Prevaccination screening of health care workers for immunity to measles, rubella, mumps and varicella in a developing country. What do we save?

SummaryA structured questionnaire was administered to health-care workers (HCWs). The HCWs were also screened for measles, rubella, mumps, and varicella (MMRV) using serological methods. One thousand two hundred and fifty-five HCWs were tested. Of the HCWs examined, 94% were immune to measles, 97% to rubella, 90% to mumps and 98% to varicella. The positive predictive values of histories of measles, mumps, rubella and varicella were 96%, 93%, 100% and 98%, respectively. The negative predictive values of histories of measles, mumps, rubella and varicella were 13%, 17%, 5% and 2%, respectively. The cost of vaccination without screening was significantly more expensive (cost difference: €24,385) for varicella, although vaccination without screening was cheap (cost difference: €5693) for MMR. Although the use of cheaper vaccines supports the implementation of vaccination programs without screening, the cost of vaccination should not be calculated based only on the direct costs. The indirect costs associated with lost work time due to vaccination and its side effects and the direct costs of potential side effects should be considered. However, if prescreening is not conducted, some HCWs (2–7%) would be unprotected against these contagious illnesses because of the unreliability of their MMRV history. In conclusion, the screening of HCWs before vaccination continues to be advisable

A systemic model for differentiating school technology integration

School technology integration rarely begins with school or educator choice. It is part of a wider context where external and internal factors have direct influence on the goals and tools that are adopted over time. The objective of this study is to investigate the systemic conditions that contribute or inhibit the development of different activities by teachers making use of new media. We compiled a list of well-known conditions for technology integration success and mapped these in the historical and culturally bound perspective of activity theory (cultural historical activity theory). We conducted a multiple case study analysis of four schools, public and private. The results point to unique and distinctive scenarios even when homogeneity would be expected, reinforcing the argument that material conditions do not determine pedagogical outcomes nor do they determine changes in practice. Beyond this, the study proposes a methodology that can help elicit tensions in technology integration, pointing to avenues for school development

Investigation of pituitary functions in patients with acute meningitis: A pilot study

Objective: Although long-term pituitary consequences of tuberculous meningitis are well documented in the literature, there have been few case reports of pituitary dysfunction after acute bacteria[ or viral meningitis. In this preliminary study, we have assessed the pituitary functions in adult patients who had acute bacterial or viral meningitis. Design and methods: Fourteen patients (8 men, 6 women; mean age 35.3 +/- 13.3) were included in the study. The diagnosis of bacterial and viral meningitis was proven by clinical findings, cerebrospinal fluid (CSF) examination, gram staining, and blood and CSF cultures. Pituitary functions were evaluated ranging from 6 to 48 months (mean 20 months) after acute meningitis. GH deficiency was investigated by the GHRH+arginine stimulation test. Results: Four of 14 patients (28.6%) had isolated GH deficiency. In GH-deficient patients, the earliest duration was 6 months and the latest duration was 48 months after the diagnosis of acute meningitis. Three of the GH-deficient patients had acute bacterial meningitis and I patient had acute viral meningitis. Pituitary magnetic resonance imaging revealed normal pituitary gland in the patients with GH deficiency. Conclusions: This is the first systematic study evaluating the anterior pituitary function long term after the diagnosis of acute meningitis. Based on the present study, it is tempting to speculate that pituitary dysfunction is a more common sequel of acute bacterial or viral meningitis than hitherto reported. Studies with high numbers of patients are warranted to ascertain the prevalence of meningitis-induced hypopituitarism