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Background: This study aimed to identify the potential roles for Community Health Navigators (CHNs) in addressing problems faced by patients on discharge from hospital to the community, and attitudes and factors which may influence their adoption. Methods: Twenty-six qualitative interviews and an online codesign workshop were conducted with patients, nurses, general practice staff, health service managers, community health workers, general practitioners, medical specialists, and pharmacists in the Sydney Local Health District. Qualitative themes from the interviews and workshop transcripts were analysed inductively and subsequently grouped according to a socio-ecological model. Results: CHNs could assist patients to navigate non-clinical problems experienced by patients on discharge through assessing needs, establishing trust, providing social and emotional support that is culturally and linguistically appropriate, engaging family and carers, supporting medication adherence, and helping to arrange and attend follow up health and other appointments. Important factors for the success of the CHNs in the performance and sustainability of their roles were the need to establish effective communication and trust with other healthcare team members, be accepted by patients, have access to information about referral and support services, receive formal recognition of their training and experience, and be supported by appropriate supervision. Conclusions: This study was unique in exploring the potential role of CHNs in addressing problems faced by patients on discharge from Australian hospitals and the factors influencing their adoption. It informed training and supervision needs and further research to evaluate CHNs' effectiveness and the acceptance of their role within the healthcare team. Community health workers have been demonstrated in overseas research to play a key role in supporting patients to prevent hospital readmission. This role is now emerging in Australia especially for vulnerable and disadvantaged groups. This study identifies the key potential roles in the Australian context and the training and supervision required. [ABSTRACT FROM AUTHOR]

Problem Although most primary hepatocellular cancers (HCCs) are attributable to chronic viral hepatitis and largely preventable, such cancers remain a leading cause of cancer-related mortality wherever chronic hepatitis B is endemic. Approach Many HCCs could be prevented by increasing awareness and knowledge of hepatitis B, optimizing the monitoring of chronic hepatitis B and using antiviral treatments--but there are gaps In the implementation of such strategies. Local setting The 'B Positive' programme, based in Sydney, Australia, Is designed to Improve hepatitis-B-related health outcomes among immigrants from countries with endemic hepatitis B.The programme offers information about disease screening, vaccination and treatment options, as well as optimized access to care. Relevant changes The B Positive programme has been informed by economic modelllng.The programme offers culturally tailored education on chronic hepatitis B to target communities and their health practitioners and regular follow-up through a population- based registry of cases. Lessons learnt As the costs of screening for chronic hepatitis B and follow-up are relatively low and less than one in every four cases may require antiviral drugs, optimizing access to treatment seems an appropriate and cost-effective management option.The Identification and accurate staging of cases and the judicious use of antiviral medications are predicated upon an Informed and educated health workforce. As establishing community trust Is a lengthy process, delaying the Implementation of programmes against chronic hepatitis B until antiviral drugs become cheaper is unwarranted. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Probleme Bien que la majorite des cancers hepatocellulaires primaires (CHC) soient attribuables aux hepatites virales chronlques et qu'ils puissent etre evites en grande partie, ces cancers restent une des principales causes de mortalite liee au cancer partout ou l'hepatite B chronique est endemique. Approche De nombreux CHC pourraient etre evites par une sensibilisation et une connaissance accrues de l'hepatite B, l'optimisation du suivi des hepatites B chroniques et i'utilisation de traitements antiviraux--mais il existe des lacunes dans la mise en ceuvre de ces strategies. Environnement local Le programme <>, base a Sydney en Australie, est concu pour ameliorer l'etat de sante lie a l'hepatite B chez les immigrants venus de pays ou l'hepatite B est endemique. Le programme offre des informations sur le depistage de la maladie, la vaccination et les options de traitement, alnsi qu'un acces optimise aux soins. Changements significatifs Le programme <> a ete elabore par modelisation economique. Le programme offre un enseignement sur l'hepatite B chronique culturellement adapte pour cibler les communautes et leurs professionnels de sante, et un suivi regulier via un registre de cas base sur la population. Lecons tirees Puisque les couts de depistage et de suivi de l'hepatite B chronique sontrelativementfaiblesetquemoinsd'unmaladesurquatre peut avoir besoin de medlcaments antiviraux, l'optimisation de l'acces au traitement semble etre une option de gestion appropriee et rentable. Identification des cas, leur triage precis et l'utilisation judicieuse des medlcaments antiviraux s'appuient sur un effectif de sante informe et eduque. Letablissement de liens de confiance avec les communautes est un processus long. Par consequent, il n'est pas justifie de retarder la mise en ceuvre de programmes de lutte contre l'hepatite B chronique jusqu'a ce que les medicaments antiviraux deviennent plus abordables. [TEXT NOT REPRODUCIBLE IN ASCII] Situacion Aunque la mayoria'de carcinomas hepatocelulares (CHC) primarios se atribuyen a la hepatitis virica cronica y son evitables en gran parte, ese tipo de canceres sigue siendo una de las principales causas de la mortalidad relacionada con el cancer en aquellos lugares en los que la hepatitis B cronica es endemica. Enfoque Muchos CHC podrian evitarse con un aumento de la concienciaclon y el conocimiento sobre la hepatitis B, la optimizacion de la supervision de la hepatitis B cronica y el uso de tratamientos antiviricos, pero existen lagunas en la puesta en practica de estas estrategias. Marco regional El programa'B Positive' con sede en Sidney, Australia, se ha disenado para mejorar los resultados sanitarios relacionados con la hepatitis B entre los inmigrantes procedentes de paises en los que la hepatitis B es endemica, y ofrece Informacion acerca dela deteccion de la enfermedad, la vacunacion y las opciones de tratamiento, asi como un acceso optimizado a la atencion. Cambios importantes El programa 'B Positive' se fundamenta en modelos economicosy ofrece educacion culturalmente adaptada sobrela hepatitis B cronica para llegar a las comunidades y sus medicos, y realizar un seguimiento regular a traves de un registro poblacional de casos. Lecciones aprendidas Puesto que los costes de deteccion y seguimiento de la hepatitis B son relativamente bajos y menos de uno de cada cuatro casos requiere medicamentos antiviricos, la optimizacion del acceso al tratamiento parece ser una opcion de gestion adecuada y rentable. La identificacion y clasificacion correcta de los casos y el uso acertado de los medicamentos antiviricos se apoya en una personal sanitario Informado y formado. El establecimiento de la confianza de la comunidad es un proceso muy largo, por lo que retrasar la ejecucion de programas contra la hepatitis B cronica hasta que los medicamentos antiviricos se abaraten no tiene justificacion alguna., Problem In May 2010, the Sixty-third World Health Assembly adopted a resolution calling for a comprehensive approach to the prevention and control of all forms of viral hepatitis--which kills over [...]

Abstract Background Recent research has shown that wearing multifocal glasses increases the risk of trips and falls in older people. The aim of this study is to determine whether the provision of single-lens distance glasses to older multifocal glasses wearers, with recommendations for wearing them for walking and outdoor activities, can prevent falls. We will also measure the effect of the intervention on health status, lifestyle activities and fear of falling, as well as the extent of adherence to the program. Methods/Design Approximately 580 older people who are regular wearers of multifocal glasses people will be recruited. Participants will be randomly allocated to either an intervention group (provision of single lens glasses, with counselling and advice about appropriate use) or a control group (usual care). The primary outcome measure will be falls (measured with 13 monthly calendars). Secondary measures will be quality of life, falls efficacy, physical activity levels and adverse events. Discussions The study will determine the impact of providing single-lens glasses, with advice about appropriate use, on preventing falls in older regular wearers of multifocal glasses. This pragmatic intervention, if found to be effective, will guide practitioners with regard to recommending appropriate glasses for minimising the risk of falls in older people. Trial Registration The protocol for this study was registered with the Clinical Trials.gov Protocol Registration System on June 7th 2006 (#350855).

Background The benefits and harms of bupropion as an aid for smoking cessation in schizophrenia remain uncertain. Aims To summarise the current evidence for efficacy and safety of bupropion as treatment for nicotine dependence in schizophrenia. Method Systematic review and random-effects meta-analysis of randomised controlled trials (RCTs) comparing bupropion with placebo or alternative therapeutic control in adult smokers with schizophrenia. Results Twenty-one reports from seven RCTs were included. Biochemically verified self-reported smoking cessation rates after bupropion were significantly higher than placebo at the end of treatment (risk ratio (RR)=2.57, P=0.004) and at 6 months (RR = 2.78, P = 0.05). Expired carbon monoxide level was significantly lower with bupropion at the end of therapy (P = 0.002) but not at 6 months (P=0.37). There was no significant difference in positive (P=0.28) or negative symptoms (P = 0.49) between the bupropion and the placebo group. Conclusions Bupropion increases the rates of smoking abstinence in smokers with schizophrenia, without jeopardising their mental state. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the provision of single lens distance glasses to older wearers of multifocal glasses reduces falls., Design: Parallel randomised controlled trial stratified by recruitment site and source of referral, with 13 months' follow-up and outcome assessors blinded to group allocation., Setting: Community recruitment and treatment room assessments in Sydney and Illawarra regions of NSW, Australia., Participants: 606 regular wearers of multifocal glasses (mean age 80 (SD 7) years). Inclusion criteria included increased risk of falls (fall in previous year or timed up and go test >15 seconds) and outdoor use of multifocal glasses at least three times a week., Interventions: Provision of single lens distance glasses with recommendations for wearing them for walking and outdoor activities compared with usual care., Main Outcome Measures: Number of falls and injuries resulting from falls during follow-up., Results: Single lens glasses were provided to 275 (90%) of the 305 intervention group participants within two months; 162 (54%) of the intervention group reported satisfactory use of distance glasses for walking and outdoor activities for at least 7/12 months after dispensing. In the 299 intervention and 298 control participants available to follow-up, the intervention resulted in an 8% reduction in falls (incidence rate ratio 0.92, 95% confidence interval 0.73 to 1.16). Pre-planned sub-group analyses showed that the intervention was effective in significantly reducing all falls (incidence rate ratio 0.60, 0.42 to 0.87), outside falls, and injurious falls in people who regularly took part in outside activities. A significant increase in outside falls occurred in people in the intervention group who took part in little outside activity., Conclusions: With appropriate counselling, provision of single lens glasses for older wearers of multifocal glasses who take part in regular outdoor activities is an effective falls prevention strategy. The intervention may be harmful, however, in multifocal glasses wearers with low levels of outdoor activity., Trial Registration: Clinical trials NCT00350389.