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Purpose of Review We investigated the risk profiles of patients using direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) in European cohort studies to estimate the importance of potential (measured or unmeasured) confounding factors in analyses comparing these drugs. We searched MEDLINE and EMBASE (2008–2018) for relevant studies and extracted information on age, sex, comorbidity, Charlson comorbidity index, HAS-BLED score (assessing risk of bleeding) and CHA2DS2-VASc score (assessing risk of stroke). Recent Findings Overall, 66 studies with 2,808,757 patients were included. Most patients were from France (37%), Denmark (24%) and Germany (23%). In 56 studies (85%), the focus was on patients with atrial fibrillation. Of the 43 studies comparing DOAC with VKA users, 33% reported a higher and 16% a lower age of DOAC compared with VKA users. The mean age varied by about 1 year in most of these studies. Rivaroxaban was used in the widest age range. Patients with DOAC more often had a history of stroke or bleedings, and patients with VKA more often had a history of diabetes, renal failure, cancer, heart failure or other heart diseases. Most studies did not observe differences regarding the HAS-BLED score or the CHA2DS2-VASc score between groups. Summary Our review suggests that there are relevant differences in the risk profiles of DOAC versus VKA users and between users of individual DOACs. Reported HAS-BLED or CHA2DS2-VASc scores did not reflect these differences. These patterns require careful consideration in the interpretation of observational studies comparing the effectiveness and the risks of these drugs, also when comparing the results of studies conducted in different countries.

Background Adolescents with externalising problems in secure residential care differ in age of onset of disruptive behaviour and in cumulative risks in several domains. In order to reduce negative consequences of externalising behaviour for society and the adolescents themselves, it is important to gain more insight into the complexity and heterogeneity of disruptive behaviour in these adolescents. To look beyond the influence of single risk factors, the aim of this study is to investigate the moderator effect of co-occurring risk factors in multiple domains on the relation between age of onset of disruptive behaviour and two types of externalising problems in adolescence. Methods Retrospectively collected data of 225 adolescents admitted to secure residential care were analysed. The four risk profiles were based on co-occurring pre-admission risk factors in four domains, which were identified in a previous study by latent class analysis. Multiple regression models were used to test whether the independent variable age of onset and dummy-coded moderator variable risk profiles had statistically significant associations with aggressive behaviour and rule-breaking behaviour of the adolescents, as reported by professional caregivers in the first months of admission. Results Risk profiles moderated the relation between age of onset of disruptive behaviour and rule-breaking behaviour. Adolescents with childhood-onset disruptive behaviour within the risk profile with mainly family risks showed more rule-breaking behaviour in the first months of their admission to secure residential care than adolescents with an onset in adolescence within the same risk profile. Risk profiles, however, did not moderate the relation between age of onset of disruptive behaviour and aggressive behaviour. Conclusion Heterogeneity of aggressive and rule-breaking behaviour was established in this study by finding differences on these two types of externalising behaviour between the childhood- and adolescence-onset groups and between the four risk profiles. Furthermore, risk profiles moderated the effect between age of onset of disruptive behaviour and rule-breaking behaviour—not aggressive behaviour—in adolescents admitted to secure residential care. While respecting the limitations, adolescents’ childhood-onset disruptive behaviour within a profile with mainly family risk factors appear to be distinctive from adolescents with adolescence-onset disruptive behaviour within the same risk profile.

Background Anticoagulation therapy is a standard treatment for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) that have risk factors for stroke. However, anticoagulant increases the risk of bleeding, especially in Asians. We aimed to investigate the risk profiles and pattern of antithrombotic use in patients with NVAF in Thailand, and to study the reasons for not using warfarin in this patient population. Methods A nationwide multicenter registry of patients with NVAF was created that included data from 24 hospitals located across Thailand. Demographic data, atrial fibrillation-related data, comorbid conditions, use of antithrombotic drugs, and reasons for not using warfarin were collected. Data were recorded in a case record form and then transferred into a web-based system. Results A total of 3218 patients were included. Average age was 67.3 ± 11.3 years, and 58.2% were male. Average CHADS2, CHA2DS2-VASc, and HAS-BLED score was 1.8 ± 1.3, 3.0 ± 1.7, and 1.5 ± 1.0, respectively. Antiplatelet was used in 26.5% of patients, whereas anticoagulant was used in 75.3%. The main reasons for not using warfarin in those with CHA2DS2-VASc ≥2 included already taking antiplatelet (26.6%), patient preference (23.1%), and using non-vitamin K antagonist oral anticoagulants (NOACs) (22.7%). Anticoagulant was used in 32.3% of CHA2DS2-VASc 0, 56.8% of CHA2DS2-VASc 1, and 81.6% of CHA2DS2-VASc ≥2. The use of NOACs increased from 1.9% in 2014 to 25.6% in 2017. Conclusions Anticoagulation therapy was prescribed in 75.3% of patients with NVAF. Among those receiving anticoagulant, 90.9% used warfarin and 9.1% used NOACs. The use of NOACs increased over time. Electronic supplementary material The online version of this article (10.1186/s12872-018-0911-4) contains supplementary material, which is available to authorized users.

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is a dreaded complication in patients with compromised bone metabolism. The purpose of the present study was to examine the occurrence of ARONJ and its related factors among patients with a history of antiresorptive therapy undergoing tooth extraction using preventive protocols at a Swiss university clinic. Data were retrospectively pooled from health records of patients having received a surgical tooth extraction between January 2015 and April 2020 in the Clinic of Cranio-Maxillofacial and Oral surgery, University of Zurich. A total of 970 patients received an extraction with flap elevation or wound closure during this period. A total of 104 patients could be included in the study. Furthermore, variables including age, gender, smoking, risk profile, choice, indication and duration of antiresorptive therapy, number of extractions, extraction site, surgical technique, choice and duration of antibiotics as well as the presence of postoperative inflammatory complications were assessed. Overall, 4 patients developed ARONJ (incidence of 3.8%) after tooth extraction at the same location, without previous signs of osteonecrosis. Preventive methods included predominantly primary wound closure using a full thickness mucoperiosteal flap and prolonged perioperative antibiotic prophylaxis. In accordance with current literature, the applied protocol showed a reliable outcome in preventing ARONJ when a tooth extraction is required.

Objective: Detecting the early emergence of childhood risk for adult mental disorders may lead to interventions for reducing subsequent burden of these disorders. We set out to determine classes of children who may be at risk for later mental disorder on the basis of early patterns of development in a population cohort, and associated exposures gleaned from linked administrative records obtained within the New South Wales Child Development Study. Methods: Intergenerational records from government departments of health, education, justice and child protection were linked with the Australian Early Development Census for a state population cohort of 67,353 children approximately 5 years of age. We used binary data from 16 subdomains of the Australian Early Development Census to determine classes of children with shared patterns of Australian Early Development Census–defined vulnerability using latent class analysis. Covariates, which included demographic features (sex, socioeconomic status) and exposure to child maltreatment, parental mental illness, parental criminal offending and perinatal adversities (i.e. birth complications, smoking during pregnancy, low birth weight), were examined hierarchically within latent class analysis models. Results: Four classes were identified, reflecting putative risk states for mental disorders: (1) disrespectful and aggressive/hyperactive behaviour, labelled ‘misconduct risk’ ( N = 4368; 6.5%); (2) ‘pervasive risk’ ( N = 2668; 4.0%); (3) ‘mild generalised risk’ ( N = 7822; 11.6%); and (4) ‘no risk’ ( N = 52,495; 77.9%). The odds of membership in putative risk groups (relative to the no risk group) were greater among children from backgrounds of child maltreatment, parental history of mental illness, parental history of criminal offending, socioeconomic disadvantage and perinatal adversities, with distinguishable patterns of association for some covariates. Conclusion: Patterns of early childhood developmental vulnerabilities may provide useful indicators for particular mental disorder outcomes in later life, although their predictive utility in this respect remains to be established in longitudinal follow-up of the cohort.

BackgroundWhile single psychosocial factors have been associated with cardiovascular outcomes, it is still unclear how they cluster. Therefore, we examined whether latent multidimensional psychosocial risk profiles could be identified in the European Society of Cardiology (ESC) psychosocial screening interview. Additionally we examined whether these profiles were associated with specific sociodemographic, clinical, and psychosocial characteristics.Method681 coronary artery disease patients (age = 64.9 ± 10.6; 80% men) completed the ESC interview, comprising 15 items on 7 predefined components. Multiple self-report questionnaires focusing on demographics, mood symptoms, personality, coping, and life events were used. Clinical information was extracted from patients' medical records.ResultsLatent class analysis identified four psychological classes: 1. Low psychological distress (62%), 2. High hostility (19%), 3. High tension (11%), 4. High psychological distress (8%), and two social classes: Low chronic stress (81%), and High work stress (%19). Characteristics increasing the odds to belong to the “High hostility” class were male sex, negative affectivity, and psychiatric history. “High tension” membership was associated with female sex, being single, a sedentary lifestyle, seeking social support, NA, early adverse life-events, depression, anxiety, and psychiatric history. “High psychological stress” characteristics were younger age, smoking, a sedentary lifestyle, NA, depression, anxiety, early adverse life-events, psychiatric history. Being younger, alcohol use and avoidance-oriented coping increased the odds to be in the “High work stress” class.ConclusionsThis study characterized four psychological and two social latent risk profiles. Results indicate the importance of a multidimensional psychosocial screening, potentially uncovering differential mechanistic pathways, which also may prove beneficial in clinical practice and in risk prevention strategies.

Background Adolescents in residential care are a vulnerable population with many problems in several life areas. For most of these adolescents, these problems persist after discharge and into adulthood. Since an accumulation of risk factors in multiple domains increases the likelihood of future adverse outcomes, it would be valuable to investigate whether there are differences in life after residential care between subgroups based on multiple co-occurring risk factors. Aims and hypothesis The aim of this exploratory follow-up study is to explore differences between young adults—classified in four risk profiles—in relation to life after discharge from a secure residential care setting. It is hypothesised that young adults with a profile with many risks in multiple domains will experience more problems after discharge, such as (persistent) delinquency, compared to young adults with a profile with lower risks. Methods Follow-up data were collected from 46 former patients of a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands. In order to illustrate these young adults’ life after discharge, self-reported outcome measures divided into five domains (i.e., quality of life, daily life, social life, problems, and delinquency) were used. Differences between four classes based on pre-admission risk factors, which were identified in a previous study by latent class analysis, were explored by three (non-)parametric statistical tests. Results Life after discharge for most young adults was characterised by close friends and a high quality of life, but also by substance abuse, professional support, debts, and delinquency. Only a few significant differences between the classes were found, primarily between young adults with risk factors in the individual, family, school, and peer domains and young adults in the other three classes. Conclusions Young adults experience a high quality of life after discharge from secure residential care, despite the presence of persistent problems. Some indications have been found that young adults with risk factors in four domains are at greatest risk for persistent problems in young adulthood. Because of the high amount of persistent problems, residential treatment and aftercare should focus more on patients’ long-term needs.

Background Suicide is the second leading cause of death for young people worldwide. A significant amount of suicide attempts is known to be unplanned, but research on unplanned attempts among adolescents is limited. As knowledge on the profile of unplanned suicide attempts is crucial for effective prevention efforts, this study aims to characterize and compare three suicide behaviour profiles among adolescents: planned attempts, unplanned attempts and ideation without attempt. Methods Data from the 2014 Luxembourgish Health Behaviour in School-aged Children study was used. 879 adolescents aged 12 to 18 years old are included in this study. Data was gathered using paper questionnaires. ANOVAs with Games-Howell post-hoc tests were conducted for 18 independent variables, using the suicide behaviour variable as the dependent variable. Results Unplanned attempters report higher levels of parental and classmate support (p < 0.01), fewer health complaints (p < 0.001), higher life satisfaction (p < 0.01) and a more positive body image (p < 0.01) than planned attempters and ideators. Unplanned and planned attempters are younger than ideators (p < 0.01) and report more substance use and physical fighting than ideators (p < 0.01). Conclusions Unplanned attempters report better health (behaviour) and more social support than planned attempters and ideators. Unplanned attempters and planned attempters have higher levels of risk behaviour than ideators. Prevention efforts should be mindful of similarities and differences between the behaviours, and identify and address at risk adolescents accordingly. Key messages Unplanned attempters have better health (behaviour) and more social support than planned attempters and ideators. Results are incorporated in the Luxembourgish national plan for suicide prevention.

Objective: We examined associations between developmental vulnerability profiles determined at the age of 5 years and subsequent childhood mental illness between ages 6 and 13 years in an Australian population cohort. Methods: Intergenerational records from New South Wales (NSW) Government Departments of Health and Child Protection spanning pre-birth to 13 years of age were linked with the 2009 Australian Early Development Census records for 86,668 children. Mental illness indices for children were extracted from health records between 2009 and 2016 (child’s age of 6–13 years). Associations between mental disorder diagnoses and membership of early childhood risk groups, including those with established ‘special needs’ (3777, 4.3%) at school entry, or putative risk classes delineated via latent class analysis of Australian Early Development Census subdomains – referred to as ‘pervasive risk’ ( N = 3479; 4.0%), ‘misconduct risk’ ( N = 5773; 6.7%) or ‘mild generalised risk’ ( N = 9542; 11%) – were estimated using multinomial logistic regression, relative to children showing ‘no risk’ ( N = 64,097; 74%). Poisson regression models estimated the relative risk of a greater number of days recorded with mental health service contacts among children in each Australian Early Development Census risk group. Adjusted models included child’s sex, socioeconomic disadvantage, child protection contacts and parental mental illness as covariates. Results: The crude odds of any mental disorder among children aged 6–13 years was increased approximately threefold in children showing pervasive risk or misconduct risk profiles at the age of 5 years, and approximately sevenfold in children with special needs, relative to children showing no risk; patterns of association largely remained after adjusting for covariates. Children with special needs and the misconduct risk class used mental health services over a greater number of days than the no risk class. Conclusion: Patterns of early childhood developmental vulnerability are associated with subsequent onset of mental disorders and have the potential to inform interventions to mitigate the risk for mental disorders in later childhood and adolescence.

Purpose: Adolescents who are admitted to secure residential care have a high risk of delinquency after discharge. However, this risk may differ between subgroups in this heterogeneous population of adolescents with severe psychiatric problems and disruptive problem behaviour. In this study, the predictive validity of four risk profiles was examined for the number of minor, moderate, and severe offences after discharge from secure residential care.Methods: The sample comprised 238 male former patients of a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands. In three Poisson regression analyses, the relationship between four previously identified risk profiles and the number of minor, moderate, and severe offences after discharge was examined.Results: The results showed that the four risk profiles differed significantly in the number of minor, moderate, and severe offences after discharge. Post hoc analysis revealed no mediating effect of termination of treatment on the relationship between the risk profiles and the number of minor, moderate, and severe offending after discharge.Conclusion: Adolescents with many risk factors in multiple domains and adolescents with mainly family risks have an increased risk of persistent delinquency after discharge. Treatment should be tailored more effectively to the specific risks and needs of these adolescents.

Introduction: In the Netherlands, skin cancer is the most common type of cancer KWF, 2016. More than 51.000 new cases of skin cancer are diagnosed every year and over 900 fatalities are reported RIVM, 2017. Skin cancer incidence rates increase dramatically: since 1990 the number of new patients with skin cancer quadrupled RIVM, 2017. This increase is much higher than in other types of cancer IKNL, 2016. It is expected that incidence rates of skin cancer will increase even further, probably with a factor 2 to 5 RIVM, 2017. Direct costs for medical treatment of skin cancer are estimated at 325 million each year 250-400 million RIVM, 2017. On top of that, sick leave and premature mortality are also important indirect costs in melanoma Brochez et al., 1999. Increasing use of more costly treatment, such as Mohs surgery and photodynamic therapy, is contributing to rising treatment costs Hollestein et al, 2017. In addition to the costs, this growing group of patients with skin cancer will represent an important burden on the limited specialized dermatological care in the Netherlands. Subsequent early assessment of skin cancer risk is necessary for timely preventive measures in the general population. Methods: 1- A systematic review of the literature on patient characteristics with a prognostic predictive value for future basal cell carcinoma, squamous cell carcinoma or melanoma such as age, gender, presages, signs and risk behaviour. 2- A Current practice analysis on care concerning risk behaviour, presages and signs of skin cancer. 3- Prognostic modelling using existing data of over 5000 cases from the Netherlands Comprehensive Cancer Organisation IKNL. 4- Developing risk profiles and implement these through internet and social media. Results: It will provide insight in early risk behaviours in the general population. It also provide knowledge of serious presages or signs enabling these patients to be seen by their GP timely. Conclusion: Basal cell carcinoma BCC, approx. 70%, squamous cell carcinoma SCC, approx. 20% and melanoma approx. 10% are the three most common types of skin cancer. Melanoma is the most lethal type, accounting for 90% of all skin cancer fatalities. The incidence of melanoma in the Netherlands is among the highest in Europe RIVM, 2017. Despite the fact that most non-melanoma skin cancers BCC and SCC can be cured, the treated lesions can be disfiguring or even lethal if not treated timely. Lessons learned: Risk profiles will enable healthcare professionals and citizens both with knowledge which persons are at high risk and should be screened and insight in risk behaviour. Limitations: Risk screening is costly, time consuming and it is to be expected that the adherence will be moderate. Suggestions for future research: Behaviour change intervention target groups in the society as implementation research

Background: It has become increasingly common in multiple purpose general population surveys to integrate different kinds of biomarker in the data collection process. Objective: In this article we test the predictive power of five different functional forms of CVD-related biomarkers for all-cause and CVD mortality in the Health and Retirement Study (HRS). Methods: We use five different functional forms of biomarker: A risk factor index, risk factors separately, continuous biomarkers, risk groups comprising every possible combination of risk factors, and a cluster analytic approach to identify risk profiles in the sample. We use data from the Health and Retirement Study (HRS) with information on four collected biomarkers (glycated hemoglobin (hbA1c), high-density lipoprotein (HDL), total cholesterol, and C-reactive protein (CRP)) with an eight-year mortality follow-up period. Results: The results show that the additive index has comparatively high predictive power, relative to its simplicity. Risk profiles were identified in the data, with substantial differences in mortality risk between the profiles. The more complex functional forms improve prediction only moderately compared to the simple index, although we can identify groups with an elevated mortality risk that are not identified in more parsimonious approaches. Conclusions: Depending on the specific research question, both a very simple modeling of biomarker information and more detailed examinations of specific complex risk profiles can be appropriate. Contribution: The study provides initial guidelines for the measurement of commonly used biomarkers, which can be a reference for other studies that use biomarkers as health indicators or for mortality prediction.

Background: Prostate cancer incidence is rising in the United Kingdom but there is little data on whether the disease profile is changing. To address this, we interrogated a regional cancer registry for temporal changes in presenting disease characteristics. Methods: Prostate cancers diagnosed from 2000 to 2010 in the Anglian Cancer Network (n=21 044) were analysed. Risk groups (localised disease) were assigned based on NICE criteria. Age standardised incidence rates (IRs) were compared between 2000–2005 and 2006–2010 and plotted for yearly trends. Results: Over the decade, overall IR increased significantly (P

金沢大学人間社会研究域人間科学系, This study aimed to develop a criterion for screening high risk elderly using Demura's fall risk assessment chart (DFRA), compared with the Tokyo Metropolitan Institute of gerontology (TMIG) fall risk assessment chart. Participants included 1122 healthy elderly individuals aged 60 years and over (380 males and 742 females) 15.8% of whom had experienced a fall. We assessed fall risk of the elderly by DFRA and TMIG. To develop a criterion for screening high fall risk subjects among community-dwelling elderly, receiver-operating-characteristic (ROC) analysis was conducted using fall experience (separated into the categories of faller and non-faller) and the following fall risk scale scores: (1) TMIG score, (2) DFRA score, and (3) potential for falling score according to the DFRA (summing the scores of three items). In ROC analyses, the area under the ROC curve (AUC) for evaluating the potential for falling gave a value of 0.797 (95% CI = 0.759-0.834) which proved better than the evaluation of the overall TMIG (0.654, 95% CI = 0.600-0.706) and DFRA scores (0.680, 95% CI = 0.633-0.727). Assessment of the potential for falling and fall experience are of benefit in screening for elderly persons deemed to be at a high fall risk. Further examinations based on the prospective data setting will be required. © 2011 Elsevier Ireland Ltd. All rights reserved.

Objective: Prostate cancer in the United Kingdom is mainly diagnosed from primary care referrals based on national guidelines published by the Department of Health. Here we investigated the characteristics of cancers detected through the use of these guidelines. Methods: A prospective two-centre study was established to assess men referred from the primary care based on the UK national guidelines. Results: The overall cancer detection rate was 43% (169 out of 397) with 15% (26 out of 169) of all cancers metastatic at presentation. Amongst 50–69-year-old men these rates were 34% (68 out of 200) and 15% (10 out of 68). Only 21% (25 out of 123) of men with local cancers had low-risk disease. In comparison to a historical cohort from 2001 (n=137) we found no overall differences in rates of metastatic disease, locally advanced tumours, or risk categories. Amongst 50–69-year-old men with local disease, however, we observed an increase in detection of low-risk cancers in a contemporary cohort (P=0.04). This was primarily because of the increased detection of low-stage organ-confined tumours in this group (P=0.02). Conclusion: Use of the UK prostate cancer guidelines detects a high proportion of clinically significant cancers. Use of the guidelines does not seem to have led to an overall change in the clinical characteristics of presenting cancers. There may, however, be a specific benefit in detecting more low-risk disease in younger men.

This note aims to build understanding of the existing disaster risk financing and insurance (DRFI) tools in use in The Marshall Islands and to identify gaps where potential engagement could further develop financial resilience. The likelihood that a hazardous event will have a significant impact on the Marshall Islands has risen with the increasing levels of population and assets in the urban areas of Majuro and Ebeye. The low-lying atolls are at risk of damage to both assets and people as a result of storm surges and tsunamis. The Marshall Islands is expected to incur, on average over the long term, annual losses of US$3 million due to earthquakes and tropical cyclones. In the next 50 years, the Marshall Islands has a 50 percent chance of experiencing a loss exceeding US$53 million. The government takes an ex-ante approach to financing the cost of disasters, but the resources available are limited. The Marshall Islands has a maximum amount of US$15.6 million potentially available in ex-ante instruments to facilitate disaster response. The government s post-disaster budget execution process relies on a variety of financial tools, but the size of the economy limits access to immediate post-disaster cash resources. A number of options for improving disaster risk financing and insurance are presented here for consideration: (a) develop an integrated disaster risk financing and insurance strategy; (b) assess the domestic insurance market for both public and private assets to establish what products are currently offered and to determine their level of uptake; (c) carry out a quantitative analysis to determine whether contingent credit could be an effective tool to access additional liquidity post-disaster; and (d) investigate the possibility of establishing policies for financial assistance to disaster victims in remote communities.

The Pacific Region is one of the most natural disaster prone regions on earth. The Pacific Island Countries (PICs) are highly exposed to the adverse effects of climate change and natural hazards, which can result in disasters affecting their entire economic, human, and physical environment and impact their long-term development agenda. The average annual direct losses caused by natural disasters are estimated at US$284 million. Since 1950 natural disasters have affected approximately 9.2 million people in the Pacific Region, causing 9,811 reported deaths. This has cost the PICs around US$3.2 billion (in nominal terms) in associated damage costs. This report focuses on the development of the country catastrophe risk profiles, the information collected, how it was catalogued and processed, and now being used for a variety of applications in Climate and Disaster Risk Management. The country risk profiles integrate data collected and produced through risk modeling and include maps showing the geographic distribution of assets and people at risk (section one), hazards assessed (section two) and potential monetary losses and casualties (section three). The profiles also include an analysis of the possible direct losses (in absolute terms and normalized by GDP) caused by tropical cyclones and earthquakes, and their impact though severe winds, rainfall, coastal storm surge, ground shaking and tsunami waves. The expected return period indicates the likelihood of a certain specified loss amount to be exceeded in any one year.

Biological processes are full of variations and so are responses to therapy as measured in clinical research. Estimators of clinical efficacy are, therefore, usually reported with a measure of uncertainty, otherwise called dispersion. This study aimed to review both the flaws of data reports without measure of dispersion and those with over-dispersion. Examples of estimators commonly reported without a measure of dispersion include: number needed to treat; reproducibility of quantitative diagnostic tests; sensitivity/specificity; Markov predictors; risk profiles predicted from multiple logistic models. Data with large differences between response magnitudes can be assessed for over-dispersion by goodness of fit tests. The χ2 goodness of fit test allows adjustment for over-dispersion. For most clinical estimators, the calculation of standard errors or confidence intervals is possible. Sometimes, the choice is deliberately made not to use the data fully, but to skip the standard errors and to use the summary measures only. The problem with this approach is that it may suggest inflated results. We recommend that analytical methods in clinical research should always attempt to include a measure of dispersion in the data. When large differences exist in the data, the presence of over-dispersion should be assessed and appropriate adjustments made.

Objectives Rates of sexually transmitted infections (STIs) in UK young people remain high in men and women. However, the National Chlamydia Screening Programme has had limited success in reaching men. The authors explored the acceptability of various medical, recreational and sports venues as settings to access self-collected testing kits for STIs and HIV among men in the general population and those who participate in sport. Methods A stratified random probability survey of 411 (weighted n=632) men in Great Britain aged 18–35 years using computer-assisted personal and self-interviews. Results Young men engaged well with healthcare with 93.5% registered with, and 75.3% having seen, a general practitioner in the last year. 28.7% and 19.8% had previously screened for STIs and HIV, respectively. Willingness to access self-collected tests for STIs (85.1%) and HIV (86.9%) was high. The most acceptable pick-up points for testing kits were general practice 79.9%, GUM 66.8% and pharmacy 65.4%. There was a low acceptability of sport venues as pick-up points in men as a whole (11.7%), but this was greater among those who participated in sport (53.9%). Conclusions Healthcare settings were the most acceptable places for accessing STI and HIV self-testing kits. Although young men frequently access general practice, currently little STI screening occurs in this setting. There is considerable potential to screen large numbers of men and find high rates of infection through screening in general practice. While non-clinical settings are acceptable to a minority of men, more research is needed to understand how these venues could be used most effectively.

Background School dropout is a persisting problem with major socioeconomic consequences. Although poor health probably contributes to pathways leading to school dropout and health is likely negatively affected by dropout, these issues are relatively absent on the public health agenda. This emphasises the importance of integrative research aimed at identifying children at risk for school dropout at an early stage, discovering how socioeconomic status and gender affect health-related pathways that lead to dropout and developing a prevention tool that can be used in public health services for youth. Methods/design The SIODO study is a sequential mixed-methods study. A case–control study will be conducted among 18 to 24 year olds in the south of the Netherlands (n = 580). Data are currently being collected from compulsory education departments at municipalities (dropout data), regional public health services (developmental data from birth onwards) and an additional questionnaire has been sent to participants (e.g. personality data). Advanced analyses, including cluster and factor analyses, will be used to identify children at risk at an early stage. Using the quantitative data, we have planned individual interviews with participants and focus groups with important stakeholders such as parents, teachers and public health professionals. A thematic content analysis will be used to analyse the qualitative data. Discussion The SIODO study will use a life-course perspective, the ICF-CY model to group the determinants and a mixed-methods design. In this respect, the SIODO study is innovative because it both broadens and deepens the study of health-related determinants of school dropout. It examines how these determinants contribute to socioeconomic and gender differences in health and contributes to the development of a tool that can be used in public health practice to tackle the problem of school dropout at its roots.