BACKGROUND: Previous research has shown a link between low positive affect (PA) and numerous physical and psychological well-being outcomes but, recent research has raised the possibility that this relationship may be driven by physical activity. Thus, we were interested in exploring the PA-exercise connection by examining this relationship across differing levels of body mass and athleticism. We also looked at whether the item active that is used in many PA assessments was responsible for this effect. METHOD: Participants were part of the Norwegian SHoT2018 national survey of 50,054 young adults (mean age = 23.2, 68.9% women), who completed electronic surveys about their exercise levels (duration, frequency and intensity) and affect. RESULTS: There was a clear and strong dose-response association between current state PA and the duration, frequency and intensity of exercise. For example, duration, magnitude, and slope effects were strongly driven by regular exercisers who had more than a 20-fold greater likelihood of being in the highest PA deciles compared to the least frequent exercisers. These dose-response connections replicated across both healthy and overweight BMIs, as well as in elite athletes. Removing the word active from the PA measure substantially reduced the size of this association, although the dose-response relationship remained. CONCLUSION: The observed strong connections have critical implications for health researchers and clinicians, and point to a need to carefully consider what types of activities are most strongly tied to well-being.

OBJECTIVE: Numerous epidemiological studies have been conducted to examine the prevalence and comorbidities of insomnia and document sleep duration, but a common limitation in many studies is the lack of use of agreed-upon definitions of insomnia, as well as insufficient statistical power to examine comorbid mental and physical disorders/conditions. AIM: To examine the prevalence of insomnia operationalized according to formal DSM-5 criteria and differences in mean sleep duration across a wide range of mental and physical disorders, examining men and women separately. MATERIALS AND METHODS: Data stem from the SHoT study (Students Health and Wellbeing Study), a national survey of all college and university students in Norway. In all, 162,512 students aged 18-35 received an invitation to participate, of whom 50,054 students completed the internet-based survey (attendance rate: 30.8%). Insomnia was defined according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria and sleep duration was calculated separately for weekdays and weekends. Self-reported mental and physical disorders/conditions were assessed using a pre-defined list modified to fit this age group. Pearson chi-squared tests were used to examine the prevalence of insomnia across the various mental and physical disorders/conditions in men and women separately, and log-link binomial regression analysis were used to calculate effect-sizes, adjusting for age. RESULTS: The prevalence of insomnia in both sexes was significantly higher across all mental disorders compared with a healthy reference group. Among females, the prevalence of insomnia ranged from 61.3% for comorbid depression (adj. RR = 2.49, 95% CI: 2.40) to 83.3% for comorbid schizophrenia (adj. RR = 3.37, 95% CI: 2.61-4.35). For males, the insomnia prevalence ranged from 32.3% for comorbid autism/Asperger (adj. RR = 2.02, 95% CI: 1.39-2.92) to 74.2% for comorbid eating disorder (adj. RR = 4.51, 95% CI: 3.87-5.27). The overall prevalence of insomnia was also significantly higher across most physical conditions compared with the healthy reference group, although generally lower compared to the mental disorders. For females, the insomnia prevalence ranged from 25% for comorbid multiple sclerosis (not significant) to 65.4% for comorbid chronic fatigue syndrome/ME (adj. RR = 2.66, 95% CI: 2.44-2.89). For males, the insomnia prevalence ranged from 20% for both comorbid cancer and diabetes (not significant) to 74.2% for comorbid fibromyalgia (adj. RR = 4.35, 95% CI: 2.96-6.39). Similar patterns were observed for sleep duration, with a significantly shorter sleep duration for across many physical disorders, but especially mental disorders. CONCLUSION: Insomnia and short sleep duration are strongly associated with a range of different disorders and conditions. Insomnia is most strongly associated with mental disorders, and physical conditions characterized by some level of psychological or psychosomatic properties.

BACKGROUND: As new targeted oral antineoplastic therapies have emerged in recent years, the development of effective strategies that promote optimal adherence to cancer medication regimens has become an important priority. METHODS: We conducted a scoping literature review to search for English language articles published through July 15, 2019, to identify studies that reported the testing and/or evaluation of interventions to improve adherence to oral antineoplastic agents. RESULTS: A total of 56 articles were selected for review. Of the studies evaluated, 14 were randomized trials. All interventions except two targeted adult patients. Thirty-three studies enrolled fewer than 100 patients. Most interventions were education- and counseling-based and centered on provision of information about the drug and strategies to manage side effects. Only eight studies used an mHealth tool and/or text messages to target nonadherence. Among studies with a comparison sample, fewer than one-half (44.7%) reported statistically significant improvements in adherence or persistence associated with the intervention; however, some pharmacist-directed programs, particularly those that integrated monitoring or routine follow-up with a provider, did demonstrate efficacy. CONCLUSION: Although the development of adherence-promoting interventions for oral antineoplastic therapies has increased recently, few have been rigorously tested. The nascent literature suggests those that are pharmacist directed and use regular monitoring show promise, though additional prospective studies are needed. Study methodology, population selection, and potential challenges that may be encountered in the implementation and dissemination phases should be considered when developing new interventions to address nonadherence to oral antineoplastic treatment.

Background:Previous research has shown a link between low positive affect and mortality, but questions remain about how positive affect is related to mortality and how this differs by gender and age. Purpose:To investigate the relationships between positive affect, negative affect, and mortality in a general population sample, and to examine whether these relationships were related to age, sex, or cause-specific mortality. Methods:We used data from 5,554 Norwegian participants aged 47-49 and 71-74 years who completed the Positive and Negative Affect Schedule (PANAS) and also provided data on demographics, health behaviors, and physical health as part of the Hordaland Health Study. The primary outcome was mortality after an average follow-up period of 16.5 years. Results:Participants in the lowest positive affect tertile had a near twofold increased mortality risk, compared to those in the highest positive affect tertile. This association was driven primarily by the PANAS "active" item and persisted, even after controlling for activity-related confounds and other positive affect items. No significant associations were found between negative affect and mortality. The relationship between positive affect and mortality was not significantly attenuated by age or sex. Although low positive affect was associated with an increased risk of mortality, it was not related to a specific cause of death. Conclusions:Low positive affect was significantly associated with mortality risk. The relationship was driven by the PANAS active item and not associated with cause-specific mortality. Findings suggest future research should examine the association between feeling inactive, sedentary behavior, and subsequent mortality.

Background

Adherence to adjuvant endocrine therapy (ET) influences breast cancer survival. Because ET side effects are frequently cited as reasons for nonadherence, understanding how perceptions and motivations in relation to ET are associated with symptom attribution can help promote timely symptom management.

Materials and methods

Participants were 2,086 breast cancer survivors recruited through the Army of Women registry who were current tamoxifen or aromatase inhibitor (AI) users. Participants reported whether they were bothered by each of 47 symptoms during the past month and whether they thought each symptom was related to taking ET. Frequencies of overall symptoms and symptoms attributed and misattributed to ET were calculated, and linear regression was used to assess sociodemographics, emotions, and illness perceptions as predictors of symptoms attributed to ET.

Results

Women attributed a mean of 8.9 symptoms and misattributed a mean of 1.5 symptoms to ET. In the multivariable analysis, younger age, a more recent diagnosis, AI use (vs. tamoxifen), anxiety, depressive symptoms, more ET-related negative emotions, more concern about long-term ET use, and greater perceived ET necessity were independently associated with attribution of more symptoms to ET. More perceived ET necessity was associated with correctly attributing symptoms to ET, whereas higher depressive symptoms and more concern about ET use were associated with misattribution of symptoms to ET.

Conclusion

Given that many women perceive a range of symptoms as a consequence of ET, attention to these symptoms may reduce symptom burden and improve quality of life, potentially improving ET adherence and optimizing survival.

Implications for practice

Many breast cancer survivors on endocrine therapy (ET) experience a range of side effects while taking ET. Targeting potentially modifiable factors associated with attributing a greater number of symptoms to ET, including perceived need for ET, concerns about long-term ET use, negative emotions toward ET, and symptoms of anxiety and depression, may reduce symptom burden and improve quality of life.

BACKGROUND: There is evidence of increasing levels of loneliness in Norwegian young people before the COVID-19 pandemic. It is not clear how the COVID-19 pandemic, and the associated necessary restrictions, impacted on these trends. AIMS: To examine how loneliness in young people changed across the pandemic, how loneliness relates to demographic characteristics and how different pandemic restrictions impacted loneliness. METHOD: We analyzed data from three waves of a Norwegian national higher education student survey (the SHoT-study). Data was examined from 2018 from a total of 49,836 students, 2021 from 62,212 students, and from 2022 from 53,362 (response rates 31-35%). Loneliness was measured by The Three-Item Loneliness Scale (T-ILS). RESULTS: There was a sharp increase in loneliness from 2018 to 2021, and a reduction in levels of loneliness in 2022, although at increased levels compared to prior to the pandemic. Females consistently report higher levels of loneliness than males, with a larger difference during the peak of the pandemic. There were higher rates of loneliness in geographical regions with higher COVID rates and greater pandemic-related restrictions during 2021. Loneliness was lower among students reporting more days on campus in 2021 and for those with lectures on campus in 2022, both with dose-response associations. CONCLUSIONS: Loneliness is a major public health problem among young adults in higher education. Loneliness increased during the pandemic and has decreased but is still not back to pre-pandemic levels. The results suggest the importance of open campuses and in-person lectures, for increased social connectedness among young people.