Journals Watch - Diverticulitis, diabetes and Wii

Too busy to catch up on the latest research? Let Dr Suzanne Hunter update you on recent papers.

Perforated diverticulitis Br J Surg 2008; 95: 876-81

Diverticulosis is a very common condition in the west and is viewed frequently as an incidental finding. It does, however, have complications. This study looked at the incidence and risk factors for mortality from perforated diverticulitis.

Data were collected from hospital records spanning five years from five hospitals in East Anglia. The incidence of perforated diverticulitis was 3.5 per 100,000 per annum.

Studies showed an increased risk of mortality from perforated diverticulitis in patients using NSAIDs

More than 90 per cent went on to have surgery and a quarter of all patients died. Mortality risk tripled in over-65s and NSAID users, and increased 18-fold in those with renal disease. Perforation was slightly more common in women than men. There was no mortality in the under-55s, suggesting that surgery can be avoided in these patients.

There is an argument, therefore, that NSAIDs should be used with caution in those with known diverticular disease and poor renal function.

Preventing type-2 diabetes Br J Gen Pract 2008; 58: 541-7
I have long had a sneaking suspicion that the vast majority of type-2 diabetes results from lifestyle choice. This study examined whether intensive lifestyle advice can make a difference to those with pre-diabetes.

Patients at a general practice in Sheffield were divided into three groups; the control group had usual GP care, while two intervention groups had education, exercise, motivational talks and either a low-fat or a low glycaemic load diet.

In six months, improvements were seen in three markers of risk of progression to diabetes in the intervention groups - weight, BMI and waist circumference - with the low glycaemic group marginally better than the low-fat group.

Although this study was performed in an affluent area where motivation may be higher than other areas, it does point to a possible way to reduce the diabetes epidemic.

Counterweight for obesity Br J Gen Pract 2008; 58: 548-54
'Counterweight' is a weight-loss programme run by practice nurses coached in the method (weekly appointments to educate and formulate strategies and goals) and mentored by Counterweight staff.

The aim of this study was to see if such an obesity-management programme would be successful in a primary care setting. Main outcome measures were weight change and percentage of patients achieving a 5 per cent loss at 12 and 24 months.

The patients enrolled in this study lost on average 3kg from an average starting weight of 101kg, with one third having maintained a weight loss of greater than 5 per cent at 24 months.

The authors felt this showed an effective programme, but I am not totally convinced. The lack of a control arm is a problem and I wonder if this is a fairly modest percentage weight loss for an intensive intervention.

Predicting poor LRTI outcome in diabetics Br J Gen Pract 2008; 58: 564-8
We see a lot of patients with LRTI. In patients with diabetes there is increased risk of complications and/or death. A Dutch team developed a scoring system for predicting the risk of patients requiring a 30-day hospital stay or risk of death.

In this retrospective study they tested out the system that scores patients on diagnosis, age, co-morbidity, previous hospitalisations and prior use of steroids and antibiotics.

They found that patients with a high score had a sixfold chance of hospitalisation or death compared with the lowest risk score.

This looks like an excellent tool for assessing individual risk.

Death post-febrile convulsion Lancet 2008; 372: 457-63

Febrile convulsions are relatively common (affecting 2-5 per cent of under-fives) and can be frightening for parents. It is known that children with epilepsy have higher mortality, but it is not known whether the same applies to febrile convulsions.

This Danish study followed up more than 50,000 children with febrile convulsions.

Although the study found higher mortality in the first two years post-convulsion, this was partly due to newly diagnosed epilepsy. If the convulsion lasted less than 15 minutes and didn't recur within 24 hours, there was no increase in mortality, as was the case in children with a birth weight more than 2,500g and born after 37-40 weeks with normal Apgar scores.

Parents are understandably frightened after a febrile convulsion, but with this study we are able to give more reassurance.

Energy expenditure when playing computer games Br J Sports Med 2008; 42: 592-4
With active computer games such as those designed for the Wii console, gamers physically move around to play, thereby increasing energy expenditure.

This study was a small cross-sectional comparison involving three 'active' computer games (Wii Sports bowling, tennis and boxing) and a game on a sedentary console (Xbox 360).

The participants (six boys and five girls aged 13-15) wore a device to measure energy expenditure while they played each of the games for 15 minutes. The main outcome measure was predicted energy expenditure.

The mean standard energy expenditure was significantly greater in those playing the 'active' Wii Sports games than in sedentary gamers.

However, the predicted energy expenditure was likely to be greater in those playing the actual sports. The energy used when playing active Wii Sports games was not of high enough intensity to contribute towards the recommended daily amount of exercise in children.

  • Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals

The quick study

  • Fatal perforated diverticulitis is more common in older patients and those on NSAIDs or with renal failure.
  • Pre-diabetes can be improved by intensive lifestyle advice and a low glycaemic load diet.
  • Weight loss was achieved by patients using the nurse-led Counterweight approach.
  • Complicated LRTIs in diabetics can be predicted using a scoring system.
  • Febrile convulsions do not have an associated increase in mortality.
  • Energy expenditure was significantly greater when playing 'active' rather than sedentary computer games.

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