Effective Risk Communication for Public Health Emergency: Reflection on the COVID-19 (2019-nCoV) Outbreak in Wuhan, China
Identifieur interne : 000C61 ( Ncbi/Merge ); précédent : 000C60; suivant : 000C62Effective Risk Communication for Public Health Emergency: Reflection on the COVID-19 (2019-nCoV) Outbreak in Wuhan, China
Auteurs : Liwei Zhang ; Huijie Li ; Kelin ChenSource :
- Healthcare [ 2227-9032 ] ; 2020.
Abstract
Risk communication is critical to emergency management. The objective of this paper is to illustrate the effective process and attention points of risk communication reflecting on the COVID-19 (2019-nCoV) outbreak in Wuhan, China. We provide the timeline of risk communication progress in Wuhan and use a message-centered approach to identify problems that it entailed. It was found that the delayed decision making of the local government officials and the limited information disclosure should be mainly responsible for the ineffective risk communication. The principles for effective risk communication concerning Wuhan’s outbreak management were also discussed. The whole communication process is suggested to integrate the accessibility and openness of risk information, the timing and frequency of communication, and the strategies dealing with uncertainties. Based on these principles and lessons from Wuhan’s case, this paper employed a simplified Government–Expert–Public risk communication model to illustrate a collaborative network for effective risk communication.
Url:
DOI: 10.3390/healthcare8010064
PubMed: 32245157
PubMed Central: 7151105
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effective Risk Communication for Public Health Emergency: Reflection on the COVID-19 (2019-nCoV) Outbreak in Wuhan, China</title><author><name sortKey="Zhang, Liwei" sort="Zhang, Liwei" uniqKey="Zhang L" first="Liwei" last="Zhang">Liwei Zhang</name><affiliation><nlm:aff id="af1-healthcare-08-00064">School of Public Administration, Jilin University, Changchun 130012, China;<email>lihuijie@jlu.edu.cn</email></nlm:aff></affiliation></author><author><name sortKey="Li, Huijie" sort="Li, Huijie" uniqKey="Li H" first="Huijie" last="Li">Huijie Li</name><affiliation><nlm:aff id="af1-healthcare-08-00064">School of Public Administration, Jilin University, Changchun 130012, China;<email>lihuijie@jlu.edu.cn</email></nlm:aff></affiliation></author><author><name sortKey="Chen, Kelin" sort="Chen, Kelin" uniqKey="Chen K" first="Kelin" last="Chen">Kelin Chen</name><affiliation><nlm:aff id="af2-healthcare-08-00064">Institute of Urban Governance, Shenzhen University, Shenzhen 518060, China;<email>chenkelin@szu.edu.cn</email></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32245157</idno><idno type="pmc">7151105</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151105</idno><idno type="RBID">PMC:7151105</idno><idno type="doi">10.3390/healthcare8010064</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000672</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000672</idno><idno type="wicri:Area/Pmc/Curation">000672</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000672</idno><idno type="wicri:Area/Pmc/Checkpoint">000446</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000446</idno><idno type="wicri:Area/Ncbi/Merge">000C61</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effective Risk Communication for Public Health Emergency: Reflection on the COVID-19 (2019-nCoV) Outbreak in Wuhan, China</title><author><name sortKey="Zhang, Liwei" sort="Zhang, Liwei" uniqKey="Zhang L" first="Liwei" last="Zhang">Liwei Zhang</name><affiliation><nlm:aff id="af1-healthcare-08-00064">School of Public Administration, Jilin University, Changchun 130012, China;<email>lihuijie@jlu.edu.cn</email></nlm:aff></affiliation></author><author><name sortKey="Li, Huijie" sort="Li, Huijie" uniqKey="Li H" first="Huijie" last="Li">Huijie Li</name><affiliation><nlm:aff id="af1-healthcare-08-00064">School of Public Administration, Jilin University, Changchun 130012, China;<email>lihuijie@jlu.edu.cn</email></nlm:aff></affiliation></author><author><name sortKey="Chen, Kelin" sort="Chen, Kelin" uniqKey="Chen K" first="Kelin" last="Chen">Kelin Chen</name><affiliation><nlm:aff id="af2-healthcare-08-00064">Institute of Urban Governance, Shenzhen University, Shenzhen 518060, China;<email>chenkelin@szu.edu.cn</email></nlm:aff></affiliation></author></analytic><series><title level="j">Healthcare</title><idno type="eISSN">2227-9032</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Risk communication is critical to emergency management. The objective of this paper is to illustrate the effective process and attention points of risk communication reflecting on the COVID-19 (2019-nCoV) outbreak in Wuhan, China. We provide the timeline of risk communication progress in Wuhan and use a message-centered approach to identify problems that it entailed. It was found that the delayed decision making of the local government officials and the limited information disclosure should be mainly responsible for the ineffective risk communication. The principles for effective risk communication concerning Wuhan’s outbreak management were also discussed. The whole communication process is suggested to integrate the accessibility and openness of risk information, the timing and frequency of communication, and the strategies dealing with uncertainties. Based on these principles and lessons from Wuhan’s case, this paper employed a simplified Government–Expert–Public risk communication model to illustrate a collaborative network for effective risk communication.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kenis, P" uniqKey="Kenis P">P. Kenis</name></author><author><name sortKey="Schol, L G" uniqKey="Schol L">L.G. Schol</name></author><author><name sortKey="Kraaj Dirkzwager, M M" uniqKey="Kraaj Dirkzwager M">M.M. Kraaj-Dirkzwager</name></author><author><name sortKey="Timen, A" uniqKey="Timen A">A. Timen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Campbell Lendrum, D" uniqKey="Campbell Lendrum D">D. Campbell-lendrum</name></author><author><name sortKey="Manga, L" uniqKey="Manga L">L. Manga</name></author><author><name sortKey="Bagayoko, M" uniqKey="Bagayoko M">M. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Healthcare (Basel)</journal-id><journal-id journal-id-type="iso-abbrev">Healthcare (Basel)</journal-id><journal-id journal-id-type="publisher-id">healthcare</journal-id><journal-title-group><journal-title>Healthcare</journal-title></journal-title-group><issn pub-type="epub">2227-9032</issn><publisher><publisher-name>MDPI</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32245157</article-id><article-id pub-id-type="pmc">7151105</article-id><article-id pub-id-type="doi">10.3390/healthcare8010064</article-id><article-id pub-id-type="publisher-id">healthcare-08-00064</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Effective Risk Communication for Public Health Emergency: Reflection on the COVID-19 (2019-nCoV) Outbreak in Wuhan, China</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="true">https://orcid.org/0000-0002-9243-8338</contrib-id><name><surname>Zhang</surname><given-names>Liwei</given-names></name><xref ref-type="aff" rid="af1-healthcare-08-00064">1</xref><xref rid="c1-healthcare-08-00064" ref-type="corresp">*</xref></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Huijie</given-names></name><xref ref-type="aff" rid="af1-healthcare-08-00064">1</xref></contrib><contrib contrib-type="author"><name><surname>Chen</surname><given-names>Kelin</given-names></name><xref ref-type="aff" rid="af2-healthcare-08-00064">2</xref></contrib></contrib-group><aff id="af1-healthcare-08-00064"><label>1</label>School of Public Administration, Jilin University, Changchun 130012, China;<email>lihuijie@jlu.edu.cn</email></aff><aff id="af2-healthcare-08-00064"><label>2</label>Institute of Urban Governance, Shenzhen University, Shenzhen 518060, China;<email>chenkelin@szu.edu.cn</email></aff><author-notes><corresp id="c1-healthcare-08-00064"><label>*</label>Correspondence: <email>zhanglw16@mails.jlu.edu.cn</email>; Tel.: +86-188-0417-5058</corresp></author-notes><pub-date pub-type="epub"><day>21</day><month>3</month><year>2020</year></pub-date><pub-date pub-type="collection"><month>3</month><year>2020</year></pub-date><volume>8</volume><issue>1</issue><elocation-id>64</elocation-id><history><date date-type="received"><day>27</day><month>2</month><year>2020</year></date><date date-type="accepted"><day>18</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 by the authors.</copyright-statement><copyright-year>2020</copyright-year><license license-type="open-access"><license-p>Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>).</license-p></license></permissions><abstract><p>Risk communication is critical to emergency management. The objective of this paper is to illustrate the effective process and attention points of risk communication reflecting on the COVID-19 (2019-nCoV) outbreak in Wuhan, China. We provide the timeline of risk communication progress in Wuhan and use a message-centered approach to identify problems that it entailed. It was found that the delayed decision making of the local government officials and the limited information disclosure should be mainly responsible for the ineffective risk communication. The principles for effective risk communication concerning Wuhan’s outbreak management were also discussed. The whole communication process is suggested to integrate the accessibility and openness of risk information, the timing and frequency of communication, and the strategies dealing with uncertainties. Based on these principles and lessons from Wuhan’s case, this paper employed a simplified Government–Expert–Public risk communication model to illustrate a collaborative network for effective risk communication.</p></abstract><kwd-group><kwd>risk communication</kwd><kwd>public health</kwd><kwd>outbreak management</kwd><kwd>COVID-19</kwd></kwd-group></article-meta></front><floats-group><fig id="healthcare-08-00064-f001" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Timeline of official reports about infected cases by the Wuhan Health Commission. <bold>Source:</bold> This timeline is a processing of data from Website of Wuhan Health Commission and a generalized report and in-depth investigation from China Business Network [<xref rid="B10-healthcare-08-00064" ref-type="bibr">10</xref>,<xref rid="B11-healthcare-08-00064" ref-type="bibr">11</xref>]. Note: Blue represents “No report”; Red represents Wuhan and Hubei’s Congress; Date in yellow represents confirmed infected case of medical worker.</p></caption><graphic xlink:href="healthcare-08-00064-g001"></graphic></fig><fig id="healthcare-08-00064-f002" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Government–Expert–Public Risk Communication model.</p></caption><graphic xlink:href="healthcare-08-00064-g002"></graphic></fig><table-wrap id="healthcare-08-00064-t001" orientation="portrait" position="float"><object-id pub-id-type="pii">healthcare-08-00064-t001_Table 1</object-id><label>Table 1</label><caption><p>The message-centered approach and its best practices of risk communication.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Best Practices for Risk Communication</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Description</th></tr></thead><tbody><tr><td align="center" valign="middle" rowspan="1" colspan="1">Infuse risk communication into policy decisions</td><td align="center" valign="middle" rowspan="1" colspan="1">Policies about risk may evolve and be communicated in a variety of ways. Decision making needs to be based on constant risk communication.</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Treat risk communication as a process</td><td align="center" valign="middle" rowspan="1" colspan="1">Effective risk communication is a dynamic, interactive, and adaptive process.</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Account for the uncertainty inherent in risk</td><td align="center" valign="middle" rowspan="1" colspan="1">Using equivocal messages to convey risk information.</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Design risk messages to be culturally sensitive</td><td align="center" valign="middle" rowspan="1" colspan="1">Risk communication should fit specific features of the audience. These features include gender, education, age, and culture.</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Acknowledge diverse levels of risk tolerance</td><td align="center" valign="middle" rowspan="1" colspan="1">People have widely varying capacities to process risk messages, including scientific and technical understandings of risk.</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Involve the public in dialogue about risk</td><td align="center" valign="middle" rowspan="1" colspan="1">Risk communication dialogues should involve collaborations between the government, industry, and citizens that are open, inclusive, and deliberative.</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Present risk messages with honesty</td><td align="center" valign="middle" rowspan="1" colspan="1">Risk communication should be an open, honest, and frank process, instead of essentially manipulative.</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Meet risk perception needs by remaining open and accessible to the public</td><td align="center" valign="middle" rowspan="1" colspan="1">Honest communication is accessible and open as well, which means that the public can receive messages by various channels.</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Collaborate and coordinate about risk with credible information sources</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Coordination of risk communication strategies requires information sharing and establishing networks of working relationships between groups and agencies.</td></tr></tbody></table><table-wrap-foot><fn><p><bold>Source:</bold> This table is a content summary from Sellnow et al. [<xref rid="B8-healthcare-08-00064" ref-type="bibr">8</xref>] (pp. 19–29).</p></fn></table-wrap-foot></table-wrap><table-wrap id="healthcare-08-00064-t002" orientation="portrait" position="float"><object-id pub-id-type="pii">healthcare-08-00064-t002_Table 2</object-id><label>Table 2</label><caption><p>Risk communication timeline of COVID-19 outbreak management.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Date</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Internal Communication</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">External Communication</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Other Events Related to COVID-19 Information Disclosure</th></tr></thead><tbody><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">27 December 2019</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Initial report: A doctor named Zhang Jixian reported cases related to COVID-19 to the Health Commissions of Wuhan and Hubei Province.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">29 to 30 December 2019</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Initial investigation: The Health Commission of Wuhan required that all medical institutions must investigate patients who have such unknown pneumonia privately.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Private whistleblowing: An ophthalmologist named Li Wenliang used social media to whistleblow that seven cases associated with SARS were identified and that detailed experimentation was ongoing.</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">31 December 2019</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Action at the Central level: The National Health Commission’s initial action for organizing a group to investigate the outbreak.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Initial announcement: The Health Commission of Wuhan publicly announced the outbreak but highlighted that there was no evidence of human-to-human transmission, that no medical workers were infected, and that this outbreak could be prevented and controlled.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">1 January 2020</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">“Attacking the rumor”: Li Wenliang and a further seven doctors were interrogated for “spreading rumors”.</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">3 to 5 January 2020</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Further Evidence submitted: An academic group from Fudan University, Shanghai, found the SARS-like coronavirus and submitted the finding to the National Health Commission on 5 January.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Official announcement: Official announcement repeatedly conveyed that there was no evidence of human-to-human transmission, that no medical workers were infected, and that this outbreak was preventable and controllable.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">6 January 2020</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Response at the Central level: The Chinese Center for Disease Control and Prevention (CCDC) activated II Level Response of Public Health Emergency.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">7 January 2020</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Supreme direction: The Leader of the Chinese Communist Party (CCP), Xi Jinping, arranged countermeasures to respond to this outbreak.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Official explanation on confirming a new coronavirus: Chinese official media announced there is a new coronavirus that has emerged in Wuhan.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">10 January 2020</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Scientific explanation and risk assessment from expert: A medical expert at Peking University indicated that the outbreak can be controlled.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">15 January 2020</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Upgrading the response at the Central level: CCDC activated the highest I Level Response of Public Health Emergency.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">16 January 2020</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Official risk assessment: Wuhan municipal authority informed that there is low risk in persistent person-to-person transmission.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">17 January 2020</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Divergence in the epidemiological investigation: An academic group from Hong Kong University found evidence of person-to-person transmission and infection without symptoms. An expert named Kwok-Yung Yeun reported the finding to CCDC.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">20 January 2020</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Supreme command: CCP’s leader, Xi, required local governments to highly focus on controlling the outbreak by applying proper measures.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Verified epidemiological characteristics of COVID-19 from the academic community: A famous respiratory physician, Zhong Nanshan, confirmed the evidence of person-to-person transmission.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">22 January 2020</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Response at the provincial level: Hubei Province activated II Level Response for Emergency.</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">23 January 2020</td><td colspan="3" align="center" valign="middle" style="border-bottom:solid thin" rowspan="1">The Wuhan government officially announced that the whole city would be under large-scale quarantine at 10 a.m., which meant the beginning of formal and comprehensive management on this outbreak.</td></tr></tbody></table><table-wrap-foot><fn><p><bold>Source:</bold> This timeline is a summary of paraphrased reports from China’s official media.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list></list><tree><noCountry><name sortKey="Chen, Kelin" sort="Chen, Kelin" uniqKey="Chen K" first="Kelin" last="Chen">Kelin Chen</name><name sortKey="Li, Huijie" sort="Li, Huijie" uniqKey="Li H" first="Huijie" last="Li">Huijie Li</name><name sortKey="Zhang, Liwei" sort="Zhang, Liwei" uniqKey="Zhang L" first="Liwei" last="Zhang">Liwei Zhang</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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