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The quality of infertility care is dependent upon adequate material resources and the appropriate use of it. In addition, a mutual understanding between physicians and patients is necessary. These imperatives are more salient in the era of the new reproductive technologies. However, in poor-resource areas these imperatives are insufficiently met. Moreover, in developing countries the negative consequences of childlessness are much stronger than in Western societies. Until recently, the problem of infertility in Third World countries has received little public attention. A plea is made for a stronger policy interest in Third World infertility care. In this it is important to focus on prevention, appropriate diagnosis and treatment at primary and secondary health-care level and to take the existing cultural beliefs into account.

OBJECTIVE: To determine the effect of antibiotic treatment for acute otitis media in children between 6 months and 2 years of age. DESIGN: Practice based, double blind, randomised, placebo controlled trial. SETTING: 53 general practices in the Netherlands. SUBJECTS: 240 children aged 6 months to 2 years with the diagnosis of acute otitis media. INTERVENTION: Amoxicillin 40 mg/kg/day in three doses. MAIN OUTCOME MEASURES: Persistent symptoms at day four and duration of fever and pain or crying, or both. Otoscopy at days four and 11, tympanometry at six weeks, and use of analgesic. RESULTS: Persistent symptoms at day four were less common in the amoxicillin group (risk difference 13%; 95% confidence interval 1% to 25%). The median duration of fever was two days in the amoxicillin group versus three in the placebo group (P=0.004). No significant difference was observed in duration of pain or crying, but analgesic consumption was higher in the placebo group during the first 10 days (4.1 v 2.3 doses, P=0.004). In addition, no otoscopic differences were observed at days four and 11, and tympanometric findings at six weeks were similar in both groups. CONCLUSIONS: Seven to eight children aged 6 to 24 months with acute otitis media needed to be treated with antibiotics to improve symptomatic outcome at day four in one child. This modest effect does not justify prescription of antibiotics at the first visit, provided close surveillance can be guaranteed.

The introduction and acceptance of new techniques in the field of reproductive medicine and antenatal genetic diagnosis is a complicated process in which biomedical professionals, and also social scientists and ethicists, play an important role. In this study the attitudes, expectancies and opinions of a pond of biological and medical professionals working in the field of this new technology are compared with those of a panel of concerned social scientists, psychologists, ethicists and leading members of patient groups. Various aspects of the new techniques are investigated: the present and future feasibility, the potential importance, the ethical evaluation and the social acceptance. The social-ethical panel appears to be much more reluctant regarding the importance, ethical values and social acceptability of new techniques man the biomedical panel, in particular, for preimplantation genetic diagnosis and fetal cell sorting large differences exist.

The present study compares the evidence of pregnancy and delivery among in-vitro fertilization (IVF) parents (45 couples), other formerly infertile parents (35 couples) and fertile parents (35 couples). All deliveries concerned primaparous women and singleton births. In addition, the burden of fertility treatments was investigated. Results show that the psychological burden of the treatments exceeds the physical burden. Fertility treatments were judged very worthwhile. Complications during pregnancy were more frequently reported by IVF mothers and other initially infertile mothers than by fertile mothers. However, controlling for the older age in both formerly infertile groups (IVF and non-IVF), no significant difference was found. No differences appeared regarding the evaluation of the development of the delivery. IVF parents and other infertile parents evaluated the pregnancy as more stressful than fertile parents. However, mothers experienced their delivery as more exceptional, and fathers experienced the pregnancy as more exceptional. In addition, IVF fathers enjoyed the pregnancy more than fathers from the other groups.

Appropriate use of antibiotics is a major issue in today's medicine. The increasing worldwide bacterial resistance to antimicrobial agents is forcing us to prescribe antibiotics more rationally. It is known that overuse of antibiotics for upper respiratory tract infections exists. Little is known about the reasons for actual prescribing of antibiotics. In order to be able to implement strategies to restrict inappropriate antibiotic prescriptions, insight into the reasons for the actual prescribing could be important.

Long-term infertile couples often reflect seriously on their desire for a child. By investigating involuntarily childless couples we might get a better understanding of the intensity of the desire for the first child, the motives behind this desire and the difference between men and women in these respects. In this study among 108 couples with a mean infertility period of 8.6 years, the desire for children was still very strong especially among the women. Also, there were differences between men and women as to their motives for having a child. The most frequent motives for wanting a child are part of the categories happiness and well-being. Motives within the categories social control and continuity were seldom mentioned. Among women with the most intense desire for a child, motives within the categories motherhood and identity-development were very important.

The aim of the study was to investigate factors that may influence the well-being of long-term infertile couples. One hundred and eight childless couples with a long-term infertility completed a structured questionnaire. Three groups of independent variables were discerned: sociodemographic factors, factors associated with infertility and the desire to have a child, and personality characteristics. The effect of these variables upon seven dimensions of (negative) well-being: depression, anxiety, hostility, health complaints, guilt/blame, self-esteem and sexuality was investigated. Strong negative feelings concerning infertility and a high degree of femininity were associated with a low level of well-being (among women as well as among men). To a lesser extent, secrecy with regard to infertility and being the infertile partner (among men) and still pursuing medical treatment (among women) were related to a lower sense of well-being. Recognition of these relations may help in the counselling of infertile couples.

The relation between women's age and fertility, and the factors that influence the age at which couples desire to have their first child, were analysed in a national sample of women aged 25-49 years. A random sample of 8050 households in the Netherlands was approached. In these households, 3295 women between the ages of 25 and 49 years answered a short questionnaire about planning their first pregnancy and about fertility. Furthermore, sociodemographic data were gathered. There appeared to be almost no variation in cumulative pregnancy rate between age 20 and 28: between 65 and 70% at 6 months, just below 90% at 12 months and approximately 93% at 24 months. After the age of 33 years, the cumulative pregnancy rate at 6 months decreased. From the age of 28 years the cumulative pregnancy rate at 12 months and at 24 months decreased gradually, reaching 75 and 80% respectively, by the age of 35 years. The year of birth of the woman (the 'time' factor) was the most important factor influencing the age at which couples desired to have their first child. In addition, demographic factors, particularly a high level of education, a high professional level and a high level of family income, were associated with the desire to have the first child at a relatively late age.

Childlessness is analysed on the individual, the national and the international level. On the individual level five categories of consequences are described: grief and sadness; social isolation and stigma; restricted rights; religious effects and economic aspects. The first category concerns individual feelings and the others are socio-cultural effects in broad-sense. In developing countries childlessness has consequences on individual and socio-cultural level. In the West consequences are mostly restricted to individual feelings. In poor-resource areas there are limited possibilities for modern biomedical treatment. Traditional medicine, with its easy access and cultural acceptation, is a serious ‘competitor’. On the national level there are few incentives and possibilities for development of adequate infertility treatment. Though local and national authorities might be sensitive to the problem, allocation of funds is mostly determined by international agencies, which consider other issues more important. On the international level Western perceptions about the urgency of health issues are still dominant. In the Western world there is little interest and understanding in the problem of ‘barrenness among plenty’ because a focus on population growth reduction and on other problems. Also, the perception of childlessness as an individual problem, makes it difficult to change this attitude. Possibilities for change are discussed.

In a double-blind four-block randomized trial the efficacy and tolerance of a single dose of pefloxacin 800 mg was compared with a five day treatment with norfloxacin 400 mg twice daily in the treatment of uncomplicated urinary tract infections in general practice. The 222 patients included were all healthy non-pregnant women, aged between 18 and 65 years, with dysuria, urinary frequency or urgency, who visited their general practitioner. Outcome parameters were the rates of resolution of symptoms after eight to ten days (T2) and after six weeks (T3), the bacteriological response at T2 and T3, and the tolerance of pefloxacin and norfloxacin. Only slight differences were demonstrated at any stage and after six weeks the success rates in the pefloxacin group were not different from those in the norfloxacin group. Tolerance in both groups was rated as satisfactory, although the higher dose of pefloxacin caused more gastrointestinal side effects.