TikTok misinformation and user engagement in female pelvic floor conditions.

IMPORTANCE: Social media platforms are increasingly utilized to distribute medical information. Our study emphasizes the need for accuracy in pelvic health education on social media and the involvement of female pelvic floor (FPF) specialists in content creation. AIMS: In this cross-sectional study, we assessed the FPF TikTok videos with the highest engagement for quality of information and misinformation and investigated the relationship between misinformation and user engagement. METHODS: We collected all TikTok videos on the US app with hashtags related to FPF conditions, including 76 on pelvic organ prolapse, 323 on urinary tract infection, 84 on overactive bladder, and 972 on incontinence. The top 20 videos for each FPF condition were selected based on highest engagement, and 74 videos total met inclusion criteria. TikTok videos were scored with the validated DISCERN instrument for quality of consumer health information and a 5-point Likert scale for misinformation. The correlation between misinformation and user engagement was assessed. RESULTS: Our analysis revealed positive correlations among higher average misinformation scores and shares (r = 0.37, p < 0.001), likes (r = 0.23, p = 0.004), and overall engagement (r = 0.25, p = 0.002) in FPF TikTok videos as a group, likely driven by the #UTI category. Most TikTok videos (96%) had poor quality of information (DISCERN score < 3), and 18% of TikTok videos contained misinformation. CONCLUSION: The poor quality and prevalence of misinformation in FPF-related TikTok videos with the highest engagement raise concerns about the propagation of nonevidence-based health information.

Role of State Insurance Policy in Orthotic Helmet Access for Deformational Plagiocephaly.

BACKGROUND: Helmet therapy for deformational plagiocephaly has an ideal window for treatment, and timely access to care is vital to achieving optimal benefit. The authors evaluated the hypothesis that patients insured through Medicaid experience decreased access to helmet therapy. METHODS: This was a retrospective analysis of referrals for helmet therapy to Cranial Technologies, Inc. between 2014 and 2020 across 21 states. Outcome measures were likelihood of receiving a helmet, receiving a second helmet, receiving delayed treatment, and having delayed presentation. RESULTS: From 2014 to 2020, a total of 219,869 patients were referred and 141,513 of these received a helmet. Patients with Medicaid were less likely to receive treatment (OR, 0.63; P < 0.001) and more likely to present late (OR, 1.55; P < 0.001) or receive delayed treatment (OR, 3.24; P < 0.001) compared with the commercially insured. Patients with Medicaid were less likely to receive helmet therapy in nine states, with the strongest association in Texas (OR, 0.32; P < 0.001), and more likely to receive helmet therapy in five states, with the strongest association in Colorado (OR, 1.89; P < 0.001). Medicaid was associated with late presentation and delayed treatment in all states. CONCLUSIONS: Patients with Medicaid presented later and were less likely to receive helmet therapy. Findings reflected state-specific Medicaid policies, with patients in some states more likely to receive a helmet with Medicaid than with commercial insurance. However, late presentation and delays in treatment with Medicaid were observed across all states. State-specific Medicaid restrictions are likely a driving factor in determining access to helmet therapy.

Blubber proteome response to repeated ACTH administration in a wild marine mammal.

While the response to acute stress is adaptive in nature, repeated or chronic stress can impact an animal's fitness by depleting its energy stores and suppressing immune function and reproduction. This can be especially deleterious for species that rely on energy reserves to fuel key life history stages (e.g. reproduction), already experience physiological extremes (e.g. fasting), and/or have undergone significant population declines, such as many marine mammals. However, identifying chronically stressed individuals is difficult due to the practical challenges to sample collection from large aquatic animals and a paucity of information on downstream consequences of the stress response. We previously simulated repeated stress by ACTH administration in a model marine mammal, the northern elephant seal, and showed that changes in blubber gene expression, but not circulating cortisol levels, could distinguish between single and repeated responses to ACTH. Here, we profiled changes in the proteome of the same blubber cell population and identified a set of differentially expressed proteins that included extracellular matrix components, heat shock and mitochondrial proteins, metabolic enzymes, and metabolite transporters. Differentially expressed proteins and genes shared similar functions that suggest that repeated corticosteroid elevation may affect blubber tissue proteostasis, mitochondrial activity, adipogenesis, and metabolism in marine mammals. For marine mammal species from which blubber biopsies, but not blood can be obtained by remote sampling, measurement of abundance of such proteins may serve as a novel method for identifying chronically stressed animals.

Expression of obesity-related adipokine genes during fasting in a naturally obese marine mammal.

Northern elephant seals (Mirounga angustirostris) are exceptional among fasting-adapted animals in coupling prolonged fasting with energetically costly activities, relying on oxidation of fat stores accrued during foraging to power metabolic demands of reproduction and molting. We hypothesized that high rates of energy expenditure, insulin resistance, and immune responses to colonial breeding in fasting seals are mediated by adipokines, or signaling molecules secreted by adipose tissue that are associated with obesity and inflammation in humans. We measured mRNA expression of 10 adipokine genes in blubber tissue of adult female elephant seals sampled early and late during their lactation and molting fasts and correlated gene expression with adiposity and circulating levels of corticosteroid and immune markers. Expression of adiponectin (ADIPOQ) and its receptor ADIPOR2, leptin receptor (LEPR), resistin (RETN), retinol binding protein 4 (RBP4), and visfatin/nicotinamide phosphoribosyltransferase (NAMPT) was increased, whereas that of fat mass and obesity-associated protein (FTO) was decreased in late-fasted compared with early-fasted groups. Abundance of adipokine transcripts that increased in late fasting was negatively associated with body mass and positively associated with cortisol, suggesting that they may mediate local metabolic effects of cortisol in blubber during fasting. Expression of several adipokines was correlated with the immune markers IL-6, haptoglobin, IgM, and IgE, suggesting a potential role in modulating immune responses to colonial breeding and molting. Since many of these adipokines have not been measured in other wild animals, this study provides preliminary insights into their local regulation in fat tissue and targeted assays for future studies.

Blubber transcriptome responses to repeated ACTH administration in a marine mammal.

Chronic physiological stress impacts animal fitness by catabolizing metabolic stores and suppressing reproduction. This can be especially deleterious for capital breeding carnivores such as marine mammals, with potential for ecosystem-wide effects. However, the impacts and indicators of chronic stress in animals are currently poorly understood. To identify downstream mediators of repeated stress responses in marine mammals, we administered adrenocorticotropic hormone (ACTH) once daily for four days to free-ranging juvenile northern elephant seals (Mirounga angustirostris) to stimulate endogenous corticosteroid release, and compared blubber tissue transcriptome responses to the first and fourth ACTH administrations. Gene expression profiles were distinct between blubber responses to single and repeated ACTH administration, despite similarities in circulating cortisol profiles. We identified 61 and 12 genes that were differentially expressed (DEGs) in response to the first ACTH and fourth administrations, respectively, 24 DEGs between the first and fourth pre-ACTH samples, and 12 DEGs between ACTH response samples from the first and fourth days. Annotated DEGs were associated with functions in redox and lipid homeostasis, suggesting potential negative impacts of repeated stress on capital breeding, diving mammals. DEGs identified in this study are potential markers of repeated stress in marine mammals, which may not be detectable by endocrine profiles alone.

Repeated adrenocorticotropic hormone administration alters adrenal and thyroid hormones in free-ranging elephant seals.

Understanding the physiological response of marine mammals to anthropogenic stressors can inform marine ecosystem conservation strategies. Stress stimulates the activation of the hypothalamic-pituitary-adrenal (HPA) axis and synthesis of glucocorticoid (GC) hormones, which increase energy substrate availability while suppressing energy-intensive processes. Exposure to repeated stressors can potentially affect an animal's ability to respond to and recover from subsequent challenges. To mimic repeated activation of the HPA axis by environmental stressors (or challenges), we administered adrenocorticotropic hormone (ACTH) to free-ranging juvenile northern elephant seals (Mirounga angustirostris; n = 7) once daily for 4 days. ACTH administration induced significant elevation in circulating cortisol and aldosterone levels. The cortisol responses did not vary in magnitude between the first ACTH administration on Day 1 and the last administration on Day 4. In contrast, aldosterone levels remained elevated above baseline for at least 24 h after each ACTH injection, and responses were greater on Day 4 than Day 1. Total triiodothyronine (tT3) levels were decreased on Day 4 relative to Day 1, while reverse triiodothyronine (rT3) concentrations increased relative to baseline on Days 1 and 4 in response to ACTH, indicating a suppression of thyroid hormone production. There was no effect of ACTH on the sex steroid dehydroepiandrosterone. These data suggest that elephant seals are able to mount adrenal responses to multiple ACTH administrations. However, repeated ACTH administration resulted in facilitation of aldosterone secretion and suppression of tT3, which may impact osmoregulation and metabolism, respectively. We propose that aldosterone and tT3 are informative additional indicators of repeated stress in marine mammals.