Social inequality in cancer survivors' health behaviours-A Danish population-based study.

The aim of this study was to compare health behaviours (smoking, alcohol consumption, physical activity and diet), to explore social inequality in these behaviours among cancer survivors and individuals with no history of cancer, respectively, and to study the impact of time since diagnosis on cancer survivors' health behaviours. Data from the Danish National Health Survey from 2013 were linked with data from the Danish Cancer Registry to identify all cancer diagnoses among the respondents during the period 1945-2012. In total, 11,166 cancer survivors and 151,117 individuals with no history of cancer were included. Cancer survivors smoked less and had a more sedentary lifestyle than individuals with no history of cancer. In relation to alcohol and dietary habits, no differences were found between the groups. Wide variations in health behaviours were seen across cancer sites, and in particular lung, bladder and oral cancer survivors had poor health behaviours. We found a clear social gradient in cancer survivors' health behaviours which reveals the need for greater focus on socially differentiated initiatives within prevention and patient education for cancer survivors. Our study revealed rather blurred results in relation to identifying the optimal timing for health-related behavioural interventions in cancer survivors.

Screening instruments for predicting return to work in long-term sickness absence.

BACKGROUND: Multiple somatic symptoms are common and may cause prolonged sickness absence (SA) and unsuccessful return to work (RTW). AIMS: To compare three instruments and their predictive and discriminative abilities regarding RTW. METHODS: A longitudinal cohort study of participants recruited from two municipal job centres, with at least 8 weeks of SA. The instruments used were the Symptom Check List of somatic distress (SCL-SOM) (score 0-48 points), the Bodily Distress Syndrome Questionnaire (BDSQ) (0-120 points) and the one-item self-rated health (SRH) (1-5 points). The instruments' predictive value was explored in a time-to-event analysis. Different cut-points were analysed to find the highest number of correctly classified RTW cases, identified in a register on public transfer payments. RESULTS: The study involved 305 subjects. The adjusted relative risk regarding prediction of RTW was 0.89 [95% confidence interval (CI) 0.83-0.95], 0.89 (95% CI 0.83-0.95) and 0.78 (95% CI 0.70-0.86) per 5-, 10- and 1-point increase in the SCL-SOM, BDSQ and SRH, respectively. After mutual adjustment for the three instruments, only the prediction of RTW from SRH remained statistically significant 0.81 (95% CI 0.72-0.92). The highest sensitivity (86%) was found by SRH at the cut-point ≤5, at which 62% were correctly classified. CONCLUSIONS: All three instruments predicted RTW, but only SRH remained a significant predictor after adjustment for the SCL-SOM and BDSQ. The SRH provides an efficient alternative to more time-consuming instruments such as SCL-SOM or BDSQ for estimating the chances of RTW among sickness absentees.