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Server intervention is a relatively new approach in the attempt to reduce the incidence of drinking and driving. Although a number of evaluations have suggested that the approach may be effective, there have been few comprehensive evaluations of such programmes. The present study utilized process evaluation techniques to assess reactions to a programme developed by the Addiction Research Foundation, and a quasi-experimental design to determine the impact of the programme on the serving practices of servers. Actors portrayed behaviours often faced by servers, and observers rated the reactions of the servers, who were unaware of the simulations, to these situations. The programme appears to have been effective in changing behaviour, in that trained servers exhibited less inappropriate responses than did untrained servers. In addition the results suggested that the programme increased servers' knowledge about their obligations and potential strategies for dealing with these situations. The implications of these findings for future implementations of such programmes are discussed.

ABSTRACT. Objective. Urinary tract infections (UTIs) are common among infants and toddlers. Children can be treated effectively with short courses (2-4 days) of intravenous (IV) therapy followed by oral therapy. If IV therapy is chosen, use of once-daily dosing may allow outpatient management instead of hospital admission. However, no description of ambulatory treatment with IV antibiotics of UTI among febrile children has been reported to date. We aimed to describe the feasibility and complications of outpatient management with IV antibiotics of UTI among febrile children, at the day treatment center (DTC) of a tertiary-care pediatric hospital.Methods. Between April 1, 2002, and March 31, 2003, a prospective cohort of patients 3 months to 5 years of age who were examined in the emergency department (ED) and diagnosed as having presumed febrile UTI were treated according to a clinical protocol. Patients were treated at the DTC unless they met exclusion criteria, in which case they were hospitalized. The DTC was open 7 days per week, including holidays, from 8:30 AM to 4:30 PM. At the DTC, patients were initially treated with a daily dose of IV gentamicin, until the child had been afebrile for at least 24 hours, and with oral amoxicillin, until preliminary urine culture results were available. Children allergic to penicillin received gentamicin only. IV antibiotics were administered through peripheral IV access; the IV catheter's patency was maintained with injection of 50 U of heparin once daily throughout the treatment period. Parental satisfaction with the DTC experience was assessed with an anonymous, self-administered questionnaire.Results. Two hundred ninety-one episodes of presumed febrile UTI were diagnosed in the ED, of which 212 (72.9%) were sent to the DTC. There were 71 hospital admissions (24.4%); in 9 of these instances, the child was admitted because parents refused or were unable to comply with DTC treatment. Adherence to the treatment protocol in the ED was excellent; in 92.1% of presumed febrile UTI episodes (268 of 291 episodes), the patient was referred to the appropriate setting for treatment. In 8 instances, patients who met an exclusion criterion were sent to the DTC. They should have been hospitalized, according to the protocol. At the DTC, a final diagnosis of UTI was made in 178 of the 212 episodes (84%). Patients treated at the DTC, with a final diagnosis of UTI, had a median age of 12.0 months (range: 3-68 months), and their mean initial temperature was 39.2°C (SD: 1.1°C). Patients were afebrile by 24 hours in 52% of UTI episodes and by 48 hours in 82%. Minor problems with IV access occurred in 9.0% of cases. The duration of IV antibiotic therapy at the DTC was 1.9 days (SD: 0.9 day). The mean number of visits to the DTC, including appointments for renal ultrasound and voiding cystourethrography evaluations, was 3.5 (SD: 0.9). Parents were present at all scheduled visits in 98.9% of cases. Four patients needed to be hospitalized from the DTC, but in only 1 case was hospital admission r...

T he diagnosis of an intellectual disability (ID) relates to a heterogeneous group of individuals, approximately 3% of the population, whose intelligence quotient is <70. Behaviour disorders are frequent in children with an ID, can create problems in everyday life and can mask, or reveal an organic or psychiatric illness. It is crucial to adopt a multidisciplinary approach in treating these behaviours.In the present review, we first describe some general concepts dealing with the management of behaviour disorders in children with an ID, and then provide an overview of, in our experience, the four most common of these disorders: sleep disturbances, agitation (as it relates to attention-deficit hyperactivity disorder [ADHD]), aggression and self-injury. The treatment of organic problems and psychiatric illnesses that may cause behaviour disorders is beyond the scope of the present article. The present article is based on a conventional and complete literature review, with many of the practical suggestions based on the experience of the authors (ie, group consensus). General concepts assessmentThe first step is to obtain an adequate medical history including onset of the behaviour disorder, evolution over time, extenuating or aggravating factors (eg, environmental stressors that could be impacting the child), functional impairment, a family history of psychiatric problems and the impact of the child's behavioural difficulties on other family members. It is also important to have information on the individual's level of functioning including cognitive, adaptive, social-functioning, levels of receptive understanding and expressive language (1). A thorough physical examination is required in all cases.In cases where parents or tutors 'no longer recognize the child' and there are, for example, autonomic symptoms such as loss of appetite combined with a loss of weight or marked changes in sleep habits, a specific questionnaire dealing with psychiatric symptoms must be completed. A family history of depression, loss of interest in favourite activities, evidence of sadness and recent irritability should suggest the possibility of a depression. In investigating a possible anxiety problem, it is important not only to consider the family history, but also the avoidance of specific situations, difficulties with transitions, difficulties encountered in distancing oneself from attachment figures or the presence of adrenergic symptoms (eg, tachycardia, tremor) during a crisis. A bipolar illness must be considered in the presence of a family history or severe agitation cycles alternating with periods of apathy.In most circumstances, a suspected psychiatric etiology would require evaluation and management by a child psychiatrist. The prevalence rate of psychiatric disturbances, in the population of children with an ID, is 20% to 35%, that is, three to five times higher than that for the general population. It is important to rule out the possibility of a psychiatric disturbance when the patient shows behavioural symptoms of recent...