Green Health Prescribing involves health and care professionals prescribing structured, nature-based interventions, such as gardening, walking in green spaces, or cultural activities outdoors. With population ageing and increasing pressure on healthcare systems, Green Health Prescribing has been proposed as a potentially cost-effective approach to support healthy ageing in older adults with long-term conditions. This review summarises evidence on the effectiveness of Green Health Prescribing and related nature-based interventions for older adults.

A systematic review was conducted of intervention studies reporting the effectiveness of Green Health Prescribing and nature-based interventions for adults aged 50 years and over in primary or community care settings. Eligible designs included randomised trials, other comparative designs, and before-after studies. Searches up to October 2024 were performed in major medical, psychological, social science, and environmental databases, alongside grey literature sources. Study selection, data extraction, and quality appraisal were undertaken independently by at least two reviewers. Quantitative findings were synthesised narratively using a Grading of Recommendations, Assessment, Development and Evaluation-informed approach, with reporting guided by established systematic review standards. Patient and provider input informed the design and interpretation of findings.

Twenty-one studies, including 11 randomised trials, evaluated interventions among older adults living in the community or residential care. Interventions included activities in nature, exercise in green spaces, indoor gardening, and horticultural therapy. Many studies reported improvements in at least one health or wellbeing outcome; however, statistically significant effects compared with control conditions were uncommon. Evidence suggested potential benefits for quality of life, mental health, physical function, fatigue, loneliness, and social connectedness, but findings were inconsistent. Overall certainty of evidence was low or very low, largely because of small sample sizes, risk of bias, and limited replication across outcomes.

Evidence supporting the effectiveness of Green Health Prescribing and nature-based interventions for older adults remains limited. Given continued policy priority and funding for green space prescribing, high-quality pragmatic trials and implementation studies are needed, particularly among older adults, to robustly assess health outcomes, cost-effectiveness, and healthcare resource use in routine practice for Green Health Prescribing as a referral option in primary and community care.

CRD42025603199.

Stigma and violence experienced by transgender women and women engaged in transactional sex may negatively impact health and access to HIV care. We investigated typologies of past-year violence experienced by transgender women living with HIV (TWLH), with or without involvement in transactional sex (TWLH-TS and TWLH-nTS, respectively) in France.

We used data from the 2020-2022 French national cross-sectional ANRS-TRANS&HIV survey, which included TWLH recruited in 36 HIV care centres. We performed latent class analyses using variables representing combinations of past-year violence type and perpetrator separately for TWLH-TS and TWLH-nTS. Correlates of the resulting past-year violence typologies among TWLH-TS were assessed using multinomial logistic regression.

Among TWLH-TS (66% of the 501 participants), three typologies emerged: low reported violence (42% of the 501 participants), multiple-perpetrator violence (8%) and client and street violence (17%). Among TWLH-nTS (34% of the 501 participants), two typologies emerged: low reported violence (30% of the 501 participants) and multiple-perpetrator violence (3%). In TWLH-TS, correlates of client and street violence were inadequate housing, ART interruption, stimulant use and daily cannabis use, while those of multiple-perpetrator violence were depression and a lack of emotional support. Client and street violence and multiple-perpetrator violence were correlated with meeting clients in outdoor locations.

TWLH in France face intersecting forms of systemic violence and structural vulnerability. One in ten experienced multi-form, multiple-perpetrator violence, regardless of transactional sex involvement, with potential consequences for mental health. Client and street violence affected one in four TWLH-TS, and was associated with precarious housing and working conditions, as well as substance use and ART adherence difficulties. Ensuring equitable access to HIV care and mental health services for transgender women is essential and inseparable from protecting their fundamental human rights and improving their socioeconomic conditions.

NCT04849767.

Digital health interventions for psychosis, like SloMo, leverage smartphone technology to help transfer learning from therapy to real-life situations. Usage relies on motivation, recall, and awareness. Wearable devices that track physiological signs of stress can boost engagement by encouraging the use of coping strategies when most needed.

This study aims to co-design an integrated user interface for wearable technology and the SloMo mobile app, and explore its usability, acceptability, engagement, and preliminary clinical outcomes for individuals with psychosis through a feasibility study.

A co-design team developed the wearable augmented SloMo app using the Double Diamond framework. The team included 10 experts by experience based across three UK National Health Service (NHS) mental health trusts, who had completed SloMo as part of a randomized controlled trial, and were purposively recruited to ensure a range of demographic backgrounds. Users tested the app for 8 consecutive weeks during a 5-month data collection period in 2018, providing feedback that guided iterative improvements. Self-reported engagement, usability, and acceptability were collected through quantitative ratings and interviews, evaluated through qualitative content analysis. Assessments of paranoia and well-being were completed pre- and post use, summarized descriptively, with change scores calculated and evaluated for reliable change.

The Spire Stone clothing-adhered biosensor, which monitors respiratory rate and stress physiology, was chosen to augment SloMo. A minimum viable product of an integrated interface was developed. Feedback identified that users needed the technology to be easy to use, secure, and tailored to them through user control. Eight (8/10, 80%) users reported that the wearable prompted increased use of the SloMo app's features and other coping strategies. Self-reported engagement varied according to EBE user experience of the technology: higher use of the technology (n=3) was associated with higher usefulness (25% reduction in paranoia, SD 6%) and acceptability (84% satisfaction, SD 13%). Conversely, individuals that engaged with the device less (n=7) did not find it as useful (11% increase in paranoia, SD 17%) and were only modestly satisfied (63%, SD 20%).

Wearable technology is acceptable and can be integrated with a digitally supported therapy for psychosis to promote engagement and potentially support management of difficulties. However, further development work is needed to ensure acceptability and usefulness across a broader range of user needs.

46, XY disorder of sex development (46, XY DSD) is relatively rare and frequently missed in clinical practice, necessitating early standardized diagnosis and treatment. Androgen insensitivity syndrome (AIS), a major subtype, should be considered in phenotypic females with suggestive clinical clues.

A 29-year-old phenotypic female presented with primary amenorrhea and intermittent abdominal pain. Examination revealed normal breast development, sparse pubic hair, and female external genitalia. Pelvic ultrasonography and CT showed an absent uterus and ovaries, with bilateral inguinal masses.

The case met the 3 diagnostic criteria for 46, XY DSD: 46,XY karyotype, testicular tissue, and feminized external genitalia. A diagnosis clinically consistent with complete AIS was further supported by the characteristic phenotype - female appearance, normal breast development, sparse pubic hair, and absent Müllerian structures. Other etiologies of undervirilization, including 5α-reductase deficiency and 17β-hydroxysteroid dehydrogenase deficiency, were considered. Genetic confirmation was unavailable, limiting subtype certainty.

Following counseling, the patient underwent laparoscopic bilateral orchiectomy as prophylactic gonadectomy to reduce malignancy risk, together with inguinal hernia repair, followed by postoperative hormone replacement therapy. Postoperative histopathology confirmed testicular tissue with Leydig cell hyperplasia, absent spermatogenic cells, and no malignancy.

Abdominal pain resolved postoperatively, with improved psychological well-being and adaptation to the diagnosis under ongoing endocrine and psychological support.

46, XY DSD is underdiagnosed due to phenotypic variability, reliance on specialized tests, and social biases. AIS should be considered in the differential diagnosis of phenotypic females presenting with primary amenorrhea, developed secondary sexual characteristics, and an absent uterus on ultrasound. However, definitive subtyping requires AR gene sequencing, which was not available in this case. Early diagnosis requires careful assessment of newborn external genitalia, with specialist evaluation prompted by any atypical findings, and hormonal and genetic testing in adolescents with abnormal development. Multidisciplinary care - involving gynecologists, endocrinologists, surgeons, geneticists, and mental-health professionals - is essential for comprehensive management, including psychological support, hormone therapy, and timely prophylactic gonadectomy. Establishing specialized multidisciplinary centers for DSD is also recommended.

Prior evidence suggests that people from racial/ethnic minority (REM) groups experience greater psychological distress, especially if they are isolated from their cultural ingroup. This study examined associations between REM status and psychological symptoms measured before and after therapy, as well as interactions with neighbourhood-level REM density.

Electronic health records from 130,857 patients who accessed psychological interventions in primary care services in England were analyzed. Pre- and post-treatment depression (PHQ-9), anxiety (GAD-7) and functional impairment measures (WSAS) were linked to individual-level and neighbourhood-level demographic and socioeconomic data. Multilevel (mixed effect) models were used to examine associations between individual and neighbourhood socioeconomic variables with available measures of psychological distress.

Specific (rather than all) REM groups had higher indices of psychological distress, and there was little evidence of a moderating effect of neighbourhood ethnic density in the hypothesized direction. After controlling for socioeconomic variables, consistently higher indices of distress before and after therapy were evident for patients from White-other, Pakistani, Bangladeshi, and "Other" backgrounds.

Mental health inequalities are evident for people from specific REM groups.

The Research Domain Criteria (RDoC) domains of the negative valence system (NVS) and the cognitive system (CS) offer a framework for current research on aggression. In particular, the projects of the Transregio "Neuropsychobiology of Aggression" (Transregional Collaborative Research Center 379, TRR 379) are grouped according to these domains.

The present review article describes how these domains are conceptualized and what role they play in the investigation and understanding of aggressive behavior in mental disorders and its biological correlates within the framework of TRR 379.

This is a qualitative review that summarizes empirical findings based on exemplary studies and selected reviews and discusses recent developments. The focus is on work that explicitly links aggression to the NVS and/or CS and on work within TRR 379.

Using the NVS and the CS, the projects within TRR 379 are developing a wide range of innovative, experimental setups to investigate the various aspects of aggression in a transdiagnostic manner across large samples of individuals with mental disorders, in conjunction with established paradigms and questionnaires as well as a rich repertoire of neurophysiological measures. Based on the initial results, the interdisciplinary community of TRR 379 researchers engages in intensive and critical discussions on how the various aspects of the RDoC approach, as well as other transdiagnostic approaches such as "HiTOP" and "Computational Psychiatry," can be utilized both conceptually and methodologically for current and future projects. Early-career researchers are particularly active in this area.

Founder effects are important population genetic mechanisms that influence the distribution of inherited neurological diseases. To review the global distribution of founder mutations across the spectrum of inherited movement disorders, summarize the molecular mechanisms, and discuss their clinical implications for diagnosis, genetic counselling, and emerging precision therapies. A scoping review was conducted following PRISMA-ScR principles, searching PubMed/MEDLINE and secondary reference lists for studies reporting founder mutations, shared haplotypes, or population-specific mutation enrichment in inherited movement disorders; studies lacking genetic or epidemiological evidence for a founder effect were excluded. Seventy-one studies described 53 founder-mutation entries across 40 movement-disorder phenotypes and 48 genes or repeat-expansion loci (Table 1), most frequently spinocerebellar ataxias, dystonia, and NBIA syndromes. Shared haplotypes, mutation-age estimation, and genealogical evidence consistently supported a founder origin (e.g., TOR1A dystonia in Ashkenazi Jews, LRRK2/GBA1-associated Parkinson disease in Ashkenazi Jewish and North African populations, SCA2 in Cuba, SCA3 in the Azores and Brazil). These founder mutations enable ancestry-targeted diagnostic testing, inform genetic counselling and carrier screening in endogamous populations, and identify genetically homogeneous cohorts increasingly used for natural-history studies and precision therapeutic trials, including antisense and gene-silencing approaches. Founder effects, driven predominantly by endogamy, geographic isolation, and migration-associated bottlenecks, account for a disproportionate share of the mutational spectrum in spinocerebellar ataxias, dystonia, and NBIA syndromes. Ancestry-informed testing algorithms, targeted carrier screening, and enrolment of genetically homogeneous founder cohorts into precision therapeutic trials represent the most immediate translational applications of these findings.

Surrogacy includes traditional surrogacy, in which the carrier contributes her own oocyte, and gestational surro-gacy, in which the embryo is derived exclusively from the gametes of the intended parents or donors. In Brazil, only gestational surrogacy is legally recognized. It is governed by resolutions of the Federal Council of Medicine and the national health surveillance agency in the absence of spe-cific federal legislation, and it requires altruistic, unpaid participation and compliance with carrier eligibility crite-ria. This Position Statement, developed by the Strategic Committee on Gestational Surrogacy of the Brazilian As-sociation of Assisted Reproduction, addresses the clinical, bioethical, legal, and psychological dimensions of the prac-tice and is intended to guide specialists throughout Brazil. Clinical indications include uterine absence or anomalies, contraindications to pregnancy, medical conditions that may be aggravated by pregnancy, and biological inability to conceive or carry a pregnancy. No universally validated protocol for carrier selection exists; current requirements include a maximum age of 50 years, at least one previous live birth, and satisfactory physical and mental health. Peri-natal outcomes are comparable to those of conventional in vitro fertilization, although long-term data on cross-border arrangements remain scarce. The bioethical framework is based on autonomy, beneficence, non-maleficence, and justice. SBRA opposes simultaneous surrogacy arrange-ments because they are incompatible with the altruistic na-ture of the practice and supports gradual, age-appropriate disclosure of the child's gestational origin. Legal challenges include the absence of statutory regulation, cross-border reproductive tourism, and the child's right to know their origins. Continuous psychological support for all parties is mandatory and central to favorable long-term outcomes. Gestational surrogacy is a valid reproductive option for se-lected patients but requires rigorous oversight and must prioritize the best interests of the child within the Brazilian regulatory framework.

Fragile X syndrome is a monogenic disorder caused by the expansion of CGG trinucleotide repeats in the fragile X mental retardation 1 (FMR1) gene and is a major cause of inherited intellectual disability and reproductive impair-ment. Preimplantation genetic testing for monogenic disor-ders (PGT-M) has become an important strategy in assisted reproduction to prevent the transmission of FMR1-related disorders. This narrative review aimed to summarize cur-rent evidence on the molecular basis, technical approaches, clinical outcomes, and challenges associated with PGT-M for FMR1 CGG repeat expansions. A literature search was performed in the PubMed database, including English-lan-guage original studies, clinical investigations, and reviews. The reviewed studies demonstrate that advances in multi-plex PCR, linked-marker analysis, and next-generation se-quencing have significantly improved diagnostic accuracy, overcoming earlier limitations related to CGG repeat analy-sis, allele dropout, and mosaicism. Although women carry-ing FMR1 premutations frequently present with diminished ovarian reserve and reduced response to ovarian stimula-tion, pregnancy and live birth rates per embryo transfer are comparable to those of non-carriers when individual-ized stimulation protocols are applied. The combined ap-plication of PGT-M and Preimplantation Genetic Testing for Aneuploidy may be considered in selected clinical scenarios to optimize embryo selection, although indications should be individualized. In addition to its clinical benefits, PGT-M raises ethical, psychological, and economic considerations, emphasizing the importance of genetic counseling in re-productive decision-making. Overall, PGT-M represents a safe and effective tool in assisted reproduction for couples at risk of transmitting FMR1 related disorders, with grow-ing relevance in clinical practice and public health.

Tuberous sclerosis complex (TSC) is a multisystem genetic disorder frequently accompanied by epilepsy and TSC-associated neuropsychiatric disorders. Psychiatric-predominant seizure presentations may, however, delay recognition. This clinical challenge describes a 26-year-old woman with recurrent panic-like episodes characterized by dyspnea, choking sensations, palpitations, and derealization, followed by depressive symptoms. The episodes persisted despite treatment with selective serotonin reuptake inhibitors and benzodiazepines. Further examination revealed hypomelanotic macules, prompting neurologic and systemic evaluation. Brain imaging demonstrated findings consistent with cortical tubers and subependymal nodules, while video electroencephalography captured frequent focal seizures without impaired awareness arising from the left frontotemporal region. Positron emission tomography/computed tomography identified a corresponding frontal abnormality. Although genetic testing detected a nonclassical TSC1 variant, the TSC diagnosis was established on clinical grounds. Treatment with lacosamide eliminated detectable epileptiform activity and substantially reduced the frequency and severity of her panic-like episodes; depressive and anxiety symptoms also improved with combined lacosamide and duloxetine treatment. This case illustrates how focal seizures involving frontal, temporal, and limbic-autonomic networks may mimic primary panic disorder. Stereotyped, brief, recurrent, and treatment-refractory psychiatric episodes-particularly when accompanied by neurocutaneous findings-should prompt electroencephalography and brain imaging. The case also emphasizes that an uninformative or uncertain genetic result does not exclude clinically established TSC or alter recommended surveillance and multidisciplinary management.