Utility of self-reported mental health measures for preventing unintentional injury: results from a cross-sectional study among French schoolchildren
© Constant et al.; licensee BioMed Central Ltd. 2014
Received: 14 June 2013
Accepted: 10 December 2013
Published: 8 January 2014
Identify children at-risk of having mental health problems is of value to prevent injury. But the limited agreement between informants might jeopardize prevention initiatives. The aims of the present study were 1) to test the concordance between parents and children reports, and 2) to investigate their relationships with parental reports of children’ unintentional injuries.
In a population-based sample of 1258 children aged 6 to 11, the associations between child psychopathology (using the Dominic Interactive and the Strengths and Difficulties Questionnaire) and unintentional injuries in the past 12 months were examined in univariate and multivariate models.
As compared to children, parents tended to overestimate behavior problems and hyperactivity/inattention, and underestimate emotional symptoms. Unintentional injury in the last 12-month period was reported in 184 out of 1258 children (14.6%) and multivariate analyses showed that the risk of injury was twice as high in children self-reporting hyperactivity/inattention as compared to others. However this association was not retrieved with the parent-reported instrument.
Our findings support evidence that child-reported measures of psychopathology might provide relevant information for screening and injury prevention purposes, even at a young age. It could be used routinely in combination with others validated tools.
KeywordsADHD Injury School children Screening Infant mental health Self-report
For the assessment of childhood psychopathology, there is no measurement for which the accuracy (validity) and precision (reliability) are sufficiently high to give indisputable evidence, either for clinical care, research, or screening purposes . Accordingly, assessment using data from multiple informants (e.g., children themselves; their parents, teachers, and clinicians) is highly recommended to improve decision making on diagnostic and intervention issues . However, convergence of the data is rarely achieved. Recent evidence indicated that data from teachers and parents might disagree in their reports because of differing expertise . Additionally, there is scepticism about children’s reliability . Furthermore, when screening children who did not yet have behavioral symptoms, both parent and teacher measures resulted in substantial misclassification errors .
This issue might be of importance for prevention initiatives towards schoolchildren. Indeed, mental health problems such as Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD) might increase the risk of injury among children [6–12]. Byrne et al.  found that preschool-aged children with ADHD exhibit behaviours (e.g., inattention and impulsivity) which place them at a higher risk of serious injury requiring a visit to the emergency department. This is explained by a reduced attentional monitoring required to complete daily activities without danger  and a greater difficulty in recognizing hazards and evaluating risks . Others Significant risk factors include demographic, family, and environmental variables . Unintentional injuries are more common in boys as compared to girls, and are associated with lower Socio Economic Status , neighbourhood deprivation , and rural area of residence .
Unintentional injuries are the leading cause of childhood morbidity and mortality in elementary school children [20–22]. To prevent such severe health issues, it is valuable to identify children and adolescents at-risk of having mental health problems and those who would most benefit from more in-depth assessment. However, there is little or no data on this topic, and misclassification errors might jeopardize prevention initiatives. The aims of the present study were 1) to test the concordance between parents and children reports, and 2) to investigate their relationships with parental reports of children‘s’ unintentional injuries in the last 12-month period.
To ensure representativeness across the 1856 schools of the area (approximately 296,257 pupils), a stratified 2-level probability sample was selected with randomization of 100 primary schools and 25 children per school (five from each of grades 1 to 5). Randomization was stratified on the following school characteristics: public/private, rural/urban, and Deprived School Areas (DSA)/no DSA. Of the 100 primary schools selected, 99 agreed to participate. Contacts were attempted for 2,341 children. Further details on the sampling procedure and methods can be found in previous reports .
Ethical approval and data collection
The research plan was approved by the French national Committee on Ethics (CNIL). Informational letters about the objectives of the study, refusal forms, and a postage-paid return envelope were sent to parents of the selected children. Anonymity was guaranteed, and participants were able to withdraw from the study at any time.
Self-reported child measure
The Dominic Interactive (DI) is an interactive self-report instrument for young children (6 years and older), consisting of 91cartoons depicting a child named Dominic/Dominique with a feeling, a thought or an act. A voice-over describes the symptom and asks the child if she or he acts, feels or thinks similarly. The DI generates a probability diagnosis towards the following seven mental health disorders: specific phobias (SPh), major depression, (MDD), separation anxiety (SAD), generalized anxiety disorders (GAD), hyperactivity/inattention, Oppositional Defiant Disorder (ODD), and Conduct problem (CP). The DI has been validated by several studies [24–28]. Loney et al. found that the reliability of the DI is better than those of structured interviews for young children . The psychometric properties of the French version of the DI are satisfactory . Children completed the DI on a computer station at school under the supervision of a research assistant.
Reported parental measures
The Strengths and Difficulties Questionnaire (SDQ) provides diverse measures of child mental health problems (emotional symptoms, hyperactivity/inattention, conduct problems, peer relationship problems and prosocial behavior (5 items)) [30, 31]. The SDQ is shorter than alternative measures of child psychopathology and has been used to study injured children . It has been extensively evaluated and is reliable and valid . Good psychometric properties of the French version of the SDQ have been reported in an epidemiological sample of 1,400 youths  and in this sample .
Parental reports of injury
Sociodemographic data, parents were asked “in the past 12 months, did your child incur an accident requiring either a contact with a physician or a visit to the hospital?”. If yes, they were asked to provide details about the most recent injury, including where (e.g., home, school) and how (e.g., falling, poisoning, etc.) the injury occurred. Information on the anatomical site of the injury (e.g., head, limbs), and the type of injury (e.g., burn, fracture) were also collected. Injuries were coded according to the International Classification of Diseases, Ninth edition (N codes 800–994).
Parents’ reports of child’s injury in the last 12-month and others categorical variables were expressed as a percentage (%) and compared with Chi square tests. A mean score was calculated for each subscale of the DI and the SDQ, and validated cut-off limits were applied to classify children as regards to the presence of a mental health problem (yes/ borderline/no). In order to obtain conservative estimates, borderline scores were considered as an absence of psychopathology. Kappa coefficients were computed to estimate the level of agreement between DI and SDQ. Since our study outcome was binomial (injuries: yes/no), we used logistic regression models to estimate the odds ratios of reported unintentional injury as a function of emotional and behavioral problems, separately for each tool. In order to address the potential confounding effect of each factor, we used two series of models. First, the association of each mental health problem with the risk of reporting injury was assessed separately (model 1; one model per factor, adjusted on male gender, parental unemployment; living in rural area and school located in a deprived area ). All variables associated (p value <0.10) with the risk of reporting injury in model 1 were included in a single multivariate analysis (model 2), with adjustment on male gender, parental unemployment; living in rural area and school located in a deprived area. The analyses were carried out with SPSS version 19.
Socio-demographic characteristics of the study sample
Presence of unintentional injuries
Reliability between parents and children reports
Hyperactivity/inattentionHyperactivity/inattention was reported in 12.2% of children by parents and self-reported by 4.5% of children using the DI. The value for Kappa is 0.04, indicating a very low level of agreement. Cross-Tables statistics indicates that 138 children (11.0%) considered as having hyperactivity/inattention with the SQD were considered normal with the DI.
Conduct problems were reported in 11.8% of children by parents using the SDQ, while 8.3% of children self-reported at least one conduct problem (CD, ODD) using the DI, the value for Kappa is 0.10, indicating a poor level of agreement. A Cross-Tables analysis indicates that 125 (9.9%) children considered as having conduct problem with the SQD were considered normal with the DI.
Sociodemographic characteristics of the study sample (N = 1258)
627 (49.8 )
< High school
≥ High School
Deprived school area
Characteristics of the 184 unintentional injuries of children aged 6 to 11 from a French representative sample (N = 1258)
Place of occurrence 1
Activity during injury 1
47 (27.0 )
Non motor-vehicle pedal cycle
17 (9.4 )
Hit by object
17 (9.3 )
Cutting or piercing
11 (6.1 )
Injured part 1
114 (59.2 )
47 (25.0 )
21 (11.2 )
Others (Chest, abdomen, back)
25 (13.9 )
Lesion type 1
54 (29.3 )
48 (28.1 )
43 (23.0 )
36 (19.0 )
19 (10.3 )
5 (2.3 )
4 (2.3 )
Prevalence of mental health problems, by gender, according to parent and child report, in a representative sample of children aged 6–11 years old (N = 1258)
Parent report – SDQ
At least one
Parent report – SDQ
Child report - DI
Parent report – SDQ
Child report DI
At least one
Concordance in mental health screening between parent and children’ reports
Type of mental health problems assessed both by DI and SDQ
Presence of mental health problems
None, according to SDQ and DI
Yes, according to SDQ only
Yes, according to DI only
(Child self-reported measure)
Yes, according to SDQ and DI
Association between unintentional injuries and parents’ and children’ reports of mental health problems, determined by logistic regression
Univariate model; adjusted estimates
Multivariate model; adjusted estimates
Parent report – SDQ
Child report - dominic interactive
Findings from the present study showed that parent- and child-reported measures of psychopathology were not concordant. Estimates of behavior problems/hyperactivity/inattention were higher in parent’s reports compared to children’s reports, while those of emotional symptoms were higher in children compared to parents. Multivariate analyses showed that the risk of injury was twice as high in children reporting hyperactivity/inattention as compared to others, a result in line with previous studies [6–8]. However this association was not retrieved with the parent-reported instrument. Our findings support the evidence that child-reported measures of psychopathology might provide relevant information for screening and injury prevention purposes, even at a young age. It could be used routinely in combination with others validated tools.
Both parent and children measures indicated a higher prevalence of behavior problems and a lower prevalence of emotional symptoms among boys as compared to girls. However, the concordance between children and parental estimates was poor. As compared to the children’s reports, parents seem to have minimized intrinsic problems such as anxiety, phobia or depression, and amplified extrinsic problems with visible manifestations, such as behavior problems and hyperactivity/inattention. Interestingly, such a tendency has been previously observed. In a study including schoolchildren in Canada , internalizing disorders were underestimated by external observers (parents and teachers) while ADHD was reported more frequently by teachers (9.8%) as compared to parents (6.9%) and children (3.8%). When it comes to anxiety, of which symptoms are quite covert, reliance on parent reporting produces lower rates of anxiety than using children alone, or in combination with other informants . In a study focusing on discrepant reports where only one of the informant accounted for the presence of a child diagnosis, authors suggested that children could be better informants than parents for their internalizing disorders, because they directly experience and are quite often aware of their internal states and feelings, whereas parent might be better reporters of externalizing disorders .
This statement however has to be mitigated. To some degree, impulsive behaviors, intense activity, and distraction are common among children 6–11 years old. These might be interpreted as pathologic symptoms by parents, in a context where ADHD was largely mediatized. Such bias has been recently documented among specialists; this has led to ADHD over-diagnosis in the past decades, as well as significant increases in medication costs [37–39]. In addition, the prevalence of ADHD is 5.2% worldwide and 4.6% in Europe . In the present study, the prevalence of hyperactivity/inattention was 4.5% according to children self-report, and 12.2% according to parental measures. Only child-reported hyperactivity/inattention was related to unintentional injury. In the absence of any clinical psychiatric assessment, there remains the possibility of misclassification errors. But these results nonetheless suggest that a tool designed to thoroughly assess children perception of their own difficulties could be of interest for screening purposes in combination with other validated tools.
When it comes to other mental health problems assessed in the study, comparing findings from the present study with other estimates is difficult, since epidemiological studies have varied substantially in the prevalence rates reported. A review including 11 studies that investigated the prevalence of DSM-III or DSM-IV anxiety, specifically in children aged under 12, indicated that the rates of diagnosis varied between 2.6% and 41.2% . It must be stressed, however, that children’s reports from our study are in line with aggregated results indicating that separation anxiety is the most common individual disorder and that anxiety disorders are more common than depressive disorders .
This report has various strengths. The sample is a large-scale randomized French sample using strategies to ensure faithful estimates of population values; the association between unintentional injuries and child psychopathology symptoms was examined using both parent and child report; and the non-response rate was satisfactory and consistent with many cross-sectional surveys using mailed self-report questionnaires [41, 42]. Although parents were asked to describe only one injury, the estimate of one-year incidence in our study (13.6%) fell within the known French range (11.4% to 15.3%) [43, 44]. And the hospitalization rate in our sample was also close to that of other studies (7%-9%) [44, 45]. However, parents’ alcohol consumption, poor parental supervision, deliberate injuries and injuries as a result of violence were not assessed and it was not possible to determine the causal relationship between psychopathology and unintentional injuries given the cross-sectional design of our study.
Health practitioners might be reluctant for practical and ethical reasons to interview the children themselves and rely on information from adults only. Our findings however support the evidence that child-reported measures of psychopathology symptoms might provide relevant information for screening and injury prevention purposes, even at a young age. They could therefore be used routinely in combination with others validated tools.
Competing of interest
The authors report no conflict of interest.
We are indebted to Miki Duruz, Christine Chan-Chee, Fabien Gilbert, Robert Goodman, Jean-Pierre Valla, the French Ministry of Health and Social Affairs, the French Ministry of Education, the PACA Regional Directorate for Health and Social Affairs, the Aix-Marseille and Nice Educational Authority, as well as to the children, parents, teachers and principals of participating schools.
This research was funded by the Mutuelle Assurance Elève, Mutuelle Assurance des Instituteurs de France, Mutuelle Générale de l’Education Nationale, the MGEN Foundation for Public Health, FNMF and the Regional Directorate for Health and Social Affairs of PACA region, France. Study sponsors, had no role in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
- Pedhazer E, Schmelkin L: Measurement, Design, and Analysis: An Integrated Approach. 1991, NJ, Hillsdale: Lawrence Erlbaum AssociatesGoogle Scholar
- Piacentini JC, Cohen P, Cohen J: Combining discrepant diagnostic information from multiple sources: are complex algorithms better than simple ones?. J Abnorm Child Psychol. 1992, 20 (1): 51-63. 10.1007/BF00927116.View ArticlePubMedGoogle Scholar
- Kraemer HC, Measelle JR, Ablow JC, Essex MJ, Boyce WT, Kupfer DJ: A new approach to integrating data from multiple informants in psychiatric assessment and research: mixing and matching contexts and perspectives. Am J Psychiatry. 2003, 160 (9): 1566-1577. 10.1176/appi.ajp.160.9.1566.View ArticlePubMedGoogle Scholar
- Deater-Deckard K: Parenting and child behavioral adjustment in early childhood: a quantitative genetic approach to studying family processes. Child Dev. 2000, 71 (2): 468-484. 10.1111/1467-8624.00158.View ArticlePubMedGoogle Scholar
- Dwyer SB, Nicholson JM, Battistutta D: Parent and teacher identification of children at risk of developing internalizing or externalizing mental health problems: a comparison of screening methods. Prev Sci. 2006, 7 (4): 343-357. 10.1007/s11121-006-0026-5.View ArticlePubMedGoogle Scholar
- Bijur P, Golding J, Haslum M, Kurzon M: Behavioral predictors of injury in school-age children. Am J Dis Child. 1988, 142 (12): 1307-1312.PubMedGoogle Scholar
- Bijur PE, Stewart-Brown S, Butler N: Child behavior and accidental injury in 11,966 preschool children. Am J Dis Child. 1986, 140 (5): 487-492.PubMedGoogle Scholar
- Davidson LL, Taylor EA, Sandberg ST, Thorley G: Hyperactivity in school-age Boys and subsequent risk of injury. Pediatrics. 1992, 90 (5): 697-702.PubMedGoogle Scholar
- Langley J, McGee R, Silva P, Williams S: Child behavior and accidents. J Pediatr Psychol. 1983, 8 (2): 181-189. 10.1093/jpepsy/8.2.181.View ArticlePubMedGoogle Scholar
- Lalloo R, Sheiham A, Nazroo JY: Behavioural characteristics and accidents: findings from the health survey for England, 1997. Accid Anal Prev. 2003, 35 (5): 661-667. 10.1016/S0001-4575(02)00044-1.View ArticlePubMedGoogle Scholar
- Bruce B, Kirkland S, Waschbusch D: The relationship between childhood injuries and behavior disorders. Ped and Child Health. 2007, 12 (9): 749-754.Google Scholar
- Rowe R, Maughan B, Goodman R: Childhood psychiatric disorder and unintentional injury: findings from a national cohort study. J Pediatr Psychol. 2004, 29 (2): 119-130. 10.1093/jpepsy/jsh015.View ArticlePubMedGoogle Scholar
- Byrne JM, Bawden HN, Beattie T, DeWolfe NA: Risk for injury in preschoolers: relationship to attention deficit hyperactivity disorder. Child Neuropsychol. 2003, 9 (2): 142-151. 10.1076/chin.18.104.22.16801.View ArticlePubMedGoogle Scholar
- Rowe R, Simonoff E, Silberg JL: Psychopathology, temperament and unintentional injury: cross-sectional and longitudinal relationships. J Child Psychol Psyc. 2007, 48 (1): 71-79. 10.1111/j.1469-7610.2006.01674.x.View ArticleGoogle Scholar
- Farmer JE, Peterson L: Injury risk-factors in children with attention-deficit hyperactivity disorder. Health Psychol. 1995, 14 (4): 325-332.View ArticlePubMedGoogle Scholar
- Rutter M, Giller H, Hagell A: Antisocial Behavior by Young People. 1998, New York: Cambridge University PressGoogle Scholar
- Brehaut JC, Miller A, Raina P, McGrail KM: Childhood behavior disorders and injuries among children and youth: a population-based study. Pediatrics. 2003, 111 (2): 262-269. 10.1542/peds.111.2.262.View ArticlePubMedGoogle Scholar
- Reading R, Langford IH, Haynes R, Lovett A: Accidents to preschool children: comparing family and neighbourhood risk factors. Soc Sci Med. 1999, 48 (3): 321-330. 10.1016/S0277-9536(98)00311-6.View ArticlePubMedGoogle Scholar
- Otters H, Schellevis FG, Damen J, van der Wouden JC, van Suijlekom-Smit LW, Koes BW: Epidemiology of unintentional injuries in childhood: a population-based survey in general practice. Br J Gen Pract. 2005, 55 (517): 630-633.PubMedPubMed CentralGoogle Scholar
- Deal LW, Gomby DS, Zippiroli L, Behrman RE: Unintentional injuries in childhood: analysis and recommendations. Future Child. 2000, 10 (1): 4-22. 10.2307/1602823.View ArticlePubMedGoogle Scholar
- Danseco ER, Miller TR, Spicer RS: Incidence and costs of 1987–1994 childhood injuries: demographic breakdowns. Pediatrics. 2000, 105 (2): E27-10.1542/peds.105.2.e27.View ArticlePubMedGoogle Scholar
- Organization WH: The Injury Chart Book: A Graphical Overview of the Global Burden of Injuries. 2002, Geneva: World Health OrganizationGoogle Scholar
- Shojaei-Brosseau T, Wazana A, Kovess V: The strengths and difficulties questionnaire: French results and cross-cultural comparison. Soc Psychiatry Psychiatr Epidemiol. 2009, 44: 740-747. 10.1007/s00127-008-0489-8.View ArticleGoogle Scholar
- Valla JP, Bergeron L, Smolla N: The Dominic-R: a pictorial interview for 6- to 11-year-old children. J Am Acad Child Adolesc Psychiatry. 2000, 39 (1): 85-93. 10.1097/00004583-200001000-00020.View ArticlePubMedGoogle Scholar
- Valla JP, Kovess V, Chan Chee C, Berthiaume C, Vantalon V, Piquet C, Gras-Vincendon A, Martin C, Alles-Jardel M: A French study of the Dominic Interactive. Soc Psychiatry Psychiatr Epidemiol. 2002, 37 (9): 441-448. 10.1007/s00127-002-0575-2.View ArticlePubMedGoogle Scholar
- Valla JP, Bergeron L, Berube H, Gaudet N, St-Georges M: A structured pictorial questionnaire to assess DSM-III-R-based diagnoses in children (6–11 years): development, validity, and reliability. J Abnorm Child Psychol. 1994, 22 (4): 403-423. 10.1007/BF02168082.View ArticlePubMedGoogle Scholar
- Bidaut-Russell M, Valla JP, Thomas JM, Bergeron L, Lawson E: Reliability of the Terry: a mental health cartoon-like screener for African-American children. Child Psychiatry Hum Dev. 1998, 28 (4): 249-263. 10.1023/A:1022636115485.View ArticlePubMedGoogle Scholar
- Murphy D, Cantwell C, Jordan D, Lee M, Cooley-Quille M, Lahey B: Test-retest reliability of Dominic anxiety and depression items among young children. J of Psychopathology and Behavioral Assessment. 2000, 22: 257-270. 10.1023/A:1007562200613.View ArticleGoogle Scholar
- Loney B, Frick P: Structured diagnostic interviewing. Handbook of Psychological and Educational Assessment of Children: Personality, Behavior and Context. Edited by: Reynolds C, Kamphaus R. 2003, New York, NY: Guilford, 235-247. 2Google Scholar
- Scott TJ, Short EJ, Singer LT, Russ SW, Minnes S: Psychometric properties of the Dominic interactive assessment: a computerized self-report for children. Assessment. 2006, 13 (1): 16-26. 10.1177/1073191105284843.View ArticlePubMedGoogle Scholar
- Goodman R: Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001, 40 (11): 1337-1345. 10.1097/00004583-200111000-00015.View ArticlePubMedGoogle Scholar
- Meltzer H, Gatward R, Goodman R, Ford T: Mental Health of Children and Adolescents in Great Britain. 2000, London: HMSOView ArticleGoogle Scholar
- Capron C, Therond C, Duyme M: Psychometric properties of the French version of the self-report and teacher Strengths and Difficulties Questionnaire (SDQ). Eur J Psychol Assess. 2007, 23: 79-88. 10.1027/1015-5722.214.171.124.View ArticleGoogle Scholar
- Breton JJ, Bergeron L, Valla JP, Berthiaume C, Gaudet N, Lambert J, St-Georges M, Houde L, Lepine S: Quebec child mental health survey: prevalence of DSM-III-R mental health disorders. J Child Psychol Psychiatry. 1999, 40 (3): 375-384. 10.1111/1469-7610.00455.View ArticlePubMedGoogle Scholar
- Cartwright-Hatton S, McNicol K, Doubleday E: Anxiety in a neglected population: prevalence of anxiety disorders in pre-adolescent children. Clin Psychol Rev. 2006, 26 (7): 817-833. 10.1016/j.cpr.2005.12.002.View ArticlePubMedGoogle Scholar
- Jensen PS, Rubio-Stipec M, Canino G, Bird HR, Dulcan MK, Schwab-Stone ME, Lahey BB: Parent and child contributions to diagnosis of mental disorder: are both informants always necessary?. J Am Acad Child Adolesc Psychiatry. 1999, 38 (12): 1569-1579. 10.1097/00004583-199912000-00019.View ArticlePubMedGoogle Scholar
- Treceno C, Martin Arias LH, Sainz M, Salado I, Garcia Ortega P, Velasco V, Jimeno N, Escudero A, Velasco A, Carvajal A: Trends in the consumption of attention deficit hyperactivity disorder medications in Castilla y Leon (Spain): changes in the consumption pattern following the introduction of extended release methylphenidate. Pharmacoepidemiol Drug Saf. 2012, 21 (4): 435-441. 10.1002/pds.2348.View ArticlePubMedGoogle Scholar
- Bruchmuller K, Margraf J, Schneider S: Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. J Consult Clin Psychol. 2012, 80 (1): 128-138.View ArticlePubMedGoogle Scholar
- Chilakamarri JK, Filkowski MM, Ghaemi SN: Misdiagnosis of bipolar disorder in children and adolescents: a comparison with ADHD and major depressive disorder. Ann Clin Psychiatry. 2011, 23 (1): 25-29.PubMedGoogle Scholar
- Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA: The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007, 164 (6): 942-948. 10.1176/appi.ajp.164.6.942.View ArticlePubMedGoogle Scholar
- Bälter K, Bälter O, Fondell E, Lagerros Y: Web-based and mailed questionnaires: a comparison of response rates and compliance. Epidemiology. 2005, 16 (4): 577-579. 10.1097/01.ede.0000164553.16591.4b.View ArticlePubMedGoogle Scholar
- Ritter P, Lorig K, Laurent D, Matthews K: Internet versus mailed questionnaires: a randomized comparison. J Med Internet Res. 2004, 6 (3): e29-10.2196/jmir.6.3.e29.View ArticlePubMedPubMed CentralGoogle Scholar
- Auvray L, Dumesnil S, Le Fur P: Sante et protection sociale en 2000, enquete sur la sante et la protection sociale, France 2000. IRDS, series resultats. 2001, 508: 50-51.Google Scholar
- Thélot B: Résultats de l’Enquête permanente sur les accidents de la vie courante, années 1999-2000-2001. 2003, Saint Maurice: Réseau EPAC; Institut de veille sanitaire, 10-12.Google Scholar
- Spady DW, Saunders DL, Schopflocher DP, Svenson LW: Patterns of injury in children: a population-based approach. Pediatrics. 2004, 113 (3 Pt 1): 522-529.View ArticlePubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2431/14/2/prepub
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.