A segurança do paciente cirúrgico é problemática complexa e desafiadora em âmbito global. A presente pesquisa teve como objetivos (a) analisar as evidências disponíveis na literatura sobre o processo de implementação da lista de verificação de segurança cirúrgica da Organização Mundial da Saúde na prática dos serviços de saúde, e (b) analisar o processo de implementação e o uso diário da lista de verificação de segurança cirúrgica, segundo o relato de enfermeiros que atuavam em unidades de centro cirúrgico de hospitais de duas cidades localizadas no estado do Paraná. A pesquisa foi conduzida em duas fases: revisão integrativa e estudo descritivo. A busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL e LILACS. A amostra da revisão integrativa foi composta de 27 pesquisas agrupadas em três categorias, a saber: processo de implementação: estratégias para introdução da lista de verificação de segurança cirúrgica nos serviços de saúde (n=15); processo de implementação: estratégias para otimização do uso da lista de verificação de segurança cirúrgica nos serviços de saúde (n=9) e facilitadores e barreiras para implementação da lista de verificação de segurança cirúrgica nos serviços de saúde (n=3). A condução da revisão integrativa possibilitou compreender o processo de implementação da lista, as diferentes estratégias utilizadas para sua implantação, aspectos da implementação considerados bem-sucedidos ou pouco exitosos no alcance dos resultados esperados, facilitadores e barreiras deste processo. O estudo descritivo foi realizado em 25 hospitais de duas cidades que compõem a mesorregião do Norte Central Paranaense (Londrina e Maringá). Os participantes foram 91 enfermeiros que atuavam em centro cirúrgico dos hospitais selecionados. Para a coleta de dados elaborou-se dois instrumentos, os quais foram submetidos à validação aparente e de conteúdo. Os resultados evidenciaram que, na maioria dos hospitais investigados, a lista de verificação de segurança cirúrgica foi implementada, sendo que, para a maioria dos participantes, as estratégias adotadas na introdução da lista foram o planejamento prévio conduzido pelos enfermeiros, a adaptação com predominância do uso no formato impresso e programa educacional. Com relação ao uso diário da lista, a maioria dos enfermeiros apontou a utilização inadequada desta prática nos seguintes aspectos: adesão parcial ao uso pela equipe cirúrgica, diferença de adesão entre as etapas de checagem e entre as categorias profissionais e condutas inadequadas da equipe cirúrgica na checagem da lista em sala cirúrgica (equipe incompleta, desatenta e sem participação ativa de seus membros). Para a maioria dos participantes, o uso da lista trouxe benefícios ou tem potencial para produzir efeitos benéficos para o paciente, equipe cirúrgica e serviço de saúde. As evidências geradas trazem subsídios para os enfermeiros e demais profissionais de saúde na elaboração de protocolos relativos ao processo de implementação ou uso diário da lista mais adequados e compatíveis com as especificidades estruturais e organizacionais dos serviços de saúde nacionais, com o propósito de viabilizar a integração desta ferramenta no processo de trabalho, melhorar a adesão da equipe e alcançar os melhores resultados em prol da segurança do paciente / Surgical patient safety is a complex and challenging problem at the global level. This study aimed to analyze (a) the available evidence in the literature on the process of implementation of the surgical safety checklist of the World Health Organization in the practice of health services, and (b) the implementation process and the daily use of the surgical safety checklist, according to the report of nurses working in surgical center units of hospitals of two cities located in the state of Paraná. The research was conducted in two phases: integrative review and descriptive study. The search for primary studies was carried out in PubMed, CINAHL and LILACS databases. The sample of the integrative review consisted of 27 studies grouped into three categories, namely: implementation process: strategies for the introduction of the surgical safety checklist in the health services (n = 15); implementation process: strategies to optimize the use of the surgical safety checklist in health services (n = 9) and facilitators and barriers to the implementation of the surgical safety checklist (n = 3). Conducting the integrative review made it possible to understand the process of implementing the list, the different strategies used for its implementation, aspects of implementation considered successful or not very successful in achieving the expected results, facilitators and barriers of this process. The descriptive study was carried out in 25 hospitals of two cities that make up the mesoregion of Northern Central of Paraná state (Londrina and Maringá). Participants were 91 nurses who worked in the surgical center of the selected hospitals. For the data collection, two instruments were elaborated, which were submitted to the apparent validation and content. The results showed that, in most of the hospitals investigated, the surgical safety checklist was implemented, and, for most of the participants, the strategies adopted in the introduction of the list were the previous planning conducted by the nurses, the adaptation with predominance of the use in the printed format and educational program. Regarding the daily use of the list, most of the nurses pointed out the inadequate use of this practice in the following aspects: surgical team\'s partial adherence to the use of it, difference in adherence between the check-up stages, and between the professional categories and inadequate behavior of the surgical team in checking the list in the surgical room (incomplete, inattentive team, and members not taking part actively). For most participants, using the list has brought benefits or can potentially produce beneficial effects for the patient, surgical team, and health service. The evidence generated provides subsidies for nurses and other health professionals in elaborating protocols related to the implementation process or daily use of the list more adequate and compatible with the structural and organizational specificities of the national health services, in order to make feasible the integration of this tool into the work process, to improve team adherence and to achieve the best results for patient safety

A produção e o uso global de produtos químicos é alta e está em ascensão. Provocado pela globalização econômica, o movimento trans-fronteiriço de produtos químicos e seus resíduos tornam a exposição humana a produtos químicos um grande risco para a saúde pública. O Regulamento Sanitário Internacional (RSI-2005) revisado reconhece os riscos impostos pelos produtos químicos à saúde pública ao incorporá-los entre aqueles com potencial para se tornar uma Emergência de Saúde Pública de Importância Internacional (ESPII). A falta de implementação do RSI-2005 em um país pode ameaçar a segurança sanitária global. Objetivos: O objetivo geral desta tese é apresentar uma proposta para superar o problema da baixa implementação das capacidades de saúde pública em produtos químicos no RSI-2005 e usar o regulamento como uma plataforma para fortalecer a governança para a saúde pública em produtos químicos em todos os níveis de complexidade dos sistemas de saúde. Os objetivos específicos são: desvendar os determinantes, forças motrizes, caminhos e processos que poderiam levar a eventos químicos com potencial ESPII; propor um construto teórico que possa orientar a governança para a saúde pública nesta questão; e identificar os mecanismos que poderiam facilitar a implementação das principais capacidades de saúde pública em produtos químicos para mitigar riscos. Métodos: A secção de métodos inclui: uma revisão sobre riscos químicos locais e globais, apresentando seus determinantes; revisão do conceito de bens públicos, aplicando-o a aspectos relacionados à segurança química; revisão de eventos químicos passados que poderiam atender aos critérios de potencial ESPII; revisão dos princípios da atenção primária à saúde, explorando possibilidades e oportunidades de incorporar a capacidade em riscos ambientais no contexto dos sistemas locais de saúde para fortalecer a vigilância, o monitoramento e a análise da saúde ambiental em todos os níveis; e proposição de um kit de ferramentas de apoio à implementação das capacidades básicas do RSI-2005 em produtos químicos. Resultados: Esta tese constrói seu argumento na seguinte sequência: \"Segurança Química é um Bem Público Global para a Saúde\"; \"Lições Aprendidas de Surtos Químicos Mortais\"; \"O Estado da Vigilância em Saúde Pública para Incidentes Químicos: Dez Anos de RSI-2005 na América Latina e no Caribe\"; \"Capacidade de Vigilância em Saúde e Resposta: do Local ao Global\"; e \"Um Guia para a Implementação de Capacidades Básicas de Saúde Pública para Eventos Químicos\". Discussão: Existe relação entre as agendas globais e locais. O RSI-2005 pode ser interpretado como uma oportunidade para rever os princípios e as capacidades essenciais de saúde pública e para revitalizar a forma como os sistemas de saúde são organizados, fortalecendo os mecanismos de governança para a saúde e a produção de bens públicos globais para a saúde. Isto requer o envolvimento do setor saúde com a sociedade em geral e um papel proeminente e proativo de liderança da OMS. Conclusão: Atuação local não resolverá problemas globais, mas ela não pode ser desvinculada da atuação global. A necessidade de revisitar e atualizar os sistemas nacionais de saúde para responder a esse contexto de globalização é clara e urgente e o RSI-2005 fornece uma plataforma que pode ser inteligentemente usada na elaboração desta resposta. Não para proteger o comércio e a economia, mas a saúde do povo. / The global production and use of chemicals is high and on the rise. Triggered by economic globalization, the transboundary movement of chemicals and their waste makes human exposure to chemicals a widespread public health risk. The revised International Health Regulations (IHR-2005) recognized the risks posed by chemicals to public health by incorporating them among those with the potential to become a Public Health Emergency of International Concern (PHEIC). Lack of implementation of the IHR-2005 in one country can threaten global health security. Objectives: The general objective of this thesis is to present a proposal to overcome the problem of low implementation of the public health capacities on chemicals in the IHR-2005 and to use the regulations as a framework to strengthen governance for public health on chemicals at all levels of complexity of the health systems. The specific objectives are: to unveil the determinants, main drivers, pathways and processes that could lead to chemical events with potential PHEIC; to propose a theoretical construct that could guide governance for public health on this matter; and to identify the mechanisms that could facilitate the implementation of the core public health capacities on chemicals to mitigate risks. Methods: The methods section includes: a literature review of local and global chemical risks, presenting their drivers; review of the concept of public goods, applying it to aspects related to chemical safety; review of past chemical events that could meet the criteria of potential PHEIC; review of the principles of primary health care, exploring possibilities and opportunities of incorporating capacity on environmental risks in the context of local health systems to strengthen environmental health surveillance, monitoring and analysis at all levels; and proposition of a toolkit for the implementation of the IHR-2005 core capacities on chemicals. Results: This thesis builds its argument in the following sequence: \"Chemical Safety is a Global Public Good for Health\"; \"Lessons Learned from Deadly Chemical Outbreaks\"; \"Status of Public Health Surveillance for Chemical Incidents: Ten Years of IHR-2005 in Latin America and the Caribbean\"; \"From Local to Global Capacity for Health Surveillance and Response\"; and \"A Guide for the Implementation of Core Public Health Capacities on Chemicals\". Discussion: There are linkages between the global and local agendas. The IHR-2005 can be taken as an opportunity to revisit public health principles and core capacities, and revitalize the way health systems are organized, strengthening mechanisms of governance for health, and the delivery of global public goods for health. This requires the engagement of the health sector with the society in general, and a prominent and proactive leadership role of the WHO. Conclusion: Acting local will not solve global problems, but it can no longer be disentangled from acting global. The need to revisit and update national health systems to respond to this context of globalization is clear and urgent, and the IHR-2005 provides a framework that can be smartly used in the elaboration of this response. Not to protect trade and the economy, but the health of the people.

No description available.

The CIDI is a fully standardised, structured interview for the assessment of psychiatric disorders according to DSM-II-R and proposed ICD-10 criteria. The development of this interview has been the collaborative effort of researchers from 18 sites around the world. In a field trial to test the cross-cultural acceptability and reliability of the questions, there was found to be high acceptance and excellent reliability for the substance use questions, problems with the lengthy alcohol section, and difficulties translating relevant substance use concepts into different languages. There is therefore room for further improvement in the substance-related questions. There proved to be differences between ICD-10 and DSM-III-R regarding substance abuse and dependence disorders.

Globally female smoking rates are considerably lower than male smoking rates. However, there is great concern regarding female smoking due to the potential for future increases and the associated harm to health. To gain a better understanding regarding female smoking, this study examines the role of gender equality and economic development in explaining the variability in female smoking rates and female-to-male smoking differentials by examining data from 193 World Health Organization member states. Data on the dependent variables, female smoking prevalence rates and female-to-male smoking prevalence ratio, were obtained from the Tobacco Atlas. Data on independent variables i.e., measures of gender equality and gross national income per capita, proxy measure for economic development, were obtained from the 2005 Human Development Report, Central Intelligence Agency, and the World Bank. A composite gender equality index was constructed from the individual measures of gender equality. Multiple regression analysis showed composite gender equality index and gross national income per capita to be significant positive predictors of relative and absolute female smoking rates, with income being a stronger predicator. Individual measures of gender equality failed to show significance with either dependent variable. The results attest to the need for disentangling smoking from the notion of advancement in gender equality and economic development.

Šiame darbe yra analizuojamos Tarptautinės sveikatos priežiūros taisyklės, aptariant jų istoriją, pagrindinius principus bei įtaką šiuolaikiniu globalizacijos periodu. Tarptautinės sveikatos taisyklės yra neatsiejama dalis, siekiant išvengti tarptautinio infekcinių ligų plitimo tarptautiniu mastu, netrukdant tarptautinei prekybai bei susisiekimui. Norint išlikti visaverte partnere tarptautinėje erdvėje vystant ekonominę, socialinę padėtį, privalu taisykles įgyvendinti. Lietuva, būdama Pasaulio sveikatos organizacijos, Europos Sąjungos narė, ratifikavo taisykles bei įsipareigojo jas įgyvendinti Lietuvos Respublikos Vyriausybės nutarime iki 2012 metų. Pagrindiniai uždaviniai – suderinti atitinkamus teisės aktus su Taisyklių reikalavimais, užtikrinti tinkamą pasirengimą ir reagavimą į ekstremalias visuomenės sveikatai situacijas, keliančias tarptautinį susirūpinimą, taip pat efektyviai ir laiku koordinuoti tokias situacijas, sustiprinti administracinius gebėjimus, kurių reikia reaguojant į ekstremalias visuomenės sveikatai situacijas, keliančias tarptautinį susirūpinimą. Teisinė bazė yra rengiama pakeičiant/priderinant jau egzistuojančias bei kuriant naujas teisės normas. Lietuvos Respublikos Vyriausybė įsipareigoja teisinę bazę galutinai parengti 2009 metais. / This work is an analysis of the International Health Regulations, discussing their history, basic principles and the impact of globalization in the contemporary period. International Health Regulations are an integral part, to prevent the international spread of infectious diseases internationally, impeding international trade and travel. To remain full–fledged partner in international space development in economic, social situation, the regulations must be implemented. Lithuania as the member of World Health Organization and European Union has ratified the regulations, and undertook implement by the resolution of the Goverment Republic of Lithuania until 2012. The main tasks of harmonizing the legislation with the regulations, are to ensure adequate preparedness and response to emergency public health situations which pose an international concern, as well as an efficient and timely coordination of such situations, to reinforce the administrative capacity needed to respond to emergency public health situations which pose an international concern. The legal framework is being prepared modyfing / adjusting existing and the developing new legal norms. The Government of the Republic of Lithuania commited to finalise legal framework in 2009.

In attempting to give more years of life to cancer patients, their Quality of Life (QoL) during this time has frequently been compromised. Assessment of patients’ QoL provide nurses with an opportunity to know about the whole range of patients’ needs and desires. These information would be potentially very useful for health care professionals particularly nurses for planning, conducting and evaluating the nursing care of cancer patients. Questionnaire survey research carried out in countries other than Australia identified a varied amount of agreement between cancer patients and nurses about cancer patients’ QoL. However, based on the literature review, no research study has been found in Australia that provides a detailed understanding of how nurses and cancer patients are similar or different in their perceptions of cancer patients’ QoL. A research study, therefore, was conducted to answer the following key questions: (a) what differences and/or similarities are there between patients’ and nurses’ perceptions of cancer patients’ QoL; (b) why do these differences and/or similarities exist? A research study with a mixed approach was undertaken to answer the research questions. In the first phase, a survey by questionnaire was conducted. The main aims were to identify: (a) the level of agreement between cancer patients’ and nurses’ scores on the World Health Organisation’s Quality of Life Brief questionnaire (WHOQoL-BREF); and (b) variables that may influence the level of agreement between them. Each patient and nurse was invited to complete the WHOQoL-BREF questionnaire, which was considered as an appropriate tool for evaluating cancer patients’ QoL. This questionnaire considers QoL across four domains or dimensions: physical, psychological, social relationship and environmental. In the first phase of the study, 166 cancer patients and 95 nurses were recruited from three major hospitals in Adelaide, South Australia. The patients had a range of cancer diagnoses with breast cancer being the most prevalent. Most patients were being treated as inpatients with chemotherapy being their primary treatment. The mean age of nurses was approximately 37 years and their clinical experience with cancer patients averaged approximately eight years. Intraclass Correlation Coefficient (ICC) between patients’ and nurses’ scores ranged from ‘poor’ in the social relationship and psychological domains up to ‘moderate’ in the physical domain indicating that generally nurses were different in their perceptions from those of cancer patients. Another major finding of this phase was that nurses underestimated cancer patients’ QoL in the social relationship and environmental aspects, which consisted of more personal and private issues. Having finished the first phase, the second phase was conducted based on the principles of a classical version or mode of grounded theory. The aim here was to include an interpretive perspective and explore the reasons why nurses may differ in their perceptions about cancer patients’ QoL in comparison to cancer patients. In this phase, three cancer patients and 10 nurses took part in semi-structured interviews. Participants were selected from different inpatient and outpatient oncology services and a palliative setting. Differences in patients’ and nurses’ perceptions about cancer patients’ QoL and their implications for nursing clinical practice were discussed further in the light of six important categories found in the second phase including: QoL meanings, QoL aspects, Cues-based QoL assessment; Purpose-based QoL assessment; Facilitators of QoL assessment; and Barriers to QoL assessment. It emerged that QoL has individualised meanings and nurses generally have difficulties understanding their patients’ personal perspective or definition of QoL. Another interpretive outcome that may explain why nurses differed in their perceptions when compared with cancer patients is that nurses’ assessment of cancer patients’ QoL in oncology wards is mainly made during their interaction with patients when providing care. Such an assessment has a focus on physical cues and may not facilitate nurses developing a more holistic picture of cancer patients’ QoL. Participants in the interpretive phase indicated that time limitations, focus on care tasks, and discontinuity of care, all work against nurses developing a more accurate understanding of cancer patients’ QoL. Conversely, it was found that building a relationship and stronger rapport with patients is the main facilitator in improving nurses’ understanding of cancer patients’ QoL.

Thesis (MPhil)--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: Health scientists agree that the media is a crucial conduit for communicating life-saving, preventative and curative health messages to a wider audience. They also concur that they are the gatekeepers, and the responsibility of communicating their findings and health information to the public rests with them. And yet, their relationship with journalists is often unhealthy and in need of attention. Many health scientists lack knowledge and understanding about who the media are, and what they require to do the job of reporting ethically and professionally. They often lack the skills needed to frame simple, succinct messages timeously, especially on controversial issues such as vaccines and drug safety, immunisation and drug treatment for infectious diseases such as HIV/AIDS. This study argues that health scientists/professionals globally, irrespective of culture, ethnicity, creed, language or media systems, need training on how to communicate with the media in the interests of public health. This is especially so in the modern world with its complex, high-speed communication. The objective of the study was to assess the impact of a WHO media communication training programme for health scientists worldwide. More specifically, the study sought to shed light on whether the training shifted their perceptions and attitudes to the media. And, if so, in what way? It also aimed to find out if the trainees learned any skills on how to deal with reporters. The research methodology was qualitative. A review of the literature, to establish current thinking in the field, was followed by interviews with health professionals. The interviewees are from China, South Africa and Ghana and received the same basic training either in South Africa, China or Sri Lanka. Some were trained in 2005, others in 2004 and others before that. Most had been trained together with participants from other countries. Two focus groups were conducted in China before and after training. Included, is an account of the aims and objectives of each module of the actual training. The study also made use of WHO documents and news and feature articles from newspapers, radio and the internet. Most participants had never had media communication training but had been interviewed by reporters. While some had positive experiences, others felt bruised by their interactions with journalists. After training, however, they registered a shift in attitude toward feeling more positive and less fearful of the media. They felt more confident and better equipped to engage with journalists. Most participants desired more training to consolidate the skills that they had learned. Some had managed to put the training to good use by developing similar programmes in their own country. Others who were trained more recently were enthusiastic about the prospect of sharing ideas with colleagues. Those who were unlikely to deal with the media directly said they felt they could at last contribute to discussions on the media in the workplace. The WHO training, albeit a first step aimed at bridging the gap between health professionals and journalists, goes a long way in addressing the frustrations and the complexities of dealing with the media. Health professionals want to communicate because they need to reach their target population, the ordinary person in the street. Training and facilitation can empower health professionals to deal constructively with the media in getting health messages to the public. This training programme, which imparts practical skills including how to prepare and manage interviews, could be adapted to meet the needs of scientists from different disciplines. / AFRIKAANSE OPSOMMING: Gesondheidswetenskaplikes is dit eens dat die media ‘n uiters belangrike middel is om lewensreddende, voorkomende en genesende gesondheidsboodskappe aan ‘n groter gehoor oor te dra. Hulle stem ook saam dat hulle die hekwagters is en die verantwoordelikheid het om hul bevindinge en gesondheidsinligting aan die publiek oor te dra. Tog is hul verhouding met joernaliste dikwels ongesond en sorgwekkend. Talle gesondheidswetenskaplikes het geen kennis en begrip van wie die media is en wat hulle nodig het om hul taak – verslaggewing – eties en professioneel te verrig nie. Hulle kort dikwels die vaardighede om eenvoudige, saaklike boodskappe betyds te formuleer, veral as dit kom by omstrede aangeleenthede soos veilige entstowwe en medisyne, immunisering en medisyne vir die behandeling van aansteeklike siektes. Hierdie studie voer aan dat wetenskaplikes/gesondheidsberoepslui wêreldwyd – ongeag kultuur, etnisiteit, geloof, taal of mediastelsels – ‘n behoefte het aan opleiding om beter met die media te kommunikeer ter wille van openbare gesondheid. Dit is veral belangrik vir die ingewikkelde en snelle kommunikasie van die moderne wêreld. Die doel van die studie was om die uitwerking van ‘n wêreldwye opleidingsprogram van die WGO oor kommunikasie met die media te bepaal. Die studie het meer spesifiek probeer lig werp op die vraag of die opleiding hul begrip van en ingesteldheid teenoor die media verander het. En, indien wel, op watter manier? Dit het ook probeer vasstel of deelnemers enige vaardighede aangeleer het oor hoe om met verslaggewers om te gaan. ‘n Kwalitatiewe navorsingsmetodiek is gevolg. Bestaande literatuur is bestudeer om huidige denkrigtings op die gebied te bepaal, waarna onderhoude met gesondheidsberoepslui asook ‘n TV-gesondheidsverslaggewer van Beijing, China, gevoer is. Die ondervraagdes kom van China, Suid-Afrika en Ghana en het dieselfde basiese opleiding in Suid-Afrika, China of Sri Lanka ondergaan. Sommige is in 2005 opgelei, party in 2004 en ander vroeër. Die meeste is saam met deelnemers van ander lande opgelei. Twee fokusgroepe is voor en ná opleiding in China bestudeer. ‘n Verslag oor die oogmerke en doelwitte van elke module van die werklike opleiding is ingesluit. Die studie het ook gebruik gemaak van WGO-dokumente, nuus- en artikels uit nuusblaaie, die radio en die internet. Die meeste deelnemers het nooit opleiding in mediakommunikasie gehad nie, hoewel verslaggewers al onderhoude met hulle gevoer het. Terwyl dit vir sommige ‘n aangename ondervinding was, het ander nie goeie herinneringe aan hul interaksie met joernaliste nie. Ná opleiding het hulle egter getuig van ‘n positiewer gesindheid teenoor en minder vrees vir die media. Die meerderheid van die deelnemers wou graag verdere opleiding hê om hul pas verworwe vaardighede uit te bou. Party kon selfs soortgelyke programme in hul eie lande ontwikkel. Van die meer onlangse deelnemers was geesdriftig oor die vooruitsig om gedagtes met kollegas te wissel. Diegene wat waarskynlik nie veel met die media te doen sou hê nie, het gesê hulle kon nou minstens by die werk aan gesprekke oor die media deelneem. Hoewel dit maar die eerste tree is om die gaping tussen gesondheidsberoepslui en joernaliste te oorbrug, slaag die WGO se opleiding in ‘n groot mate daarin om die frustrasies en verwikkeldhede van omgang met die media te oorkom. Mense in die gesondheidsberoepe wil graag kommunikeer omdat hulle hul teikenbevolking – die gewone mense – moet bereik. Opleiding en tussentrede kan hulle toerus om konstruktief met die media om te gaan ten einde gesondheidsboodskappe aan die publiek oor te dra. Hierdie opleidingsprogram kan aangepas word om in die behoeftes van wetenskaplikes in verskeie vakgebiede te voorsien.

Dissertation submitted in fulfilment of the requirements for the degree Doctor of Technology: Informatics in the Faculty of Informatics and Design at the Cape Peninsula University of Technology / Background: Daily activities within a health care organization are mediated by information communication processes (ICP), which involve multiple health care professionals. During pregnancy, birth and motherhood a woman may encounter different professionals including midwives, doctors, laboratory personnel and others. Effective management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as; inadequate critical information, misconception of information and uninformed decisions being made. Method: Multi method, multiple case study approach was used to explore and describe the complexities involved in the (ICP), during the management of the intrapartum period. During the study the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. 24 In-depth interviews with skilled birth attendants were conducted, observer- as- participant role was utilized during the observation, fild notes, reflective diaries and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data. Findings: The findings illuminated that there are expectations of accessibility to care of the woman during pregnancy birth and the intrapartum, especially linked to referral processes. The actual ICP focused on documentation and communication of the information within and between organizations. Communication was marked by inadequate documentation and therefore errors in the information communicated. The desires for communication were illuminated by the need to change the current situation. Further a framework for effective information communication was developed: the FAAS framework for the effective management of the intrapartum period. Conclusion: In conclusion what is expected is not what is actually happening. The skilled birth attendants (SBAs) do not necessarily have the answers for change but the challenges were identified as desires for change. I urge that the framework will provide a basis for the evaluation of the effectiveness involved in the ICP for the effective management of the intrapartum period.

Human life and maintainable advancement are still more combined and discusseable.Thus in this days much more attention is beeing concerntrated at the project titled as Healthy town.Under this title one can imagine a lot of its meanings.Someone might take it as injuries,others as clean parks, whereby the kids could play without any concern.As you notice, everyone under the title Healthy town is taking it differently, but altogerther it gives the same meaning as Healthy town. I have choosen this theme for its actuallity.This project Healthy town is completely dealing with the problems of the inhabitants,but does not forget for theire responsibilities and allows an active dialog amongst them and its leadership of the town.We should not forget, that healthy towns have got well worked out methods of public administration, which is well valued by the EU.This fact helps in requirements for grants from EU which is a privilege for healthy towns,which is the reality of today. In the theoritical part of the corrent state I have hilghlited the basic information of the WHO and its communual project Healthy town, which I have aquired through out my studies from special literatures, internet references,magayines,which I have listed in the used sources. In the practical part of the research I have added the information of the findings, which I have aquired wiith the help of my own findings.Initially I have conducted the secondary data analysis, which I have obtained from the database of the national net of healthy towns in CZ, Association of healthy towns in SR,of the Czech statistical office and Slovakian statistical office. Since the project Healthy town is part of the communal project is partially formed induvidually.As a result of this I have refered in the practical part of this work two case studyies of healthy towns,which serves as an exemplary of this project.