Report of the International Workshop on Animal Disposal Alternatives: from concept to catalyst for change.

The principle of animal depopulation and animal disposal has been a fundamental approach of veterinary and regulatory interventions for the effective biological containment and eradication of contagious diseases since the science and art of veterinary medicine began. Today's world, however, is one of epidemiological globalisation, changing social values concerning the management of animal populations, and recognition of the environmental consequences associated with animal disposal, especially during animal disease emergencies. It has consequently become apparent that new approaches are required to minimise both the need for mass culling of animals in response to disease occurrences and the associated negative consequences. In addition, where a level of animal depopulation remains the only recourse, it is imperative that the undertaking be conducted in a manner which is socially and environmentally responsible.

Alternatives to animal disposal--epilogue: what the future holds.

The quest for alternatives to mass animal destruction and disposal represent the findings and advancement of an international initiative that was originated by Canada. Slaughter will remain an important disease management tool for zoonotic and highly infectious diseases. When animal diseases do not constitute a public health risk, however, mass slaughter will continue to be questioned. Solving broad issues of economic, political and social forces is equally as important as addressing technical needs. These issues influence gaining, maintaining or losing consumer confidence during disease events. Therefore, effective, meaningful and inclusive communication with the public is necessary. Furthermore, strategic investments to develop new technical tools collaboratively will be required on a global scale. In addition, other positive contributing factors include capacity building in veterinary services, the use of disease modelling, trends analysis, anticipation and agricultural intelligence, and the vision and enthusiasm of young scientists. The challenges which lie ahead are threefold, namely: to find acceptable alternatives, to develop new international standards to provide confidence and to communicate future approaches more effectively. The concluding result is a re emphasised statement of the urgent need for legitimate, alternative strategies, the challenges which make this difficult and the exciting opportunities ahead. There is a need for renewed creativity, innovation and support to further advance the concept and vision of the four international workshops on animal disposal alternatives for the betterment of global society.

Supplement use among men with prostate cancer.

OBJECTIVES: To characterize supplement use within a sample population of men diagnosed with prostate cancer. METHODS: A census of men diagnosed with prostate cancer at Duke University Medical Center from 1997 to 2002 (n = 1402) was mailed a survey that ascertained data on health status, education, diet, exercise, smoking status, and information on supplement use. Differences between demographic and treatment subgroups were described and tested, as was change in supplement use after diagnosis. RESULTS: Data from 805 respondents indicated that a majority (73%) used supplements, and 68% claimed that this information was shared with their cancer care provider. The most commonly reported supplements were multivitamins (56%), vitamin E (43%), vitamin C (33%), and calcium (26%). On average, 2.7 +/- 2.8 supplements per day were taken, and use increased significantly after diagnosis for most supplements. Use was significantly higher among men who were white (P = 0.043), were more highly educated (P = 0.002), exercise regularly (P = 0.020), and who consume five or more daily servings of fruits and vegetables (P = 0.040). CONCLUSIONS: A high percentage of men with prostate cancer take supplements, especially those who are white, more educated, and who pursue healthful behaviors. Systematic means of capturing these data are necessary to begin to understand the potential impact of supplements on disease outcome, especially because no data exist to suggest that supplements are of any benefit after diagnosis.

Management of nephropleural fistula after supracostal percutaneous nephrolithotomy.

OBJECTIVES: Access to complex urinary tract pathology may require supracostal access placing patients at risk for intrathoracic complications. Our objective was to retrospectively review our experience with percutaneous renal surgery with a particular emphasis on identifying the incidence of nephropleural fistula and management of this unusual complication. METHODS: The records of 375 consecutive patients who underwent percutaneous renal surgery between 1993 and 2001 were reviewed. Supracostal access was placed to address the intrarenal pathologic findings most directly in 120 (26.0%) of the 462 tracts, with 87 (18.8%) above the 12th rib, 32 (6.9%) above the 11th rib, and 1 (0.2%) above the 10th rib. RESULTS: Of 375 patients, 4 (1%) developed a nephropleural fistula. Of the 87 with supracostal-12th rib access, 2 (2.3%) developed a nephropleural fistula, and 2 (6.3%) of the 32 with supracostal-11th rib access developed the same complication. The overall incidence of nephropleural fistulas in our patient population per access tract placed was 0.87% (4 of 462 percutaneous tracts), which increased to 3.3% (4 of 120) when considering only supracostal access. All patients were treated conservatively, although 1 patient required thoracoscopy with decortication for persistent pleural effusion. No further sequelae developed in any of the other 3 patients, and all fistulas had resolved at 3 months of follow-up. CONCLUSIONS: As aggressive percutaneous renal surgery with supracostal access to the collecting system becomes more common, the incidence of intrathoracic complications, including nephropleural fistula, may increase. Early recognition and management of a pleural injury is critical to avoid life-threatening situations. Low-morbidity measures are typically successful; however, more aggressive treatment may be required on occasion.

No difference in response rate to a mailed survey among prostate cancer survivors using conditional versus unconditional incentives.

Mailed surveys are widely used to collect epidemiological and health service data on cancer populations. Nonresponse can threaten the validity of surveys and various strategies, including the enclosure of modest incentives, are often used to increase response rates. A study was undertaken to determine whether response rate to a mailed survey differed with provision of immediate versus delayed incentives. A six-page mailed survey to ascertain dietary supplement use was sent to 1402 men who had been diagnosed with prostate cancer. Subjects were block randomized into two groups based on age (< or =65 years versus >65 years), race (white versus nonwhite), and disease status (locoregional versus distant). One group received a 30-min prepaid phone card concurrently with their blank survey (unconditional incentive), whereas the other group received the incentive only on receipt of their completed survey (conditional incentive). A 60% overall response rate was achieved, and no differences in response rates were noted between conditional and unconditional incentive groups (overall, as well as within defined age, race, and disease-defined strata). Nonwhites, however, were significantly less likely to respond than whites (P < 0.0001). In conclusion, acceptable response rates to a mailed survey can be achieved in a general population of cancer survivors using modest incentives. Given no differences in response rates using conditional versus unconditional incentives, the decision to provide immediate versus delayed incentives is one that should be considered on a study-specific basis, and a decision based primarily on cost. Other means, however, appear necessary to achieve acceptable response rates among minority group cancer survivors.