Perceived Causes and Solutions to Soil Degradation in the UK and Norway

Soil quality is declining in many parts of the world, with implications for the productivity, resilience and sustainability of agri-food systems. Research suggests multiple causes of soil degradation with no single solution and a divided stakeholder opinion on how to manage this problem. However, creating socially acceptable and effective policies to halt soil degradation requires engagement with a diverse range of stakeholders who possess different and complementary knowledge, experiences and perspectives. To understand how British and Norwegian agricultural stakeholders perceived the causes of and solutions to soil degradation, we used Q-methodology with 114 respondents, including farmers, scientists and agricultural advisers. For the UK, respondents thought the causes were due to loss of soil structure, soil erosion, compaction and loss of organic matter; the perceived solutions were to develop more collaborative research between researchers and farmers, invest in training, improve trust between farmers and regulatory agencies, and reduce soil compaction. In Norway, respondents thought soils were degrading due to soil erosion, monocultures and loss of soil structure; they believed the solutions were to reduce compaction, increase rotation and invest in agricultural training. There was an overarching theme related to industrialised agriculture being responsible for declining soil quality in both countries. We highlight potential areas for land use policy development in Norway and the UK, including multi-actor approaches that may improve the social acceptance of these policies. This study also illustrates how Q-methodology may be used to co-produce stakeholder-driven policy options to address land degradation

Randomized implementation of a primary human papillomavirus testing-based cervical cancer screening protocol for women 34 to 69 years in Norway

Background: Cervical cancer screening programs are facing a programmatic shift where screening protocol based on human papillomavirus testing (HPV-Screening protocol) is replacing the liquid-based cytology (LBC-Screening protocol). For safe technology transfer within the nationwide screening programme in Norway, HPV-Screening protocol was implemented randomized to compare the real-world effectiveness of HPV-Screening protocol and LBC-Screening protocol at the first screening round. Methods: Among 302,295 women ages 34 to 69 years scheduled to attend screening from February 2015 to June 2017, 157,447 attended. A total of 77,207 were randomly allocated to the HPV-Screening protocol and 80,240 were allocated to the LBC-Screening protocol. All women were followed up for 18 months. Results: The HPV-Screening protocol resulted in a relative increase of 60% in the detection of cervical intraepithelial neoplasia (CIN) grade 2 or worse [risk ratio (RR) = 1.6, 95% confidence interval (CI) = 1.5–1.7], 40% in CIN grade 3 or worse (RR = 1.4, 95% CI = 1.3–1.6), 40% in cancer (RR = 1.4, 95% CI = 1.0–2.1), and 60% in colposcopy referrals (RR = 1.6, 95% CI = 1.5–1.6) compared with LBC-Screening. The performance of both protocols was age dependent, being more effective in women ages under 50 years. Conclusions: The HPV-Screening protocol was well accepted by women in Norway and detected more CIN2, CIN3, and cancers compared with the LBC-Screening protocol. Impact: A randomized implementation of the HPV-Screening protocol with real-world assessment enabled a gradual, quality assured, and safe technology transition. HPV-based screening protocol may further be improved by using HPV genotyping and age-specific referral algorithms.publishedVersio

Increased Risk of Recurrence After Hormone Replacement Therapy in Breast Cancer Survivors

Background Hormone replacement therapy (HT) is known to increase the risk of breast cancer in healthy women, but its effect on breast cancer risk in breast cancer survivors is less clear. The randomized HABITS study, which compared HT for menopausal symptoms with best management without hormones among women with previously treated breast cancer, was stopped early due to suspicions of an increased risk of new breast cancer events following HT. We present results after extended follow-up. Methods HABITS was a randomized, non-placebo-controlled noninferiority trial that aimed to be at a power of 80% to detect a 36% increase in the hazard ratio (HR) for a new breast cancer event following HT. Cox models were used to estimate relative risks of a breast cancer event, the maximum likelihood method was used to calculate 95% confidence intervals (CIs), and χ2 tests were used to assess statistical significance, with all P values based on two-sided tests. The absolute risk of a new breast cancer event was estimated with the cumulative incidence function. Most patients who received HT were prescribed continuous combined or sequential estradiol hemihydrate and norethisterone. Results Of the 447 women randomly assigned, 442 could be followed for a median of 4 years. Thirty-nine of the 221 women in the HT arm and 17 of the 221 women in the control arm experienced a new breast cancer event (HR = 2.4, 95% CI = 1.3 to 4.2). Cumulative incidences at 5 years were 22.2% in the HT arm and 8.0% in the control arm. By the end of follow-up, six women in the HT arm had died of breast cancer and six were alive with distant metastases. In the control arm, five women had died of breast cancer and four had metastatic breast cancer (P = .51, log-rank test). Conclusion After extended follow-up, there was a clinically and statistically significant increased risk of a new breast cancer event in survivors who took H

Neil3-dependent base excision repair regulates lipid metabolism and prevents atherosclerosis in Apoe-deficient mice

Increasing evidence suggests that oxidative DNA damage accumulates in atherosclerosis. Recently, we showed that a genetic variant in the human DNA repair enzyme NEIL3 was associated with increased risk of myocardial infarction. Here, we explored the role of Neil3/NEIL3 in atherogenesis by both clinical and experimental approaches. Human carotid plaques revealed increased NEIL3 mRNA expression which significantly correlated with mRNA levels of the macrophage marker CD68. Apoe−/−Neil3−/− mice on high-fat diet showed accelerated plaque formation as compared to Apoe−/− mice, reflecting an atherogenic lipid profile, increased hepatic triglyceride levels and attenuated macrophage cholesterol efflux capacity. Apoe−/−Neil3−/− mice showed marked alterations in several pathways affecting hepatic lipid metabolism, but no genotypic alterations in genome integrity or genome-wide accumulation of oxidative DNA damage. These results suggest a novel role for the DNA glycosylase Neil3 in atherogenesis in balancing lipid metabolism and macrophage function, potentially independently of genome-wide canonical base excision repair of oxidative DNA damage

Medical abortion with mifepristone and home administration of misoprostol up to 63 days' gestation

Objective. To evaluate the acceptability and efficacy of medical abortion at home up to 63 days’ gestation without limits on travel distance to a registered institution. Design. Observational prospective study. Setting. Haukeland University Hospital between May 2006 and May 2009. Population. A total of 1018 women requesting abortion before 63 days’ gestation who chose medical termination with mifepristone and home administration of misoprostol. Methods. The women took 200 mg mifepristone under nurse supervision and self-administered 800 lg misoprostol vaginally 36–48 h later at home. All were contacted by phone for follow-up and assessment of bleeding, pain and acceptability. Main outcome measures. Evacuation rate, pain, bleeding, acceptability, influence of distance on treatment. Results. Median gestational age was 50 (range 35– 63) days and 70 (7.1%) of the women lived more than 60 min travel from the clinic. The rate of completed abortion was 93.6% and surgical evacuation was performed in 50 (4.9%) cases. Two women requested treatment on the day of misoprostol use. Moderate to strong pain was experienced by 68.4%, and 74.7% reported moderate to heavy bleeding. Parous women experienced less pain than nulliparous women (odds ratio 0.27; 95% confidence interval 0.19–0.34). In all, 95.1% of the women were satisfied with staying at home. Travel distance did not influence treatment outcome variables. Conclusions. In our experience, home administration of misoprostol is an effective and acceptable method for abortion up to 63 days of gestation and women should be eligible for this treatment option regardless of their travel distance from hospital