How are you thinking about blood pressure and lipid management these days?

I guess I've come to realize how important it is to have these things well controlled and maybe a bit more so in the middle years rather than leaving it to people who get older.

I'm cognizant of some of the ethnic differences with things like heart failure, which are the end result of these things not being well treated, being 64 in Maori and Pacific and 81 in European.

So I think there's something wrong there.

And I think that's a lack of attention to these sort of risk factors.

And I guess the more recent thing given that we're doing blood pressure and lipids, is the Lancet thing on dementia.

7% of dementia is explained by high LDL in middle years.

view is actually pretty good of risk.

In our patients with pre-diabetes or recent onset diabetes without any heart failure symptoms, are there any particular things that we can do to try and prevent heart failure from developing?

Don't worry about heart failure, but you can prevent diabetes.

And I think one of the things with prediabetes, to control the blood pressure, I would be a little bit cautious with the hydrochlorothiazide-type diuretics, possibly with the exception of indapamide.

But certainly hydrochlorothiazide is a problem, and you might increase the risk of diabetes.

Ironically, ACEs and even statins have a slight increase in diabetes, but the benefit on the other side of that is greater than the harms.

So if you had somebody with prediabetes and you're trying to control their blood pressure to prevent heart failure, I would use ACEs and ARBs rather than diuretics.

I would start an ARB basically.

What would be your three key tape comb messages for our listeners today?

Can you explain the complexity of being homeless in a health sense?

Well, uh, there's, there can be everything.

Um, there's, there's serious physical illness.

Um, people obviously get very depressed, um, when they're, when they're homeless.

It's, you know, not a lot of fun.

Um, there's social complexity.

There are family issues.

Their chronic disease remains, their trauma remains, their need for housing remains." Are we addressing these issues?

Can you explain the complexity of being homeless in a health sense?

Well, uh, there's-- there can be everything.

Um, there's, there's serious physical illness.

Um, people obviously get very depressed, um, when they're, when they're homeless.

It's, you know, not a lot of fun.

Um, there's social complexity, there are family issues, there's housing issues.

Uh, it's the most complex patients.

Their chronic disease remains, their trauma remains, their need for housing remains." Are we addressing these issues?

And just for context, how serious is antibiotic resistance as a public health issue?

There was a chap die in Wellington a few years ago of, I think, a fairly simple skin infection because everything...

He'd been living in Bangkok and going to the pharmacy and buying himself antibiotics.

He wrote to his sister and said how wonderful Bangkok was.

You can go and just pay money and get antibiotics whenever you want them.

And he ended up dying... from antibiotic resistant organism.

So that doesn't happen very often, but we can see increasing resistance.

Do you agree that there is a genuine access problem that needs to be addressed?

And just for context, how serious is antibiotic resistance as a public health issue?

There was a chap die in Wellington a few years ago of, I think, a fairly simple skin infection because everything...

He'd been living in Bangkok and going to the pharmacy and buying himself antibiotics.

He wrote to his sister and said how wonderful Bangkok was.

You can go and just pay money and get antibiotics whenever you want them.

And he ended up dying... from antibiotic-resistant organism.

So that doesn't happen very often, but we can see increasing resistance.

Do you agree that there is a genuine access problem that needs to be addressed?

Before we get to written exposure therapy, how hard is it to treat currently?

Um, reasonably well.

If you're willing to go through some form of exposure therapy, um, you can get rid of it.

About 80% of people can get rid of it.

Um, people find exposure therapy a little bit confronting, which is why the written stuff is a little bit easier because they're...

They've had a terrible thing happen to them, and of course, they don't wanna go back and revisit it.

But until you go back and revisit it, you can't get rid of it.

Is it the sort of thing that our listeners could just have a go at? Or is it the sort of thing that you need some sort of professional guidance and assistance with?