Anxiety sensitivity, or fear of anxiety-related symptoms, is a "core dysfunction" associated with the development and maintenance of youth anxiety disorders and obsessive-compulsive disorder (OCD). Accordingly, anxiety sensitivity is a common target of transdiagnostic cognitive behavioral therapy (CBT) interventions, like the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A). However, no studies have empirically evaluated anxiety sensitivity as a mechanism of symptom change within UP-C/A treatment. This study examined anxiety sensitivity among a clinical sample of 583 youth ages 8-18 with anxiety disorders and/or OCD who received transdiagnostic CBT treatment with the UP-C/A. At pre-treatment, greater anxiety sensitivity was associated with greater symptom severity across diagnostic categories. This relationship was strongest for panic disorder symptoms. After treatment with the UP-C/A, both anxiety sensitivity and anxiety disorder symptoms decreased. Through lagged mediation analysis, we found that reductions in anxiety sensitivity at one timepoint predicted reductions in anxiety disorder symptoms at the subsequent timepoint. These findings suggest that anxiety sensitivity is a transdiagnostic risk factor and a potential mechanism of change in the treatment of youth anxiety disorders and OCD with the UP-C/A.

IntroductionPancreatic cancer is associated with substantial symptom burden, but access to supportive care medications (SCMs) may vary by socioeconomic context. We examined associations between neighborhood socioeconomic status (SES) and the receipt and timing of SCMs among older adults with pancreatic cancer in the United States.MethodsWe conducted a retrospective cohort study using SEER-Medicare data (from 2005-2020). The cohort included beneficiaries aged 65 years or older with incident pancreatic cancer and Part D coverage. SCMs included psychotropics, pain medications, anti-nausea agents, appetite stimulants, and sleep aids. Neighborhood SES was measured using Yost Index quintiles (with Q5 representing the highest SES). Multivariable logistic regression estimated associations with medication receipt, and Fine-Gray competing risk models estimated associations with the cumulative incidence of medication initiation, treating death as a competing event.ResultsAmong 81,535 beneficiaries, 69% received at least one SCM after diagnosis. Compared with beneficiaries in Q5, those in Q1 had lower adjusted odds of receiving antipsychotics (aOR 0.81; 95% CI 0.68-0.96), antidepressants (aOR 0.80; 95% CI 0.73-0.88), anxiolytics (aOR 0.87; 95% CI 0.78-0.97), anti-nausea agents (aOR 0.77; 95% CI 0.71-0.83), appetite stimulants (aOR 0.78; 95% CI 0.72-0.85), and sleep aids (aOR 0.67; 95% CI 0.60-0.76). Lower neighborhood SES was also associated with lower cumulative incidence of psychotropic, anti-nausea, appetite stimulant, and sleep aid initiation. Associations with pain medication receipt and initiation were smaller and less consistent.ConclusionLower neighborhood SES was associated with lower receipt and cumulative incidence of several SCM classes among older adults with pancreatic cancer. Because SEER-Medicare does not capture symptom burden or clinical indication, these findings describe medications dispensed through Part D rather than the adequacy of supportive care received and identify targets for research on the mechanisms underlying these differences and on interventions to improve equitable symptom management.

Sexual role identity (SRI; e.g. Top, Bottom, Versatile, Side/Others) is a central feature of gay and bisexual men's sexual self-definition and a potential source of intra-minority stress such as bottom-shaming, yet its mental health correlates remain unclear and empirical findings are mixed. This preregistered three-level meta-analysis synthesized 393 effect sizes from 41 studies (N = 27,819) on men with a history of same-sex behavior, published in Chinese and English databases up to January 2025. All effect sizes were converted to Cohen's d and modeled using three-level random-effects models. Across studies, Tops showed the most favorable mental health profile, followed by Versatiles and then Bottoms; the Top-Bottom contrast was small-to-moderate for negative indicators (d = -0.27), indicating higher depression, anxiety, and related distress among Bottoms, and the difference between Tops and Others was marginal. Available sexual-role categories significantly moderated the Top-Bottom association, suggesting that traditional binary classifications (Top vs. Bottom) may exaggerate role-related disparities when Versatile and Side/Others identities are not distinguished. Overall, the findings identify SRI as a small but statistically reliable correlate of mental health disparities among sexual minority men and underscore the need for role-sensitive assessment and interventions that target sexual-role-specific stressors within gay and bisexual communities.

Acellular dermal matrix (ADM) is a tissue-engineered biological scaffold widely adopted in plastic reconstructive surgery, yet its application in spine surgery remains largely underexplored. No prior systematic review has synthesized the available evidence. A systematic search of PubMed, Embase, Cochrane CENTRAL, Web of Science, and Scopus was performed from inception through 31 July 2026, following PRISMA 2020 guidelines (PROSPERO: CRD420261326660). Studies were stratified a priori into three evidence tiers: direct spine surgery evidence, craniovertebral/neuraxis evidence, and indirect cranial evidence. Risk of bias was assessed with ROBINS-I and JBI checklists; certainty was rated using GRADE. Ten studies comprising 385 enrolled patients met inclusion criteria: 172 patients in seven studies providing direct spine surgery evidence, 13 patients in two craniovertebral/neuraxis studies, and 200 patients in one predominantly cranial duraplasty series. Five application categories were identified. The single comparative study-a propensity score-matched cohort of 108 patients undergoing ACDF-reported lower Swallowing Impairment Scores at the pre-specified three-month endpoint (0.26 ± 0.16 vs. 0.68 ± 0.27, p = 0.01, significant after Bonferroni correction), although the observed difference (Δ = 0.42) fell below the suggested minimal clinically important difference, and adhesion scores did not differ between groups. All remaining studies were uncontrolled. GRADE certainty was very low across all outcomes. Efficacy of ADM in spine surgery cannot be determined from the current evidence base. Reported adverse events were infrequent, but ascertainment was neither standardized nor prospective, and these data are insufficient to establish safety. Findings are product- and indication-specific and should not be generalized across ADM formulations or clinical applications.