This article describes a meta-analysis of published associations between depression and heart failure (HF) in regard to 3 questions: 1) What is the prevalence of depression among patients with HF? 2) What is the magnitude of the relationship between depression and clinical outcomes in the HF population? 3) What is the evidence for treatment effectiveness in reducing depression in HF patients? Key word searches of the Medline and PsycInfo databases, as well as reference searches in published HF and depression articles, identified 36 publications meeting our criteria. Clinically significant depression was present in 21.5% of HF patients, and varied by the use of questionnaires versus diagnostic interview (33.6% and 19.3%, respectively) and New York Heart Association-defined HF severity (11% in class I vs. 42% in class IV), among other factors. Combined results suggested higher rates of death and secondary events (risk ratio = 2.1, 95% confidence interval 1.7 to 2.6), trends toward increased health care use, and higher rates of hospitalization and emergency room visits among depressed patients. Treatment studies generally relied on small samples, but also suggested depression symptom reductions from a variety of interventions. In sum, clinically significant depression is present in at least 1 in 5 patients with HF; however, depression rates can be much higher among patients screened with questionnaires or with more advanced HF. The relationship between depression and poorer HF outcomes is consistent and strong across multiple end points. These findings reinforce the importance of psychosocial research in HF populations and identify a number of areas for future study.

Objective This meta-analysis systematically examined the association of reported psychological trauma and posttraumatic stress disorder (PTSD) with functional somatic syndromes including fibromyalgia, chronic widespread pain, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. Our goals were to determine the overall effect size of the association and to examine moderators of the relationship. Methods Literature searches identified 71 studies with a control or comparison group and examined the association of the syndromes with traumatic events including abuse of a psychological, emotional, sexual, or physical nature sustained during childhood or adulthood, combat exposure, or PTSD. A random effects model was used to estimate the pooled odds ratio and 95% CI. Planned subgroup analyses and meta-regression examined potential moderators. Results Individuals who reported exposure to trauma were 2.7 (95% CI = 2.27 – 3.10) times more likely to have a functional somatic syndrome. This association was robust against both publication bias and the generally low quality of the literature. The magnitude of the association with PTSD was significantly larger than with sexual or physical abuse. Chronic fatigue syndrome had a larger association with reported trauma than either irritable bowel syndrome or fibromyalgia. Studies using non-validated questionnaires or self-report of trauma reported larger associations than those using validated questionnaires. Conclusions Findings highlight limitations of the existing literature and emphasize the importance of conducting prospective studies, further examining the potential similarities and differences of these conditions, and pursuing hypothesis-driven studies of the mechanisms underlying the link between trauma, PTSD, and functional somatic syndromes.

BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths in the United States. Randomized controlled trials have shown that annual screening fecal occult blood testing (FOBT) reduces CRC mortality and incidence. However, patient compliance with FOBT is low. OBJECTIVE:To determine whether a mailed educational reminder increases FOBT card return rates and to examine predictors of FOBT compliance. DESIGN:Blinded, randomized, controlled trial at the Veteran Affairs Medical Center, San Diego, California.PATIENTS: Seven hundred and seventy-five consecutive patients ≥50 years of age referred by their primary care physicians for FOBT. INTERVENTION:Patients were randomly assigned to the usual care group or the intervention group. Ten days after picking up the FOBT cards, a 1-page reminder with information related to CRC screening was mailed to the intervention group only. MEASUREMENTS:The primary outcome was proportion of returned FOBT cards after 6 months. Patient demographic, clinical characteristics and prior FOBT completed were collected for multivariate regression analysis.RESULTS: At 6 months after card distribution, 64.6% of patients in the intervention group returned cards compared with 48.4% in the control group (P<0.001). Patients who received a mailed reminder (OR 2.02; 95% CI: 1.48-2.74) or have a prior history of returning the FOBT cards (OR 1.87; 95% CI: 1.29-2.70) were more likely to return the FOBT cards. Patients with current or recent illicit drug use were less likely to return the FOBT cards (OR 0.26; 95% CI: 0.13-0.50).CONCLUSION: A simple mailed educational reminder significantly increases compliance with FOBT for CRC screening.

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A shift in the Th1/Th2 ratio may play a role in the association between depressive symptoms and morbidity and mortality in CHF patients, suggesting broader immune dysregulation than previously considered.

Nonverbal facial signals provide valuable information for successful social interactions. Previous findings showed left-right facial asymmetry in attractiveness, smiling, and health in faces, and here we investigated the asymmetrical status of trustworthiness. Pairs of left-left and right-right faces from 38 photographs were viewed by participants who judged which member of the pair looked the most trustworthy. The results were compared to attractiveness and smiling judgements (Zaidel, Chen, & German, 1995). We found that trustworthiness was more related to attractiveness than to smiling in the women's faces, but no significant asymmetry for trustworthiness was found; in the men's faces, trustworthiness was neither related to attractiveness nor to smiling, nor was there a significant asymmetry. Taken together, trustworthiness as a facial display is complex; even when it appears to confirm the "halo effect", its expression is not strongly left-right asymmetrical in contrast to attractiveness or smiling.

The expression of health on the human face, like beauty or emotions, is an important biological display. Previous findings of left-right functional asymmetry in facial attractiveness and the linkage of attractiveness and health in evolutionary biology notions have prompted the present study. A total of 38 pairs of left-left and right-right facial composites were viewed by 24 subjects on a computer screen, and the task was to decide which member of the pair looked healthier or there was no difference. The results revealed a significant interaction between face side and sex of face. Right-right composites of women's faces were judged significantly healthier than left-left, whereas in men's faces, no significant left-right difference emerged. As these results parallel previous findings of attractiveness in the identical set of faces, we propose that evolutionary biology notions linking the appearance of health and of attractiveness apply to the human face as well.

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