Our results suggest that education and physical workload factors appear to be the major reasons for excess disability retirement as a result of hip OA in manual occupations, particularly among men.

Background Highly utilized risk scores for clinically relevant postoperative pancreatic fistula (CR-POPF) have guided clinical decision-making in pancreatoduodenectomy. However, none has been successfully developed for distal pancreatectomy. This study aimed to develop and validate a new fistula risk score for distal pancreatectomy. Methods Patients undergoing distal pancreatectomy at Helsinki University Hospital, Finland from 2013 to 2021, and at Karolinska University Hospital, Sweden, from 2010 to 2020, were included retrospectively. The outcome was CR-POPF, according to the 2016 International Study Group of Pancreatic Surgery definition. Preoperative clinical demographics and radiological parameters such as pancreatic thickness and duct diameter were measured. A logistic regression model was developed, internally validated with bootstrapping, and the performance assessed in an external validation cohort. Results Of 668 patients from Helsinki (266) and Stockholm (402), 173 (25.9 per cent) developed CR-POPF. The final model consisted of three variables assessed before surgery: transection site (neck versus body/tail), pancreatic thickness at transection site, and diabetes. The model had an area under the receiver operating characteristic curve (AUROC) of 0.904 (95 per cent c.i. 0.855 to 0.949) after internal validation, and 0.798 (0.748 to 0.848) after external validation. The calibration slope and intercept on external validation were 0.719 and 0.192 respectively. Four risk groups were defined in the validation cohort for clinical applicability: low (below 5 per cent), moderate (at least 5 but below 30 per cent), high (at least 30 but below 75 per cent), and extreme (75 per cent or more). The incidences in these groups were 8.7 per cent (11 of 126), 22.0 per cent (36 of 164), 63 per cent (57 of 91), and 81 per cent (17 of 21) respectively. Conclusion The DISPAIR score after distal pancreatectomy may guide decision-making and allow a risk-adjusted outcome comparison for CR-POPF.

ObjectivesTo examine the association of education and physical work load factors on the occupational differences in disability retirement due to knee osteoarthritis (OA).DesignLongitudinal study.SettingLinkage of several nationwide registers and a job exposure matrix in Finland.ParticipantsA total of 1 135 654 Finns aged 30–60 years in gainful employment were followed from 2005 to 2013 for full disability retirement due to knee OA.Primary and secondary outcome measuresWe calculated age-adjusted incidence rates and examined the association of occupation, education and physical work load factors with disability retirement using competing risk regression model. Disability retirement due to other causes than knee OA, old-age retirement and death were treated as competing risk.ResultsA total of 6117 persons had disability retirement due to knee OA. Women had a higher age-adjusted incidence rate than men (72 vs 60 per 100 000 person-years, respectively). In men, a very high risk of disability retirement was found among construction workers, electricians and plumbers (HR 16.6, 95% CI 12.5 to 22.2), service workers (HR 12.7, 95% CI 9.2 to 17.4) and in women among building caretakers, cleaners, assistant nurses and kitchen workers (HR 15.5, 95% CI 11.7 to 20.6), as compared with professionals. The observed occupational differences were largely explained by educational level and noticeably mediated by physical work load factors in both genders.ConclusionOur observational study suggests that the risk of disability retirement among manual workers is strongly attributed to the physically heavy work.

Objective.To examine to what extent disabling osteoarthritis (OA), leading to a prolonged sickness absence (SA), interferes with work participation and shortens working life–years.Methods.A total of 4704 wage earners aged 30 to 59 years, whose SA due to OA started in 2006, were followed until October 31, 2014. Kaplan–Meier analysis was used to plot sustained (at least 28 consecutive days) return-to-work curves. The associations of potential determinants with early exit from paid employment were examined applying Cox proportional hazards regression analysis. Years expected to be spent in different work participation statuses until statutory retirement age were estimated based on daily work participation statuses using adapted Sullivan method.Results.Persons with knee OA showed the fastest, and persons with hip OA the slowest, sustained return to work. Although most participants typically were at work during the first year of followup, a considerable proportion was permanently retired. Male sex, older age, low education, long initial SA, and having not returned to work sustainably, as well as receiving vocational rehabilitation, predicted early exit from paid employment during the followup. Overall, only 45–53% of potential working life–years were estimated to be spent at work, being highest for the oldest age group.Conclusion.Our study showed a considerable effect of OA on work participation and working life duration. Clinicians should avoid prescription of long SA or temporary work disability due to OA without a clear treatment or return-to-work plan.