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BACKGROUND: Breathlessness is a troublesome and prevalent symptom in the population, but knowledge of related factors is scarce. The aim of this study was to identify the factors most strongly associated with breathlessness in the general population and to describe the shapes of the associations between the main factors and breathlessness. METHODS: A cross-sectional analysis was carried out of the multicentre population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) of adults aged 50 to 64 years. Breathlessness was defined as a modified Medical Research Council breathlessness rating ≥2. The machine learning algorithm extreme gradient boosting (XGBoost) was used to classify participants as either breathless or nonbreathless using 449 factors, including physiological measurements, blood samples, computed tomography cardiac and lung measurements, lifestyle, health conditions and socioeconomics. The strength of the associations between the factors and breathlessness were measured by SHapley Additive exPlanations (SHAP), with higher scores reflecting stronger associations. RESULTS: A total of 28 730 participants (52% women) were included in the study. The strongest associated factors for breathlessness were (in order of magnitude): body mass index ( SHAP score 0.39), forced expiratory volume in 1 s (0.32), physical activity measured by accelerometery (0.27), sleep apnoea (0.22), diffusing lung capacity for carbon monoxide (0.21), self-reported physical activity (0.17), chest pain when hurrying (0.17), high-sensitivity C-reactive protein (0.17), recent weight change (0.14) and cough (0.13). CONCLUSION: This large population-based study of men and women aged 50-64 years identified the main factors related to breathlessness that may be prevented or amenable to public health interventions.

INTRODUCTION: Health-related quality of life (HRQoL) is essential for human wellbeing, influenced by a complex interplay of factors, and is reported lower in women than men. We aimed to evaluate which factors were the most important for HRQoL in a middle-aged general population. METHODS: This was a cross-sectional, multi-centre study of 29,212 men (48%) and women (52%) aged 50-64 in the general population in Sweden. Physical and mental HRQoL (0-100) was assessed using the Short Form 12 questionnaire, and association was evaluated for 356 variables including demographics, lifestyle, symptoms, physiological measurements, and health conditions. Using machine learning, each variable´s importance for HRQoL was measured by an importance score, comparable to effect size, and summarised in 54 factors, in men and women separately. RESULTS: Men and women had similar mean and standard deviation (SD) scores for physical HRQoL (53.4 [SD 8.1] vs 51.4 [9.7]) and mental HRQoL (37.1 [5.0] vs 37.3 [5.4]). The most important factors for physical HRQoL were (importance score) physical activity (40), employment (36), pain (33), sleep (33), and sense of control (26). The most important factors for mental HRQoL were sense of control (18), physical activity (12), depression (12), pain (6), and employment (5). CONCLUSIONS: The factors important for HRQoL identified by this study are likely to be amenable to interventions, and our findings can support prioritising interventions. The identified factors need to be a target even before middle-age to lay the foundation for long and happy lives.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The main funding body of The Swedish CArdioPulmonary bioImage Study (SCAPIS) is the Swedish Heart-Lung Foundation. The study is also funded by the Knut and Alice Wallenberg Foundation, the Swedish Research Council and VINNOVA (Sweden’s Innovation agency) the University of Gothenburg and Sahlgrenska University Hospital, Karolinska Institutet and Stockholm county council, Linköping University and University Hospital, Lund University and Skåne University Hospital, Umeå University and University Hospital, Uppsala University and University Hospital. Introduction Physical activity intensity can be expressed in either absolute (e.g. brisk walking or metabolic equivalents) or relative terms (e.g. proportion of maximal oxygen consumption or perceived exertion) (1). Although intervention studies typically use relative intensity for exercise prescription, large scale observational studies measuring physical activity with accelerometers always use absolute intensity. The association between relative physical activity intensity and cardiometabolic risk factors has not been studied using accelerometry previously. Purpose To compare absolute and relative measures of physical activity intensity in terms of physical activity level and associations with cardiovascular risk factors among individuals with different fitness level. Methods A subsample of the Swedish CArdioPulmonary bioImage Study (SCAPIS), in total 4234 men and women aged 50-64, was analysed (2). Physical activity was measured by accelerometers and the raw data processed with the 10 Hz frequency extended method (FEM) to get a more accurate measure of physical activity intensity compared to previous methods (3). Maximal oxygen consumption (fitness) was estimated by a submaximal ergometer test. Waist to hip ratio, systolic blood pressure, glycated haemoglobin (HBA1c) and high-density lipoprotein to total cholesterol ratio were combined in

Improved clinical care has led to an increase in the number of adults with congenital heart disease (CHD) eng

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Travel time and travel cost are key variables for explaining travel behaviour and deriving the value of time. However, a general problem in transport modelling is that these variables are subject to measurement errors in transport network models. In this paper we show how to assess the magnitude of the measurement errors in travel time and travel cost by latent variables, in a large-scale travel demand model. The case study for Stockholm commuters shows that assuming multiplicative measurement errors for travel time and cost result in a better fit than additive ones, and that parameter estimates of the choice model are impacted by some of the key modelling assumptions. Moreover, our results suggest that measurement errors in our dataset are larger for the travel cost than for the travel time, and that measurement errors are larger in self-reported travel time than software-calculated travel time for car-driver and car-passenger, and of similar magnitude for public transport. Among self-reported travel times, car-passenger has the largest errors, followed by car-driver and public transport, and for the software-calculated times, public transport exhibits larger errors than car. These errors, if not corrected, lead to biases in measures derived from the models, such as elasticities and values of travel time., QC 20190205

Correspondence Address: Bastian, A.; Department for Transport Science, KTH Royal Institute of TechnologySweden; email: anne.bastian@abe.kth.se. QC 20170306

People with rheumatoid arthritis (RA), often associated with psychosocial problems and reduced quality of life, benefit from the guidance of trained medical social workers. This study explores the effectiveness of psychosocial treatment in patients with RA using a structured interview to detect psychosocial problems for 100 patients. These individuals were offered regular sessions with a medical social worker. Three types of mixed-problems were found: mixed problems related to RA, mixed problems related to the life situation, and mixed problems related to a combination of RA and the life situation. The RA patients who reported mixed-problems at time of their diagnosis received psychosocial treatment from a medical social worker regardless of the mixed problems they experienced. In addition, we found that disease-related mixed problems seemed more treatable than other problems. Social work in somatic healthcare seems most successful in patients with sickness-related social and psychosocial problems.

BACKGROUND: Studies have reported that early physical rehabilitation after surgical procedures is associated with improved outcome measured as shorter hospital stay and enhanced recovery. The aim of this study was to explore the relationship between the preoperative physical activity level and subsequent postoperative complications, sick-leave and hospital stay after radical prostatectomy for prostate cancer in the setting of the LAPPRO trial (LAParoscopic Prostatectomy Robot Open). METHODS: LAPPRO is a prospective controlled trial, comparing robot-assisted laparoscopic and open surgery for localized prostate cancer between 2008 and 2011. 1569 patients aged 64 or less with an occupation were included in this sub-study. The Gleason score was <7 in 52 % of the patients. Demographics and the level of self-assessed preoperative physical activity, length of hospital stay, complications, quality of life, recovery and sick-leave were extracted from clinical record forms and questionnaires. Multivariable logistic regression, with log-link and logit-link functions, was used to adjust for potential confounding variables. RESULTS: The patients were divided into four groups based on their level of activity. As the group with lowest engagement of physical activity was found to be significantly different in base line characteristics from the other groups they were excluded from further analysis. Among patients that were physically active preoperativelly (n = 1467) there was no significant difference between the physical activity-groups regarding hospital stay, recovery or complications. However, in the group with the highest self-assessed level of physical activity, 5-7 times per week, 13 % required no sick leave, compared to 6.3 % in the group with a physical activity level of 1-2 times per week only (p < 0.0001). CONCLUSIONS: In our study of med operated with radical prostatectomy, a high level of physical activity preoperatively was associated with reduced need for sick, CC BY 4.0Funders: Gothenburg Medical Society; Sahlgrenska University Hospital, 146201; Tornspiran Foundation; Mrs Mary von Sydow Foundation

Purpose This cross-sectional observational study examined the degree to which cardiorespiratory fitness (CRF) and self-perceived stress are associated with cardiometabolic risk factors and the overall risk score for cardiovascular diseases. The second aim was to determine whether participants' CRF levels moderate the relationships between stress and cardiometabolic risk.Methods A gender-matched stratified sample (N = 197, 51% men, M-age = 39.2 yr) was used to ensure that participants with varying stress levels were equally represented. CRF was assessed with the angstrom strand bicycle test, and perceived stress was assessed with a single-item question. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), glycated hemoglobin, and total cardiometabolic risk score (sum of the z-standardized residuals of the previously mentioned indicators) were assessed as outcomes.Results Higher LDL-C, TG, and total metabolic risk were found in participants with high stress scores (P < 0.05). In addition, lower SBP, DBP, BMI, LDL-C, TG, and total metabolic risk were observed in participants with high CRF (P < 0.05). Two-way ANCOVA provided significant interaction effects for five of the nine outcome variables (P < 0.05, 3.6%-4.8% of explained variance). Participants with high stress who also had high CRF levels had lower SBP, DBP, LDL-C, TG, and total cardiometabolic risk than participants with high stress but low or moderate CRF levels. No significant main or interaction effects occurred for BMI, total cholesterol, high-density lipoprotein cholesterol, and glycated hemoglobin.Conclusion Better CRF is associated with more favorable levels of several cardiometabolic risk factors, specifically in participants experiencing high stress. Higher CRF may provide some protection against the health hazards of high chronic stress

Issues concerning risks in the military have gained increased attention within the Swedish Armed Forces, particularly relating to the new focus on an all voluntary force participating in international missions. Military activities inevitably include an element of calculated risk-taking, while at the same time the unnecessary taking of risks must be minimized. Within the context of the specific mission and situation, a number of factors relating to demographic variables, traits and beliefs may influence individual inclinations towards risk behaviour. The purpose of this study was to examine the relationship between such factors and individual risk propensity. Data were collected from two samples of Swedish soldiers and officers. Examining demographic variables, negative safety values and risk propensity were found to decrease with age, while men demonstrated a more sceptical view of safety measures and a higher risk propensity than women. The trait known as lack of deliberation, reflecting an inability to think ahead and foresee consequences, was positively related to risk propensity. A more sceptical view of safety was shown to be associated with a higher sense of personal invincibility and together with lack of deliberation predicted variations in danger-seeking scores. The distinction between functional and non-functional risk-taking is discussed on the basis of the relationships found in the study. Implications for recruitment to the military as well as for training and leadership are suggested, emphasizing the need for military leaders to balance their leadership in terms of safety-oriented and risk-promoting behaviours.