Atuação da enfermeira eleva o controle de hipertensos e diminui o efeito do avental branco

Realizou-se estudo comparativo randomizado para avaliar o controle de hipertensos, com uso da medida residencial da pressão arterial (MRPA) e medida casual, bem como para analisar o efeito do avental branco. Hipertensos atendidos em unidades básicas de saúde foram divididos aleatoriamente em: grupo I, participante das atividades educativas, e grupo II, que seguiu a rotina de atendimento. Os hipertensos do grupo I realizaram MRPA no início e final do estudo. Efeito do avental branco foi avaliado pela diferença entre a medida casual e MRPA. Foram incluídos 290 hipertensos, porém realizaram MRPA 82 hipertensos. Houve aumento no controle da pressão do início ao final do estudo nos hipertensos do grupo I (p < 0,05) avaliado pela MRPA (60% para 68,3%) e pela medida casual (62% para 71%); no grupo II o controle foi maior na MRPA do que na medida casual (63% vs 50%). O efeito do avental branco foi maior no grupo II.

Dental caries associated factors in 12 year-old schoolchildren from a municipality in the state of São Paulo, Brazil

Objective To analyze the possible association between dental caries, fluorosis and the need for treatment in 12 year-old schoolchildren and the socioeconomic conditions of parents/guardians in the city of Franca, in the state of São Paulo. Methods A random sample of schoolchildren aged 12 was obtained from the school records in Franca, using a systematic random technique. The epidemiological survey was carried out by a single calibrated examiner, on 258 public and private schoolchildren in order to obtain the prevalence of dental caries, the need for treatment and the severity of dental fluorosis. Parents/guardians were also interviewed to assess their socioeconomic conditions (education and per capita income). We used multiple correlation analysis to investigate associations between category variables. Results It was possible to identify two distinct groups, with associations between the variables: the first group, represented by schoolchildren with average prevalence of caries, need for treatment, low level of parental education and income; and a second group represented by schoolchildren with low prevalence of caries, no need for treatment, high parental education and income. The two dimensions explained approximately 35% of total inertia. The factors within each group are related. Conclusion High income and parental education are associated with the low prevalence of dental caries but there is no association with dental fluorosis.

Análisis de la relación que se establece entre las expectativas de padres y profesores de alumnos con necesidades educativas especiales sobre la atención escolar que reciben los hijos/alumnos y el progreso de los mismos

Programa de Doctorado: Formación del Profesorado

El impacto de la injusticia en los hoteles : respuestas del cliente y del empleado como víctimas y testigos de un maltrato

Programa de doctorado: Perspectivas científicas sobre el turismo y la dirección de empresas turísticas.

Study of Italian isolates of Alternaria spp.: molecular and morphological characterization and pathogenesis on apple tree

It was decided to carry out a morphological and molecular characterization of the Italian Alternaria isolatescollected from apple , and evaluate their pathogenicity and subsequently combining the data collected. The strain collection (174 isolates) was constructed by collecting material (received from extension service personnel) between June and August of 2007, 2008, and 2009. A Preliminary bioassays were performed on detached plant materials (fruit and leaf wounded and unwounded), belonging to the Golden cultivar, with two different kind of inoculation (conidial suspension and conidial filtrate). Symptoms were monitored daily and a value of pathogenicity score (P.S.) was assigned on the basis of the diameter of the necrotic area that developed. On the basis of the bioassays, the number of isolates to undergo further molecular analysis was restricted to a representative set of single spore strains (44 strains). Morphological characteristics of the colony and sporulation pattern were determined according to previous systematic work on small-spored Alternaria spp. (Pryor and Michaelides, 2002 and Hong et al., 2006). Reference strains (Alternaria alternata, Alternaria tenuissima, Alternaria arborescens and four Japanese strains of Alternaria alternata mali pathotype), used in the study were kindly provided by Prof. Barry Pryor, who allows a open access to his own fungal collection. Molecular characterization was performed combining and comparing different data sets obtained from distinct molecular approach: 1) investigation of specific loci and 2) fingerprinting based on diverse randomly selected polymorphic sites of the genome. As concern the single locus analysis, it was chosen to sequence the EndoPG partial gene and three anonymous region (OPA1-3, OPA2- and OPa10-2). These markers has revealed a powerful tool in the latter systematic works on small-spored Alternaria spp. In fact, as reported in literature small-spored Alternaria taxonomy is complicated due to the inability to resolve evolutionary relationships among the taxa because of the lack of variability in the markers commonly used in fungi systematic. The three data set together provided the necessary variation to establish the phylogenetic relationships among the Italian isolates of Alternaria spp. On Italian strains these markers showed a variable number of informative sites (ranging from 7 for EndoPg to 85 for OPA1-3) and the parsimony analysis produced different tree topologies all concordant to define A. arborescens as a mophyletic clade. Fingerprinting analysis (nine ISSR primers and eight AFLP primers combination) led to the same result: a monophyleic A. arborescens clade and one clade containing both A. tenuissima and the A. alternata strains. This first attempt to characterize Italian Alternaria species recovered from apple produced concordant results with what was already described in a similar phylogenetic study on pistachio (Pryor and Michaelides, 2002), on walnut and hazelnut (Hong et al., 2006), apple (Kang et al., 2002) and citurus (Peever et al., 2004). Together with these studies, this research demonstrates that the three morphological groups are widely distributed and occupy similar ecological niches. Furthermore, this research suggest that these Alternaria species exhibit a similar infection pattern despite the taxonomic and pathogenic differences. The molecular characterization of the pathogens is a fundamental step to understanding the disease that is spreading in the apple orchards of the north Italy. At the beginning the causal agent was considered as Alteraria alternata (Marshall and Bertagnoll, 2006). Their preliminary studies purposed a pathogenic system related to the synthesis of toxins. Experimental data of our bioassays suggest an analogous hypothesis, considering that symptoms could be induced after inoculating plant material with solely the filtrate from pathogenic strains. Moreover, positive PCR reactions using AM-toxin gene specific primers, designed for identification of apple infecting Alternaria pathovar, led to a hypothesis that a host specific toxin (toxins) were involved. It remains an intriguing challenge to discover or not if the agent of the “Italian disease” is the same of the one previously typified as Alternaria mali, casual agent of the apple blotch disease.

"Tracciature Digitali": la conoscenza nell'era informazionale

La specificità dell'acquisizione di contenuti attraverso le interfacce digitali condanna l'agente epistemico a un'interazione frammentata, insufficiente da un punto di vista computazionale, mnemonico e temporale, rispetto alla mole informazionale oggi accessibile attraverso una qualunque implementazione della relazione uomo-computer, e invalida l'applicabilità del modello standard di conoscenza, come credenza vera e giustificata, sconfessando il concetto di credenza razionalmente fondata, per formare la quale, sarebbe invece richiesto all'agente di poter disporre appunto di risorse concettuali, computazionali e temporali inaccessibili. La conseguenza è che l'agente, vincolato dalle limitazioni ontologiche tipiche dell'interazione con le interfacce culturali, si vede costretto a ripiegare su processi ambigui, arbitrari e spesso più casuali di quanto creda, di selezione e gestione delle informazioni che danno origine a veri e propri ibridi (alla Latour) epistemologici, fatti di sensazioni e output di programmi, credenze non fondate e bit di testimonianze indirette e di tutta una serie di relazioni umano-digitali che danno adito a rifuggire in una dimensione trascendente che trova nel sacro il suo più immediato ambito di attuazione. Tutto ciò premesso, il presente lavoro si occupa di costruire un nuovo paradigma epistemologico di conoscenza proposizionale ottenibile attraverso un'interfaccia digitale di acquisizione di contenuti, fondato sul nuovo concetto di Tracciatura Digitale, definito come un un processo di acquisizione digitale di un insieme di tracce, ossia meta-informazioni di natura testimoniale. Tale dispositivo, una volta riconosciuto come un processo di comunicazione di contenuti, si baserà sulla ricerca e selezione di meta-informazioni, cioè tracce, che consentiranno l'implementazione di approcci derivati dall'analisi decisionale in condizioni di razionalità limitata, approcci che, oltre ad essere quasi mai utilizzati in tale ambito, sono ontologicamente predisposti per una gestione dell'incertezza quale quella riscontrabile nell'istanziazione dell'ibrido informazionale e che, in determinate condizioni, potranno garantire l'agente sulla bontà epistemica del contenuto acquisito.

Ex occulto carpere agmen: la guerriglia antiromana in Britannia e in Giudea

Scopo di questo lavoro è quello di analizzare le componenti tattiche, strategiche e sociali della guerriglia antiromana in Britannia e in Giudea, in un periodo che va dal I secolo a. C. al III secolo d. C., con l'obiettivo di mettere in luce la differente efficacia delle tattiche non ortodosse rispetto a quelle convenzionali; e di analizzare le risposte teoriche ed empiriche concepite dai Romani per affrontare questa forma di lotta. La tesi è stata articolata nel modo seguente: una prima parte analizza gli aspetti tattici, strategici e sociali della guerriglia e della controguerriglia, anche attraverso il metodo comparativo, mettendo cioè a confronto alcuni dei principali testi sulla guerra non convenzionale redatti in epoche e contesti diversi, dai quali si è cercato di delle costanti potenzialmente applicabili a qualsiasi periodo storico e a qualsiasi area geografica. Nella seconda parte si cerca di applicare tali costanti alla realtà storico – sociale dell'impero romano. Particolare attenzione è stata riservata al rapporto tra la mentalità romana, basata sul concetto di bellum iustum, e le tattiche non ortodosse. La terza e la quarta parte analizzano la resistenza antiromana in Britannia e in Giudea, mettendone in luce tutti gli aspetti, in particolare quelli legati alla guerriglia rurale, a quella urbana, al terrorismo, all'evoluzione della guerriglia da guerra per bande a guerra convenzionale e alla controguerriglia. La scelta di queste due province non è casuale. In province così lontane e diverse tra loro, Roma inviò spesso gli stessi generali esperti di controguerriglia. Questo particolare permette di notare la presenza, a Roma, di una grand strategy che, consapevole del fenomeno della guerriglia, ne affidò la repressione agli stessi generali, specialisti della controguerriglia, non esitando a spostarli, in caso di necessità, da un capo all'altro dell'impero.

Abitati rupestri e citta' fortificate nella Sicilia occidentale dai bizantini ai normanni

La ricerca effettuata, analizza in modo razionale ma contestualmente divulgativo, le dinamiche insediative che hanno caratterizzato il paesaggio della Sicilia occidentale dall'occupazione bizantina al dominio da parte dei Normanni ( 535-1194 d.C. circa ). Il volume presenta una chiara raccolta dei documenti e delle fonti letterarie che riguarda gli abitati rurali ed i borghi incastellati della Sicilia occidentale e pone l’interesse sia per la cultura materiale che per la gestione ed organizzazione del territorio. Attraverso i risultati delle attestazioni documentarie, unite alle ricerche archeologiche ( effettuate nel territorio preso in esame sia in passato che nel corso degli ultimi anni ) viene redatto un elenco dei siti archeologici e dei resti monumentali ( aggiornato fino al 2013-14 ) in funzione della tutela, conservazione e valorizzazione del paesaggio. Sulla base dei documenti rinvenuti e delle varie fonti prese in esame ( letterarie, archeologiche, monumentali, toponomastiche ) vengono effettuate alcune considerazioni sull’insediamento sparso, sull’incastellamento, sulle istituzioni e sulla formazione delle civitates. L’indagine svolta, attraverso cui sono stati individuati i documenti e le fonti, comprende anche una parziale ricostruzione topografica dei principali centri abitativi indagati. Per alcune sporadiche strutture medievali, talvolta raffigurate in fortuite stampe del XVI-XVII secolo, è stato possibile, in aggiunta, eseguire un rilievo architettonico. La descrizione degli abitati rurali e dei siti fortificati, infine, è arricchita da una serie di schede in cui vengono evidenziati i siti archeologici, i resti monumentali ed i reperti più interessanti del periodo bizantino, arabo e normanno-svevo della Sicilia occidentale.

Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study

Background: Annual syphilis testing was reintroduced in the Swiss HIV Cohort Study (SHCS) in 2004. We prospectively studied occurrence, risk factors, clinical manifestations, diagnostic approaches and treatment of syphilis. Methods: Over a period of 33 months, participants with positive test results for Treponema pallidum hemagglutination assay were studied using the SHCS database and an additional structured case report form. Results: Of 7244 cohort participants, 909 (12.5%) had positive syphilis serology. Among these, 633 had previously been treated and had no current signs or symptoms of syphilis at time of testing. Of 218 patients with newly detected untreated syphilis, 20% reported genitooral contacts as only risk behavior and 60% were asymptomatic. Newly detected syphilis was more frequent among men who have sex with men (MSM) [adjusted odds ratio (OR) 2.8, P < 0.001], in persons reporting casual sexual partners (adjusted OR 2.8, P < 0.001) and in MSM of younger age (P = 0.05). Only 35% of recommended cerebrospinal fluid (CFS) examinations were performed. Neurosyphilis was diagnosed in four neurologically asymptomatic patients; all of them had a Venereal Disease Research Laboratory (VDRL) titer of 1:≥32. Ninety-one percent of the patients responded to treatment with at least a four-fold decline in VDRL titer. Conclusion: Syphilis remains an important coinfection in the SHCS justifying reintroduction of routine screening. Genitooral contact is a significant way of transmission and young MSM are at high risk for syphilis. Current guidelines to rule out neurosyphilis by CSF analysis are inconsistently followed in clinical practice. Serologic treatment response is above 90% in the era of combination antiretroviral therapy.

Sex Differences in Hookup Behavior: a Replication and Examination of Parent-Child Relationship Quality

In the current research, we assessed the impact of parent-child relationships on attitudes toward, and engagement in, hookup behaviors using a sample of 407 college students. Based on prior research, it was hypothesized that heterosexual participants, especially women, who do not perceive themselves as having a strong, close, positive relationship with their opposite-sex parent would be more likely to engage in or attempt to engage in casual sexual behavior (hookups). Also, men were expected to be more satisfied with, and more in agreement with, hookup behavior than women. The results were partially consistent with the hypotheses. Men were more satisfied with and more in agreement with hookup behavior than women. But, opposite sex parent-child relationship quality only affected men’s agreement with the hookup behavior of their peers. Men with lower relationship quality with their mothers agreed more with the hookup behavior of their peers. These results are discussed in relation to prior research on hooking up and prior research on parent-child relationships.

Sex Differences in Hookup Behavior: A Replication and Examination of Parent-Child Relationship Quality

In the current research, we assessed the impact of parent-child relationships on attitudes toward, and engagement in, hookup behaviors using a sample of 407 college students. Based on prior research, it was hypothesized that heterosexual participants, especially women, who do not perceive themselves as having a strong, close, positive relationship with their opposite-sex parent would be more likely to engage in or attempt to engage in casual sexual behavior (hookups). Also, men were expected to be more satisfied with, and more in agreement with, hookup behavior than women. The results were partially consistent with the hypotheses. Men were more satisfied with and more in agreement with hookup behavior than women. But, opposite sex parent-child relationship quality only affected men’s agreement with the hookup behavior of their peers. Men with lower relationship quality with their mothers agreed more with the hookup behavior of their peers. These results are discussed in relation to prior research on hooking up and prior research on parent-child relationships.

Relationships Past and Present: Examining the Impact of One's Relationship with His/her Opposite-sex Parent on His/her Attitudes Toward and Engagement in Hookup Culture

Hooking up has become a common and public practice on university campuses across the country. While much research has determined who is doing it, with whom they are doing it, and what they are hoping to get out of it, little work has been done to determine what personal factors motivate students to participate in the culture. A total of 407 current students were surveyed to assess the impact of one’s relationship with his/her opposite-sex parent on his/her attitudestoward and engagement in hookup culture on campus. Scores were assigned to the participants to divide them into categories of high and low attachment with their parent. It was hypothesizedthat heterosexual students who do not perceive themselves as having a strong, close, positive relationship with their opposite-sex parent would be more likely to engage in or attempt to engage in casual sexual behavior. This pattern was expected to be strongest for women on campus. Men and women differed in their reasons for hooking up, with whom they hook up, to what they attribute the behaviors of their peers, and what they hope to gain from their sexual interactions. Effects of parent-child relationships were significant only for women who reported hooking up because “others are doing it,” men’s agreement with the behavior of their peers, and women’s overall satisfaction with their hookups. Developmental, social, and evolutionary perspectives are employed to explain the results. University status was determined to be most telling of the extent to which a student is engaged in hookup culture.

Evaluation of flood risk in response to climate variability

Standard procedures for forecasting flood risk (Bulletin 17B) assume annual maximum flood (AMF) series are stationary, meaning the distribution of flood flows is not significantly affected by climatic trends/cycles, or anthropogenic activities within the watershed. Historical flood events are therefore considered representative of future flood occurrences, and the risk associated with a given flood magnitude is modeled as constant over time. However, in light of increasing evidence to the contrary, this assumption should be reconsidered, especially as the existence of nonstationarity in AMF series can have significant impacts on planning and management of water resources and relevant infrastructure. Research presented in this thesis quantifies the degree of nonstationarity evident in AMF series for unimpaired watersheds throughout the contiguous U.S., identifies meteorological, climatic, and anthropogenic causes of this nonstationarity, and proposes an extension of the Bulletin 17B methodology which yields forecasts of flood risk that reflect climatic influences on flood magnitude. To appropriately forecast flood risk, it is necessary to consider the driving causes of nonstationarity in AMF series. Herein, large-scale climate patterns—including El Niño-Southern Oscillation (ENSO), Pacific Decadal Oscillation (PDO), North Atlantic Oscillation (NAO), and Atlantic Multidecadal Oscillation (AMO)—are identified as influencing factors on flood magnitude at numerous stations across the U.S. Strong relationships between flood magnitude and associated precipitation series were also observed for the majority of sites analyzed in the Upper Midwest and Northeastern regions of the U.S. Although relationships between flood magnitude and associated temperature series are not apparent, results do indicate that temperature is highly correlated with the timing of flood peaks. Despite consideration of watersheds classified as unimpaired, analyses also suggest that identified change-points in AMF series are due to dam construction, and other types of regulation and diversion. Although not explored herein, trends in AMF series are also likely to be partially explained by changes in land use and land cover over time. Results obtained herein suggest that improved forecasts of flood risk may be obtained using a simple modification of the Bulletin 17B framework, wherein the mean and standard deviation of the log-transformed flows are modeled as functions of climate indices associated with oceanic-atmospheric patterns (e.g. AMO, ENSO, NAO, and PDO) with lead times between 3 and 9 months. Herein, one-year ahead forecasts of the mean and standard deviation, and subsequently flood risk, are obtained by applying site specific multivariate regression models, which reflect the phase and intensity of a given climate pattern, as well as possible impacts of coupling of the climate cycles. These forecasts of flood risk are compared with forecasts derived using the existing Bulletin 17B model; large differences in the one-year ahead forecasts are observed in some locations. The increased knowledge of the inherent structure of AMF series and an improved understanding of physical and/or climatic causes of nonstationarity gained from this research should serve as insight for the formulation of a physical-casual based statistical model, incorporating both climatic variations and human impacts, for flood risk over longer planning horizons (e.g., 10-, 50, 100-years) necessary for water resources design, planning, and management.

WATER ACCESS AND MAINTENANCE IN KARONGA, MALAWI

This report is a case study of how Mwangalala community accesses water and how that access is maintained. Mwangalala community is located in the northern tip of Karonga district in Malawi, Africa. The case study evaluates how close the community is to meeting target 10 of the Millennium Development Goals, sustainable access to safe drinking water, and evaluates the current water system through Human Centered Design’s criteria of desirability, feasibility, and viability. It also makes recommendations to improve water security in Mwangalala community. Data was collected through two years of immersive observation, interviews with 30 families, and observing two wells on three separate occasions. The 30 interviews provided a sample size of over 10% of the community’s population. Participants were initially self-selected and then invited to participate in the research. I walked along community pathways and accepted invitations to join casual conversations in family compounds. After conversing I asked the family members if they would be willing to participate in my research by talking with me about water. Data collected from the interviews and the observations of two wells were compared and analyzed for common themes. Shallow wells or open wells represented the primary water source for 93% of interview participants. Boreholes were also present in the community, but produced unpalatable water due to high concentrations of dissolved iron and were not used as primary water sources. During observations 75% of community members who used the shallow well, primarily used for consumptive uses like cooking or dinking, were females. Boreholes were primarily used for non-consumptive uses such as watering crops or bathing and 77% of the users were male. Shallow wells could remain in disrepair for two months because the repairman was a volunteer, who was not compensated for the skilled labor required to repair the wells. Community members thought the maintenance fee went towards his salary, so did not compensate the repairman when he performed work. This miscommunication provided no incentive for the repairman to make well repairs a priority, and left community members frustrated with untimely repairs. Shallow wells with functional pumps failed to provide water when the water table levels drop during dry season, forcing community members to seek secondary or tertiary water sources. Open wells, converted from shallow wells after community members did not pay for repairs to the pump, represented 44% of the wells originally installed with Mark V hand pumps. These wells whose pumps were not repaired were located in fields and one beside a church. The functional wells were all located on school grounds or in family compounds, where responsibility for the well’s maintenance is clearly defined. Mwangalala community fails to meet Millennium Development goals because the wells used by the community do not provide sustainable access to safe drinking water. Open wells, used by half the participants in the study, lack a top covering to prevent contamination from debris and wildlife. Shallow well repair times are unsustainable, taking longer than two weeks to be repaired, primarily because the repair persons are expected to provide skilled labor to repair the wells without compensation. Improving water security for Mwangalala can be achieved by improving repair times on shallow wells and making water from boreholes palatable. There are no incentives for a volunteer repair person to fix wells in a timely manner. Repair times can be improved by reducing the number of wells a repair person is responsible for and compensating the person for the skilled labor provided. Water security would be further improved by removing iron particulates from borehole water, thus rendering it palatable. This is possible through point of use filtration utilizing ceramic candles; this would make pumped water available year-round.

Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling

BACKGROUND Partner notification is essential to the comprehensive case management of sexually transmitted infections. Systematic reviews and mathematical modelling can be used to synthesise information about the effects of new interventions to enhance the outcomes of partner notification. OBJECTIVE To study the effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections (STIs). DESIGN Secondary data analysis of clinical audit data; systematic reviews of randomised controlled trials (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) published from 1 January 1966 to 31 August 2012 and of studies of health-related quality of life (HRQL) [MEDLINE, EMBASE, ISI Web of Knowledge, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA)] published from 1 January 1980 to 31 December 2011; static models of clinical effectiveness and cost-effectiveness; and dynamic modelling studies to improve parameter estimation and examine effectiveness. SETTING General population and genitourinary medicine clinic attenders. PARTICIPANTS Heterosexual women and men. INTERVENTIONS Traditional partner notification by patient or provider referral, and new partner notification by expedited partner therapy (EPT) or its UK equivalent, accelerated partner therapy (APT). MAIN OUTCOME MEASURES Population prevalence; index case reinfection; and partners treated per index case. RESULTS Enhanced partner therapy reduced reinfection in index cases with curable STIs more than simple patient referral [risk ratio (RR) 0.71; 95% confidence interval (CI) 0.56 to 0.89]. There are no randomised trials of APT. The median number of partners treated for chlamydia per index case in UK clinics was 0.60. The number of partners needed to treat to interrupt transmission of chlamydia was lower for casual than for regular partners. In dynamic model simulations, > 10% of partners are chlamydia positive with look-back periods of up to 18 months. In the presence of a chlamydia screening programme that reduces population prevalence, treatment of current partners achieves most of the additional reduction in prevalence attributable to partner notification. Dynamic model simulations show that cotesting and treatment for chlamydia and gonorrhoea reduce the prevalence of both STIs. APT has a limited additional effect on prevalence but reduces the rate of index case reinfection. Published quality-adjusted life-year (QALY) weights were of insufficient quality to be used in a cost-effectiveness study of partner notification in this project. Using an intermediate outcome of cost per infection diagnosed, doubling the efficacy of partner notification from 0.4 to 0.8 partners treated per index case was more cost-effective than increasing chlamydia screening coverage. CONCLUSIONS There is evidence to support the improved clinical effectiveness of EPT in reducing index case reinfection. In a general heterosexual population, partner notification identifies new infected cases but the impact on chlamydia prevalence is limited. Partner notification to notify casual partners might have a greater impact than for regular partners in genitourinary clinic populations. Recommendations for future research are (1) to conduct randomised controlled trials using biological outcomes of the effectiveness of APT and of methods to increase testing for human immunodeficiency virus (HIV) and STIs after APT; (2) collection of HRQL data should be a priority to determine QALYs associated with the sequelae of curable STIs; and (3) standardised parameter sets for curable STIs should be developed for mathematical models of STI transmission that are used for policy-making. FUNDING The National Institute for Health Research Health Technology Assessment programme.