Objectives:To provide additional data concerning the safety, effectiveness and local prescribing trends of clozapine in elderly patients.Design:Retrospective observational case-series analysis.Setting:Data were collected from the medical files of 167 patients prescribed clozapine.Participants:All patients prescribed clozapine in the last 15 years by the psychogeriatric service in Christchurch, New Zealand. The subjects were mostly aged over 65; however, patients under 65 are also accepted into the service on a case by case basis if they have an age-related health condition.Results:Twenty-five (15.0%) patients had their clozapine stopped due to a significant adverse reaction, including eleven who developed significant neutropenia. Seventy-four (44.3%) of the patients had no recorded side effects at all. Sixty-five (38.9%) of our elderly patients died while taking clozapine, though none of these deaths was felt to be related to clozapine use. Several patients safely initiated clozapine in either their own home or a nursing home without requiring hospital admission. Only two patients ceased clozapine due to ineffectiveness, and one hundred, forty-two (86.1%) of the patients had positive comments in their medical record regarding the benefits of clozapine for their particular case.Conclusions:We found clozapine could be used safely and effectively in our patient group, for a wider range of indications and at lower doses than younger patients. Data collection regarding cause of death in elderly patients who were ever prescribed clozapine was problematic, and more research into this area is required.

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Infection with Streptococcus pneumoniae is the leading cause of death in children and burden of disease is greatest where helminth infections are also common. We investigated the impact of intestinal helminth co-infection on pneumococcal carriage; a risk factor for invasive disease. We used a mouse co-infection model and clinical data to assess the impact of co-infection on carriage density. Co-infection in mice was associated with increased pneumococcal carriage density and dissemination into lungs. Helminth-infected children also exhibited increased carriage density as compared to uninfected children. Anthelmintic treatment may be a cost-effective method of reducing pneumococcal disease burden in lower-income countries.

Background: High pneumococcal carriage density is a risk factor for invasive pneumococcal disease (IPD) and transmission, but factors that increase pneumococcal carriage density are still unclear. Methods: We undertook a cross-sectional study to evaluate the microbial composition, cytokine levels and pneumococcal carriage densities in samples from children presenting with an influenza-like illness (ILI) and asymptomatic healthy controls (HC). Results: The proportion of children harbouring viral organisms (Relative risk (RR) 1.4, p = 0.0222) or ≥ 4 microbes at a time (RR 1.9, p < 0.0 0 01), was higher in ILI patients than HC. ILI patients had higher IL-8 levels in nasal aspirates than HC (median [IQR], 265.7 [0-452.3] vs. 0 [0-127.3] pg/ml; p = 0.0154). Having an ILI was associated with higher pneumococcal carriage densities compared to HC (RR 4.2, p < 0.0 0 01). Conclusion: These findings suggest that children with an ILI have an increased propensity for high pneumococcal carriage density. This could in part contribute to increased susceptibility to IPD and transmission in the community.

Whāia te iti kahurangi! Strive for something of great value!Psychiatry is often thought to be a polarising specialty. You may have noticed some of your friends becoming quickly enthused by their mental health attachments, or conversely, being equally quick to declare that a career as a psychiatrist is just not for them. But do not give up reading if you are still sitting on the fence. In this editorial, we reflect on what brought us into psychiatry and how we have found this career choice. As you will see, while some of us took to it straight away, others came to the profession unconvinced before realising psychiatry was the right choice. We explain the benefits and challenges from our own experience and offer advice to medical students contemplating a career in psychiatry. What is psychiatry and why is it important?Have you ever wondered why a change in stress levels can prevent a myocardial infarction or the development of diabetes? Or why soldiers in World War I were offered placebo anaesthesia for leg amputations and suffered no pain? Why would an occupied rat eschew addictive drugs whilst the bored one chooses heroin? And why are mental health and addiction issues becoming more common in a comparatively developed, safer, longer-living, technologically-enabled world?These are some of the questions of psychiatry and for those that want to understand one of the most complex things in the known universe -the human brain.The word psychiatry is derived from the Greek for "doctor of the soul". Psychiatrists are doctors who specialise in the promotion, protection, and restoration of mental health; a primary concern of individuals, communities, and societies throughout the world. 1 Mental health goes beyond physical health, but this does not mean that the mind and the body can be disentangled. As Dr Brock Chisholm, the first Director-General of the World Health Organization, famously stated that "without mental health there can be no true physical health". 2 As a major priority of the current government, mental health was a central focus of the 2019 Budget, aptly named the "Wellbeing Budget". This makes it an exciting, but also a challenging time to be a psychiatrist, with a high and growing demand for our services.Unfortunately, mental health and addiction problems touch the lives of almost all New Zealanders directly or indirectly. In any given year, around one in five of us experience mental illness or significant mental distress. 3 Prevalence studies show that 50-80% of people in Aotearoa New Zealand will experience mental distress and/or addiction challenges in their lifetime, 4 and worryingly, there are some indications that prevalence is increasing. 5 In addition, our rates of suicide remain stubbornly high and have been edging upward in the last five years.As well as the personal harms of mental illness, the annual cost to society of the burden of serious mental illness and addiction is sub-stantial, comprising an estimated $12 billion NZD or 5% of our gross domestic product. 6