Social media plays an increasing role in healthcare, influencing patient education, provider selection, and physician marketing. Previous studies show mixed results on its impact on physician review scores, and limited data exist within orthopedic oncology. The purpose of this study was to quantify social media utilization among Musculoskeletal Tumor Society (MSTS) members as well as identify any differences by physician sex or practice type. All active MSTS members were searched for common social media accounts. Account activity and engagement data were acquired. Publicly available ratings from popular physician review websites were compiled. Data were collected on each member's demographic details including sex, geographical location, type of practice, and h-index. The association between social media activity and online review scores was analyzed using chi-square tests for categorical data and t-tests for continuous variables. A total of 247 MSTS members, comprising 199 academic and 48 private surgeons, revealed significant differences in orthopedic surgeon social media engagement and online presence. At least 1 social media account was used by 178 (72.1%) of MSTS members with LinkedIn most used (57.9%) followed by ResearchGate (39.7%). Surgeons with 3 or more active social media accounts demonstrated significantly higher ratings on practice-affiliated scoring sites compared with those without any social media presence (4.88 ± 0.10 vs. 4.82 ± 0.13, p = 0.017), and a significant difference was observed in practice-affiliated scoring, with higher h-index surgeons receiving better ratings (4.84 ± 0.10 vs. 4.79 ± 0.11, p = 0.009). Most MSTS members do not have professional social media accounts geared toward the patient population (i.e. Instagram, TikTok). Although social media demonstrates benefits of patient engagement, education, and recruitment, there was only significant difference in ratings on practice-affiliated scoring sites with over 3 social media accounts compared with surgeons without any accounts. Level IV. See Instructions for Authors for a complete description of levels of evidence.
Social media has become an increasingly prevalent platform for exchanging health information, facilitating professional networking, promoting education, and fostering public engagement. For surgeons, its benefits-rapid dissemination of knowledge, community building, conference amplification, advocacy, and recruitment-coexist with heightened ethical risks, including breaches of confidentiality, blurred professional boundaries, misinformation, conflicts of interest, and inequities in access. This SAGES Ethics Committee white paper provides an ethics-focused overview of surgeon social media use and offers practical recommendations aligned with core bioethical principles, incorporating previous work from the SAGES Social Media Committee, the SAGES Facebook Taskforce, and the SAGES Ethics Committee. We synthesize existing professional guidance and the peer-reviewed literature on social media in healthcare and surgery to identify recurring ethical dilemmas across stakeholder groups (surgeons, patients, institutions, and society). We organize these issues using the four principles of biomedical ethics-autonomy, beneficence, non-maleficence, and justice-and translate them into actionable standards for professional conduct, content stewardship, and institutional oversight. Key ethical domains include the following: (1) professionalism and identity management in blended personal/professional spaces; (2) confidentiality and the Health Insurance Portability and Accountability Act of 1996 (HIPAA)-informed safeguards when sharing clinical images, videos, and case discussions; (3) disclosure and conflict-of-interest management in self-promotion, marketing, endorsements, and "non-evidence-based" content; (4) boundaries in patient interaction, emphasizing that social media should not be used for direct patient-provider communication in lieu of secure, trackable clinical platforms; (5) respect for patient privacy, including a general expectation that clinicians should not search patients' social media absent compelling, disclosure-supported exceptions (e.g., emergent identification needs); (6) consent standards for recording or posting media involving patients or clinicians; (7) equity considerations, recognizing that reliance on social platforms can worsen disparities for individuals lacking access or digital health literacy; and (8) societal-level implications such as clinical trial recruitment, crowdsourcing, misinformation correction, wellness harms from excessive use, and emerging risks/opportunities from artificial intelligence (AI)-enabled amplification and data mining. Ethical social media engagement by surgeons is feasible and often beneficial when guided by transparency, accuracy, confidentiality protection, boundary maintenance, and equity. We recommend clear disclosures, separation of personal/professional accounts when feasible, institutional and society-level monitoring frameworks for official messaging, strict consent and de-identification standards for clinical content, avoidance of social media as a clinical communication channel, and ongoing review of AI-driven changes to platform dynamics and privacy risk.
Otitis media is a complex disease. The pathogenesis of both acute and chronic otitis media results from a complex interplay of anatomical, microbiological, and immunological factors. Identified risk factors include patient-related aspects such as nutrition, allergies, ethnicity, and genetic predisposition, as well as environmental factors such as socioeconomic status, tobacco use, attendance at daycare centers and recurrent respiratory infections. During the COVID-19 pandemic, strict measures led to a significant decline in the incidence of acute otitis media. However, infections with variants such as Omicron showed an increased rate of secretory otitis media. In the post-COVID phase, complication rates due to middle ear infections rose again, with prevalence returning to pre-lockdown levels. Preventive measures focus on ensuring adequate Eustachian tube function, treating allergies, and consistently administering pneumococcal vaccinations. In contrast, surgical treatment remains the gold standard for chronic middle ear infections and cholesteatoma. However, radical removal can be associated with high morbidity rates, underscoring the need for innovative approaches. These include optical coherence tomography (OCT) and minimally invasive laser surgery. Furthermore, new insights into the role of the immune system in the pathogenesis of both acute and chronic otitis media could open up new therapeutic possibilities for the future. This article discusses the current state of knowledge on the pathophysiological mechanisms, classification, diagnosis, and treatment of otitis media, as well as new treatment models and their implications.
To summarise how anti-tobacco mass media campaigns delivered via digital media are evaluated, including campaign characteristics, targeted populations, behavioural outcomes and exposure measurement strategies. Six databases (PubMed, Web of Science, Scopus, PsycINFO, Embase, Communication & Mass Media) were searched using tobacco-related, digital media-related and prevention-related terms. Articles were eligible if they were peer-reviewed, written in English, published between 2004 and 2025 and evaluated an anti-tobacco mass media campaign that used social media or web-based platforms and assessed a tobacco-related behaviour. Studies that exclusively assessed campaign awareness, knowledge or attitudes towards tobacco use were excluded. Two independent coders screened all titles and abstracts. Full texts were coded for campaign characteristics, exposure measurement and behavioural outcomes. The final sample included 21 studies with 236 915 participants. Most campaigns were conducted in the USA (n=16, 76.2%) and used national samples (n=17, 81.0%). Campaigns targeted adolescents (n=87 746, 45.2%) and young adults (n=83 683, 38.7%). Exposure was assessed using aided recall (n=12, 57.1%) and binary response formats (n=9, 42.9%). Across all studies, 37 statistical effects were reported; the most examined behavioural outcomes were past 30-day tobacco use (k=15, 40.5%) and quit intentions (k=12, 32.4%). Of these, 73.3% (k=11/15) and 75.0% (k=9/12) reported statistically significant improvements, respectively. Digital anti-tobacco mass media campaigns show promise in influencing tobacco-related behaviours. However, existing exposure measures in the evolving digital environment may limit the ability to accurately link campaign exposure to behavioural outcomes. Advances in exposure measures are needed.
Since the HPV vaccine's introduction in China, growing numbers of women have proactively vaccinated and shared their experiences and bodily sensations on social media, engaging in health-centered self-writing. Based on Foucault's theory of 'technologies of the self', this study views such practices as a digital-age form of reflection and subject formation. Through participatory observation and in-depth interviews with 26 participants, the study found that the technologies of the self have shifted from traditional private reflection to a platform-led co-creation, with digital media participating as 'co-authors' in individuals' self-writing. This has not only reconfigured the logic of writing personal health experiences and reflections but also constructed a highly homogenized self-identity, compressing the space for women to shape diverse ethical subjects. Although women use technologies of the self to resist patriarchal discipline and pursue self-awakening on social media, such expressions often fall into performative obedience to mainstream female discourses, such as 'self-love'. While actively shaping their subjectivity, they are constrained by platform power and group identity pressure, and continuously internalize new forms of discipline, forming an ethical subject that appears autonomous but is actually controlled. This study reveals the evolution of Foucault's 'technologies of the self' in the digital media field, emphasizes the contradictions, tensions, and complexities in the formation of ethical subjects under the influence of the logic of platforms, and provides new insights into the understanding of self-governance in the digital society.
Media messaging offers insight into the informational context that may shape the public's acceptance of xenotransplantation (XTx). The purpose of this study was to characterize the media's portrayal of the initiation of contemporary in-human XTx and assess both the accuracy and the ethical valence of XTx messaging. This study employed a summative qualitative content analysis of online print media coverage of the first contemporary experimental pig-to-human transplants in the United States. A comprehensive search of the 50 most-trafficked online news sources in the US was conducted for print articles pertaining to XTx published between July 13, 2021 and July 13, 2022. All articles in the sample were coded using qualitative data analysis software. Using a combined deductive and inductive approach to analysis, codes were grouped into topical categories representing patterns of meaning and subsequently interpreted into overarching themes. The search yielded 208 unique print-based articles. The top five most prevalent codes were "genetically modified," "reference to animal organ," "XTx rejection possibility," "novelty of the procedure," and "XTx as a 'success'/extending life." Code patterns were interpreted into the following overarching themes: (1) value judgments about XTx, (2) justifications for XTx, and (3) emphasis on technical details. Results suggest that media reporting on XTx during this time period frequently employed incomplete and hyperbolic narratives to support and justify XTx. As the field of XTx evolves with the initiation of human clinical trials, efforts to communicate accurate, balanced information to the general public should be prioritized.
Institutions shape ideas and bridge gaps between competing views, but their role in managing tensions within scientific communities is under-researched. This paper uses social cohesion and new institutionalism frameworks to explore conservative New Zealanders' perspectives that compete with dominant institutional scientific narratives. We conducted semi-structured interviews with conservative-leaning New Zealanders, enquiring about their perspectives on the politics and practice of science in Aotearoa New Zealand. We found a strong belief in the importance of science and a high regard for scientists, provided they maintain objectivity and challenge prevailing ideas, alongside concerns about institutional bias and outspoken scientists being cancelled by institutions. We discuss how these themes undermine social cohesion, with perceived institutional bias eroding vertical cohesion-trust between groups and institutions-and leading to the emergence of parallel alternative institutions that break horizontal cohesion-trust between groups in society.
Science-based experts have started to utilize social media to seek direct contact with audiences and social recognition for their expertise. Experts need to balance professional principles and the expectations arising from the changing media landscape. To understand how science-based experts navigate their way on social media, we utilize the concept of boundary work. We analyze how medical doctors enact and expand expertise on Instagram via boundary work in relation to publics, self, and markets. Using qualitative content analysis, we studied 2125 Instagram posts from the 20 most-followed doctors in Finland. Doctors enacted expertise by holding on to their epistemic authority, maintaining their professional role at the core of their posts, and avoiding advertising medical services. However, they expanded expertise by building relationships with their audiences, using anecdotes and personal experiences in their communication, and creating new communicational products for their audiences.
Marketing frames oral nicotine pouches (ONPs) as convenient, pleasurable and compatible with numerous activities without attracting the stigma sometimes associated with smoking or vaping. Regulation of ONPs varies considerably across countries, though tobacco companies have lobbied for their introduction as a harm-reduced alternative to smoking. Probing how young people perceive ONPs and integrate them into their daily lives should inform ONP regulation. We interviewed 25 young people aged 16-25 and living in Aotearoa New Zealand in late 2025. We recruited participants via social media, community advertising and snowball sampling and probed their awareness, use and perceptions of ONPs. We interpreted the data using reflexive thematic analysis. We identified three themes: ONPs' acceptability and versatility, discretion as an ambiguous attribute and risk calibration. High exposure to social media promotions embedded ONPs within young people's everyday activities, where they enhanced focus, offered pleasure without impinging on others and enabled nicotine consumption without creating a distinctive and stigmatising smoke, aerosol or smell. Product aesthetics and the absence of inhalation led participants to view ONPs as less harmful than smoking or vaping, though some noted oral health concerns and believed ONPs would increase nicotine product use. Sophisticated marketing has framed ONPs as flexible lifestyle accessories. While they may assist some people to stop smoking or vaping, they may also promote poly-use and attract new consumers. Until policy makers have robust independent evidence on safety and cessation efficacy, a precautionary regulatory approach is warranted.
Five billion individuals worldwide lack access to safe and affordable surgical care, a deficit disproportionately skewed toward low- and middle-income countries. Global surgery may be defined as "an area of study, research, practice, and advocacy" aiming to improve health outcomes for surgical patients. Universities play an important role in global surgical work in high-income countries. We aimed to determine the relevant knowledge, attitudes, and perspectives of medical students in Australia and Aotearoa New Zealand (ANZ). We surveyed senior medical students in ANZ medical schools (n = 24) from August to October 2022. Participants were recruited through university channels, social media, and snowball sampling. Participants completed questionnaires examining attitudes, exposures, and content knowledge relating to global surgery. A total of 851 eligible responses were analyzed. This included 189 of 851 (22.2%) participants with prior global surgery exposure, most commonly through student organizations (10.9%), and 686 of 851 (80.6%) participants believed global surgery to be relevant to medical students. Few participants (72 of 851; 8.5%) reported timetabled teaching of global surgery content, despite 494 of 741 (66.7%) supporting mandatory inclusion in medical school curricula. Preferred methods of global surgery exposure did not align with the methods received, and global surgery was infrequently reported in university curricula. Global surgery knowledge was limited and lower than that of students overseas. Despite this, participants indicated significant interest in global surgery teaching. ANZ medical students lack global surgery education and knowledge. Most global surgery education is delivered through nonacademic methods, including student societies and social media. Educators should consider these findings when planning medical school curricula.
Suicide is the second leading cause of death among young people aged 10-24 worldwide, yet identifying individuals at risk remains a major challenge. In Norway, suicide rates reached their highest level in 25 years in 2024, underscoring persistent knowledge gaps in national prevention efforts and the need for innovative, interdisciplinary, and supplementary approaches. There are no simple solutions to mental ill health or suicide, and no single factor can adequately explain such complex phenomena; however, it remains crucial to examine how interacting risk factors may increase vulnerability and whether artificial intelligence can help identify emerging risk windows earlier, thereby complementing conventional clinical approaches in this field. The current evidence base suggests a need for increased vigilance in several areas, particularly regarding Gen Z's digital lifestyle, exposure to shock-like societal events, and patterns of alcohol consumption, as these factors may interact in ways that elevate suicide risk. The rapid growth of social media use over the past decade have given both a Werther- and Papageno-effects, raising questions about both the positive effects of social media use and also whether certain patterns of social media engagement may contribute to suicide risk among vulnerable groups. Emerging evidence indicates that shock events in society and extreme media exposure may affect vulnerable individuals indirectly and without conscious awareness, thereby increasing short-term suicide risk. Research from Norway and other countries shows that traumatic events may trigger acute spikes in suicides, influence perinatal outcomes, and affect population-level health indicators such as sex ratios and infant mortality. These "triple-hit" patterns suggest that indirect exposure through media may be more consequential than previously assumed. Additionally, alcohol use may play a significant role in short-term risk escalation by increasing impulsivity, reducing cognitive control, and intensifying emotional distress. International studies show that alcohol use is significantly associated with increased suicidality, and in Norway approximately four in ten individuals who die by suicide have alcohol in their bloodstream at the time of death. Early-warning systems could thus benefit from integrating alcohol-related indicators. This position paper argues that three opportunities are particularly salient. First, the majority of primary studies within this area rely on conventional research designs and analytical approaches, with limited use of artificial intelligence-supported methods that could potentially enhance measurement precision, validity, and reliability in the analysis of complex digital behaviors. For example, AI-based linguistic analysis of social media content may help detect short-term "risk windows" associated with psychological distress, depression, and suicidality. Second, improved access to anonymized, high-quality platform data from technology companies could strengthen population-level monitoring and research. Third, actigraphy and AI integrated with wearable sensors and brief daily ecological momentary assessments (EMA) may capture subtle fluctuations in sleep, stress, heart rate, and activity-patterns that often precede clinical deterioration but may go unnoticed by patients, families, and clinicians. While international studies suggest that AI can enhance short-term risk detection, such systems must neither replace human contact nor override core principles of privacy, consent, and autonomy. Rather, AI should function as a complementary, real-time alert layer (symbiotic intelligence) capable of informing timely and tailored interventions within existing health services. Given current knowledge gaps and the rising impact of shock-related stressors, health authorities should consider piloting AI-supported early-warning systems that are tightly embedded in clinical pathways, e.g., through a new conceptual model presented in this paper. AI alone will not save lives, but small, ethically grounded steps may help identify individuals in rapidly escalating distress before it is too late.
"Sharenting," the practice of parents posting photographs, videos, and information about their children on social media, has an ever-growing presence in modern society. However, researchers and the public are now recognizing the potential consequences of sharing, including creation of permanent digital footprints, strained familial relationships, and threats to children's safety. Despite this emerging evidence, no U.S. clinical or legal guidelines exist for parents on safe sharing. Visits with behavioral health providers and family physicians can serve as key points for intervention. This column aims to provide clinicians with a better understanding of sharenting and its potential effects on patients and families, guidance on discussing safe online sharing, and a tool for parents and other caregivers to use when deciding whether to post.
The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported adverse events of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2024 for articles related to endoscopic submucosal dissection. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
The evolution of social movements in the age of datafication has challenged prevailing social movement theories. Contrary to scholarly forecasts, datafication empowered social movements by reducing the cost of participation and removing barriers to disseminating information, while also facilitating authoritarianism and imposing new constraints on movements' organizational dynamics and long-term impact. While literature reviews of the field suggest that these gaps have largely been overcome, little is known about how the field as a whole has evolved to address these questions. Using bibliometric tools to visualize and analyze a dataset of 6701 studies on social media and social movements published between 2005 and 2023, we identify the canonical literature, research approaches, and research methods used to study these developments. Our findings highlight a consistent scarcity in experimental research that isolates causal mechanisms, and we point to experimental work in related fields that could advance this line of research. We conclude by discussing opportunities for next-step research that emerge from our findings, including the use of big data analysis as well as qualitative and experimental studies to address unresolved questions about social movements in the age of datafication.
The morphology, reproduction, molecular phylogeny and chemical physiology of a new genus and species of thraustochytrid, Caledochytrium aldermanii gen. et sp. nov is described here. Caledochytrium aldermanii has, amongst its means of reproduction, a novel method not previously reported, in which a mature cell vacuolates and produces secondary cell(s) within the vacuole. Daughter cells are released by rupture of the mother cell. The daughter cell may already contain a tertiary cell within it. Caledochytrium aldermanii displays a range of dispersal mechanisms from sporangia, including unflagellated aplanospores moving on ectoplasmic nets, and ovoid spores with paired flagellae typical of thraustochytrids. In media cultures, pyriform spores with flagellae are also produced, as well as round, flagellated cells resembling gametes. In pollen cultures, some sporangia release an amoeba, which produces two aplanospores, which then divide further. The development of residual elements as thraustochytrid cells die is also described. The plasticity of growth and reproductive strategies in these thraustochytrids is discussed, together with their pathogenicity, which suggests the organism is an environmental saprotroph and an opportunist pathogen in the presence of stressed animal hosts. Initial investigations of compounds of commercial importance produced by C. aldermanii are also described.
Stillbirth has profound implications for parents and families, including trauma and prolonged grief. Research indicates that social support is pivotal for parents bereaved by perinatal loss. However, there is limited research considering women's experiences of informal online support following stillbirth loss specifically. This qualitative study aimed to explore the experiences of women living in Australia who engaged with informal online support following stillbirth. In-depth semi-structured interviews were conducted with 13 women aged 29 to 45 years (Mage = 34.46, SD = 4.67) who had engaged with informal online support following stillbirth. Through inductive and deductive thematic analysis, the researchers generated two key themes; 'It Takes a Village' and 'A Double-Edged Sword' and five sub-themes; 'Finding the Village', 'Grieving in the Village', 'Leaving the Village', 'Triggers and Challenges', and 'A Sense of Safety and Connection'. Interpreted through Worden's Task-Based Grief Model, informal online support was found to support bereaved mothers as they navigated stillbirth loss. Participants described the benefits of informal online support as they grappled with their new reality, expressed their grief, adjusted to life following loss, and developed enduring bonds. Despite challenges of triggering content and comparison, participants valued the perceived accessibility, safety, control, and connection provided by informal online support. Bereaved mothers requested warm referrals from health services to better facilitate timely access to online support. These findings have clinical implications for trauma-informed healthcare referral pathways, suggesting the need for targeted promotion of online resources to better support women bereaved by stillbirth.
Access to information has been identified as a social determinant of health, influencing knowledge, attitudes, and behaviors that can shape health outcomes. Contraceptive information influences how individuals make decisions about accessing contraceptive care and method use, as well as broader reproductive health trajectories. The recent proliferation of contraceptive misinformation has led to increased research and media attention on this topic. Misinformation from all types of information sources must be understood and addressed by the sexual and reproductive health, rights, and justice field to enable people to make informed, autonomous decisions about contraception based on high-quality, high-integrity evidence. This Research Practice Support aims to guide researchers interested in studying contraceptive misinformation. First, we define key terms related to the information environment and ecosystem, including misinformation, disinformation, and other related concepts. Then, we provide actionable recommendations for each stage of the research process for studies focused on contraceptive misinformation, including study design and ethical considerations, data sources and collection, and dissemination. Scholars are encouraged to consider these recommendations to maximize the impact of their research focused on contraceptive misinformation.
Early adoption of innovation is important for the implementation of evidence-based practices. Care of older adults using Age-Friendly practices optimizes the What Matters, Medication, Mobility, and Mentation (4Ms) framework. Within the first year of availability, over 1900 individuals acquired Age-Friendly pharmacist recognition. The purpose of this study is to characterize the demographics, preparedness, motivation, and professional association affiliation of pharmacists who received Age-Friendly recognition. A quantitative survey was administered to all participants as the last of four steps in Age-Friendly pharmacist recognition. The target population was Age-Friendly pharmacists who self-administer the online questionnaire. New practitioners (within 6 years of graduation) and pharmacists with 6+ (6+) years of practice were compared using descriptive statistics. Between March 2025 and February 2026, 1953 individuals received Age-Friendly Pharmacist recognition, 285 (15.4% of cohort) of whom were new practitioners with a mean age of 29.7 ± 4.4 years and 74.4% female. The 6+ group comprised 1567 (84.6% of cohort) pharmacists, mean age 45.3 ± 9.1 years, and 74.6% female. One quarter of new practitioners and 57.4% of the 6+ group were board-certified. Of those who were board-certified, 34% of new practitioners were board-certified in geriatrics and pharmacotherapy, whereas geriatrics certification was prevalent (82.2%) in the 6+ group. Improving the quality of care was the primary motivation to seek Age-Friendly recognition for both groups, followed by free continuing education, a digital badge, and advancing their skill set. New practitioners learned about Age-Friendly recognition from employers (46.7%), peers (39.1%), and social media (18.6%), whereas the 6+ group learned about Age-Friendly on the ASCP website (43.3%). For both groups, employers played an important role in disseminating information about and in supporting pharmacists to achieve Age-Friendly recognition. Highly qualified pharmacists were motivated to seek Age-Friendly recognition by a desire to improve the quality of care for older adults, free continuing education, a digital badge, and to advance their skill set.
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