Suchergebnisse

BACKGROUND: The human papillomavirus (hpv) is a common sexually transmitted infection and a primary cause of cervical cancer. The Government of Canada has set a target of reaching 90% hpv vaccine coverage among adolescents by 2025. Here, we examine hpv vaccine uptake in school-based immunization programs across Canada and explore how achieving the 90% target could affect the future incidence of cervical cancer, mortality, and health system expenditures in a cohort of Canadian women. METHODS: Data for hpv vaccine uptake in the most recent reported school year available in each jurisdiction were provided in 2017 by jurisdictional school-based immunization programs and were used to estimate a national weighted average of 67%. The OncoSim microsimulation model (version 2.5) was used to compare 3 different levels of hpv vaccine uptake (0%, 67%, 90%) on health and economic outcomes for a hypothetical cohort of all 5- to 10-year-old girls in Canada in 2015. RESULTS: Vaccine uptake for girls in school-based programs varied from 55.0% to 92.0% in the jurisdictions reviewed. The OncoSim model projects that increasing uptake to 90% from 67% would result in a 23% reduction in cervical cancer incidence rates (to 3.1 cases from 4.0 cases per 100,000, averaged across the lifetime of the cohort) and a 23% decline in the average annual mortality rate (to 1.0 deaths from 1.3 deaths per 100,000). Finally, the model projects that the health system will incur a cost of $9 million (1% increase) during the lifetime of the cohort if uptake is increased to 90% from 67%. Costs are discounted (1.5%) and expressed in 2016 Canadian dollars. Costs reflect the payer perspective. CONCLUSIONS: Our model shows that increasing hpv vaccine uptake to 90% from current levels for girls in school-based immunization programs could result in substantial reductions in the future incidence and mortality rates for cervical cancer in Canada.

Protected area networks facilitate community changes in responses to climate warming. However, the contribution of the site environmental and conservation-oriented characteristics to these responses to climate warming are not well understood. Here, we investigate how composition of non-breeding waterbird communities within the European Union Natura 2000 (N2K) network changes in response to increases in temperature. We measured the community reshuffling of 97 waterbird species in 3,018 N2K sites over 25 years in 26 European countries. We find that N2K sites explicitly designated for protection of waterbirds and with a management plan had faster climate-driven community changes. In contrast, the designation period of the N2K sites was not associated with community adjustment, and sites funded under EU-LIFE had lower climate-driven community changes. Our findings imply that efficient conservation policy that may help waterbird community responses to climate warming is to manage sites that are specifically designated for waterbirds.

Protected area networks facilitate community changes in responses to climate warming. However, the contribution of the site environmental and conservation-oriented characteristics to these responses to climate warming are not well understood. Here, we investigate how composition of non-breeding waterbird communities within the European Union Natura 2000 (N2K) network changes in response to increases in temperature. We measured the community reshuffling of 97 waterbird species in 3,018 N2K sites over 25 years in 26 European countries. We find that N2K sites explicitly designated for protection of waterbirds and with a management plan had faster climate-driven community changes. In contrast, the designation period of the N2K sites was not associated with community adjustment, and sites funded under EU-LIFE had lower climate-driven community changes. Our findings imply that efficient conservation policy that may help waterbird community responses to climate warming is to manage sites that are specifically designated for waterbirds.