Inclusion of hydrodynamic properties of bathing waters is critical in selecting faecal indicators to assess public health impacts of faecal contamination.

The EU Bathing Water Directive (BWD) requires member states to assess bathing water quality according to the levels of faecal indicator bacteria (FIB) in designated bathing areas. However, this criterion has two significant limitations given that the BWD does not; (i) account for differences in hydrodynamic properties of bathing waters and, (ii) assumes that all faecal pathogens decay equally in aquatic environments. This study simulated sewage discharge events in three hypothetical aquatic environments characterised by different advection and dispersion parameters in the solute transport equation. Temporal changes in the downstream concentration of six faecal indicators were determined in simulations that utilised measured decay rates of each faecal indicator from a programme of controlled microcosm experiments in fresh and seawater environments. The results showed that the decay rates of faecal indicators are not a critical parameter in advection dominant water bodies, such as in fast-flowing rivers. Therefore, faecal indicator selection is less important in such systems and for these, FIB remains the most cost-effective faecal indicator to monitor the public health impacts of faecal contamination. In contrast, consideration of faecal indicator decay is important when assessing dispersion and advection/dispersion dominant systems, which would pertain to transitional (estuarine) and coastal waterbodies. Results suggest that the inclusion of viral indicators, such as crAssphage and PMMoV, could improve the reliability of water quality modelling and minimise the risk of waterborne illnesses from faecal contamination.

SARS-CoV-2 variant trends in Ireland: Wastewater-based epidemiology and clinical surveillance.

SARS-CoV-2 RNA quantification in wastewater is an important tool for monitoring the prevalence of COVID-19 disease on a community scale which complements case-based surveillance systems. As novel variants of concern (VOCs) emerge there is also a need to identify the primary circulating variants in a community, accomplished to date by sequencing clinical samples. Quantifying variants in wastewater offers a cost-effective means to augment these sequencing efforts. In this study, SARS-CoV-2 N1 RNA concentrations and daily loadings were determined and compared to case-based data collected as part of a national surveillance programme to determine the validity of wastewater surveillance to monitor infection spread in the greater Dublin area. Further, sequencing of clinical samples was conducted to determine the primary SARS-CoV-2 lineages circulating in Dublin. Finally, digital PCR was employed to determine whether SARS-CoV-2 VOCs, Alpha and Delta, were quantifiable from wastewater. No lead or lag time was observed between SARS-CoV-2 wastewater and case-based data and SARS-CoV-2 trends in Dublin wastewater significantly correlated with the notification of confirmed cases through case-based surveillance preceding collection with a 5-day average. This demonstrates that viral RNA in Dublin's wastewater mirrors the spread of infection in the community. Clinical sequence data demonstrated that increased COVID-19 cases during Ireland's third wave coincided with the introduction of the Alpha variant, while the fourth wave coincided with increased prevalence of the Delta variant. Interestingly, the Alpha variant was detected in Dublin wastewater prior to the first genome being sequenced from clinical samples, while the Delta variant was identified at the same time in clinical and wastewater samples. This work demonstrates the validity of wastewater surveillance for monitoring SARS-CoV-2 infections and also highlights its effectiveness in identifying circulating variants which may prove useful when sequencing capacity is limited.

Exploring the prevalence of gambling harm among active duty military personnel: a systematic scoping review.

The prevalence of gambling harm among active duty military personnel is a largely unexplored topic. With different forms of social gambling often found within (or in close proximity to) military bases around the world, understanding the extent of gambling activities and consequent harms occurring within military contexts warrants further attention. This review aims to identify, describe and thematically synthesise published literature on gambling harm and related issues among active duty military personnel. Scoping review methods were applied in order to understand this relatively under-researched population and understand appropriate avenues for future research. A systematic multi-database text word search, incorporating search results from Scopus, Pubmed, Web of Science, PsychInfo, and the Journal Military Medicine, was conducted. A total of 11 sources met inclusion criteria, all originating from the United States of America. The results suggest a distinct gap in the current international literature on this topic. Despite gambling's long and colourful association with defence downtime, research into gambling harm prevalence rates in relation to what could be considered a high-risk group is limited. Findings reveal that strategies to identify and address gambling harm within this population are severely lacking from the published literature and non-existent outside North America. Implications for understanding and addressing gambling harm among active duty personnel and directions for future research are discussed.

An overview of digital and online strategies to reduce gambling harm.

ISSUE ADDRESSED: Advancements in mobile- and web-based technologies proliferate everyday opportunities to gamble. The increased availability, popularity and intensity of online gambling platforms and interactive gaming activities also changes the way we construct gambling harm reduction interventions. Information and communication technologies (ICT) provide potential opportunities to reduce harm from online gambling through harm minimisation initiatives and currently available services. The aim of this review was to firstly understand the scope of peer-reviewed evidence on ICT-based strategies to reduce online gambling harm, and secondly, what evidence exists specifically in relation to ICT-based harm reduction initiatives for people who gamble online. METHODS: Scoping review methods and a five-stage model of analysis were used to: identify the published literature on ICT-based harm minimisation activities for online gambling; distil models appropriate to address gambling harm in this setting; and synthesise all available evidence, noting gaps and patterns. RESULTS: Sixteen gambling-specific ICT-based interventions were reviewed in depth. The majority of included studies focused on different components of computer-assisted or online therapy programs for disordered gambling, specifically the development of individual skills in managing problematic gambling behaviour. CONCLUSIONS: The review found that despite the widespread potential ICT represent for addressing gambling harm there has been only limited published research to date. SO WHAT: There is a clear need for further investigation into uptake, usage, focus and effectiveness of all online gambling interventions on offer. The dearth of gambling-specific empirical knowledge potentially indicates a serious resourcing and reporting issues in this area.

Evaluation of Electronic Mental Health Implementation in Northern Territory Services Using the Integrated "Promoting Action on Research Implementation in Health Services" Framework: Qualitative Study.

BACKGROUND: Electronic mental health is a promising strategy to bridge the treatment gap in mental health care. Training workshops have been delivered to service providers working with Aboriginal and Torres Strait Islander people at a primary health care level to raise awareness and knowledge of electronic mental health approaches. OBJECTIVE: This study aimed to understand service providers' perspectives and experiences of electronic mental health adoption. More specifically, it aimed to use the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to further identify and understand how different factors facilitate or impede electronic mental health uptake within primary health care settings providing services to Aboriginal and Torres Strait Islander people. METHODS: Qualitative interviews were conducted with 57 service providers working with Aboriginal and Torres Strait Islander people, who had undergone electronic mental health training workshops. RESULTS: Several factors related to innovation (electronic mental health approach), recipients (service providers as an individual and as a team), and context (local, organizational, and external contexts) were found to influence electronic mental health uptake. Particularly, organizational readiness, in terms of information technology resources and infrastructure, policies, workforce and culture, and processes to mandate electronic mental health use, were found to be significant impediments to electronic mental health utilization. These findings led to the development of a three-phase implementation strategy that aims to enhance electronic mental health adoption by addressing organizational readiness before and post electronic mental health training. CONCLUSIONS: The i-PARIHS provides a useful determinant framework that deepens our understanding of how different factors impede or facilitate electronic mental health adoption in this setting. This insight was used to develop a practical and comprehensive implementation strategy to enhance the utilization of electronic mental health approaches within primary health care settings, involving three phases: pretraining consultations, training workshops, and post-training follow-up support.

Development and evaluation of training in culturally specific screening and brief intervention for hospital patients with alcohol-related injuries.

OBJECTIVE: To evaluate health practitioners' confidence and knowledge of alcohol screening, brief intervention and referral after training in a culturally adapted intervention on alcohol misuse and well-being issues for trauma patients. DESIGN: Mixed methods, involving semi-structured interviews at baseline and a post-workshop questionnaire. SETTING: Targeted acute care within a remote area major tertiary referral hospital. PARTICIPANTS: Ten key informants and 69 questionnaire respondents from relevant community services and hospital-based health care professionals. INTERVENTION: Screening and brief intervention training workshops and resources for 59 hospital staff. MAIN OUTCOME MEASURES: Self-reported staff knowledge of alcohol screening, brief intervention and referral, and satisfaction with workshop content and format. RESULTS: After training, 44% of participants reported being motivated to implement alcohol screening and intervention. Satisfaction with training was high, and most participants reported that their knowledge of screening and brief intervention was improved. CONCLUSION: Targeted educational interventions can improve the knowledge and confidence of inpatient staff who manage patients at high risk of alcohol use disorder. Further research is needed to determine the duration of the effect and influence on practice behaviour. Ongoing integrated training, linked with systemic support and established quality improvement processes, is required to facilitate sustained change and widespread dissemination.

Evaluation of an intervention for patients with alcohol-related injuries: results of a mixed methods study.

OBJECTIVE: To explore the effect of education and training on the delivery of alcohol screening and brief intervention and referral to high-risk patients in a hospital setting. Main outcome measures included; delivery of training; practice change in relation to staff performing alcohol screening, brief intervention and referrals. METHODS: Observational study design using mixed methods set in a tertiary referral hospital. Pre-post assessment of medical records and semi-structured interviews with key informants. RESULTS: Routine screening for substance misuse (9% pre / 71.4% post) and wellbeing concerns (6.6% pre / 15 % post) was more frequent following the introduction of resources and staff participation in educational workshops. There was no evidence of a concomitant increase in delivery of brief intervention or referrals to services. Implementation challenges, including time constraints and staff attitudes, and enablers such as collaboration and visible pathways, were identified. CONCLUSION: Rates of patient screening increased, however barriers to delivery of brief intervention and referrals remained. Implementation strategies targeting specific barriers and enablers to introducing interventions are both required to improve the application of secondary prevention for patients in acute settings. IMPLICATIONS: Educational training, formalised liaison between services, systematised early intervention protocols, and continuous quality improvement processes will progress service delivery in this area.

Prevention of Alcohol-Related Crime and Trauma (PACT): brief interventions in routine care pathway - a study protocol.

BACKGROUND: Globally, alcohol-related injuries cause millions of deaths and huge economic loss each year . The incidence of facial (jawbone) fractures in the Northern Territory of Australia is second only to Greenland, due to a strong involvement of alcohol in its aetiology, and high levels of alcohol consumption. The highest incidences of alcohol-related trauma in the Territory are observed amongst patients in the Maxillofacial Surgery Unit of the Royal Darwin Hospital. Accordingly, this project aims to introduce screening and brief interventions into this unit, with the aims of changing health service provider practice, improving access to care, and improving patient outcomes. METHODS: Establishment of Project Governance: The project governance team includes a project manager, project leader, an Indigenous Reference Group (IRG) and an Expert Reference Group (ERG).Development of a best practice pathway: PACT project researchers collaborate with clinical staff to develop a best practice pathway suited to the setting of the surgical unit. The pathway provides clear guidelines for screening, assessment, intervention and referral. IMPLEMENTATION: The developed pathway is introduced to the unit through staff training workshops and associate resources and adapted in response to staff feedback. EVALUATION: File audits, post workshop questionnaires and semi-structured interviews are administered. DISCUSSION: This project allows direct transfer of research findings into clinical practice and can inform future hospital-based injury prevention strategies.

High risk alcohol-related trauma among the Aboriginal and Torres Strait Islanders in the Northern Territory.

High risk drinking is linked with high rates of physical harm. The reported incidence of alcohol - related trauma among Aboriginal and Torres Strait Islander people in the Northern Territory is the highest in the world. Facial fractures are common among young Aboriginal and Torres Strait Islanders. They are often linked with misuse of alcohol in the Northern Territory and are frequently secondary to assault. This review focuses on alcohol-related trauma in the Territory and draws attention to an urgent need for preventative health approach to address this critical issue.