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The growing prevalence of chronic disabling diseases, such as OA, jeopardizes any effort to prolong the working life of the labour force of modern societies. In spite of this, research about the effect of OA on work participation and its economic burden is still lacking [14, 15].

Regarding the case definition for the main outcome, individuals were asked directly about their employment status and all those who did not report any kind of paid work (part- or full-time), including students, housekeepers or anyone without a regular salary; as well as those in official early retirement or disability pensions, were included in the early exit from paid employment group. All those reporting any form of regularly paid work were considered employed. This definition was used elsewhere in earlier research [1, 26].

OA generates disabling pain, which might push patients to leave work prematurely [14]. We captured pain through alternative measures (i.e. pain interference, bodily pain item from the SF-36 questionnaire, and self-reported longstanding musculoskeletal pain) and, as expected, OA patients consistently report more pain than others without the condition. In addition, we observed a relation between pain and withdrawal from employment. This is consistent with the literature [32, 35, 36]. For instance, Dibonaventura et al., using data from the US National Health and Wellness Survey, have shown that individuals with OA pain were less likely to be employed relative to workers without OA pain [35]. We also detected that OA patients with higher levels of disability, measured by high scores of HAQ, were at the highest risk of early exit from work. This also aligns with earlier research [37, 38] and with the etiological model adopted, which assumes that OA generates pain, impairment, and disability that may ultimately lead to work withdrawal. Thus, we confirmed in our research and study population that pain and disability are key factors for job loss driven by OA.

It would be valuable to further explore if this occurs because labour market policies are restricting early retirement in this sort of patients (e.g. formal rejection of early retirement applications to Social Security from employees with OA) or if other reasons are taking the lead instead. This finding highlights the need to target research and integration-oriented policies toward unemployment generated by OA. More knowledge in this area may produce employment gains since premature retirement restriction policies by themselves are insufficient to mitigate the job losses, as alternative routes may take place as seen herein in the OA case. Although unemployment benefits may be time limited, from the societal perspective these pathways of early exit from work embody the same economic burden (i.e. identical productivity losses), and therefore strategies that simply push individuals from one route to another are truly not socially efficient.

This study has several strengths as well. It is based on the largest population-based study about rheumatic diseases ever performed in Portugal (i.e. high external validity). It uses confirmed diagnosis of OA done by rheumatologists (i.e. very strict and controlled case definition). To our knowledge, this must be amongst the few studies focusing on indirect costs of OA based on such a representative sample specifically dedicated to rheumatic and musculoskeletal conditions, a sample that is likely to accurately reflect this particular type of economic impact on society. It will certainly facilitate future research on the cost-effectiveness of interventions targeting reduced work ability due to OA.

This population-based study unveils the impact of the association between OA and early exit from paid employment. It describes the high economic burden underlying this association. The findings justify giving more attention to OA when discussing policies facing the ageing of higher income countries. The depreciation in the stock of human capital due to OA is already extensive, and given the demographic and epidemiological trends, it may even worsen if nothing is done. This research should provide important evidence for decision makers to prioritize investments in health and policies targeting patients with OA.

The effect of Tofu (bean curd) ingestion on uric acid metabolism was examined in 8 healthy and 10 gout subjects. Ingestion of Tofu increased plasma concentration of uric acid, together with increases in uric acid clearance and urinary excretion of uric acid. However, the increase in plasma concentration of uric acid was fairy small. Interestingly, no significant rise in the plasma, urinary and clearance of uric acid was observed in gout patients with uric acid clearance > 6.0 mL/min (lower normal limit). The results suggest that Tofu is a preferable source of protein, especially in gout patients with uric acid clearance > 6.0 mL/min.

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Abstract. The sinking and decomposition of particulate organic matter are critical processes in the ocean's biological pump, but are poorly understood and crudely represented in biogeochemical models. Here we present a mechanistic particle remineralization and sinking model (PRiSM) that solves the evolution of the particle size distribution with depth. The model can represent a wide range of particle flux profiles, depending on the surface particle size distribution, the relationships between particle size, mass and sinking velocity, and the rate of particle mass loss during decomposition. The particle flux model is embedded in a data-constrained ocean circulation and biogeochemical model with a simple P cycle. Surface particle size distributions are derived from satellite remote sensing, and the remaining uncertain parameters governing particle dynamics are tuned to achieve an optimal fit to the global distribution of phosphate. The resolution of spatially variable particle sizes has a significant effect on modeled organic matter production rates, increasing production in oligotrophic regions and decreasing production in eutrophic regions compared to a model that assumes spatially uniform particle sizes and sinking speeds. The mechanistic particle model can reproduce global nutrient distributions better than, and sediment trap fluxes as well as, other commonly used empirical formulas. However, these two independent data constraints cannot be simultaneously matched in a closed P budget commonly assumed in ocean models. Through a systematic addition of model processes, we show that the apparent discrepancy between particle flux and nutrient data can be resolved through P burial, but only if that burial is associated with a slowly decaying component of organic matter such as might be achieved through protection by ballast minerals. Moreover, the model solution that best matches both data sets requires a larger rate of P burial (and compensating inputs) than have been previously estimated. Our results imply a marine P inventory with a residence time of a few thousand years, similar to that of the dynamic N cycle. 041b061a72


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