Twelve-month and lifetime health service use in Te Rau Hinengaro: The New Zealand Mental Health Survey.

OBJECTIVE: To estimate the 12 month and lifetime use of health services for mental health problems. METHOD: A nationwide face-to-face household survey carried out in 2003-2004. A fully structured diagnostic interview, the World Health Organization Composite International Diagnostic Interview (CIDI 3.0) was used. There were 12 992 completed interviews from participants aged 16 years and over. The overall response rate was 73.3%. In this paper, the outcomes reported are 12 month and lifetime health service use for mental health and substance use problems. RESULTS: Of the population, 13.4% had a visit for a mental health reason in the 12 months before interview. Of all 12 month cases of mental disorder, 38.9% had a mental health visit to a health or non-health-care provider in the past 12 months. Of these 12 month cases, 16.4% had contact with a mental health specialist, 28.3% with a general medical provider, 4.8% within the human services sector and 6.9% with a complementary or alternative medicine practitioner. Most people with lifetime disorders eventually made contact if their disorder continued. However, the percentages seeking help at the age of onset were small for most disorders and several disorders had large percentages who never sought help. The median duration of delay until contact varies from 1 year for major depressive disorder to 38 years for specific phobias. CONCLUSIONS: A significant unmet need for treatment for people with mental disorder exists in the New Zealand community, as in other comparable countries.

The ECOMAN project: A novel approach to defining sustainable ecosystem function.

The ECOMAN was initiated in 2001 by the University of Plymouth, UK, Plymouth Marine Laboratory and the Department of the Environment, Fisheries and Rural Affairs (DEFRA) to address the need for more pragmatic assessment techniques linking environmental degradation with its causes. The primary aim of the project was to develop an evidence-based approach in which suites of easy-to-use, cost-effective and environmentally valid biological responses (biomarkers) could be used together to assess the health of coastal systems through the general condition of individuals. A range of sub-lethal endpoints, chosen to reflect successive levels of biological organisation (molecular, cellular, physiological), was evaluated in common coastal organisms showing different feeding types (filter feeding, grazing, predation) and habitat requirements (estuary, rocky shore). Initially, the suite of biomarkers was used in laboratory studies to determine the relative sensitivities of key species within different functional groups to common contaminants. These results were then validated in field studies performed in a range of ecosystems exhibiting different degrees/signatures of contamination. Here, an example is provided of a field study in the Humber Estuary, UK, which illustrates how multivariate statistical analysis can be used to identify patterns of response to discriminate between contaminated and clean sites. The use of a holistic, integrated approach of this kind is advocated as a practical means of assessing the impact of chemical contamination on organismal health and of ranking the status of marine ecosystems.

Ecosystem management bioindicators: the ECOMAN project--a multi-biomarker approach to ecosystem management.

The ECOMAN project was initiated from an awareness of the complexity of the functioning of coastal marine systems and the clear need for more pragmatic environmental assessment techniques linking environmental degradation with its causes. The aim of the project is to develop a suite of easy to use, cost effective and environmentally valid biological responses (biomarkers) to assess the general health of coastal systems, including estuaries. To achieve this aim, various sublethal endpoints are being measured and evaluated from a range of common coastal organisms showing different feeding types (filter feeding, grazing and predation) and habitat requirements (estuary and rocky shore) and at different levels of biological response (cellular, physiological and behavioural). This holistic integrated approach is essential to identify the full impact of chemical contamination on organisms, and enables the sensitivity of organisms to be ranked and key sentinel species for specific habitats to be identified.

A multibiomarker approach to environmental assessment.

Incorporation of ecologically relevant biomarkers into routine environmental management programs has been advocated as a pragmatic means of linking environmental degradation with its causes. Here, suites of biomarkers, devised to measure molecular damage, developmental abnormality and physiological impairment, were combined with chemical analysis to determine exposure to and the effects of pollution at sites within Southampton Water (UK). Test species included a filter feeder, a grazer, and an omnivore to determine the sensitivity of organisms occupying different trophic levels. Linear regression confirmed a significant association between incidence of intersex in Littorina littorea and tributyltin (TBT) concentrations (R2 = 0.954) and between PAH metabolites in Carcinus maenas urine and PAHs in sediments (R2 = 0.754). Principal component analysis revealed a gradient of detrimental impact to biota from the head to the mouth of the estuary, coincident with high sediment concentrations of heavy metals, PAHs, and biocides. Multidimensional scaling identified C. maenas as the organism most sensitive to contamination. Carboxylesterase activity, metallothionein and total haemolymph protein were the most discriminating biomarkers among sites. This holistic approach to environmental assessment is encouraged as it helps to identify the integrated impact of chemical contamination on organisms and to provide a realistic measure of environmental quality.