This week in the BMJ
Volume 333, Number 7558, Issue of 8 Jul 2006New onset rectal bleeding should be investigated in everybody over 45
New onset rectal bleeding should be investigated in everybody over 45
The risk for primary care patients aged 
45 years with new onset rectal bleeding of having colonic neoplasia may be one in 10, irrespective of other symptoms. Over a decade, du Toit and colleagues (p 69) undertook bowel investigation in all patients 45 years who presented in their general practice with new onset rectal bleeding. Of the 265 patients with new onset rectal bleeding, 15 (5.7%) were diagnosed with colorectal cancer, and 13 (4.9%) patients had colonic adenoma. Only two of the patients with cancer had had diarrhoea. Current UK referral guidelines for suspected cancer should be changed, suggest the authors.
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Psychological treatments improve glycaemic control in children and adolescents with diabetes
A meta-analysis of 21 randomised trials by Winkley and colleagues (p 65) finds weak but significant evidence that psychological treatments improve glycaemic control in children and adolescents with type 1 diabetes, and no evidence of an effect in adults. In the 10 studies of children and adolescents, the pooled absolute reduction in glycated haemoglobin was 0.5% in those who had received a psychological intervention. The success of psychological interventions in children may be explained by higher levels of psychological distress in children with diabetes and their families.
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Have England's road traffic injuries really fallen?
Police statistics show an overall fall in people with road traffic injuries, but this probably represents a fall in completeness of reporting of these injuries, say Gill and colleagues on page 73. They compared England's police statistics with hospital episode statistics on rates of injury and death and their change from 1996 to 2004. According to police statistics, rates of people killed or seriously injured on the roads fell by almost a third in that period. Over the same time, however, hospital admission rates for road traffic injuries were almost unchanged.
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Drivers can assess when they are sleepy, but they don't act
Self assessed driving while sleepy is a powerful predictor of serious road traffic accidents, suggesting that drivers' awareness of their sleepiness while driving is not enough to prevent them from having road traffic accidents. Nabi and colleagues (p 75) asked 13 000 members of the GAZEL cohort about sleepiness and driving behaviours and followed them for three years. The number of serious road traffic accidents increased proportionally with the frequency of self reported driving while sleepy. Messages on prevention should therefore focus on convincing sleepy drivers to stop driving, say the authors.
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Drivers of four wheel drive vehicles show risky driving behaviours
The level of non-compliance with the UK laws on the use of hand held mobile phones and seat belts by drivers in London is high, especially in those driving four wheel drive vehicles, say Walker and colleagues on p 71. They observed the use of hand held mobile phones and seatbelts in more than 40 000 drivers at three different sites in London over two periods of three weeks. The authors found that 8.2% of drivers of four wheel drive vehicles and 2.0% of people driving other cars were seen using hand held mobile phones, and 19.5% and 15.0% respectively were not wearing seat belts.
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