Aims: To evaluate the benefits and harms of treatments for vesicoureteric reflux in children. Methods: Meta-analyses of randomised controlled trials using a random effects model. Main outcome measures were incidence of urinary tract infection (UTI), new or progressive renal damage, renal growth, hypertension, and glomerular filtration rate. Results: Eight trials involving 859 evaluable children comparing long term antibiotics with surgical correction of reflux (VUR) and antibiotics (seven trials) and antibiotics compared with no treatment (one trial) were identified. Risk of UTI by 1-2 and 5 years was not significantly different between surgical and medical groups (relative risk (RR) by 2 years 1.07; 95% confidence interval (CI) 0.55 to 2.09, RR by 5 years 0.99; 95% CI 0.79 to 1.26). Combined treatment resulted in a 60% reduction in febrile UTI by 5 years (RR 0.43; 95% CI 0.27 to 0.70) but no concomitant significant reduction in risk of new or progressive renal damage at 5 years (RR 1.05; 95% CI 0.85 to 1.29). In one small study no significant differences in risk for UTI or renal damage were found between antibiotic prophylaxis and no treatment. Conclusion: It is uncertain whether the identification and treatment of children with VUR confers clinically important benefit. The additional benefit of surgery over antibiotics alone is small at best. Assuming a UTI rate of 20% for children with VUR on antibiotics for five years, nine reimplantations would be required to prevent one febrile UTI, with no reduction in the number of children developing any UTI or renal damage. P rimary vesicoureteric reflux is thought to be caused by a maturational abnormality of the vesicoureteric junction, so that urine passes in a retrograde manner up the ureter. Although the exact prevalence in the general childhood population is unknown, about a third of children with urinary tract infection are consistently found to have reflux.1 Urinary tract infection occurs in approximately 5-10% of children, and so 1-3% of children are identified with vesicoureteric reflux.

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There is no evidence of effect of SSRIs in children and emerging evidence of harm. There is limited evidence of the effectiveness of SSRIs in adults from small studies in which risk of bias is unclear.

Studies evaluated in this review report significant improvements in knowledge measures and protective behaviours. Results might have differed had the true ICCs from studies been available or cluster-adjusted results been available. Several studies reported harms, suggesting a need to monitor the impact of similar interventions. Retention of knowledge should be measured beyond 3-12 months. Further investigation of the best forms of presentation and optimal age of programme delivery is required.

The Campbell Collaboration (C2) was founded on the principle that systematic reviews on the effects of interventions will inform and help improve policy and services. C2 offers editorial and methodological support to review authors throughout the process of producing a systematic review. A number of C2's editors, librarians, methodologists and external peerreviewers contribute. The Campbell Collaboration SynopsisSchool-based programmes for preventing child sex abuse may improve knowledge and selfprotective behaviours but also increase anxiety; further research is needed Childhood sexual abuse is a serious problem for school aged children worldwide. There is no consistent definition of sexual abuse. Some studies restrict sexual abuse to instances of sexual body contact with the child, while others define sexual abuse as any sexual behaviour in a child's presence. Whatever its form, childhood sexual abuse can have a very negative impact on a child. The United Nations' Convention on the Rights of the Child states that "children have the right to be protected from being hurt and mistreated, physically or mentally" and the international community needs to investigate ways this can be done effectively. One widespread method used is to teach school aged children, using school-based programs, about child sexual abuse and how to protect themselves from it. It is important to know if this approach works, for how long it works and if it causes any unintended harm to children and adolescents. This is the purpose of this systematic review.While this review found improvements in knowledge and protective behaviours among children who had received school-based programs, these results should be interpreted with caution. The reasons for a need for caution is that there were problems with the way that many of the original studies were analysed, children's knowledge was tested only a short time period after the program, the studies were conducted in North America and therefore may not apply to other countries and cultures, and several studies reported harms, such as increased anxiety in children. Potential harms need to be closely monitored in future studies and existing school based programs. It is difficult to know if the changes in children's knowledge and protective behaviours seen in the studies will result in prevention of child sexual abuse. As such, school-based programs should, at best, be seen as part of a community approach to the prevention of child sexual abuse.School-based education programmes for the prevention of child sexual abuse 5 Abstract Background Child sexual abuse is a significant problem that requires an effective means of prevention. ObjectivesTo assess: if school-based programmes are effective in improving knowledge about sexual abuse and self-protective behaviours; whether participation results in an increase in disclosure of sexual abuse and/or produces any harm; knowledge retention and the effect of programme type or setting.