Vanishing vaccinations: why are so many Americans opting out of vaccinating their children?

Vaccinations against life-threatening diseases are one of the greatest public health achievements in history. Literally millions of premature deaths have been prevented, and countless more children have been saved from disfiguring illness. While vaccinations carry unavoidable risks, the medical, social and economic benefits they confer have led all fifty states to enact compulsory childhood vaccination laws to stop the spread of preventable diseases. Today, however, vaccines are becoming a victim of their success--many individuals have never witnessed the debilitating diseases that vaccines protect against, allowing complacency toward immunization requirements to build. Antivaccination sentiment is growing fast in the United States, in large part due to the controversial and hotly disputed link between immunizations and autism. The internet worsens fears regarding vaccination safety, as at least a dozen websites publish alarming information about the risks of vaccines. Increasing numbers of parents are refusing immunizations for their children and seeking legally sanctioned exemptions instead, apparently fearing vaccines more than the underlying diseases that they protect against. A variety of factors are at play: religious and philosophical beliefs, freedom and individualism, misinformation about risk, and overperception of risk. State legislatures and health departments now face a difficult challenge: respecting individual rights and freedoms while also safeguarding the public welfare. Nearly all states allow vaccination exemptions for religious reasons and a growing number provide "philosophical" opt-outs as well. However, in all but a handful of jurisdictions, neither objection is seriously documented or verified. Often, the law requires a parent to do no more than simply check a box indicating she does not wish her child to receive immunizations. The problem is exacerbated by financial incentives schools have to encourage students to opt out of vaccinations. The rise in parents opting out has caused the AMA grave concern, with many experts decrying the rise of so-called "exemptions of convenience." In some areas, nearly one out of five children have not received their recommended vaccines. The consequences are serious not only for those unprotected children, but for the rest of society as well. "Herd immunity" is threatened as more and more parents free ride off of the community's dwindling immunity, and outbreaks of diseases thought to have been conquered have already occurred. Lawsuits against vaccine manufacturers threaten them with bankruptcy, costs are being externalized onto the healthcare and legal systems, and vulnerable populations are suffering harm or even death. In the interests of social welfare, state legislatures and health departments should consider methods to ensure that the exemption process is carefully tailored to prevent check-the-box opt-outs of convenience, while still allowing exemptions for those with earnest and informed convictions or medical reasons.     

Has the cocaine epidemic arrived in the UK?

National surveys of the UK drug situation in 2000 found that cocaine was the most frequently seized Class A drug, with 25-40 tonnes of cocaine being smuggled into the UK each year. In the light of these findings, an audit of the analytical monitoring for cocaine abuse has been performed covering the period from 1996 to 2002. It was found that there has been a consistent upward trend in the percentage of requests found to be positive for cocaine over this 7-year study period, rising from 9.7% in 1996 to 22% in 2002. This data would suggest that the use of cocaine has increased dramatically over the past few years, indicating that the arrival of the "cocaine epidemic" has now started to become a reality in the UK.     

Differences in the predictive validity of actuarial risk assessments in relation to sex offender type

This study seeks to expand on the previously reported validity of the Static-99, RRASOR, MnSOST-R, and SORAG in predicting sexual recidivism utilizing a regional sample of offenders. The predictive validity of each test was determined utilizing subgroups of the sample based on each offender's known offense history. The effectiveness of each instrument varied depending on offender type. The Static-99 and SORAG were both significantly predictive of sexual, violent, and any recidivism for extra-familial child molesters, and all four tests were predictive of violent or any recidivism in this subgroup. For incest offenders, all four tests were at least moderately predictive of sexual recidivism, whereas the Static-99 and the SORAG were highly predictive of violent or any recidivism. None of the four tests established consistent predictive validity across recidivism categories in regard to rapists or hands-off offenders, however, the Static-99 and the SORAG were significant in terms of sexual recidivism.     

Confronting the challenges of urban development in São Paulo: the Operações Interligadas/Urbanas

This article examines the contribution of international municipal cooperation (IMC) to the resolution of long standing planning challenges in the city of São Paulo (Brazil), South America's largest urban agglomeration. Specifically, the study investigates the early development and subsequent evolution of a planning‐related project developed in collaboration with the city of Toronto, Canada. In its first phase–dubbed the Operações Interligadas (OI)–the initiative was directed towards expansion and improvement of São Paulo's housing stock. The second phase, known as the Operações Urbanas, has focused more broadly on urban renewal. As will be shown, both phases of the programme have provided an important fund‐raising mechanism for confronting the challenges of urban growth and change. At the same time, however, the study reveals a number of limitations to the overall strategy, perhaps restricting its use as a model for other developing world cities. Copyright © 2001 John Wiley & Sons, Ltd.