Background Tobacco has significant cultural and spiritual uses in many Indigenous communities. The tobacco industry has long appropriated American Indian or Alaska Native (AI/AN or Indigenous) cultural imagery in print media and signage to advertise commercial tobacco products. In the internet era, little is known about the representation of commercial tobacco product advertising using AI/AN terms and images on social media. Methods With structured platform searches, custom data collection approaches and a combination of manual content analysis and natural language processing approaches (NLP), we identified and characterised content using the hashtag #TraditionalTobacco (specific to Indigenous contexts) on Instagram and Twitter. Results Using a combination of manual annotation and NLP, we identified prevalent themes and discussion topics, such as misrepresentation of traditional AI/AN uses of tobacco, appropriation of AI/AN imagery in retail advertising of tobacco and different uses for tobacco among North American Indigenous communities in 486 Instagram posts and 89 tweets. The representation of retail and recreational use of tobacco was more prevalent than traditional tobacco use on Instagram, a platform popular among youth and adolescents, while tobacco-related conversations on Twitter (X) primarily focused on debunking misconceptions about traditional tobacco use. Several tobacco retailers using AI/AN imagery in their advertising claimed to be affiliated with an AI/AN community, but we were unable to verify if these claims were authorised or legitimate. Conclusions Findings may inform the design of culturally appropriate tobacco cessation interventions among AI/AN youth and lead to greater regulation of commercial tobacco product advertising.
Objective Physician burnout threatens healthcare quality, safety, and sustainability. Identifying individual (e.g., lifestyle) and organizational (e.g., work environment, leadership) factors is critical for developing effective interventions. This study aimed to examine the factors associated with burnout among board-certified internists in Japan. Methods A nationwide cross-sectional survey was conducted from November 15 to December 31, 2024, among 3,320 internists on the Japanese Society of Internal Medicine mailing list; 353 responded (10.6%). Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which covers emotional exhaustion, depersonalization, and reduced personal accomplishment. The survey also captured professional, community, and personal factors. Results Among 316 complete responses, 17.1% (n=54) met the criteria for extreme burnout (high-risk thresholds in all domains), and 64.6% (n=204) met high-risk thresholds for emotional exhaustion and/or depersonalization. The risk factors included a high workload (OR 2.16, 95% CI 1.36-3.41), electronic health record burden (OR 1.42, 95% CI 1.11-1.83), and preoccupation with the past or future (OR 2.43, 95% CI 1.84-3.21). Protective factors included in-person social interaction (OR 0.58, 95% CI 0.39-0.87), supportive/respectful leadership from supervisors (OR 0.52, 95% CI 0.38-0.69), and perceived support from senior leadership (OR 0.60, 95% CI 0.47-0.78) and co-workers (OR 0.63, 95% CI 0.49-0.81). Conclusion Workload, psychological stress, and leadership quality strongly influence burnout among Japanese internists. Structural interventions that promote a supportive culture and relational well-being may help mitigate burnout.
AIM:This article provides a theoretical critique and policy innovation perspective on integrating generative artificial intelligence (AI) into nursing informatics. It draws on a 2023 nationwide survey in Japan and established models, including the technology acceptance model and risk perception frameworks, to examine AI's transformative potential and its challenges. BACKGROUND:Rapid AI evolution is reshaping healthcare by enhancing clinical decision-making and efficiency. Generative AI shows promise in improving patient outcomes, yet its integration into nursing practice raises ethical, educational, and regulatory concerns. Nursing informatics now requires robust governance, ethical oversight, and updated educational frameworks. SOURCES OF EVIDENCE:Evidence is derived from a 2023 survey by the Health and Global Policy Institute and a comprehensive literature review. Key studies (e.g., Nashwan et al. 2025; Booth et al. 2021) and foundational models (Davis 1989; Venkatesh et al. 2003) underpin the analysis. DISCUSSION:The findings suggest that while generative AI may enhance access to information and service quality, significant challenges-such as low digital literacy, liability issues, data accuracy, and privacy concerns-persist. A multidimensional strategy, incorporating targeted education, ethical governance, and continuous feedback from healthcare practitioners, is essential for effective integration. CONCLUSION:Generative AI holds transformative promise for nursing informatics. However, its successful adoption depends on balancing innovation with comprehensive regulatory and educational strategies to mitigate associated risks. IMPLICATIONS FOR NURSING PRACTICE AND POLICY:Enhancing digital literacy, establishing clear guidelines for liability and data security, and fostering international collaboration are critical to the safe and effective integration of AI in nursing practice.
Growing cannabis use has made it the most widely cultivated and trafficked illicit drug globally according to the World Health Organization, with 147 million people consuming cannabis-derived products (CDPs) in various product forms and constituency. Despite restrictions in certain countries, unregulated access can still be found on the dark web which specializes in trafficking of illicit goods. The objective was to systematically collect data from multiple marketplaces to identify types of cannabis products offered for sale. The study was conducted in three phases: (1) data mining transactions on dark web markets using cannabis and tobacco keywords; (2) inductive coding of selling-related characteristics; and (3) pricing analysis of one marketplace based on product type, shipping, and cannabis policy status. Four dark web markets (Archetyp, Incognito, Royal, and Wethenorth) yielded 2,954 selling posts. The top 3 products based on keyword searches included CDPs (n = 2629, 89%), illicit and prescription drugs (n = 223, 7.55%), and psychedelics (n = 102, 3.45%). For Archetyp listings, cannabis concentrates pricing had a statistically significant difference in average price p/mg when shipped from a country with a complete prohibition. The dark web represents an unregulated digital space where numerous CDPs are sold and shipped to various countries at different prices.
Abstract Given the female predominance of thyroid cancer, particularly in the reproductive age range, female sex hormones have been proposed as an etiology; however, previous epidemiological studies have shown conflicting results. We conducted a pooled analysis using individual data from nine prospective cohorts in the Asia Cohort Consortium to explore the association between 10 female reproductive and hormonal factors and thyroid cancer risk. Using Cox proportional hazards models, cohort-specific hazard ratios (HR) and 95% confidence intervals (CI) were estimated and then pooled using a random-effects model. Analyses were stratified by country, birth years, smoking status, and body mass index, and thyroid cancer risk based on age of diagnosis was also examined. Among 259,649 women followed up for a mean of 17.2 years, 1,353 incident thyroid cancer cases were identified, with 88% (n = 1,140) being papillary thyroid cancer. Older age at first delivery (≥26 vs. 21–25 years) was associated with increased thyroid cancer risk (P-trend = 0.003; HR = 1.16; 95% CI, 1.03–1.31), particularly when diagnosed later in life (≥55 vs. < 55 years; P-trend = 0.003; HR = 1.19; 95% CI, 1.02–1.39). Among younger birth cohorts, women with more number of deliveries showed an increased thyroid cancer risk [P-trend = 0.0001, HR = 2.40; 95% CI, 1.12–5.18 (≥5 vs. 1–2 children)], and there was no substantial trend in older cohorts. Distinct patterns were observed for the number of deliveries and thyroid cancer risk across countries, with a significant positive association for Korea [P-trend = 0.0008, HR = 1.89; 95% CI, 1.21–2.94 (≥5 vs. 1–2 children)] and nonsignificant inverse associations for China and Japan. Contextual and macrosocial changes in reproductive factors in Asian countries may influence thyroid cancer risk. Prevention Relevance: This analysis of prospective cohort studies across three Asian countries highlights that older age at first birth is linked to increased thyroid cancer risk. As women delay motherhood, understanding these trends is vital for public health strategies addressing reproductive factors influencing thyroid cancer risk in these populations.
