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Background: The frequency of and risk factors for shaken baby syndrome remain poorly documented for several reasons: the real number of "benign" cases of shaken baby syndrome are not known; information sources used are diverse, there have been changes over time in the definition of this pathology and few population-based epidemiological studies are available., Objective: Estimate the frequency of fatal shaken baby syndrome and determine its risk factors through research carried out on fatal cases in three regions of France while comparing them to data from international publications., Materials and Methods: A retrospective epidemiological study of all cases of fatal shaken baby syndrome affecting infants younger than 1 year of age who were examined by the courts during a 5-year period in a defined geographical area. Shaken baby syndrome cases were compared with infanticide cases for risk factors and a comparison was made of family characteristics with those of the general population., Results: Thirty-seven cases of shaken baby syndrome were recorded (a rate of 2.9 for 100,000 live births). As in other studies, we found a strong predominance of male victims (78%), young age (median age: 4 months) and a high rate of prematurity (22%). Conversely, results on family educational and socioeconomical levels differ from those reported in numerous studies. Parent perpetrators of shaken baby syndrome belong to higher social classes than those of other types of homicide and socially reflect the population they come from., Conclusion: Our study suggests 1) that epidemiological studies on shaken baby syndrome should include both medical and judicial information sources and 2) that primary prevention strategies (especially in maternity wards) should target all social classes.

Introduction: Neonaticide is the term used to refer to the killing of newborn infants within the first 24 hours of life. A recent study conducted by Inserm Unit 750 found a frequency of 2.1 cases of neonaticide for 100,000 births in France. The persistence of these crimes raises serious issues, and scientists have attempted to explain this by the profile of neonaticidal mothers: young, or even teenage, single, primiparous, and socially deprived. The present study sought to question this profile, and to suggest a new profile for neonaticidal mothers., Data and Methods: This retrospective study over the years 1996-2000 comprised 32 cases of neonaticide perpetrated in three French regions. Seventeen solved cases of these 32 cases generated 54 documents by expert consultants, mainly psychiatric and psychological expertise, studied and analysed here using Modalisa software for quantitative analyses and Nvivo software for qualitative data., Results: No single socio-demographic profile was observed. The mothers were in contrasting situations at the time of the event. There were few psychotic profiles. The other psychopathological disturbances detected were very often related to the event. The most surprising feature in the expert reports describing the neonaticidal mothers was the existence of what we have termed "descriptive absent-factors". These mothers had not experienced major trauma in childhood such as the death of persons close or foster care. They were not living in an environment of family violence. They did not exhibit addictive or self-harm behaviour. Their parents before them had similar profiles, except three cases of alcoholism. Their parentage, and that of the infants, was not an issue. The most widely described personality features were immaturity, dependency on others, withdrawal, inhibition, emptiness, lack of affectivity, non-expressiveness, and devaluation of self-image. The very impoverished relational environment of these mothers also appears in the expertise data. Their affective and relational foundations were insecure., Discussion: The "classic" profile of the neonaticidal mother as being young, single, and primiparous is not confirmed in this study. Recent American and European studies reach similar conclusions. More than half of these mothers already had other children; more than half were living with a partner. Nor did these mothers have an evident psychopathological profile, and even less so a psychopathic profile. This study suggests a "psycho-relational" profile for the neonaticidal mother: immature, affectively dependent, expressing herself very little, and experiencing considerable affective isolation., Conclusion: These neonaticidal mothers did not present any specific socio-demographic or evident psychopathological profile. The study nevertheless enabled definition of a "psycho-relational" profile., (Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Using judicial files on neonaticides, (1) to examine the frequency of the association between neonaticide and denial of pregnancy; (2) to assess the accuracy of the concept of denial of pregnancy; (3) to examine its usefulness in programs to prevent neonaticides., Methods: Quantitative and qualitative analyses of data collected from judicial files during a population-based study carried out in 26 courts in 3 regions of France over a 5-year period., Results: There were 32 cases of neonaticides identified; 24, perpetrated by 22 mothers, were solved by police investigation. Aged 26 years on average, the mothers had occupations that resembled those of the general population and 17 had jobs, 13 were multiparous and 11 lived in a couple relationship. No effective contraception was used by women in 20 cases. Psychopathology was rare but mothers shared a personality profile marked by immaturity, dependency, weak self esteem, absence of affective support, psychological isolation and poor communication with partners. No pregnancy was registered nor prenatal care followed. Two (perhaps 3) pregnancies were undiscovered until delivery. No typical denial of pregnancy was observed in the other cases. Pregnancies were experienced in secrecy, with conflicting feelings of desire and rejection of the infant and an inability to ask for help. Those around the mothers, often aware of the pregnancy, offered none. In the absence of parallel clinical data, it is not possible to calculate the frequency of the association between neonaticide and denial of pregnancy., Conclusions: The term 'denial of pregnancy' cannot fully reflect the complexity of emotions and feelings felt by all perpetrators of neonaticide and is used differently by different professionals. The term itself and its excessive generalization contribute to pathologizing women while absolving those around them and has little operational value in preventing neonaticides. The authors suggest rethinking the terms presently used to describe the phenomenon of pregnancy denial., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: To measure the extent and analyse the mechanisms of underestimation of neonaticides (infanticides in the first 24 h of life) and to identify characteristics of neonaticidal mothers., Design: A retrospective study was carried out in 26 courts in three French regions covering 34.6% of all births in France. Included in the study were all cases of infants dying on their day of birth during a 5-year period (1996-2000) that were submitted to courts by the state prosecutor. Complete court case data cover 1996-2007. WHO-International Classification of Diseases cause of death codes assigned in the mortality statistics were compared to causes assigned by the courts. Analysis was carried out on the psychiatric assessments of the mothers., Results: 27 cases of neonaticides were analysed. 17 mothers were identified. We observed sizeable underestimation of neonaticides in official mortality statistics (0.39 per 100 000 births vs 2.1 in our study). Mothers' median age was 26 years; one third had at least three children. More than half lived with the child's father. Two thirds were employed and did not differ significantly from women in the general population regarding occupation. These women appeared to have low self-esteem, be immature and dependent, but did not have frank mental illness. There was no true case of 'denial of pregnancy'. Contraception was not used., Conclusion: This study has implications for prevention in terms of contraception and appropriate targeting of vulnerable women. It encourages the development of case-control studies on maternal risk factors within the framework of the French birth cohort currently being established.

Among factors identified as being statistically associated with child abuse, we can broadly distinguish those related to characteristics of the child itself and those related to family characteristics, bearing in mind that parents are the perpetrators of child abuse in the vast majority of cases. Observed among children are: young age (abuse begins very early in life); male sex, as concerns shaken baby syndrome and lethal violence; the presence of mental disability and/or behavioural disorders; and particularly frequently, prematurity, especially if it requires neonatal hospitalisation. In fact, any circumstance that makes early attachment between the newborn and its parents difficult or impossible, such as prematurity or postpartum depression, constitutes a situation of risk for subsequent child abuse. Among parents, psycho-affective factors take precedence over socio-economic factors, which play no role. Child abuse is found in all social classes, as is the transgenerational transmission of violence, with those parents having suffered from abuse as children being more at risk than others of becoming abusive themselves.

In the international scientific literature, data from birth cohorts clearly show the statistical relationships existing between abuse experienced in childhood and disorders in adulthood, in particular somatic, psychological (depression, suicide, anti-social behaviour, addiction, etc.), and cognitive problems, as well as difficulties in social integration. When abused children are cared for by Child Protective Services, the success or failure of placements is conditioned by a web of factors in which the severity of the initial trauma becomes intertwined with characteristics of the care given. Autonomy in adulthood is more likely to be achieved when placement is continuous and long-term, includes siblings and allows the creation of new bonds of attachment and identification with adult role models. Only these characteristics can attenuate the deleterious effects of the violence suffered in the past, one of the most disturbing consequences of which is the trans-generational transmission of violence. It is therefore important that physicians (general practitioners and paediatricians) who see foster children for vaccinations or childhood diseases are aware of their situation, enquire about the quality of care and know how to establish partnerships with those responsible for the education of these children (foster families, special educators).

Objectives: Test the hypothesis of an underestimation of infant homicides in mortality statistics in France; identify its causes; examine data from the judicial system and their contribution in correcting this underestimation., Methods: A retrospective, cross-sectional study was carried out in 26 courts in three regions of France of cases of infant deaths submitted to the courts, 1996-2000, with follow-up of their files until case closing (1996-2008). For each case, cause of death established by the courts was compared with ICD cause of death as coded in official mortality statistics., Results: We examined 247 cases. Shortcomings in investigations were noted (autopsies: 75% of cases; fundus examination: 11%; diagnosis of sudden infant death syndrome [SIDS] without autopsy: 41%). Eighty deaths were considered homicides by the courts. Homicide rates in the court study are 2-3.6 times higher than those in mortality statistics. Nearly 1/3 of "accidental" deaths and 1/4 of deaths from unknown cause in mortality statistics are homicides. Mechanisms of underascertainment are: physicians' inappropriate death certification and underreporting of suspicious cases; inadequate investigation of cases; incomplete communication of final medical and forensic results to the mortality statistics department., Conclusions: In a country where neither transportation of the body to a hospital nor autopsy is obligatory, judicial data can make an important contribution to correcting mortality statistics., Practice Implications: This study led to the first French protocol for investigating sudden unexpected deaths in infancy (SUDI). The protocol includes a physician "training" section focused on understanding the symptomatology and risk factors of violence, as well as the quality of death certification., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Epidemiological research on the mental health of children is not well developed in France, as demonstrated by the very small number of publications on the subject, especially in French. The purpose of this article is to show the contribution of epidemiology to an understanding of childhood mental illness. We emphasize descriptive epidemiology (currently the most developed component), but discuss analytic and evaluative epidemiology as well. We have thus considered methodological issues related to the advantages and limitations of techniques employed, using concrete examples from international publications. For example, an extensive review of the literature reveals considerable disparity in figures on the prevalence of psychiatric disorders, chiefly because of problems of variation in definitions used and in the places and techniques of data collection (especially screening tools and diagnostic classifications). Only studies carried out in representative samples of the general population allow reliable evaluation of frequency, but these are particularly difficult and costly. The same may be said for follow-up studies, in particular those on birth cohorts, whose principle importance is that they enable the identification of predictive factors for mental disorders, starting from earliest childhood. Entire areas are currently in need of development, such as the genetic epidemiology in mental illness, clinical trials, or the evaluation of programs. Epidemiology enables the evaluation of service needs, the identification of 'risk groups' and a scientific approach to explanatory factors. In a country such as France where nearly all children are in the school system from the age of 3 years on, schools should become a place for early detection, which assumes a considerable increase in the means available and an innovative policy in the training of health personnel, especially in the area of mental health.

Goal: To determine the frequency and categories of sequelae related to accidental injuries (of all types) in childhood, a prospective follow up study was conducted on a geographically defined population near Paris, France., Methods: The study concerned all child residents of one health care district, aged under 15 years, and hospitalised in the two public hospitals of the district, and/or transported by mobile emergency units, after an accident, during a one year period (in 1981-82; n = 785). Initial severity was scored using the injury severity score (ISS). Sequelae were defined as established impairments (leading or not to disabilities), identified by physicians, reporting their clinical diagnosis or complaints by the child and/or the family., Results: After a follow up period of 3.6-29.2 months after the accident, six children died and 78 (10%) were lost to follow up. Among the 701 others, 73 (10.4%) presented 80 sequelae, major (limiting daily activities) in 44 children (6.3%), with no gender difference. These increased significantly with age. The main causes of major sequelae were eye injuries and sports related injuries to the limbs. ISS did not correlate well with sequelae, but the maximum abbreviated injury scale appeared to be a better predictor of long term functional prognosis., Conclusion: Prospective follow up and population based studies are still needed, especially on children's injuries initially perceived as benign, such as most of the sports related injuries in our study.

Since the end of the 1970's, excess mortality among girls, from the end of the neonatal period until the age of 4 years, has been observed in some South Asian countries. Explanatory hypotheses for this situation have in fact noted differences by sex in food allocation and in care during illness. In some North African and sub-Saharan countries in Africa, mortality data suggest the same type of phenomenon, but less reliable statistics and a lack of data analysis by sex on use of health services does not really allow clarification of the problem. The objective of this study was to analyse health seeking behaviour by sex and to identify explanatory factors for any differences found. A cross sectional study of 1560 consultations of under-5 children was carried out in 6 university and regional hospitals in 3 African countries: Algeria (the zones of Aïn Taya and Tigzirt); Togo (the zones of Lomé, Atakpamé and Kara) and the Congo (Brazzaville). Results confirm the existence of discrimination against girls. In ways which vary according to zones, and in comparison to boys, observations of girls show: under-representation among outpatients (29% in Tigzirt, 40% in Kara), especially when they have many siblings, of which some are sisters; longer duration of the development of symptoms before first resort (leading to increased severity of symptoms); less investment in health care; detrimental feeding practices. Higher SES of the father plays a favourable role, especially for girls, and children of both sexes benefit when the mother has a good educational level. The large regional differences demonstrate the complex interaction among explanatory factors: rurality, problems of access to the hospital, low economic level, low social status of women. This research opens the way so that, in Africa, research will no longer be carried out on health seeking behaviour and utilisation of health services without examining separately the situation of boys and girls, and analysing the possible causes of any differences.

Epidemiological and anthropological studies were carried out in Togo on health seeking behavior for under 5 children to determine causes of dysfunctions in health services. This article reports on the main findings of the anthropological study. Anthropological literature on health seeking behavior has identified labeling and associated explanatory models of illness as important factors for making choices in the use of health services. This study, carried out among 100 families in Togo on health seeking behavior for under-five children, found little difference in the signs and symptoms of illness recalled and the health resources used. Different causal explanations similarly showed little variation in signs and symptoms of illness. The only causal explanation for illness which appeared to correspond to place of recourse was related to social causes, where traditional practitioners were more often consulted. Families explained choices more on the basis of the accessibility and quality of health services (geographical and financial accessibility, reception by health personnel, organization of services, drug availability) than on the basis of the particular signs and symptoms of the illness. Improving the organization and functioning of health services should contribute more to appropriate use of the modern health care sector than interventions targeting user populations, since the latter appear to be aware of the advantages of modern medicine, but find financial, social and organizational features of services unsatisfactory.

The functioning and efficacy of pediatric emergency services are currently being questioned in many Northern countries, as well as in the South, for example in North Africa. Reference is often made to unjustified medical emergencies in the face of an influx of patients with benign problems who come from socially disadvantaged families. In the university and regional hospitals in three regions in Togo, we compared three categories of under-5 patients: children sent to "day-time" emergency services after triage done by health personnel; those sent to the "ordinary consultation"; and children brought after hours by their family (without referral by a health professional in 92% of cases) and seen in the "after-hours" emergency service. Serious tropical pathology (cerebral malaria, malaria, sickle cell disease) is mainly seen in emergency consultations, in which high hospitalization rates are noted (83% during the day, 67% at night) and a lethality of 3.4%. One cannot therefore use terms such as "false emergencies", "felt" and "medically unjustified" and the pediatric supervisor for the research considered that recourse to after-hours emergency services was justified in 75% of cases. Families using night services have higher educational levels than those sent to day emergency services, the mother's educational level being the main factor associated with certain characteristics of health seeking behavior (duration of symptoms prior to arrival at hospital, recourse to modern medical drugs). There is often a long delay before recourse to hospital: only 45% of children seen after hours and half of those who died came the 1st or 2nd day of the illness. Self-medication at home is usual but recourse to tradi-practitioners appears rare (4%). Several solutions can be envisaged and should be linked: strengthening of the first level of care, technical improvements in emergency services, training of tradi-practitioners in the recognition and referral of emergency cases, improvement of reception practices at the hospital level, prophylactic and preventive measures for tropical diseases.

In many developing countries, dissatisfaction with primary health care has been accompanied by inappropriate use of university teaching hospitals, frequently for benign health problems. This situation is often attributed to the user population who supposedly misunderstands the functioning of health systems. This article describes the health seeking process and outcome of consultations for under-five children in two geographic zones in Algeria (very different in their care networks, and in the socioeconomic and educational characteristics of their populations), using a representative sample of users of public and private health services. During 4 one-week periods in 1991, a cross-sectional study was carried out among families of children and the health personnel they consulted, in all the health structures in the 2 zones. A Franco-Algerian supervisory team prepared consensual definitions of both the seriousness and the urgency of the pathology, as well as of the appropriateness of the health care structure chosen for that condition. The analysis of 1560 consultations shows dysfunctions in the health seeking process: numerous "self-referrals" (94%); unjustified recourse to university hospitals in 29% of cases; important delays before consulting (> or = 1 week in 14% of cases); absence of the mother during the consultation; differences in the mode of recourse according to the child's sex (for equivalent seriousness and urgency, recourse is more frequent to the emergency room and university hospital for boys, but girls are more often hospitalized). Nonetheless, the Algerian supervisors of the research consider that the choice of the health care facility is appropriate in 91% of cases. At the service level, dysfunctions are equally frequent, especially the absence of the transfer of information on the child between different health care professionals. The primary preoccupation of parents is with accessibility (distance, cost), which leads to recommending the revitalizing of small first-line facilities, especially in rural areas, the more so because they are used and appreciated by families.

In most of the large cities in developing countries, geographic accessibility to health care is not a major problem. Thus, indifference to public services and a preference for home treatment, recourse to traditional medicine or to the private sector may be related to problems in the quality of services. A cross-sectional epidemiological study of hospital visits by under-5 children was carried out in health centres and hospital out-patient services in Brazzaville (Congo). Sampling in these health facilities was done using a systematic random sample with a proportion of 25%, during 4 periods chosen according to seasonal factors. An exhaustive investigation of the entire public sector serving children was done in the study. At the same time, the same data were gathered in a sample of private facilities (doctors' and nurses' offices, traditional healers, religious healing centres), chosen as a function of their permanence and the numbers of their clientele. This article analyses services offered during 2215 visits by children, who were under 1 year of age in more than 50% of cases. In the public sector, 75% of visits were to first-line health centres. Public services show marked dysfunctions: the complexity of internal referrals, clinical examinations which are inadequate in relation to symptoms, and poor communication (explanations as to cause of illness in less than 2% of cases, and on treatments in less than 50% of cases). Communication seems well developed among private physicians and traditional healers, the latter engaging in both preventive and curative activities. Communication during well-child visits and consultations at health centres is especially disappointing, in light of the very young age of the parents (1/4 are high-school or college students). There is a two-fold risk in this situation: flight towards non-conventional medicine on the one hand, and access to private medicine based on socio-economic status on the other. It thus appears necessary to standardise procedures and acts in first line public health services and to promote training of personnel in communication skills with families (training using social science perspectives and participative pedagogical techniques).

Background: In all industrialized countries, injuries constitute the primary public health problem during adolescence; study of long-term outcome of injuries to adolescents remains poor., Population and Methods: A longitudinal epidemiological study performed on 8,140 students in 17 secondary schools in Paris and the Department of the Côte-d'Or followed the development over one year of 777 adolescents who had injuries in 1990. All injuries, both within and outside school, were included if they fulfilled the following criteria: school absence or excused from vocational training exceeding or equal to 2 days, or excused from physical education classes for at least 14 days., Results: One year after the injury, 13% of the adolescents were still bothered by their injury, especially those who were older and the girls. Among described impairments, musculo-skeletal problems (88% of cases) were the major difficulty. These impairments were primarily in the lower limbs (53%). Unaesthetic scars were found in 17% of cases, and a psychological impact was found in 16.5% of the adolescents. The presence of sequelae was related to the type of initial lesion (present in 24% of head injuries and in 16% of cases affecting the lower limbs). The most serious difficulties were caused by dislocations, serious sprains and fractures. One year after the injury, sequelae were serious in 10% of those adolescents still experiencing problems; they had some impact on the daily life of the adolescents in 36% of cases, that is, 5% of all adolescents experiencing an injury. These sequelae were responsible for a high level of consumption of medical services., Conclusions: Although observed sequelae were relatively minor, the high frequency of injuries during adolescence, as well as their high economic costs, justify the most appropriate care available for victims of injuries, even those which appear benign. In addition, longitudinal studies should be prepared using adapted tools (scales for the evaluation of the gravity of injury sequelae).

Through a prospective survey coordinated by the CIE of Paris, and carried at a semi-urban regional hospital (Atakpame), the authors studied the use of health structures by inpatient and outpatient consulting children. Questionnaires were filled for the 112 children of the study. Results were as follows: There is a maladjustment between recruitment at the regional hospital and its real mission (emergency cases and special health care). Thus only 13.3% of children were seen for an emergency, and 4.5% admitted for special health case. In the majority of cases (69.4%), the health state of patients was not alarming. Improper channelling of the patients is responsible for this condition. 79.4% of children consult directly at the hospital without prior consultation at the "peripheral" health centers. The regional health center thus finds itself overburdened, whereby long waiting periods before consultation (> 300 mn for certain patients), and delay in the management of referred patients.

In the field of safety, accidents and injuries, laws and regulations can either ensure a passive protection of persons, or need their active participation. In the latter situation, beside the use of health indicators (rates of fatalities, accidents, injuries), the evaluation will also focus on changes of behaviour. In the case of mandatory restraint devices for young children, the evaluation of the laws indicates their effectiveness, but also: 1) methodological issues in interpretation of the results (reliability of the sources of information, choice of relevant denominators for the calculation of rates ...); 2) families low compliance, due to problems of acceptability of the laws and regulations, and to personal factors (demographic, socio-economic, cultural, and mainly psychological).

The French situation with respect to mortality from unintentional injuries in children is far from satisfactory. International comparison is made difficult by statistical bias, but although excess injury mortality is decreasing in France, rates are higher than in most advanced European countries. Many regulations have been enacted during the past 30 years to reduce the economic and social burden of injuries, but political will is insufficient to establish a consolidated national program and enforcement of existing legislation is inadequate. Evaluation of preventive and educational programs is less than optimal; many attempts have not met basic methodologic requirements. The situation is improving, partly because of growing social concern. New regulations are in preparation, but solution of this major public health problem also demands behavioral change, which is much more difficult to effect than other measures. Greater commitment to research, proper evaluation of sound programs, and enforcement of existing law doubtless would reduce the excess morbidity and mortality resulting from unintended injuries to children.

Within a population-based register of childhood injuries, 641 home accidents to children aged under 2 years were recorded in six hospitals. The annual rate was higher in children over 1 year (6.6 per 100) than in infants (2.7 per 100). A male predominance was observed only after the first birthday. Most injuries were related to physical trauma (mainly falls), but burns and poisonings were frequent in the second year. Most lesions were benign, except in the case of falls from a height (from a window or baby furniture). Nineteen per cent of the children were admitted to hospital. There were 15 skull fractures, two fatal cases and two severe sequelae. Child abuse was seldom suspected and the reasons for this are discussed. The study of the circumstances in which accidents occur leads to the conclusion that the main aspect of prevention should be passive protection ensured by the creation of a safe environment (compulsory safety standards for baby furniture, child resistant packaging), but that parents' information and education should also be developed, with emphasis on knowledge of children's normal psychological and motor development and abilities.

Every year, several thousands of North African children receive transfers to France for hospitalization. The need for these medical transfers is linked to a rapidly expending population, improving diagnostic techniques and inadequate therapeutic technology. Affected children are referred most often for cardiac and oncological diseases. Efforts have been made to discern the medical indications for such transfers, to facilitate the acceptance by social aid agencies and to provide the best possible psychosocial and educational settings for the children involved. Yet, many problems remain, such as advanced disease states and associated diseases at the time of transfer, affective disorders, worsened by the prolonged stay in hospital. Solutions must be found for these problems. Examples would include close collaboration between referred North African and French medical teams, and the existence in France of cultural environment sensitive to the needs to the North African patients. Because transfers are responsible for a high financial and affective cost, and for a dependent relationship between countries, long-term solutions must be considered and could include the transfer of technology and cooperation in research rather than medical care.

In 1981-82, 5, 963 children's accidents were reported over a one-year period in 2 public and 11 private hospitals in a given public health district. The nature of treated accidents in the public hospitals differs from that in the private facilities. Reporting of cases reaches 75% in the public hospitals; only about 50% in the private hospitals. Characteristics of reported accidents differ from those unreported. While the quality of clinical data is satisfactory, the site of the accident is unknown in 14%, and the causal agent, in 35% of the cases. The estimation of incidence implies the extension of registrations to the private sector, source of 31% of reported cases, and where significant differences from the public sector were observed in the nature of the accidents. A permanent system requires use of a rolling sample and training of personnel. Systematic registration is a tool to measure incidence of accidents, but is not a suitable instrument for the surveillance of dangerous products and objects.

In 1981 to 1982, within a 1 year period, details were recorded of children aged 0 to 15 years and 3 months, who were treated for accidental injury in a French health care district; 789 sports-related accidents were registered, representing 11% of all accidents. Sports areas were the leading sites of accident among children over age 12. Out-of-school sports accidents were more frequent among boys, but boys and girls had similar injury rates in school physical education. Compared to home, school, and road accidents, sports accidents had the highest rate of upper limb injury. The fracture rate was 22% and the hospitalization rate 11%. In most cases children were injured without any participation of other players or sports equipment. Sports-related injuries were usually benign, but several hospital admissions for the same accident were required in 20% of the admitted children (significantly higher than in home, school, and road accidents), and the time elapsed between the accident and the end of the last stay in hospital was significantly greater than in other kinds of accidents. This might be explained by a higher rate of epiphyseal fractures (10%) and internal fixation (17%). Musculoskeletal sequelae were observed in 12% of inpatient children.

From 1981 to 1982, within a one year period, all medically treated childrens' accidents were recorded in the public and private medical facilities of a French health care district near Paris. Sports injuries represented 11% of all injuries, and in children aged 12 years and over, sports areas were the leading site of accidents (24%). Seven hundred thirty-eight sports injuries to children aged 6 years and over were analysed and compared to other types of accidental injuries (home, school and traffic accidents). The overall incidence of sports injuries was estimated to be 1.1% in children aged 6 to 14 years. Out-of-school sports accidents were more frequent among boys, but boys and girls had similar injury rates in school physical education. Most lesions were benign but the fracture rate was 22%. A majority of lesions were located on the upper limb. Most commonly, the mechanism of accident was a forward fall and children were injured without any participation of sports equipment. The hospitalization rate was 11%. Repeated hospital admissions and a long time elapsing between the accident and full recovery were significantly more often observed than in other types of accidents. This might be explained by a higher rate of epiphyseal fractures and internal fixations. Eighteen months after the accident, musculo-skeletal sequelae were observed in 12% of the inpatient children.

In 1980, within a 29 day-period, we studied all the hospitalizations of children in 14 departments of the "Assistance Publique" in Paris. The survey included 940 children and 978 hospitalizations. We compared French children with foreign children, living in France and born to 2 foreign parents. The rate of foreign children among the hospitalized children is abnormally high. This high rate is partly explained by social factors but remains high after adjustment of those factors. The 2 groups of children are not hospitalized for the same kind of diseases: French children are more frequently hospitalized for congenital malformations, foreign children for accidents and infections. Foreign children are hospitalized longer than French children for a same disease. The length of hospitalization is not connected with the father's type of work but rather with the occupation of the mother. The child's hospitalization is shorter when the mother has a professional occupation, and that influence of the mother's work is independent of the other factors.

The etiological study conducted in 1975 in Haut-Ogooué and Ogooué-Lolo included 1,548 patients male and female. In the 21 investigated areas the patients were asked questions and examined by a medical team which took swabs so that bacterial, parastic, immunological and genetical assays could be carried out. The object of this article is to review the feasibility of such a local inquiry and state the first findings. Abnormalities of the epididymis are more commonly verified in non-fertile men. Microfilaremia is related to the presence of hydroceles and epididymis lesions. It shows more often in men with less than 3 children. The authors do not refer to any of physiopathology to explain these findings which need to be ascertained in further inquiries.

Injuries due to accidents are the primary cause of fatalities among adolescents. Between the ages of 10 and 19, mortality caused by accidents augments significantly, and there is an excess of male mortality, increasing with age. This mortality has remained virtually unchanged over the past 25 years, except for a small narrowing of rate differences by sex. Traffic accidents, particularly those involving motorcycles, are the leading cause of accident fatalities. Though not easily assessed, morbidity due to accidents is probably very high, especially among males. Sports accidents are the most frequent. Adolescents appear to be particularly exposed to some risks, but also tend to be careless about safety. Risk-taking is a source of rewards: pleasure, self-affirmation, sense of independence; but it is described by some authors as self-destructiveness, death from accidents reflecting suicidal tendencies. Paradoxical results of prevention have been observed in this age group.

Eight hundred fifty-four injuries to children under 2 years of age were analysed. Injuries were more frequent in the second year than in younger infants. No major male predominance was observed. Most injuries were related to home accidents and mainly to mechanical trauma. Burns and poisonings were less frequent but their percentage was higher during the second year. Most lesions were benign, except in case of fall from a height (window falls, falls from baby furniture). Medical cost was rather high due to a 17% rate of hospital admissions and a 4 days average length of stay. Two fatal cases were registered. Sequelae appeared to be rare. Child abuse was seldom suspected and reason for that remains unclear. The study of accidents mechanism leads to think that teaching young children the control of hazardous situations should play a large part in prevention.