[Tuberculosis in France: new challenges for practitioners]. / Tuberculose en France : nouveaux enjeux pour le praticien en 2008.

The need for a national tuberculosis control program was based on disparities of incidence by geographical area or by population group, and differences in tuberculosis control practice. This program was developed within the context of the 2004 public health act that prioritised tuberculosis control with the objective "to stabilise the tuberculosis incidence by reinforcing control strategies in groups and zones at risk". The tuberculosis control programme, launched in July 2007, aims to consolidate the decrease of the tuberculosis incidence and to reduce the inequalities. This implies, in particular, reaching the most exposed populations, to ensure an adequate management of cases with a good treatment observance. This also implies preventing transmission in health care settings, and maintaining the low level of multiresistance and must be done despite the loss of expertise due to a decrease in incidence. The six major objectives of the tuberculosis control program are to ensure an early diagnosis and an adequate treatment for all tuberculosis cases, to improve screening, to optimise the BCG policy, to maintain antituberculosis resistance at a low level, to improve the epidemiological surveillance and the knowledge of the determinants of tuberculosis and to improve the management of tuberculosis control activities.

[Premature discontinuation of breastfeeding]. / Les arrêts prématurés d'allaitement maternel.

UNLABELLED: This study was performed to describe the factors associated with a premature cessation of breastfeeding. BACKGROUND AND METHODS: Three hundred and forty nine women with a plan for prolonged breastfeeding over two months were interviewed during their hospital stay to define sociological and medical variables. One month after discharge, mothers were contacted by a physician for making out evolution of the breastfeeding. RESULTS: Eighty-eight (28%) women were no more breastfeeding their infant and were compared to the other 224 (64%) mothers. The main sociological factors influencing the cessation of breastfeeding were low education level (odds ratio 4.2 [95% CI 2.2-8.3]), and primiparity (odds ratio 2.1 [95% CI 1.1-3.9]). Pacifier use was associated with a lower duration of breastfeeding (odds ratio 2.5 [95% CI 1.4-4.5]). Medical predictive factors were infant weight loss (odds ratio 4.3 [95% CI 1.7-10.6]), respect of intervals between feeding times (odds ratio 2.1 [95% CI 1.1-4.4]), delay before the first feeding (odds ratio 1.9 [95% CI 1.0-3.6]). On the other hand formula supplementation was not related with cessation of breastfeeding. DISCUSSION AND CONCLUSION: As the success of breastfeeding depends on maternal motivation, it seems essential to take into account mothers' plan to study breastfeeding duration. The knowledge of predictive factors of the cessation of breastfeeding should allow to identify mothers who need particularly the attention of healthcare professionals.