Spread of awareness of COVID-19 between December 2019 and March 2020 in France

During the early phase of outbreaks, awareness of the presence of the disease plays an important role in transmission dynamics. To investigate the processes of how people become aware of a disease, we conducted two complementary investigations. First, we surveyed 868 academic researchers in France, on the time and circumstances when they became aware of COVID-19 as an important event. We found that 25% did so before February 18th (first death in France), 50% did so before March 10th (first presidential allocution) and 75% did so before March 16th (announcement of the lockdown). Awareness came from nine categories of circumstances: (1) decisions taken by the government (elicited by 35.7% participants); (2) information from media or social media (24.7%); (3) conversation with friends (22.4%); (4) observed changes in their personal lives (14.0%); (5) decisions taken by the employer (9.2%); (6) observed changes at work (9.9%); (7) suspected case of COVID-19 in their entourage (3.1%); (8) fear for oneself or their entourage (2.8%) and (9) self-appraisal of scientific reports (2.8%). Second, we appraised three general media in France (a television news show, a radio news show, and a newspaper) and showed that COVID-19 became a preeminent topic only after March 1st 2020 when the epidemic is present on national soil. Our results show that multiple intricated factors prompt the awareness of an emerging infectious disease. Awareness is not solely driven by general media as they begin to focus on the topic late.

Entre déni et considération, le corps de l’enfant dans les procédures judiciaires d’infanticides

Cadre de la recherche: une recherche rétrospective sur les morts suspectes d’enfants de moins d’un an réalisée en France a permis de constituer deux bases de données, une base de données judiciaires et une base d’articles de presse. L’analyse de ces données a donné lieu à plusieurs publications qui précisent les déterminants psychosociaux des infanticides et caractérisent le traitement des institutions de la police, de la justice et de la presse vis-à-vis de ces homicides.

Objectifs : Il s’agit d’étudier quelle place est réservée au corps de l’enfant décédé dans ces procédures d’infanticides et d’en inférer les conceptions de l’enfant qui sous-tendent les discours et les pratiques des différents acteurs (parents, mis en cause, témoins, acteurs de la police et de la justice).

Méthodologie : L’analyse porte sur des données textuelles issues de dossiers judicaires et d’articles de presse et compare des affaires d’infanticides similaires quant aux actes incriminés, mais aux traitements judiciaires et médiatiques contrastés et présentant des conclusions judiciaires hétérogènes.

Résultats : Le corps de l’enfant décédé est considéré comme un corps-objet et non comme un corps-sujet. Ce corps-objet est instrumentalisé par les différents acteurs de la procédure dans la perspective, consciente ou non, d’influencer la conclusion judiciaire. Il est alors corps politique soumis aux rivalités de différentes légitimités.

Conclusions : Plusieurs facteurs contribuent à ce que le corps de l’enfant décédé soit objectalisé et instrumentalisé : la mort, qui en elle-même favorise une conception du corps comme objet, le manque de reconnaissance sociale des victimes qui résulte de leur jeune âge, l’idée que les enfants appartiennent aux parents. La conception de l’enfant comme personne apparaît incertaine.

Contribution : Ces affaires d’infanticide questionnent la conception de l’enfant comme personne. Il semble que deux conceptions coexistent : l’enfant est une personne dès sa naissance, l’enfant n’est pas tout à fait une personne tant qu’il n’a pas été prénommé, n’a pas développé de relations, n’a pas eu une existence sociale et publique.

[The profile of neonaticide mothers in legal expertise]

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.

Analysis of the relationship between neonaticide and denial of pregnancy using data from judicial files

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.

[Pathology seen in French "Hikikomori"]

Young people who meet the definition of "Hikikomori" have come to be seen in France since around 2008. However, simply "fitting the definition" does not necessarily mean that they are the same as "Hikikomori" in Japan. Rather, it is important to ask what kind of young people "fit the definition of Hikikomori in France" and what kind of pathology they have. With these questions, our Japanese-French joint research team comprising specialists in various fields conducted a survey of "Hikikomori" in French youth, with support from a Grant-in-Aid for Scientific Research B (overseas research), and started a comparative joint study on "Hikikomori" in Japan and "Hikikomori" in France. In that study it was found that whereas one aspect of "Hikikomori" in Japan is described by the word déraillement (coming off the "rails"), "Hikikomori" in France is a state closer to dropping out and is accompanied by a type of "sense of insufficiency". This "sense of insufficiency" is above all related to something in the society and culture of France, and an investigation of how it is linked to "Hikikomori" is an issue for the future.

[Pregnancy and poly-drug use: changes in patient population and care, 1999-2008]

Changes in drug use in the general French population over the last decade have also been observed among pregnant women. There have also been significant changes in the treatment of substance users. Data relating to maternal drug use and the treatment of drug-using mothers were collected based on a retrospective cohort of 170 newborns with mothers using at least two different substances. The decrease in the proportion of heroin-users, the rise of opiate maintenance treatments and cannabis, and the development of new forms of treatment are linked to shorter maternity stays for newborns and shorter treatments for neonatal abstinence syndrome. The percentage of preterm births and of children placed in foster care is also on the decrease. Changes in drug use among mothers and new forms of treatment given to mother-infant dyads may account for the decrease in treatment for NAS, the shorter length of hospital stays, and the decreasing number of children placed in foster care.

[Consequences for the newborn of alcohol consumption during pregnancy]

BACKGROUND

This paper aims at showing the immediate and long-term consequences affecting newborns whose mothers did not reduce or stop their consumption of alcohol when they were pregnant; these women were chosen among women who also used psychoactive substances.

METHODS

A retrospective cohort was constituted of babies who were found to have been exposed in utero to one or more legal or illegal psychoactive substance(s) and who were born or hospitalized between 1999 and 2008 in a hospital near Paris. Among the cohort of 170 babies, 56 had mothers who had not modified their alcohol consumption when they were pregnant, 30 had mothers who had reduced their alcohol consumption, and 84 had mothers who declared having been abstinent.

RESULTS

The babies born to mothers who did not modify their alcohol consumption when pregnant were more likely to be premature (30%) and hospitalized in the neonatology hospital unit (60.7%). They needed specific care for durations significantly longer than the babies exposed in utero to other psychoactive substances (P<0.005). They were more often diagnosed with fetal alcohol spectrum disorders (18%) and placed in a foster family (18%).

CONCLUSION

Given the negative consequences on the babies born to mothers who do not modify their alcohol consumption when pregnant, these mothers should be identified and provided with better care. The successful strategies for early therapeutic interventions used in other countries should be studied as examples. This would make it possible to reduce the enormous financial, material and human costs that are a direct consequence of alcohol consumption during pregnancy.