[Scared to death? Retrospective at the time of COVID-19]. / Mourir de peur ? Rétrospective au temps du COVID-19.

TITLE: Mourir de peur ? Rétrospective au temps du COVID-19. ABSTRACT: Un proverbe allemand du XIVe siècle disait que la peste s'attaque à ceux qui ont le plus peur. Est-ce la peur du virus qui tue ou le virus ? Des observateurs étrangers1 s'étonnent que le confinement jusqu'ici ait été dans l'ensemble respecté en France sans révoltes véritables. Les héritiers de la Révolution française ont admis une restriction sans précédent de leurs libertés et se sont soumis à la décision du confinement. La peur du virus inconnu, invisible et sournois, qui a frappé la population, mais aussi la peur de l'autorité et des contrôles, celle de l'Autre et celle de l'étranger possibles porteurs, sont probablement pour beaucoup dans cette résignation. Mais cette peur n'est-elle pas en soi délétère, comme semble nous le montrer une rétrospective sur les épidémies passées ?

Knowledge, attitude and practices on cholera in an arid county, Kenya, 2018: A mixed-methods approach.

BACKGROUND: Cholera remains a public health problem in Kenya despite increased efforts to create awareness. Assessment of knowledge, attitude and practice (KAP) in the community is essential for the planning and implementation of preventive measures. We assessed cholera KAP in a community in Isiolo County, Kenya. METHODS: This cross-sectional study involved a mixed-methods approach utilizing a questionnaire survey and focus group discussions (FGDs). Using multistage sampling with household as the secondary sampling unit, interviewers administered structured questionnaires to one respondent aged ≥18 years old per household. We created knowledge score by allotting one point for each correct response, considered any total score ≥ median score as high knowledge score, calculated descriptive statistics and used multivariate logistic regression to examine factors associated with high knowledge score. In FGDs, we randomly selected the participants aged ≥18 years and had lived in Isiolo for >1 year, conducted the FGDs using an interview guide and used content analysis to identify salient emerging themes. RESULTS: We interviewed 428 participants (median age = 30 years; Q1 = 25, Q3 = 38) comprising 372 (86.9%) females. Of the 425/428 (99.3%) who had heard about cholera, 311/425 (73.2%) knew that it is communicable. Although 273/428 (63.8%) respondents knew the importance of treating drinking water, only 216/421 (51.3%) treated drinking water. Those with good defecation practice were 209/428 (48.8%). Respondents with high knowledge score were 227/428 (53.0%). Positive attitude (aOR = 2.88, 95% C.I = 1.34-6.20), treating drinking water (aOR = 2.21, 95% C.I = 1.47-3.33), age <36 years (aOR = 1.75, 95% C.I = 1.11-2.74) and formal education (aOR = 1.71, 95% C.I = 1.08-2.68) were independently associated with high knowledge score. FGDs showed poor latrine coverage, inadequate water treatment and socio-cultural beliefs as barriers to cholera prevention and control. CONCLUSIONS: There was a high knowledge score on cholera with gaps in preventive practices. We recommend targeted health education to the old and uneducated persons and general strengthening of health education in the community.

Risk perception and behavioral change during epidemics: Comparing models of individual and collective learning.

Modern societies are exposed to a myriad of risks ranging from disease to natural hazards and technological disruptions. Exploring how the awareness of risk spreads and how it triggers a diffusion of coping strategies is prominent in the research agenda of various domains. It requires a deep understanding of how individuals perceive risks and communicate about the effectiveness of protective measures, highlighting learning and social interaction as the core mechanisms driving such processes. Methodological approaches that range from purely physics-based diffusion models to data-driven environmental methods rely on agent-based modeling to accommodate context-dependent learning and social interactions in a diffusion process. Mixing agent-based modeling with data-driven machine learning has become popularity. However, little attention has been paid to the role of intelligent learning in risk appraisal and protective decisions, whether used in an individual or a collective process. The differences between collective learning and individual learning have not been sufficiently explored in diffusion modeling in general and in agent-based models of socio-environmental systems in particular. To address this research gap, we explored the implications of intelligent learning on the gradient from individual to collective learning, using an agent-based model enhanced by machine learning. Our simulation experiments showed that individual intelligent judgement about risks and the selection of coping strategies by groups with majority votes were outperformed by leader-based groups and even individuals deciding alone. Social interactions appeared essential for both individual learning and group learning. The choice of how to represent social learning in an agent-based model could be driven by existing cultural and social norms prevalent in a modeled society.

"It depends how one understands it:" a qualitative study on differential uptake of oral cholera vaccine in three compounds in Lusaka, Zambia.

BACKGROUND: The Zambian Ministry of Health implemented a reactive one-dose Oral Cholera Vaccine (OCV) campaign in April 2016 in three Lusaka compounds, followed by a pre-emptive second-round in December. Understanding uptake of this first-ever two-dose OCV campaign is critical to design effective OCV campaigns and for delivery of oral vaccines in the country and the region. METHODS: We conducted 12 Focus Group Discussions (FGDs) with men and women who self-reported taking no OCV doses and six with those self-reporting taking both doses. Simple descriptive analysis was conducted on socio-demographic and cholera-related data collected using a short questionnaire. We analyzed transcribed FGDs using the framework of dose, gender and geographic location. RESULTS: No differences were found by gender and location. All participants thought cholera to be severe and the reactive OCV campaign as relevant if efficacious. Most reported not receiving information on OCV side-effects and duration of protection. Those who took both doses listed more risk factors (including 'wind') and felt personally susceptible to cholera and protected by OCV. Some described OCV side-effects, mostly diarrhoea, vomiting and dizziness, as the expulsion of causative agents. Those who did not take OCV felt protected by their good personal hygiene practices or, thought of themselves and OCV as powerless against the multiple causes of cholera including poor living conditions, water, wind, and curse. Most of those who did not take OCV feared side-effects reported by others. Some interpreted side-effects as 'western' malevolence. Though > 80% discussants reported not knowing duration of protection, some who did not vaccinate, suggested that rather than rely on OCV which could lose potency, collective action should be taken to change the physical and economic environment to prevent cholera. CONCLUSIONS: Due to incomplete information, individual decision-making was complex, rooted in theories of disease causation, perceived susceptibility, circulating narratives, colonial past, and observable outcomes of vaccination. To increase coverage, future OCV campaigns may benefit from better communication on eligibility and susceptibility, expected side effects, mechanism of action, and duration of protection. Governmental improvements in the physical and economic environment may increase confidence in OCV and other public health interventions among residents in Lusaka compounds.

Influence of human behavior on cholera dynamics.

This paper is devoted to studying the impact of human behavior on cholera infection. We start with a cholera ordinary differential equation (ODE) model that incorporates human behavior via modeling disease prevalence dependent contact rates for direct and indirect transmissions and infectious host shedding. Local and global dynamics of the model are analyzed with respect to the basic reproduction number. We then extend the ODE model to a reaction-convection-diffusion partial differential equation (PDE) model that accounts for the movement of both human hosts and bacteria. Particularly, we investigate the cholera spreading speed by analyzing the traveling wave solutions of the PDE model, and disease threshold dynamics by numerically evaluating the basic reproduction number of the PDE model. Our results show that human behavior can reduce (a) the endemic and epidemic levels, (b) cholera spreading speeds and (c) the risk of infection (characterized by the basic reproduction number).

Relación entre estados de ánimo y rendimiento en voleibol masculino de alto nivel / Relationship between mood states and performance in elite male volleyball / Relação entre estados de humor e desempenho no voleibol masculino de alto rendimento

El presente estudio, valiéndose de un diseño ex post facto retrospectivo, analizó la relación entre los estados de ánimo precompetitivos y el rendimiento deportivo de un equipo de doce jugadores de voleibol durante el campeonato del mundo de Brasil-2011, categoría masculina sub-20. Para la medición de los estados de ánimo se utilizó el instrumento Profile of Moods States (POMS). La medición del rendimiento deportivo se llevó a cabo a partir de dos instrumentos: por una parte, una escala de valoración o percepción de los entrenadores a propósito del rendimiento de sus jugadores y, por otra, el software Data Voley System. Se procedió con estadística descriptiva y estadística inferencial no paramétrica. Los participantes mostraron un perfil anímico de alto vigor, moderada tensión, baja cólera, y mínima fatiga y depresión. Se detalla la relación entre las variables estudiadas y se discute cómo el hecho de perder un partido que tuvo como consecuencia la exclusión del equipo a la opción de ganar medalla, influyó hacia una menor tensión y vigor de los jugadores, a la vez que aumentó la depresión y la fatiga

This paper presents an ex post facto study. The aim was to analyse the relationship between pre-competition mood states and sports performance in a team of twelve male players from the under 20 category during the Brazil 2011 World Volleyball Championship. The Profile of Mood States (POMS) was used to measure mood, while sports performance was measured using two instruments: on the one hand, a scale for the coach’s perception of his players’ sports performance and, on the other, Data Volley System software. The data was analysed using descriptive and non-parametric inferential statistics. The participants showed a high drive, moderate stress, and low anger, with minimal fatigue and depression. The paper outlines significant relationships among the variables under analysis. It is noted that when the team lost a match, thus losing out on the chance to win a medal, the players’ moods changed: they felt less stressed and their drive fell, while their sense of depression and fatigue rose

O presente estudo, utilizando um delineamento ex post facto retrospectivo, analisou a relação entre os estados de humor pré-competitivos e o rendimento desportivo de uma equipa de doze jogadores de voleibol durante o Campeonato do Mundo Brasil 2011, escalão sub-20 masculino. Para avaliação dos estados de humor foi utilizado o Profile of Moods States (POMS). A avaliação do rendimento desportivo foi levado a cabo através de dois instrumentos: um primeiro, uma escala de avaliação ou percepção dos treinadores a propósito do rendimento dos seus jogadores, e outro, o software Data Voley System. Procedeu-se a uma análise estatística descritiva e inferencial não paramétrica. Os participantes revelaram um perfil de alto vigor, moderada tensão, baixa cólera, fadiga e depressão mínimas. Explana-se a relação entre as variáveis estudadas e discute-se como o facto da derrota num jogo que teve como consequência a exclusão da equipa da luta pela medalha, influenciou uma menor tensão e vigor dos jogadores, aumentando por sua vez a depressão e fadiga nos mesmos

Comparing sociocultural features of cholera in three endemic African settings.

BACKGROUND: Cholera mainly affects developing countries where safe water supply and sanitation infrastructure are often rudimentary. Sub-Saharan Africa is a cholera hotspot. Effective cholera control requires not only a professional assessment, but also consideration of community-based priorities. The present work compares local sociocultural features of endemic cholera in urban and rural sites from three field studies in southeastern Democratic Republic of Congo (SE-DRC), western Kenya and Zanzibar. METHODS: A vignette-based semistructured interview was used in 2008 in Zanzibar to study sociocultural features of cholera-related illness among 356 men and women from urban and rural communities. Similar cross-sectional surveys were performed in western Kenya (n = 379) and in SE-DRC (n = 360) in 2010. Systematic comparison across all settings considered the following domains: illness identification; perceived seriousness, potential fatality and past household episodes; illness-related experience; meaning; knowledge of prevention; help-seeking behavior; and perceived vulnerability. RESULTS: Cholera is well known in all three settings and is understood to have a significant impact on people's lives. Its social impact was mainly characterized by financial concerns. Problems with unsafe water, sanitation and dirty environments were the most common perceived causes across settings; nonetheless, non-biomedical explanations were widespread in rural areas of SE-DRC and Zanzibar. Safe food and water and vaccines were prioritized for prevention in SE-DRC. Safe water was prioritized in western Kenya along with sanitation and health education. The latter two were also prioritized in Zanzibar. Use of oral rehydration solutions and rehydration was a top priority everywhere; healthcare facilities were universally reported as a primary source of help. Respondents in SE-DRC and Zanzibar reported cholera as affecting almost everybody without differentiating much for gender, age and class. In contrast, in western Kenya, gender differentiation was pronounced, and children and the poor were regarded as most vulnerable to cholera. CONCLUSIONS: This comprehensive review identified common and distinctive features of local understandings of cholera. Classical treatment (that is, rehydration) was highlighted as a priority for control in the three African study settings and is likely to be identified in the region beyond. Findings indicate the value of insight from community studies to guide local program planning for cholera control and elimination.

Distinguishing social and cultural features of cholera in urban and rural areas of Western Kenya: Implications for public health.

Urban and rural areas have distinctive health problems, which require consideration. To examine sociocultural features of cholera and its community context, a semi-structured explanatory model interview based on vignettes depicting typical clinical features of cholera was used to interview 379 urban and rural respondents in Western Kenya. Findings included common and distinctive urban and rural ideas about cholera, and its prevention and treatment. The three most commonly perceived causes among urban and rural respondents collectively were drinking contaminated water, living in a dirty environment and lacking latrines. However, a dirty environment and flies were more prominently perceived causes among urban respondents. Rural respondents were less likely to identify additional symptoms and more likely to identify biomedically irrelevant perceived causes of cholera. Oral rehydration therapy was the most frequently reported home treatment. Health facilities were recommended unanimously at both sites. For prevention, rural respondents were more likely to suggest medicines, and urban respondents were more likely to suggest health education and clean food. Findings indicate community priority, demand for and potential effectiveness of enhanced efforts to control cholera in Western Kenya, and they suggest strategies that are particularly well suited for control of cholera in urban and rural areas.

Death by the numbers.

A review of Steven Johnson's The ghost map: the story of London's most terrifying epidemic- and how it changed science, cities and the modern world (New York: Riverhead Books, 2006),

Hope in a time of cholera.

What are the internal conditions or mental states that may facilitate the moving on with life? How does one explain that some, after undergoing severe trauma, fail to go on with productive and creative lives while others do? In this paper, I shall explore the effect of hope and its central position in mobilizing traumatized individuals so that they can move on with their lives. I shall be focusing on a specific aspect of trauma often neglected in the literature, namely the trauma elicited by the sudden, almost overnight loss of monetary funds accumulated over years of hard work. I will be referring to the psychological impact suffered by Argentineans after severe economic measures taken by the government in late 2001. I shall delve into these solutions and attempt to explore their influence on a contemporary exodus from Argentina. Hope nurtured by despair will be discussed. Is hope a mere palliative, a mental configuration coupling with a furtive affective state? Hope joins the ranks of religion in building a buffer against the silent awareness of inner despair-the most private of madness. I shall try to discuss how hope brings to the fore psyche's devices that are deployed in attempting to deal with our deepest fears.

[Cholera++ epidemic in Kenya]. / Epidémie de choléra au Kenya.

A cholera epidemic in 1997 followed on the heels of the 1992 epidemic that claimed thousands of victims in Kenya. This time, it emerged in the Migori district near the Tanzanian border, when a woman who had married in Tanzania brought her five-month-old baby to visit her parents. The infant, who contracted serious diarrhea and vomiting, died before the mother could reach a dispensary. During the funeral, a perfect opportunity for the disease to spread, those attending observed the traditional ritual of touching the corpse, and then ate and drank with the next of kin. Many developed symptoms of cholera, and several died in the next few days, even before first aid could be administered. At the Public Health Laboratory in Nairobi, analyses confirmed the presence of the Ogawa strain of Vibrio cholerae. Given the global reputation of Médecins Sans Frontières [Doctors Without Borders] in the field of cholera, the head of public health for Homa Bay District issued a call for help in August 1997, asking the team to provide preventive solutions and assess the gravity of the situation. Despite intense logistical, technical and health initiatives, the epidemic spread like wildfire. Five months after the initial outbreak, in February 1998, two Canadian nurses working for MSF in Homa Bay hurriedly surveyed the situation in Nyanza Province, which has a population of three million. The author accompanied one of these nurses, Joceline Roy, a Quebecer in her forties, on a tour that lasted more than 15 hours. Roy worked conscientiously, with great precision and energy. This narrative conveys much more than the fatigue and hazards of travel in the developing world; it tells the story of an important, but little publicized, aspect of nursing.

Cultural models of diarrheal illness: conceptual framework and review.

Health planning for diarrheal diseases must be responsive to both epidemiological patterns and local perceptions of health, illness and need. A conceptual framework that relates patterns of distress, explanatory models, help seeking and treatment practices to knowledge and use of oral rehydration therapy (ORT), dietary management, other specific treatments and health policy issues provides the basis for our review of research on diarrheal illness-related beliefs and practices. The ethnomedical model asserts that efforts to secure the compliance of target populations are likely to be inadequate without an alliance between health professionals and communities to identify and address mutually comprehensible objectives that are perceived locally as meaningful and relevant. An appreciation of local cultural models and the diversity of cultural contexts enables health professionals to (1) recognize the significance of local perceptions of diarrheal illness with respect to pertinent outcomes and perceived needs, (2) develop ways to introduce recommendations that communities will accept, and (3) make appropriate use of existing community resources representing local traditions. An agenda for needed research concludes the review.