Defining Manhood for Ourselves

Chapter 2 provides practical tips for starting conversations with boys about how they can help fight sexual violence. As a backdrop to this lesson, the author provides his own backstory and identifies protective factors that led him to reconsider his stance toward sexual violence. Readers are invited to consider which of these factors can be replicated for the boys they know, such as providing them with a community, a space to practice, and a personal invitation to help. Some common defenses held by boys are also identified so that readers can consider how to overcome them as they craft their own personalized methods of reaching out to boys.

Cultivating Faith in Young Adults

Current data on trends toward agnosticism, atheism, and religious disaffiliation is compelling and deeply challenging for religious leaders who want to be effective in transmitting faith to succeeding generations and cultivating mature, adult faith in their churches’ members. However, where there is present the desire for meaning, belonging, forgiveness, self- and communal improvement, joy, consolation, or a deeper understanding of life’s big questions, there is a need for religious leadership and pastoral care. There are eight principal insights that can help redress the trend of young adults to eschew religion altogether or to drift and disaffiliate from their religious upbringing. Among the core components that the most effective religious leaders are mindful of are early, personal invitation; leadership formation and training; allowing for mentors; creating a welcoming atmosphere; attending to cognitive expectations; attending to affective expectations; striving for excellence in liturgical, sacramental, communal, and programmatic life; and recognizing the role of parents and family members.

Immunization programs for hospital healthcare workers in Northern-Italy, can we do more?

Background Coverage for vaccine-preventable diseases (VPDs) among healthcare workers (HCWs) in Italy remains low, and WHO strongly recommends to tailor immunization programs to tackle hesitancy. Aim of the study was to investigate HCW-specific immunization programs within Friuli Venezia Giulia (FVG) Region in order to plan new common strategies. Methods In December 2019 we collected information about FVG hospitals and HCWs immunization programs conducted within each of them, including: number of HCWs employed, monitored VPDs, immunization assumption, vaccination strategies and refusers management. Results We obtained data from 7/7 hospitals, for a total of 12,557 employed HCWs (average 1,794; range 467-3,922); 2 hospitals are academic centers, while 2 are research institutions. All hospitals have immunization programs for measles, mumps, rubella; the majority for hepatitis B (6/7); 5 for diphtheria, tetanus, pertussis, chicken pox. Presumptive evidence of immunity is established when written vaccination documentation is available or in presence of laboratory evidence. HCWs immunization programs are responsibility of the occupational doctor in most hospitals (6/7). Vaccination promotion strategies include: mail or email personal invitation, training courses, video and notice display on hospital website, reminders. Most hospitals set up a dedicated vaccination service located in a hospital common area (4) or outside the hospital (2); one hospital also offered ward on-site vaccination. For airborne or droplets transmission diseases, refusers are asked to wear a mask during shift in 2 hospitals. Conclusions HCWs immunization programs in FVG Region are heterogeneous, and their specific effectiveness has to be studied yet. This study represents the first step in the process of FVG hospitals engagement in sharing effective actions in order to plan a new regional strategy for HWCs immunization. Key messages The investigation of effective strategies conducted in different FVG hospitals is essential for their scaling-up evaluation. A common regional plan for healthcare workers immunization is needed to tackle hesitancy and reduce infectious risk within hospitals.

The Dutch influenza vaccination policy and medication use, outpatient visits, hospitalization and mortality at age 65

Background Our objective was to obtain estimates of the impact of the Dutch vaccination programme on medication use, outpatient visits, hospitalization and mortality at age 65. Methods We linked population-wide mortality, hospitalization and municipality registries to identify influenza-related deaths and hospitalizations, and used health interview surveys to identify medication use and outpatient visits during 1996–2008. We applied a regression discontinuity design to estimate the intention-to-treat effect of the personal invitation for a free influenza vaccination sent to every Dutch inhabitant at age 65 years on each of the outcomes, separately in influenza-epidemic and non-epidemic months. Results Invitation receipt for free influenza vaccination at age 65 led to a 9.8 percentage points [95% confidence interval (CI) = 3.5 to16.1; P < 0.01] rise in influenza vaccination. During influenza-epidemic months, it was associated with 1.5 fewer influenza/pneumonia deaths per 100 000 individuals (95% CI = −3.1 to −0.0; P = 0.05), a 15 percentage point lower probability to use prescribed medicines (95% CI = −28 to −3; P = 0.02) and 0.13 fewer General Practitioner (GP) visits per month (95% CI = −0.28 to 0.02; P = 0.09), while the association with hospitalizations due to influenza/pneumonia was small and imprecisely estimated (seven more hospitalizations per 100 000 individuals, 95% CI = −20 to 33; P = 0.63). No associations were found with any outcomes during non-epidemic months. Conclusions Personal invitations for a free influenza vaccination sent to every Dutch inhabitant at age 65 took pressure off primary health care but had small effects on hospitalizations and mortality.

The Cost-Effectiveness Analysis of Cervical Cancer Screening Using a Systematic Invitation System in Lithuania

In Lithuania, cytological screening of cervical cancer (CC) is largely opportunistic. Absence of standardized systematic invitation practice might be the reason for low participation rates. The study aimed to assess the cost-effectiveness of systematic invitation approach in CC screening programme from the perspective of a healthcare provider. A decision tree was used to compare an opportunistic invitation by a family doctor, a personal postal invitation letter with appointment time and place, and a personal postal invitation letter with appointment time and place with one reminder letter. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) per one additionally screened woman and per one additional abnormal Pap smear test detected. The ICER of one personal postal invitation letter was €9.67 per one additionally screened woman and €55.21 per one additional abnormal Pap smear test detected in comparison with the current screening practice. The ICER of a personal invitation letter with an additional reminder letter compared to one invitation letter was €13.47 and €86.88 respectively. Conclusions: A personal invitation letter approach is more effective in increasing the participation rate in CC screening and the number of detected abnormal Pap smears; however, it incurs additional expenses compared with current invitation practice.

Organised Versus Opportunistic Cervical Cancer Screening in Urban and Rural Regions of Lithuania

Background and Objectives: In 2004, Lithuania started the Nationwide Cervical Cancer Screening Programme. However, screening is more opportunistic than population-wide and the programme’s coverage is insufficient. The aim of this study was to assess the effect of systematic personal invitation on coverage of cervical cancer (CC) screening in urban and rural regions of Lithuania. Materials and Methods: The study was conducted in an urban primary healthcare centre (PHCC) and in a rural PHCC, where prevailing CC screening practice was highly opportunistic. Over the first year, all women aged 25–60 who had not received a Pap smear test within the last three years in urban (n = 1591) and rural (n = 1843) PHCCs received a personal invitation letter to participate in the screening. Over the second year, the reminder letter was sent to the non-attendees (n = 1042 in urban and n = 929 in rural PHCCs). A random sample of women (n = 93), who did not attend for screening after two letters, was contacted by phone in order to identify the barriers of non-attendance. Results: Before the study, only 9.6% of the target population in urban and 14.7% in rural PHCCs participated in CC screening. After the first invitation letter, the participation in CC screening increased up to 24.6% in urban and 30.8% in rural areas (p < 0.001). After the reminder letter, the attendance was 16.4% in urban and 22.2% in rural PHCCs (p < 0.001). The most common barriers for the non-attendance were lack of time, long waiting time for family doctor’s appointment, worries that a Pap test might be unpleasant and preventive gynaecological examination outside of the screening program. Conclusions: A systematic personal invitation with one reminder letter significantly increased the coverage of CC screening and was more effective in rural regions than in urban regions. The assessed barriers for non-attendance can be used to improve the coverage of screening.

TINJAUAN KRITIS TERHADAP EPISTEMOLOGI IMMANUEL KANT (1724-1804)

The background of this article is a metaphysical problem that arose in Immanuel Kant's thought in his Critique of Pure Reason. Through a hermeneutic approach this article aims to analyze the metaphysical problems that arise in Immanuel Kant's epistemology of thought. Based on the research results can be concluded that the unequivocal separation between phenomena and noumena will cause humans will never come to the knowledge of the Transcendent, as well as with moral and aesthetics. This is because such knowledge can only be obtained through my participation as a Subject through the process of continuous existence and more of a personal invitation. In the end it can be concluded that the nature of analog knowledge is the meaning of multidimensional side of human life. This brings consequences to the need for intersubjective dialogue and continual openness. Knowledge is an infinite thing. Human knowledge therefore will never reach the end of the journey but only continuously expanded its horizon.