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Purpose: The epidemiology of personality disorder is poorly understood. This study aims to describe the population in contact with mental health services with a diagnosis of personality disorder and compare service use between this group and those with a diagnosis of depression.Methods: Investigation of a routinely collected clinical data set across New Zealand was conducted. We used data from 2008 to 2017 and 1-year data from 2016, the most complete dataset. This allowed for variation over the years and confirmation within a 1-year prevalence. These data were analysed focusing on patients with a primary diagnosis of any personality disorder and the subset with borderline personality disorder (BPD). BPD was chosen as the most common clinical personality disorder diagnosis and that most researched.Results: 8884 (2.8%) of the population in contact with mental health services carried a primary diagnosis of personality disorder. Personality diagnosis other than antisocial personality disorder (ASPD) in men and borderline personality disorder (BPD) in either gender was negligible. Rates of personality pathology increased with social deprivation and were commonest in young adults. Multi-morbidity was the norm, with internalising disorder common. Maori diagnosed with PD were over-represented both in the patient group and by population.Conclusion: Borderline personality disorder and antisocial personality disorder are routinely diagnosed in routine clinical practice in New Zealand; however, other categorical diagnoses are not made. Patients with PD are significant users of resources in comparison to depressed patients. Resource utilisation was significantly greater in those with PD, in particular use of inpatient services compared to those with depression. [ABSTRACT FROM AUTHOR]

Small changes in agricultural practices have a large potential for reducing greenhouse gas emissions. However, the implementation of such practices at the local level is often limited by a range of barriers. Understanding the barriers is essential for defining effective measures, the actual mitigation potential of the measures, and the policy needs to ensure implementation. Here we evaluate behavioural, cultural, and policy barriers for implementation of mitigation practices at the local level that imply small changes to farmers. The choice of potential mitigation practices relevant to the case study is based on a literature review of previous empirical studies. Two methods that include the stakeholders' involvement (experts and farmers) are undertaken for the prioritization of these potential practices: (a) Multi-criteria analysis (MCA) of the choices of an expert panel and (b) Analysis of barriers to implementation based on a survey of farmers. The MCA considers two future climate scenarios - current climate and a drier and warmer climate scenario. Results suggest that all potential selected practices are suitable for mitigation considering multiple criteria in both scenarios. Nevertheless, if all the barriers for implementation had the same influence, the preferred mitigation practices in the case study would be changes in fertilization management and use of cover crops. The identification of barriers for the implementation of the practices is based on the econometric analysis of surveys given to farmers. Results show that farmers' environmental concerns, financial incentives and access to technical advice are the main factors that define their barriers to implementation. These results may contribute to develop effective mitigation policy to be included in the 2020 review of the European Union Common Agricultural Policy. [ABSTRACT FROM AUTHOR]

Background: Māori in New Zealand have markedly higher incidence and poorer survival from stomach cancer than non-Māori. We investigated the presentation, management and survival of stomach cancer in a cohort of newly diagnosed Māori and non-Māori patients. Methods: A clinical notes review of all Māori from the North Island diagnosed between 2006 and 2008, and a random equivalent sample of non-Māori, was conducted (final cohort n = 335). Patient characteristics, tumour characteristics, receipt and timing of treatment and cancer-specific survival were compared. Results: Compared to non-Māori, Māori patients had a younger average age at diagnosis, higher prevalence of congestive heart failure and renal disease, and were more likely to be diagnosed with distal disease (43 % Māori, 26 % non-Māori, p = 0.004). Stage and grade distributions were similar between ethnic groups. Two-thirds (66 %) of stage I-III patients had definitive surgery, with similar rates for Māori (71 %) and non-Māori (68 %). Māori were less likely to have surgery performed by a specialist upper gastrointestinal surgeon (38 % Māori, 79 % non-Māori, p < 0.01) and less likely to be treated in a main centre (44 % Māori, 87 % non-Māori, p < 0.01). After adjusting for age, sex, stage, tumour site and comorbidity, Māori had nonsignificant 27 % poorer survival (hazard ratio 1.27, 95 % CI 0.96-1.68). Conclusions: There was evidence of differential presentation and access to specialised surgical services, as well as differential survival, for Māori stomach cancer patients compared to non-Māori. These findings support the development of the national stomach cancer treatment standards and highlight the need for an equity focus within these guidelines. [ABSTRACT FROM AUTHOR]

Agricultural water management needs to evolve in view of increased water scarcity, especially when farming and natural protected areas are closely linked. In the study site of Doñana (southern Spain), water is shared by rice producers and a world heritage biodiversity ecosystem. Our aim is to contribute to defining adaptation strategies that may build resilience to increasing water scarcity and minimize water conflicts among agricultural and natural systems. The analytical framework links a participatory process with quantitative methods to prioritize the adaptation options. Bottom-up proposed adaptation measures are evaluated by a multi-criteria analysis (MCA) that includes both socioeconomic criteria and criteria of the ecosystem services affected by the adaptation options. Criteria weights are estimated by three different methods-analytic hierarchy process, Likert scale and equal weights-that are then compared. Finally, scores from an MCA are input into an optimization model used to determine the optimal land-use distribution in order to maximize utility and land-use diversification according to different scenarios of funds and water availability. While our results show a spectrum of perceptions of priorities among stakeholders, there is one overriding theme that is to define a way to restore part of the rice fields to natural wetlands. These results hold true under the current climate scenario and even more so under an increased water scarcity scenario. [ABSTRACT FROM AUTHOR]

Background: We examine incidence trends for 18 adult cancers, by ethnicity and socioeconomic position in New Zealand. Methods: The 1981 to 2001 censuses were linked to subsequent cancer registrations, giving 47.5 million person-years of follow-up. Results: Ethnicity: Pooled over time, differences were marked: Pacific and Māori rates of cervical, endometrial, stomach and pancreatic cancers were 1.5-2.5 times European/Other rates; Māori, Pacific and Asian rates of liver cancer were 5 times European/Other; European/Other rates of colorectal, bladder and brain cancers were 1.5-2 times the rates of other groups and melanoma rates 5-10 times higher; Pacific and Asian kidney cancer rates were half those of Māori and European/Other. Over time, Māori and Pacific rates of cervical cancer fell faster and Māori rates of colorectal and breast cancer increased faster, than European/Other rates. Male lung cancer rates decreased for European/Other, were stable for Māori and increased for Pacific. Female lung cancer rates increased for all ethnic groups. Income: Other than lung (rate ratio 1.35 men, 1.56 women), cervical (1.35) and stomach cancer (1.23), differences in incidence by income were modest or absent. Conclusions: Tobacco explains many of the social group trends and differences and constitutes an inequity. Cervical cancer trends are plausibly explained by screening and sexual practices. Faster increases of colorectal and breast cancer among Māori are presumably due to changes in dietary and reproductive behaviour, but the higher Māori breast cancer rate is unexplained. Ethnic differences in bladder, brain, endometrial and kidney cancer cannot be fully explained. [ABSTRACT FROM AUTHOR]

Purpose: Previous research indicates that social support is protective for the mental health outcomes of exposure to childhood adversity. However, the impact of social support as a protective factor following exposure to cumulative childhood adversity is understudied with prospective longitudinal data. The aim of this present study was to examine how social support mediates the impact of cumulative exposure to childhood adversity on internalising disorder in adulthood.The Christchurch Health and Development Study (CHDS) is a general population birth cohort, born in 1977 and representative of Christchurch, New Zealand at the time of the cohort members’ birth. The present study used a generalised estimating equations (GEE) framework to analyse direct associations between a cumulative measure of childhood adversity (CA) and internalising disorders (major depression, and any anxiety disorder), and indirect associations through social support.Results indicated a dose-dependent relationship between increased exposure to CA and worsened odds of a diagnosis for major depression and any anxiety disorder, respectively. There was also a significant mediating effect of social support on the direct associations between CA and both major depression (OR (95%CI) =0 .98 (0.97, 0.99), p < 001) and any anxiety disorder (OR (95%CI) = .98 (0.97, 0.99), p < 001).The findings indicate that social support reduces the impact of childhood adversity on adult mental health, and is therefore a target for future work examining potential interventions following CA.Methods: Previous research indicates that social support is protective for the mental health outcomes of exposure to childhood adversity. However, the impact of social support as a protective factor following exposure to cumulative childhood adversity is understudied with prospective longitudinal data. The aim of this present study was to examine how social support mediates the impact of cumulative exposure to childhood adversity on internalising disorder in adulthood.The Christchurch Health and Development Study (CHDS) is a general population birth cohort, born in 1977 and representative of Christchurch, New Zealand at the time of the cohort members’ birth. The present study used a generalised estimating equations (GEE) framework to analyse direct associations between a cumulative measure of childhood adversity (CA) and internalising disorders (major depression, and any anxiety disorder), and indirect associations through social support.Results indicated a dose-dependent relationship between increased exposure to CA and worsened odds of a diagnosis for major depression and any anxiety disorder, respectively. There was also a significant mediating effect of social support on the direct associations between CA and both major depression (OR (95%CI) =0 .98 (0.97, 0.99), p < 001) and any anxiety disorder (OR (95%CI) = .98 (0.97, 0.99), p < 001).The findings indicate that social support reduces the impact of childhood adversity on adult mental health, and is therefore a target for future work examining potential interventions following CA.Results: Previous research indicates that social support is protective for the mental health outcomes of exposure to childhood adversity. However, the impact of social support as a protective factor following exposure to cumulative childhood adversity is understudied with prospective longitudinal data. The aim of this present study was to examine how social support mediates the impact of cumulative exposure to childhood adversity on internalising disorder in adulthood.The Christchurch Health and Development Study (CHDS) is a general population birth cohort, born in 1977 and representative of Christchurch, New Zealand at the time of the cohort members’ birth. The present study used a generalised estimating equations (GEE) framework to analyse direct associations between a cumulative measure of childhood adversity (CA) and internalising disorders (major depression, and any anxiety disorder), and indirect associations through social support.Results indicated a dose-dependent relationship between increased exposure to CA and worsened odds of a diagnosis for major depression and any anxiety disorder, respectively. There was also a significant mediating effect of social support on the direct associations between CA and both major depression (OR (95%CI) =0 .98 (0.97, 0.99), p < 001) and any anxiety disorder (OR (95%CI) = .98 (0.97, 0.99), p < 001).The findings indicate that social support reduces the impact of childhood adversity on adult mental health, and is therefore a target for future work examining potential interventions following CA.Conclusion: Previous research indicates that social support is protective for the mental health outcomes of exposure to childhood adversity. However, the impact of social support as a protective factor following exposure to cumulative childhood adversity is understudied with prospective longitudinal data. The aim of this present study was to examine how social support mediates the impact of cumulative exposure to childhood adversity on internalising disorder in adulthood.The Christchurch Health and Development Study (CHDS) is a general population birth cohort, born in 1977 and representative of Christchurch, New Zealand at the time of the cohort members’ birth. The present study used a generalised estimating equations (GEE) framework to analyse direct associations between a cumulative measure of childhood adversity (CA) and internalising disorders (major depression, and any anxiety disorder), and indirect associations through social support.Results indicated a dose-dependent relationship between increased exposure to CA and worsened odds of a diagnosis for major depression and any anxiety disorder, respectively. There was also a significant mediating effect of social support on the direct associations between CA and both major depression (OR (95%CI) =0 .98 (0.97, 0.99), p < 001) and any anxiety disorder (OR (95%CI) = .98 (0.97, 0.99), p < 001).The findings indicate that social support reduces the impact of childhood adversity on adult mental health, and is therefore a target for future work examining potential interventions following CA. [ABSTRACT FROM AUTHOR]