Cardiovascular disease (CVD) remains the leading cause of global mortality, with pathophysiological alterations such as heart failure with preserved ejection fraction, diabetic cardiomyopathy, and atherosclerotic cardiomyopathy representing major risk factors. Semaglutide, a novel long-acting glucagon-like peptide-1 receptor agonist, has demonstrated substantial efficacy in glycemic control and weight reduction. Since 2016, accumulating evidence has highlighted its promising cardiovascular benefits, establishing semaglutide as a strong therapeutic candidate for CVD. This review synthesizes evidence since 2016 to elucidate semaglutide's cardiovascular outcomes, underlying mechanisms, and emerging frontiers, employing bibliometric analytical approaches such as burst detection mapping and cluster timeline analysis of references and keywords. Research on semaglutide in CVD has advanced rapidly, with mechanistic insights ​including improvements in insulin resistance, anti-inflammatory activity, and anti-atherosclerotic effects, as well as novel associations with ferroptosis inhibition. Clinical evidence across diverse patient subgroups indicates that future implementation will require ​precision-based regimen design. Moreover, although oral semaglutide alleviates injection-related discomfort, its ​gastrointestinal tolerability remains a concern. Furthermore, the potential reduction in lean mass requires further validation. Overall, this review aims to broaden the clinical application of semaglutide and highlight novel therapeutic avenues for patients with cardiovascular disease.

Atherosclerotic cardiovascular diseases, with peripheral artery disease (PAD) and coronary artery disease (CAD) being the most common, are leading causes of morbidity and mortality. Although PAD and CAD have nearly equivalent prevalences, PAD disproportionately affects low resourced and historically marginalized populations and is predominately cared for by surgeons with a growing interest in the PAD pathology by cardiologists. We hypothesize PAD is understudied with fewer and lower quality clinical trials (CTs) than CAD.

We conducted a cross-sectional study and queried the ClinicalTrials.gov database for PAD and CAD entries (2000-2024) and abstracted the structured CT characteristic data available. Our primary outcome was the number of CT entries/year with trends compared CAD and PAD using linear regression. Secondary outcomes included CT design components compared using descriptive statistics.

Of the 7805 CTs included, most were CAD entries (n = 6278 [79.4%]). CAD CT entries/year were 4x that of PAD (beta-coefficient [95% confidence interval]: 3.9 [3.5-4.2], P < 0.001). Overall, CTs most commonly evaluated treatments (67.3%), but diagnostic (4.5% versus 10.8%, P < 0.001) or prevention (5.9% versus 11.1%, P < 0.001) evaluations were more common in CAD trials. Fewer PAD CTs evaluated efficacy or effectiveness: PAD CTs were more commonly phase I (6.9% versus 3.9%, P < 0.001) and single-arm interventions (31.8% versus 20.1%; P < 0.001). PAD CT also utilized fewer bias reducing methods: less randomization (64.5% versus 77.4%; P < 0.001), less blinding (43.2% versus 46.9%; P = 0.006), and more industry funding (35.6% versus 20.6%; P < 0.001). Among completed CTs, PAD CTs enrolled fewer participants/CT (median: 50 [interquartile range: 20-123] versus 92 [38-269]; P < 0.001).

Atherosclerotic cardiovascular disease CTs have increased over time, with CAD having 4-fold more entries than PAD. Further, PAD CT methods less frequently evaluated treatment efficacy or effectiveness and had less rigorous design. Focused efforts targeting quality PAD CT development are needed.

Cardiovascular (CV) diseases are the leading cause of mortality in patients with systemic lupus erythematosus (SLE). While traditional risk factors inadequately assess CV risk, SLE-specific determinants remain elusive. We have conducted a study of CV outcomes in a cohort of SLE patients, aiming to facilitate individualized risk assessment.

The LESLY cohort comprised patients diagnosed with SLE at the University Hospital of Lyon between January 2002 and August 2020. CV events (CVE) were defined as myocardial ischemia or stroke. Complete-case multivariable analyses identified predictors of CV risk, among baseline SLE characteristics and traditional CV factors. The identified predictors were subsequently employed to develop machine learning models estimating CV risk in patients with SLE. The dataset was partitioned into training (80%, n = 699) and validation (20%, n = 175) sets.

CVE occurred in 55 LESLY patients (6.3%), including 27 acute coronary syndromes and 25 ischemic strokes, over a mean follow-up of 8.8 ± 5.2 years. Antiphospholipid antibodies (HR = 3.51 [1.91-6.43], p < 0.001) and inaugural skin involvement (HR = 2.69 [1.25-5.77], p = 0.011) were the most potent predictors of CVE occurrence. Finally, an Elastic Net Penalized Cox model accurately predicted individualized CV risks in an internal validation cohort (C-index 0.791 [95% CI: 0.674-0.906]; Brier score 6.4% [95% CI: 3.7-9.8%]).

This study corroborates the primacy of CVD in SLE, underscoring the predictive roles of inaugural skin involvement and antiphospholipid antibodies. These findings enabled the development of an exploratory risk stratification model that may inform clinical decision-making for cardiovascular risk management in SLE, pending external validation.

ChatGPT is a cost-effective artificial intelligence (AI) tool designed to facilitate virtual interactions with humans, and its application in healthcare is expanding. However, research on ChatGPT's effectiveness in public healthcare, particularly for cardiac patients, is still limited. This study aims to evaluate ChatGPT's potential in managing cardiovascular health for patients with acute or chronic cardiac conditions.

We analyzed real medical records from 'The Cardiovascular Care' program, affiliated with a university outpatient clinic. ChatGPT's performance was evaluated in terms of its ability to analyze clinical cases, propose diagnoses, and recommend appropriate actions. We also assessed whether ChatGPT's accuracy and errors varied depending on disease severity, rarity, mortality risk, and urgency.

When compared to physicians' records, ChatGPT provided correct responses in 43% of diagnostic hypotheses, 5% of recommended supplementary exams, and 10% of laboratory tests. It showed significant accuracy and discernment in diagnosing conditions influenced by factors such as severity, rarity, risk of death, and urgency. However, this discernment did not extend to recommendations for supplementary exams and laboratory tests. Interestingly, while ChatGPT's responses in these areas were often only partially accurate, they tended to be more detailed, sometimes unnecessarily so, than those provided by physicians. Diagnostic hypotheses from multiple models, including ChatGPT Health, DeepSeek, Gemini Pro, Perplexity AI, and ESC Chat, were also evaluated. Performance varied across models, with ChatGPT demonstrating the highest diagnostic accuracy among those assessed, despite still producing incorrect outputs.

Although ChatGPT demonstrates some diagnostic capability, its overall reliability remains questionable, with performance at times approaching random chance. Caution is advised when considering its use in clinical decision-making.

To explore the experiences of Emergency Department nurses when caring for patients presenting to the Emergency Department with mental health issues.

Qualitative descriptive study.

Ten nurses with experience caring for mental health patients participated in face-to-face, semi-structured interviews. Nurses were recruited if they were employed at a single tertiary Emergency Department in the Northern Territory, Australia. Interviews were audio-recorded, transcribed, and analysed using thematic analysis. The COREQ checklist guided reporting.

The four key themes were: systemic factors; emotional impact and staff culture; influence of communication; education and training. Systemic factors, such as overcrowding, staff shortages, long stays, and unsuitable Emergency Department environments, restricted therapeutic care and increased patient distress. The emotional impact of caring for mental health patients, combined with reactive workplace culture and stigma, contributed to moral distress and burnout. Clear communication and teamwork supported care, while limited mental health education left nurses underprepared and reliant on informal learning. Participants emphasised the need for clear protocols, targeted training, and structured support to enhance patient outcomes, nurse confidence, and well-being.

Emergency Department nurses face systemic, cultural, and educational barriers that compromise patient care while contributing to stress, fatigue, and burnout. Addressing these challenges through integrated care pathways, targeted education, and staff support is essential to improve patient outcomes and sustain the nursing workforce.

Data from this study identifies there is an urgent need to implement practical strategies to reduce challenges for nurses in caring for patients presenting to the ED with mental health issues.

This study revealed that systemic pressures, emotional fatigue, and limited training hinder effective care. This research can inform hospital leaders, policymakers, and educators to improve support, training, and care pathways within ED settings.

The authors have adhered to the COnsolidated criteria for REporting Qualitative research (COREQ).

No patient or public contribution was made.

Research on the significance of comorbid personality disorders (PD) on the outcome of depression treatment has shown inconsistent findings. In addition, it is still unclear whether treatment choice based on personality traits and coping can enhance the efficacy of depression treatment. Aiming to deliver clinically representative results, we use dimensional measures to examine avoidant personality and coping as moderators for the efficacy of cognitive-behavioral therapy (CBT) versus short-term psychodynamic psychotherapy (STPP) for depression. Furthermore, we explored whether these depression treatments reduced avoidant personality traits and coping. Included were 265 patients with major depressive disorder who received 16-week CBT or STPP in a randomized clinical trial. Depression, avoidant personality traits, and avoidant coping were measured with, respectively, the Hamilton Depression Rating Scale, NEO Five Factor Inventory (extraversion and neuroticism subscales), and Utrecht Coping List (avoidance subscale). Multilevel regression analyses estimated the moderating effects of avoidant personality traits and avoidant coping on the relationship between treatment type and depressive symptom change, as well as changes in avoidant personality traits and avoidant coping in CBT and STPP. Avoidant personality traits and avoidant coping did not moderate the efficacy of CBT and STPP. Both treatments resulted in significant reductions in avoidant personality traits, but not in coping. Both CBT and STPP can be offered to patients with avoidant personality traits and avoidant coping and can reduce avoidant personality traits. Trial Registration: ISRCTN31263312 (http://www.controlled-trials.com).

Although the mental health consequences of armed conflict, displacement, and climate-related disasters are well documented, the psychological effects of geopolitical rhetoric itself (independent of material events) remain insufficiently examined. This narrative review provides a conceptual and interdisciplinary synthesis of emerging and heterogeneous evidence on how threat-oriented political narratives may influence population mental health through indirect, mediated, and context-dependent pathways. The reviewed literature suggests convergent patterns across five thematic areas: symbolic threat and heightened vigilance; perceived uncertainty and loss of control; indirect effects of repeated media exposure; intersections with climate-related distress; and differential vulnerability across populations. Although empirical studies explicitly operationalising geopolitical rhetoric are limited, evidence from adjacent domains indicates that persistent exposure to such narratives may function as a chronic psychosocial stressor, extending beyond directly affected regions. Given the limited availability of direct empirical research, this review should be understood primarily as a theory-building synthesis rather than a consolidation of a well-established evidence base. These effects appear cumulative, are amplified by contemporary media environments, and are particularly salient in climate-sensitive and socially vulnerable contexts. Taken together, this review proposes a conceptual framework in which geopolitical rhetoric may act as an emerging contextual determinant of population mental health, with implications for preventive strategies, responsible public communication, and future research on socio-political determinants of psychological well-being.

As artificial intelligence becomes increasingly integrated into elderly healthcare systems, smart elderly health care (SEHC) has been promoted as a promising policy enhancing mental health and well-being among the elderly in China. This study examines the impact of SEHC on mental health and inequality among the elderly, with a particular focus on its unequal selection effect and the expansion of individual adaptability. Drawing on longitudinal data from China Health and Retirement Longitudinal Study, we adopt staggered difference-in-difference method to estimate the effects of SEHC policy implementation on elderly mental health and inequality, conduct robustness checks, heterogeneity tests, and mechanism analyses. SEHC significantly improves the mental health of the elderly (β = -1.391, P < 0.01) while simultaneously intensifying mental health inequality (β = 0.278, P < 0.01). However, these gains are disproportionately concentrated among individuals with higher income, lower hospitalization cost, higher educational attainment, and urban residency. Mechanism analysis reveals that SEHC improves mental health primarily by enhancing social participation and reducing hospitalization cost, with these adaptive benefits concentrated among higher-income individuals. While SEHC demonstrates significant potential to enhancing mental well-being among the elderly, it also generates disparities in mental health outcomes across different socioeconomic groups. To address this inequality, policymakers should implement inclusive intervention strategies that guarantee equitable and sustainable access to artificial intelligence-driven mental health benefits in elderly healthcare.

The use of antidepressant medications is increasing globally. Despite their obvious benefits, ongoing use of these medications is often not properly monitored or deprescribed when a person returns to better mental health; in addition, the proportion of prescriptions provided to those who do not suffer from clinical depression leads to a personal and societal cost burden.

This trial aims to assess the clinical and cost effectiveness of an online support tool to help patients with mild to no symptoms of depression and their general practitioners to manage the careful and appropriate tapering and cessation of antidepressants at 6 months compared to attention control.

This stratified, single-blind, parallel, two-arm, superiority randomised controlled trial in Australian primary care of individuals with mild to no symptoms of depression aged 18 to 75 years old and have been taking antidepressant medication for longer than 12 months After informed consent, 340 eligible patients will be randomised 1:1, stratified by general practice or state of residence if recruited via social media, into the active intervention arm, where they will be asked to reduce their antidepressant with the aid of a clinically guided online support tool, or the attention control arm, that will continue with usual care. Participants in both arms will be provided with information about antidepressants through the Beyond Blue website and followed up at 3, 6 ,12 and 18 months to record antidepressant use, depression and anxiety symptom severity, quality of life and health economics information. Intention to treat analysis will determine the clinical effectiveness of the online tool compared to attention control, where the primary outcome is between-arm difference in the proportion of participants with successful cessation of medication at 6 months with depression remaining mild or absent. Cost-consequence and cost-utility analyses will be used to determine the cost effectiveness of the intervention and its impact on quality of life, compared to control.

At submission of this manuscript in July 2025, 310 participants had been randomized and recruitment was ongoing. The target number of 340 randomized participants was achieved in January 2026.

The WiserAD online support tool assists patients and their GP with deprescribing and may lead to successful cessation of antidepressant medication, resulting in an enhanced quality of life and cost savings over the longer term.

ANZCTR ACTRN12622000567729, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12622000567729; ISRCTN 11562922, https://www.isrctn.com/ISRCTN11562922; ClinicalTrials.gov NCT05355025, https://clinicaltrials.gov/study/NCT05355025.

DERR1-10.2196/81858.

Adverse childhood experiences (ACEs) are traumatic events occurring before the age of 18 that may undermine a child's sense of safety, stability and attachment. ACEs can have lifelong consequences, including an elevated risk of developing psychological disorders and an increased likelihood of engaging in delinquent or violent behaviour later in life. Clinical practice suggests that many forensic psychiatric patients have a history of ACEs, but scientific research on ACEs within this population remains limited.

To study the prevalence of ACEs before the age of 18 within a large Dutch forensic psychiatric prison cohort and the relationship between repeated ACEs and psychopathology or violent criminal behaviour.

Data collected from 3421 adults (91% men) who had been admitted to one of the four penitentiary psychiatric centres (PPCs) in the Netherlands were used to examine the prevalence of ACEs and their association with different clusters of psychological disorders or violent criminal behaviour.

Over half of the men (1,633, 53%) and nearly two thirds of the women (198, 62%) had experienced repeated ACEs. The men with repeated ACEs had greater odds of having a neurobiological developmental disorder, having committed a violent offence and developing a substance use or addiction disorder, a personality disorder and/or a trauma- or stress-related disorder. The women with repeated ACEs had greater odds of developing a personality disorder.

Our findings underscore the importance of incorporating assessment of trauma histories and trauma-informed service for forensic psychiatric offenders. We also add evidence for the potential for early intervention, given that repeated ACEs were associated with certain mental disorders and with violent offending, in particular for men.