Impact of policy change on late-term abortion: a two-decade analysis.

OBJECTIVE: Advances in ultrasound and molecular genetics have changed the field of late termination of pregnancy (LTOP), sparking ethical debates worldwide. In 2007, Israel updated its LTOP policies, requiring a 30% or higher probability of severe handicap for approval of LTOP after 24 weeks' gestation. PURPOSE: In this retrospective study, we compared LTOP indications and approval rates before (Group 1: 1998-2007) and after (Group 2: 2008-2021) this policy change. METHODS: Shamir medical records from January 1, 1998 to December 31, 2021 were examined and yielded 4047 abortions, of which 248 were identified as LTOP preformed after 24 weeks' gestation. These cases were then categorized into two groups. Data including maternal age, obstetric history, indications for abortion, diagnosis, week of termination, and genetic/sonographic findings were analyzed. The approval rates and indications pre- and post-policy change were compared. RESULTS: Group 1 (LTOP 1998-2007) comprised 95 cases (10.6%), and Group 2 (LTOP 2008-2021) was composed of 153 cases (4.9%). Fetal structural anomalies remained the dominant indication for both groups (67.4 and 65.3%, respectively), with a slight increase in confirmed genetic anomalies from 26.3% (Group 1) to 28% (Group 2). CONCLUSION: Our findings indicate a decrees in the proportion per year from 10.6 to 4.9% LTOP. Technological advances in genetic evaluation and sonography may have contributed to the early increased detection and decrees in cases reaching LTOP. These results highlight the importance of ongoing ethical reviews and adherence to strict protocols for early detection and termination before 24 weeks' gestation.

[TERMINATION OF PREGNANCY DUE TO FETAL ABNORMALITIES PERFORMED AFTER 24 WEEKS OF GESTATION: THE EXPERIENCE OF THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY AT SHAMIR (ASSAF HAROFE) MEDICAL CENTER BETWEEN THE YEARS 1998-2021].

BACKGROUND: Termination of pregnancy is a difficult moral dilemma that provokes a discussion in the public, from an ethical, moral and religious point of view. This process is complex, especially when it comes to a fetus at a viability age (late abortion, after week 24), which requires the approval of a regional supreme committee. OBJECTIVES: To examine the various causes of abortion both before and after the fetal viability age (24 weeks of gestation and beyond) in a singleton pregnancy, as well as to examine the sequence of events that led to a late abortion. METHODS: In this cohort study, 4,057 patients who had abortions due to fetal abnormalities in the Shamir Medical Center during the years 1998-2021, were divided according to the abortion indications. Of these, 3539 (91.28%) had early abortion (24 weeks and below) and 338 (8.72%) had late abortions (24 week and later). RESULTS: In general, the leading reasons for abortions are chromosomal and genetic (1862 [46%]) as well as anatomical indication (1868 [46%]). It was found that the leading indication for early abortion is the chromosomal or genetic abnormalities (1702 [48.1%]), while the leading indication for late abortion is anatomical defects (204 [60.4%]) (p=0.000). In late abortion, the leading anatomical cause is heart defects (62 [30.54%]) followed by central nervous system defects (56 [26.6%]), and the leading chromosomal cause is trisomy 21 (Down syndrome) (23 [22.33%]). When examining the sequence of events that led to late abortion, the leading reason is abnormal findings that required further studies (125 [37%]). CONCLUSIONS: There is great importance in trying to reduce late pregnancy abortion by understanding the sequence of events and the reasons that led to it. Changing the processes that need to be performed can be implemented by combining pathways: improving the technological means, using more accurate instrumentation and advanced molecular genetics. Furthermore, it is essential to raise the awareness of the pregnant women on screening tests, and conducting this as early as possible. Additionally, it is important to raise the skill of the operators. We believe that incorporating all those actions will lead to earlier diagnosis and to a decrease in late abortions, a promising message both from the point of view of the women and the medical staff, due to the difficulty in carrying out late pregnancy terminations.

[PHYSIOTHERAPY TREATMENT DURING CORONA TIMES - SUMMARY AND GUIDELINES].

INTRODUCTION: The World Health Organization declared that the corona virus disease (COVID 19) is a global pandemic and public health emergency, following the outbreak in Wuhan, China, in December 2019. Fever, dry cough and fatigue were the main manifestations, but the primary concern is cases that deteriorated to severe pneumonia and acute respiratory distress syndrome (ARDS). The outbreak of COVID- 19 in Israel, in March 2020 caused major changes in the routine work in hospitals. Hasharon hospital, a small community hospital in Petah Tikvah was converted to corona patients' admissions only. In accordance with this new reality, the physiotherapy service prepared itself to provide treatments tailored to the clinical needs of the Covid 19 patients and the quarantine conditions of these patients' hospitalization. During a period of 2 months, we built a unique protocol adjusted to isolated patients and staff, including telemedicine and hands-on treatment. This article summarizes our experience of physiotherapy treatment in the acute and rehabilitation period.

Investigating the anatomy of the helping relationship in the context of psychiatric rehabilitation: the relation between working alliance, providers' recovery competencies and personal recovery.

Professional helping relationships established with mental health consumers are vital in mental health recovery processes. However, little is known about how the constructs of alliance building and providers' recovery promoting strategies relate to each other and play a role in supporting recovery. To this end, we examined associations between consumer-reported working alliance, perceived providers' recovery competencies, and personal recovery. In a cross-sectional study design, 72 mental health consumers who established relationships with providers through a psycho-educational intervention over a period of 10 months in hourly weekly sessions were examined as part of a larger study conducted in mental health community settings in Israel. Participants filled in the Working Alliance Inventory (Tracey and Kokotovic, 1989), the Recovery Promoting Relationships Scale (Russinova et al., 2013), and Recovery Assessment Scale (Corrigan et al., 2004). Pearson correlations and linear regression analysis showed positive correlations between relational variables and recovery. A mediating model was identified whereby providers' recovery strategies positively impact the working alliance, which, in turn, positively impact consumers' recovery. Implications of the current study for future research and clinical practice are discussed, emphasizing the importance of examining recovery strategies and the working alliance with regard to the process of mental health recovery.