Corticosteroid injection is effective in improving shoulder-related disability, and physiotherapy is effective in improving the range of movement in external rotation 6 weeks after treatment.

parental blood pressure has been measured. It is interesting, however, that the relation between birth weight, maternal age, and birth rank and blood pressure were largely unaffected by adjustment for reported parental history of high blood pressure and seemed to be similar in children with and without a maternal history of hypertension. These findings suggest that the means by which familial influences on blood pressure are mediated are quite separate from those of the other factors discussed. Conclusions-Diabetic drivers treated with insulin and attending clinics have no more accidents than non-diabetic subjects and may be penalised unfairly by insurance companies. IntroductionDiabetes mellitus in drivers of motor vehicles is assumed to be a potential danger both to the driver and to other road users. This belief stems from both the immediate disabling effects of hypoglycaemia and the long term implications of the disease, particularly retinopathy. With these problems diabetics might be expected to have more road traffic accidents than the general population, but available evidence is conflicting. Early studies from the United States have consistently shown higher accident rates for diabetic BMJ VOLUME 299 2 SEPTEMBER 1989 591 motorists,'"3 but Ysander's work showed reduced rates among Swedish diabetic drivers.4 We could not find a comparable controlled study in the United Kingdom, but recent evidence has suggested that insulin dependent diabetic drivers have no excess of accidents.5 We compared rates of road traffic accidents among diabetic drivers taking insulin and non-diabetic drivers. We also assessed the motoring practices of diabetic drivers and the attitudes of insurance companies towards them. Subjects and methodsA complete census of insulin dependent and noninsulin dependent diabetic patients, aged 18-65 inclusive on 1 October 1986, who had been taking insulin for at least one year was carried out at two diabetic clinics in Belfast. During an initial period of four months individual patients were recruited when they attended their respective clinic. A further eight months' follow up was required to recruit subjects who did not attend in the initial four months. Patients gave informed oral consent before participating in the survey, which had been approved by the ethical committee of Queen's University, Belfast. Each volunteer completed a confidential questionnaire under supervision by one of us.The questionnaire was divided into three sections. In the first section personal and clinical details were recorded by the supervisor. The second and third sections contained multiple choice questions and questions requiring simple yes/no answers. Some questions also required subjects to give brief written details. The second section asked for information on home monitoring of blood glucose concentration, experience of hypoglycaemia, and alcohol consumption. In the third section the current driving state of patients was established. All patients who at the time of the survey drove motor vehicles on public road...

Osteoporosis, although considered less common, still occurs in men. We present a cross-sectional study of a group of Northern Ireland men with low-trauma forearm fractures to determine the presence of osteoporosis and screen for secondary causes of low bone mineral density. Male patients aged 30-75 years, presenting with distal forearm fracture in 2000-2001 in Northern Ireland, were identified through a Colles fracture database. A total of 37 subjects consented to have bone mineral density measurements undertaken at the femoral neck, spine and forearm using a Lunar expert bone densitometer. Twenty-seven percent of the men had osteoporosis at the spine, femoral neck or forearm, as defined by a bone mineral density score of less than -2.5. We also found that 49% of patients had vitamin D insufficiency or deficiency, 27% had low serum testosterone, 14% had abnormal liver function test results, and 14% had raised parathyroid hormone. Only one patient received advice or treatment regarding osteoporosis at the time of fracture. Increased awareness of male osteoporosis and the need for screening for potential secondary causes in this group of patients is required, both at primary and secondary care level.

A group of Northern Ireland women aged 40-75 years of age with low-trauma forearm fracture were studied to determine the incidence of such fractures and the prevalence of osteoporosis in this fracture population. A total of 1,147 subjects were identified in 1997 and 1998 throughout Northern Ireland following low-trauma forearm fractures, as well as 699 residents in the Eastern Health and Social Services Board (EHSSB), enabling calculation of the annual incidence rate of new low-trauma forearm fractures at 2.69/1,000 population aged 40-75. A total of 375 participants consented to have bone mineral density (BMD) measurements undertaken at the femoral neck, spine, and forearm using a Lunar Expert bone densitometer. Osteoporosis at the femur was present in 14% of women, at the spine in 29%, and at the forearm in 32%. A total of 45% were osteoporotic at one or more measured sites, but only 18% were on treatment for osteoporosis. Additional significant risk factors identified included an early menopause in 24.5% and current or previous corticosteroid use in 13%. Only 1.6% received information on treatment of osteoporosis at the time of fracture. Increased awareness is needed in both primary and secondary care including fracture services to improve treatment of women with low-trauma fracture.

Background: Shoulder pain is common in primary care. The management of subacromial impingement (SAI) can include corticosteroid injections and physiotherapy. Physiotherapy can be on an individual or group basis. Aim: To examine the clinical effectiveness and make an economic analysis of individual versus group physiotherapy, following corticosteroid injection for SAI. Design and Setting: A single-blind, open-label, randomised equivalence study comparing group and individual physiotherapy. Patients referred by local general practitioners and physiotherapists were considered for inclusion. Method: Patients were randomised to individual or group physiotherapy groups, and all received corticosteroid injection before physiotherapy. The primary outcome measure was shoulder pain and disability index (SPADI) at 26 weeks. An economic analysis was conducted. Results and Conclusion: 136 patients were recruited, 68 randomised to each group. Recruitment was 68% of the target 200 participants. SPADI (from baseline to 26 weeks) demonstrated a difference (SE) in mean change between groups of −0.43 (5.7) (p-value = 0.050001), and the TOST (two-one-sided test for equivalence) 90% CI for this difference was (−10.0 to 9.14). This was borderline. In a secondary analysis using inputted data, patients without SPADI at week 26 were analysed by carrying forward scores at week 12 (mean difference (95% CI) = −0.14 (−7.5 to 7.3), p-value = 0.014). There is little difference in outcome at 26 weeks. Group physiotherapy was cheaper to deliver per patient (£252 versus £84). Group physiotherapy for SAI produces similar clinical outcomes to individual physiotherapy with potential cost savings. Due to low recruitment to our study, firm conclusions are difficult and further research is required to give a definitive answer to this research question. (NCT Clinical Trial Registration Number NCT04058522).

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