Aim: Adolescence represent an important period for positive mental health development. The aim of the present paper was to investigate gender differences as well as the level, stability and predictive role of mental health (symptoms of depression/anxiety and mental well-being) and self-esteem in adolescents during a school year.Methods: The study sample consisted of a cohort of 351 students aged 15–21 years in Mid-Norway. In a survey administrated at the beginning and end of the 2016/2017 school year, mental well-being was assessed with Warwick-Edinburgh Mental Well-Being Scale, depression/anxiety with Hopkins Symptom Checklist and self-esteem with the Rosenberg Self-Esteem Scale. Two models were tested for prediction; self-esteem on mental health (vulnerability model) and mental health on self-esteem (scar model).Results: Girls reported significantly higher depression/anxiety than boys and showed a slightly significant increase in depression/anxiety, stress and self-esteem during the two assessments. Boys scored significantly higher on mental well-being and self-esteem and reported stable mental health during the school year. Selfesteem significantly predicted depression/anxiety and mental well-being. Mental well-being and depression/ anxiety also significantly predicted self-esteem.Conclusion: The results suggest that self-esteem and mental health are reciprocally associated. The results underline the gender differences in overall mental health in adolescents and thus the potential importance of acknowledging gender when working on universal strategies for positive mental health development.

By assisting these women in finding new patterns of meaningful occupations that positively affect their everyday life, the study suggests some central elements to be included in future follow-up practice for breast cancer survivors. Approaching this goal, occupational therapists should contribute to more involvement assisting cancer survivors and their partners in finding new patterns of meaningful occupations that positively affect their everyday life.

Background and purpose . The aim of this study was to report on early effects of contemporary radiotherapy (RT) on healthrelated quality of life (HRQOL) and explore treatment-related contributors to the development of fatigue during RT in breast cancer (BC) patients. Material and methods . Consecutive BC patients (n ϭ 248) referred for postoperative RT at St. Olavs University Hospital in Trondheim, Norway were enrolled from February 2007 to October 2008. Clinical-and treatment data were recorded, and HRQOL were assessed before starting (baseline) and immediately after ending RT using the " EORTC QLQ-C30 " and the breast module " EORTC QLQ-BR23 " . Change scores from baseline were calculated. Predictors of increased fatigue during RT were explored with multiple regression analysis adjusted for relevant confounders. Results. The global QOL-and all functional scales remained stable, except for " future perspective " which improved signifi cantly during RT. Breast symptoms and fatigue increased signifi cantly during RT. Groups with elevated baseline fatigue remained more stable during RT than those with lower levels at baseline. The body volume receiving 40 Gy or more (V40) was a signifi cant predictor of increased fatigue during RT adjusted for chemotherapy, comorbidity and age (p ϭ 0.035). Conclusion . Contemporary RT has limited early effects on HRQOL. V40 is a signifi cant predictor of RT-related fatigue.Multimodal treatment has become standard management of most breast cancer (BC) patients [1]. Where multiple treatment modalities are involved, the contribution of each to quality of life and symptoms is diffi cult to quantify [2]. The impact of BC treatment on health-related quality of life (HRQOL) has broadly been reported in relation to surgery techniques [3] and systemic therapies [4]. Improvements of radiotherapy (RT) techniques with more individual treatment plans (contemporary RT) should indicate less adverse effects and impact on HRQOL, but these assumptions have not been documented sufficiently [2,3,5,6]. Limitations of previous studies involve lack of baseline measures [7,8], small study samples [6,9] or older trials with incomparable RT-techniques to current practice [5,10].Fatigue is one of the most frequent and debilitating side effects of BC treatment with adverse effects on quality of life [6,11 -16]. The etiologies of fatigue are multi-factorial and poorly understood and the relative contributions of the various treatment modalities remain unclear [14,17,18]. The association between the severity of fatigue and RT-variables (like dose or dose-volume) has been investigated [13,15], but hampered by limited samples (n ϭ 41 and n ϭ 52). To our knowledge no studies have tested specifi c hypotheses concerning RT-related contributors to fatigue developed during RT.Prospective longitudinal study designs are generally preferred when exploring associations and predictors of post-RT fatigue [11], and baseline-values of fatigue have commonly been adjusted for in regression models [11,14]. However, incl...