Analysis 1.21. Comparison 1 TCAs versus placebo, Outcome 21 Clinical response: studies with no competing interest. Analysis 2.1. Comparison 2 SSRIs versus placebo, Outcome 1 Clinical response at post-treatment.. .. .. .. Analysis 2.2. Comparison 2 SSRIs versus placebo, Outcome 2 Occurrence of adverse effects at post-treatment.. . Analysis 2.3. Comparison 2 SSRIs versus placebo, Outcome 3 Withdrawal from trials at post-treatment.. .. .. Analysis 2.4. Comparison 2 SSRIs versus placebo, Outcome 4 Clinical response: UK vs USA/European-based studies. Analysis 2.5. Comparison 2 SSRIs versus placebo, Outcome 5 Clinical response: high quality studies.. .. .. . Analysis 2.6. Comparison 2 SSRIs versus placebo, Outcome 6 Clinical response: major depression diagnosis.. .. Analysis 2.7. Comparison 2 SSRIs versus placebo, Outcome 7 Depression symptoms: use of Montgomery-Asberg scale. Analysis 2.8. Comparison 2 SSRIs versus placebo, Outcome 8 Clinical response: use of Montgomery-Asberg scale. .

Analysis 3.4. Comparison 3 Antibiotic versus placebo, purulent rhinitis, Outcome 4 Adverse e ects for purulent rhinitis studies.... Analysis 4.1. Comparison 4 Antibiotic versus placebo, sore throat, Outcome

Aims: To explore how patients with COPD experience helplessness. Methods:In-depth interviews with 29 patients with moderate to very severe COPD. Data were analysed using a general inductive approach.Results: All patients focused on acute symptoms and expressed feelings of helplessness in the management of their condition; little attention was paid to longer-term strategies. For one group of patients, mostly European, self blame appeared to intensify feelings of helplessness. For a second group, mostly Pacific, a focus on faith in God, Church and family provided a more positive affect and existed alongside helplessness.Conclusions: Clinicians seeking to support patients to include longer term strategies in their self management will need to coach patients to experiences of short-term success, and be aware of the ways that patients experience and interpret their helplessness. Clinicians need to address self blame, and recognise patients' priorities of faith and family.

Aims/hypothesis Few studies examine the association between age at diagnosis and subsequent complications from type 2 diabetes. This paper aims to summarise the risk of mortality, macrovascular complications and microvascular complications associated with age at diagnosis of type 2 diabetes. Methods Data were sourced from MEDLINE and All EBM (Evidence Based Medicine) databases from inception to July 2018. Observational studies, investigating the effect of age at diabetes diagnosis on macrovascular and microvascular diabetes complications in adults with type 2 diabetes were selected according to pre-specified criteria. Two investigators independently extracted data and evaluated all studies. If data were not reported in a comparable format, data were obtained from authors, presented as minimally adjusted ORs (and 95% CIs) per 1 year increase in age at diabetes diagnosis, adjusted for current age for each outcome of interest. The study protocol was recorded with PROSPERO International Prospective Register of Systematic Reviews (CRD42016043593). Results Data from 26 observational studies comprising 1,325,493 individuals from 30 countries were included. Random-effects meta-analyses with inverse variance weighting were used to obtain the pooled ORs. Age at diabetes diagnosis was inversely associated with risk of all-cause mortality and macrovascular and microvascular disease (all p < 0.001). Each 1 year increase in age at diabetes diagnosis was associated with a 4%, 3% and 5% decreased risk of all-cause mortality, macrovascular disease and microvascular disease, respectively, adjusted for current age. The effects were consistent for the individual components of the composite outcomes (all p < 0.001). Conclusions/interpretation Younger, rather than older, age at diabetes diagnosis was associated with higher risk of mortality and vascular disease. Early and sustained interventions to delay type 2 diabetes onset and improve blood glucose levels and cardiovascular risk profiles of those already diagnosed are essential to reduce morbidity and mortality.

Background Primary health care does not adequately respond to populations known to have high needs such as those with compounding jeopardy from chronic conditions, poverty, minority status and age; as such populations report powerlessness.