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  1. Keith Palmer, Editor


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    Climate change is predicted not only to increase the average temperature of our planet but also to increase the frequency of extreme weather events, including very hot and very cold spells of weather. Controversy exists as to the net impact on mortality and whether declines in cold-related mortality will offset increases in heat-related mortality. Medina-Ramón et al explored this question in a case-crossover study using daily mortality and weather data related to over 6.5 million deaths across 50 US cities during 1989–2000.1 Mortality increases were found with both extremes of cold and heat. A homogeneous impact was found with cold, even though cities differed in their climates. However, heat effects were largest in cities with mild summers, less air conditioning and a high population density. The authors estimate that deaths from heat are unlikely to be compensated for by a decline in excess winter mortality.


    Prevention of premature ill-health retirement is an important goal, nowhere more so than in the arduous construction industry. de Boer et al investigated whether a counselling and education programme is effective in improving work capability and reducing disability pensioning in a cohort of construction workers at high risk of disability.2 In the intervention group, 42% of participants successfully completed the programme. In comparison with a control group receiving care as usual, only small improvements were found as assessed by the Work Ability Index and no meaningful reduction in work disability pensions. The evidence base on factors affecting changes in work capability is limited—a point emphasised in a second paper by the same research group focusing especially on sicklisted employees with heart, back and psychological problems.3 A systematic literature review found a dearth of evidence over the period 1990–2006 and this information gap seems important to fill.


    Most research on work and knee osteoarthritis has focused on the physical loading of work activities rather than organisational policies to accommodate and ameliorate the impact of health problems (eg switching to lighter work, paid sick leave). Chen et al report that those in workplaces with better policies tend to report significantly fewer knee symptoms, with differences apparent in relation to policies of accommodating job switching, paid sick leave and payment of disability benefits.4 Symptomatic and asymptomatic knee osteoarthritis were also less prevalent in workplaces with benevolent policies. Such policies may carry a health benefit but another possibility is that selection forces could be operating to remove affected workers in these settings. The authors call, therefore, for further targeted longitudinal research.


    This month's Journal also includes a study of depleted uranium in UK military personnel serving in the Iraq conflict,5 an analysis of mortality from Alzheimer's disease and motor neuron disease in electricity generation and transmission workers6 and a study of end-stage renal disease and its relation to selected solvents and occupations.7