BACKGROUND: Lung cancer, a major global health concern, disproportionately impacts low socioeconomic status (SES) patients, who face suboptimal care and reduced survival. This study aimed to evaluate the prognostic performance of traditional Cox proportional hazards (CoxPH) regression and machine learning models, specifically Decision Tree (DT), Random Forest (RF), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost), in patients with advanced lung cancer with low SES.
METHODS: A retrospective study.
METHODS: The 949 patients with advanced lung cancer with low SES who entered the hospice ward of a tertiary hospital in Wuhan, China, from January 2012 to December 2021 were randomized into training and testing groups in a 3:1 ratio. CoxPH regression methods and four machine learning algorithms (DT, RF, SVM, and XGBoost) were used to construct prognostic risk prediction models.
RESULTS: The CoxPH regression-based nomogram demonstrated reliable predictive accuracy for survival at 60, 90, and 120 days. Among the machine learning models, XGBoost showed the best performance, whereas RF had the lowest accuracy at 60 days, DT at 90 days, and SVM at 120 days. Key predictors across all models included Karnofsky Performance Status (KPS) score, quality of life (QOL) score, and cough symptoms.
CONCLUSIONS: CoxPH, DT, RF, SVM, and XGBoost models are effective in predicting mortality risk over 60-120 days in patients with advanced lung cancer with low SES. Monitoring KPS, QOL, and cough symptoms is crucial for identifying high-risk patients who may require intensified care. Clinicians should select models tailored to individual patient needs and preferences due to varying prediction accuracies.
UNASSIGNED: This study was reported in strict compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.
UNASSIGNED: No patient or public contribution.

OBJECTIVE: To explore the experiences, expectations and needs of mothers from low socioeconomic status at 3 months postpartum.
METHODS: Descriptive qualitative.
METHODS: Mothers aged 21 years old and above, from low socioeconomic status (monthly household income is less than Singapore Dollar [SGD] $4300), and irrespective of their parity were invited to participate in one-to-one in-depth interviews at 3 months postpartum from September 2022 to June 2023. A semistructured guide was used in the interviews, which were conducted until data saturation. A trained researcher conducted the interviews that were audio recorded, transcribed verbatim and analysed thematically. Written informed consent was obtained and voluntary participation was reinforced.
RESULTS: Twenty mothers participated in this study and four themes were identified: (1) difficult trade-offs; (2) help-seeking behaviours and (3) \'But if?\' Concerns about Emergencies.
CONCLUSIONS: This study explored the difficult circumstances that mothers from low socioeconomic status face in their third month postpartum, and how wider societal inequalities exacerbated these circumstances. Current policies and practices need to be relooked, reframed, and reformed to address the unique needs of this community.
CONCLUSIONS: Nurses should keep mothers\' struggles in balancing employment and childcare in consideration and explore other ways of supporting the low socioeconomic status mothers such as online modes in providing patient education and peer support.
CONCLUSIONS: Mothers from low socioeconomic status are less likely to seek formal help from healthcare professionals, external organizations and the government. These mothers need flexible, affordable and accessible childcare options to return to work. More targeted family-oriented policies that create empowering and understanding workplaces in Singapore could help ease the stress on mothers returning to employment postpartum. Online peer support groups consisting of mothers of similar socioeconomic backgrounds could help engage and retain this hard-to-reach yet vulnerable population.
UNASSIGNED: COREQ checklist.
UNASSIGNED: No patient or public contribution.

OBJECTIVE: To explore the factors influencing help-seeking behaviours amongst mothers with low socioeconomic status at pregnancy, 1 month postpartum and 3 months postpartum.
METHODS: A prospective cohort study was conducted from September 2022 to August 2023. A total of 209 mothers aged 21 years and above, with low socioeconomic status and irrespective of parity, were recruited from a local hospital using convenience sampling. Self-administered questionnaires were used to collect data at (1) third trimester of pregnancy, (2) 1 month postpartum and (3) 3 months postpartum. Multiple regression analysis was used to identify significant factors influencing help-seeking behaviour at 3 months postpartum. Sub-analyses were conducted between primiparous mothers and multiparous mothers. General linear model repeated measures were used to identify longitudinal trends in outcomes of help-seeking behaviour.
RESULTS: Help-seeking behaviour at pregnancy and 1 month postpartum, sources of social support at 3 months postpartum, birth order of the child, attendance of antenatal classes, paternal involvement in feeding and changing diapers and mode of delivery significantly predicted mothers\' help-seeking behaviour at 3 months postpartum. Amongst primiparous mothers, help-seeking behaviour at pregnancy at 1 month, social support at 3 months postpartum, employment in part-time jobs and exclusively breastfeeding their infant were significant factors in influencing their help-seeking behaviours at 3 months postpartum. For multiparous mothers, help-seeking behaviour at pregnancy and 1 month postpartum, number of hours of antenatal class attended, Malay ethnicity, educational background, parental satisfaction at 3 months postpartum and infant bonding at both time points were significant factors influencing their help-seeking behaviours at 3 months postpartum.
CONCLUSIONS: Primiparous mothers with low socioeconomic status who underwent caesarean section exhibited less help-seeking behaviours. Attendance of antenatal classes and greater paternal involvement in infant care encouraged mothers with low socioeconomic status to help-seeking behaviours. A tailored approach is needed to support mothers with low socioeconomic status by providing additional support in improving the accessibility of antenatal classes and involving fathers in infant care.
CONCLUSIONS: What Problem Did the Study Address? Mothers with low socioeconomic status tend to exhibit lower help-seeking behaviours due to limited support and access to care services. What Were the Main Findings? First-time mothers who underwent caesarean section, did not attend antenatal classes, and had husbands uninvolved in feeding and diaper changing were significantly less likely to seek help in the third month postpartum. One and 3 months postpartum are crucial time points when mothers with low socioeconomic status could benefit from additional support. Hospitals should explore online informational resources, forums, teleconsultations and virtual antenatal classes as possible alternative options to improve accessibility for mothers with low socioeconomic status. Where and on Whom Will the Research Have an Impact? Mothers with low socioeconomic status and healthcare providers of mothers with low socioeconomic status will benefit from the findings of this research. This study was conducted within the Singapore context. Findings could be generalizable to other cultural contexts with similar multi-ethnic populations.
UNASSIGNED: STROBE checklist.
UNASSIGNED: No patient or public contribution.

Nonalcoholic fatty liver disease (NAFLD) and periodontitis share common risk factors such as obesity, insulin resistance (IR), and dyslipidemia, which contribute to systemic inflammation. It has been suggested that a bidirectional relationship exists between NAFLD and periodontitis, indicating that one condition may exacerbate the other. NAFLD is characterized by excessive fat deposition in the liver and is associated with low-grade chronic inflammation. There are several risk factors for the development of NAFLD, including gender, geriatric community, race, ethnicity, poor sleep quality and sleep deprivation, physical activity, nutritional status, dysbiosis gut microbiota, increased oxidative stress, overweight, obesity, higher body mass index (BMI), IR, type 2 diabetes mellitus (T2DM), metabolic syndrome (MetS), dyslipidemia (hypercholesterolemia), and sarcopenia (decreased skeletal muscle mass). This systemic inflammation can contribute to the progression of periodontitis by impairing immune responses and exacerbating the inflammatory processes in the periodontal tissues. Furthermore, individuals with NAFLD often exhibit altered lipid metabolism, which may affect oral microbiota composition, leading to dysbiosis and increased susceptibility to periodontal disease. Conversely, periodontitis has been linked to the progression of NAFLD through mechanisms involving systemic inflammation and oxidative stress. Chronic periodontal inflammation can release pro-inflammatory cytokines and bacterial toxins into the bloodstream, contributing to liver inflammation and exacerbating hepatic steatosis. Moreover, periodontitis-induced oxidative stress may promote hepatic lipid accumulation and IR, further aggravating NAFLD. The interplay between NAFLD and periodontitis underscores the importance of comprehensive management strategies targeting both conditions. Lifestyle modifications such as regular exercise, a healthy diet, and proper oral hygiene practices are crucial for preventing and managing these interconnected diseases. Additionally, interdisciplinary collaboration between hepatologists and periodontists is essential for optimizing patient care and improving outcomes in individuals with NAFLD and periodontitis.

Disadvantaged schoolchildren from rural and low socioeconomic backgrounds face persistent oral health inequalities, specifically dental caries, and periodontal diseases. This protocol aims to review the effectiveness of promotive and preventive oral health interventions for improving the oral health of primary schoolchildren in these areas. We will search the PubMed, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost, Cochrane Library, Web of Science, Dentistry and Oral Sciences databases for studies published from 2000-2023. The review includes randomised/nonrandomised controlled trials and community trials evaluating the effectiveness of promotive and preventive oral health interventions on at least one of these outcomes: changes in dental caries status, periodontal disease status, oral hygiene status/practices, sugar consumption, or smoking behaviours. Two reviewers will independently assess the searched articles, extract the data, and assess the risk of bias in the studies using the Cochrane Risk of Bias 2 (ROB 2) for randomised controlled trials and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for non-randomised controlled trials. Both narrative and quantitative analyses will be conducted. However, only narrative synthesis will be performed if the data are substantially heterogeneous. The synthesised evidence from this review can inform policymakers on evidence-based interventions to improve the oral health outcomes of schoolchildren from rural and low socioeconomic backgrounds. Systematic Review Registration PROSPERO (Registration number: CRD42022344898).

OBJECTIVE: Cardiovascular health is acknowledged as a crucial concern among cancer survivors. Socioeconomic status (SES) is an essential but often neglected risk factor for cardiovascular disease (CVD). We conducted this study to identify the relationship between SES and CVD mortality in cancer survivors.
RESULTS: Using the National Health Insurance Service-National Health Examinee database, we identified cancer survivors diagnosed and surviving beyond 5 years post-diagnosis. SES was assessed based on insurance premiums and classified into 5 groups. The primary outcome was overall CVD mortality. This study analyzed 170 555 individuals (mean age 60.7 ± 11.9 years, 57.8% female). A gradual increase in risk was observed across SES groups: adjusted hazard ratios (95% confidence intervals) for overall CVD mortality were 1.15 (1.04-1.26), 1.28 (1.15-1.44), 1.31 (1.18-1.46), and 2.13 (1.30-3.49) for the second, third, and fourth quartile, and medical aid group (the lowest SES group) compared to the highest SES group, respectively (p for trend < 0.001). The lowest SES group with hypertension exhibited a 3.4-fold higher risk of CVD mortality compared to the highest SES group without hypertension. Interaction analyses revealed that low SES synergistically interacts with hypertension, heightening the risk of CVD mortality (synergy index 1.62).
CONCLUSIONS: This study demonstrates a significant correlation between low SES and increased CVD mortality among cancer survivors. Particularly, the lowest SES group, when combined with hypertension, significantly escalates CVD mortality. Our findings underscore the critical importance of recognizing SES as a significant risk factor for CVD mortality in this population of cancer survivors.
Our population-based cohort study, involving over 170 000 cancer survivors, demonstrates a significant association between socioeconomic status (SES) and cardiovascular disease (CVD) mortality.

OBJECTIVE: Research indicates that people with lower socioeconomic status (SES) receive inferior healthcare and experience poorer health outcomes compared with those with higher SES, in part due to health professional (HP) bias. We conducted a scoping review of the impact of HP bias about SES on clinical decision-making and its effect on the care of adults with lower SES.
METHODS: JBI scoping review methods were used to perform a systematic comprehensive search for literature. The scoping review protocol has been published in BMJ Open.
METHODS: Medline, Embase, ASSIA, Scopus and CINAHL were searched, from the first available start date of the individual database to March 2023. Two independent reviewers filtered and screened papers.
METHODS: Studies of all designs were included in this review to provide a comprehensive map of the existing evidence of the impact of HP bias of SES on clinical decision-making and its effect on the care for people with lower SES.
METHODS: Data were gathered using an adapted JBI data extraction tool for systematic scoping reviews.
RESULTS: Sixty-seven papers were included from 1975 to 2023. 35 (73%) of the included primary research studies reported an association between HP SES bias and decision-making. Thirteen (27%) of the included primary research studies did not find an association between HP SES bias and decision-making. Stereotyping and bias can adversely affect decision-making when the HP is fatigued or has a high cognitive load. There is evidence of intersectionality which can have a powerful cumulative effect on HP assessment and subsequent decision-making. HP implicit bias may be mitigated through the assertiveness of the patient with low SES.
CONCLUSIONS: HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities. Research that focuses on decision-making when the HP has a high cognitive load, would help the health community to better understand this potential influence.

UNASSIGNED: There is a well-known association between low socioeconomic status (SES), poor survival, and clinician-reported outcomes after stroke. We aimed to assess socioeconomic differences in Patient Reported Outcome Measures 3 months after stroke.
UNASSIGNED: This nationwide cohort study included patients registered with acute stroke in the Swedish Stroke Register 2015-2017. Patient Reported Outcome Measures included activities of daily living (mobility, toileting, and dressing), and poststroke symptoms (low mood, fatigue, pain, and poor general health). Information on SES prestroke was retrieved from Statistics Sweden and defined by a composite measure based on education and income tertiles. Associations between SES and Patient Reported Outcome Measures were analyzed using logistic regression adjusting for confounders (sex and age) and additionally for potential mediators (stroke type, severity, cardiovascular disease risk factors, and living alone). Subgroup analyses were performed for stroke type, men and women, and younger and older patients.
UNASSIGNED: The study included 44 511 patients. Of these, 31.1% required assistance with mobility, 18% with toileting, and 22.2% with dressing 3 months after stroke. For poststroke symptoms, 12.3% reported low mood, 39.1% fatigue, and 22.7% pain often/constantly, while 21.4% rated their general health as poor/very poor. Adjusted for confounders, the odds of needing assistance with activities of daily living were highest for patients with low income and primary school education, for example, for mobility, odds ratio was 2.06 (95% CI, 1.89-2.24) compared with patients with high income and university education. For poststroke symptoms, odds of poor outcome were highest for patients with low income and university education (eg, odds ratio, 1.79 [95% CI, 1.49-2.15] for low mood). Adjustments for potential mediators attenuated but did not remove associations. The associations were similar in ischemic and hemorrhagic strokes and more pronounced in men and patients <65 years old.
UNASSIGNED: There are substantial SES-related differences in Patient Reported Outcome Measures poststroke. The more severe outcome associated with low SES is more pronounced in men and in patients of working age.

BACKGROUND: The well-established inverse relationship between socioeconomic status (SES) and risk of developing coronary heart disease (CHD) cannot be explained solely by differences in traditional risk factors.
OBJECTIVE: To model the role SES plays in the burden of premature CHD in Argentina.
METHODS: We used the Cardiovascular Disease Policy Model-Argentina to project incident CHD events and mortality in low and high-SES Argentinean adults 35 to 64 years of age from 2015 to 2024. Using data from the 2018 National Risk Factor Survey, we defined low SES as not finishing high-school and/or reporting a household income in quintiles 1 or 2. We designed simulations to apportion CHD outcomes in low SES adults to: (1) differences in the prevalence of traditional risk factors between low and high SES adults; (2) nontraditional risk associated with low SES status; (3) preventable events if risk factors were improved to ideal levels; and (4) underlying age- and sex-based risk.
RESULTS: 56% of Argentina´s 35- to 64-year-old population has low SES. Both high and low SES groups have poor control of traditional risk factors. Compared with high SES population, low SES population had nearly 2-fold higher rates of incident CHD and CHD deaths per 10 000 person-years (incident CHD: men 80.8 [95%CI 76.6-84.9] vs 42.9 [95%CI 37.4-48.1], women 39.0 [95%CI 36.-41.2] vs 18.6 [95%CI 16.3-20.9]; CHD deaths: men 10.0 [95%CI 9.5-10.5] vs 6.0 [95%CI 5.6-6.4], women 3.2 [95%CI 3.0-3.4] vs 1.8 [95%CI 1.7-1.9]). Nontraditional low SES risk accounts for 73.5% and 70.4% of the event rate gap between SES levels for incident CHD and CHD mortality rates, respectively.
CONCLUSIONS: CHD prevention policies in Argentina should address contextual aspects linked to SES, such as access to education or healthcare, and should also aim to implement known clinical strategies to achieve better control of CHD risk factors in all socioeconomic levels.

UNASSIGNED: Health agency refers to one\'s capacity to form health-related goals, experience control, and possess the means to pursue them. Low socioeconomic status (SES) is linked to impaired health agency and increased risk of adverse pregnancy outcomes, potentially due to a reduced tendency to seek care. Better healthcare availability may not improve their pregnancy outcomes, and therefore improved understanding of maternal health agency is paramount.
UNASSIGNED: Semi-structured interviews were conducted with 15 participants who either had children or desired to have them. Low SES was determined by neighborhood median income and educational attainment. A thematic content analyses was conducted.
UNASSIGNED: Two themes emerged: 1) Origin and development of personal goals, and 2) Awareness and competence. Participant\'s goals stemmed from cultural norms, personal narratives, and intuition. Integrated goals were those participants valued highly, were aware of, and strived for. Four subthemes were identified in goal-awareness and competence. Internal conflict due to discrepancies between goals and behavior resulted in the need to balance the burdens and benefits of behavior change.
UNASSIGNED: Maternal health agency is a modifiable outcome dependent on goal-awareness and various factors. Impaired agency seemed to stem from lack of goal-awareness rather than an inability to meet established pillars.