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DoseCal software has been used to evaluate the Entrance Surface Dose (ESD) and Effective Dose (ED) of adult patients undergoing abdomen, cervical spine, chest, lumbar spine and skull diagnostic X-ray examinations in AP, PA and LAT projections. The survey was carried out in nine hospitals in Rio de Janeiro state with a total of 1917 radiographs. The mean values of ESD (mGy) and ED (mSv) were recorded. Although the results obtained are below the international diagnostic reference levels, they present large variations within and between hospitals which reflects the disparity of radiographic techniques used in the examinations. The results were compared with the European Community Reference Levels. Even though in Brazil there are specific legislations on radiation protection and implementation of Quality Assurance Programs (QAPs) in all medical institutions, there is still a need for personnel training and national guidance on good practice for optimization of patients' doses.

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Studies were performed on five Brazilian populations of Lutzomyia longipalpis: Salvaterra (PA), São José do Ribamar (MA), Canindé (CE), Natal (RN) and Gruta da Lapinha, Lagoa Santa (MG). No morphological differences were observed that could distinguish between these populations. Homogeneity tests showed that the allopatric populations display a certain heterogeneity and that the sympatric populations, with different patterns of spots, are homogeneous. The Student-Newman-Keuls test, represented by Euler-Venn diagrams, showed a disjunction between the populations from the north/northeast and the one from Gruta da Lapinha. Genetic distances between the four populations (excluding the Canindé population) were within the range of intrapopulational differences. The Gruta da Lapinha population displayed a heterozygotic deficiency that could be a consequence of high levels of inbreeding due to cryptic habits of living in a small cave. These results do not favor the hypothesis of a L. longipalpis species complex in Brazil, and the species should be considered high polymorphic.

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The basic concepts, evolution and practice of health planning are described, in the context of WHO role. Special emphasis is given to the Cendes-OPS methodology, to be this procedure a more specific, articulated and implemented widely in the American region. Finally, future projections of these activities are given.

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Recent literature (up to 1988) on health services assessment in general and especially on hospital service assessment is reviewed, with special attention to its conceptual and methodological aspects. The history of this process is also examined, from the first attempts by the American College of Surgeons, through the Joint Commission for Hospital Accreditation activities up to more recent efforts. The Diagnosis Related Group methodology is commented especially, as well as its more recent complement, the severity of illness indicators. Progress made in this field is briefly examined as in the light of the Brazilian situation. The origins of the growing international concern with this field are enumerated: soaring costs of health services; the recent growth in the number of medical malpractice suits; and the sharp increase in the complexity of health services. The sources of information used in the process, such as immediate observation (case-control type studies), medical records, and summary instruments already in use for payment or financial control purposes, are commented on. Mention is made of the deep influences of the assessment process on practice as in the case of the standardization of practices and procedures, staging of the pathological processes, trajectory-type studies; the utilization of tracer situations, and, finally, the most influential on practice of all these assessment instruments: the diagnosis and treatment protocols, already in wide use in some medical fields such as cancer treatment even in developing countries.

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This article describes community participation in a comprehensive eight-year health program at Porto Nacional, a town in Brazils Amazon region. The authors discuss various techniques employed to encourage community participation, indicate methods used to resolve low-key conflicts in a positive manner, describe the major contributions made by community participation in this program, and present a number of conclusions considered applicable to other communities in this part of Brazil.

PIP: Community participation was found to be an important resource for ascertaining and achieving the project health goals of a multiprofessional health team in Porto Nacional, an Amazon community in Brazil's interior. The project was established in 1968 to provide comprehensive, integrated medical care. The health team consisted of 6 physicians (1 sanitarian, 2 surgeons, 2 internists, and 1 pediatrician), 2 social workers, 1 nurse, and 1 educator. The team assumed operating responsibility for the area's health unit and 50 bed hospital, and worked closely with other local health agencies and providers. To attract financial and technical resources, the team founded a non-profit agency, COMSAUDE, to promote health and educational activities. The area's health problems consisted of a predominance of waterborne and foodborne diseases, an infant mortality rate of approximately 70 deaths/1000 live births, high malaria morbidity, tuberculosis, leprosy, cutaneous leishmaniasis, a moderate incidence of Chagas' disease, and extensive infestation of vermin. The local health unit was well-known and accepted in the community which facilitated the team's activities. At the time of the team's arrival, the vermin problem was causing public concern. Work on controlling this problem appeared an appropriate vehicle to achieve the dual objectives of promoting sanitation activities and becoming familiar with and accepted by the community. A combination of home visits and general meetings with institutional and local leaders mobilized a significant segment of the population. Increased cesspool construction resulted. Among the poorest neighborhoods, residents developed an organization to finance the cost of construction materials. Technical assistance from sanitation aides was provided to rural communities. Municipal health boards were organized to assure maximum utilization of visiting physicians, to conduct health surveys, and to oversee the implementation of recommended preventive health measures. A health board of volunteers was initiated in Porto Nacional to identify health related problems and propose solutions within the scope of the local government. The board was responsible for improvements in sanitation at the market place and the organization of trash collection. Health surveys were conducted utilizing students from local schools as interviewers. The surveys increased community awareness of health problems in addition to providing health data. A center for malnourished children was established which served as a recuperation facility for the children and a nutrition and hygiene education center for mothers. A cooperative housing improvement program was initiated. Residents worked Saturdays gathering construction materials and working on neighbors' houses. The sanitation aides assisted in drawing plans and selecting building, cesspool, and well sites. The team participated in educational activities at the schools, including a controversial sex education/marriage preparation course that was ultimately limited to prospective newlyweds. Based on 8 years of program operation, the authors conclude that community participation is an important development resource and that the process of working together is as important as the results achieved.

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