Search

The future of successful public health practice requires public health students to be educated within a decolonised curriculum that challenges the historical biases and inequalities that are deeply embedded within global public health and society. In this commentary, we reflect on what it can mean and why it’s important to decolonise and diversify a public health curriculum. We describe how we used a student-led approach to begin this process, and share recommendations that are applicable to national and international curricula.

Introduction and ObjectivesAlcohol consumption is a well-recognised risk factor for a range of diseases, but there is relatively little knowledge on the association between alcohol consumption and respiratory disease risk. We present systematic reviews of alcohol effects on Adult Respiratory Distress Syndrome, asthma, COPD, community acquired pneumonia, obstructive sleep apnoea and tuberculosis.MethodsSystematic reviews identified comparative observational studies listed on Medline, EMBASE and Web of Science, published between 1985 and December 2015, with the exception of tuberculosis, for which we performed a separate search from 2005 to 2017. The reference lists of the eligible studies were also searched. We imposed no language restrictions. Random effects meta-analysis was used to estimate pooled effect sizes with 95% confidence intervals (CI). Heterogeneity was explored using subgroup analyses. Funnel plots and Egger’s asymmetry test were used for the assessment of publication bias.ResultsA total of 120 papers were included in these reviews (see Table 1). Our reviews confirmed an approximate doubling in the risk of CAP among drinkers. In addition, we found that there is an 8% increase in the risk of CAP for every 10–20 grams higher alcohol intake per day. Also, heavy alcohol consumption was found to significantly increase the odds of ARDS/ALI. Furthermore, a subgroup analysis indicated that this association was primarily due to alcohol abuse. Alcohol consumption increased the risk of TB between 2 and 3- fold, depending on study design. We found no evidence of an effect of alcohol consumption on the risk of asthma and COPD.Abstract P122 Table 1Alcohol consumption and respiratory diseasesAlcohol consumptionRespiratory DiseasesNumber of studies included in the reviewNumber of high quality studiesEffect estimateARDS/ALI117OR=1.98,95% CI: 1.50–2.60Asthma152RR=1.00,95%CI: 0.83–1.20COPD137RR=1.05,95%CI: 0.86–1.28CAP117RR=1.98,95% CI:1.45–2.69OSA311RR=1.23,95%CI:1.12–1.36TB3920OR=1.99,95% CI: 1.63–2.43ConclusionsOur review highlights that high alcohol intake is linked to the risks of several respiratory diseases, and that reducing alcohol intake may have an important role to play in respiratory disease prevention.

ObjectivesTo investigate the effectiveness of the systematic default provision of smoking cessation support to all adult smokers admitted to hospital, relative to usual care.DesignOpen, cluster randomised controlled trial.SettingAcute medical wards in one large teaching hospital in the United Kingdom.Participants264 patients randomised to intervention and 229 to usual care; primary outcome data were available at four weeks for 260 and 224 patients, respectively. All adult smokers and recent ex-smokers able to give informed consent were eligible for entry into the study.InterventionsThe intervention comprised systematic smoking ascertainment and default provision of behavioural support and cessation pharmacotherapy for the duration of the hospital stay for all smokers and recent ex-smokers, with follow-up and referral to community services after discharge. Usual care comprised cessation support delivered at the initiative and discretion of clinical staff. All staff and patients were aware of group assignment.Main outcome measuresSmoking cessation at four weeks, validated by measuring exhaled carbon monoxide. Secondary outcomes were uptake of inpatient behavioural support, use of cessation pharmacotherapy, referral to and uptake of community support after discharge, and validated smoking cessation at six months. Participants lost to follow-up were assumed to have reverted to smoking.ResultsAll patients in the intervention group received at least brief advice to quit smoking, compared to 106 (46%) patients in the usual care group. Cessation at four weeks was achieved by 38% (n=98) of intervention patients and 17% (n=37) of usual care patients (adjusted odds ratio 2.10 (95% confidence interval 0.96 to 4.61), P=0.06, number of patients needed to treat 8). Uptake of inpatient behavioural support, use of pharmacotherapy, and referral to and uptake of community support after discharge were all substantially and statistically significantly higher in the intervention group than in the usual care group. Cessation at six months was achieved by 19% (n=47) of intervention and 9% (n=19) of usual care patients, although this difference was not significant (adjusted odds ratio 1.53 (95% confidence interval 0.60 to 3.91); P=0.37).ConclusionsSubstantial improvements in smoking cessation among smokers admitted to hospital can be achieved by systematic ascertainment and delivery of cessation support in secondary care.Trial registrationInternational Standard Randomised Controlled Trial Number ISRCTN25441641.