Two studies are reported examining intimacy and loneliness in sex offenders and various control subjects. Sex offenders were both more lonely and deficient in intimacy than other offenders and community controls. Intimacy seemed to be the most important deficit among the sex offenders with the rapists and child molesters being the most deficient. The results are discussed in terms of their relevance for theory and clinical practice.

A wide variety of barriers that impede the delivery of optimal care have been identified. These range from the attitudes of individual clinicians to the structure of the systems within which they work. A system of key principles and processes for organizing treatment in a way which helps overcome these barriers is proposed.

ObjectivesTo understand health disparities in cardiovascular disease (CVD) in the indigenous Māori of New Zealand, diagnosed and undiagnosed CVD risk factors were compared in rural Māori in an area remote from health services with urban Māori and non-Māori in a city well served with health services.DesignProspective cohort study.SettingHauora Manawa is a cohort study of diagnosed and previously undiagnosed CVD, diabetes and risk factors, based on random selection from electoral rolls of the rural Wairoa District and Christchurch City, New Zealand.ParticipantsScreening clinics were attended by 252 rural Māori, 243 urban Māori and 256 urban non-Māori, aged 20–64 years.Main outcome measuresThe study documented personal and family medical history, blood pressure, anthropometrics, fasting lipids, insulin, glucose, HbA1c and urate to identify risk factors in common and those that differ among the three communities.ResultsMean age (SD) was 45.7 (11.5) versus 42.6 (11.2) versus 43.6 (11.5) years in rural Māori, urban Māori and non-Māori, respectively. Age-adjusted rates of diagnosed cardiac disease were not significantly different across the cohorts (7.5% vs 5.8% vs 2.8%, p=0.073). However, rural Māori had significantly higher levels of type-2 diabetes (10.7% vs 3.7% vs 2.4%, p<0.001), diagnosed hypertension (25.0% vs 14.9% vs 10.7%, p<0.001), treated dyslipidaemia (15.7% vs 7.1% vs 2.8%, p<0.001), current smoking (42.8% vs 30.5% vs 15.2%, p<0.001) and age-adjusted body mass index (30.7 (7.3) vs 29.1 (6.4) vs 26.1 (4.5) kg/m2, p<0.001). Similarly high rates of previously undocumented elevated blood pressure (22.2% vs 23.5% vs 17.6%, p=0.235) and high cholesterol (42.1% vs 54.3% vs 42.2%, p=0.008) were observed across all cohorts.ConclusionsSupporting integrated rural healthcare to provide screening and management of CVD risk factors would reduce health disparities in this indigenous population.

One stereotype that has arisen suggests Maori have been incapable of and/or unable to manage the production and use of alcohol. On the other hand, another commonly held belief has been that Maori supported abstinence or 'resisted alcohol' because they recognised its 'ruinous nature' and because it was contrary to traditional custom and practices. Historical information indicates that the Maori response to the introduction of alcohol was in fact diverse and for much of the nineteenth century alcohol was non-problematic for many Maori. This reinterpretation of the historical record can potentially empower contemporary Maori to take greater responsibility for the use of alcohol. It also challenges the negativity of the stereotypes generated by historical misinformation.

Culturally responsive treatments are often cited as essential for successfully addressing substance use-associated problems in indigenous and other ethnic groups. However, there has been little investigation of the support for this assertion among alcohol and drug-user treatment workers, or how it might translate into clinical practice. The current paper reports on the results of a survey of the New Zealand alcohol and drug-user treatment field, which canvassed these issues. Eighty-six percent of respondents advocated adjustment of clinical practice when working with Măori. Two key strategies were referral to specialist Măori groups or individuals and/or contacting/meeting with whănau (family). Comparisons were made between respondents who referred clients on and those who provided intervention themselves. Implications of results, limitations and future research are discussed.