Conscious Bias in YouTube Video Evaluations: The Role of Gender and Attire on Effectiveness, Credibility, and Physiological Responses

Interest is growing in targeting physician attire to improve the patient experience. Few studies in ophthalmology have examined patient preferences for physician attire. To understand patient preferences for physician attire in ophthalmology practices in the United States. Survey-based, cohort study. Two private and two academic ophthalmology practices. A convenience sample of patients receiving ophthalmic care between June 1, 2015 and October 31, 2016. A questionnaire containing 22 questions and photographs of a male and female physician in seven forms of attire were presented to patients; 14 unique questionnaires were randomly distributed. Patient preference for physician attire was the primary outcome determined by summing ratings of how knowledgeable, trustworthy, caring, approachable, and comfortable the pictured physician made the respondent feel. One-way ANOVA assessed differences in mean composite scores. Comparisons between respondent demographics, practice type, and attire preferences were assessed by chi-square tests. Patient satisfaction was assessed by agreement with questions about importance of physician attire and whether this influences happiness with care. In total, 1,297 of 1,826 (71.0%) questionnaires were completed. Physician attire was rated as "important" by 62.9% of participants. A total of 43.6% of participants indicated that physician attire influenced how happy they were with their care. Overall, formal attire with white coat was preferred to casual, formal, and business attire (all comparisons, p < 0.05). No differences in composite scores between formal attire with white coat, scrubs alone, scrubs with white coat, or casual attire with white coat were observed. However, compared with formal attire with white coat, physicians wearing scrubs without white coat appeared less knowledgeable (mean [standard deviation]: 8.2 [1.8] vs. 7.4 [2.1]; p < 0.05) and trustworthy (8.3 [1.8] vs. 7.6 [2.1]; p < 0.05). Additionally, casual attire with white coat was rated as less knowledgeable compared with formal attire with white coat (7.4 [2.0] vs. 8.2 [1.8]; p < 0.05). Preferences for attire varied by clinical setting: patients preferred surgeons (45.2%) and physicians in emergency rooms (41.7%) in scrubs rather than formal attire with white coat. Physician attire is important to patients receiving ophthalmic care. Policies aimed at physician attire in ophthalmology practices should be considered.

BackgroundIn Ethiopia, physicians commonly wear formal attire, surgical scrubs, casual attire, or business attire during patient care, but there is no evidence to show which attire is preferred within the patients. So this study aims to assess the influence of physicians’ attire on patients’ perceptions.MethodologyAfter ethical approval, a cross-sectional study was conducted with written informed consent; data were collected and checked for its completeness, later entered into SPSS version 25 for statistical analysis. Descriptive statistics was presented with frequency, percentage, tables, graphs, and texts based on the nature of the data. All the four attires were compared using the Friedman test and pair wise comparisons were conducted with Bonferroni correction for multiple comparisons, and Mann–Whitney U-test was used to know the preferred attire on patients’ perception about physicians’ skill, with 95% confidence and a p-value of less than 0.05 were considered as statistically significant.ResultsIn this study, out of the total respondents 66.7% are males and 71.9%, 50.3% of the respondents were degree or diploma holders, and aged 18–34 years respectively. Among participants’ 77.1% and 55.9% preferred formal attire and surgical scrub respectively. For male surgeons, formal attire and surgical scrub have an equal preference in surgical patients (p<0.001), but business and casual attire have no statistically significant difference. The patients’ preference in male formal physician attire in surgeon’s confidence, willingness to discuss confidential information and safeties of the surgeon were 76.2%, 75.7%, and 70.5% respectively, and for female surgeons, formal attire on surgical patients’ confidence in the surgeon, safety, and willingness to discuss confidential information were 74.9%, 73.8%, and 71.8% respectively.ConclusionPhysician attire is one of the important factors that inspire surgical patient confidence, smartness, surgical skill, discussion of confidential information, and caring ability in physicians. Formal attire and surgical scrub were the most preferred physician’s outfits.

This randomized controlled trial aimed to compare the impact of a physician's attire on the perceptions of patients with cancer of compassion, professionalism, and physician preference. Our hypothesis was that patients would perceive the physician with formal attire as more compassionate than the physician wearing casual attire. One hundred five adult follow-up patients with advanced cancer were randomized to watch two standardized, 3-minute video vignettes with the same script, depicting a routine physician-patient clinic encounter. Videos included a physician in formal attire with tie and buttoned-up white coat and casual attire without a tie or white coat. Actors, patients, and investigators were all blinded to the purpose and videos watched, respectively. After each video, patients completed validated questionnaires rating their perception of physician compassion, professionalism, and their overall preference for the physician. There were no significant differences between formal and casual attire for compassion (median [interquartile range], 25 [10-31] vs. 20 [8-27]; p = .31) and professionalism (17 [13-21] vs. 18 [14-22]; p = .42). Thirty percent of patients preferred formal attire, 31% preferred casual attire, and 38% had no preference. Subgroup analysis did not show statistically significant differences among different cohorts of age, sex, marital status, and education level. Doctors' attire did not affect the perceptions of patients with cancer of physician's level of compassion and professionalism, nor did it influence the patients' preference for their doctor or their trust and confidence in the doctor's ability to provide care. There is a need for more studies in this area of communications skills. Clinical trial identification number. NCT03168763 IMPLICATIONS FOR PRACTICE: The significance of physician attire as a means of nonverbal communication has not been well characterized. It is an important element to consider, as patient preferences vary geographically, are influenced by cultural beliefs, and may vary based on particular care settings. Previous studies consisted of nonblinded surveys and found increasing confidence in physicians wearing a professional white coat. Unfortunately, there are no randomized controlled trials, to the authors' knowledge, to confirm the survey findings. In this randomized, blinded clinical trial the researchers found that physician's attire did not affect patients' perception of the physician's level of compassion and professionalism. Attire also did not influence the patients' preferences for their doctor or their trust and confidence in the doctor's ability to provide care.

39 Background: Environment is important component of communication skills. Physicians’ communication style including attire may influence patient perceptions. Previous studies mostly based on pictures of providers in different attires provide conflicting evidence. This RCT aimed to explore the effects of physician attire on patients’ perceptions of compassion, professionalism and physician preference. Hypothesis was that patients will perceive the doctor in formal attire as more compassionate than the doctor wearing casual attire. Methods: 105 English speaking adult follow-ups at outpatient supportive care center, were randomized to watch 2 standardized, 3-minute video vignettes, with similar script, depicting a routine clinic encounter. In one video, physician was wearing formal attire with tie and buttoned up white coat, while in the other, physician was in casual attire without a tie or white coat. Actors and patients were all blinded to purpose of the study. Investigators were blinded to the videos watched by patients. After viewing each video, patients completed validated questionnaires rating their perception of physician compassion (0 = best, 50 = worst) and professionalism (5 = poor, 25 = very good). Patients were also asked to rate their preference for the physician. Results: There were no significant differences between formal and casual attire for compassion [median (IQR), 25 (10, 31) vs 20 (8, 27); P = 0.31] and professionalism, [17 (13, 21) vs 18 (14, 22); P = 0.42]. 32 (30%) patients preferred formal, 33 (31%) preferred casual attire and 40 (38 %) patients had no preference. Subgroup analysis did not show significant differences among age, sex, marital status and education level for compassion, professionalism and physician preference. Conclusions: Doctor’s attire did not have an effect on patients’ perception of physicians’ level of compassion and professionalism. Dress code also did not influence the patients’ preference for their doctor or their trust and confidence in the doctor’s ability to provide care. There is need for more RCTs in area of communication skills specifically to better understand the impact of different attires on patient perceptions. Clinical trial information: NCT03168763.

Impact of Physician Attire on Palliative Care Patients’ Perception of Physician Compassion and Professionalism: A Randomized Clinical Trial (RCT) (S804)

As more individuals experience tinnitus, some researchers have labeled the condition a “global burden” (J Formos Med Assoc. 2016 Mar;115(3):139). As such, social awareness of the condition has spread, in no small part due to the internet and social media. About 75 percent of American adults use the internet, including various social media platforms, to learn about health conditions like tinnitus (PEW, 2014 https://pewrsr.ch/2FgioCJ). The World Health Organization has asserted the importance of modern social media platforms, particularly in their ability to provide more people with instant and easy access to health-related information (Bull World Health Organ. 2009 Aug;87(8):566). Social media also allow users to discuss health conditions (like tinnitus) and build relationships with others who share symptoms or experiences (Am J Audiol. 2017 Mar 1;26(1):1; J Neurosurg Pediatr. 2017 Aug;20(2):119). These virtual platforms can encourage communication about and management of disorders, thereby promoting confidence and empowerment.social media, tinnitus, online informationFigure 1: Patterns of social media usage and categories across platforms.Table 1: Descriptive Statistics of Overall, Management, Information Sharing, and Misinformation of YouTube VideosHowever, the lack of adequate gate-keeping mechanisms on social media may pose a threat to information accuracy. Misinformation can be particularly dangerous to people who are distressed by their condition, like tinnitus, and desperate to find an effective treatment (J Acad Librariansh. 2015;41:583). In fact, billions of dollars are spent each year on items marketed online as “tinnitus cures” (Otol Neurotol. 2016 Aug;37(7):991). If tinnitus-related information posted online is systematically analyzed, audiologists and other hearing health care professionals can be better equipped to correct possible patient misinformation. As such, this study assessed the prevalence, quality, and trends of tinnitus-related information across three popular social media platforms: Facebook, Twitter, and YouTube (AJA. 2018. doi:10.1044/2018_AJA-18-0033). METHOD The study was approved by the Institutional Review Board of Hofstra University. A comprehensive evaluation of three social media platforms was performed by searching the keywords ”tinnitus” and “ringing in the ears” on Facebook (pages and groups), Twitter (accounts), and YouTube (videos). These platforms were selected based on present popularity and ease of quantifiable data (PEW, 2018 https://pewrsr.ch/2FkijOg). Search results were examined by two reviewers and included in the investigation only if they were in English, contained the keyword “tinnitus” within the title and/or description, and relevant to the audiological condition of tinnitus. Included items also had to meet the following criteria: 10 or more “likes” and five or more posts for Facebook pages; 10 or more members for Facebook groups; 10 or more followers and five or more tweets for Twitter accounts; and 100 or more views for YouTube videos. Public and closed Facebook groups were included and categorized based on page description. Among the studied YouTube videos, the first 100 that came up by each sorting option (i.e., relevance, view count, and rating) were assessed. The results for each platform were quantified based on various social media metrics, including likes, members, followers, and views. All results were sorted into the following categories based on primary functionality: (1) fundraising, (2) information sharing, (3) misinformation, (4) personal story, (5) promotion of a product, (6) service provider/institution, and (7) support group. Two additional categories were created for YouTube: (8) tinnitus assessment, and (9) tinnitus management. It should be noted that the authors defined misinformation as any shared information that is currently considered untrue (e.g., miracle pills), lacking peer-reviewed evidence (e.g., acupuncture), or uninvestigated at the time of the study. RESULTS Of the 1,459 search result items that were assessed, 624 met the inclusion criteria (49.2% Facebook pages, 36.5% YouTube videos, 8.4% Twitter accounts, and 5.9% Facebook groups). Figure 1 shows the breakdown of the different information categories in each of the studied social media platform. The highest levels of activity within the tinnitus community were found on Facebook pages (n = 307), which amassed a total of 214,184 likes and a mean of 701 likes. The most prevalent categories were misinformation (42.7% of pages; 75,581 total likes; 577 mean likes), service provider (27.4% of pages; 45,749 total likes; 545 mean likes), and information sharing (14.7% of pages; 33,080 total likes; 735 mean likes). A total of 37 Facebook groups were included in the study, totaling 45,664 members and a mean of 1,234 members. Of these, nine groups were public and 28 were closed. Public groups totaled 712 members (mean = 79) and the two most common categories were misinformation (44.44% of public groups; 123 total members; 30.75 mean members) and support group (33.3% of public groups; 360 total members; 120 mean members). Closed groups amassed 44,952 members (mean = 1,605). The three most common categories were support group (67.85% of closed groups; 38,266 total members; 2,014 mean members), information sharing (14.29% of closed groups; 4,433 total members; 1,108 mean members), and service provider (10.71% of closed groups; 2,206 total members; 735 mean members). For YouTube, 228 videos were examined after removing irrelevant and overlapping videos across sorting options. These videos amassed a total of 41,296,486 views, 170,707 likes, 15,479 dislikes, and 31,798 comments, and had a total duration of 340:29:12 (hh:mm:ss). Video upload dates ranged from July 2006 to July 2017 (when data collection took place) and duration ranged from 00:00:07 to 13:31:19. The three most common categories of videos were management, information sharing, and misinformation. The amount of misinformation varied by sorting option, with the most misinformation found when sorting by relevance (30.9%) and the least when sorting by rating (15.9%). Results for YouTube videos are summarized in Table 1. Fifty-two tinnitus-related Twitter accounts were analyzed. These accounts had a total of 155,167 followers (mean = 2,984) and produced a total of 33,932 tweets (mean = 6,499). The three most common categories were misinformation (34.6% of accounts; 28,042 total followers, 1,558 mean followers), service provider (25% of accounts; 96,959 total followers; 7,458 mean followers), and information sharing (25% of accounts; 23,376 total followers; 1,798 mean followers). Overall, the studied information varied in authenticity. Social media users who search for tinnitus-related information can get information about the condition, locate medical professionals, find peer support, and advocate for increased awareness of tinnitus. DISCUSSION The findings of this study suggest that social media platforms offer a multitude of tinnitus-related information that can help affected individuals cope with the condition. The highest rates of activity were found on Facebook, which is currently the world's most utilized social media platform (J Neurosurg Pediatr. 2017). YouTube was a unique platform in that tinnitus management videos (the most popular category) offered potential self-help and “do-it-yourself” relief options. Additionally, the study authors noted that some of the most pertinent and accurate videos resulted when sorting YouTube videos by rating, rather than YouTube's default sorting option of relevance. Substantial amounts of misinformation were found throughout all investigated platforms. Of the six social media metrics assessed, five had misinformation as one of the top categories. Although not all misinformation was spread maliciously, it became clear that social media may attract those with malevolent intentions. For example, several products and supplements were found across platforms that marketed themselves as tinnitus cures, some being sold for hundreds of dollars each. Many of these products have been clinically investigated and determined to offer no benefits besides a possible placebo effect (J Am Acad Audiol. 2014 Jan;25(1):106). Further investigation is needed to determine how to flag search results or products promoting misinformation on social media. This study had some limitations, many of which are unavoidable and inherent to social media, including potentially targeting search results based on IP addresses and personal accounts, the evolving nature of social media, and the possibility that the keywords searched may not have been all-inclusive. Future investigations should consider assessing micro-level trends in social media use and the susceptibility of the tinnitus community to online misinformation. Nonetheless, the results of this study can help audiologists and other hearing health professionals understand the current online portrayal of tinnitus. Clinicians should be prepared to combat the significant online tinnitus-related misinformation and offer patients correct information to help them effectively manage their condition.

Introduction Media and gender are intricately linked in our society. Every day we see representations of women and men on the screen, read about politicians in the press, watch influencers on YouTube or go to the cinema where we meet screen heroes. Our images and notions of gender draw on these media narratives and role models. Children and young people are socialised with these views and cultivate their own identity and gender roles accordingly. Ideas of gender are not static. They are produced discursively in an ongoing process. Gender is understood as a social category, and this perspective is interwoven with an observation of people’s social behaviour, their “doing gender” (West and Zimmerman). From a social constructivist, the focus lies on the production processes connected with the construction of gender representations through the media. The question of how masculinity and femininity, concepts of “being a man” or “being a woman”, represented on a platform such as YouTube become relevant. Our research interest lies exactly in this: How gender inclusive is the video platform YouTube? Are male and female representations equally visible—or do we find exclusion mechanisms that hinder this? Literature Review Europe-wide studies show that children and adolescents are online for an average of 2.4 hours a day (Hasebrink et al.). Eighty-seven per cent of young people report watching videos (e.g. on YouTube) at least once a week (ibid., 11). This applies for Germany as well (MPFS). Considering the relevance YouTube has for adolescents, the question arises as to which role models are portrayed through YouTube and how diverse the representations of gender are depicted there. Initial analyses, primarily for the English-language YouTube platform, see its potential to counteract gender stereotypes (Maloney et al.), but generally show an unequal visibility of the genders on YouTube. These studies find that women are underrepresented, receive more hostile feedback and present themselves in stereotypical forms (Wotanis and McMillan; Döring; Molyneaux et al.). Döring and Mohseni showed in their current nine-country comparative analysis that men dominate the popular YouTube across countries and women are more likely to give up after hostility. The existing research usually examined the English-language, mainly US YouTube, it analysed gender performance, stereotypes in selected genres such as advertising or gaming, the stigmatisation of obesity, the representation and experiences of black women on YouTube, and the staging of alternative images of masculinity (see Hussin et al.; Kataria and Pandey; Wotanis and McMillan; Casabianca; Maloney et al.; Sobande). Molyneaux et al. noted in their landmark study gender-specific differences: female YouTubers tend to focus on private matters and interact more frequently with their users. Male YouTubers, on the other hand, share opinions and information and avoid emotions (Pedersen and Macafee). In addition, female vloggers are more often criticised for their appearance than for the content of their videos (Molyneaux et al.). Even though YouTube is an international medium, its use remains limited to language and nation. For example, the most popular YouTube stars among German children and young people are predominantly German-speaking influencers or sportsmen and women. In 2019, girls between the ages of 6 and 13 most often name Bibi, Dagi Bee, Shirin David, Lisa &amp; Lena, and Miley; boys at the same age Julien Bam, Gronkh, Die Lochis, LeFloid and Manuel Neuer (IZI). All these are German YouTube or sports stars. YouTube itself shows in its recommendations under the heading “most popular videos in Germany” exclusively German-language videos, music videos, or sporting events (YouTube). Therefore, YouTube also needs to be examined in national contexts, as well as in cross-national context. Our study will focus on the national German context to examine whether there are similar gender differences in the German-speaking YouTube as have been identified for the English-speaking YouTube. For German-speaking YouTube, few studies are available. Döring and Mohseni examined male and female operators of the top 100 YouTube channels in nine different countries. The results show that women make up 25 per cent of the top 100 German YouTube channel operators, a distribution which is similarly uneven in other countries. Usage data shows that the German-speaking YouTube appears to have a greater relevance among boys than girls. Boys (93%) use YouTube more often on a regular basis, than girls (86%), and rank it higher as their favourite app (MPFS). Other than for traditional media such as television or film, where intensive research has for decades shown a wide gender gap in the visibility of women (Prommer and Linke; Linke and Prommer), research on German-speaking YouTube is rare (Döring and Mohseni). Hypotheses In reflection of the research outlined above on representations of gender in media and the stereotypical portrayals of men and women in film and television, we assume that these gender role depictions are carried over into online videos on social media platforms. The fact that girls use YouTube somewhat less often, consider themselves less competent in the necessary Internet skills, and anticipate greater risks related to communicative aspects suggests that female operators might have been held back and that the female perspective might be marginalised in public (self-)portrayals. The following hypotheses will therefore guide our study: H1: Fewer women are channel operators of Germany’s most popular YouTube channels, and they are more limited in their choice of genres. H2: Women are less visible than men in popular YouTube videos. H3: Women portray themselves more often as connected to stereotypically female topics or are depicted as such in videos. H4: Men stage themselves as professionals. Methods and Sample Following these hypotheses, we conducted a two-step research. The first research step was to analyse to what extent women and men produce popular content. For this, we looked at the ratio of female to male YouTubers among the 1,000 most successful German channels. These YouTubers are called either creators or channel operators by the industry. Both terms are used synonymously here. To identify the most popular YouTube channels, we acquired the viewing and ranking data from the market research company Social Blade, which is one of the very few sources for these data. We measured the popularity of the channels by the number of subscribers to a channel. The success of individual videos was measured by individual views. We coded the 1,000 most successful German YouTube channels, with a standardised quantitative content analysis. This method is frequently applied in existing studies on gender representations in YouTube (Döring; Döring and Mohensi). Different to existing research, we looked at a larger number of channels. This quantified analysis was combined with a more qualitative, but still standardised analysis of visibility of gender and concrete content and presentation forms (Prommer and Linke). For the second step we used the Audio-Visual Character Analysis (ACIS) developed by Prommer and Linke as a method that is able to code any audio-visual content in order to describe visibility and diversity of the depicted people. Here, the analysis considered the individual video as the unit of analysis. For 20 videos from each of the top 100 YouTube creators, we chose the 10 of most recent videos plus the 10 videos with the most views to be analysed. In total, 2,000 videos were analysed. For the qualitative analysis, looking at the visibility of gender, we excluded channels operated by institutions, such as radio and TV broadcasters, music labels, and other commercial entities. These were not considered since there is no individual person responsible. We also excluded “Let’s Play” videos, since these often do not show the operator, but only show game play from video games. Results H1: Fewer women are operators of Germany’s most popular YouTube channels, and they are more limited in their choice of genres. As the analyses show, if the non-individual channel operators are included in the statistics, we see that 27 per cent of the top popular channels in Germany are hosted by institutions (270); this leaves 172 channels operated by women (17%), 525 channels by men (53%), and 25 (3%) by mixed-gender teams. Further on, we will only consider the top 1,000 channels produced by one or more individuals; of these, one quarter (24%) of channel operators are female (fig. 1). This shows that, for every channel in the list produced by a woman, three are produced by men. Only three per cent of the channels are produced by men and women together, constituting a mixed-gender team. The YouTube genres, according to the YouTube classification, also show significant gender differences. Women can be seen first and foremost in tutorial channels (women: 61; men: 9). However, because only 24 per cent of channels in which an individual operator could be identified are contributed by women, all other genres except for tutorial channels are produced disproportionally more often by men. Gaming videos are solid male territory, as almost all "Let’s Play" channels are operated by men (women: 6; men: 150). Here, there are 25 men for every one woman who operates a gaming channel. This is particularly remarkable, as women make up 46 per cent of gamers (ISFE), and their underrepresentation can generally not be explained by lack of interest. Men operate channels in a wide variety of other genres, such as music (women: 9; men: 80) and sports (women: 4; men: 20). The genres of comedy, film, and education show only one female operator each—outnumbered from 10 to 1 to as much as 20 to 1. Examining the statistics for men and women separately reveals that men do not only operate the majority of the top 1,000 channels, but they

BackgroundLargely absent from research on how users appraise the credibility of professionals as sources for the information they find on social media is work investigating factors shaping credibility within a specific profession, such as physicians.ObjectiveWe address debates about how physicians can show their credibility on social media depending on whether they employ a formal or casual appearance in their profile picture. Using prominence-interpretation theory, we posit that formal appearance will affect perceived credibility based on users' social context—specifically, whether they have a regular health care provider.MethodsFor this experiment, we recruited 205 social media users using Amazon Mechanical Turk. We asked participants if they had a regular health care provider and then randomly assigned them to read 1 of 3 Twitter posts that varied only in the profile picture of the physician offering health advice. Next, we tasked participants with assessing the credibility of the physician and their likelihood of engaging with the tweet and the physician on Twitter. We used path analysis to assess whether participants having a regular health care provider impacted how the profile picture affected their ratings of the physician’s credibility and their likelihood to engage with the tweet and physician on Twitter.ResultsWe found that the profile picture of a physician posting health advice in either formal or casual attire did not elicit significant differences in credibility, with ratings comparable to those having no profile image. Among participants assigned the formal appearance condition, those with a regular provider rated the physician higher on a credibility than those without, which led to stronger intentions to engage with the tweet and physician.ConclusionsThe findings add to existing research by showing how the social context of information seeking on social media shapes the credibility of a given professional. Practical implications for professionals engaging with the public on social media and combating false information include moving past debates about casual versus formal appearances and toward identifying ways to segment audiences based on factors like their backgrounds (eg, experiences with health care providers).

Empirical research has highlighted the persistence of gender bias over centuries despite the global initiatives to promote gender equality and remove gender bias in various spheres including education. The contents of educational materials like textbooks can exert a crucial role in shaping and reinforcing the learners’ views and perceptions especially about gender roles. Addressing gender bias in textbooks is necessary in fostering a more equitable educational environment equitable, hence, promoting equitable society for future generations. The present study examined gender bias in three ELT Indonesian textbooks for three levels of education (When English Rings a Bell for Grade VII, When English Rings a Bell for Grade VIII, and Think Globally and Act Locally for Grade IX). Specifically, it investigated the distribution, types and the representation of gender bias in these textbooks. It employed both quantitative and qualitative methods of analysis to provide a more comprehensive outcomes on the gender bias presented in the textbooks. The findings indicate that gender bias is present in the three textbooks despite the urge by the Directorate General of Legislation and Regulations (2016) that textbooks must be devoid of gender stereotypes, bias, and discrimination. The portrayal of gender in the textbooks reinforces stereotype social constructs where men are depicted in leading and active roles, while women are usually shown in passive or secondary positions. This can affect the learners’ conscious and subconscious views on their own attitude, career choice and social behaviour. To develop educational materials that are free of gender-based stereotypes and reflect balanced representations of both genders, concerted effort from policy makers, educators, authors and publishers are important.

BackgroundAdolescence is a critical period for development, and health risk behaviors at this stage can have lasting physical and mental health consequences. While previous studies have examined social media’s role in adolescent behavior, they often overlook the specific impact of positive feedback and the underlying psychological mechanisms. This study addresses this gap by exploring the influence of social media positive feedback on adolescents’ health risk behaviors and analyzing the mediating roles of cognitive bias and negative emotions.MethodsA cross-sectional survey design was adopted for this study, and data were collected from 6210 adolescents. The Health Risk Behavior Scale, Social Media Positive Feedback Scale, Negative Cognitive Processing Bias Questionnaire, and DASS-21 Scale were used for assessment. Structural Equation Modeling (SEM) was employed to examine both the direct and indirect effects of social media positive feedback on adolescents’ health risk behaviors and to explore the mediating roles of cognitive bias and emotions.ResultsPositive feedback on social media, adolescents’ health risk behaviors, cognitive bias, and negative emotions were all found to be significantly positively correlated. The analysis indicated that social media positive feedback was associated with adolescents’ health risk behaviors both directly and indirectly through cognitive bias and negative emotions. Furthermore, cognitive bias and negative emotions acted as chain mediators in the relationship between social media positive feedback and health risk behaviors.ConclusionsThis study found that social media positive feedback was significantly associated with adolescents’ health risk behaviors, and cognitive bias and emotional states play a mediating role in this influence. These findings highlight the potential role of social media in influencing adolescents’ risk behaviors and suggest that public health interventions should focus on the impact of the social media environment on adolescents’ behaviors. Interventions that improve emotional regulation and reduce cognitive biases may help decrease the occurrence of health risk behaviors.

Previous work has established that physician attire influences patients' perceptions of their physicians. However, research from different specialties has disagreed regarding what kinds of physician attire might result in increased trust and confidence on the part of patients. The purpose of this study was to investigate how surgeon attire affects patients' perceptions of trust and confidence in an urban orthopaedic outpatient setting. Eighty-five of 100 patients solicited completed a three-part questionnaire in the outpatient orthopaedic clinic at an urban teaching hospital. In the first section, participants viewed eight images, four of a male surgeon and four of a female surgeon wearing a white coat over formal attire, scrubs, business attire, and casual attire, and rated each image on a five-level Likert scale. Participants were asked how confident, trustworthy, safe, caring, and smart the surgeon appeared, how well the surgery would go, and how willing they would be to discuss personal information with the pictured surgeon. The participant ranked all images from most to least confident in the second part and the last section obtained demographic information from the patients. Surveys were scored using a five-level Likert scale and a Friedman test was used to detect statistical significance when comparing all attires. For multiple pairwise comparisons, a Bonferroni correction was applied. The white coat on the male surgeon elicited modestly higher ratings in confidence (mean difference [MD], 0.367±0.737; 95% CI, 0.202-0.532; p < 0.001), intelligence (MD, 0.216 ± 0.603; 95% CI, 0.077-0.356; p = 0.027), surgical skill (MD, 0.325 ± 0.658; 95% CI, 0.175-0.474; p < 0.001), trust (MD, 0.312 ± 0.613; 95% CI, 0.173-0.451; p < 0.001), ability to discuss confidential information (MD, 0.253 ± 0.742; 95% CI, 0.087-0.419; p = 0.023), caring (MD, 0.279 ± 0.655; 95% CI, 0.124-0.432; p = 0.006), and safety (MD, 0.260 ± 0.594; 95% CI, 0.125-0.395; p = 0.002) compared with business attire. Similarly, the white coat was preferred to casual attire in all categories (confidence: MD, 0.810 ± 0.921; smart: MD, 0.493 ± 0.801; surgical skill: MD, 0.640 ± 0.880; ability to discuss: MD, 0.564 ± 0.988; trust: MD, 0.545 ± 0.836; safety: MD, 0.581 ± 0.860; caring: MD, 0.479 ± 0.852; p < 0.001 for all comparisons). For the female surgeon, white coat and scrubs were not different, however the white coat was preferred to business attire in four of seven categories. Casual clothing was widely disliked in all categories for surgeons (men and women). When attire was compared for confidence on a scale, the white coat ranked higher than business (MD, 0.439 ± 1.491; p = 0.006) and casual attire (MD, 1.043 ± 2.054; p < 0.001), but not scrubs (MD, 0.169 ± 1.230; p = 1.000). In this urban outpatient orthopaedic practice, patients' preferences varied based on the sex of the pictured surgeon in the survey. Overall, however, modest preferences were observed for the white coat in terms of confidence, intelligence, trust, and safety. Furthermore patients are more willing to discuss personal information and believe that their surgery will go better if the surgeon wears a white coat or scrubs. These results are consistent with those of several studies in other settings and therefore may be generalizable in other locations and specialties. Given the increasing awareness and concern for physician-spread hospital infection, this study lends support to scrub attire over business or casual attire if physicians do not wear a white coat. Level II, therapeutic study.

Navigating Social Media in #Ophthalmology

(391) Comparative Analysis of YouTube and TikTok Videos on Treatments for Low Testosterone

The “Buzz” About Tinnitus: A Social Media Study

Introduction Gender and gender role pain expectations may influence how health care providers interact with and manage their patients’ symptoms. Purpose The purpose of this study was to describe gendered traits and gender role pain expectations among physical therapy students. Method A survey assessing gendered traits and gender role expectations in relation to pain was completed by a sample of 171 physical therapy students (120 women, 51 men). Data were analyzed using descriptive statistics and differences between men and women were tested with chi-square or Kruskal-Wallis. Results Men and women in physical therapy training were not different on 13 out of 16 of the gendered traits. The exceptions were that men rated themselves as more “decisive” compared to women (mean rank = 103.8 vs. mean rank = 78.4, P = 0.001) and women rated themselves as more “emotional” (mean rank = 91.95 vs. mean rank = 72.01, P = 0.009) and more “nurturing” (mean rank = 90.89 vs. mean rank = 72.91, P = 0.020). No significant differences were found in terms of gendered expectations of pain sensitivity, endurance, or in terms of personal experience of pain between the men and women in the sample. However, the majority (75%) of participants reported that women were more willing to report pain compared to men. Finally, both groups rated themselves as no different in handling pain compared to a typical man or woman. Conclusion In conclusion, men and women in training to be physical therapists demonstrate similar gendered trait profiles and little gender bias in relation to pain expectations.