Adolescent mental health and cardiorespiratory fitness: A comparison of two cohorts 12 years apart.

The aim of the study was to compare the mental health and cardiorespiratory fitness (CRF) of adolescents in two cross-sectional cohorts, one measured in 2003 and the other in 2015, both at age 15 and across sexes. The study also sought to estimate the association between mental health and CRF in the two cohorts and examine the relationship between the level of CRF and mental health in each cohort overall and by sex. Data from 443 participants born in 1988 (228 males, 215 females) and 303 participants born in 1999 (126 males, 177 females) were analyzed. Mental health was assessed using self-reports of body image, self-esteem, and symptoms of depression and anxiety. CRF was estimated using a maximal cycle ergometer test. From 2003 to 2015, body image scores improved (p = .043), self-esteem remained stable, and CRF declined significantly (p < .001). No self-esteem differences were observed between sexes in any cohort. Males had higher CRF and body image scores than females in both cohorts (p < .001 for all comparisons). Higher CRF correlated with fewer depressive symptoms across sexes and cohorts. Specifically, higher CRF was associated with anxiety in females and improved body image in males (2003) and both sexes (2015). Increased CRF was linked to higher self-esteem in females but not in males. Overall, higher CRF levels were associated with better mental health outcomes for both sexes. These results highlight the potential of improving adolescent mental health through increased physical fitness.

Changes in health-related lifestyle choices of university students before and during the COVID-19 pandemic: Associations between food choices, physical activity and health.

The COVID-19 pandemic has had a profound effect on our lives and society, influencing both individuals' lifestyles and habits. Recent research shows that anxiety and loneliness have continued to rise, along with changes in food and lifestyle choices. The aim of the study was to investigate whether the pandemic influenced food choices and consumption of energy drinks, alcohol, fruits, and vegetables among first-year university students. Additionally, assessing the relationship between mental and physical health, physical activity, and food choices. A total of 128 male and 128 female first-year students at the University of Iceland were invited to answer an electronic questionnaire in January and early February 2021. A total of 118 students (54% men) participated in the study and valid answers were 115 (46% participation rate). Almost half of the students (44%) experienced that their food choices had worsened, while 14% reported an improvement, compared to before the pandemic. Consumption of caffeinated beverages increased for 26% of students, while 19% experienced a decrease. Just over half of the students reported not drinking alcohol (13%) or reduced consumption (41%). Participants who reported that their mental health had deteriorated or remained the same tended to spend less time on physical activity and experienced worsened food choices (p<0.05). Similarly, those who spent less or the same time on physical activity estimated that their food choices had deteriorated (p<0.05). The COVID-19 pandemic has had a significant impact on the lifestyles of university students and this study has revealed how lifestyle choices and mental health seem to be highly affected by one another. Additionally, the potentially harmful effects of excessive intake of energy drinks need to be enhanced. Interestingly, about 40% of the respondents in the current study drank less alcohol during the pandemic than prior to the pandemic, indicating a strong relationship between alcohol drinking and social gatherings. This study reveals the importance of educating young people on healthy lifestyle choices and the importance of mental health needs to be emphasised.

The relationship between online communication and adolescents' mental health: Long-term evaluation between genders.

AIMS: In a relatively short time, online communication has become an important part of adolescents' lives, and concerns have been raised about its potential effects on mental health. The first aim was to compare mental health status and online communication in 15-year-old Icelanders born in 1988 and in 1994. The second aim was to assess whether the relationship between online communication and mental health has changed among 15-year-old Icelanders from 2003 to 2015 across genders. METHODS: Analysis used data from self-reports from 2003 (N=385, 51% males) and 2015 (N=302, 42% males). Mental health was assessed with subscales of Symptom Checklist 90 and online communications with self-reports. To evaluate the difference in anxiety and depression, a factorial analysis of variance was conducted between gender and years. Multigroup structural equation modelling was used to assess the change in the relationship between years. RESULTS: Symptoms of anxiety and depression remained unchanged for males. Symptoms of depression increased for females, while anxiety was stable between 2003 and 2015. In 2003, there was no relationship between online communication and mental health. However, in 2015, an association was found for females. CONCLUSIONS: Depression is getting worse for adolescent females, and an association between time spent online communicating and mental health emerged for them in 2015, which did not exist in 2003. These findings add to the possibility that online communication is harmful for mental health, but more detailed studies are still needed.

New reimbursement model in Icelandic primary care in 2017: first-year comparison of public and private primary care.

OBJECTIVE: To analyze and compare the effect of a new reimbursement model (based on a modified version of the Swedish free choice reform) on private and public primary care in Iceland during its first year of use. DESIGN: Descriptive comparison based on official data from the Ministry of Welfare, Directorate of Health, and the Icelandic Health Insurance on payments in the Icelandic primary care system. SETTING: Primary care system operating in the Reykjavik capital area. Public primary care has dominated the Icelandic health sector. Both public and private primary care is financed by public taxation. SUBJECTS: Fifteen public and four private primary care centers in the capital region. MAIN OUTCOME MEASURES: Different indexes used in the reimbursement model and public vs. private primary care costs. RESULTS: No statistically significant cost differences were found between public and private primary care centers regarding total reimbursements, reimbursements per GP, number of registered patients, or per visit. Two indexes covered over 80% of reimbursements in the model. CONCLUSION: The cost for Icelandic taxpayers was equal in numerous indexes between public and private primary care centers. Only public centers got reimbursements for the care need index, which considers a patient's social needs, strengths, and weaknesses.KEY POINTSThe Icelandic primary care system underwent a reform in 2017 to improve availability and quality. A new reimbursement model was introduced, and two new private centers opened following a tender.Two out of 14 indexes cover over 80% of total reimbursements from the new model.Only 5 primary care centers, all publicly driven, got reimbursement for the care need index, which is a social deprivation index.Reimbursement systems should mirror the policies of health authorities and empower the workforce.

Health and well-being of university students before and during COVID-19 pandemic: A gender comparison.

OBJECTIVE: COVID-19 has affected people's health in various ways. University students are a particularly sensitive group for mental and physical health issues. The aim of this study was to assess and compare the mental and physical health of male and female first-year university students during and before COVID-19. METHOD: Total of 115 first-year university students (54% male) answered questions about mental and physical health. The students were asked to estimate their physical activity, sedentary behavior, loneliness, stress, and sleep quality during COVID-19 opposed to before the pandemic. RESULT: Males had fewer symptoms of anxiety and depression, and their self-esteem was higher than females (p<0.05). Over 50% of both genders estimated their mental health to be worse than before COVID-19. Larger proportion of males (69%) compared to females (38%) estimated that their physical health had worsened than before the pandemic. Larger proportion of females (38%) than males (14%) experience increased loneliness and stress (68% vs. 48%). Over 70% of both genders estimated increased sedentary behavior than before the pandemic, and larger proportion of males (76%), compared to females (56%), estimated that they were less physically active than before COVID-19. About 50% of participants estimated their sleep quality was worse than before COVID-19. CONCLUSION: University students estimated their mental and physical health to have deteriorated during the pandemic. Therefore, it is important that the school and healthcare systems assist students in unwinding these negative health and lifestyle changes that have accompanied the pandemic.

Prevalence, mental health and substance use of anabolic steroid users: a population-based study on young individuals.

Aims: The use of anabolic androgen steroids to enhance performance is not a modern phenomenon. However, the majority of today's anabolic androgen steroid users are not competitive athletes, but individuals who want to look leaner and muscular. This study aimed to examine the prevalence of anabolic androgen steroid use among young individuals and assess whether their mental health, lifestyle and substance use differ from non-anabolic androgen steroid users. Methods: A population-based study conducted in secondary schools, mean age was 17.3 years. A total of 10,259 participants (50% young women, 1% reported gender as 'other', 49% young men) answered questions on mental health, anabolic androgen steroid use, substance use and sports participation. Statistical analysis included descriptive statistics, t-test, χ2 and logistic regression. Results: The prevalence of anabolic androgen steroid use was 1.6%, and 78% of users were young men. Anabolic androgen steroid users had more anger issues, anxiety, depression, and their self-esteem was lower than among non-anabolic androgen steroid users (P<0.05). A larger proportion of anabolic androgen steroid users, 30%, had attempted suicide compared to 10% of non-users (χ2 (1, 9580) = 57.5, P<0.001). Proportionally, anabolic androgen steroid users were more likely to take medicine for mental health problems and misuse substances than non-users. Participation in non-organised sports, increased anger and body image were associated with increased odds of using anabolic androgen steroids. Conclusions: Anabolic androgen steroid use is a public health threat. It had an alarming effect on the life of individuals who report having used anabolic androgen steroids. Authorities, healthcare workers, parents and others working with young people need to be informed of the signs and risks of anabolic androgen steroid use to reduce future negative implications.

Association between free-living sleep and memory and attention in healthy adolescents.

In laboratory studies, imposed sleep restriction consistently reduces cognitive performance. However, the association between objectively measured, free-living sleep and cognitive function has not been studied in older adolescents. To address this gap, we measured one week of sleep with a wrist-worn GT3X+ actigraph in 160 adolescents (96 girls, 17.7 ± 0.3 years) followed by assessment of working memory with an n-back task and visual attention with a Posner cue-target task. Over the week, participants spent 7.1 ± 0.8 h/night in bed and slept 6.2 ± 0.8 h/night with 88.5 ± 4.8% efficiency and considerable intra-participant night-to-night variation, with a standard deviation in sleep duration of 1.2 ± 0.7 h. Sleep measures the night before cognitive testing were similar to weekly averages. Time in bed the night before cognitive testing was negatively associated with response times during the most challenging memory task (3-back; p = 0.005). However, sleep measures the night before did not correlate with performance on the attention task and weekly sleep parameters were not associated with either cognitive task. Our data suggests shorter acute free-living sleep may negatively impact difficult memory tasks, however the relationship between free-living sleep and cognitive task performance in healthy adolescents is less clear than that of laboratory findings, perhaps due to high night-to-night sleep variation.

Changes in sleep and activity from age 15 to 17 in students with traditional and college-style school schedules.

OBJECTIVES: Sleep duration and physical activity decline with age during adolescence. Earlier school schedules may contribute to these declines. The aim of this longitudinal study was to track changes in sleep and activity of Icelandic youth from primary to secondary school and compare students who enrolled in secondary schools with traditional and college-style schedules. METHODS: We measured free-living sleep and activity with wrist actigraphy and body composition by dual-energy x-ray absorptiometry in 145 students at age 15 and age 17, when 58% attended schools with college-style scheduling. Differences from 15 to 17 and between students of different school structures were assessed with mixed-effect models. RESULTS: Actigraphs were worn for 7.1 ± 0.4 nights at 15 and 6.9 ± 0.4 nights at 17. Overall, sleep duration decreased from 6.6 ± 0.7 h/night to 6.2 ± 0.7 h/night from age 15 to 17 (P < .001). Students with traditional schedules reduced school-night sleep duration 26 min/night at follow-up (P< .001), while sleep duration did not change for college-style students. All students went to bed later on school nights at follow-up, but only college-style students rose later. Sleep efficiency and awakenings did not differ by schedule-type. Neither sex changed body fat percentage, but average school-day activity decreased by 19% (P< .001) on follow-up and did not differ by schedule-type. CONCLUSIONS: Over the 2-year period, adolescents decreased weekly sleep duration and activity, but only those continuing traditional schedules reduced school-night sleep. This suggests greater individual control of school schedule may preserve sleep duration in this age group, which may be beneficial during the transition into adulthood.

Longitudinal Change in Adolescent Bedtimes Measured by Self-Report and Actigraphy.

INTRODUCTION: Sleep is often quantified using self-report or actigraphy. Self-report is practical and less technically challenging, but prone to bias. We sought to determine whether these methods have comparable sensitivity to measure longitudinal changes in adolescent bedtimes. METHODS: We measured one week of free-living sleep with wrist actigraphy and usual bedtime on school nights and non-school nights with self-report questionnaire in 144 students at 15 y and 17 y. RESULTS: Self-reported and actigraphy-measured bedtimes were correlated with one another at 15 y and 17 y (p < .001), but reported bedtime was consistently earlier (>30 minutes, p < .001) and with wide inter-method confidence intervals (> ±106 minutes). Mean inter-method discrepancy did not differ on school nights at 15 y and 17 y but was greater at 17 y on non-school nights (p = .002). Inter-method discrepancy at 15 y was not correlated to that at 17 y. Mean change in self-reported school night bedtime from 15 y to 17 y did not differ from that by actigraphy, but self-reported bedtime changed less on non-school nights (p = .002). Two-year changes in self-reported bedtime did not correlate with changes measured by actigraphy. CONCLUSIONS: Although methods were correlated, consistently earlier self-reported bedtime suggests report-bias. More varied non-school night bedtimes challenge the accuracy of self-report and actigraphy, reducing sensitivity to change. On school nights, the methods did not differ in group-level sensitivity to changes in bedtime. However, lack of correlation between bedtime changes by each method suggests sensitivity to individual-level change was different. Methodological differences in sensitivity to individual- and group-level change should be considered in longitudinal studies of adolescent sleep patterns.

Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents.

OBJECTIVE: Few studies have explored the potential interrelated associations of screen time and physical activity with mental health in youth, particularly using objective methods. We examined cross-sectional associations of these variables among Icelandic adolescents, using objective and subjective measurements of physical activity. METHODS: Data were collected in the spring of 2015 from 315 tenth grade students (mean age 15.8 years) in six elementary schools in metropolitan Reykjavík, Iceland. Participants reported, via questionnaire, on demographics, weekly frequency of vigorous physical activity, daily hours of screen time and mental health status (symptoms of depression, anxiety and somatic complaints, self-esteem and life satisfaction). Total physical activity was measured over one week with wrist-worn accelerometers. Body composition was determined by DXA-scanning. Poisson regression analysis was used to explore independent and interactive associations of screen time and physical activity with mental health variables, adjusting for gender, body fat percentage and maternal education. RESULTS: Less screen time (below the group median of 5.3 h/day) and more frequent vigorous physical activity (≥4x/week) were each associated with reporting fewer symptoms of depression, anxiety, low self-esteem, and life dissatisfaction. No significant associations were observed between objectively measured physical activity and mental health outcomes. Interactive regression analysis showed that the group reporting both less screen time and more frequent vigorous physical activity had the lowest risk of reporting symptoms of depression, anxiety, low self-esteem, and life dissatisfaction. CONCLUSIONS: Reports of less screen time and more frequent vigorous physical activity were associated with lower risk of reporting mental health problems among Icelandic adolescents. Those who reported a combination of engaging in less screen time and more frequent vigorous physical activity had the lowest risk, suggesting a synergistic relationship between the two behaviors on mental health outcomes. Our results support guiding youth towards more active and less sedentary/screen-based lifestyle.

Sleep deficiency on school days in Icelandic youth, as assessed by wrist accelerometry.

AIMS: The purpose of this study was to objectively measure, with wrist-worn actigraphy, free-living sleeping patterns in Icelandic adolescents, and to compare sleep duration, sleep quality and clock times between school days (SchD) and non-school days (NSchD) and the association between sleep and body mass index (BMI). METHODS: A cross-sectional study on 15.9-year-old (±0.3) adolescents from six schools in Reykjavík, Iceland, took place in the spring of 2015. Free-living sleep was measured on 301 subjects (122 boys and 179 girls) over seven days using wrist-worn actigraphy accelerometers. Total rest time (TRT), total sleep time (TST), sleep quality markers, and clock times for sleep were quantified and compared between SchD and NSchD and between the sexes, using paired and group t-tests as appropriate. Linear regression was used to assess the association between sleep parameters and BMI. RESULTS: On SchD, TST was 6.2 ± 0.7 h, with sleep efficiency (SLE) of 87.9 ± 4.4% for the group. On NSchD, TST increased to 7.3 ± 1.1 h (p < 0.001), although SLE decreased to 87.4 ± 4.7% (p < 0.05). On SchD and NSchD, 67% and 93% had bed times after midnight, respectively, and on SchD 10.7% met sleep recommendations (8 h/night). There was no association between BMI and average sleep parameters. CONCLUSION: The majority of Icelandic adolescents did not get the recommended number of hours of sleep, especially on SchD. While TST increased on NSchD, many participants still did not achieve the recommendations. These findings provide information on the sleep patterns of adolescents and may serve as reference for development of policies and interventions to promote better sleep practices.

[General practice in Iceland and Norway: GP's experience of different primary health care systems].

INTRODUCTION: Most GPs in Iceland are public employees on fixed salaries which is very different from their Norwegian colleagues. The aim of this study was to explore the experience of Icelandic GPs who have also worked as GPs in Norway and compare their experience of working in these two neighboring countries. MATERIAL AND METHODS: Data were collected through interviews with 16 GPs that during the study period 2009-2010 were all working in Iceland. Two to ten years had passed since their return from Norway. We used qualitative methodology, the Vancouver-School of doing phenomenology. This methodology seeks to increase understanding of human phenomena for the purpose of improving healthcare services. RESULTS: The doctors discussed the benefits of the different systems of delivering medical services. They saw the advantages of the Norwegian healthcare system mostly in that all Norwegians have their own GP, thus achieving a good overview of the health problems of each individual. The GPs are gatekeepers for medical services which potentially -reduces duplication of medical services. The participants also noted more efficient medical services in Norway than in Iceland. What characterizes Icelandic healthcare outside the hospital from their perspective is direct patient contact with specialists without referrals from GPs and incomplete registration system of patients and much use of emergency services in Iceland. CONCLUSION: Participants agreed upon stronger primary healthcare system in Norway compared to Iceland. Moreover, a good job situation in primary care is needed in Iceland to appeal to junior doctors. When changes are made to the Icelandic healthcare system it is important to acknowledge the experience of neighboring countries in terms of advancing health care system reforms. Key words: general practitioner, primary care, job situation, health service research, qualitative research. Correspondence: Hedinn Sigurdsson, hedinn.sigurdsson@heilsugaeslan.is.

[The effects of physical activity intervention on symptoms in schizophrenia, mental well-being and body composition in young adults]. / Áhrif hreyfiíhlutunar á einkenni geðklofa, andlega líðan og líkamssamsetningu hjá ungu fólki.

INTRODUCTION: Due to an unhealthy lifestyle, individuals with schizophrenia are at higher risk of morbidity compared to the general population. Studies have shown that physical activity can have positive effects on physical and mental health in these patients. The aim of the study was to evaluate the effects of a physical activity intervention on symptoms of schizophrenia, as well as on a number of physical and mental health variables. The aim was also to gain more understanding of the participants´ experience of the intervention with interviews. MATERIAL AND METHODS: Seventeen individuals between the ages of 21-31, diagnosed with schizophrenia participated in the study. They exercised under professional supervision for a minimum of two sessions per week for 20 weeks and attended weekly lectures on a healthy lifestyle. The participants answered standardized questionnaires (PANSS, DASS, Rosenberg, CORE-OM, BHS, QOLS), and physical measurements (weight, height, body mass index, resting blood pressure, waist circumference and resting heart rate) were taken before and after the intervention. Six participants were interviewed after the intervention and asked about their experience. RESULTS: Negative and general psychiatric symptoms, depression, anxiety and stress scores decreased significantly whereas well-being, quality of life and physical activity increased (p<0.05). Apart from resting heart rate that decreased (p<0.05), physical measurements remained unchanged at the end of the intervention. CONCLUSION: The participants´ physical activity increased, their mental well-being improved, and they did not gain weight during the intervention period. Regular exercise under supervision and education about a healthy lifestyle are a beneficial adjunct to the primary treatment of people with schizophrenia.

Gender differences in development of mental well-being from adolescence to young adulthood: an eight-year follow-up study.

BACKGROUND: The transition from adolescence to young adulthood is marked by many changes. Mental well-being plays an important role in how individuals deal with these changes and how they develop their lifestyle. The goal of this study was to examine gender differences in the long-term development of self-esteem and other mental well-being variables from the age of 15 to the age of 23. METHODS: A baseline measurement was performed in a nationwide sample of 385 Icelandic adolescents aged 15, and a follow-up measurement was conducted eight years later, when participants had reached the age of 23. Standardized questionnaires were used to measure self-reports of self-esteem, life satisfaction, body image, anxiety, depression and somatic complaints. RESULTS: Women improved their self-esteem significantly more than men from the age of 15 to 23 (p=0.004). Women were more satisfied with their life than men at the age of 23 (p=0.009). Men had a better body image, less anxiety, less depression and fewer somatic complaints than women, independent of age. Across gender, anxiety declined and somatic complaints became fewer (p<0.05). CONCLUSIONS These findings suggest that gender differences in mental well-being factors, favouring men, found in adolescents, are not as long-lasting as previously thought. Women improve their mental well-being from adolescence to young adulthood while men's mental well-being does not change.