elementos específicos, orienta las acciones de los participantes hacia determinados comportamientos, observados para componer un guion en el que el juego (ocio activo) emerge como central en la infancia y el caminar (circulación) como el más potente para las personas mayores. Los resultados demuestran que el diálogo entre la Psicología Ambiental y la ciencia del desarrollo humano ha sido muy fructífero y ha contribuido a la comprensión de aspectos de la relación persona-entorno en diferentes momentos del ciclo de vida.(AU)

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Who is afraid of obstetric violence? / Quem tem medo da violência obstétrica?

Abstract Despite being a relatively new term, obstetric violence is an old problem. In 2014, the World Health Organization declared: "Many women experience disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment not only violates the rights of women to respectful care, but can also threaten their rights to life, health, bodily integrity, and freedom from discrimination". This problem, named as "abuse", "disrespect" and/or "mistreatment" during childbirth, has been addressed in several studies. However, there has been no consensus on how to properly name this problem, although its typology has been well described. Considering the magnitude of this problem, it is essential to give the correct terminology to this important health and human rights issue. Naming it as obstetric violence and understanding it as gender-based violence will ensure appropriate interventions to avert this violation of women's rights.

Resumo Apesar de ser um termo relativamente novo, a violência obstétrica é um problema antigo. Em 2014, a Organização Mundial da Saúde declarou: "Muitas mulheres sofrem tratamento desrespeitoso e abusivo durante o parto em instalações de saúde em todo o mundo. Esse tratamento não só viola os direitos das mulheres a cuidados respeitosos, mas também pode ameaçar seus direitos à vida, saúde, integridade corporal e liberdade de discriminação". Esse problema, denominado "abuso", "desrespeito" e /ou "maus-tratos" durante o parto, foi abordado em vários estudos. No entanto, não houve consenso sobre como nomear adequadamente esse problema, embora sua tipologia tenha sido bem descrita. Considerando a magnitude desse problema, é essencial dar a terminologia correta para essa importante questão de saúde e direitos humanos. Nomear como violência obstétrica e entendê-la como violência baseada em gênero garantirá intervenções apropriadas para evitar essa violação dos direitos das mulheres.

Influence of Spiritual Dimensions on Suicide Risk: The Role of Regional Differences.

The field of suicide prevention has been enriched by research on the association between spirituality and suicide. Many authors have suggested focusing on the various dimensions of religiosity in order to better understand the association between religion and suicidal risk, but it is unclear whether the relationship between spirituality and suicidality differs between countries with different cultures, life values, and sociohistorical experiences. To explore this, the aim of this multicenter study was to investigate the possible relationship between suicide and spirituality in Italy and Austria. In the two countries, two different groups of subjects participated: psychiatric patients and university students. The patients were evaluated with the Mini International Neuropsychiatric Interview. In addition, the following measures were used: a sociodemographic questionnaire, the Columbia-Suicide Severity Rating Scale-B, the Symptom-Checklist-90-Standard, and the Multidimensional Inventory for Religious/Spiritual Well-Being. Our results confirmed the multifactorial nature of the relation between suicide risk and the various religious/spiritual dimensions, including religious/spiritual well-being and hope immanent. However, regional differences moderated this relationship in both the clinical and nonclinical samples.

Effects of wisdom and religiosity on subjective well-being in old age and young adulthood: exploring the pathways through mastery and purpose in life.

ABSTRACTObjectives:Prior research found that the positive association between wisdom and subjective well-being might at least partially be explained by a greater sense of mastery and purpose in life. This study tested whether religiosity provides an alternative pathway to well-being and whether the associations are moderated by age cohort and nation of residency. DESIGN AND PARTICIPANTS: A quota sample design was used, stratified by age group, sex, and nation of residency, to collect cross-sectional survey data of 111 older adults (age range 62-99 years, M = 77.20, SD = 8.98) and 100 young adults (age range 21-30 years, M = 24.05, SD = 2.69) from Canada and the United States. MEASUREMENTS: Face-to-face interviews were conducted to administer the survey. All measures consisted of validated scales and items. RESULTS: Multi-group path analysis confirmed that mastery and purpose in life partially mediated the association between wisdom and well-being. Religiosity offered an alternative pathway to well-being, also partially through a greater sense of mastery and purpose in life. Wisdom was statistically more strongly related to mastery among older adults, whereas the association between mastery and purpose in life was statistically stronger among young adults. The mediated pathways from wisdom and religiosity to well-being did not differ by nation of residency. CONCLUSIONS: These results highlight the importance of internal strengths for subjective well-being among both young and older adults and add confidence to the generalizability of the mediated path model for North America.

"What is the point of life?": An interpretative phenomenological analysis of suicide in young menwith first-episode psychosis.

BACKGROUND: Lifetime risk of suicide in first-episode psychosis far exceeds the general population, with the risk of suicide persisting long after first presentation. There is strong evidence to suggest that women more frequently attempt suicide, while men are at a greater risk of completing suicide. First-hand experiential evidence is needed in order to better understand men's motives for, and struggles with, suicidality in early psychosis. METHODS: Semi-structured interviews were conducted with 7 participants. The interviews explored each respondent's account of their suicide attempt within the broader context of their life, in relation to their past, present and future. In line with the exploratory, inductive nature of the study, an Interpretative Phenomenological Analysis was used to explore the meaning of suicide attempts in these accounts. RESULTS: Three super-ordinate themes emerged: Self-as-vulnerable (intra- and inter-personal relationships), appraisal of cumulative life events as unbearable and meaning of recovery marked by shared sense of hope and imagery for the future. CONCLUSIONS: Young men in the early stages of their treatment are seeking to find meaning for frightening, intrusive experiences with origins which often precede psychosis. These experiences permeate personal identity, relationships and recovery. Suicide was perceived as an escape from this conundrum, and was pursued angrily and impulsively. By contrast, the attainment of hope was marked by sharing one's burden and finding a sense of belonging. Specialized assertive outreach programmes may be beneficial in improving the social inclusion of young men who may be particularly marginalized.

When the human spirit helps? The moderating role of somatization on the association between Olympic game viewing and the will-to-live.

This study examined whether participants with low somatization (no bodily manifestations of anxiety) who are assumed to identify with- and be inspired- by the Olympic-Games-spirit will present a stronger association between their Olympic-game viewing hours and their will-to-live, than persons with high somatization. One hundred and thirty seven participants reported their daily Olympic-game viewing hours, somatization and will-to-live levels. Results show that while among those with low somatization symptoms level, the relationships between Olympic game viewing hours and will-to-live was positive, the opposite was found among those with high somatization symptoms level. Viewing the Olympic Games may be beneficial for individuals with low somatization level but less so to individuals with higher somatization.

Midwives' and patients' perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study.

BACKGROUND: It is increasingly recognized that disrespect and abuse of women during labor and delivery is a violation of a woman's rights and a deterrent to the use of life-saving, facility-based labor and delivery services. In Ethiopia, rates of skilled birth attendance are still only 28% despite a recent dramatic national scale up in the numbers of trained providers and facilities. Concerns have been raised that womens' perceptions of poor quality of care and fear of mistreatment might contribute to this low utilization. This study examines the experiences of disrespect and abuse in maternal care from the perspectives of both providers and patients. METHODS: We conducted 45 in-depth interviews at four health facilities in Debre Markos, Ethiopia with midwives, midwifery students, and women who had given birth within the past year. Students and providers also took a brief quantitative survey on patients' rights during labor and delivery and responded to clinical scenarios regarding the provision of stigmatized reproductive health services. RESULTS: We find that both health care providers and patients report frequent physical and verbal abuse as well as non-consented care during labor and delivery. Providers report that most abuse is unintended and results from weaknesses in the health system or from medical necessity. We uncovered no evidence of more systematic types of abuse involving detention of patients, bribery, abandonment or ongoing discrimination against particular ethnic groups. Although health care providers showed good basic knowledge of confidentiality, privacy, and consent, training on the principles of responsive and respectful care, and on counseling, is largely absent. Providers indicated that they would welcome related practical instruction. Patient responses suggest that women are aware that their rights are being violated and avoid facilities with reputations for poor care. CONCLUSIONS: Our results suggest that training on respectful care, offered in the professional ethics modules of the national midwifery curriculum, should be strengthened to include greater focus on counseling skills and rapport-building. Our findings also indicate that addressing structural issues around provider workload should complement all interventions to improve midwives' interpersonal interactions with women if Ethiopia is to increase provision of respectful, patient-centered maternity care.

Educating student midwives around dignity and respect.

FOCUS: There is currently limited information available on how midwifery students learn to provide care that promotes dignity and respect. BACKGROUND: In recent years the importance of dignity in healthcare and treating people with respect has received considerable emphasis in both a national and international context. AIM: The aim of this discussion paper is to describe an educational workshop that enables learning to promote dignity and respect in maternity care. DISCUSSION: An interactive workshop, using different creative methods as triggers for learning will be described. Provision of learning opportunities for students around dignity and respect is important to ensure appropriate care is provided in practice. The use of creative methods to inspire has contributed to deep learning within participants. An evaluation of the workshop illustrated how learning impacted on participants practice. Data to support this is presented in this paper. CONCLUSION: The use of creative teaching approaches in a workshop setting appears to provide an effective learning opportunity around dignified and respectful care. These workshops have evoked a deep emotional response for some participants, and facilitators must be prepared for this outcome to ensure a safe space for learning.

Driven to extinction? The ethics of eradicating mosquitoes with gene-drive technologies.

Mosquito-borne diseases represent a significant global disease burden, and recent outbreaks of such diseases have led to calls to reduce mosquito populations. Furthermore, advances in 'gene-drive' technology have raised the prospect of eradicating certain species of mosquito via genetic modification. This technology has attracted a great deal of media attention, and the idea of using gene-drive technology to eradicate mosquitoes has been met with criticism in the public domain. In this paper, I shall dispel two moral objections that have been raised in the public domain against the use of gene-drive technologies to eradicate mosquitoes. The first objection invokes the concept of the 'sanctity of life' in order to claim that we should not drive an animal to extinction. In response, I follow Peter Singer in raising doubts about general appeals to the sanctity of life, and argue that neither individual mosquitoes nor mosquitoes species considered holistically are appropriately described as bearing a significant degree of moral status. The second objection claims that seeking to eradicate mosquitoes amounts to displaying unacceptable degrees of hubris. Although I argue that this objection also fails, I conclude by claiming that it raises the important point that we need to acquire more empirical data about, inter alia, the likely effects of mosquito eradication on the ecosystem, and the likelihood of gene-drive technology successfully eradicating the intended mosquito species, in order to adequately inform our moral analysis of gene-drive technologies in this context.

Valuing Treatments for Parkinson Disease Incorporating Process Utility: Performance of Best-Worst Scaling, Time Trade-Off, and Visual Analogue Scales.

OBJECTIVE: The objective of this study was to compare treatment profiles including both health outcomes and process characteristics in Parkinson disease using best-worst scaling (BWS), time trade-off (TTO), and visual analogue scales (VAS). METHODS: From the model comprising of seven attributes with three levels, six unique profiles were selected representing process-related factors and health outcomes in Parkinson disease. A Web-based survey (N = 613) was conducted in a general population to estimate process-related utilities using profile-based BWS (case 2), multiprofile-based BWS (case 3), TTO, and VAS. The rank order of the six profiles was compared, convergent validity among methods was assessed, and individual analysis focused on the differentiation between pairs of profiles with methods used. RESULTS: The aggregated health-state utilities for the six treatment profiles were highly comparable for all methods and no rank reversals were identified. On the individual level, the convergent validity between all methods was strong; however, respondents differentiated less in the utility of closely related treatment profiles with a VAS or TTO than with BWS. For TTO and VAS, this resulted in nonsignificant differences in mean utilities for closely related treatment profiles. CONCLUSIONS: This study suggests that all methods are equally able to measure process-related utility when the aim is to estimate the overall value of treatments. On an individual level, such as in shared decision making, BWS allows for better prioritization of treatment alternatives, especially if they are closely related. The decision-making problem and the need for explicit trade-off between attributes should determine the choice for a method.

[Dignity and Ethics of Care in the Neurodegenerative Diseases]. / Dignidad y Ética del Cuidar en las Enfermedades Neurodegenerativas.

In the context of neurodegenerative diseases the doctor is called more than in other areas to respond not only to the simple question of health, but also to the need of assistance, which implicates the necessity of relationship, too. The scheme of symptom diagnosis treatment healing is to be replaced in these cases with a treatment based on an open system of uncertain length and results. It is a model called ″medicine of incurable″, which aims to combat the discomfort of the disease rather than the fight against the disease. In this perspective, the commitment to ensure a quality of life to the sick in itself means attention to his dignity, which is expressed in acting towards him treating him always as a person, that is protagonist of his life, and then to recognize his right to be assisted in physical, psychological and spiritual dimensions. In this model it becomes particularly important to converse with the patient, even if affected by cognitive pathologies, as well as to stimulate hope, with the belief that human being, if properly supported, is still able, even in extremely critical situations, to make out of his personal experience a chance to grow, thanks to the construction of new balances, however weak they may be.

[Bioethics is dead. Long live medical ethics!]. / La Bioética ha Muerto. ¡Viva la Ética Médica!

The purpose of this paper is to show a paradigmatic crisis in academic bioethics. Since an important part of bioethicists began to relativize the ethical prohibition of killing an innocent human being, one way or another they began to ally with the death industry: the business of abortion, and then that of euthanasia. The thesis of this paper is that by crossing that Rubicon bioethics has been corrupted and has lost its connection to the ethical, political and legal discourse. One can only hope that it will revive from its ashes if it retakes the ″taboo″ of the sacredness of human life, something for which medical ethics could provide invaluable help, because it still keeps the notion that ″a doctor should not kill″, although in an excessively ″discreet″ and somehow ″ashamed″ way. However, conscientious doctors know more about ethics than most bioethicists.

[Spiritual care in hospitals and other healthcare settings in Israel--a profession in the making].

Faced with a serious, incurable illness, disability, and other symptoms, both physical and mental, some patients find themselves wondering about the meaning of their Lives. They need the help of a professional who can perceive their mental turmoil and identify their spiritual needs, and who knows how to help them find meaning in their uncertain state. Spiritual care providers are professionals whose role it is to provide patients with support in their hour of need, to help them preserve their identity in life-threatening situations, and to help them re-endow their world with meaning, employing a special language and set of tools that enable patients to get in touch with their spiritual resources and internal powers of healing. Spiritual care providers serve on the medical staff in Western countries. In the United States, some 2,600 are employed in general hospitals, psychiatric hospitals, long-term care facilities, and palliative care units. Approximately ten years ago, the profession began developing in Israel. Today, dozens of spiritual care providers are now working in the healthcare system. There is a spiritual care network with 21 member organizations. Although the profession is laying down roots in the healthcare system in this country, it is still in its infancy and has to contend with substantial barriers and challenges, including professional recognition, creating positions, and identifying sources of funding for positions. The profession still has much room to grow as it is further incorporated into the healthcare system and continues undergoing adaptation to the Israeli cultural setting.

Meaning in life in patients with progressive supranuclear palsy.

This exploratory study investigated meaning in life (MiL) in patients with progressive supranuclear palsy (PSP). In the "Schedule for Meaning in Life Evaluation" (SMiLE), respondents list individual MiL areas before rating their current satisfaction and importance with them (index of weighting [IoW], index of satisfaction [IoS], and index of weighted satisfaction [IoWS], range 0-100). A total of 38 patients with PSP completed the SMiLE (IoS: 68.6 ± 25.6, IoW: 79.6 ± 12.6, and IoWS: 69.2 ± 26.1). A representative sample of healthy participants (n = 977) scored significantly higher in the IoS (82.8 ± 14.7, P < .001), the IoW (85.6 ± 12.3, P = .006), and the IoWS (83.3 ± 14.8, P < .001). Compared to healthy individuals, patients with PSP were less likely to list health (P = .001) and more likely to list partner (P = .04), leisure (P = .01), home/garden (P = .01), and pleasure (P = .02). Patients with PSP seem to focus on supportive relationships and leisure, while the decreasing health status is becoming less important to them.

[ABORTION AND CHARTER FOR THE EMBRYO BETWEEN THE ANCIENT WORLD AND THE THIRD MILLENNIUM]. / DARE VOCE AI NON-NATI: ABORTO E STATUTO GIURIDICO DELL'EMBRIONE TRA TRADIZIONE IPPOCRATICA E DIRITTO CONTEMPORANEO.

In 2012 the Italian Court of Cassation recognized a young woman the right not to be born and a compensation for her Down's syndrome. Before her birth, her parents asked their gynaecologist for abortion in case he had found any patology affecting the baby. The clinical tests didn't reveal the syndrome, so, after the baby's birth, the doctor was sued for damages. A similar case had occurred in France, where the High Court affirmed that constitution is based on the right to live, not to die. A debate was opened, in which the hippocratic oath has been used to support the pro vita position. This article focuses on whether, when and why the hippocratic tradition allows abortion; when and by whom the embryo was considered to be a human being; if, according to the few sources we have, a charter for the embryo existed in ancient times.