Mixed-Methods Evaluation of the Initial Implementation of Advanced Home Visits in Chile

Home visiting programs are evidence-based interventions that have a myriad outcomes for mothers and newborns. Chile offers these services as part of the Chile Crece Contigo, a nationwide program. However, implementing home visiting programs in community settings is difficult. In this study, we report clinic, provider, and participant engagement with the implementation of advanced home visits (ViDAs) in Chilean primary care clinics. ViDAs include a high number of visits, external supervision, and the use of technology. In this study, qualitative and quantitative data were collected to assess the initial implementation of the home visiting strategy. Qualitative data consisted of individual interviews and focus groups with directors of city health departments, clinic managers, and providers conducting home visits. Quantitative data included clinic, provider, and participant recruitment. City health departments were approached to authorize the participation of primary care clinics in the ViDAs program. Then, clinic directors were invited to approve the implementation of the home visiting program at their health centers. In total, 16 clinics, 42 practitioners, and 185 participants were recruited. A large amount of resources was needed to recruit clinics, providers, and participants. The intervention had low acceptability, low adoption, and a high implementation cost. Initial program implementation experienced several challenges. Identified facilitators and barriers both highlighted the need for community engagement at all levels for the successful implementation of an innovation in Chilean primary care clinics. In addition, this article provides recommendations for practitioners and researchers regarding the conduct of research in community-based settings.

Successful defibrillation in the prone position

Early defibrillation provides the greatest chance of survival after ventricular fibrillation. Conventional cardiopulmonary resuscitation and defibrillation requires the patient to be in the supine position. Electrical treatment of arrhythmias such as atrial fibrillation by means of a defibrillator back paddle in patients receiving prone ventilation in intensive care has been described. We report a case in which electrical defibrillation was successfully performed in the prone position in a patient undergoing complex spinal surgery. We suggest that, if defibrillation were required in ventilated patients positioned prone, defibrillation should be attempted in the prone position, as turning the patient supine would consume valuable minutes and reduce the chances of successful defibrillation.

[The infected partners view of AIDS]

Our objective was to reflect upon the HIV contamination in women who has a stable relationship. We have used semi-structure interview with an ethnographic way of focussing to the women from Infections diseases hospital, also STD's at the State of Ceará. At the interview questions about prevention in the couple relationship, the HIV positive result reaction, the feelings toward children and living with family and friends have been made. The interview analysis has identified the absence of prevention, the lack of search about HIV information, the wives wrath and the worries about the children, and also the difficult situation between family and friends.