The exponential power (EP) distribution is a very important distribution that was used by survival analysis and related with asymmetrical EP distribution. Many researchers have discussed statistical inference about the parameters in EP distribution using i.i.d random samples. However, sometimes available data might contain only record values, or it is more convenient for researchers to collect record values. We aim to resolve this problem. We estimated two parameters of the EP distribution by MLE using upper record values. According to simulation study, we used the Bias and MSE of the estimators for studying the efficiency of the proposed estimation method. Then, we discussed the prediction on the next upper record value by known upper record values. The study concluded that MLEs of EP distribution parameters by upper record values has satisfactory performance. Also, prediction of the next upper record value performed well

Abstract Purpose: In Sweden, the authorities have long realized that increasing cycling would give the community huge profits from an environmental perspective. About one third of the Swedish population is inactive during the day. Inactivity costs society annually six billion SEK. Single statistics states that around 30 people are killed in bicycle accidents every year. In addition, an average of 350 cyclists are seriously injured. Many of these accidents are related to the cycling paths physical design. The average cycling path distance per person has decreased by 20% over the past 20 years. The aim of the project is to provide suggestions for improvements in physical design on the cycle paths in order to increase safety and accessibility that lead to increased cycling. Method: The work begins with literature studies and document analysis to gain an insight into what has been found in previous research on this subject. In order to be able to deepen more on the subject and to investigate what officials in the Municipality of Linköping have to say about problems with cycle paths, three interviews were made with officials who work with cycling issues. Result: Generally, cycling routes in Linköping municipality and Sweden maintain good quality, but there is much to be done to improve. The municipality is working actively to address problems that arise on the roads, but the accident statistics will remain unchanged. The interviewees believe that knowledge about the design of cycle paths affects accident statistics. Also, the implementation of what they actually know about road design does not always work That is, Sweden needs to invest more resources on the cycling network and make use of the knowledge that Denmark and the Netherlands have. Implications: There are countries that have developed further in the cycling network than Linköping, such as Denmark and the Netherlands. Linköping and other cities in Sweden can benfit from their knowledge and experience. In order to achieve the set goals, of course, a larger investment of capital must be made on the infrastructure, focusing on cycling in order to make cycling more accessible and safe. Research must focus more on detailed solutions of traffic elements. The authors of this project recommend traffic planners to collaborate with other traffic planners in other municipalities in Sweden as well as municipalities from other countries to drive development faster. Another recommendation from the authors is to create an organization that is only responsible for the walking and cycling routes just like what the Netherlands has done. In addition, cycling must be prioritized more in traffic planning than it is today. Limitations: There are many factors that affect the use of bicycles, but the project has only considered had the physical design as an area of ​​investigation. Furthermore, due to lack of time, the work has only chosen to compare Linköping municipality with cities in Denmark and the Netherlands. Keywords: Safety, Accessibility, Cycle Routes, Bike Accidents, Criminal Record. / Sammanfattning Syfte: I Sverige har myndigheterna sedan lång tid tillbaka insett att ökat cyklande skulle ge samhället stora vinster ur ett miljöperspektiv. Ungefär en tredjedel av den svenska befolkningen är inaktiva under dagen. Inaktivitet kostar samhället årligen sex miljarder. Enlig statistiken har cirka 30 personer omkommit i cykelolyckor årligen under 2000-talet i Sverige. Dessutom skadas i genomsnitt 350 cyklister allvarligt. Många av dessa olyckor är relaterade till cykelvägarnas fysiska utformning. Den genomsnittliga cykelsträckan per person har minskat med hela 20 % under de senaste 20 åren. Målet med arbetet är att ge förslag på förbättringar i den fysiska utformningen på cykelvägarna i syfte att öka säkerheten och framkomligheten som leder till ökad cykelanvändning. Metod: Arbetet inledes med litteraturstudie och dokumentanalys för att få en inblick i vad som har framkommit i tidigare forskning i ämnet. För att kunna fördjupa sig mer i ämnet utfördes tre intervjuer med personer som är ansvariga för cykelfrågor i Linköpings kommun för att ta reda på vilka problem de har på cykelvägarna. Resultat: Generellt håller cykelvägar i Linköpings kommun och Sverige bra kvalité men det finns fortfarande mycket att förbättra. Kommunen arbetar aktivt med att åtgärda problem som uppstår på vägarna men olycksstatistiken blir oförändrad. De intervjuade personerna menar att det behövs mer kunskap om hur utformningen av cykelvägar påverkar olycksfallsstatistiken eller att implementeringen av det de faktiskt vet om utformning inte funkar. Sverige behöver satsa mer resurser på cykelnätet och utnyttja kunskaperna som Danmark och Holland har. Konsekvenser: Det finns städer som har kommit längre i utvecklingen av cykelnätet än Linköping exempelvis Köpenhamn och Amsterdam. Linköping och andra städer i Sverige kan ta del av deras kunskaper och erfarenheter. För att uppnå de uppsatta målen måste naturligtvis en större satsning av kapital göras på infrastrukturen med fokus på cyklandet i syfte att göra cyklingen mer attraktiv och säker. Forskning måste fokuseras mer på detaljerande lösningar av trafikelement. Författarna rekommenderar att trafikplanerare samarbetar med andra trafikplanerare i andra kommuner i Sverige samt även kommuner från andra länder för att driva utvecklingen snabbare. En annan rekommendation från författarna är att skapa en organisation som ansvarar endast för gång- och cykelvägarna som Holland har gjort. Dessutom måste cykeln prioriteras mer i trafikplaneringen än vad det görs idag Begränsningar Det finns många faktorer som påverkar cykelanvändningen men arbetet har endast haft den fysiska utformningen som undersökningsområde. Vidare har arbetet på grund av tidsbrist endast valt att jämföra Linköpings kommun med städer i Danmark och Holland. Nyckelord: Säkerhet, framkomlighet, cykelvägar, cykelolyckor, stradaregistret.

With widespread use of the Internet, data is often shared between organizations in B2B health care networks. Integrating data across all sources in a health care network would be useful to public health surveillance and provide a complete view of how the overall network is performing. Because of the lack of standardization for a common data model across organizations, matching identities between different locations in order to link and aggregate records is difficult. Moreover, privacy legislation controls the use of personal information, and health care data is very sensitive in nature so the protection of data privacy and prevention of personal health information leaks is more important than ever. Throughout the process of integrating data sets from different organizations, consent (explicitly or implicitly) and/or permission to use must be in place, data sets must be de-identified, and identity must be protected. Furthermore, one must ensure that combining data sets from different data sources into a single consolidated data set does not create data that may be potentially re-identified even when only summary data records are created. In this thesis, we propose new privacy preserving data integration protocols for public health surveillance, identify a set of privacy preserving data integration patterns, and propose a supporting framework that combines a methodology and architecture with which to implement these protocols in practice. Our work is validated with two real world case studies that were developed in partnership with two different public health surveillance organizations.

The objective of the thesis was to evaluate the quality of diabetes care in the Canadian Forces by determining the extent to which physicians adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines. In addition, the effect of patient age, sex, rank and size of base on quality of care was assessed and the accuracy of a diagnosis of diabetes in an extract of the electronic medical record (EMR) was evaluated. Fourteen bases within the Canadian Forces were selected for investigation, representing roughly half of the Canadian Forces population. Cases of diabetes were ascertained based on laboratory criteria following a chart review. Twenty-one CDA guideline recommendations were considered. The Canadian Forces demonstrated greater than 75% adherence with each of 9 recommendations, 50-75% adherence with each of 7 recommendations and less than 50% adherence with each of 5 recommendations. The overall adherence with all applicable recommendations per patient was 60.3% (SE 0.66). Age, sex, rank and size of base were not important factors influencing guideline adherence. The sensitivity of a diabetes diagnosis in an extract of the EMR was 84.5%, the specificity was 99.8%, the positive predictive value was 85.1% and the negative predictive value was 99.8%. This is similar to the performance of provincial and national diabetes registries. The quality of diabetes care in the Canadian Forces compared favourably with that of the civilian population within Canada and internationally. The creation of a diabetes registry is expected to lead to further improvements in diabetes care.

Electronic data has become the standard method of storing information in our modern age. Evolving from paper-based data to electronic data creates opportunities to share information between organizations in record speeds, especially when handling large data sets. However, sharing sensitive information creates requirements for electronic data exchange: privacy requires that the original data will not be revealed to unauthorized parties. In the healthcare sector in particular, there are two important use cases that require exchanging information in a privacy-preserving way. 1. Contract research organizations (CROs) need to verify the eligibility of a participant in a phase 1 clinical trial. One criterion is checking that an individual is not concurrently enrolled in a trial at another CRO. However, privacy laws and the maintenance of a private list of participants for competitive purposes prevent CROs from checking against that criterion. 2. A patient’s medical record is usually distributed amongst several healthcare organizations. To improve healthcare services, it is important to have a patient’s complete medical history: either to help diagnose an illness or to gather statistics for better disease control. However, patient medical files need to be confidential. Two healthcare organizations cannot link their large patient databases by disclosing identity revealing details (e.g., names or health card numbers). This thesis presents the development and evaluation of protocols capable of querying and linking datasets in a privacy-preserving manner: TRACK for checking concurrent enrolment in phase 1 clinical trials, and SHARE for linking two large datasets in terms of millions of (patient medical) records. These protocols are better than existing approaches in terms of the privacy protection level they offer (e.g., against dictionary and frequency attacks), of the reliance on trusted third parties, and of performance when performing blocking. These protocols were extensively validated in simulated scenarios similar to their real-world counterparts. The thesis presents novel identity representation schemes that offer strong privacy measures while being efficient for very large databases. These schemes may be used by other researchers to represent identity in different use cases. CROs may implement the protocols (and especially TRACK) in systems to check if an individual exists in another CRO’s dataset without revealing the identity of that individual. Two healthcare organizations may use a system based on this research (and especially the SHARE protocol) to discover their common patients while protecting the identities of the other patients.

The thesis deals with the issues of record keeping of the municipal property with regard to their development. The main goal is an identification of obtaining information resources for property passportization from time and financial point of view. The property passportization is defined as multifunctional record keeping and the thesis contains a proposal based on experience (for real estate -- on the basis of real situation in municipalities). The draft of the evidential card is created in Microsoft Excel.

Orientador: Altair A. Del Bel Cury / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-07-24T00:30:08Z (GMT). No. of bitstreams: 1 Zuim_PauloRenatoJunqueira_D.pdf: 6108175 bytes, checksum: 409aa3be25670ffc4a218d07a70122b8 (MD5) Previous issue date: 1998 / Resumo: O estudo dos movimentos mandibulares e a determinação da trajetória condilar sagital, durante o movimento de protrusão, têm sido observado em diversos trabalhos da literatura odontológica, cujos resultados demonstraram grande variação. O objetivo deste trabalho foi verificar a relação entre os diferentes métodos propostos para o registro e ajuste da TSCM, empregando, no método Intra-Oral, um articulador do tipo "arcon" (Gnatus 8600) e outro "não-arcon" (Dentatus ARL), verificando também as diferenças nos ângulos obtidos entre estes dois tipos e articuladores, ajustados por um mesmo registro. Os resultados médios obtidos para o método Intra-Oral com articulador "arcon" - Grupo 1 foram: 40,61°, e 40,06°; com articulador "não-arcon" - Grupo 2: de 40,77°, e 43,33°; no método Extra-Oral - Grupo 3: de 45,43°, e 43,37°; no método Radiográfico - Grupo 4: de 53,01°, e 51,97°, para os lados direito e esquerdo respectivamente. Foi observada correlação positiva, para ambos os lados, somente entre os dados do método Intra-Oral (Grupos 1 e 2). Não houve diferenças significantes entre os dados obtidos empregando-se articuladores "arcon" (Grupo 1) e "não-arcon" (Grupo 2) (p>0,05). Pode-se concluir, nas condições experimentais empregadas, que os métodos Radiográfico e Extra-Oral não devem ser utilizados para o ajuste dos articuladores, e ainda que não houve diferenças para o ajuste da TSCM entre os dois tipos de articuladores empregados / Abstract: The study of the mandibular movements and the determination of the condylar sagital pathway during the protrusion movement have been carried out in dental literature and the results obtained demonstrated great variation and controversy among the authors. The purpose of this study is to verify the relationship between the different methods proposed for the registration and adjustment of the condylar pathway using an "arcon" (Gnatus 8600) and a "non-arcon" type (Dentatus ARL), verifying the angle differences obtained, using the same registration. The medium data obtained were, in the Intra-Oral method with the "arcon" type (Group 1), 40,61° to the right side and 40,06° to the left side; with the "non-arcon" type (Group 2), 40,77° to the right side and 43,33° to the left; in the Extra-Oral method (Group 3), 45,43° to the right and 43,37° to the left; in the Radiographic method (Group 4), 53,01° to the right the side and 51,97° to the left. There was correlation (for both sides) between data ofthe Intra-Oral method (Groups 1 and 2). There were no significant differences between the articulators employed (p>0,05). Under these experimental conditions it could be concluded that the Extra-Oral and Radiographic methods should not be used for the adjustment of the articulators without presenting differences related to the Intra-Oral ones / Doutorado / Doutor em Clínica Odontológica

This study has been based on a qualitative approach where the focus has, primarily, been on increasing the understanding of the phenomenon of recruitment of individuals who are included and registered in criminal records. The purpose of the study was to investigate the opinions and perceptions of individuals with criminal backgrounds among persons working in recruitment. To answer the purpose, three questions were formulated: What perspectives do employers and recruiters have about people with a criminal background? What do they think about hiring people with a criminal background? How can this be linked to the labelling theory and the stigmatization theory? The usage of empirical data was collected through qualitative interviews with recruiters and employers, the data was further complemented by a questionnaire that was also addressed to recruiters and employers. Thematic analysis was then used to analyze the collected data. In the study, the collected empirical data is linked to two different theoretical points of departure: Goffman's stigmatization theory and Becker's labelling theory. The stigmatization theory and the labelling theory are used to identify recruiters' perspectives on people with criminal backgrounds, and to investigate how recruiters approach hiring people who have committed crimes. The stigmatization theory helped to clarify if and how recruiters relate to character stigmatized criminals. The labelling theory was used to understand how recruiters categorizes and uses "stamps" on job seekers based on their criminal acts. The study has shown that there appear to be varying perceptions and prejudices about people with criminal background among recruiters. A vast majority of the respondents had at some point requested an extraction of previous criminal records from their job seekers. The study has also shown that recruiters can be open and positive about hiring people who have committed crimes, at least when it comes to less serious crimes. Whether a recruiter is positive or negative about hiring a person with a criminal background seems often to be dependent on the individual case. If a recruiter chooses to hire a person who has committed a crime, they usually make their decision from the three following factors: the nature of the crime, the severity of the crime and the time of the criminal act. The workplace, type of service and tasks can also be important factors for the recruitment process. / Studien är baserad på ett kvalitativt synsätt där fokus har legat på att utöka förståelsen kring fenomenet rekrytering av personer som finns med i belastningsregistret. Syftet med studien var att undersöka åsikter och uppfattningar om individer med brottslig bakgrund bland personer som arbetar med rekrytering. För att besvara syftet formulerades tre frågeställningar: Hur betraktar rekryterare personer med brottslig bakgrund? Hur ställer man sig till att anställa personer med brottslig bakgrund? Hur kan detta kopplas till stämplingsteorin och teorin om stigmatisering? Som empiri användes data från kvalitativa intervjuer med rekryterare samt data från ett frågeformulär som också riktades till personer som arbetar med att rekrytera personal. Tematisk analys användes för att analysera det insamlade materialet. I studien kopplades empirin till två olika teoretiska utgångspunkter: Goffmans stigmatiseringsteori och Beckers stämplingsteori. Stigmatiseringsteorin och stämplingsteorin användes för att identifiera rekryterares perspektiv på personer med brottslig bakgrund, samt för att undersöka hur rekryterare ställer sig till att anställa personer som begått brott. Stigmatiseringsteorin bidrog till att belysa om och hur rekryterare förhåller sig till karaktärsstigmat brottsling. Stämplingsteorin användes för att förstå hur rekryterare kategoriserar och ”stämplar” arbetssökande personer utifrån deras brottsliga handlingar. Studiens resultat har visat att rekryterares uppfattningar om personer som begått brott kan variera. Majoriteten av respondenterna hade vid något tillfälle begärt ett utdrag ur belastningsregistret på en arbetssökande person. Det har även framkommit att rekryterare ibland kan ha fördomar om personer som begått brott. Vidare har studien visat på att rekryterare kan vara öppna och positiva till att anställa personer som begått brott, åtminstone då det gäller mindre allvarliga brott. Om en rekryterare är positiv eller negativ till att anställa en person med brottslig bakgrund beror ofta på det enskilda fallet. Om en rekryterare väljer att anställa en person som begått brott tar hen vanligtvis hänsyn till följande tre faktorer: brottets karaktär, brottets allvarlighet och tidpunkten för den brottsliga handlingen. Även arbetsplatsen, typ av tjänst och arbetsuppgifter kan vara av betydelse för rekryteringsprocessen.

abstract: Blockchain technology enables a distributed and decentralized environment without any central authority. Healthcare is one industry in which blockchain is expected to have significant impacts. In recent years, the Healthcare Information Exchange(HIE) has been shown to benefit the healthcare industry remarkably. It has been shown that blockchain could help to improve multiple aspects of the HIE system. When Blockchain technology meets HIE, there are only a few proposed systems and they all suffer from the following two problems. First, the existing systems are not patient-centric in terms of data governance. Patients do not own their data and have no direct control over it. Second, there is no defined protocol among different systems on how to share sensitive data. To address the issues mentioned above, this paper proposes MedFabric4Me, a blockchain-based platform for HIE. MedFabric4Me is a patient-centric system where patients own their healthcare data and share on a need-to-know basis. First, analyzed the requirements for a patient-centric system which ensures tamper-proof sharing of data among participants. Based on the analysis, a Merkle root based mechanism is created to ensure that data has not tampered. Second, a distributed Proxy re-encryption system is used for secure encryption of data during storage and sharing of records. Third, combining off-chain storage and on-chain access management for both authenticability and privacy. MedFabric4Me is a two-pronged solution platform, composed of on-chain and off-chain components. The on-chain solution is implemented on the secure network of Hyperledger Fabric(HLF) while the off-chain solution uses Interplanetary File System(IPFS) to store data securely. Ethereum based Nucypher, a proxy re-encryption network provides cryptographic access controls to actors for encrypted data sharing. To demonstrate the practicality and scalability, a prototype solution of MedFabric4Me is implemented and evaluated the performance measure of the system against an already implemented HIE. Results show that decentralization technology like blockchain could help to mitigate some issues that HIE faces today, like transparency for patients, slow emergency response, and better access control. Finally, this research concluded with the benefits and shortcomings of MedFabric4Me with some directions and work that could benefit MedFabric4Me in terms of operation and performance. / Dissertation/Thesis / Masters Thesis Computer Engineering 2020

This thesis is devoted to general practice (GP) networks in Belgium, their development and their activities within the Belgian health system context. These networks are specific research tools for the repeated or continuous collection and analysis of data related to diseases and other health events observed in general practice, including interventions of general practitioners. The thesis focuses on three not-for-profit general practice research networks which are operational today: (1) the national Network of Sentinel General Practices (SGP), coordinated by the Federal research institute Sciensano; (2) the Flemish Intego network, coordinated by the Academic Center for General Practice of Catholic University Leuven; (3) the network of the Fédération des maisons médicales et des collectifs de santé francophones (FMM) with its Monitoring Chart (Tableau de bord), which collects data from Wallonia and the Brussels-Capital Region. The thesis is divided into a general introduction, three main parts and a final discussion with concluding remarks. The general introduction outlines the importance of data from general practice and the contribution of GP networks to research. Furthermore, it points out the importance of general practice for the control of sexually transmitted infections (STIs), a specific field of action. The first main part of the thesis investigates the research question of how the three GP research networks developed within the specific context of the Belgian health system. It is based on the interpretation of written sources such as project reports, annual network reports, research publications, parliamentary documents, relevant websites and the existing research literature. The context analysis included a comparison with the Netherlands since the latter have strong traditions with regard to the position of the general practitioner in the health system (gatekeeper to secondary care, whereas in Belgium the patient generally chooses his/her health provider, and a Global Medical File administered by the general practitioner is not mandatory in Belgium), to general practice research networks and computerisation. It could be shown (1) that Belgium has held a middle position in the European Union regarding GP computerisation; (2) that, contrary to the Netherlands, an operational national GP network based on data from electronic health records (EHRs) could not be established; and (3) that Belgian health system computerisation, which advanced substantially in the last decade, put the issue of health data collection and storage by a new digital service on the agenda. Subsequently, three sub-chapters focus on the development of the three GP networks from their foundation until today. They demonstrate that the SGP and Intego were founded as innovative tools originating from Flemish general practice research, whereas the Monitoring Chart originated from the dynamism of Integrated Primary Health Care Centres (IPHCCs, Maisons médicales) in French-speaking Belgium. Acting as health observatories was both part of the mission of the IPHCCs and the demand of the Regional governments. With time, the research designs of the three GP networks became more sophisticated. Furthermore, European cooperation of the SGP with other GP networks since the late 1980s stands out, since the vision to establish a European sentinel general practice network led to joint influenza surveillance as one of its lasting achievements. In continuation of the developments described above, the second main part of the thesis addresses the missions and the organisation of the three GP networks today as well as their respective strengths and limitations in comparative perspective. It is based on network publications and reports, relevant websites and informal information from the networks themselves. The comparison shows that there is little overlap between the activities of the three GP networks, given the different areas of investigation and the complementarity of supplementary information collected by the SGP versus routine data extraction from EHRs in the other two networks. Furthermore, Intego and the Monitoring Chart essentially cover different parts of the country. The prospective research design of the SGP allows formulating hypotheses and designing research questionnaires with precise definitions of diagnoses before the start of a new research topic in order to minimise inter-observer variability, whereas the diagnosis in the other two networks is the result of the general practitioner's clinical judgement. The Intego network disposes of a substantial number of routine parameters collected over more than two decades by now. With these data, the researchers can design retrospective cohort studies without recording or recall bias by the GP who does not know during his/her daily routine for which research questions his/her data may be used later. The Monitoring Chart stands out by its comparatively strong presence in the Brussels-Capital Region and its data from the less well-to-do part of the population. The third main part of the thesis focuses on STIs which provided a research opportunity, given that Belgian public health efforts to control them have increased in recent years and that the three GP networks engaged in research activities in this regard. The first sub-chapter addresses challenges for the surveillance and monitoring of STIs due to the nature of the pathogens, followed by a sub-chapter about characteristics of STI surveillance and monitoring in Belgium. Afterwards, a sub-chapter describes health policy efforts in order to establish the Belgian HIV Plan 2014-2019. The development of the HIV Plan was analysed by applying the policy streams model of John Kingdon. The analysis was based on published government statements, parliamentary documents, and websites of stakeholders, and showed that the Federal Ministry of Health initiative to achieve the HIV Plan was characterised by a coordinating role with a participatory approach towards the other Belgian governments and stakeholders. The 2013 protocol agreement of the Belgian governments committed them to principles, actions, and cooperation regarding HIV prevention, testing, treatment of persons living with HIV and care for their quality of life, but not to budgets, priorities or target figures. The implementation of the plan, highlighting aspects relating to general practice, is addressed in the subsequent sub-chapter. Two further sub-chapters are based on the analysis of retrospective cohort studies with Intego data from 2009 to 2013, based on EHR routine registration by over 90 general practitioners in Flanders. In the first sub-chapter, the frequencies of gonorrhoea and syphilis diagnoses were investigated. Case definitions were applied. Due to small case numbers obtained, cases were pooled and averaged over the observation period. Frequencies were compared with those calculated from mandatory notification. A total of 91 gonorrhoea and 23 syphilis cases were registered. The average Intego annual frequency of gonorrhoea cases obtained was 11.9 (95% Poisson confidence interval (CI) 9.6; 14.7) per 100,000 population, and for syphilis 3.0 (CI 1.9; 4.5), respectively, while mandatory notification was calculated at 14.0 (CI: 13.6, 14.4) and 7.0 (CI: 6.7, 7.3), respectively. In spite of limitations such as small numbers and different case definitions, the data suggests that the general practitioner was involved in the large majority of gonorrhoea cases, while the majority of new syphilis cases did not come to the knowledge of the general practitioner. The second sub-chapter deals with the prescription of antibiotics to treat gonorrhoea in general practice in Flanders 2009-2013. Belgian guidelines recommended ceftriaxone or alternatively spectinomycin from 2008 onwards and azithromycin combination therapy since 2012. The study investigated to which extent contemporary gonorrhoea treatment guidelines were followed. Ninety-one gonorrhoea cases with ten chlamydia and one genital trichomonas coinfections in 90 patients were registered between 2009 and 2013. The proportion of cases with ceftriaxone and/or spectinomycin prescriptions rose from 13% (two of 15 cases) in 2009 to 56% (nine of 16 cases) in 2013. Combination therapy of ceftriaxone and/or spectinomycin together with azithromycin rose from 0 of 15 cases (0%) in 2009 to 7 of 16 cases (44%) in 2013. Although numbers are small, the results suggest that gonorrhoea therapy guideline adherence improved between 2009 and 2013. Future opportunities, recommended in the final discussion, include (1) extending provider-led STI testing in Belgium, with a prominent role for general practitioners; (2) investigating barriers and facilitators for the achievement of the Global Medical File, notably if sensitive and potentially stigmatising issues such as STIs or mental health are involved; (3) making task delegation by the general practitioner towards other primary health care providers more attractive; (4) facilitating general practitioners' tasks by the introduction of support features into the EHR in order to improve registration and quality of care in general; (5) eliciting Regional government support in order to investigate the diagnostic profiles of the patient population of IPHCCs; and (6) establishing an extended network for the collection and analysis of "production data" (such as the number of contacts, interventions, referrals, prescriptions and diagnostic requests) from general practitioners and other primary health care providers, proceeding from the know-how and the experience of the three investigated GP networks. / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished