Objectives To compare the clinical effectiveness of Kirschner wire fixation with locking plate fixation for patients with a dorsally displaced fracture of the distal radius.

The way to treat the correlation between circumstances and effort is a central, yet largely neglected issue in the applied literature on inequality of opportunity. This paper adopts three alternative normative ways of treating this correlation championed by Roemer, Barry and Swift and assesses their empirical relevance using survey data. We combine regression analysis with the natural decomposition of the variance to compare the relative contributions of circumstances and efforts to overall health inequality according to the different normative principles. Our results suggest that, in practice, the normative principle on the way to treat the correlation between circumstances and effort makes little difference on the relative contributions of circumstances and efforts to explained health inequality.

This article analyses the role played by childhood circumstances, especially social and family background in explaining health status among older adults. We explore the hypothesis of an intergenerational transmission of health inequalities using the French part of SHARE. As the impact of both social background and parents' health on health status in adulthood represents circumstances independent of individual responsibility, this study allows us testing the existence in France of inequalities of opportunity in health related to family and social background. Empirically, our study relies on tests of stochastic dominance at first order and multivariate regressions, supplemented by a counterfactual analysis to evaluate the longlasting impact of childhood conditions on inequality in health. Allocating the best circumstances in both parents' SES and parents' health reduces inequality in health by an impressive 57% using the Gini coefficient. The mother's social status has a direct effect on the health of her offspring. By contrast, the effect on descendant's health from their father's 3 social status is indirect only, which goes through the descendant's social status as an adult. There is also a strong effect of the father vital status on health in adulthood, revealing a selection effect.

SummaryBackgroundSelf-harm in adolescents is common and repetition occurs in a high proportion of these cases. Scarce evidence exists for effectiveness of interventions to reduce self-harm.MethodsThis pragmatic, multicentre, randomised, controlled trial of family therapy versus treatment as usual was done at 40 UK Child and Adolescent Mental Health Services (CAMHS) centres. We recruited young people aged 11–17 years who had self-harmed at least twice and presented to CAMHS after self-harm. Participants were randomly assigned (1:1) to receive manualised family therapy delivered by trained and supervised family therapists or treatment as usual by local CAMHS. Participants and therapists were aware of treatment allocation; researchers were masked. The primary outcome was hospital attendance for repetition of self-harm in the 18 months after group assignment. Primary and safety analyses were done in the intention-to-treat population. The trial is registered at the ISRCTN registry, number ISRCTN59793150.FindingsBetween Nov 23, 2009, and Dec 31, 2013, 3554 young people were screened and 832 eligible young people consented to participation and were randomly assigned to receive family therapy (n=415) or treatment as usual (n=417). Primary outcome data were available for 795 (96%) participants. Numbers of hospital attendances for repeat self-harm events were not significantly different between the groups (118 [28%] in the family therapy group vs 103 [25%] in the treatment as usual group; hazard ratio 1·14 [95% CI 0·87–1·49] p=0·33). Similar numbers of adverse events occurred in both groups (787 in the family therapy group vs 847 in the treatment as usual group).InterpretationFor adolescents referred to CAMHS after self-harm, having self-harmed at least once before, our family therapy intervention conferred no benefits over treatment as usual in reducing subsequent hospital attendance for self-harm. Clinicians are therefore still unable to recommend a clear, evidence-based intervention to reduce repeated self-harm in adolescents.FundingNational Institute for Health Research Health Technology Assessment programme.

HighlightsThe use of decision aids for immunisation decisions is under researched and controversial.Parents receiving a decision aid or a leaflet had reduced decisional conflict for the MMR decision.MMR uptake in the decision aid and control arms achieved levels required for population immunity.Leaflet arm parents were less likely to vaccinate their child.Childhood immunisation decision aids can achieve both informed decision-making and uptake.