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adminBy Neha Mathur Jan 17 2024 Reviewed by Lily Ramsey, LLM
In a recent article published in JAMA Network Open, researchers compared the efficacy of antidepressant medication management (MEDS) against behavioral activation psychotherapy (BA) among inpatients admitted to a hospital with heart failure (HF) and outpatients presenting to clinics for HF follow-up, both experiencing depressive symptoms.
They conducted a randomized controlled trial (RCT) between 2018 and 2022, including a one-year follow-up within Cedars-Sinai Health System in California, United States.
Study: Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure. Image Credit: New Africa/Shutterstock.com Background
The interplay of biological and psychosocial mechanisms gives rise to depression among ~50% of HF survivors.
As a result, HF patients with depression have poorer health-related quality of life (HRQOL) than patients with HF without depression.
The patient's depressive symptom severity also increases the risks of decline in cognitive functions or death at six months; moreover, it is an independent factor associated with all-cause mortality.
Accordingly, the American Heart Association (AHA) recommends screening for depression in patients with HF and other heart diseases.
However, it is equally crucial to make treatments, such as antidepressant medications and psychotherapy, available for patients diagnosed with depression, which often is not the case.
Some notable evidence-based treatments for depression in patients with HF are cognitive behavioral therapy (CBT), e.g., BA, and antidepressant medications, also known as pharmacotherapy.
However, limited access to these interventions and a lack of evidence for clinicians on which intervention to use for depression treatment in HF patients are some of the issues that require attention. About the study
In the present study, researchers addressed these challenges facing clinicians, patients, and caregivers and compared the effectiveness of psychotherapy vs pharmacotherapy for patient-centered outcomes in an RCT. Related StoriesStudy sheds light on how impaired autophagy can play a role in causing heart failureGroundbreaking drug offers new hope for life-threatening heart conditionTaking medical cannabis for chronic pain linked to increased risk of arrhythmia
The study cohort had a life expectancy of over six months post-HF, confirmed by their treating physician, and depressive disorder, based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria.
The team randomly assigned participants to BA or MEDS in a 1:1 ratio. BA therapists, licensed social workers, and MEDS care managers took a 50-minute introductory session of participants, followed by 12 weekly sessions of BA or MEDS.
These sessions were run monthly for three months, followed by contact for six more months, as deemed necessary.
They delivered 50-minute BA and 15-minute MEDS sessions on telephone/video call, which was easy to access for HF patients, saved time, and improved adherence to the program; additionally, it improved mood and HRQOL without compromising efficacy.
This trial had multiple outcomes of interest, with depressive symptom severity at six months, measured by the patient health questionnaire 9-item (PHQ-9) being the primary outcome.
Secondary outcomes were physical/mental HRQOL and HF-specific HRQOL, measured using the short-form 12-item version 2 (SF-12) and Kansas City cardiomyopathy questionnaire, respectively.
The team also monitored caregiver burden, measured using the caregiver burden questionnaire for HF; additionally, they collected emergency department (ED) visits, readmissions, days of hospitalization, and mortality at three, six, and 12 months. Results
Of 416 patients with HF enrolled in this RCT, 243 were male, and the median age of the study participants was 60.71 years.
Both BA and MEDS groups had 208 patients whose mean (SD) PHQ-9 scores at baseline were 14.54 (3.45)and 14.31 (3.60), respectively.
Even at six months, their PHQ-9 scores were not statistically different (7.53 vs 8.09; P=0.88). Moreover, both BA and MEDS recipients experienced ~50% reduction in depressive symptoms at three, six, and 12 months.
On other measures, for instance, physical HRQOL at six months,
BA recipients showed fewer improvements than MEDS recipients (mean SF-12 physical score: 38.82 vs 37.12; P=0.04).
They also had fewer ED visits and had to spend fewer days in the hospital at all three-time points, all statistically significant observations.
However, there was no significant difference in hospital readmissions of BA group participants versus MEDA recipients.
The authors attributed these differences to poor general health, a reliable risk factor associated with rehospitalization in patients with HF and depression.
It is also noteworthy that BA recipients are encouraged to be more physically active than MEDS recipients, which likely would have contributed to their tendency to have fewer ED visits and hospital days. Conclusions
Overall, the present RCT confirmed that both interventions, BA and MEDS, reduced depressive symptoms in patients with HF and depression by almost 50%.
In addition, BA recipients experienced better physical HRQOL, made fewer ED visits, and had fewer days hospitalized.
This data could inform clinicians and caregivers that they can choose both psychotherapy and pharmacotherapy to improve depressive symptoms in HF patients. Journal reference:
Waguih W I, (2024), Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure A Randomized Clinical Trial, JAMA Network Open. doi:10.1001/jamanetworkopen.2023.52094.
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US
RFK Jr chosen as Donald Trump’s health secretary – as president-elect says he will do ‘unbelievable things’
Published
2 hours agoon
November 15, 2024By
adminDonald Trump has chosen vaccine sceptic Robert F Kennedy Jr as his new health secretary and said he will do “unbelievable things”.
The news was announced by Donald Trump Jr on X, before the president-elect confirmed the appointment just moments later.
Former Democrat RFK Jr, the nephew of former president John F Kennedy, had been running as an independent presidential candidate but dropped out of the race and endorsed Mr Trump in August.
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In return for Mr Kennedy’s support during the election, president-elect Trump pledged to give him a “big role” – and RFK Jr’s preference for the health position was widely reported.
Mr Trump spoke on Thursday night at a gala, hosted at his Mar-a-Lago retreat in Florida, which included tech billionaire Elon Musk and actor Sylvester Stallone.
Directly addressing RFK Jr, who was in the audience, Mr Trump said: “We want you to come up with things… and ideas… and what you’ve been talking about for a long time. I think you’re going to do some unbelievable things. Nobody’s going to be able to do it like you.”
The health and human services (HHS) department includes the Food and Drug Administration, the Centers for Disease Control and Prevention, Medicare, Medicaid and the National Institutes of Health.
RFK Jr will “restore these Agencies to the traditions of Gold Standard Scientific Research, and beacons of Transparency, to end the Chronic Disease epidemic, and to Make America Great and Healthy Again,” the president-elect wrote on X.
Mr Trump added: “For too long, Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation, and disinformation when it comes to Public Health.
“The Safety and Health of all Americans is the most important role of any Administration.”
Mr Kennedy is a known vaccine sceptic who has repeated misinformation on multiple occasions, including the discredited theory that childhood immunisations cause autism.
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The RFK Jr-led health department will “play a big role in helping ensure that everybody will be protected from harmful chemicals, pollutants, pesticides, pharmaceutical products, and food additives that have contributed to the overwhelming Health Crisis in this Country,” the president-elect added.
Earlier, his son Donald Trump Jr was the first to confirm the appointment, writing on X: “Robert F Kennedy Jr will be The Secretary of Health and Human Services! Promises Made Promises Kept.”
Read more:
Who’s in and who’s out of Trump’s top team?
Who is Robert F Kennedy Jr?
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RFK Jr’s position will need to be confirmed with a Senate vote – but even with the chamber under Republican control, his appointment may face opposition because of his views on health issues.
Before Mr Trump announced his choice, Mr Kennedy had already claimed the new president would push to remove fluoride from drinking water on his first day in office. The addition of the compound has been cited as helping to improve dental health.
The department RKF Jr is hoping to oversee has more than 80,000 employees across the United States.
US
Donald Trump picks controversial MAGA loyalist Matt Gaetz to be his attorney general
Published
2 hours agoon
November 15, 2024By
adminDonald Trump has picked fiery Florida congressman Matt Gaetz to be his attorney general – a man who was under investigation over sex trafficking just days ago.
Democrats have described the MAGA loyalist as “a gonzo agent of chaos” and his appointment a “red alert moment for our democracy”, while some Republican senators have also raised doubts about his suitability for the role.
It comes as Mr Trump won control of the House of Representatives, giving him full control of the government, and continues to fill out his top team.
Mr Gaetz, 42, has been under investigation by the House of Representatives’ ethics committee over allegations he was part of a scheme that led to the sex trafficking of a 17-year-old girl.
But after he resigned from Congress on Wednesday following being named as Mr Trump’s pick for attorney general, that probe has ended – without the publication of any findings.
Despite the cloud over his character – Mr Gaetz denies all allegations – he has repeatedly shown his loyalty to the president-elect, attending his hush money trial in Manhattan and vociferously calling out prosecutors.
The MAGA firebrand in the past has spread the conspiracy theory that the January 6 riots were actually orchestrated by the left-leaning group Antifa.
If he’s going to lead the Department of Justice, the Florida politician needs to be confirmed by a Senate vote like other cabinet positions. That’s where it could get difficult for him.
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What have Republicans said?
“I don’t think it’s a serious nomination for the attorney general,” Republican senator Lisa Murkowski said. “This one was not on my bingo card.”
Senator Susan Collins said she was “shocked” by the pick and said there would be “an awful lot of questions being asked in this case”.
Both Ms Murkowski and Ms Collins have been vocal Trump critics (the latter vowed to write fellow Republican Nikki Haley’s name on her ballot) and will be under the spotlight next year as their party retakes control of the Senate.
“I think it’s a little bit of a test,” said Republican senator Kevin Cramer.
He said he sees Mr Gaetz as a disruptive force in the House and has concerns about the “serious allegations” against him – but stopped short of saying he would not vote for him.
“It will take a lot of political capital to get him across,” he added.
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“I’ve known Matt for a very long time, we’re friends,” said Florida senator Marco Rubio, who was nominated for secretary of state on Wednesday. “I think he would do a very good job for the president.”
Some Republican senators were reluctant to publicly criticise the incoming president’s pick to lead the justice department but did not endorse him either.
Senator John Cornyn, a member of the judiciary panel, said he did not know Mr Gaetz “other than his public persona”, and said he will not “prejudge any of these” nominations.
“I’ve got nothing for you,” said senator Katie Britt when asked by reporters. “We’ll see,” said senator Ron Johnson, when asked if he is voting for Mr Gaetz.
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What have Democrats said?
Unsurprisingly, Democrats in Congress have been less restrained with their reactions to Mr Gaetz’s nomination.
Veteran senator Chris Murphy declared the announcement to be “a red alert moment for our democracy”.
Representative Jim Himes meanwhile, who sits on the House Intelligence Committee, told CNN the role of attorney general requires “care, prudency, a deep respect for the rule of law… Matt Gaetz is the opposite of all of those things, he is a gonzo agent of chaos”.
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Senator Richard Blumenthal, who sits on the Senate’s judiciary panel, said the nomination was the “first test of whether Republicans are willing to stand up to Donald Trump and go with conscience and conviction as opposed to just politics”.
New Mexico senator Martin Heinrich was even more blunt, posting on X: “People voted for cheaper eggs, not whatever the f@#€ this is.”
US
Trump hands out top jobs: Who is in, who is out and who are the leading contenders?
Published
2 hours agoon
November 15, 2024By
adminAs the dust settles on Donald Trump’s US election win, the president-elect has begun choosing who will be in his administration for his second stint in the White House.
During the campaign, Mr Trump avoided directly confirming any appointments but frequently dropped hints about who he would like in his top team.
Nominees must be questioned by members of the Senate before it votes on their appointment. Even with the Republicans in control some of the picks are very controversial and could be blocked.
So who is in, who is out and who are the leading contenders for jobs?
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Who is in?
Susie Wiles is a veteran Republican campaign manager – having helped Ronald Reagan and Ron DeSantis get elected as well as Donald Trump in 2016 and 2024. She is the first member of his team to be announced – and becomes the first female chief-of-staff in American history.
The 67-year-old, who lives in Florida, has a political career that spans decades but has largely kept out of the limelight and rarely given interviews.
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She is the daughter of late American footballer Pat Summerall and one of her first jobs in politics was as an assistant to one of his former New York Giants teammates when he became a Republican representative.
Outside politics, she has worked in the private sector as a lobbyist, for both Ballard Partners, whose clients include Amazon, Google, and the MLB (Major League Baseball), and then Mercury, which works with Elon Musk’s SpaceX and the embassy of Qatar.
This time around, Mr Trump credited her with his “best-run” presidential campaign, describing her as “incredible” at a Milwaukee rally earlier this year, and an “ice maiden” in his victory speech.
Matt Gaetz
Mr Trump has chosen Matt Gaetz, a man who once faced a federal sex trafficking probe, to be the nation’s top prosecutor.
The investigation, carried out by the Justice Department he will now lead, ended without charges.
However, it is just one of a number of reasons why his appointment as attorney general has raised concerns in Washington.
Mr Gaetz had also been under scrutiny by the House Ethics Committee over wider allegations including sexual misconduct, illicit drug use and accepting improper gifts.
The inquiry was dropped on Wednesday 13 November when Mr Gaetz left Congress – the only forum where the committee has jurisdiction.
The 42-year-old is a fierce Trump supporter who has regularly attacked both the Justice Department and the FBI, and even called for the FBI to be defunded and abolished.
He was particularly critical of the Justice Department’s investigation into the January 6 attack on the Capitol in 2021 – which resulted in charges against more than 1,500 Trump supporters and hundreds of convictions.
Veteran Democratic senator Chris Murphy declared his appointment as attorney general as “a red alert moment for our democracy”.
Another senior Democrat described Mr Gaetz as a “gonzo agent of chaos”.
Steve Bannon, Trump’s former adviser told NBC news: “President Trump is going to hit the Justice Department with a blowtorch, and Matt Gaetz is that torch.”
His nomination, which must be ratified by Congress, could be blocked unless Republicans unite around him.
Elon Musk
Tech billionaire Elon Musk became one of Mr Trump’s staunchest supporters in the months leading up to the election and spent at least $119m (£92m) canvassing for him in the seven battleground states.
Awarding his loyalty, Mr Trump announced Mr Musk will co-lead the new Department of Government Efficiency (DOGE) alongside former Republican presidential candidate Vivek Ramaswamy.
In a statement on Tuesday, the president-elect said Mr Musk and Mr Ramaswamy “will pave the way for my administration to dismantle government bureaucracy, slash excess regulations, cut wasteful expenditures, and restructure federal agencies”.
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Despite its name, the DOGE is not a government agency and is instead set to provide “advice and guidance” from the outside of government.
The statement released by Mr Trump said it will partner with the office of management and budget to “drive large-scale structural reform, and create an entrepreneurial approach to government never seen before”.
The department has been given a deadline of 4 July 2026 to conclude its work.
Vivek Ramaswamy
Former Republican presidential candidate Vivek Ramaswamy will join Elon Musk in leading DOGE.
Mr Ramaswamy, the founder of a pharmaceutical company, suspended his campaign in January to support Mr Trump.
In his 2021 bestseller book Woke, Inc, Mr Ramaswamy criticised the decisions of some big companies to base business strategy around social justice and climate change concerns.
Pete Hegseth
Fox News commentator and National Guard veteran Pete Hegseth has been picked as Mr Trump’s defence secretary.
In a statement, the president-elect described the 44-year-old as “tough, smart and a true believer in America First”.
He said: “With Pete at the helm, America’s enemies are on notice – our military will be great again, and America will never back down.”
If confirmed by the Senate, Mr Hegseth could make good on Mr Trump’s campaign promises to rid the US military of
generals who he accuses of pursuing progressive policies on diversity in the ranks that conservatives have rallied against.
In the past Mr Hegseth has expressed disdain for the so-called “woke” policies of Pentagon leaders including its top military officer.
He has also railed against NATO allies for being weak and claimed China is on the verge of dominating its neighbours.
Mr Hegseth has pushed for making the US military more lethal and argued allowing women to serve in combat hurts that effort.
“Everything about men and women serving together makes the situation more complicated, and complication in combat, that means casualties are worse,” he said in an interview on The Shawn Ryan Show podcast.
Though he said diversity in the military is a strength, he said that was because minority and white men “can perform similarly” but the same is not true for women.
Critics have pointed to Mr Hegseth’s lack of experience with some suggesting he could be defence secretary in name only as the Trump White House runs the department.
“There is reason for concern that this is not a person who is a serious enough policymaker, serious enough policy implementer, to do a successful job,” said Adam Smith, the ranking Democrat on the House Armed Services Committee.
Robert F Kennedy Jr
Mr Trump has confirmed vaccine sceptic Robert F Kennedy Jr as his pick for health secretary – meaning he’ll oversee a huge department that includes the Food and Drug Administration, the Centers for Disease Control and Prevention, and Medicare.
The president-elect wrote on X that RFK Jr will “restore these Agencies to the traditions of Gold Standard Scientific Research, and beacons of Transparency, to end the Chronic Disease epidemic, and to Make America Great and Healthy Again”.
RFK Jr abandoned his independent presidential campaign to back Mr Trump in August.
It was a move that saw RFK Jr condemned by many members of his family, but as with Musk, his public support has been rewarded.
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Mr Kennedy – the son of politician Robert F Kennedy and the nephew of assassinated president John F Kennedy – made a name for himself as a vaccine sceptic during the COVID-19 pandemic and has frequently repeated debunked claims, including linking vaccines to autism in children.
He has claimed Mr Trump will push to remove fluoride from drinking water on his first day in office. The addition of the compound has been cited as helping to improve dental health.
RFK Jr’s controversial views could see him struggle to land enough votes to have his role confirmed, even in a Republican-controlled Senate.
Marco Rubio
Donald Trump has named Marco Rubio as his secretary of state, making him the first Latino member of the president-elect’s top team.
Mr Rubio, a Florida senator, unsuccessfully ran against Mr Trump to be the Republican presidential candidate in 2016.
In the past, the 53-year-old has advocated for muscular foreign policy with respect to the US’s geopolitical rivals, including China, Iran and Cuba.
However, over the last several years he has softened some of his stances to align more closely with Mr Trump’s views.
He was a contender to be his 2024 running mate before JD Vance landed the role.
Elise Stefanik
According to US network CNN, Mr Trump has offered fierce ally Elise Stefanik the job as US ambassador to the UN.
Citing two anonymous sources, CNN confirms rumours the Republican – who represents New York in the House – was lined up for the role.
Ms Stefanik has built up a national profile as an unwavering ally of the president-elect, shedding her early reputation as a moderate – having worked on Mitt Romney’s 2012 campaign – to become the highest-ranking woman in the House Republican leadership.
Sky News’ US partner network NBC News reported in January this year she was being considered as Mr Trump’s pick for vice president.
Mr Trump reportedly described her as a “killer”.
Tom Homan
Mr Trump said late on Sunday that Tom Homan will return to government to be in charge of US borders and the deportation of illegal immigrants.
Announcing the news on Truth Social, the president-elect said “there is nobody better at policing and controlling our Borders” than his new “border czar”.
Mr Homan served as former acting director of Immigration and Customs Enforcement (ICE) during Mr Trump’s first term, and was an early backer of the president’s “zero tolerance” policy – which NBC News reported led to at least 5,500 families being separated at the southern border in 2018.
Earlier this year, he told a conservative conference he would “run the biggest deportation force this country has ever seen,” per NBC.
Mr Homan was also a contributor to Project 2025’s Mandate for Leadership book.
Mike Waltz
Trump loyalist Mike Waltz is the president-elect’s national security adviser – a powerful role which does not require confirmation from the Senate.
The 50-year-old, who served in the National Guard, will be responsible for briefing Mr Trump on key national security issues and coordinating with different agencies.
Having praised Mr Trump’s foreign policy views, Mr Waltz is a leading critic of China, and has spoken out about the country’s activity in the Asia-Pacific, claiming the US needs to be ready for a potential conflict in the region.
Kristi Noem
South Dakota governor Kristi Noem has been picked to serve as the next homeland security secretary.
Once seen as a possible running mate for the president-elect, Ms Noem is currently serving her second four-year term as South Dakota’s governor, having risen to prominence after refusing to impose a statewide mask order during the COVID-19 pandemic.
As head of homeland security, she will be responsible for everything from border protection and immigration to disaster response and the US Secret Service.
In a statement on Tuesday, Mr Trump said: “Kristi has been very strong on border security. She was the first governor to send National Guard soldiers to help Texas fight the Biden border crisis, and they were sent a total of eight times.”
He said Ms Noem would work closely with his “border czar,” Mr Homan.
Stephen Miller
Mr Trump has named Stephen Miller, an immigration hardliner, to be his deputy chief of staff for policy and homeland security adviser.
Mr Miller was a vocal spokesperson during the presidential campaign for Mr Trump’s priority of mass deportations.
The 39-year-old previously served as a senior adviser during Mr Trump’s first administration.
Mr Miller has been a central figure in some of Mr Trump’s policy decisions, notably his move to separate thousands of immigrant families.
John Ratcliffe
Former director of national intelligence John Ratcliffe has been picked by Mr Trump to serve as director of the
Central Intelligence Agency (CIA).
A former congressman and prosecutor, Mr Ratcliffe is seen as a Trump loyalist who is likely to win Senate confirmation.
Tulsi Gabbard
Tulsi Gabbard, a former Democratic member of Congress and presidential candidate, has been chosen to serve as director of national intelligence.
“As a former Candidate for the Democrat Presidential Nomination, she has broad support in both Parties – She is now a proud Republican!” Mr Trump said.
“I know Tulsi will bring the fearless spirit that has defined her illustrious career to our Intelligence Community, championing our Constitutional Rights, and securing Peace through Strength. Tulsi will make us all proud!”
She has been accused of amplifying Russian propaganda and would come to the job having never worked in the intelligence world or served on a congressional intelligence committee.
Two years ago it was claimed she echoed Russian propaganda by posting a video saying there were bio labs across Ukraine funded by the US.
Who is out?
Nikki Haley
Nikki Haley was once Mr Trump’s main rival during his run for the Republican presidential nomination.
Despite losing the contest, she proved her popularity with parts of the GOP and previously served in his first presidential cabinet as the US ambassador to the United Nations.
The 51-year-old also served as governor of South Carolina but news of her not being involved this time around was broken by the president-elect on his own social media platform, Truth Social.
In a short statement, Mr Trump said he would not be inviting either her or former secretary of state Mike Pompeo back but thanked them for their service.
In response, Ms Haley, who eventually endorsed Mr Trump despite harshly criticising him in the party primaries, said: “I was proud to work with President Trump defending America at the United Nations.
“I wish him, and all who serve, great success in moving us forward to a stronger, safer America over the next four years.”
Mike Pompeo
Mike Pompeo also served as the director of the CIA under Mr Trump and had been mentioned in some reports as a possible defence secretary or in relation to another role linked to national security, intelligence or diplomacy.
Keep up with all the latest news from the UK and around the world by following Sky News
Mr Trump confirmed Mr Pompeo would not be returning to his cabinet in the same post that he ruled out Ms Haley.
Previously among Mr Trump’s closest allies, Mr Pompeo is one of the fiercest US defenders of Ukraine.
Who is yet to be decided?
Don Jr, Eric and Lara Trump
Mr Trump’s daughter and son-in-law, Ivanka Trump and Jared Kushner, were among his senior advisers during his first term. But will the businessman once again keep any family members close when he is in the Oval Office?
In June 2023, Mr Trump said he did not want his children to serve in a second administration, saying it was “too painful for the family”.
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Nevertheless, while Ms Trump and Mr Kushner have stayed away from politics since, two of Mr Trump’s other sons – Don Jr and Eric – have played prominent roles on the campaign trail.
Eric’s wife, Lara Trump, already has a significant role in US politics, as she serves as co-chair of the Republican Party.
Larry Kudlow
Fox News personality Larry Kudlow served as director of the National Economic Council for much of Mr Trump’s first term and is said to have an outside shot at becoming his treasury secretary this time.
Other names being linked to the post include John Paulson – a billionaire hedge fund manager and donor, who hosted a fundraiser that raked in more than $50m (£38m) for the former president.
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