Specialist vaccination advice and pockets of resistance to MMR vaccination: lessons from an outbreak of measles.

An outbreak of measles was associated with a private nursery school in north west London. Sixteen cases were identified of whom 13 were laboratory confirmed. The majority of cases were aged three years or younger. Older cases were siblings of younger cases. None of the cases had been vaccinated against measles. In the nursery school 33% of the children had not received MMR vaccination. Based on specialist advice from the Health Protection Agency the outbreak control team recommended that children with no history of MMR vaccination should have a first MMR dose as soon as possible and that children with one MMR dose should receive the second dose as soon as possible (minimum of one month between doses). Some parents had strong negative views about MMR and represented 'pockets of resistance' to vaccination advice. The specialist vaccination advice, which was different to national immunisation guidelines, also caused some confusion amongst other health professionals. With a decrease in MMR vaccination uptake and resulting increased potential for future measles outbreaks, clinicians should be aware of and understand specialist vaccination advice intended to deal with outbreaks.

Rational Choice theory and prison chaplaincy: the chaplain's dilemma.

Critical responses to the application of Rational Choice theories to the study of religious phenomena tend to be polarized between outright denial that the theories have any relevance to religion and equally outspoken claims that the theories are the only hope for progress in the sociology of religion. This article aims to avoid both of these extreme positions by raising a question, instead, about one of Rational Choice's central propositions about religion. This proposition holds that levels of religious vitality vary positively with the degree to which agencies of the state are prevented from regulating religious activity. The findings of recent research into prison chaplaincy in the UK and the USA will be used to test this claim. The main argument will be that the existence of an established church has facilitated a higher level of religious activity, especially for minority faiths, in prisons in England and Wales than is possible in American prisons. This difference in religious vitality is explained in terms of the Church of England's privileged position as a 'broker' between the state and minority faith communities. There is greater equality of opportunity for religious activity in American prisons, but the level of the activity is necessarily lower. In neither country is there anything truly resembling a 'free' market for religion in prisons, but the established Church of England is able to use its quasi-monopoly powers to broker advantageous conditions for minority faith communities. This brokerage function may be advantageous to all religious organizations in the highly regulated 'economy' of prisons.

Efficacy of prednisone in refractory multiple myeloma and measurement of glucocorticoid receptors. A Southwest Oncology Group study.

BACKGROUND: Prednisone is an active drug in the treatment of multiple myeloma. The optimal dose, frequency, and role of glucocorticoid receptors (GR) in response to prednisone is unknown. PURPOSE: The purposes of this study were (1) to estimate the response rate of alternate-day high dose prednisone in patients with relapsing and refractory multiple myeloma; (2) to measure the rate of GR levels; and (3) to correlate the response of prednisone with GR status. PATIENTS AND METHODS: Between 8/86 and 1/90, 127 patients were entered onto the study with 121 evaluable for response. The number of GR sites/cell was determined on mononuclear cells isolated from pretreatment bone marrow aspirates using a one point GR binding assay. Patients received prednisone 100 mg po qod x 2 weeks, followed by 50 mg po qod x 10 weeks. RESULTS: The overall response rate was 10% (95% CI: 5-15%) with a median survival of 11.8 months. The GR sites/cell ranged from 0-53,212 with a mean of 8,371 sites/cells. Stratification of GR sites into 0-2,500, 2,501-6,000 and > 6,000 sites/cells was associated with a response rate of 6%, 27% and 4% respectively (p = 0.009). The median survival of patients in these categories was 8.1, 14.9 and 10.6 months respectively. This was not significant by the logrank test (p = 0.11). Although myeloma patients with intermediate levels of GR sites/cell initially responded more favorably to prednisone, their long-term survival was not significantly improved. CONCLUSIONS: Alternate-day high-dose prednisone was well tolerated and may provide palliative benefit for a subset of patients with relapsing and refractory multiple myeloma. The survival of patients on this study was comparable to that reported with other but more toxic doses of glucocorticoids.