GThelobe Newsletter of the School of Public Health and Community Medicine Smokescreen – the smoking cessation program for use in general practice smoking cessation techniques as they Professor Richmond, the training group are the deliverers of the interventions.” has comprised Dr Phillip Georgouras, Dr Colin Mendelsohn, Dr Steven The major funding sources for these Faux, and Professor Nicholas Zwar. studies in general practice are: The smoking cessation resources for NHMRC, National Heart Foundation of GPs have been translated into other Australia, NSW Department of Health, languages such as Vietnamese, Arabic, Commonwealth Department of Health, Japanese, Malaysian and French. and pharmaceutical companies which Training workshops in the Smokescreen provide the nicotine replacement program have been conducted in products such as GlaxoSmithKline. New Zealand since 1986, in Mainz, Germany in 1994, in Laos in 1995, in The RCTs carried out usually take Istanbul, Turkey in 1996, at the World between five and eight years to Conference in Tobacco or Health in complete. Consequently, it is Beijing in 1997, in specific training necessary to screen large numbers of workshops in Beijing, Shanghai, rofessor Robyn Richmond has patients in general practice to derive Changchun and Wuhan, China in been conducting research in samples with eligible characteristics. 1997 and 1998, in Bangkok in 1998, Pgeneral practice to reduce This inevitably means that large Cambodia in 1998, France in 1999 and smoking prevalence for over a quarter numbers of subjects are managed Spain in 2007. of a century. Robyn explains: “I in trials and large databases are commenced research in this area developed with data collected for “When I commenced research in 1981 for my PhD and from then it has each individual at baseline, and at in smoking cessation the smoking blossomed into many research projects, three, six and twelve months. rates were 41% for males and 31% policy development and training and for females. By 2008 these rates have teaching.” Robyn says: “Over my research career reduced to 18% and 15%, respectively. my studies have recruited more than This downturn in smoking rates is “The majority of my research projects 3000 patients in general practice, due to the multipronged approach have been randomised research which has meant we have had to screen by many individuals, organisations trials (RCTs) in which we compare more than 22,000 patients to derive an intervention with a control group the study sample; over 600 general or placebo condition. In our studies practitioners and 31 practice nurses Inside this Issue we pilot test the research methods, have participated, and more than 2000 measures and multicomponent medical schools worldwide have been • Major successes in the NHMRC interventions. During the many screened three times over 10 years.” project grants years of conducting clinical trials we • Public health: A medical student’s have incorporated evidence based Critical to the success and longevity perspective components into our interventions. of any research program is the • Welcome to Muru Marri These include: the stage of readiness development of effective research to change smoking behaviour, various teams who will sustain through many • More research successes doses of cognitive behavioural therapy, of the issues and problems of clinical • Timor-Leste health and pharmacotherapies used to aid smoking trials and collaborate in further studies. development research forum cessation, booklets for distribution to Since mid 1980s the Smokescreen • New staff at the School smokers, and other services such as group has trained more than 8,500 • Bright young minds: Postgraduate Quitline. In the development phase GPs and over 2000 pharmacists in Research Student Conference we train doctors and practice nurses in smoking cessation methods. Apart from Issue 3: December 2008 www.sphcm.med.unsw.edu.au page 1 Smokescreen MAJOR SUCCESSES IN NHMRC GRANTS and governments. Our research in general practice has played its The School and its Centres have had major successes in the latest NHMRC small part in this significant change. Project Grants: When I commenced research in general practice, GPs did not engage QUIT IN GENERAL PRACTICE in preventive activities. Research $1,076,950 has shown the important role School of Public Health and Community Medicine that the GP can take in reducing Prof Nicholas A Zwar, Prof Robyn L Richmond, Dr Elizabeth J Halcomb, Dr John S smoking prevalence and has been Furler, Dr Julie P Smith substantially supported by the range of pharmacotherapies to aid cessation,” IMPROVING THE LIFESTYLE OF PEOPLE WITH PSYCHOTIC ILLNESSES says Robyn. $773,000 University of Newcastle The Smokescreen program forms A/Prof Amanda L Baker, Prof Robyn L Richmond, Prof Castle David, Prof Jayashri the basis of the smoking cessation Kulkarnie, A/Prof Jill M Williams, Dr Frances J Kay-Lambkin intervention in the Guidelines for Smoking Cessation for Australian ANGER AND VIOLENCE IN TIMOR LESTE General Practice which were developed $540,125 by an expert panel comprising School of Psychiatry Zwar, Richmond, Borland, Stillman, Prof Derrick Silove, Prof Anthony Zwi, Zachary Steel, Dr Robert Brooks, Cunningham and Litt and funded by Dr Susan Rees the Commonwealth Department of Health and Ageing. The Guidelines CAN BETTER CLINICAL PRACTICE LOWER THE RATES OF SEXUALLY were launched to 23,000 GPs in TRANSMITTED INFECTIONS IN REMOTE ABORIGINAL COMMUNITIES? Australia in 2004. Evaluation found $1,746,788 that 81% of GPs had adopted the National Centre in HIV Epidemiology and Clinical Research Guidelines and were using them, three Prof John M Kaldor, James S Ward, Dr Alice R Rumbold, Rebecca J Guy, months after receiving them. Taking Prof Robyn A McDermott, A/Prof Lisa Maher a conservative estimate, there would be more than two million patients RCT COMPARING THE EFFECTS OF TAP WATER VERSUS NORMAL SALINE who were advised by their GPs to ON THE INFECTION AND HEALING RATES OF WOUNDS quit. With an average quit rate of 17% $583,250 at one year, then 351,900 smokers University of Western Sydney in Australia were assisted to quit. Prof Rhonda Griffiths AM, Dr Ritin Fernandez, A/Prof Mary-Louise McLaws, Dr Jeff Rowland, Assoc Investigator: Prof Patricia Davidson In the Canterbury region of New Zealand, the Smokescreen program was implemented into 40 general PATIENT SAFETY: ENABLING AND SUPPORTING CHANGE FOR A SAFER AND practices and also has been adapted for MORE EFFECTIVE HEALTH SYSTEM implementation in France. Recommended Budget $8,400,000 University of New South Wales Studies in general practice for smokers Prof Jeffrey Braithwaite, Prof Johanna Westbrook, Prof Enrico W Coiera, have also led to other research among Prof William B Runciman, Prof Richard Day smokers. These include studies among: indigenous smokers (two completed PhD candidates), prisoners (current NHMRC funded study), those with a mental illness (former and present NHMRC funded studies), general Chinthaka Balasooriya was practice with the practice nurse providing the smoking cessation awarded the Faculty Award intervention (recent NHMRC funded for Teaching Excellence study with Nick Zwar), smokers in hospital, workplace (police, and for his outstanding Australia Post), and education of undergraduate teaching. medical students on smoking cessation. Well done Chinthaka! Issue 3: December 2008 www.sphcm.med.unsw.edu.au page 2 Public health: A medical student’s perspective weekly topics and characterised by activities in community settings and supported by on-campus activities concluding with a case method tutorial at the end of the week. Kieran’s experiences with this approach were both positive and negative. Negative insofar as the practice-based learning sessions were very participant dependent. “In my experience, an engaged group Kieran Owens is sitting on the right, next to him is Lachlan Donaldson (the other Co-Chair of MSAP) and on generally translated into a productive the left of the photo is Paolo Polimeni (works in the development sector and helps to provide oversight and monitoring/evaluation frameworks for the project). The photo was taken by Lucy Hobgood-Brown, the main session, whereas a more disinterested, collaborator from HandUp Congo. apathetic group tended to make sessions less effective. My suspicion is that student engagement was largely a function of the quality of the lecturer Kieran Owens shares his views with and the perceived relevance of the material by the students. The positive Sophie di Corpo side is that the practice-based learning style helped me to develop skills he undergraduate medicine • individual practitioners do not relevant to later pursuits”, he says. program (UMP) has a strong simply work in isolation, but exist as T public/population health focus, part of a system whose coordination Kieran has already applied some of the introducing students to important is important if the overall health of skills that S&H 3 helped him develop. public health issues - particularly in the population is to be improved. “As the 2008 co-chair of the UNSW- the first four years of their six year based Medical Students’ Aid Project program. SPHCM plays an important Kieran says: “I enjoyed being (MSAP) I successfully applied for a role in ensuring this focus remains encouraged to view health from a grant for a collaborative project set in integral and supported in the program. number of different perspectives - the Democratic Republic of Congo. The Kieran Owens is a student in his third ethical, economic, epidemiological, collaborators were the group HandUp year of study in the under-graduate cultural, etc. Such thought experiments Congo and a Congolese womens’ NGO medical program. He recently are stimulating and can yield useful called Foundation Lucie Otaenga (FLO). completed the course Society and tools for approaching health issues.” In the development of this project I Health 3 (S&H3) which has given him have participated in brainstorming a greater insight into the role public “I feel that the course is very successful sessions similar to those found in the health plays in the overall health at both making a strong argument for S&H 3 practice-based learning sessions.