One manifestation of globalization is medical tourism. As its implications remain largely unknown, we reviewed claimed benefits and risks. Driven by high health-care costs, long waiting periods, or lack of access to new therapies in developed countries, most medical tourists (largely from the United States, Canada, and Western Europe) seek care in Asia and Latin America. Although individual patient risks may be offset by credentialing and sophistication in (some) destination country facilities, lack of benefits to poorer citizens in developing countries offering medical tourism remains a generic equity issue. Data collection, measures, and studies of medical tourism all need to be greatly improved if countries are to assess better both the magnitude and potential health implications of this trade.

4 46 69 9 C ervical cancer is an important cause of preventable cancer-related death among women. Because of the overwhelming burden of this disease in developing countries, cervical cancer is the second most common cause of cancer among women worldwide.1 It primarily affects women between 30 and 45 years of age, thereby representing in an important source of potential years of life lost.With the obligate link between HPV and cervical cancer now established, prophylactic HPV vaccination represents a potential means of reducing the burden of cervical cancer and its precursor lesions. Two prophylactic HPV vaccines are now available. Both target HPV types 16 and 18, and one of the vaccines also targets HPV types 6 and 11. There are over 100 known subtypes of HPV, but types 16 and 18 are the most prevalent oncogenic strains of the virus, accounting for an estimated 70% of cervical cancers worldwide.1,2 Non-oncogenic strains, such as HPV types 6 and 11, are associated with the development of external genital disease, including genital warts. Most sexually active women will become infected with HPV in DOI:10.1503/cmaj.070948 Lisa Rambout BScPhm, Laura Hopkins MD MSc, Brian Hutton MSc, Dean Fergusson PhD Prophylactic vaccination against human papillomavirus infection and disease in women: a systematic review of randomized controlled trials Background: Human papillomavirus (HPV) is now known to be a necessary cause of cervical cancer, and prophylactic HPV vaccines aimed at preventing genital warts, precancerous cervical lesions and cervical cancer are now available. To gauge the potential impact on disease burden, we performed a systematic review of the evidence from randomized controlled trials. Methods:We conducted a systematic search of the literature to identify all randomized controlled trials of prophylactic HPV vaccination. Reports in 5 electronic databases covering 1950 to June 2007 (MEDLINE, MEDLINE in process, EMBASE, the Cochrane Central Registry of Controlled Trials and the Cochrane Library), bibliographies of all included studies and of narrative reviews (2006)(2007), clinical trial registries, Google Scholar, public health announcements, selected conference proceedings (2004)(2005)(2006)(2007) and manufacturers' information on unpublished data or ongoing trials were screened against predefined eligibility criteria by 2 independent reviewers. Vaccines had to contain coverage against at least 1 oncogenic HPV strain. The primary outcome of interest was the frequency of high-grade cervical lesions (high-grade squamous intraepithelial lesion, or grade 2 or 3 cervical intraepithelial neoplasia). The secondary outcomes were persistent HPV infection, low-grade cervical lesions (low-grade squamous intraepithelial lesion or grade 1 cervical intraepithelial neoplasia), external genital lesions, adverse events and death. Meta-analysis of the data was done in all cases where adequate clinical and methodological homogeneity existed.Results: Of 456 screened reports, 9 were included in the review (6 were reports of ran...

Understanding factors which arbitrate in vaccination decisions among key target groups can improve the success of health promotion interventions. Additional studies of superior methodological quality are needed to produce reliable data to inform health promotion strategies.

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