Following DSH there is a significant and persistent risk of suicide, which varies markedly between genders and age groups. Reduction in the risk of suicide following DSH must be a key element in national suicide prevention strategies.

Cognitive behavioural therapy is an effective treatment for childhood and adolescent anxiety disorders; however, the evidence suggesting that CBT is more effective than active controls or TAU or medication at follow-up, is limited and inconclusive.

In patients with PsA, the severity of nail disease correlates with indicators of severity of both skin and joint disease. Although rheumatologists can adequately screen for nail disease, the management of this aspect of PsA is often overlooked.

Objective-To assess the relation between reported physical activity and the risk of heart attacks in middle aged British men.Design-Prospective study of middleaged men followed for a period of eight years (The British Regional Heart Study).Setting-One general practice in each of 24 British towns. Participants-7735 men aged 40-59 years at initial examination.End point-Heart attacks (non-fatal and fatal).Measurements and main resultsDuring the follow up period of eight years 488 men suffered at least one major heart attack. A physical activity score used was developed and validated against heart rate and lung function (FEV1) in men without evidence of ischaemic heart disease. Risk of heart attack decreased significantly with increasing physical activity; the groups reporting moderate and moderately vigorous activity experienced less than half the rate seen in inactive men. The benefits of physical activity were seen most consistently in men without preexisting ischaemic heart disease and up to levels of moderately vigorous activity. Vigorously active men had higher rates of heart attack than men with moderate or moderately vigorous activity. The relation between physical activity and the risk of heart attack seemed to be independent of other cardiovascular risk factors.Men with symptomatic ischaemic heart disease showed a reduction in the rate of heart attack at light or moderate levels of physical activity, beyond which the risk of heart attack increased. Men with asymptomatic ischaemic heart disease showed an increasing risk of heart attack with increasing levels of physical activity, but with a progressive decrease in case fatality. Overall, men who engaged in vigorous (sporting) activity of any frequency had significantly lower rates of heart attack than men who reported no sporting activity. However, when all men reporting regular sporting activity at least once a month were excluded from analysis, there remained a strong inverse relation between physical activity and the risk of heart attack in men without pre-existing ischaemic heart disease. Conclusion-This study suggests that the overall level of physical activity is an important independent protective factor in ischaemic heart disease and that vigorous (sporting) exercise, although beneficial in its own right, is not essential in order to obtain such an effect.There is considerable evidence that increased levels of physical activity are associated with lowered incidence rates of ischaemic heart disease.' Particular attention has been paid to leisure time activity because few middle-aged men do physically demanding work and because, in public health terms, occupational activity is not amenable to change. Studies in British civil servants suggest that exercise is associated with a reduced risk of coronary events only when the exercise is both vigorous and sustained.' This raises the important issue of whether lesser levels of physical activity have any effect on diminishing the risk of heart attack, an issue of considerable importance in a society ...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: • To carry out a meta-analysis of identified studies to determine whether CBT leads to remission of 1) the primary child/ adolescent anxiety disorder and 2) all anxiety diagnoses, and/or 3) a clinically significant reduction in anxiety symptoms in comparison with passive (waiting list) controls, active controls, treatment as usual, or medication. • To determine the comparative efficacy of CBT alone, and the combination of CBT and medication, versus drug placebo. • To determine whether post-treatment gains of CBT are maintained at longer-term follow-up. • To describe the age range of participants included in CBT trials in order to determine the age of the youngest participants. • To determine whether CBT for anxiety leads to a clinically significant reduction in depressive symptoms, and/or improvements in global functioning. • To carry out subgroup analyses of different types of CBT according to 1) amount of therapist contact time; and 2) delivery format (child-focused individual, group, and with/without family involvement, and parent-delivered). • To carry out a subgroup analysis of CBT for children and adolescents with ASD and for children and adolescents with intellectual impairments.