Services on Demand
- Similars in SciELO
Print version ISSN 1415-790X
Rev. bras. epidemiol. vol.15 no.1 São Paulo Mar. 2012
Luiz Marcelo Robalinho Ferraz; Isaltina Maria de Azevedo Mello Gomes
Programa de Pós-Graduação em Comunicação da Universidade Federal de Pernambuco, Recife, PE
The aim of this paper was to understand how the media in the state of Pernambuco portrays dengue fever, a disease that is affecting more and more Brazilians. Taking the explosive epidemic of 2002 as the starting point, we tried to understand the effects of meaning produced by the press in a comparative discourse strategy analysis used in 2002, 2004, 2006 and 2008. We selected 291 articles and notes published in the Jornal do Commercio (Recife-Brazil), on the situation of this viral disease in the state of Pernambuco in the four years. We also analysed dengue fever surveillance reports published by the health department of Pernambuco. To complement discourse analysis, we proposed the construction of a medialogy diagram, a graphic representation that tries to establish a relationship between newspaper texts and number cases of dengue reported. Results indicate that media coverage generally followed the development of dengue fever cases, with more news published during the epidemic periods and showing the appeal of the illness as a mass media phenomenon despite its risk to the Brazilian people.
Keywords: Dengue fever. Discourse memory. Epidemic. Journalistic discourse. Medialogy diagram. Newsworthiness.
Dengue fever is one of the current concerns of the Brazilian public health. Despite losing space on the news in 2009 for pandemic influenza A (H1N1) that struck the planet, it never ceases to be the characteristic of presenting news epidemic cycles that reach a greater or lesser degree the population, depending on the viral circulation and environmental conditions that favor infection. Besides AIDS, dengue appeared in fact to become known in the country in the 80s of the twentieth century, when successive epidemics were recorded in several Brazilian cities, beginning with Rio de Janeiro and spreading to other locations.
In Pernambuco, the mosquito Aedes aegypti (carrier of disease) was identified in late 1984 in 90 municipalities of the state. With the reintroduction of the virus and the occurrence of the first epidemic in Rio in 1986, monitoring began to be adopted by health authorities. Later that year, records were first reported, with imported cases of Alagoas and Ceara, mostly. The first outbreak - as with the finding of the virus circulating in the territory of Pernambuco - occurred in 1987 (2.118 cases), as can be seen in Table 1.
With the exception of 1989, Pernambuco experienced a gap in reporting cases until 1995, when he returned to account for new records of dengue, starting a second outbreak, caused by the introduction of DENV-2. Since then, the disease has become a reality for the people from Pernambuco, especially in the first half of each year, a period that historically there are more cases. The 2002 epidemic - caused by the introduction of third serotype (DENV-3)1 in Brazil and it involves characteristic explosive "in a short time, virtually all of those affected" and have rapid progression of cases as a criterion differentiating (ROUQUAYROL; ALMEIDA FILHO, 2003, p. 142) - was a significant achievement for public health in the state. It were 116,245 notifications and 96,470 confirmed cases of classic dengue and 340 of the hemorrhagic type, and 20 deaths, being decisive for the media to disseminate widely the subject.
Given the strength of dengue in the scheduling of the media, especially with the record of epidemics of the last decade or so, we analyze the discourse published by Pernambuco´s press in 2002, 2004, 2006 and 2008, in relation to the great epidemic of dengue fever 2002 as a starting point. We opted for using the newspaper to understand how a symbolic object in writing, with statements stabilized produces senses. A device for readability in which the "weight of words," plays the role of proof to establish the truth, says Charaudeau (2006, p. 113)3. For the author, the print media is characterized by:
[...] a distant relationship between one who writes and who reads, the absence of the issue for instance with the instance of receipt, a conceptualization of activity from the two bodies to represent the world, which produces logic specific production and comprehension, an ocular route multiorientado space of writing that makes the stay that was written as a feature for which you can always return: one who writes, to rectify or erase, those who read, or to recall recompose your reading.
The Jornal do Commercio (Recife-Pernambuco) was the chosen press organization as material study for being one of the three most important journals in Pernambuco and due to the largest circulation in the state. It has an average paid circulation of 31,847 copies sold on Tuesday (day of lower circulation)4, reaching 65,028 copies on Sunday (largest circulation). Another factor was the importance given by the newspaper to the health theme. The concern and interest in the subject are confirmed by the results of a survey which has been conducted annually since 2004 by the Institute Ipsos Marplan, JC's own request. The aim is to evaluate the issues of greatest interest to its audience (Diagram 1).
Noting the interest of readers to themes related to health, partly understand the privilege that dengue had and still has, within the newspaper. That's because, thinking of issues of interest to the readers, the disease could be included both in the whole theme health / wellbeing / quality of life and medical / scientific discovery / healing and in updates / news of the moment, especially considering the periods of increased risk of dengue as epidemic in 2002, when 144 were produced newspaper articles, or in 2008, the year that dengue returned to again threaten Pernambuco, leading the newspaper to publish 106 issues.
We focus the analysis on issues, news and notes, since the number of texts published on the disease (291 in all) points to a dual importance of dengue fever: epidemiological and media as a phenomenon. Complementing our work, we establish a relationship between the text of the press and reported cases of the disease. For this, we constructed a graphic device that we named as medialogy diagram of dengue, it was inspired by the methodology of monitoring conducted by public health. The diagram medialogy helped us understand the seasonality of the media in dealing with dengue, with an auxiliary instrument for deepening the analysis, from the view of the moments of silence and overexposure of dengue in the pages of the newspaper.
For construction of the diagram medialogy, we selected the texts of JC and notifications of the disease in order to assess the evolution of news in parallel to registration. We believe that the results helped us to deepen the analysis. For pointing out interesting issues in the years studied, the intention was to examine more closely the discourses produced by the press, especially during periods of increasing reports of dengue fever (with a focus on epidemics) and decrease, and the moments when the materials did not follow the curve epidemiology.
Discourse, memory and journalism
The increasing presence of dengue has led to an involvement of the media in disseminating the news. The privileged position it occupies in public, the media sets an important locus of meaning. In large part, the information we have about dengue come from the press release, based on the speech of different stakeholders related to the subject: managers, doctors, scientists, citizens and patients, to name the most significant. Based on these statements and the disease evolution, the media was, and will, his speech building and consolidating the framework of information and values that underlie the disease.
We know that this construction did not come just from this. The past is also fundamental to the understanding we have of diseases, including infectious diseases, which account today for over 25% of deaths worldwide5 each year. Articulating then, past and present, the media has been building his own memory of dengue, with the epidemic as a beacon for production of the senses. The epidemic of 2002 is one recent example of this memory in the discursive construction in the following years.
Epidemiological event that affects the health of the ecosystem, the epidemic is inscribed in memory by the unpredictability and uniqueness6. Speak of the epidemic leads us to the disorder caused by the accidental character of the disease on a large scale, causing deaths and affecting the routine of the cities. Therefore, they acquire a symbolic meaning in the everyday life of contemporary societies, says Barata (1990, p. 3857):
In health, the predominant role of the media will be revealed in collective situations such as epidemics, when the population is seen equally threatened, that is, the importance of the press as a channel for information / claim, is mediated by the character more or less collective grievance on the issue as well as the diffusion potential social problem
To Discourse Analysis (DA), the discourse is conceived as the language being implemented in the social environment, a symbolic work to produce meanings constitutive of man and its history, according to Orlandi (2007, p. 15)8:
Discourse analysis sees language as the necessary mediation between man and the natural and social reality. This mediation, which is the speech, makes possible both the permanence and continuity as the displacement and transformation of man and reality in which he lives. Symbolic work underpins the production of human existence.
In this conception, discourse is seen as a practical structure of language that unites current and memory at the same time. Based on previously established meanings (the memory), the discourse is constituted from new developments, which melts regularizations exist, giving rise to a new system through a power game that aims to keep the already-produced and in the opposite direction to modify the existing senses9. In AD, memory plays an important role by "invoking" the prebuilt elements, or existing traits in other statements.
Reflections on discourse and discursive memory led to the concept of interdiscourse, recognizing that the speeches are not isolated, but linked to each other. Charaudeau and Maingueneau (2008, p. 286, authors' italics)10 determine both directions interspeech: a more restrictive, referring to a discursive space, "a set of discourses (of the same discursive field or different fields) that maintain relationships of mutual boundaries with each other ", and a more broad, as "a set of discursive units (previous speeches that belong to the same genre of contemporary discourses of other genres, etc..) with which a particular discourse comes into relationship implicit or explicit."
Discuss about interdiscourse is also assessing how the senses were being produced by the media based on memory of other diseases. Although the diseases have distinct characteristics, the feelings that surround each - sickness, fear, evil, danger, death and pestilence - mobilize networks of shared memory on diseases in general (FERRAZ, 2010)11. In the case of health matters, we do correlate with epidemics. Considered significant events in our treatment of diseases, particularly infectious (for affect part or the whole of society), the epidemics are critical for the media spread the word by setting up a discourse event and doing great appeal to evoke the past. So it was with the H1N1 flu, whose record of the pandemic has led to the news media to permanently report in the initial stage of the virus discovery and first cases, linking the horror experienced during the Spanish flu in the late 1910s, when about 22 million people died12. It's usually like this with dengue, whose epidemics cause the channels of communication to broadcast the news with more intensity, emphasizing in their speeches a higher risk for the mosquito to infect and kill13.
The onset of disease in communities has a strong appeal for journalistic news, singularity, social weight and magnitude of fact, when we take into account the main criteria of newsworthiness of an event (GALTUNG; RUGE, 1965; SODRÉ, 2009). It was thus in 2002 when the epidemic was framed in almost all those features of markup. In 2008, the increase of dengue cases and deaths have been the main reason for the disease made headlines, and news values similar to those of 2002, based on recent experience discursive memory.
The criteria for newsworthiness are directly related to the notion of agenda-setting, developed in 70 years by McCombs and Shaw14. According to this concept, through the facts that it becomes news, the media defines the topics to be discussed or not by public opinion, changing in a way, social reality, according to Barros Filho (2001)15. Hence, Traquina (2000) have described the scheduling process as interactive, because the public agenda influences the media and vice versa16.
Moreover, we must consider the credibility that the media have on society. By portraying the transformation of reality and record them, the media reached a position of "official spokesman of events" and "power to raise the status of historical events" as Ribeiro (2005, p. 115)17. She said it takes vehicles to produce statements about social reality accepted as true. "What passes off the media is regarded by society as unimportant" (p. 115). For the author, this phenomenon stems from the myth of neutrality and impartiality, created in the mid-nineteenth century journalism and information that was consolidated in the next century with the advent of the concept of objectivity (much criticized tell by the way).
The myth of objectivity, however much has already been thoroughly criticized by journalists themselves and the communication theory, is largely responsible for the welcome that journalism has. Even today, his speech takes on an aura of fidelity to the facts leads us to believe that what "happened in the newspaper is true. Moreover, much as scholars proving non-journalistic objectivity can never deny its factual grounding.
The journalistic discourse has thus a certain objectivity, a sense effect produced by their own declared strategies. And this is what gives it objectivity in contemporary societies, the status of spokesman of factual truths. (2005, p. 117-8, italics author's)18.
Once the media intends to act in favor of democracy, we must not forget that it has a dubious purpose. According to Charaudeau (2006), this ambiguity stems from being an expert body which operates under two perspectives: a democratic citizen, who make public information public interest, thereby participating in the construction of public opinion, and one commercial, which captures the audience with an economically viable product, that is news19. A special commodity that responds to market demands and appeals20.
A reading of the speeches on dengue
In this article, we did the analysis using the medialogy dengue diagram, proposed by us and inspired by the logic of public health monitoring. Of simple design and unlike the control diagram (used to monitor the dengue), our graph brings the journalistic texts and reported cases. The intention is to visualize the seasonal approach to dengue and media practice, noting that the biggest "impact" of news is in the same time that the records of cases have increased or occurred differently (Figure 2).
For large numerical difference between cases and materials, we insert a scale on the right side, which sees the number of subjects (in black), ranging from 0 to 60, and another on the left side, where are the records of dengue (in gray), ranging from 0 to 45,000. Although the black columns are very close, sometimes even above, painted gray area, there is a large quantitative difference between the two variables. Therefore, the need to observe the numbers on both sides. The option of double-wide was made to bring the two variables in one graph to take a global view of intuitive and immediate connection between these two groups, thus avoiding a bias that would occur if there was only one scale.
In terms of coverage, we verified that the press tends to follow the evolution of dengue, publishing more papers in the first half of the years studied in the second. This trend also occurs with the monthly distribution of dengue cases in Pernambuco. Historically, the records are most numerous in the first six months of the year due to a correlation between changes in temperature and rainfall. On top of that, the state of Pernambuco still faces, for decades, intermittent supply, forcing residents to store water often inappropriately, making it easier during dry seasons the proliferation of the mosquito vector21.
Medialogy by reading the diagram, we identified two instances in which the subjects followed the curve of notifications, something that was expected, since the public agenda influences the media, such as the occurrence of epidemics and disasters. These two moments that we refer to coincide with the epidemic periods of greater magnitude in the 2000s. The first occurred in early 2002 with the explosive epidemic. 144 texts were published in the Jornal do Commercio, of which 119 in the first half (82.6% of total), mainly in February and March (94 texts). Compared with the notifications, the news had a direct influence of the increase in registrations. Our data were reported 116,148 cases and 111,729 in the first half of 2002 (95.7% of total). Chart 1 shows the headlines of that period, influenced by the evolution of dengue early in the epidemic:
We note that the contexts of the epidemic or the threat of epidemic led JC to post material in a quantity much higher than the controlled periods. The increase in cases and deaths from dengue fever have a strong journalistic appeal, imposing a permanent coverage of unfolding events because of the threat caused by the disease. Discursively, we saw that the news has strengthened their focus on telling the notifier. In the headlines, the verb "confirm" - which means "to affirm the truth or accuracy", "validate", "prove"22 - was widely used as a strategy enunciation of the newspaper. Besides "confirm" the verb "reach" appeared in the article titles, expressing the meaning of "get to" and "achieve". Bolstered by the numbers of public health, the newspaper media mediatized the case records and gave meaning to the disease affecting the bodies and confirmed, little by little, a framework of possible chaos.
Even at this stage of coverage, we observed the use of the terms "dengue hemorrhagic fever", "health" and especially "epidemic" in the strategies of title to the materials. All of them, especially the latter, became significant for the production of meanings. Fausto Neto (1999, p. 62)23 states that the use of specific terms such as editing the titles of the newspaper creates a sub-agenda on the topic in question in the daily agenda set by the vehicle of communication. "Through him, the newspaper announced a sort of rendezvous with the reader." Thus, the epidemic has occupied a privileged and visible to the public in the Jornal do Commercio, giving way to the headlines.
The second time the subjects followed the curve of notifications occurred late in the first quarter of 2008, when there was a significant increase of cases, leading the media to increase coverage (Figure 2). It was published 106 texts on the disease, of which 99 in the first seven months of the year (93.3%), especially in April, May and June (88 texts), during which the number of records has also increased.
Selected by the headlines, it is possible to identify the negative direction given to dengue. In our view, the notions of fear and evil are intimately linked to the production of meanings of infectious disease, transmitted by a biological agent (in the case of dengue, a virus). In these communicable diseases, the materialization of the disease in the context of the community exposes the notion of "evil" spreading throughout the country and spreading fear among people. Despite not having the mark of other diseases such as leprosy, AIDS and cancer, which marked the memory by visible changes in the body, dengue carries the potential risk of death, especially by way of further development hemorrhagic fever. Understanding this threat is fundamental to understanding the state of readiness of the media before the increase in suspected cases and deaths.
In the four years surveyed, we also observed that government initiatives to control dengue had privileged space in the newspaper, especially with the finding of the increase in cases and the record of early deaths. Of the 291 documents produced by JC in 2002, 2004, 2006 and 2008, the materials on joint efforts to combat and announcements of new measures amounted to 27.5%. Thus, the Aedes aegypti has become a major villain who was a need to combat by eliminating their breeding places. Chart 2 presents excerpts of material reinforcing this combat.
In Brazil, the use of metaphors of war leads us to the first vaccination campaigns, the example of the strategy undertaken by Oswaldo Cruz in the early twentieth century to contain a smallpox epidemic. The concepts of containment and surveillance, military-inspired, emerged after the First World War, being used by public health, adopted the view that the "enemy" to combat the health problems of the time. Later, these words were assimilated by the press in the construction of his speech to treat illnesses, according to Gomes (2000, p. 190, emphasis added)25:
[...] in matters involving the development of drugs against diseases, studies are also treated as a war, with the use of terms such as challenge, strategy, attack, and target driven. Because they belong to another context, such expressions act as resources needed in order to re-semanticizing what is stated.
In our view, the discourse of war set out in this newspaper about dengue reinforces the idea of a disease difficult to control, requiring the adoption of true "tactics" to curb their expansion. This type of speech was observed in sections highlighted through the use of warlike terms, such as strengthening the combat, army combat, combat dengue, weapons, occupying territory inch by inch the city, the fight against dengue, to visit, to identify and to destroy. Discursively, this phenomenon characterizes the role of memory in the discursive production of meanings from the time when the media takes up not only the meanings of past illnesses, but also common sense to the military to consolidate the framework of information and values that underlie the disease.
Possibly no other infectious disease has had so much space in recent years on the news about dengue due to the cyclical occurrence of epidemics and the risk of death from hemorrhagic form, which represents a growing threat. Dengue always finds a permanent place in the press, making the experience of the most common disease for the population by the wide dissemination of the subject.
For the analysis undertaken in this article, we note that the epidemic tends to be prioritized by unpredictability, novelty, social weight, geographic proximity, audience impact and outlook for the event, almost all the criteria that guide the newsworthiness of an event. Moreover, the notion of epidemic discursively redeems the memory of ancient plagues in the constitution of the senses, bringing up ideas on matters such as fear, evil, death and risk, linked to conditions that made history in the past (FERRAZ, 2010)26. From the idea of proximity of the danger caused to each new epidemic, the press values as well as the uncontrolled way of giving meaning to dengue. Perhaps, therefore, the use of metaphors of war - fairly common when speaking of health managers and media discourse in itself - is a form of co-responsibility in society, who is called to be part of the "army" in the "battle" against dengue.
Actions guided by responsibility between government and population have been, moreover, emphasized increasingly as a way to ensure success in fighting dengue. Although social mobilization to strengthen citizenship and health awareness and promote the setting of a healthy environment27, the media discourse has led in recent years, the blame society in general, as if she were responsible for the dengue situation. Faced with the impossibility of eradicating Aedes aegypti, the World Health Organization (WHO) has set since 1995, involved the participation of the community and all sectors of society as one of the basic elements to prevent and control dengue, according to Guzman and Kouri (2006)28. When evaluating the treatment given to dengue by the media, we believe it is important to promote a discussion on the subject, shedding light at the rethinking strategies for dengue control and prevention and also in communication.
The elaboration of the diagram as an aid medialogy analysis of the news helped us visualize moments of overexposure of the disease, as well as periods of "silence", recognizing that dengue is a seasonal disease not only from the epidemiological point of view, but also media. This phenomenon could be explained by the theory of scheduling, which, according to Pena (2006, p. 142), "supports the idea that news consumers tend to consider more important issues that are revealed in the press, suggesting that the means of communication schedule our conversations." The emphasis on dengue in the cover also shows the tendency of the press to highlight certain diseases to the detriment of others, such as leprosy and tuberculosis, neglected diseases by the Ministry of Health, which represent an obstacle to the development of the country29.
In our view, the analysis of data gives us indications of how the media can be sensitized on the importance of talking about dengue in different periods of the year. Rather than fulfilling its role of disseminating information and complete transparent way the government can and should encourage healthy habits in the press, encouraging a wider knowledge of journalists on the field of health.
Moreover, even the media can and should also reassess their coverage, seeking to address other issues that permeate the subject dengue, but are poorly explored in the articles. Among them we can highlight the sanitation and water rationing (which encourage the proliferation of Aedes aegypti). Furthermore, the importance of prevention could be focused at times when it is still possible to eliminate the breeding grounds, and not only in epidemic periods when shares of combat and war speech heralded by the media seek only to ensure the field imbalance, not assisting in change the course of the disease.
Finally, we consider that the emphasis on dengue in the news provides opportunities for performance assessment of the media in relation to other diseases that also pose a risk to the population, such as leptospirosis, leprosy, tuberculosis, AIDS and H1N1 flu, to verify the weight of the journalistic field gives different diseases.
1. Cordeiro M et al. Vinte anos de evolução da dengue no Estado de Pernambuco. Recife: Ed. da UFPE; 2008. [ Links ]
2. Rouquayrol MZ, Almeida Filho N. Epidemiologia e saúde. 6ª ed. Rio de Janeiro: MEDSI; 2003. [ Links ]
3. Charaudeau P. O discurso das mídias. São Paulo: Contexto; 2006. [ Links ]
4. Dados relativos ao mês de maio de 2009 fornecidos pelo Instituto Verificador de Circulação. Disponível em www.ivc.org.br. [Acessado em 10 de novembro de 2009] [ Links ]
5. Silva LJ, Angerami RN. Viroses emergentes no Brasil. Rio de Janeiro: Fiocruz; 2008. [ Links ]
6. Foucault M. O nascimento da clínica. 6ª ed. Rio de Janeiro: Forense; 2006 [ Links ].
7. Barata RCB. Saúde e direito à informação. Cad Saúde Pública 1990; 6(4): 385-99. [ Links ]
8. Orlandi EP. Análise do discurso: princípios e procedimentos. 7ª ed. Campinas, SP: Pontes; 2007. [ Links ]
9. Pêcheux M. O discurso: estrutura ou acontecimento. 5ª ed. Campinas, SP: Pontes; 2008 [ Links ].
10. Charaudeau P, Maingueneau D. Dicionário de Análise do Discurso. 2ª ed., São Paulo: Contexto; 2008. [ Links ]
11. Ferraz LMR. Epidemia e memória: narrativas jornalísticas na construção discursiva sobre a dengue [dissertação de mestrado]. Recife: Programa de Pós-Graduação em Comunicação, 2010. [ Links ]
12. Ujvari SC. A história e suas epidemias: a convivência do homem com os microorganismos. Rio de Janeiro: SENAC; São Paulo: SENAC; 2003. [ Links ]
13. Galtung J, Ruge MH. The structure of foreign news. Journal of Peace Research. 1965; 1: 64-90 // Sodré M. A narração do fato: notas para uma teoria do acontecimento. Petrópolis: Vozes; 2009. [ Links ]
14. McCombs ME, Shaw DL. A função do agendamento dos media, 1972. In: Traquina N. O poder do jornalismo: análise e textos da teoria do agendamento. Coimbra: Minerva; 2000. [ Links ]
15. Barros Filho C de. Ética na Comunicação: da informação ao receptor. São Paulo: Moderna; 2001. [ Links ]
16. Traquina N. O poder do jornalismo: análise e textos da teoria do agendamento. Coimbra: Minerva; 2000. [ Links ]
17. Ribeiro APG. A mídia e o lugar da história. In: Herschamann M, Pereira CA (org.). Mídia, memória e celebridades. 2ª ed. Rio de Janeiro: E-Papers; 2005. p. 105-29. [ Links ]
18. Marcondes Filho C. O capital da notícia: jornalismo como produção social da segunda natureza. São Paulo: Ática; 1986. [ Links ]
19. Donalisio MR. O dengue no espaço habitado. São Paulo: Hucitec: Funcraf; 1999 // Cordeiro MT, Freese E, Schatzmayr H, Nogueira MR. Vinte anos de evolução da dengue no Estado de Pernambuco. Recife: Ed. Universitária da UFPE; 2008. [ Links ]
20. Houaiss A. Dicionário Houaiss da Língua Portuguesa. Rio de Janeiro: Objetiva; 2009. [ Links ]
21. Fausto Neto A. Comunicação e mídia impressa: estudo sobre a Aids. São Paulo: Hacker; 1999. [ Links ]
22. Gomes IMAM. A Divulgação Científica em Ciência Hoje: características discursivo-textuais. 2002 [tese de doutorado]. Recife: Programa de Pós-graduação em Letras; 2000. [ Links ]
23. Ministério da Saúde. Ações integradas de educação, comunicação e mobilização social no controle de doenças preveníveis. Disponível em http://www.dengue.lcc.ufmg.br/dengue_cd/ files/ministerio/materiais/encontro_nacional/apresentacaodagepdengue01.pdf [Acessado em 29 de janeiro de 2011] [ Links ]
24. Guzmán MG, Kourí GG y G. El dengue y el dengue hemorrágico: prioridades de investigación. Rev Panam Salud Pública 2006; 19(3); 204-15. [ Links ]
25. Pena F. Teoria do jornalismo. 2ª ed. São Paulo: Contexto; 2006. [ Links ]
26. Ministério da Saúde. Doenças negligenciadas: estratégias do Ministério da Saúde. Rev Saúde Pública. 2010, v. 44, n. 1, p. 200-2. [ Links ]
Luiz Marcelo Robalinho Ferraz
Rua Maria Ramos, 1153/02, Bairro Novo
Olinda, PE CEP 53030-050
Final version: 20/02/11