[Obscurity still exists with regard to the policy in undescended testes: early operation versus well-underpinned wait-and-see policy]. / Nog steeds onduidelijkheden over het beleid bij niet-scrotale testis: vroeg opereren versus onderbouwd afwachten.

The frequency of orchidopexy in the Netherlands is higher than the frequency of genuine undescended testes in spite of an existing consensus guideline on the subject. Evidence that orchidopexy has a positive effect on fertility or the decrease of testicular malignancy is lacking. Clinical trials are necessary to answer the question whether orchidopexy before the age of 2 years prevents malignancy or improves fertility. It is important that research that shows no results of early orchidopexy is also published. A public health approach is necessary to prevent unnecessary surgical interventions.

Prevention of smoking in adolescents with lower education: a school based intervention study.

OBJECTIVE: To assess the effect of an antismoking intervention focusing on adolescents in lower education. Students with lower education smoke more often and perceive more positive norms, and social pressure to smoke, than higher educated students. An intervention based on peer group pressure and social influence may therefore be useful to prevent smoking among these students. DESIGN: Group randomised controlled trial. SETTING: 26 Dutch schools that provided junior secondary education. SUBJECTS: 1444 students in the intervention and 1118 students in the control group, all in the first grade, average age 13 years. INTERVENTION: Three lessons on knowledge, attitudes, and social influence, followed by a class agreement not to start or to stop smoking for five months and a class based competition. MAIN OUTCOME MEASURES: Comparison of smoking status before and immediately after and one year after the intervention, using multilevel analysis. RESULTS: In the intervention group, 9.6% of non-smokers started to smoke, in the control group 14.2%. This leads to an odds ratio of 0.61 (95% CI= 0.41 to 0.90) to uptake smoking in the intervention group compared with the control group. One year after the intervention, the effect was no longer significant. CONCLUSIONS: In the short-term, an intervention based on peer pressure decreases the proportion of adolescents with lower education who start smoking. Influencing social norms and peer pressure would therefore be a promising strategy in terms of preventing smoking among adolescents. The results also suggest that additional interventions in later years are needed to maintain the effect.

[Non-scrotal testes; first line of management]. / Niet-scrotale testes; beleid voor de eerste lijn.

For non-scrotal testes a distinction can be made between retractile testes (completely descended and normally developed but sometimes situated subcutaneously in the groin area), retained testes (testes cannot be brought into the scrotum or this can only be achieved using light manual pressure) and ectopic testes (lying outside of the descent trajectory). It is estimated that 0.7-0.8% of all boys have as yet undescended testes. The first few days after the birth are the most suitable for testing and registration, as then the cremaster reflex is absent. Registration should take place in both the youth healthcare file and in the 'growth book' for the parents. Retractile testes do not require treatment. There is no consensus concerning the treatment of (possible) acquired nonscrotal testes. For undescended testes the management depends on previous testes localisations. For ectopic testes and testes that have never been scrotal, a referral for surgical treatment should be made prior to the second birthday. Orchidopexy (a better description is orchidofuniculolysis followed by orchidopexy) is only justified in the case of testes which have never descended. In the case of a clear indication, the general practitioner should make a prompt referral (before the second birthday) and in other cases assurance should be provided and an expectant policy adopted until puberty.

[Youth health care: much prevention for little money]. / Jeugdgezondheidszorg: veel preventie voor weinig geld.

As part of government policy, the 'Youth healthcare' prevention programme is offered free of charge to all children aged 0 to 19 years who are resident in the Netherlands. It consists of a programme of primary prevention (including vaccinations, information and advice) and secondary prevention (screening, surveillance, early diagnosis) and individual prevention and care. Many elements from the programme package have been shown to have a favourable cost-effectiveness relationship, in terms of health benefits and financially. Other elements have a social priority. The present government expenditure for the total youth healthcare package is about 380 million euros per year, that is 1900 euros per child. In terms of conditions prevented or years of life gained, this is cheaper than accepted prevention programmes for adults. The present approach can only be maintained and strengthened, if the expenditure is increased so that new programme elements can be investigated and--if found effective--implemented.

Effect of dry bed training on behavioural problems in enuretic children.

UNLABELLED: Children with nocturnal enuresis (n = 91) selected by school doctors in The Netherlands from 1991 to 1994 were included in a study to assess the course of behavioural problems especially when the children became dry after the Dry Bed Training (DBT) programme. The Child Behaviour Checklist (CBCL) questionnaire was completed by 88 parents (96%) prior to DBT (T1) and by 83 parents (91%) 6 mo after DBT (T2). The mean CBCL total problem score at T1: 24.0 (range 2-91, SD 16) was significantly higher than that of a Dutch norm group: 20.45, (p=0.025). Compared to T1, the mean CBCL total problem score at T2 was 16.8 (range 0-73; SD 14.7; p < 0.0001). Of the children with CBCL total problem scores at T1 in the borderline or clinical range, 92% became dry and 58% improved to the normal range. At T2, the children seemed to have less internal distress, fewer problems with other people, and were less anxious and/or depressed. CONCLUSION: Children with behavioural/emotional problems who wet their beds need not first be treated for their behavioural/emotional problems. Bedwetting can be treated successfully with DBT when other treatments such as normal alarm treatment have failed, and alarm treatment/DBT can have a positive influence on behavioural/emotional problems.