Background: Because economic conditions are both a risk factor for disease and may themselves be objectives for health delivery interventions, monitoring changes in economic outcomes has become a routine priority for health and development efforts. However, the lack of formal commerce in poor agrarian communities creates challenges for measuring economic status. Data on household finances, such as income, are ideal but are time-consuming, costly, and less reliable, whereas proxy measures of wealth such as indices of durable assets are easier to measure but relatively coarse and are less sensitive to rapid changes in underlying drivers. Methods: We used data from a cohort of 528 people living with HIV/AIDS (PLHA) enrolled in a food intervention study on household demographics, agricultural production, cash income, in-kind income, household durable assets and health status, including CD4 count. We created a household economic index using principal components analysis (PCA) and compared it with three other economic indicators generated from the data (income, expenditures, poverty score). Through multivariate logistic regression analysis we evaluated the effect of the economic metric on probability of survival within the first year of study. Results: Socioeconomic status determined by PCA of durable assets, weighted by the square root of the household size, was the only consistently significant economic predictor of probability of death. It remained significant even after controlling for direct health indicators such as CD4 count. There was no significant correlation between CD4 count and the economic indicators, which may be attributable to uniform access to ART among study participants. Conclusion: Among people who have HIV and are all enrolled in ART and food programs, household socioeconomic status is an important predictor of mortality rates, even after controlling for direct health measurements such as CD4 count and other health-related covariates. The SES indicator from PCA is also a simple metric to estimate. The study underscores that poverty is a social determinant of mortality even in the context of equal access to health services, and is suggestive of the importance of poverty alleviation activities as an important supplement to clinical interventions.

Background: Previous research states that chronic widespread pain (CWP) has a negative impact on health status and daily life activities. Risk factors for developing CWP are, e.g. female sex, other chronic diseases, smoking, inactivity, sleeping problems and obesity. The average prevalence of CWP is 9.6-15% in the general population. The results vary regarding sex differences in prevalence, pain experience, impact on daily life, work, and health status. Therefore, the overall aim was to investigate CWP’s impact on health status and long-term lifestyle predictors for better health when having CWP. Method: The study is a general population cohort study including 975 participants (442 men, 533 women) at the age of 35-54 years with a 12- and 21-year follow-up. CWP was defined according to the American College of Rheumatology’s (ACR) definition stating pain must be present for at least three months, below and above the waist, on both sides of the body, and the axial skeleton to be classified as widespread. Using a pain mannequin and additional questions the individuals were sorted in three different pain groups: no chronic pain (NCP), chronic regional pain (CRP), and CWP. The questionnaire included questions about lifestyles factors (personal support, friendship circuit, smoking, alcohol intake, physical activity and sleeping habits) and SF-36 measuring health status. Differences in health status were analysed by independent samples t-test and health predictors by logistic regression analysis. The results were further analysed using Tengland’s two-dimensional health theory and the relational gender theory. Results: The prevalence of CWP was higher among women during all time points, but health status was statistically significant reduced for both women and men with CWP (p <0.001) showing no sex differences of clinical relevance. At the 12-year follow-up, 58% of the women and 53% of the men had persistent CWP (p <0.001). At the 21-year follow-up, 59% of the women and 29% of the men had persistent CWP (p <0.001). Health predictors for better health when having persistent CWP were male sex (OR 3.03-6.76), having social support (OR 9.27), no sleeping problems (OR 3.48-4.76), being a former smoker (OR 4.38-7.83) and a weekly intake of alcohol (OR 4.94). Conclusion: More women reported persistent CWP in a 12- and 21-year perspective than men, but when having CWP the health status was equally as bad among women and men. Modifiable health factors such as having no sleeping problems was strongly associated with better mental health, and personal support could be of importance for a better vitality. The higher prevalence reported among women and male sex as a health predictor seems to be influenced by the psychosocial mechanisms of gender. However, health status did not show any association with the relational gender theory. The results suggests, even though men have less prevalence of CWP the condition should be regarded as having the same impact for women and men in health care. Further research should continue studying persistent CWP and possible confounders to establish the sex and gender differences in the long-term perspective. / Bakgrund: Tidigare forskning visar att långvarig generell smärta (CWP) har en negativ påverkan på hälsostatus och dagliga aktiviteter. Riskfaktorer för att utveckla CWP är t.ex. kvinnligt kön, andra kroniska sjukdomar, rökning, inaktivitet, sömnproblem och övervikt. Den genomsnittliga prevalensen av CWP i den allmänna befolkningen är 9,6–15 %. Resultat på könsskillnader varierar gällande prevalens, upplevelse av smärta, påverkan på det dagliga livet, arbetslivet samt hälsostatus. Det övergripande syftet var därför att undersöka CWP:s påverkan på hälsostatus samt långsiktiga livsstilsfaktorer för en bättre hälsa för dem med CWP. Metod: Studien är en befolkningskohort med 975 deltagare (442 män, 533 kvinnor) i åldern 35–54 år med en 12- och 21-års uppföljning. CWP definierades enligt American College of Rheumatology (ACR) definition som säger att smärta ska vara närvarande i minst tre månader, under och över midjan, på båda sidorna av kroppen samt axialskelettet för att klassificeras som generell. Med hjälp av en ritad smärtfigur och ytterligare frågor sorterades deltagarna in i tre olika smärtgrupper: ingen långvarig smärta (NCP), långvarig regional smärta (CRP) och CWP. Frågeformuläret bestod av frågor om livsstilsfaktorer (personligt stöd, vänskapskrets, rökning, alkoholintag, fysisk aktivitet samt sovvanor) och SF-36 som mäter hälsostatus. Skillnader i hälsostatus analyserades genom ett oberoende t-test och hälsoprediktorer genom logistisk regressionsanalys. Resultatet analyserades ytterligare utifrån Tenglands två-dimensionella hälsoteori och den relativa genusteorin. Resultat: Prevalensen av CWP var högre bland kvinnor vid samtliga tidpunkter och hälsostatus var statistiskt signifikant lägre för både kvinnor och män med CWP (p < 0.001). Det fanns inga könsskillnader av klinisk relevans. Vid 12 års uppföljningen hade 58 % av kvinnorna och 53 % av männen långvarig CWP (p < 0.001). Vid 21 års uppföljningen hade 59 % av kvinnorna och 29 % av männen långvarig CWP (p < 0.001). Hälsoprediktorer för bättre hälsostatus för CWP-drabbade var manligt kön (OR 3,03–6,76), socialt stöd (OR 9,27), inga sömnproblem (3,48–4,76), före detta rökare (4,38–7,83) och att varje vecka dricka alkohol (OR 4,94). Slutsats: Fler kvinnor än män rapporterade långvarig CWP i ett 12- och 21-års perspektiv, men bland de som hade CWP var hälsostatusen lika dålig hos kvinnor och män. Att inte ha några sömnproblem var starkt förknippat med en bättre mental hälsa och personligt stöd kan vara av betydelse för en bättre vitalitet. Den högre prevalensen bland kvinnor samt manligt kön som hälsoprediktor verkar vara påverkade av de psykosociala mekanismerna för genus. Hälsostatus visade emellertid inte någon koppling till den relativa genusteorin. Resultet innebär att även om män har en lägre prevalens av CWP bör tillståndet betraktas detsamma för män som hos kvinnor i vården. Vidare forskning bör studera långvarig CWP och möjliga confounders för att faststlå köns- och genusskillnader i ett långsiktigt perspektiv.

Background: Russia has undergone tremendous socioeconomic transformations. Particularly detrimental was the period of 1990-s that evidenced hazardous trends in public health. Alcohol consumption was suggested to be responsible for the negative health trends in the society. Male alcohol consumption attracted disproportional attention leaving female alcohol consumption, its predictors and influence on women’s health disregarded and uninvestigated. Aim: To describe the practices of female alcohol consumption and socio-demographic predictors of drinking, to explore the impact that drinking might have on the self-rated health of Russian women. Method: Cross-sectional analysis of data drawn from the Russia Longitudinal Monitoring Survey, round 20th. The association tests between the measures of alcohol consumption and covariates were run. Ordinal regression model tested the predictors of self-rated health.      Results: A Russian female drinker is middle-aged, high-educated, married/ cohabiting or divorced, resides from the urban area and is infrequent drinker. The frequency of drinking increases when she is young, high-educated, married/ cohabiting, resides from urban area. U-shaped relation between drinking and self-rated health was demonstrated: never drinkers and regular drinkers report poorer health than seldom-drinkers.  Conclusion: Predictors of female drinking in Russia are poorly investigated due to overrepresentation of research focused on men’s drinking. More studies are needed in order to explore the impact of drinking on self-rated health of  Russian women.