[Factors associated to breastfeeding up to 6 months in the maternity of Antoine-Béclère Hospital, Clamart]. / Facteurs associés à l'allaitement maternel du nourrisson jusqu'à 6 mois à la maternité de l'hôpital Antoine-Béclère, Clamart.

OBJECTIVES: In order to improve the frequency and duration of breastfeeding, various public health initiatives have been established at local and national levels in France. In 2002, we conducted a study in the maternity center of the Antoine Beclere Hospital with the aim to describe breastfeeding practices and to identify factors associated with its duration. METHODS: This prospective study was conducted among newborns of immediate postpartum women admitted to the maternity center of the Antoine Beclere Hospital (Clamart, France). Extremely premature newborns were excluded (<31 weeks of amenorrhea). Mothers were interviewed at delivery, at one month and 6 months postpartum. Data were collected on maternal medical history, pregnancy and delivery, the newborn's health status, feeding practices, and the reasons for their choice in feeding practices. RESULTS: Between January 7 and April 7, 2002, 562 newborns were included in the study. At birth, 73% were breastfed, whereas 68% were breastfed at discharge from the maternity center. Among the latter, 89% of infants were still being breastfed at one month, and 37% at 6 months of age. Factors associated with breastfeeding at one month were as follows: a secondary level of education (OR(a): 2.4 [1.0-5.7] compared to primary level), multiparity (OR(a): 3.0 [1.2-8.0] compared to primiparity), full-term birth (OR(a): 6.6 [2.4-18.4] compared to premature birth), treatment during pregnancy (OR(a): 0.2 [0.04-0.6]), and medical history (OR(a): 0.4 [0.2-1.0]). Among women who were breastfeeding at one month, the continuation of breastfeeding at 6 months was associated with a secondary education level (OR(a): 2.2 [1.0-5.0]), the choice of feeding practice during pregnancy (OR(a): 2.5 [1.1-5.0] compared to those who did not choose), and to medically assisted reproduction (OR(a): 5.0 [1.2-14.3] compared to spontaneous procreation). DISCUSSION: The prevalence of breastfeeding observed in this study is higher than it was observed at the national level. Factors associated with continuation of breastfeeding at 6 months allow identifying women who should be encouraged to breastfeed by the maternity team involved during pregnancy. Interventions should therefore involve maternity healthcare professionals as a first step in breastfeeding promotion.

An outbreak of airborne tularaemia in France, August 2004.

Fifteen tularaemia cases were identified after a holiday spent at a converted mill in the Vendee region in France, between 9 and 12 August 2004. The mill was visited, and descriptive, retrospective cohort and environmental investigations were conducted. The 39 people who had stayed at the mill between 24 July and 11 August were asked about symptoms, exposure to food and animals, and leisure activities. A case was defined as a person with evidence of fever and a positive serology (seroconversion or significant rise in antibody titre, or a single titre) = 40. Culture for Francisella tularensis and polymerase chain reaction (PCR) diagnosis was carried out for drinking water, firewood, and domestic animals at the mill. Fifteen cases of tularaemia (38%) were confirmed. Twelve of the cases (80%) had the pulmonary form. None of the patients was admitted to hospital. There was a strong association between infection and participation in a dinner at the mill on 4 August (p < 10(-8)). One of the three dogs present in the dining room was serologically positive for F. tularensis. Results of analysis of environmental samples were negative. These investigations confirmed the occurrence of a cluster of 15 tularaemia cases, in patients who were infected on the evening of 4 August, in a mill in VendAe, an endemic area for tularaemia. The investigations highlight the existence of nonspecific and benign pulmonary forms of the illness in France. The pulmonary form of infection in the human cases and the positive serology of the dog suggest contamination by inhalation of contaminated particles from the dogos fur disseminated by the dog shaking itself.

An outbreak of airborne tularaemia in France, August 2004.

Fifteen tularaemia cases were identified after a holiday spent at a converted mill in the Vendee region in France, between 9 and 12 August 2004. The mill was visited, and descriptive, retrospective cohort and environmental investigations were conducted. The 39 people who had stayed at the mill between 24 July and 11 August were asked about symptoms, exposure to food and animals, and leisure activities. A case was defined as a person with evidence of fever and a positive serology (seroconversion or significant rise in antibody titre, or a single titre) = 40. Culture for Francisella tularensis and polymerase chain reaction (PCR) diagnosis was carried out for drinking water, firewood, and domestic animals at the mill. Fifteen cases of tularaemia (38%) were confirmed. Twelve of the cases (80%) had the pulmonary form. None of the patients was admitted to hospital. There was a strong association between infection and participation in a dinner at the mill on 4 August (p<10-8). One of the three dogs present in the dining room was serologically positive for F. tularensis. Results of analysis of environmental samples were negative. These investigations confirmed the occurrence of a cluster of 15 tularaemia cases, in patients who were infected on the evening of 4 August, in a mill in Vend¨¦e, an endemic area for tularaemia. The investigations highlight the existence of nonspecific and benign pulmonary forms of the illness in France. The pulmonary form of infection in the human cases and the positive serology of the dog suggest contamination by inhalation of contaminated particles from the dog¡¯s fur disseminated by the dog shaking itself.