In the late 1800s, the small Indian mongoose was introduced to the Caribbean islands in one of the most widespread purposeful introductions of a mammalian predator in history. Intended as a biological control agent for introduced rats in sugarcane plantations, the mongoose quickly became recognized as a pest due to its predation on poultry and native fauna, and injuries to livestock. Over the last 40 years, the mongoose has also emerged as the primary vector and reservoir for rabies on several Caribbean islands. Due to the estimated costs associated with this introduced carnivore, as well as potential ecological impacts, the mongoose is now listed as one of the top 100 worst invaders by the IUCN. Past large-scale control attempts in the Caribbean have proven unsuccessful, and few to none are currently being implemented. In fact, despite its renown, very little is known about the actual impacts of the mongoose. It is likely that combined with increasing rates of development in some Caribbean islands, the impact of the mongoose on native faunal communities may become more serious. This paper provides an overview of mongoose management in the Caribbean. Although current management priorities center on the role and management of the mongoose as a disease vector, this paper will also discuss opportunities to pair this research with 1) an assessment of the ecological impacts of the mongoose on native species, and 2) the development of mongoose control methods. The Caribbean National Forest, Puerto Rico is used as a case study; however, these methods can potentially apply to other Caribbean islands.

In natural recreation areas, habituated wildlife can pose a threat to visitor health and safety by transmitting disease or causing physical injury. Although removal of problem wildlife can help to alleviate these problems, it can also be a labor-intensive, costly practice. To improve the efficiency of a removal program, trapping efforts should be directed towards the spatial and temporal peaks of the target species’ activity patterns. An animal’s activity is often dictated by environmental conditions such as season or lunar phase; however, in a recreation area, it can also be affected by anthropogenic factors such as human presence and provisioning of food sources (i.e. trash cans or picnic areas). A species can 1) be attracted to anthropogenic food sources when human presence is highest, or 2) be attracted to anthropogenic food sources, but only when humans are not present, or 3) avoid anthropogenic food sources and human presence entirely. Each of these scenarios would necessitate a different management strategy to achieve the highest level of trapping efficiency. In the Caribbean National Forest, Puerto Rico, small Indian mongooses are currently controlled by removal trapping to reduce the threat of rabies transmission. Although trapping usually occurs diurnally near areas of high human use, it is unknown whether or not this strategy targets the highest number of animals. Using radiotelemetry, we investigated the movement behavior of 7 mongooses trapped in the picnic areas. We determined animals’ hourly travel distances, activity levels (moving or stationary), and distance of animal locations from human structures (trails, trash cans, and picnic cabanas); and compared these measures between days of high and low visitorship. The distance mongooses were found from human structures was not affected by the day of the week. Activity levels and movements varied by day, but it was unclear how this variation was affected by forest visitor levels. This paper will discuss how these results can be used to develop the most efficient trapping strategy.

In 2001, roof rats were identified as major predators of open-cup songbird nests in old growth riparian forests of California’s Central Valley. Nest predation was as high as 80%. For some bird species in recent years, the populations had declined, and their range was reduced. A management strategy to reduce rat impacts on songbirds was considered a priority. Following a review of the literature and consultation with land managers and experts in rodent management and bird conservation, we decided to reduce rat populations with poison baits delivered in bait stations immediately prior to the songbird nesting period. We subsequently conducted studies to provide information on rat home range and habitat use, potential baits, optimal bait station placement and distribution, and the potential non-target hazards of the program. The management strategy was then implemented in one riparian forest tract in October - December 2003. This is an adaptive management approach that will be evaluated in 2004, modified as necessary, and if successful, potentially applied to other riparian forests. In this paper we describe our approach to developing the management strategy, provide preliminary results, and discuss some of the potential problems with its implementation on a large scale.

Background

Prior research suggests that women do not accurately estimate their risk for breast cancer. Estimating and informing women of their risk is essential for tailoring appropriate screening and risk reduction strategies.

Methods

Data were collected for BreastCARE, a randomized controlled trial designed to evaluate a PC-tablet based intervention providing multiethnic women and their primary care physicians with tailored information about breast cancer risk. We included women ages 40-74 visiting general internal medicine primary care clinics at one academic practice and one safety net practice who spoke English, Spanish, or Cantonese, and had no personal history of breast cancer. We collected baseline information regarding risk perception and concern. Women were categorized as high risk (vs. average risk) if their family history met criteria for referral to genetic counseling or if they were in the top 5% of risk for their age based on the Gail or Breast Cancer Surveillance Consortium Model (BCSC) breast cancer risk model.

Results

Of 1,261 participants, 25% (N=314) were classified as high risk. More average risk than high risk women had correct risk perception (72% vs. 18%); 25% of both average and high risk women reported being very concerned about breast cancer. Average risk women with correct risk perception were less likely to be concerned about breast cancer (odds ratio [OR]=0.3; 95% confidence interval [CI]=0.2-0.4) while high risk women with correct risk perception were more likely to be concerned about breast cancer (OR=5.1; 95%CI=2.7-9.6).

Conclusions

Many women did not accurately perceive their risk for breast cancer. Women with accurate risk perception had an appropriate level of concern about breast cancer. Improved methods of assessing and informing women of their breast cancer risk could motivate high risk women to apply appropriate prevention strategies and allay unnecessary concern among average risk women.

Purpose

To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern.

Methods

From June 2011-August 2012, we enrolled women from two clinics, aged 40-74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1-2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern.

Results

580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19-2.23).

Conclusions

A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern.

Trial registration

ClinicalTrials.gov identifier NCT01830933.

Background

Assessment and discussion of individual risk for breast cancer within the primary care setting are crucial to discussion of risk reduction and timely referral.

Methods

We conducted a randomized controlled trial of a multiethnic, multilingual sample of women ages 40 to 74 years from two primary care practices (one academic, one safety net) to test a breast cancer risk assessment and education intervention. Patients were randomly assigned to control or intervention group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room before visit for intervention). Intervention (BreastCARE) patients and their physicians received an individualized risk report to discuss during the visit. One-week follow-up telephone surveys with all patients assessed patient-physician discussion of family cancer history, personal breast cancer risk, high-risk clinics, and genetic counseling/testing.

Results

A total of 655 control and 580 intervention women completed the risk assessment and follow-up interview; 25% were high-risk by family history, Gail, or Breast Cancer Surveillance Consortium risk models. BreastCARE increased discussions of family cancer history [OR, 1.54; 95% confidence interval (CI), 1.25-1.91], personal breast cancer risk (OR, 4.15; 95% CI, 3.02-5.70), high-risk clinics (OR, 3.84; 95% CI, 2.13-6.95), and genetic counseling/testing (OR, 2.22; 95% CI, 1.34-3.68). Among high-risk women, all intervention effects were stronger.

Conclusions

An intervention combining an easy-to-use, quick risk assessment tool with patient-centered risk reports at the point of care can successfully promote discussion of breast cancer risk reduction between patients and primary care physicians, particularly for high-risk women.

Impact

Next steps include scaling and dissemination of BreastCARE with integration into electronic medical record systems.