***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background High prevalence rates of Chlamydia trachomatis ( CT ) and Neisseria gonorrhoeae ( NG ) have been reported in Aboriginal people in remote and regional areas of Australia for well over two decades , and repeat positivity rates are high . To interrupt disease transmission and reduce the risk of complications , early diagnosis and treatment is important . However in many remote and regional areas there are long delays between testing for these curable sexually transmissible infections and providing treatment , due to both physical distance from laboratories and difficulties when recalling patients for subsequent management once results are available . Point-of-care ( POC ) tests have the potential to provide more timely diagnosis , to increase treatment and contact tracing , and in turn reduce CT and NG infection rates . Methods / design TTANGO ( Test , Treat , ANd GO ) is a cross-over cluster r and omised controlled trial in 12 regional or remote Australian health services , which predominantly provide clinical services to Aboriginal people . The overall aim of TTANGO is to measure the clinical effectiveness , cost-effectiveness and cultural and operational acceptability of  molecular POC testing for CT and NG infection . The primary outcome is repeat positivity at three months after treatment of an initial CT or NG infection . Participating health services will undertake the clinical management of CT and NG under two different modalities for one year each . In the first year , six health services will be r and omly assigned to manage these infections under current diagnostic guidelines . The other six will supplement current diagnostic guidelines with POC testing , whereby diagnosis is made and subsequent treatment for those with positive POC tests is offered at the initial consultation . In the second year , the health services will cross over to the opposite management modality . TTANGO will be conducted over four years ; 1.5 years of trial initiation and community consultation , 2 years of trial conditions and evaluation , and 6 months of data analysis and feedback . Discussion TTANGO is the first cluster r and omised trial of POC testing for CT and NG internationally . The results of this trial will provide crucial information to guide sexual health clinical practice in remote Aboriginal communities and other high prevalence setting s . Trial registration Australian and New Zeal and Clinical Trials Registry Objective To evaluate the effectiveness of register based , yearly chlamydia screening . Design Controlled trial with r and omised stepped wedge implementation in three blocks . Setting Three regions of the Netherl and s : Amsterdam , Rotterdam , and South Limburg . Participants 317 304 women and men aged 16 - 29 years listed on municipal registers at start of trial . Intervention From March 2008 to February 2011 , the Chlamydia Screening Implementation programme offered yearly chlamydia screening tests . Postal invitations asked people to use an internet site to request a kit for self collection of sample s , which would then be sent to regional laboratories for testing . Treatment and partner notification were done by the general practitioner or at a sexually transmitted infection clinic . Main outcome measures Primary outcomes were the percentage of chlamydia tests positive ( positivity ) , percentage of invitees returning a specimen ( uptake ) , and estimated chlamydia prevalence . Secondary outcomes were positivity according to sex , age , region , and sociodemographic factors ; adherence to screening invitations ; and incidence of self reported pelvic inflammatory disease . Results The participation rate was 16.1 % ( 43 358/269 273 ) after the first invitation , 10.8 % after the second , and 9.5 % after the third , compared with 13.0 % ( 6223/48 031 ) in the control block invited at the end of round two of the intervention . Chlamydia positivity in the intervention blocks at the first invitation was the same as in the control block ( 4.3 % ) and 0.2 % lower at the third invitation ( odds ratio 0.96 ( 95 % confidence interval 0.83 to 1.10 ) ) . No substantial decreases in positivity were seen after three screening rounds in any region or sociodemographic group . Among the people who participated three times ( 2.8 % of all invitees ) , positivity fell from 5.9 % to 2.9 % ( odds ratio 0.49 ( 0.47 to 0.50 ) ) . Conclusions There was no statistical evidence of an impact on chlamydia positivity rates or estimated population prevalence from the Chlamydia Screening Implementation programme after three years at the participation levels obtained . The current evidence does not support a national roll out of this register based chlamydia screening programme . Trial registration NTR 3071 ( Netherl and s Trial Register , www.trialregister.nl ) Abstract Background High blood pressure in patients with stroke increases the risk of recurrence but management in the community is often inadequate . Home blood pressure monitoring may increase patients ' involvement in their care , increase compliance , and reduce the need for patients to attend their General Practitioner if blood pressure is adequately controlled . However the value of home monitoring to improve blood pressure control is unclear . In particular its use has not been evaluated in stroke patients in whom neurological and cognitive ability may present unique challenges . Design Community based r and omised trial with follow up after 12 months . Participants : 360 patients admitted to three South London Stroke units with stroke or transient ischaemic attack within the past 9 months will be recruited from the wards or out patients and r and omly allocated into two groups . All patients will be visited by the specialist nurse at home at baseline when she will measure their blood pressure and administer a question naire . These procedures will be repeated at 12 months follow up by another research er blind as to whether the patient is in intervention or control group . Intervention : Intervention patients will be given a vali date d home blood pressure monitor and support from the specialist nurse . Control patients will continue with usual care ( blood pressure monitoring by their practice ) . Main outcome measures in both groups after 12 months : 1 . Change in systolic blood pressure.2 . Cost effectiveness : Incremental cost of the intervention to the National Health Service and incremental cost per quality adjusted life year gained . Trial registration Clinical Trials.gov registration OBJECTIVE The objective of the study was to estimate whether midpregnancy genitourinary tract infection with Chlamydia trachomatis is associated with an increased risk of subsequent preterm delivery . STUDY DESIGN Infection with C. trachomatis was determined using a ligase chain reaction assay ( performed in batch after delivery ) of voided urine sample s collected at the r and omization visit ( 16(0/7 ) to 23(6/7 ) weeks ' gestation ) and the follow-up visit ( 24(0/7 ) to 29(6/7 ) weeks ) among 2470 gravide women with bacterial vaginosis or Trichomonas vaginalis infection enrolled in 2 multicenter r and omized antibiotic treatment trials ( metronidazole versus . placebo )  . RESULTS The overall prevalence of genitourinary tract C. trachomatis infection at both visits was 10 % . Preterm delivery less than 37 weeks ' or less than 35 weeks ' gestational age was not associated with the presence or absence of C. trachomatis infection at either the r and omization ( less than 37 weeks : 14 % versus 13 % , P=.58 ; less than 35 weeks : 6.4 % versus 5.5 % , P=.55 ) or the follow-up visit ( less than 37 weeks : 13 % versus 11 % , P=.33 ; less than 35 weeks : 4.4 % versus 3.7 , P=.62 ) . Treatment with an antibiotic effective against chlamydia infection was not associated with a statistically significant difference in preterm delivery . CONCLUSION In this secondary analysis , midtrimester chlamydia infection was not associated with an increased risk of preterm birth . Treatment of chlamydia was not associated with a decreased frequency of preterm birth The objective of this research was to identify determinants of the magnitude of intracluster correlation coefficients ( ICCs ) in cluster r and omized trials from the field of implementation research . A survey of experts was conducted to generate a priori hypotheses of factors that might affect ICC size . Hypotheses were tested on empirical estimates of ICCs calculated from 21 implementation research data sets , mainly from the UK . Effects of setting ( primary or secondary care ) , type of variable ( process or outcome ) , type of measurement ( objective or subjective ) , prevalence of outcome and size of cluster were tested . In total , 220 ICCs were available ( range 0 to 0.415 ) . Significant differences in ICC magnitude were found . The ICCs were significantly higher for process than for outcome variables , and for secondary care outcomes compared with primary care outcomes . The effects of prevalence and size were less clear cut . There was no evidence to suggest that type of measurement affected ICC size . In conclusion , accurate estimates of ICCs are essential for sample size calculations for cluster r and omized trials of professional behaviour change interventions . This study demonstrates that ICCs are sensitive to a number of trial factors , particularly setting and outcome type . These factors must be considered when planning such cluster r and omized trials OBJECTIVE To determine whether asking general practitioners to offer chlamydia screening at the same time as Pap screening increases chlamydia screening rates . DESIGN A pragmatic cluster r and omised controlled trial . PARTICIPANTS AND SETTING Doctors from 31 general practice s in the Australian Capital Territory performing more than 15 Pap smear screens per year , and all women aged 16 - 39 years attending those practitioners between 1 November 2004 and 31 October 2005 . INTERVENTION Doctors in the intervention practice s were asked to routinely offer combined chlamydia and Pap screening to eligible women ; doctors in the control practice s  were asked to implement screening guidelines based on a risk assessment of the individual patient ( ie , usual practice ) . MAIN OUTCOME MEASURE Chlamydia screening rate per visit . RESULTS There were 26 876 visits by eligible women during the study period : 16 082 to intervention practice s and 10 794 to control practice s.  Chlamydia screening occurred during 6.9 % ( 95 % CI , 6.5%-7.3 % ) of visits to intervention practice s and 4.5 % ( 95 % CI , 4.1%-4.9 % ) of visits to control practice s. After controlling for clustering and potential confounders , there were twofold greater odds of chlamydia screening occurring during a visit by an eligible woman to an intervention practice than to a control practice ( adjusted odds ratio , 2.1 [ 95 % CI , 1.3 - 3.4 ] ) . CONCLUSION Combining chlamydia and Pap screening increases the rate of chlamydia screening in general practice . Implementing this approach would require little additional infrastructure support in setting s where a cervical screening program already exists Background Sexual health problems such as unwanted pregnancy and sexually transmitted infection are important public health concerns and there is huge potential for health promotion using digital interventions . Evaluations of digital interventions are increasingly conducted online . Trial administration and data collection online offers many advantages , but concerns remain over fraudulent registration to obtain compensation , the quality of self-reported data , and high attrition . Objective This study addresses the feasibility of several dimensions of online trial design —recruitment , online consent , participant identity verification , r and omization and concealment of allocation , online data collection , data quality , and retention at 3-month follow-up . Methods Young people aged 16 to 20 years and resident in the United Kingdom were recruited to the “ Sexunzipped ” online trial between November 2010 and March 2011 ( n=2036 ) . Participants filled in baseline demographic and sexual health question naires online and were r and omized to the Sexunzipped interactive intervention website or to an information-only control website . Participants were also r and omly allocated to a postal request ( or no request ) for a urine sample for genital chlamydia testing and receipt of a lower ( £ 10/US$16 ) or higher ( £ 20/US$32 ) value shopping voucher compensation for 3-month outcome data . Results The majority of the 2006 valid participants ( 90.98 % , 1825/2006 ) were aged between 18 and 20 years at enrolment , from all four countries in the United Kingdom . Most were white ( 89.98 % , 1805/2006 ) , most were in school or training ( 77.48 % , 1545/1994 ) , and 62.81 % ( 1260/2006 ) of the sample were female . In total , 3.88 % ( 79/2036 ) of registration s appeared to be invalid and another 4.00 % ( 81/2006 ) of participants gave inconsistent responses within the question naire . The higher value compensation ( £ 20/US$32 ) increased response rates by 6 - 10 % , boosting retention at 3 months to 77.2 % ( 166/215 ) for su bmi ssion of online self-reported sexual health outcomes and 47.4 % ( 118/249 ) for return of chlamydia urine sample s by post . Conclusions It was quick and efficient to recruit young people to this online trial . Our procedures for obtaining online consent , verifying participant identity , automated r and omization , and concealment of allocation worked well . The optimal response rate for the online sexual health outcome measurement was comparable to face-to-face trials . Multiple methods of participant contact , requesting online data only , and higher value compensation increased trial retention at 3-month follow-up . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 55651027 ; http://www.controlled-trials.com/IS RCT N55651027 ( Arch 
    Output:
    
There is moderate quality evidence that detection and treatment of chlamydia infection can reduce the risk of PID in women at individual level .
There is an absence of RCT evidence about the effects of chlamydia screening in pregnancy .