Symptomatic perception of patients affected by chronic chikungunya: a qualitative perspective / Percepção dos sintomas de pacientes acometidos por chikungunya crônica: um olhar qualitativo

Objective: To understand the demands caused by chikungunya in the chronic phase and their impacts on patients' mental health and quality of life. Materials and methods: This is a qualitative study, performed from November 2019 to January 2020. Focus groups and deep interviews were carried out. Then, the Discourse Analysis was performed. Results: Chronic pain was the main clinical manifestation reported by the participants, being responsible for affecting aspects related to quality of life and mental health. As for psycological view, this study showed that chronic pain was also reported as one of the main symptoms related to anxiety and depression among research subjects. Conclusion: this study demonstrated how the chronic illness caused by Chikungunya impacted the subjects' perception in the domains related to quality of life and mental health. Furthermore, we seek to focus on the management of disease in a holistic way, putting the patients' own awareness of the impacts of the disease on their lives in a relevant level of their treatment.

Objetivo: Compreender as demandas causadas pela chikungunya em sua fase crônica e seus impactos na saúde mental e na qualidade de vida dos pacientes. Métodos: Trata-se de um estudo com abordagem qualitativa, realizado entre novembro de 2019 a janeiro de 2020. Inicialmetne, foram realizados grupos focais e entrevistas em profundidade; seguidas da Análise do Discurso. Resultados: A dor crônica foi a principal manifestação clínica relatada pelos participantes, sendo responsável por afetar aspectos relacionados à qualidade de vida e saúde mental. Quanto ao aspecto psicológico, este estudo mostrou que a dor crônica também foi relatada como um dos principais sintomas relacionados à ansiedade e depressão entre os sujeitos da pesquisa. Conclusão: este estudo demonstrou como a doença crônica causada pela chikungunya impactou na percepção dos sujeitos em seus domínios relacionados à qualidade de vida e saúde mental. Além disso, procuramos centrar-nos na gestão da doença de forma holística, colocando a consciência dos próprios doentes sobre os impactos da doença nas suas vidas num nível relevante do seu tratamento.

Evaluation of pain, functional capacity and kinesiophobia in women in the chronic stage of chikungunya virus infection: A cross-sectional study in northeastern Brazil.

Arboviral diseases have been considered a global public health problem due to their growing territorial dispersion and impact on the population around the world. Individuals affected by the chikungunya virus go through an acute febrile illness associated with severe pain and long-lasting polyarthralgia. After the initial stage, infected individuals may progress to the chronic stage, which has an epidemic character and a high rate of disability and reduced mobility, impacting negatively on their quality of life. The aim of this study was to evaluate the relationship between pain, functional capacity, and kinesiophobia in individuals in the chronic stage of chikungunya virus infection. A cross-sectional study was conducted in the city of Natal, in Rio Grande do Norte, Brazil, between July and September 2018. The participants were 59 women in the chronic stage of chikungunya virus infection. Data were collected in at physical therapy outpatient clinic of the Federal University of Rio Grande do Norte (UFRN), using a socio-demographic questionnaire, the Visual Analogue Scale (VAS), the Nordic Musculoskeletal Questionnaire (NMQ), the Brief Pain Inventory (BPI), the Health Assessment Questionnaire (HAQ), and the Tampa Scale for Kinesiophobia (TSK). Descriptive statistics and bivariate analysis of the time data were conducted by simple regression. The participants' mean age was just over 50 years and average duration of virus infection was 21.54 months. Most participants had moderate to severe pain intensity that more frequent in the ankle and wrist joints. Functional capacity was low, and there was moderate fear of performing exercises and activities of daily living. Duration of infection was associated with increased pain intensity and loss of functional capacity. We can conclude that women in the chronic stage of chikungunya infection have significant pain, reduced functional capacity, and fear of performing common movements of daily living.

Screening for Depressive Mood During Acute Chikungunya Infection in Primary Healthcare Settings.

Background: We aimed to screen for depressive mood experienced during acute chikungunya (CHIKV) infection, and to evaluate the association of several exposures with the risk of depressive symptoms. Methods: A cross-sectional analysis of a multicenter cohort study took place and data from 354 adult individuals with confirmed CHIKV infection were analyzed. Participants were recruited in primary health care settings and the Patient Health Questionnaire-2 (PHQ-2) was used. Prevalence odds ratios (OR) and 95% confidence intervals (CIs) estimated by means of logistic models were used. Results: Depressive mood (PHQ-2 score 3 or higher) was reported by 44.1% of individuals. Subjects with articular effusion (OR = 3.37, 95% CI 1.77⁻8.11), gastrointestinal manifestations (diarrhea, vomiting or abdominal pain, OR = 1.97, 95 CI 1.21⁻3.19), and higher length of severe arthralgia (reference ≤ 14 days: 15⁻30 days, OR = 3.38, 95% CI 1.78⁻6.41; ≥ 30 days, OR = 1.69, 95% CI 0.95⁻3.01) were more likely to self-report depressive mood. Increasing age (≥ 40 years old, OR = 0.55, 95% CI 0.31⁻0.95) and rash (OR = 0.54, 95% CI 0.30⁻0.98) were associated with a decreased risk of depressive mood. Conclusions: Depressive mood seemed to be a frequent event among analyzed individuals, and markers associated with its risk were identified.

Public reaction to Chikungunya outbreaks in Italy-Insights from an extensive novel data streams-based structural equation modeling analysis.

The recent outbreak of Chikungunya virus in Italy represents a serious public health concern, which is attracting media coverage and generating public interest in terms of Internet searches and social media interactions. Here, we sought to assess the Chikungunya-related digital behavior and the interplay between epidemiological figures and novel data streams traffic. Reaction to the recent outbreak was analyzed in terms of Google Trends, Google News and Twitter traffic, Wikipedia visits and edits, and PubMed articles, exploiting structural modelling equations. A total of 233,678 page-views and 150 edits on the Italian Wikipedia page, 3,702 tweets, 149 scholarly articles, and 3,073 news articles were retrieved. The relationship between overall Chikungunya cases, as well as autochthonous cases, and tweets production was found to be fully mediated by Chikungunya-related web searches. However, in the allochthonous/imported cases model, tweet production was not found to be significantly mediated by epidemiological figures, with web searches still significantly mediating tweet production. Inconsistent relationships were detected in mediation models involving Wikipedia usage as a mediator variable. Similarly, the effect between news consumption and tweets production was suppressed by the Wikipedia usage. A further inconsistent mediation was found in the case of the effect between Wikipedia usage and tweets production, with web searches as a mediator variable. When adjusting for the Internet penetration index, similar findings could be obtained, with the important exception that in the adjusted model the relationship between GN and Twitter was found to be partially mediated by Wikipedia usage. Furthermore, the link between Wikipedia usage and PubMed/MEDLINE was fully mediated by GN, differently from what was found in the unadjusted model. In conclusion-a significant public reaction to the current Chikungunya outbreak was documented. Health authorities should be aware of this, recognizing the role of new technologies for collecting public concerns and replying to them, disseminating awareness and avoid misleading information.

Are Perceived Prevalences of Infection also Biased and How? Lessons from Large Epidemics of Mosquito-Borne Diseases in Tropical Regions.

BACKGROUND: Although people are likely to underestimate the frequencies of risks to health from common diseases and overestimate those from rare diseases, we still do not know much about reasons for this systematic bias, which is also referred to as "primary bias" in the literature. In this study, we take advantage of a series of large epidemics of mosquito-borne diseases to examine the accuracy of judgments of risk frequencies. In this aim, we assessed the perceived v. observed prevalence of infection by Zika, chikungunya or dengue fever during these outbreaks, as well as their variations among different subpopulations and epidemiological settings. METHODS: We used data drawn from 4 telephone surveys, conducted between 2006 and 2016, among representative samples of the adult population in tropical regions (Reunion, Martinique, and French Guiana). The participants were asked to estimate the prevalence of these infections by using a natural frequency scale. RESULTS: The surveys showed that 1) most people greatly overestimated the prevalence of infection by arbovirus, 2) these risk overestimations fell considerably as the actual prevalence of these diseases increased, 3) the better-educated and male participants consistently yielded less inaccurate risk estimates across epidemics, and 4) these biases in the perception of prevalence of these infectious diseases are relatively well predicted by the probability weighting function developed in the field of behavioral decision making. CONCLUSIONS: These findings suggest that the primary bias, which has been found in laboratory experiments to characterize a variety of probabilistic judgments, equally affects perception of prevalence of acute infectious diseases in epidemic settings. They also indicate that numeracy may play a considerable role in people's ability to transform epidemiological observations from their social environment to more accurate risk estimates.

Health-related impact on quality of life and coping strategies for chikungunya: A qualitative study in Curaçao.

INTRODUCTION: Chikungunya is an emerging public health problem in tropical and subtropical regions, due to ongoing transmission and its incapacitating acute disease phase, and chronic sequelae. The disease is responsible for a major impact on Health Related Quality of Life (HRQoL), which may last several years. To our knowledge, this study is the first qualitative examination of HRQoL and coping strategies of chikungunya-infected individuals. METHODS: Qualitative research methods consisted of 20 in-depth interviews and seven Focus Group Discussions (FGDs), n = 50. Analysis was based on the principles of the grounded theory. RESULTS: Different impacts on HRQoL were reported. The physical and emotional domains of the HRQoL were mainly affected by chikungunya, while social and individual financial consequences were limited. Individual financial impact was limited through the universal health care program of Curaçao. Long-term lingering musculoskeletal and other manifestations caused significant pain and limited mobility. Hence, participants experienced dependency, impairment of normal daily life activities, moodiness, hopelessness, a change of identity, and insecurity about their future. The unpredictable nature and consequences of chikungunya gave rise to various coping strategies. Problem-focused coping styles led to higher uptake of medical care and were linked to more negative impact of HRQoL, whereas emotional coping strategies focusing on acceptance of the situation were linked to less uptake of medical care and more positive impact on HRQoL. CONCLUSIONS: This study provides an in-depth understanding of acute and long-term HRQoL impact of chikungunya. The results can better inform health promotion policies and interventions. Messages to the public should focus on promoting healthy and efficient coping strategies, in order to prevent additional stress in affected individuals.

The Role of Risk Proximity in the Beliefs and Behaviors Related to Mosquito-Borne Diseases: The Case of Chikungunya in French Guiana.

Human behaviors are increasingly recognized to play a key role in the spread of infectious diseases. Although a set of social and cognitive determinants has been consistently found to affect the adoption of health protective behaviors aiming to control and prevent a variety of infections, little is currently known about the ecological drivers of these behaviors in epidemic settings. In this article, we took advantage of the outbreak of chikungunya, a reemerging mosquito-borne disease, that occurred in French Guiana in 2014-15 to test empirically the assumption proposed by Zielinski-Gutierrez and Hayden that the proximity of the disease and perceptions of the natural environment may considerably shape public response to an emerging health threat. To achieve this, a cross-sectional survey was conducted among high school students of the region (N = 1462) at an early stage of the epidemic. Surprisingly, spatial analysis of the collected data leads to counterintuitive results as the participants who lived in the most affected area expressed less concern about the disease and practiced preventive behaviors less frequently than did other participants. These paradoxical results may be attributed to the possible activation of risk denial processes which have previously been observed in the risk perception literature, and described by several social and psychological defensiveness theories.

Knowledge, Attitude and Practices of Vector-Borne Disease Prevention during the Emergence of a New Arbovirus: Implications for the Control of Chikungunya Virus in French Guiana.

BACKGROUND: During the last decade, French Guiana has been affected by major dengue fever outbreaks. Although this arbovirus has been a focus of many awareness campaigns, very little information is available about beliefs, attitudes and behaviors regarding vector-borne diseases among the population of French Guiana. During the first outbreak of the chikungunya virus, a quantitative survey was conducted among high school students to study experiences, practices and perceptions related to mosquito-borne diseases and to identify socio-demographic, cognitive and environmental factors that could be associated with the engagement in protective behaviors. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional survey was administered in May 2014, with a total of 1462 students interviewed. Classrooms were randomly selected using a two-stage selection procedure with cluster samples. A multiple correspondence analysis (MCA) associated with a hierarchical cluster analysis and with an ordinal logistic regression was performed. Chikungunya was less understood and perceived as a more dreadful disease than dengue fever. The analysis identified three groups of individual protection levels against mosquito-borne diseases: "low" (30%), "moderate" (42%) and "high" (28%)". Protective health behaviors were found to be performed more frequently among students who were female, had a parent with a higher educational status, lived in an individual house, and had a better understanding of the disease. CONCLUSIONS/SIGNIFICANCE: This study allowed us to estimate the level of protective practices against vector-borne diseases among students after the emergence of a new arbovirus. These results revealed that the adoption of protective behaviors is a multi-factorial process that depends on both sociocultural and cognitive factors. These findings may help public health authorities to strengthen communication and outreach strategies, thereby increasing the adoption of protective health behaviors, particularly in high-risk populations.