Acupuncture with manual and electrical stimulation for labour pain : a two month follow up of recollection of pain and birth experience.

BACKGROUND: In a previous randomised controlled trial we showed that acupuncture with a combination of manual- and electrical stimulation (EA) did not affect the level of pain, as compared with acupuncture with manual stimulation (MA) and standard care (SC), but reduced the need for other forms of pain relief, including epidural analgesia. To dismiss an under-treatment of pain in the trial, we did a long-term follow up on the recollection of labour pain and the birth experience comparing acupuncture with manual stimulation, acupuncture with combined electrical and manual stimulation with standard care. Our hypothesis was that despite the lower frequency of use of other pain relief, women who had received EA would make similar retrospective assessments of labour pain and the birth experience 2 months after birth as women who received standard care (SC) or acupuncture with manual stimulation (MA). METHODS: Secondary analyses of data collected for a randomised controlled trial conducted at two delivery wards in Sweden. A total of 303 nulliparous women with normal pregnancies were randomised to: 40 min of MA or EA, or SC without acupuncture. Questionnaires were administered the day after partus and 2 months later. RESULTS: Two months postpartum, the mean recalled pain on the visual analogue scale (SC: 70.1, MA: 69.3 and EA: 68.7) did not differ between the groups (SC vs MA: adjusted mean difference 0.8, 95 % confidence interval [CI] -6.3 to 7.9 and SC vs EA: mean difference 1.3 CI 95 % -5.5 to 8.1). Positive birth experience (SC: 54.3 %, MA: 64.6 % and EA: 61.0 %) did not differ between the groups (SC vs MA: adjusted Odds Ratio [OR] 1.8, CI 95 % 0.9 to 3.7 and SC vs EA: OR 1.4 CI 95 % 0.7 to 2.6). CONCLUSIONS: Despite the lower use of other pain relief, women who received acupuncture with the combination of manual and electrical stimulation during labour made the same retrospective assessments of labour pain and birth experience 2 months postpartum as those who received acupuncture with manual stimulation or standard care. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01197950.

Acupuncture for labour pain

Background: Acupuncture involves puncturing the skin with thin sterile needles at defined acupuncture points. Previous studies are inconclusive regarding the effect of acupuncture on labour pain, but some studies have found a reduction in the use of pharmacological pain relief when acupuncture is administered. The appropriate dose of acupuncture treatment required to elicit a potential effect on labour pain has not been fully explored. The dose is determined by many different factors, including the number of needles used and the intensity of the stimulation. In Sweden, manual stimulation of the needles is common practice when acupuncture is used for labour pain, but electrical stimulation of the needles, which gives a higher dose, could possibly be more effective. The overall aim of this thesis was to evaluate the effectiveness of acupuncture with manual stimulation (MA) of the needles as well as acupuncture with a combination of manual and electrical stimulation (EA) in reducing labour pain, compared with standard care without any form of acupuncture (SC). Methods: The study was designed as a three-armed randomised controlled trial in which 303 nulliparous women with normal pregnancies were randomised to MA, EA, or SC. The primary outcome was labour pain, assessed using the Visual Analogue Scale (VAS). Secondary outcomes were relaxation during labour, use of obstetric pain relief, and associations between maternal characteristics and labour pain and use of epidural analgesia respectively. Also, labour and infant outcomes, recollection of labour pain, and maternal experiences, such as birth experience and experience of the midwife, were investigated two months after the birth. The sample size calculation was based on the potential to discover a difference of 15 mm on the VAS. Data were collected during labour before the interventions, the day after birth, and two months later. Besides using the VAS, information was collected by means of study specific protocol, questionnaires and medical records. Results: The mean VAS scores were 66.4 in the MA group, 68.5 in the EA group, and 69.0 in the SC group (mean differences: MA vs. SC 2.6 95% CI -1.7 to 6.9, and EA vs. SC 0.6 95% CI -3.6 to 4.8). Other methods of pain relief were used less frequently in the EA group, including epidural analgesia, MA 61.4%, EA 46%, and SC 69.9%. (EA vs. SC OR 0.4 95% CI 0.2 to 0.7). No statistically significant differences were found in the recollection of labour pain between the three groups two months after birth (mean VAS score: MA 69.3, EA 68.7 and SC 70.1). A few maternal characteristics were associated with labour pain (age, dysmenorrhea, and cervix dilatation), but none of the investigated characteristics predicted the outcome of the acupuncture treatment in MA or EA. Women in the EA group experienced acupuncture as being effective for labour pain to a higher extent than women who received MA, MA 44.4%, EA 67.1% (EA vs. MA OR 2.4 95% CI 1.2 to 4.8). Women in the EA group also spent less time in labour (mean 500 min) than those who received MA (mean 619 min) and SC (mean 615 min) (EA vs. MA HR 1.4 95% CI 1.0 to1.9, EA vs. SC HR 1.4, 95% CI 1.1 to 2.0), and had less blood loss than women receiving SC, (EA vs. SC OR 0.1 95% CI 0.3 to 0.7). The women’s assessment of the midwife as being supportive during labour (MA 77.2%, EA 83.5%, SC 80%), overall satisfaction with midwife care (MA 100%, EA 97.5%, SC 98.7%), and having an overall positive childbirth experience (MA 64.6%, EA 61.0%, SC 54.3%) did not differ statistically. No serious side effects of the acupuncture treatment were reported. Conclusion: Acupuncture, regardless of type of stimulation, did not differ from standard care without acupuncture in terms of reducing women’s experience of pain during labour, or their memory of pain and childbirth overall two months after the birth. However, other forms of obstetric pain relief were less frequent in women receiving a combination of manual and electrical stimulation, suggesting that this method could facilitate coping with labour pain.

Manual and electroacupuncture for labour pain : study design of a longitudinal randomized controlled trial

Introduction. Results from previous studies on acupuncture for labour pain are contradictory and lack important information on methodology. However, studies indicate that acupuncture has a positive effect on women's experiences of labour pain. The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain as the primary outcome. This paper will present in-depth information on the design of the study, following the CONSORT and STRICTA recommendations. Methods. The study was designed as a randomized controlled trial based on western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture, or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. A Visual Analogue Scale was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment. This trial is registered at ClinicalTrials.gov: NCT01197950.

Dialectics of Diaspora Space: a Study of Contemporary, Diasporic, South Asian Fiction

In light of these continuing debates concerning immigration, national identity and belonging, re-examinations of immigrant and ethnic communities, often referred to as ‘diaspora,’ have become increasingly popular and prudent. Khachig Tololian, editor of Diaspora magazine, calls diaspora “exemplary communities of the transnational moment.”5 In an increasingly globalized world, where labor, capital, and resources are passed fluidly from continent to continent, diaspora are created by relocation or displacement of immigrant workers and their descendents.6 For these unskilled, immigrant laborers, middle class immigrants, and the children of both groups, adaptation to the culture, society, and life in a new ‘host’ country can be difficult, to say the least. So, in response to a new cultural landscape and a tenuous sense belonging, as well as to maintain a connection with a shared past, citizens of the world’s numerous diaspora replicate linguistic, cultural, and social norms, creating their own “cultural space[s]” that mirror and often replace a past relationship to their land of origin, or ‘home’.

A influência do capital social e do comportamento de cidadania organizacional na satisfação de vida e desempenho no trabalho: um estudo comparativo entre Brasil e Portugal

Desde à muito, os temas, capital social e comportamento de cidadania organizacional (CCO) têm sido extensivamente pesquisado e estudados nos EUA, no entanto estes têm recebido pouca relevância a nível de outros contextos internacionais. Se por um lado, a sua importância e inferência na performance dentro do contexto empresarial têm sido crescente, caracterizando a necessidade de um entendimento cada vez maior por parte das empresas, por outro, o investimento das corporações de grande porte, caminham cada vez mais em direção dos países com crescimento exponencial sustentado, como são o BRIC, o que cna uma necessidade fomentada de pesquisa nesta área de pesquisa para estas regiões. Este estudo pretendeu investigar, avaliar e mapear a influência do capital e do CCO na satisfação de vida e desempenho no trabalho do funcionário de nível superior, no contexto empresarial brasileiro e português, com o objetivo de identificar quais as diferenças existentes nestes duas realidade, devido ao investimento crescente do segundo para com o primeiro. Genericamente, encontramos clara influência das dimensões do CCO tanto para o desempenho no trabalho como para a satisfação de vida do trabalhador, assim como presença também marcada das duas dimensões do capital Social. Mais especificamente, foi entendido pelo nosso estudo que a realidade empresarial brasileira necessita que as empresas criem mecanismos que fomentem os laços entre colegas, a conscienciosidade, altruísmo e virtude cívica dos seus funcionários, pois assim aumentará o desempenho. Já para o contexto português, apenas a conscienciosidade e a virtude apresentaram significativa relação. Desta forma, conclui-se que para o investimento das empresas português no Brasil, estas precisam ter atenção à dimensão estrutural - relação com colegas - promovendo-a e à necessidade patente que os brasileiros têm de ajudar os seus colegas - comportamento altruísta - para aumentar o desempenho no trabalho. No que se refere a satisfação de vida, que se mostrou estreitamente relacionada com o desempenho, o brasileiro apenas precisa notar confiança nos colegas, senti-se altruísta e consciencioso, ao passo que o português necessita criar fortes laços com os colegas, mas não fomentar o comportamento altruístico. Desta forma as empresas investidoras apenas precisam ter atenção mais uma vez a necessidade de prestar ajuda especifica que o brasileiro sente, promovendo workshops com os próprios funcionários, por forma a estes passarem o seu conhecimento, monitorias, estágios, entre outros. Estes resultados demonstraram que cada continente, país (possuidor ou não da mesma língua) e/ou cultura comporta diferenças significativas no contexto empresarial, assim tornase difícil implementar técnicas e comportamentos internacionais e esperar que os resultados sejam exatamente iguais. Este estudo espera dar alguns instrumentos de comparação para que as empresas portuguesas entendam, a este nível, a realidade brasileira.

Os meios de comunicação de massa como aparelhos de hegemonia

Nas sociedades fundadas no modo de produção capitalista, os meios de comunicação de massa exercem funções políticas e econômicas fundamentais, atuando no sentido de inculcar a ideologia que dá sustentação a esse modelo econômico. A compreensão crítica de tais funções, pode ser obtida tomando-se como referência a teoria de Antonio Gramsci que situa, com precisão, através de seus conceitos de homem, ideologia, Estado, hegemonia, cultura e relações pedagógicas, a importância política dos meios de comunicação de massa, entendidos como aparelhos de hegemonia do Estado. No contexto específico da América Latina, os meios de comunicação de massa assumem dupla importância na medida em que suas práticas hegemônicas atendem, concomitantemente, aos interesses do capitalismo internacional - sobretudo aos dos Estados Unidos - e aos interesses das classes dominantes de cada um dos países deste continente, envolvidos em alianças político-econômicas, com as nações que detêm a hegemonia internacional. De acordo com essa perspectiva, podemos compreender o significado político do processo de implantação e desenvolvimento dos meios de comunicação, sobretudo da televisão, no Brasil e explicitar o sentido dessa prática hegemônica que assumiu papel de maior relevância após o golpe militar de 1964, quando a ideologia da Segurança Nacional encontrou, na comunicação de massa, difusora dos produtos da indústria cul tural, o canal mais adequado para desenvolver sua estratégia de atuação, denominada ação psicológica, objetivando consuiltar a anuência da totalidade social ao regime político que, então, se instalou no país. O caso específico da Rede Globo de Televisão, se constitui num dos mais tontundentes exemplos da concretização desta prática e pode, quando analisado, elucidar, através de fatos concretos, os mecanismos hegemônicos internacionais e nacionais que se encontram presentes desde o histôrico da implantação da referida emissora em nível de rede nacional, até os processos diários de produção de programas como o Jornal Nacional e o Fantástico - o Show da Vida. Esta análise, entretanto, não pode deixar de ressaltar que o processo de inculcação ideológica encontra diversos obstáculos a seu êxito integral junto às classes subalternas, que não podem ser compreendidas como meras receptoras passivas das mensagens produzidas pela classe dominante. Os mecanismos de resistência dessas classes existem e, embora não sejam, ainda, suficientemente conhecidos, não podem deixar de ser considerados quando o que se pretende é compreender o real significado das funções e do alcance dos meios de comunicação na sociedade.

Primed and prejudice: the Kurantha-Bothata study

O sistema de peer review é uma ferramenta fundamental nas publicações científicas, cujo objetivo é selecionar os estudos que contribuem para o avanço do conhecimento. No entanto, questionamentos tem surgido acerca de vieses no sistema de peer review. Um exemplo é o estudo "Lost science in the third world" (Gibbs, 1995), que afirma existirem sérios vieses em relação à origem dos pesquisadores. Ainda que haja evidências para suportar esse argumento, nosso conhecimento acerca de vieses no sistema de peer review ainda é limitado, já que poucos estudos controlados podem ser encontrados na literatura. No presente trabalho, foi realizado um exeprimento no qual os sujeitos deveriam avaliar um artigo sem qualquer identificação de autoria, exceto por uma nota de rodapé onde constava o nome da instituição fictícia que financiou a pesquisa. Sob uma condição, o nome da agência financiadora é associado com o continente africano, enquanto na outra condição, o nome da agência é associado ao continente europeu. Os resultados dão indícios de que possa haver um viés relacionado às origens do autor.

A nova parceria para o desenvolvimento da África : NEPAD, paradigma para o desenvolvimento

Os chefes de Estado africanos, após a transformação da Organização da Unidade Africana em União Africana, propuseram a Nova Parceria para o Desenvolvimento da África (NEPAD), como um quadro para uma nova relação de parceria entre a África e a comunidade internacional. Neste sentido de nova parceria, os dirigentes africanos se engajaram em promover nos seus países, na sua região e no Continente, a paz, a segurança, a democracia, a boa governança, o respeito dos direitos humanos e uma saudável gestão econômica, como uma estratégia para orientar o desenvolvimento da África no século XXI. A NEPAD suscitou uma reação positiva na comunidade internacional. A NEPAD repousa sobre fundamentos de desenvolvimento duradouro no Continente, sem os quais tornam-se impossíveis resultados concretos. Entre esses fundamentos podemos citar: a democracia, a boa governança, a governança econômica e a governança das empresas. Para alcançar o objetivo, a NEPAD propõe reformas institucionais como a utilização de meios de avaliação que permitem instaurar definitivamente a boa governança nas estruturas do Estado.

Reproductive Patterns and Birth Seasonality in a South-American Breeding Colony of Common Marmosets, Callithrix jacchus

SOUSA,M.B.C. et al. Reproductive Patterns and Birth Seasonality in a South-American Breeding Colony of Common Marmosets, Callithrix jacchus. Primates, v.40, n.2, p. 327-336, Apr. 1999.

Estudo clínico-laboratorial e histopatológico de cães naturalmente infectados por Leishmania chagasi com diferentes graus de manifestação física

Canine Visceral Leishmania (CVL) is an important zoonotic disease that has a world wide distribution and has a large impact on public health on the American Continent, especially in Brazil, where the nature of endemic diseases in humans affects a large part of the nation. The influence of the prevalence of CVL in the increased rate of human cases in endemic areas and in the unleashing of epidemic outbreaks shows the need for a more profound understanding, that would generate significant advances in the current measures used to control the reservoirs of sickness that are practiced by the Programa Nacional de Vigilância e Controle da Leishmaniose Visceral. The present work describes and compares the clinical-laboratorial and histopathological findings of twenty-three dogs that were naturally infected by Leishmania chagasi, from endemic areas in metropolitan Natal, Rio Grande do Norte, Brazil. These animals, that were selected and given physical and serological exams (IFI and ELISA rK-39), were classified according to the degree of clinical severity and had blood samples drawn (whole blood and serum) for a complete hemogram and a coagulogram to be done as well as biochemical tests for kidney and liver function. The confirmation of infection by L. chagasi was done after the euthanasia of the animals, through the direct demonstration of the parasite in the impression of the spleen and liver crowned with GIEMSA and through a cultivation by means of NNN/Schneider. According to the clinical evaluation, the animals were classified as asymptomatic (7), oligosymptomatic (7) and polysymptomatic (9). Among the animals that were chosen to be autopsied, there were 2 asymptomatic, 3 oligosymptomatic and 3 polysymptomatic, for the purpose of studying their histopathology, having collected fragments of the spleen, liver, kidneys and skin and were fixed in 10% tamponed formol. The comparison between the average parameters of the clinical-laboratory tested animals in the groups was done through the Student t test (a<0.05). The main clinical signals observed were lymphadenomegaly, alopecy, dermatitis, exfoliation, cutaneous ulcers, onicogriphosis and emaciation. The main clinical-laboratorial alterations established, mainly in the polysymptomatic group, were anemia, hyperproteinemia, hyperglobulinemia, alterations in the albumin/globulin ratio and increased ALT activity. Renal alterations were not verified (urea and creatinine levels were normal). Thrombocytopenia was observed in three clinical groups. However, the other indicators of coagulation function (TAP and TTPA) did not have abnormal variations. There were inflammatory infiltrations and leishmania amastigotes in the skin of polysymptomatic dogs, however, they were not found in the skin of asymptomatic animals. Hypertrophy and hyperplasia of the phagocyte mononuclear system, leishmania amastigote parasites were found in the macrophages, extramedullary hematopoiesis and degenerative alterations were detected in the spleen and liver of 8 of the animals submitted to histopathological exams. In accord with these results, it was demonstrated that the expected alterations in the hematological and biochemical parameters in function of their viscerotropic nature of CVL are mainly observed in the more advanced stages of the disease. The absence of inflammatory infiltration and parasite load in the skin suggest that infected animals without symptoms may have an importance irrelevant to the infectiousness of the vector

Projeto, construção e análise de um prototipo vibracional em escala de bancada aplicável ao tratamento de água de produção de petróleo bruto, mediante inovadora operação híbrida de adsorção e auto-flotação

A self-flotator vibrational prototype electromechanical drive for treatment of oil and water emulsion or like emulsion is presented and evaluated. Oil production and refining to obtain derivatives is carried out under arrangements technically referred to as on-shore and off-shore, ie, on the continent and in the sea. In Brazil 80 % of the petroleum production is taken at sea and area of deployment and it cost scale are worrisome. It is associated, oily water production on a large scale, carrier 95% of the potential pollutant of activity whose final destination is the environment medium, terrestrial or maritime. Although diversified set of techniques and water treatment systems are in use or research, we propose an innovative system that operates in a sustainable way without chemical additives, for the good of the ecosystem. Labyrinth adsor-bent is used in metal spirals, and laboratory scale flow. Equipment and process patents are claimed. Treatments were performed at different flow rates and bands often monitored with control systems, some built, other bought for this purpose. Measurements of the levels of oil and grease (OGC) of efluents treaty remained within the range of legal framework under test conditions. Adsorbents were weighed before and after treatment for obtaining oil impregna-tion, the performance goal of vibratory action and treatment as a whole. Treatment technolo-gies in course are referenced, to compare performance, qualitatively and quantitatively. The vibration energy consumption is faced with and without conventional flotation and self-flotation. There are good prospects for the proposed, especially in reducing the residence time, by capillary action system. The impregnation dimensionless parameter was created and confronted with consecrated dimensionless parameters, on the vibrational version, such as Weber number and Froude number in quadratic form, referred to as vibrational criticality. Re-sults suggest limits to the vibration intensity

Atividade antiplasmódica e toxicológica de plantas medicinais usadas popularmente no Brasil : uma abordagem etnobotânica

Malaria is a disease of global distribution, recognized by governments around the world as a serious public health problem, affecting more than 109 countries and territories and endangering more than 3.3 billion people. The economic costs of this disease are also relevant: the African continent itself has malaria-related costs of about $ 12 billion annually. Nowadays, in addition to chloroquine, Plasmodium falciparum is resistant to many drugs used in the treatment of malaria, such as amodiaquine, mefloquine, quinine and sulfadoxine-pyrimethamine; resistance of Plasmodium vivax to treatments, although less studied, is also reported. Nature, in general, is responsible for the production of most known organic substances, and the plant kingdom is responsible for the most of the chemical diversity known and reported in the literature. Most medicinal plants commercialized in Brazil, however, are of exotic origin, which makes the search for endemic medicinal plants, besides a patent necessity, a fascinating subject of academic research and development. This study aimed to: (i) verify the antimalarial activity of ethanolic and hydroalcoholic extracts of Boerhavia paniculata Rich. And acetonic extract of Clethra scabra Pers. in Swiss albino mice infected by Plasmodium berghei NK65, (ii) observe possible combined effects between the course of infection by P. berghei NK65 and administration of these extracts in Swiss albino mice, and (iii) conduct a preliminary study of the acute toxicity of these extracts in Swiss albino mice. All extracts notable pharmacological activities - with parasite infections inhibitions ranging from 22% to 54%.These characteristics suggest that the activities are relevant, although comparatively lower than the activity displayed by the positive control group (always above 90%). The general framework of survival analysis demonstrates an overall reduction in survival times for all groups. Necroscopy has not pointed no change in color, shape, size and/or consistency in the evaluated organs - the only exception was the livers of rats submitted to treatment to hydroalcoholic extracts: these organs have been presented in a slightly congestive aspect with mass increasing roughly 28% higher than the other two groups and a p-value of 0.0365. The 250 mg/Kg ethanolic group has been pointed out by the Dunn s post test, as the only class with simultaneous inequalities (p<0.05) between positive and negative control groups. The extracts, notably ethanol extract, have, in fact, a vestigial antimalarial activity, although well below from the ones perceived to chloroquine-treated groups; nevertheless, the survival times of the animals fed with the extracts do not rise by presence of such therapy. Both the toxicopharmacological studies of the synergism between the clinical course of malaria and administration of extracts and the isolated evaluation of toxicity allow us to affirm the absence of toxicity of the extracts at the level of CNS and ANS, as well as their non-influence on food and water consumption patterns, until dosages of 500 mg/Kg. Necroscopic analysis leads us to deduct a possible hepatotoxic effect of hydroalcoholic extract at dosages of 500 mg/Kg, and an innocuous tissue activity of the ethanol extract, in the same dosage. We propose a continuation of the studies of these extracts, with protocol modifications capable of addressing more clearly and objectively their pharmacological and toxicological aspects

Pleistocene mammals from the southern Brazilian continental shelf

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação da incontinência urinária de esforço em mulheres na pós-menopausa com e sem queixa de perda urinária através da aplicação do pad-test de 1 hora

Stress urinary incontinence (SUI) is defined as "involuntary loss of urine" due to several processes that alter the ability of the bladder to hold urine properly, regarded as a social and hygienic problem that adversely affects quality of life. In postmenopausal women, IU is associated with atrophy and weakness of the pelvic floor muscles. The objective this study was investigate, using the onehour pad test, stress urinary leakage (SUI), evaluate and compare their results in postmenopausal and premenopausal women. The survey was characterized as a cross-sectional study. The study consisted of 60 postmenopausal women were divided into GIU - consisting of 34 volunteers complaining of involuntary loss of urine during stress - and GSIU - consisting of 26 volunteers without complaints of loss of urine during stress, and 15 women, during the premenopausal (GPM), and ovulatory with normal menstrual cycle. All volunteers were evaluated clinically, subjected to one-hour pad test, after the biochemical evaluation of blood and sex hormones. Statistical analysis was performed by descriptive analysis, ANOVA, Turkey´s post-test and Pearson correlation. The results showed that 100% of postmenopausal patients had involuntary loss of urine during one hour pad test (GIU: 4.0 g; GSIU: 4.5 g). GPM remained continent after an hour pad test (GPM: 0.4 g). In addition, Pearson showed a strong correlation between urine loss with time since menopause (r = 0.8, p <0.01) and body mass index - BMI (r = 0.7; p = 0.01). These data suggest that the one-hour pad test is a useful test to assess and quantify urinary leakage, including those volunteers who had no previous complaint of SUI

A gripe de longe e de perto: comparações entre as pandemias de 1918 e 2009

Neste debate, historiadores latino-americanos comparam a pandemia de gripe de 1918-1919 com a que varre o continente em 2009, sobretudo as experiências de México, Argentina e Brasil. Analisam as estratégias adotadas nos dois momentos, com ênfase em isolamento, vigilância em portos e aeroportos, intervenções nas cidades. Comparam a atuação dos Estados nacionais e governos locais, a posição dos médicos e dos meios de comunicação e o comportamento das populações, especialmente no tocante ao medo e à morte. Analisam o desempenho das estruturas de assistência às populações e as medidas terapêuticas e profiláticas recomendadas por órgãos públicos de saúde, por interesses privados ligados à venda de medicamentos e pelas medicinas populares e caseiras. O debate trata, ainda, da influência que a experiência de 1918 teve sobre as avaliações da crise atual, bem como do legado que deixará para o futuro.