Social Class Research Articles

Many Caring Marys: Feminised Care in Mary Seacole’s Wonderful Adventures and Jackie Sibblies Drury’s Marys Seacole

Drawing upon a growing body of research in feminist care theory, this essay argues that Mary Seacole’s representation of care in her 1857 autobiography, Wonderful Adventures of Mrs. Seacole in Many Lands, uses maternal rhetoric to reinforce a Victorian vision of care grounded in feminine hospitality and domestic comfort. The essay considers Seacole’s narrative as both a sentimentalist story that sanitises care labour through her use of the figurative ‘mother,’ and as a testimony to the centrality of care labour, so often invisibilised, in grand narratives of history. I analyse this vision alongside Jackie Sibblies Drury’s 2019 play Marys Seacole, which reconsiders Seacole’s legacy by arguing instead for an entangled, interdependent model of care relations that explicitly attends to differences in class and race. Drury’s play ambivalently explores what is both inspiring and fraught within Seacole’s original narrative; its final dramatic thrust, which finds its characters clinging to the iconography of ‘Mother Seacole’ while physically clutching onto one another, registers the inadequacy of a care model dependent upon exploited mother figures and suggests the need for lateral, multiracial, and multigenerational networks of mutual support.

Trauma and social pathways to psychosis: Examining the role of attachment, social rank and dissociation in a clinical sample.

The trauma and social pathways model of psychosis proposes interactions between trauma, attachment, social rank and dissociation in pathways to psychosis, though this model has yet to be empirically investigated. The primary aim of this study was to examine the overall predictive value of the trauma and social pathways model using regression analysis. A secondary aim was to delineate hypothesized pathways between trauma and positive symptoms of psychosis using serial mediation analysis. This was a cross-sectional study of people attending mental health services for a psychosis-related diagnosis (N = 71). Measures of trauma, positive symptoms of psychosis, attachment, social comparison and dissociation were completed. A model of recurrent trauma, insecure attachment, social rank and dissociation predicted 23.2% of the variance in positive symptoms of psychosis. Recurrent trauma, attachment and dissociation contributed significantly to the model, while social rank did not. Further, serial mediation analysis indicated that the sequence of disorganized attachment and dissociation fully mediated the relationship between recurrent trauma and positive symptoms. Results provide preliminary support for the trauma and social pathways model of psychosis, specifically as it relates to recurrent trauma, insecure attachment and dissociation. Results did not support the social rank component of this model, however. These findings provide clear targets for the development of next-wave psychological interventions that focus on trauma-related variables in psychosis. Future studies should replicate these findings with a larger clinical sample, and consider a measure of shame to further elucidate social processes in pathways to psychosis.

Using Machine Learning to identify the social determinants of the mid-life decline in mental health

Abstract Background The mid-life decline in mental well-being, depicted as a U-shaped pattern, is debated across disciplines. This study seeks to identify the social determinants of this decline and the overall contribution of social determinants to changes in mid-life mental health. Methods We use data from the 1970 British Cohort Study, from the ages 26, 34, and 42 (N = 6992, 51.5% female). Mental distress was measured using the 9-score Malaise Inventory. Mental distress increased from age 34 (M = 1.67) to 42 (M = 1.86; p < 0.001), with 17.8% declining by at least 1 SD on the inventory. We contrasted this group of decliners with those exhibiting stable mental health. We included socioeconomic and family factors, as well as physical health and health behaviours as potential determinants of mental health decline (at ages 26, 34, or at birth). We combine Random Forest and logistic regressions. Results The Random Forest’s Variable Importance (VI; root Mean Squared Error (MSE)), revealed social class at birth (VI = 0.023), physical multimorbidity at age 26 (VI = 0.22), and income quintile at age 34 (VI = 0.022) as most important predictors. Regressions confirmed that low birth social class (OR = 1.51 [1.25-1.83]), high-income at age 34 (OR = 0.68 [0.53-0.88]), and physical multimorbidity at age 26 (OR = 1.25 [1.06-1.48]) predict mental health decline. For those with high income and social class, the predicted probability of mid-life mental health decline is 0.109 (CI = [0.08-0.139]), rising to 0.277 (CI = [0.227-0.324]) for high risk individuals. Social class does not predict changes in mental health between ages 26 - 34. Interpretation We show that various social determinants of health contribute to the observed decline in mental health during mid-life. Social class at birth, income, and physical health are the most relevant predictors; they reduce the risk of decline from up to 27% to 11%. The contribution of social class appears specific to mid-life, and it could help explain the U-shaped pattern. Key messages • Social Factors Matter: Social class, income, and health predict mid-life mental decline. • Mid-life Class Impact: Social class uniquely affects mental health decline in mid-life.

Filsafat Materialisme Karl Marx (Epistimologi Dialectical And Historical Materiali)

With the premise that the production and distribution of products and services is vital to aid people in growing their life, this article examines Karl Marx's historical materialism and its methodology. Economic considerations serve as the foundation of human existence, while the concrete problems of human awareness in the fields of science, philosophy, ideology, and religion serve as the superstructure, according to him. According to Marx, society's superstructure is defined by its economic foundation. Marx argued that the struggle between social classes was the driving force behind all major historical shifts. Marx posits a social hierarchy in which the capitalist bourgeoisie and the working class proletariat are the two main social groups. Thus, rather than people, social class is a product of historical development that dictates how events unfold. A class revolution is inevitable given the presence of these two social strata. Religion is the opium of the masses, according to Marx; the more one devotes oneself to religion, the more lost he will become. Religion does not create man, but rather, Marx argues that humans create religion.

Determinants of health prevention behaviors in Portugal

Abstract Background One of the main causes of death in developed societies are chronic non-communicable diseases, often originated by risky behaviors as tobacco consumption, poor diet, excessive alcohol consumption and lack of physical activity. Changing lifestyles can thus lead to a reduction in chronic diseases and in their economic costs. The objective of this study is to understand what the main factors associated with health behaviors are. Methods We used the data collected through the Portuguese National Health Surveys from 2014 and 2019. The sample analyzed was composed of individuals aged 15 or more years old living in the national territory at the time the surveys were conducted. Data on demographics, socio-economic variables and health related variables was used. A maximum likelihood estimation was performed using a multivariate probit model, by using health behaviors (weekly exercise, healthy diet, non-smoking, and prudent alcohol consumption) as the outcomes of the analysis. Results The results point to a strong association between social class and health behaviors, particularly between higher income and healthy diet. It is important to highlight that having an appointment with a General Practitioner is positively associated with all healthy behaviors. For all behaviors but healthy diet, the coefficients are statistically significant at a 5% significance level and non-smoking displays the highest one (0.135). Conclusions This study presents the first step to understand the determinants of health prevention behaviors, which is important to design policies targeting lifestyles. One of its main conclusions indicates that social class (income and education) and GP appointments are associated with health behaviors. Further research would be needed to study the underlying mechanisms through which some of these factors impact behaviors. This presentation was supported by National Funds through FCT, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020). Key messages • This study is an important step in the formulation of policies targeting lifestyles since it allows us to understand which factors are associated with health behaviors. • From this study one can conclude that social class characteristics, particularly income, and access to GP appointments are associated positively with health behaviors.

Linking health-related behaviours to quality of life in older adults: A latent class analysis

Abstract Background Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population. Methods Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions. Results In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics. Conclusions To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class. Key messages • This study explores the relationship between health behaviour and QoL in older Austrians. • Findings support the development of differentiated interventions targeting different types of behaviour.

How social and commercial determinants influence exclusive breastfeeding in the Philippines

Abstract Background The World Health Organization recommends exclusive breastfeeding (EBF) for the first six months after delivery. However, the EBF rate in the Philippines is only 29%. Existing literature suggests that the influence of infant formula marketing (IFM), communication channels, and traditional health beliefs are possible contributors to low EBF rates, but rare studies have been conducted in low-resource settings. Methods: To bridge the gap, 15 barangays in Palawan were selected; 97 interviews were conducted with lactating mothers (LM), health workers (HW), traditional healers, infant formula sellers, and community leaders (CL) to represent different perspectives. The results were coded and analyzed inductively. Results LM received EBF information through multiple resources. Poverty, lacking breast milk (BM), EBF education, and health benefits (HB) to infants are top contributors to EBF while maternal employment and no BM are top barriers to EBF. Elders, traditional health beliefs (THB), and the influence of COVID-19 can influence EBF in both directions. LM emphasized more on poverty and elders to EBF while HW and CL emphasized the role of EBF education and HB. Urban LM tend to have more regular EBF education, use pumps when going out, and are more influenced by IFM. LM in remote areas tend to have more THB, have more BM substitutes, and share BM. Social classes, locations, Indigeneity, migration, and poverty are intersectioned to influence EBF. Conclusions Multiple social and commercial determinants influenced EBF. LM is facing more challenges to EBF under globalization and capitalism. Remote LM are less benefited from new technologies and policies to promote EBF. Different stakeholders have echo chambers to perceive the determinants of EBF. To improve health equity and EBF, the situations of marginalized people in remote areas should be more considered in policy making. Community building should also be considered differently to assist in EBF. Key messages • The project focuses on social and commercial determinants of exclusive breastfeeding with people in extreme poverty. • The project includes plenty of Indigenous breastfeeding behavior that are underreported.

Aretrospective cross-sectional study on district-based socioeconomic status and prostate cancer diagnosis.

Socioeconomic disparities have been linked to delayed prostate cancer diagnosis and poorer outcomes in various countries. This study aims to evaluate the socioeconomic disparities in prostate cancer diagnostics in Vienna, Austria, by examining initial prostate-specific antigen values and age at diagnosis across different districts and nationalities. This retrospective study included 1356 prostate cancer patients treated at the Medical University of Vienna between 2012 and 2022. Influence of residential districts and nationalities of the patients on the initial prostate-specific antigen (iPSA) value and on the age at diagnosis were analyzed. Patient data, including iPSA values, residential districts, and nationalities, were retrieved from the hospital's internal documentation system. The information on average income of residential districts was obtained from the City of Vienna's municipality data. Nationalities were grouped into EU and non-EU categories. Statistical analyses, including linear regression and t‑tests, were performed to examine the relationship between iPSA values, age at diagnosis, and socioeconomic variables. Linear regression was used to analyze the relationship between district income and both iPSA values and age at diagnosis. The study found no significant differences in iPSA values and age at diagnosis between patients from higher income and lower income districts. Additionally, there were no significant differences among individual districts or between EU and non-EU nationals. The findings suggest that the Austrian healthcare system provides equitable access to prostate cancer diagnostics across different socioeconomic groups.

Effects of legal age change on adolescents’ perception of access to alcohol in Portugal

Abstract Background Adolescents and young adults are a group particularly vulnerable to the effects of alcohol consumption. In Portugal, legislative changes in 2013 and 2015 prohibited the sale of alcoholic beverages to under-18s. This study aimed, first, to evaluate the impact of these policy shifts on the perceived access to alcohol among Portuguese adolescents, and second, to assess the different impacts across gender and socioeconomic strata. Methods Data from the ESPAD survey, spanning 1995-2019, was used. A quasi-experimental difference-in-differences study design was employed, using Finland, Norway, and Sweden as controls. The perceived access to beer, wine, and spirits among 16-year-old adolescents was used as outcomes, adjusted for gender and parental education. Results were also stratified by gender and by parental education status. Results After the increase in the minimum age for alcohol sales, there was a higher perceived easiness of access to beer (coef=0.018, p = 0.001) and a decline in spirits (coef=-0.088, p = 0.022), with no changes in wine. Male adolescents exhibited a decrease in the perception of access to spirits (coef=-0.100, p = 0.007) and wine (coef=-0.049, p = 0.049), while changes in the perception of access to beer were non-significant. Similar patterns were observed in female adolescents, yet non-significant for wine or spirits. These positive impacts on beer and negative impacts on spirits were observed in the different socioeconomic groups; wine was the exception, with only the highest-education group showing a decrease in the perception of access (coef=-0.056, p = 0.011). Conclusions In this study, the effect of raising the minimum age for alcohol sales in Portugal varied according to the alcoholic beverage, gender, and, for wine, according to the socioeconomic group. These findings suggest limitations in the policy’s effectiveness and equity. Future research should delve into the underlying causes to optimize health-promoting policies. Key messages • Portugal’s alcohol policy changes led to differential impacts on the perception of access to alcohol, with an impact in higher alcohol content beverages. • The impact of alcohol policy changes also differed across gender and socioeconomic status, with a stronger effect on male adolescents and higher socioeconomic strata.

TOPSE for babies in Norwegian: Examining the reliability of a tool to measure parenting self-efficacy

Abstract Background Parents’ confidence in their parenting abilities and self-efficacy (PSE) is an important factor for parenting practices. The Tool to measure Parenting Self-Efficacy (TOPSE) is a questionnaire created to evaluate parenting programs by measuring PSE. Initially, it was designed for parents with children between 0-6 years old. A modified version specifically for parents of infants aged 0-6 months (TOPSE for babies) is currently being piloted. In this study, we have investigated the reliability of the Norwegian version. Methods The study included 123 parents of children aged 0-18 months who completed a digital version of the TOPSE questionnaire. Professional translators performed the translation from English to Norwegian and a back translation in collaboration with the author group. Mean and standard deviation were calculated for each of the questionnaire’s six domains, and a reliability analysis was conducted using a Bayesian framework for the total sample (parents of children aged 0-18 months) and specifically for the parents of the youngest group of children (0-6 months). Results The overall Bayesian alpha coefficient for the six domains ranged from 0.54 to 0.83 for the entire sample, and from 0.63 to 0.86 for parents with children aged 0-6 months. For two of the domains, one item in each proved to primarily contribute to the low alpha coefficients and removing them improved the reliability, especially for parents of the youngest group of children. Conclusions Reliable tools to assess PSE and evaluate parenting programs is important. The Norwegian version of TOPSE for babies seems to be a reliable tool for measuring PSE, although there are variations across the children’s age groups and domains. Key messages • The findings from this study indicate that TOPSE in Norwegian is a reliable tool for assessing PSE. • While our findings are promising, further research is warranted to establish a more robust evaluation, across both mothers and fathers, parental age and socioeconomic groups.

A Qualitative Scoping Review of Community Firearm Violence in Low-Income Settings.

Firearm violence is a public health crisis in the United States that disproportionately impacts community members in low-income areas who witness and experience violence and violent victimization at elevated rates compared to other socioeconomic groups, often as result of community disinvestment and systemic racism (Smith et al., Soc Sci Med 246:112587, 2020). While quantitative reviews of firearm violence and related factors exist, a review of qualitative methods and findings regarding exposure to firearm violence has not yet been conducted. This scoping review sought to address a gap in the literature by summarizing the findings of qualitative studies on community firearm violence in low-income settings in the U.S. EBSCO databases, Criminal Justice Abstracts, National Criminal Justice Reference Service Abstracts, ProQuest, and PsycINFO were searched for studies that described the firearm related experiences of individuals and families in low-income communities. Thirty studies met the criteria for review. Findings were situated within the Centers for Disease Control and Prevention's (CDC) Social-Ecological Model as a framework for prevention (CDC, The social-ecological model: a framework for prevention, https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html , 2018; Dahlberg and Krug, World Report on violence and health, World Health Organization, Geneva, 2002). A critique of the literature, as well as implications and future directions of findings, are discussed. This study may inform future research questions and programs that center the voices of those most impacted by firearm violence.

Sickness absence due to mental and somatic diagnoses by occupational class in Finland, 2011–2021

Abstract Background Sickness absence (SA) due to mental disorders has strongly increased in Finland during recent years while sickness absence due to somatic diagnoses has continued to decrease. Research is lacking on recent trends in SA by occupational class, especially during years of increasing mental disorders. The aim of the study is to analyze these trends during 2011-2021. Methods National register data from the Social Insurance Institution of Finland (Kela), Statistics Finland and Finnish Centre for Pensions were linked for all employed Finns aged 25-64 for years 2011-2021 (yearly N about 2 million). SA was measured by sickness allowance, compensated by Kela after 10 days of absence. Age-standardized yearly prevalences of SA due to different diagnoses were calculated for women and men in four occupational classes over 2011-2021. Logistic regression was used to assess differences between occupational classes adjusted for age, marital status, education and region of residence. Results SA due to mental disorders has greatly increased in all occupational classes in Finland after year 2016 among both women and men, while SA due to musculoskeletal and other somatic diagnoses has continued to decrease. Increase in SA due to mental disorders has been largest among lower non-manual employees, especially among women, whereby also overall SA prevalence among female lower non-manual employees has reached the level of manual workers. Men show broadly similar trends but manual workers still have the highest overall SA prevalence. Relative adjusted differences between occupational classes decreased slightly between 2011 and 2021. Conclusions Clear occupational class differences persisted in diagnosis-specific SA throughout 2011-2021. However, the magnitude and order of the class differences changed along with increasing SA due to mental disorders. Occupational class differences should be taken into account when aiming to prevent further increases in SA due to mental disorders. Key messages • Sickness absence (SA) due to mental disorders has increased in all occupational classes in Finland after year 2016, while SA due to somatic diagnoses has continued to decrease. • Increase in SA due to mental disorders has changed the overall occupational class differences in SA in Finland largely because the increase has been strongest among lower non-manual employees.

Development of Pancasila monopoly learning media based on SAVI to improve Pancasila education learning outcomes

The low learning outcomes of students in interpreting the rules in the school and home environment need attention. This is caused by the teacher's teaching methods, which are less varied and interesting. This study aims to develop Pancasila monopoly media to improve PPKn learning outcomes. The study applies the 4D development model, which stands for Define, Design, Development, and Dissemination. This model was chosen because the stages of implementation are divided in detail and systematically. The analysis is descriptive of quantitative and qualitative data obtained through observation, interviews, and direct measurements in the field. The results of the media expert assessment obtained a score of 93.7% with very good criteria, and the material expert obtained a score of 96.2% with very decent criteria. Student learning outcomes increased to 82.32 from the previous score of 42.50. The increase was 39.8%. While the control class that did not use media increased its score from 49.05 to 75.48. The results of the N-Gain test obtained an average difference in the experimental class of 39.8 with an n-gain of 0.76 and a moderate criterion, and the effectiveness interpretation obtained a score of 76.50 with a fairly effective criterion. While the control class with an average difference of 26 obtained an N-Gain score of 0.52 on the moderate criterion and an effectiveness level of 52.35, a less effective.

Adolescent well-being in time of crisis: The role of social and residential contexts

Abstract Background It is unknown whether social or residential context during the COVID-19 lockdowns may impact mental well-being. We identified classes of each of social and residential context during the lockdown and examined their associations with mental well-being among French adolescents one-year after the first lockdown. Methods We used data collected in a cross-sectional study design in 2021 from 387 adolescents ages 12 to 15 years enrolled in the school-based pilot study for EXIST. Participants reported social and residential characteristics during the lockdown retrospectively, and current mental well-being in self-report questionnaires. We used latent class analysis to identify classes of social and residential contexts, and linear regression models to study their association with mental well-being. Results Four social context classes were identified: class 1 ‘Low opportunities for social contacts at home’, class 2 ‘Moderate opportunities for social contact at home”, class 3 ‘High opportunities for social contact at home’, and class 4 ‘Very high opportunities for social contact at home’. Compared to class 4, lower levels of mental well-being were observed among adolescents in class 1 (b= -4.08, 95% CI [-8.06; -0.10]) one year after the lockdown. We identified four residential context classes, with differences across classes in proximity to nature, type of residence (e.g., apartment, house), and level of neighborhood deprivation. No association was found between residential context during the lockdown and adolescent mental well-being one year later. Conclusions An unsupportive social environment during the lockdown may have long-term effects on mental well-being among adolescents. Given the observed disparities in social support, future intervention should aim to strengthen social support for adolescents living in unsupportive environments (e.g., remote homework assistance, support for isolated parents, provision of virtual chat rooms for adolescents). Key messages • Mental well-being was challenged among youth with lower levels of social connectedness and support during lockdown, residential context was not associated with adolescent well-being after one year. • During crisis, a critical need among adolescents does not pertain to the physical attributes of their living environment, but rather to social support from friends or family within and outside home.

Study on Fetal and Maternal Outcome of Postdated Pregnancy

Postdated pregnancy is not so uncommon in obstetric practice. When a pregnancy crosses the expected date of delivery (beyond 280 days) it is called postdated pregnancy. The incidence is about 7% of all pregnancies. This prospective observational study was carried out in 165 postdated pregnancies admitted in the Department of Obstetrics & Gynaecology, during a period of 3 years from January 2021 to December 2023 . Majority of the patients were below 25 years of age (47.88%) and primigravida (41.82%). Most of the patients belonged to rural areas (55.75%) and were middle socio-economic status group (45.45%). The majority of these postdated women were delivered by NVD (52.12%), followed by LSCS (32.72%) and instrumental (15.15%). Postdated pregnancy was associated with perinatal complications like meconium aspiration syndrome, oligohydramnios, fetal birth injuries, septicemia, shoulder dystocia, non-reassuring fetal heart rate status, fetal distress in labour. There was an increased risk of maternal complications like increased caesarean section rate, post-partum hemorrhage (PPH) ,cervical tear, perineal tear. Management of postdated pregnancy is challenging. Careful advice and timely interventions can reduce fetomaternal complications. EWMCJ Vol. 12, No. 1&2, January-July 2024: 94-98

Treatment strategy for heart failure patients with guideline-directed medical therapy intolerance: a real-world prospective study

Abstract Background Guideline-directed medical therapy (GDMT) reduces the incidence of worsening events in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, in actual clinical practice, a proportion of patients are unable to tolerate complete GDMT. Purpose This study aimed to assess the medication strategy for patients with HFrEF who are intolerant to GDMT. Methods A total of 110 patients admitted with acute HF were included in the study. The patients were non-randomly assigned to receive complete or incomplete GDMT after assessment by doctors before discharge from the hospital. All patients were followed up for 180 days. The primary composite endpoint was worsening HF-associated events, including death or rehospitalization due to HF, and the need for intravenous diuretic therapy. The secondary endpoints were the New York Heart Association functional class, blood pressure, and cardiac structure and function assessed by echocardiography. Results The main reasons for GDMT intolerance were renal insufficiency (41.8%) and hypotension (26.4%). GDMT-intolerant patients had lower eGFR (50.4 ml/min/1.73 m² vs. 70.9 ml/min/1.73 m²; p=0.002) compared with those who tolerated GDMT, and included more patients with chronic kidney disease (56.4% vs. 23.6%, p<0.001) and higher NT-proBNP levels (5340 pg/ml vs 8080 pg/ml, p=0.039) at baseline. While patient mortality was similar between the two groups, the rate of worsening HF events was lower in patients with GDMT (hazard ratio: 0.736; 95% confidence interval: 0.389−1.393) and vericiguat treatment (p<0.001). In terms of the secondary endpoint, patients who received GDMT showed greater improvements in cardiac structure and function although there was no statistical difference between the groups. In the prespecified subgroup analysis of the effects of vericiguat on the primary endpoint, the incidence of worsening HF events was reduced by vericiguat, regardless of whether the patient was comorbid with GDMT or not, or whether they had a previous history of HF (p-interaction= 0.519 and 0.227, respectively). Conclusions Patients with early in-hospital initiation of complete GDMT and continuous GDMT after discharge had better outcomes compared with patients who were intolerant to GDMT. Co-administration of vericiguat with or without GDMT may reduce the incidence of worsening HF events in HF patients within 180 days.Results of the primary endpoint

Exploring Urban Socio-Spatial Disparities in Liverpool, Manchester, and Newcastle upon Tyne Metropolitan Areas

In recent decades, rising social disparities in European cities have structured new forms of urban inequalities. Employing an innovative analysis approach based on statistical, geographical, and spatial methods, this paper aims to explore the social geography of population groups in Liverpool, Manchester, and Newcastle upon Tyne by examining how the spatial distribution of socio-economic groups intersects with urban settlements of the resident foreign population. The study addresses methodological challenges in segregation measurement while shedding light on existing spatial patterns of vulnerable groups and emerging trajectories of residential segregation at the metropolitan scale, utilising the most recent UK Census data.

Improving breast cancer care post-pandemic from the patient perspective

Abstract Background Since the onset of the pandemic, breast cancer (BC) services have been disrupted in most countries. The purpose of this qualitative study is to explore the unmet needs, patient-priorities, and recommendations for improving BC healthcare post-pandemic for women with BC and to understand how they may vary based on socio-economic status (SES). Methods 37 women were invited to take part in follow-up semi-structured qualitative interviews in early 2023. The interviews explored their perspectives of BC care since the easing of COVID-19 government restrictions, including unmet needs, patient-priorities, and recommendations specific to BC care. Thematic analysis was conducted to synthesize each topic narratively with corresponding sub-themes. Additionally, variation by SES was analysed within each sub-theme. Results Of the 28 women who participated in interviews, 39% were categorized as high-SES, while 61% were categorized as low-SES. Women expressed unmet needs in their BC care including routine care and mental and physical well-being care, as well as a lack of financial support to access BC care. Patient-priorities included: developing cohesion between different aspects of BC care; communication with and between healthcare professionals; and patient empowerment within BC care. Recommendations moving forward post-pandemic included: improving the transition from active to post-treatment; enhancing support resources; and implementing telemedicine where appropriate. Overall, women of low-SES experienced more severe unmet needs, which resulted in varied patient-priorities and recommendations. Conclusions As health systems are recovering from the COVID-19 pandemic, the emphasis should be on restoring access to BC care and improving the quality of BC care, with a particular consideration given to those women from low-SES, to reduce health inequalities post-pandemic. Key messages • The pandemic has impacted BC services considerably and this study has identified a range of unmet needs, patient-centered priorities, and recommendations. • Particular consideration needs to be given to those women from lower socioeconomic groups, in order to reduce health inequalities, which have been further exacerbated by the pandemic.

11.F. Scientific session: If we build it, will they come? Evaluation of citywide park redesign and renovation in NYC

Abstract Urban environments, such as parks, play a crucial role in shaping the health of their residents. However, the relationship between parks and health remains inconclusive. This workshop will present findings from the Physical Activity and Redesigned Community Spaces (PARCS) Study that examined the community health impacts of the Community Parks Initiative (CPI), a citywide park equity initiative of the New York City Department of Parks and Recreation (NYC Parks) that led to citywide park redesign and renovation across 67 low-income neighborhoods in NYC. Using a quasi-experimental design with socio-demographically matched control parks, we evaluated longitudinal changes in park use, physical activity, and psychosocial well-being as a result of CPI. There will be a total of 3 presentations. The first presentation will focus on the impact of CPI on park use before and after park renovation, relative to control parks, using data collected from the System for Observing Play and Recreation in Communities (SOPARC). Results showed that CPI led to a significant net increase in park use, especially among adults. The second presentation will report on changes in perceived stress pre- and post-renovation among adults. Results showed that a greater decrease in perceived stress was associated with a sustained high or increased park use frequency in the context of high-quality CPI intervention parks. In contrast, the same association was not found in lower quality control parks. The third presentation will showcase a study that demonstrated a significant increase in children’s physical well-being, a dimension of quality of life, at CPI vs. control sites. The analysis also showed that children in the lowest socio-economic group might have benefited the greatest from CPI. PARCS is one of the largest intervention studies on the effects of park renovation on health. This workshop will engage participants in considering how these insights can be translated into actionable programs and policies in service of community health and health equity. Findings from PARCS will help inform future public health and urban planning interventions in the use of the built environment to promote population well-being. Key messages • Urban park renovations may contribute significantly to community health, demonstrating a vital link between the built environment and public health. • Investments in green spaces may enhance the physical and mental well-being of low-income urban communities, promoting social equity.

Unravelling COVID-19 social mortality patterns using conditional inference tree algorithm

Abstract Background The COVID-19 pandemic led to significant excess mortality in 2020 in Belgium. By using microlevel cause-specific mortality data for the total Belgian adult population in 2020, three outcomes were considered in this study aiming at predicting sociodemographic (SD) and socioeconomic (SE) patterns of 1) COVID-19 specific death compared to survival; 2) all other causes of death (OCOD) compared to survival; 3) COVID-19 specific deaths compared to all OCOD. Methods Multivariable logistic regression models were fitted for the three outcomes. In addition, we computed conditional inference tree (CIT) algorithms, complementing regression models, to identify and rank the strongest SD and SE predictors of the three outcomes. Results Older people, males, people living in collectivities, first-generation migrants, and deprived SE groups experienced higher odds of dying from COVID-19 compared to survival; living in collectivities was identified by the CIT as the strongest predictor followed by age and sex. Education emerged as one of the strongest predictors for people not living in collectivities. Overall, similar patterns were observed for all OCOD except for first- and second-generation migrants having lower odds of all OCOD compared to survival; age group was identified by the CIT as the strongest predictor. Older people, males, people living in collectivities, first- and second-generation migrants, and people with lower levels of education had higher odds of COVID-19 death compared to all OCOD; living in collectivities was identified by the CIT as the strongest predictor followed by age, sex, and migration status. Education and income emerged as the strongest predictors among people not living in collectivities. Conclusions This study identified important SD and SE disparities in COVID-19 mortality underlying the importance of implementing preventive measures, particularly within the most vulnerable populations, in infectious disease pandemic preparedness. Key messages • Living in collectivities appeared to be the strongest predictor of COVID-19 death across all age groups, highlighting the importance of preventive measures in reducing the transmission of the virus. • Poor education plays a crucial role in predicting COVID-19 death among people not living in collectivities, highlighting the importance of targeting preventive measures towards low educated groups.