Objective Recent meta-analyses have shown that loop treatment of the cervix of >10 mm depth may be associated with adverse outcomes in future pregnancies. The aim of this study is to assess the rate of incomplete excision and recurrent disease in relation to depth of excision in women of reproductive age undergoing loop treatment.Design Observational cohort study.Setting Colposcopy Clinic, Northern Gynaecological Oncology Centre, Gateshead, UK.Population In all, 1558 women undergoing loop treatment for high-grade cervical intraepithelial neoplasia (HGCIN) between 1998 and 2003.Methods Women were followed up until 2008. Recurrence was analysed using Kaplan-Meier plots.Outcome measures Incomplete excision rates and recurrence rates. Recurrence was defined as post-treatment disease with highgrade histology. Any dyskaryotic cytology on follow-up was also documented.Results Recurrent high-grade disease on histology was found in 57/1558 (3.7%) women. In women £35 years old, despite a greater rate of incomplete excision at the endocervical margin at loop depths <10 mm compared with ‡10 mm (24.4% versus 13.3%, P < 0.01), the recurrence rate was similar between the two groups (4.3% versus 3.4%, log-rank, P = 0.52). In contrast, a loop depth <10 mm was associated with a higher disease recurrence rate (7.5% versus 3.0%, log-rank, P = 0.05) in women >35 years. ConclusionIn women of reproductive age requiring treatment for HGCIN, colposcopists performing loop excision should aim for <10 mm depth. This provides adequate treatment for HGCIN and minimises the potential risk of adverse outcomes in future pregnancies.

Background:The commencing age of cervical screening in England was raised from 20 to 25 years in 2004. Cervical cancer incidence in young women of England is increasing. It is not clear if this is due to either greater exposure to population risk factors or reduced cervical screening.Methods:We measured if the relative risk of cervical cancer in younger women (20–29 years) of the north-east of England (NE) differed to that of women aged 30yrs and above since 2004. We also measured average annual percentage change (AAPC) in the 3 yr moving average incidence for all age-groups. Regional screening coverage rate and population risk factors were reviewed. Comparisons were made with Wales where screening continues to commence from the age of 20 yrs.Results:Cervical cancer incidence in women aged 20–29 increased annually by an average of 10.3% between 2000 and 2009. The rise in women aged 30–39 was less steep (3.5%/year) but no significant rise was observed in women aged 40–49. Socioeconomic factors remained stable or improved during the time period except for the incidence of chlamydia, herpes simplex and in particular, genital warts, which increased significantly in young women. Data from Wales show similar results.Conclusion:The incidence of cervical cancers in young women of the NE is increasing. The rise in incidence is unrelated to the change in screening policy in 2004. Close monitoring of incidence in young women and a greater attempt to reverse the current decline in screening coverage of women aged 25–29 years are recommended.

Reporting rates for glandular neoplasia in 464,754 cervical samples reported at six laboratories in 12-month periods before and after the implementation of Surepath™ LBC processing are compared. The introduction of LBC processing is seen to have resulted in a significant (P = 0.001) increase in the detection rate for endocervical glandular neoplasia (from 2.2 per 10,000 tests to 3.9 per 10,000) while maintaining high levels of reporting specificity. An observed fall in the number of samples reported as showing borderline glandular neoplasia falls short of statistical significance, and the reporting of possible endometrial and 'other' glandular abnormalities appears to be unaffected. The underlying reasons for the observed improvement in detection of endocervical glandular neoplasia are discussed.

How can multi-stakeholder dialogue help assess and address the roots of environmental resource competition and conflict? This article summarises the outcomes and lessons from action research in large lake systems in Uganda, Zambia, and Cambodia. Dialogues linking community groups, NGOs and government agencies have reduced local conflict, produced agreements with private investors, and influenced government priorities in ways that respond to the needs of marginalised fishing communities. The article details policy guidance in four areas: building stakeholder commitment, understanding the institutional and governance context, involving local groups in the policy reform process, and embracing adaptability in programme implementation.

Rural development or natural resource management program planning and implementation frequently confront challenges of environmental resource competition and conflict, particularly where common pool resources are a major component of rural livelihoods. This paper reports on an approach to multistakeholder dialogue, supported by participatory action research, to address the roots of such competition and conflict. The approach, called "Collaborating for Resilience," includes principles and guidance on building a shared understanding of risks and opportunities, weighing alternative actions, developing action plans, and evaluating and learning from the outcomes. Working in partnership with government, community and civil society actors, the approach was developed and refined through applications in large lake systems in Uganda, Zambia, and Cambodia. This paper presents a synthesis of lessons addressing practitioners in government, non-governmental development organizations, and international development agencies. These lessons include guidance on the context of multistakeholder dialogue processes, addressing gender equity, building stakeholder relationships and accountability across scales, and encouraging learning and innovation over time.Keywords: Cooperation, dialogue, governance, natural resource management, participation, resource conflict Acknowledgments: We would like to thank the wide range of partners, community organizations and agencies who took part in the Strengthening Aquatic Resource Governance project, the source of the insights and lessons summarized in this paper. For a full list of these partners in Zambia, Uganda, and Cambodia, please see the three case study reports referenced in the text. Thanks also to three anonymous reviewers for critical feedback on this paper, and to