Presse Med
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Tuberculosis causes an ever-increasing public health burden throughout the world and is one of the World Health Organization's top priorities. In France, the incidence of tuberculosis has been stable at around 10 cases per 100 000 inhabitants per year since 1997. In 2004, the incidence rate in 2004 was 9.2 per 100 000, with substantial geographic disparities: the Ile-de-France region (including Paris and its suburbs) accounted for more than 40% of all reported cases (20.8 per 100 000). ⋯ Among those cases, 76.9% were laboratory-confirmed in 2004. National guidelines to improve case management and disease control were updated in 2003 and 2005. Funding must be made available to reinforce tuberculosis surveillance and to conduct public health initiatives targeted at the populations most at risk.
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The Law of 4 March, 2002, established regional commissions of conciliation and indemnification (CRCI) to enable the swift and amicable resolution of demands for damages due to medical care (including prevention and diagnosis) by private practitioners, private clinics, and public hospitals. The commission may decide that: (1) the physician or healthcare facility is liable (generally, indemnification by the insurance company), or (2) that indemnification is due in the name of 'national solidarity' (indemnification by a national organism called ONIAM), or (3) no damages are due. ⋯ The procedure applies only to care provided since 5 September 2001. From the request for indemnification by 'ONIAM or the insurer, the process must last no longer than one year.
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The two principal characteristics of tuberculosis treatment are its length (several months) and the need to use several antibiotics simultaneously (multiple drug therapy). Multiple drug therapy is intended to prevent the selection of resistant mutants at the beginning of treatment, when the bacilli population is largest. The length of treatment is due to dormant bacilli, which are much more difficult for antibiotics to kill than actively multiplying bacilli are. ⋯ When one of these drugs cannot be used because of resistance or toxicity, duration of treatment increases to the earlier levels. In the extreme case of multidrug-resistant tuberculosis where neither isoniazid nor rifampin can be used, and sometimes even not pyrazinamide, treatment is recommended for 18 to 24 months. New antituberculosis drugs under development allow us to envision further reduction in the duration of treatment of both drug-resistant and drug-sensitive tuberculosis.
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Law no. 2004-800 dated August 6, 2004, establishes new legal measures to facilitate live organ donation, in view of the shortage of organs for transplantation. We sought to assess the knowledge of this statute among hospital personnel. ⋯ Donations by live donors raise psychological as well as ethical and legal issues. This survey increased the awareness of hospital staff, provided them with information about the relevant law and, we hope, stimulated their thinking about the topic of live donations.