Doctors use Wii games for rehab therapy
Sat, 09 Feb 2008 11:24:30 GMTBy LINDSEY TANNER, AP Medical Writer
CHICAGO - Some call it "Wiihabilitation." Nintendo's Wii video game system, whose popularity already extends beyond the teen gaming set, is fast becoming a craze in rehab therapy for patients recovering from strokes, broken bones, surgery and even combat injuries.
The usual stretching and lifting exercises that help the sick or injured regain strength can be painful, repetitive and downright boring.
In fact, many patients say PT — physical therapy's nickname — really stands for "pain and torture," said James Osborn, who oversees rehabilitation services at Herrin Hospital in southern Illinois.
Using the game console's unique, motion-sensitive controller, Wii games require body movements similar to traditional therapy exercises. But patients become so engrossed mentally they're almost oblivious to the rigor, Osborn said.
"In the Wii system, because it's kind of a game format, it does create this kind of inner competitiveness. Even though you may be boxing or playing tennis against some figure on the screen, it's amazing how many of our patients want to beat their opponent," said Osborn of Southern Illinois Healthcare, which includes the hospital in Herrin. The hospital, about 100 miles southeast of St. Louis, bought a Wii system for rehab patients late last year.
"When people can refocus their attention from the tediousness of the physical task, oftentimes they do much better," Osborn said.
Nintendo Co. doesn't market Wii's potential use in physical therapy, but company representative Anka Dolecki said, "We are happy to see that people are finding added benefit in rehabilitation."
The most popular Wii games in rehab involve sports — baseball, bowling, boxing, golf and tennis. Using the same arm swings required by those sports, players wave a wireless controller that directs the actions of animated athletes on the screen.
The Hines Veterans Affairs Hospital west of Chicago recently bought a Wii system for its spinal cord injury unit.
Pfc. Matthew Turpen, 22, paralyzed from the chest down in a car accident last year while stationed in Germany, plays Wii golf and bowling from his wheelchair at Hines. The Des Moines, Iowa, native says the games help beat the monotony of rehab and seem to be doing his body good, too.
"A lot of guys don't have full finger function so it definitely helps being able to work on using your fingers more and figuring out different ways to use your hands" and arms, Turpen said.
At Walter Reed Army Medical Center, the therapy is well-suited to patients injured during combat in Iraq, who tend to be in the 19 to 25 age range — a group that's "very into" playing video games, said Lt. Col. Stephanie Daugherty, Walter Reed's chief of occupational therapy.
"They think it's for entertainment, but we know it's for therapy," she said.
It's useful in occupational therapy, which helps patients relearn daily living skills including brushing teeth, combing hair and fastening clothes, Daugherty said.
WakeMed Health has been using Wii games at its Raleigh, N.C., hospital for patients as young as 9 "all the way up to people in their 80s," said therapist Elizabeth Penny.
"They're getting improved endurance, strength, coordination. I think it's very entertaining for them," Penny said.
"It really helps the body to loosen up so it can do what it's supposed to do," said Billy Perry, 64, a retired Raleigh police officer. He received Wii therapy at WakeMed after suffering a stroke on Christmas Eve.
Perry said he'd seen his grandchildren play Wii games and was excited when a hospital therapist suggested he try it.
He said Wii tennis and boxing helped him regain strength and feeling in his left arm.
"It's enjoyable. I know I'm going to participate with my grandkids more when I go visit them," Perry said.
While there's plenty of anecdotal evidence that Wii games help in rehab, researcher Lars Oddsson wants to put the games to a real test.
Oddsson is director of the Sister Kenny Research Center at Abbott Northwestern Hospital in Minneapolis. The center bought a Wii system last summer and is working with the University of Minnesota to design a study that will measure patients' function "before and after this 'Wiihab,' as someone called it," Oddsson said.
"You can certainly make a case that some form of endurance related to strength and flexibility and balance and cardio would be challenged when you play the Wii," but hard scientific proof is needed to prove it, Oddsson said.
Meantime, Dr. Julio Bonis of Madrid says he has proof that playing Wii games can have physical effects of another kind.
Bonis calls it acute "Wiiitis" — a condition he says he developed last year after spending several hours playing the Wii tennis game.
Bonis described his ailment in a letter to the New England Journal of Medicine — intense pain in his right shoulder that a colleague diagnosed as acute tendonitis, a not uncommon affliction among players of real-life tennis.
Bonis said he recovered after a week of ibuprofen and no Wii, and urged doctors to be aware of Wii overuse.
Still, as a Wii fan, he said in an e-mail that he could imagine more moderate use would be helpful in physical therapy "because of the motivation that the game can provide to the patient."
Company builds 361 billion juice business
Sat, 09 Feb 2008 11:51:26 GMTBy PAUL FOY, AP Business Writer
SALT LAKE CITY - On stage at a sales convention, XanGo executive vice president Joseph Morton said that when he first stumbled across mangosteen, a tropical fruit with purported curative powers, "I didn't have to have it confirmed in the New England medical journal before I would listen."
The multilevel marketing company has built a huge business around its mangosteen-based juice, which it promotes as an immunity booster. The company still hasn't proved its health benefits — which it says could include a stronger immune system and improved joint function — to skeptical experts. XanGo's Web site includes a disclaimer, noting the juice is not meant to treat or prevent disease. A lab test arranged by The Associated Press found its antioxidant power to be on par with other fruit juices.
Morton, a 37-year-old triathlete nicknamed Ironman Joe, was on a business trip in Malaysia when he saw mangosteen, a white delicacy wrapped in a blood-red leathery shell, on the dessert menu.
From that introduction, Morton and his business partners capitalized on a new brand category of liquid "super-fruits" that is "doing gangbusters," said Jeff Hilton, a partner at Integrated Marketing Group, a branding and packaging consultant.
XanGo has more than two dozen competitors that sell fruit juices, powdered drinks and vitamin fizz tablets. Tahitian Noni International Inc. sold $2 billion worth of noni juice, from the French Polynesia fruit, in its first 10 years by 2006. MonaVie, also of Utah, bottles a blend of acai juice from the Amazon basin berry. Pure Fruit Technologies Inc. underprices XanGo on a mangosteen-based juice that sells in health food stores.
XanGo, a private company that doesn't reveal financial statements, said at the October convention that since its launch five years ago, sales of the mangosteen-based juice topped a cumulative $1 billion. It ships out bottles by the case from Spanish Fork, Utah, and says it has 700,000 unsalaried sales associates in 17 countries.
"That's the only product they sell, and people are taking it around the world," said Sen. Orrin Hatch, R-Utah, who quaffs the purplish-color XanGo and pops multivitamins and other supplements every day. Hatch was the prime sponsor of the 1994 Dietary Supplement Health and Education Act, which allows the sale of supplements unless the Food and Drug Administration can prove them harmful.
An independent lab test performed for The Associated Press shows XanGo's antioxidant strength is no better than other readily available fruit juices, yet it costs nearly $40 a bottle. XanGo insists mangosteen contains other beneficial chemicals.
"My big concern with XanGo is that the business has gone a long way without showing any benefit in human trials," said Wayne Askew, director of the Division of Nutrition of the University of Utah's College of Health.
Others are skeptical, too.
"It's a 'Wizard of Oz' story," said Anthony Almada, president and chief executive of GENr8 Inc., a marketer of sports nutrition dietary supplements. "The industry is built on storytelling, and because they do it one-on-one, without advertising, they don't incur the wrath of the FDA."
Dietary supplements are a $22 billion largely unregulated business in the U.S.
For the lab test, The Associated Press shipped a 750-milliliter bottle of XanGo to Oregon State University's Linus Pauling Institute at Corvallis. The institute measured its antioxidant strength against store-bought juices that sell for a few dollars a bottle.
On a scale of molecular weight, XanGo's antioxidants measured 14,884 "micromoles" per liter — slightly higher than cranberry juice, but lower than black cherry and less than half the power of blueberry juice. Apple juice finished last in this test.
"In terms of its antioxidant capacity, XanGo is in the middle of the pack," said Balz Frei, the institute's director and chairman.
Antioxidants are substances added to many foods and even soap in the belief they can slow down the damage oxidation can do to cells.
Frei and other scientists emphasize that antioxidants haven't been shown to actually work inside the human body. Antioxidants are known to work in test tubes, but stomach acids could neutralize them before they can get to work destroying any cell-damaging free-oxygen radicals.
Uncertainties over testing protocols have stalled research, yet every day seems to bring another mangosteen bottler, as an Internet search will show.
XanGo's research and development manager insists mangosteen has more to offer than its so-called oxygen radical absorption capacity — a rich cocktail of other beneficial chemicals barely known to science.
"You have a fruit that's very complicated, with a lot of chemicals in it," said Mike Pugh, who dismissed antioxidant ratings as a "numbers game" He said the type of antioxidants can be more important.
Pugh believes all the scientific debate can be pointless: If mangosteen makes people feel better, he said, it must do some good.
"It helps with my severe allergies," said Tim Gardner of Hammond, Wis., a 27-year-old district manager for a chain of auto parts stories who drove nonstop with his wife and two other couples to Salt Lake City for the XanGo convention. Gardner said he became a sales recruit to lower his cost to $25 wholesale from $37.50 for a three-quarters of a liter bottle.
"You're not trying to sell the product; you're sponsoring other people," Gardner said. "Every distributor is a customer, and every customer is a distributor."
Jon Taylor, a one-time Nu Skin Enterprises Inc. distributor and trial consultant for disaffected distributors who analyzed XanGo's multitiered compensation plan at the AP's request, said it was little different from scores of other multilevel marketing ventures.
It's a formula, he said, that makes money for the top 1 percent of distributors and leaves many other recruits stockpiling products they can't sell.
"The reason you lose money is you have to buy products every month to stay good with the company," Taylor said. "That's the rub."
Bob Freeze, XanGo's vice president for public relations, dismissed Taylor as a "disgruntled" former Nu Skin recruit "who has taken up a fight to bring down any legitimate multilevel marketing company."
Provo, Utah-based Nu Skin, a $1 billion network marketing company that sells dietary supplements and skin care products, has been fined three times by the Federal Trade Commission for misrepresentations.
Successful XanGo distributors take a cut of commissions from others recruited into their chain of sales associates. Denise Villahermosa, 49, who lives in northern Virginia, sits atop an organization of 6,000 distributors — "we all use the product" — that produces more than $100,000 in monthly sales. That makes Villahermosa a top-level "premier" distributor; she gets commissions, bonuses and travel rewards for her efforts.
"We sell the XanGo story," Villahermosa said. "I share my story, how I got involved and how the product has worked for me. I wanted to stay healthy."
XanGo has been warned by the FDA for claiming that mangosteen could ward off disease or cancer. The company insists those claims were printed by a third party on a brochure at a recruitment seminar and it's not responsible.
XanGo executives said they haven't heard from the FDA since receiving a warning letter last summer and assume the case is closed.
Paul Teitell, the FDA's assistant district director in Denver, said the matter isn't settled. The agency can seize the product, stop the company from doing business or prosecute, he said.
"The fact they haven't heard from us since last summer doesn't mean the case is closed," Teitell responded. "We warned them, and what happens beyond that warning is based on the way they behave, not how we behave."
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On the Net:
http://www.XanGo.com
http://www.fda.gov
http://lpi.oregonstate.edu
Obese less likely to use seat belts
Fri, 08 Feb 2008 22:51:50 GMTBy KRISTIN M. HALL, Associated Press Writer
NASHVILLE, Tenn. - Like a lot of consumers, Paul McAleer focused on comfort when he recently went car shopping. Adjustable seats, a tilt steering wheel and extra height were all important. Because he's a self-described "fat guy," the Web site designer also has to check to see if he can fit in the seat belt.
While McAleer buckles up when he drives, a new study found that seat belt use declines as body size increases. But even large drivers who want to use a seat belt may be thwarted because not all carmakers offer bigger belts or extenders.
"It would be in their best interest to make seat belts longer in the first place," says McAleer, who lives in Chicago.
Federal standards that specify the length of auto seat belts date back four decades and only require that seat belts accommodate a 215-pound man. Some manufacturers offer bigger belts or extenders anyway, but other auto companies have concerns about effectiveness and liability.
Vanderbilt University psychologist David Schlundt studied the relationship between seat belt use and weight after noticing that obese people sometimes struggled to fit into the auto restraints.
"They really have a hard time getting that belt buckle over them," Schlundt said. "They have to stretch it out and then over and then some can't see the buckle."
Schlundt and his colleagues at Meharry Medical College in Nashville reviewed nearly 250,000 responses about seat belt use from a national telephone health survey by the U.S. Centers for Disease Control and Prevention.
Based on that 2002 data, the study found that seat belt use declined as body mass index — a calculation based on height and weight — increased.
Only about 70 percent of extremely obese individuals reported always using a seat belt, while nearly 83 percent of normal-weight people always used their belts, the study found. More than half of those killed in auto accidents weren't wearing seat belts, according to the latest federal figures. The study's findings were published in the journal Obesity.
"I hate seat belts because they always seem to ride up and strangle me," said Peggy Howell, the public relations director for the National Association to Advance Fat Acceptance. "But I wear them for my own safety and because it is the law."
Howell said people sometimes contact her Oakland, Calif.-based advocacy group to get information on extensions.
McAleer, who runs a Web site called Big Fat Blog, said he's worried the study will focus criticism on the obese instead of the design of seat belts. His new car has seat belts long enough for him, but he said his wife has a harder time buckling up.
Many factors affect seat belt use, including sex, age and state laws, but Schlundt said the connection between increased weight and decreased use was consistent when those things were taken into account.
Government regulations for auto manufacturers don't use BMI to determine dimensions for seat belts. The standard instead says belts must fit up to a 215-pound man who has a seated hip circumference of 47 inches. That was set in the 1960s.
When the National Highway Traffic Safety Administration considered changing the rules in 2003, it estimated that more than 38 million people, or 19 percent of the total U.S. population, were larger than the seat belt requirements.
The NHTSA decided not to revise its standards since most top manufacturers including Ford Motor Co., General Motors Corp., Chrysler LLC, Nissan Motor Co. and Honda Motor Co. have seat belts that are longer than required.
The companies each provide an average of 18-20 inches of extra belt length, more than enough to accommodate the largest percentage of drivers. Many of those manufacturers also have seat belt extensions or longer belts that can be purchased or installed at dealerships. Ford offers their extensions for free, said Wes Sherwood, a Ford spokesman.
Several foreign brands, such as Honda, BMW, Hyundai, Mercedes-Benz and Porsche, do not provide seat belt extenders. Ford's Volvo division requires buyers to sign a waiver stating they've read a list of warnings and rules for using extenders, said Daniel Johnston, a Volvo spokesman.
Extensions have to be used carefully because they can be hazardous if used by passengers who are too small, said Phil Haseltine, president of the Washington, D.C.-based Automotive Coalition for Traffic Safety.
According to the NHTSA, an incorrectly sized seat belt extender could fail to provide upper body restraint and may pull the lap belt onto the abdomen during a front impact, possibly leading to internal injury.
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On the Net:
National Highway Traffic Safety Administration: http://www.nhtsa.dot.gov/
Study Acupuncture may boost pregnancy
Fri, 08 Feb 2008 23:14:33 GMTBy MARILYNN MARCHIONE, AP Medical Writer
It sounds far-fetched — sticking needles in women to help them become pregnant — but a scientific review suggests that acupuncture might improve the odds of conceiving if done right before or after embryos are placed in the womb.
The surprising finding is far from proven, and there are only theories for how and why acupuncture might work. However, some fertility specialists say they are hopeful that this relatively inexpensive and simple treatment might ultimately prove to be a useful add-on to traditional methods.
"It is being taken more seriously across our specialty," and more doctors are training in it, said Dr. William Gibbons, who runs a fertility clinic in Baton Rouge, La., and is past president of the Society for Assisted Reproductive Technology. "I have not seen proof ... but we wouldn't mind at all" if it turned out to work, he said.
The analysis was led by Eric Manheimer, a researcher at the University of Maryland School of Medicine, and paid for by a federal agency, the National Center for Complementary and Alternative Medicine. Results were published Friday in the British medical journal, BMJ.
Acupuncture involves placing very thin needles at specific points on the body to try to control pain and reduce stress. In fertility treatment, it is thought to increase blood flow to the uterus, relax the cervix and inhibit "fight or flight" stress hormones that can make it tougher for an embryo to implant, Manheimer said.
The analysis pools results from seven studies on 1,366 women in the United States, Germany, Australia and Denmark who are having in vitro fertilization, or IVF. It involves mixing sperm and eggs in a lab dish to create embryos that are placed in the womb.
Women were randomly assigned to receive IVF alone, IVF with acupuncture within a day of embryo transfer, or IVF plus sham acupuncture, in which needles were placed too shallowly or in spots not thought to matter.
Individually, only three of the studies found acupuncture beneficial, three found a trend toward benefit and one found no benefit. When results of these smaller studies were pooled, researchers found that the odds of conceiving went up about 65 percent for women given acupuncture.
Experts warn against focusing on that number, because this type of analysis with pooled results is not proof that acupuncture helps at all, let alone by how much. IVF results in pregnancy about 35 percent of the time. Adding acupuncture might boost that to around 45 percent, the researchers said.
The authors include doctors from the Netherlands and Georgetown University in Washington, D.C. One is an acupuncturist but had no role in any studies that were analyzed.
The American Society for Reproductive Medicine has no policy on acupuncture. "There's been a lot of conflicting research" on its usefulness, said spokeswoman Eleanor Nicoll.
"It looks like, from the body of evidence out there, that some patients benefit," said Dr. James Grifo, head of the infertility program at New York University.
However, Dr. Zev Rosenwaks, director of infertility treatment at New York-Presbyterian Hospital/Weill Cornell Medical Center, said other studies, reported at recent medical meetings and not included in the published analysis, did not find it helped.
"The jury is still out," he said, but added, "It's unlikely that acupuncture does any harm."
Dr. Ann Trevino, a 37-year-old family physician who recently moved to Houston, is pregnant, and a believer. She had three unsuccessful pregnancy attempts with intrauterine insemination before trying acupuncture with IVF at a fertility clinic in San Antonio where she used to live.
"I had been reading about acupuncture, probably like every other patient on the Internet. I was just willing to do anything possible to improve our chances," she said. With acupuncture, "I just felt very warm and relaxed" when the embryos were placed.
Dr. Francisco Arredondo, who runs Reproductive Medicine Associates of Texas where Trevino was treated, said he started offering acupuncture in October, after patients requested it and because some studies suggested it helped.
Acupuncturist Kirsten Karchmer said she places about a dozen needles in the ears, hands, feet, lower legs, abdomen and sometimes the lower back. It costs $500 a month for treatments twice a week, and patients typically go for three months, she said.
IVF costs around $12,000 per attempt, so a treatment that improves its effectiveness might save money in the long run, Manheimer said.
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On the Net:
http://press.psprings.co.uk/bmj/february/ivf.pdf
Modern life means modern ills for obese Pacific islanders
Fri, 08 Feb 2008 17:49:43 GMTby David Brooks
WELLINGTON - Glossy photographs in tourist brochures showing lean, fit and muscular Pacific islanders fishing with spears from canoes in azure lagoons and shimmying up coconut palms hide an ugly truth.
Pacific islands are in the midst of a crisis of obesity and its associated dangers of diabetes, strokes and heart disease.
A diet which used to be dominated by fish, root crops, green leaves, coconuts and fruit is now heavily reliant on fatty imported meats, rice, and sugar and fat-laden processed snack foods.
Many islanders are now urbanised and drive to the local shop to buy tins of corned beef, spam, cooking oil and rice instead of tending crops and gathering seafood in the lagoon and surrounding ocean.
"What we have in this country is a raging epidemic. We have 6,000 to 8,000 cases of diabetes out of a population of 53,000 people," says Carl Hacker, the Marshall Islands director of economic policy, planning and statistics.
"What is unfolding here is a physical disaster and a fiscal disaster," he told AFP.
The pattern is being repeated through the Pacific. World Health Organisation figures show Pacific Island nations make up eight of the world's 10 most obese countries.
Nauru, once prosperous through exports of now nearly exhausted phosphate deposits, heads the list with 94.5 percent of people older than 15 defined as obese.
It also heads world tables for diabetes rates, which in Nauru is estimated to afflict as many as 45 percent of all adults.
Hospital wards from the Marshall Islands to Nauru and Tonga and throughout the region are bulging with patients suffering non-communicable diseases that are a direct result of obesity -- diabetes, stroke and heart disease.
Hacker says treating a single patient over the 15-30 year span of type two diabetes -- which usually strikes in adulthood and is caused by poor diet and inactivity -- can cost his poor country hundreds of thousands of dollars.
The symptoms of advanced diabetes include kidney failure, blindness and, in extreme cases, the amputation of limbs.
The cost of long-term rehabilitation for stroke victims is another huge burden, says Dr Jan Pryor, director of research at the Fiji School of Medicine.
"In the past it was unusual for anyone to have a stroke under 50, now people are having strokes in their 20s and 30s, you see it every day," he said.
The battle against bad health is hampered by the traditional perception of obesity as a sign of beauty and status in the Pacific Islands. In the past, traditional diets and lifestyle ensured that generally only senior chiefs and their families grew fat.
"When I was a child, there was less imported food, we would eat local food, which was high carbohydrate, low sugar and high fibre," says Dr Malokai Ake, chief medical officer for public health in Tonga.
"Usually we would only have pork or chicken on Sundays and fresh fish was a regular part of our diet along with other seafood. We would walk or ride on a horse to work in the plantations and spend a lot of time fishing, swimming or diving.
"The way we lived meant any excess calories were used up during the day. The amount of calories people have every day now, we used to only have on feast days."
Urbanisation means fewer people grow their own food or go fishing and in the Marshall Islands for example about 70 percent of the population of around 53,000 live on two crowded urban islands.
Population growth also means there is more pressure on natural resources, especially seafood.
The village of Votua, near Ba in the north of Fiji's main island of Viti Levu in January banned fishing in its traditional fishing grounds for five years to restore fish stocks.
Chief Ratu Pio Naulu was quoted by the Fiji Times saying that there had been a sharp decline in the number of fish in local water due to overfishing, including the use of dynamite.
The problem of obesity has been getting worse over the last 30 years and it is no longer confined to urban areas.
"Even if you go into a store in a remote village, you'll find shelves of spam and corned beef," says Pryor.
Researchers have suggested Pacific Islanders have a genetic disposition to obesity and its associated health problems. They say their metabolism has learned to cope over thousands of years with times of plenty and periods of famine by adapting to quickly store any surplus calories as fat.
But education about the importance of a healthy diet has been going on for 20 years among many island communities.
In Tonga, the late King Taufa'ahau Tupou, once renowned as the world's heaviest monarch, led attempts to improve the lifestyle of his subjects by taking up -- in his seventies -- regular bicycle rides up and down the runway of the country's international airport.
Education has not been enough however to curb the growth of obesity and most experts put this down to economics.
It's cheaper to buy fatty mutton flaps from New Zealand and Australia or turkey tails from the US than fresh local fish, or white rice rather than the local root crops.
"There is plenty of fresh fish in Tonga but fishermen have raised the price beyond the purchasing power of most people," Ake says.
Experts agree that governments in the region have to take the lead, coordinating a response through all their agencies and imposing "sin taxes" on unhealthy imports.
Some countries have tried banning some unhealthy imports. Fiji for example banned the importation of mutton flaps in 2000 and Samoa last year banned imports of turkey tails.
But most of the action has been piecemeal and many people just do not have access to cheap healthy food.
"Where is the leadership on these kinds of issues?" Hacker said.
"We have to have leadership to at least acknowledge these problems exist."
