Review of related studies

INCREASE AGGRESSIVE

The British Association of Anger Management (2012) the youngsters start to withdraw from family life and interaction with friends but many parents ignore the problem in order to avoid confrontations. It surveyed 204 parents of children aged nine to 18 about their use of computer games. 46 percent said their sons or daughters had become 'less co-operative' since they started playing video games. 44 percent said that they were more 'rude or intolerant towards others', 40 percent said that they were more impatient, 36 percent reported an increase in 'aggressive behaviour', 29 percent cited more mood swings and 26 percent said their offspring had become more reclusive. 28 percent admitted their children spent 16 hours or more a week playing computer games. According to Assocham (2011) reveals that over 82 percent of teenagers spend an average of 14-16 hours per week playing games on computer, web portal or consoles and about 7 percent of children surveyed qualified as being pathological video gamers (over 20 hours per week).

Gaming is taking away time that could be spend on activities that have educational benefits. Compulsive gamers display signs of diminished empathy, increased aggression and

conflicts at home, school and work. It could also create problems and lead to poor social skills.

Rising addiction to video games include easy availability of resources and absence of quality parental care reveals the survey conducted under Assocham's Social Development Foundation (SDF).

Over 2,000 teenagers and 1,000 parents' were interviewed by Assocham-SDF during April 2011 to June 2011 in Delhi-NCR, Mumbai, Chandigarh, Lucknow, Ahmedabad, Patna, Kolkata, Chennai, Bengaluru and Jaipur.

The sample included almost an equal number of males and females in the age group of 818 years.

About 84 percent (ages 8 to 18) of children said that they play violent games when they're alone than with their parents. 76% prefer to play action game and 45% of gamers who shows signs similar to addiction are also more likely to have a video game system in their bedroom.

A total of 1200 teens (76 percent) played video games. 20 percent of the gamers were girls and female gamers were found to spend an average of 30 minutes playing on the weekdays and one hour playing on the weekends. Male gamers spend an average of 50 minutes playing on the weekdays and two-three hours playing on the weekends.

Gamers who are going to school account for 72 percent and college students at 28 percent. More than half of participants said they played daily, 36 percent play weekly and 18% play 3-4 times a week. Only 36% admitted that they have addictive behaviors and cannot control themselves when they play. 64% responded said that online game makes them feel good and distressed.

The survey also disclosed that over 90 percent of kids between 8-14 years old go online to play games with Facebook being quoted as their favorite websites.

The social networking games are probably a big part of their gaming habits. Above 80 percent of parents say that videogames are getting worse day by day and some games connect to the internet, which can allow children and adolescents to play online with unknown adults and peers. March (2011)by researchers at Iowa State University and colleagues The new study included 302 mostly Hispanic youthS, ageD 10 to 14, in a small U.S. city on the border with Mexico. The participants were interviewed at the start of the study and again 12 months later. The initial interviews revealed that 75 percent of the participants played video games within the past month, and 40 percent played games with violent content. Boys were more likely than girls to play violent games. At the follow-up interview, 7 percent of the young people reported engaging in at least one criminally violent act during the previous 12 months. The most common types of violent acts were physically assaulting other students or using force to take an object or money from someone else.

The study also found that 19 percent of the youth took part in at least one nonviolent crime, such as shoplifting, over the same period. After the researchers adjusted for such variables as exposure to domestic violence, bullying and depressive symptoms, they found exposure to violence in video games or television was not a strong predictor of aggressive behavior or rule-breaking, concluded investigator Dr. Christopher Ferguson, of Texas A&M International University. About 90 percent of U.S. kids ages 8 to 16 play video games, and they spend about 13 hours a week doing so (more if you're a boy). Now a new study suggests virtual violence in these games may make kids more aggressive in real life. Kids in both the U.S. and Japan who reported playing lots of violent video games had more aggressive behavior months later than their peers who did not, according to the study, which appears in the November issue of the journal Pediatrics. Many studies have linked violence in TV shows and video games to violent behavior. But when states have tried to keep under 18 kids from playing games rated "M" for mature, the proposed restrictions have often been challenged successfully in court. In the new study, Dr. Craig A. Anderson, Ph.D., of Iowa State University in Ames, and his colleagues looked at how children and teen's video game habits at one time point related to their behavior three to six months later. The study included three groups of kids: 181 Japanese students ages 12 to 15; 1,050 Japanese students aged 13 to 18; and 364 U.S. kids ages 9 to 12. The U.S. children listed their three favorite games and how often they played them. In the younger Japanese group, the researchers looked at how often the children played five different

violent video game genres (fighting action, shooting, adventure, among others); in the older group they gauged the violence in the kids' favorite game genres and the time they spent playing them each week. Japanese children rated their own behavior in terms of physical aggression, such as hitting, kicking or getting into fights with other kids; the U.S. children rated themselves too, but the researchers took into account reports from their peers and teachers as well. In every group, children who were exposed to more video game violence did become more aggressive over time than their peers who had less exposure. This was true even after the researchers took into account how aggressive the children were at the beginning of the study a strong predictor of future bad behavior. The psychological effects of video game addiction are just as harmful as the physical effects. One of the biggest debates in the gaming world is whether playing violent video games causes increased violent behavior. Researchers have found conflicting results during controlled studies, but it is clear that some people do develop aggression as a complication of video game addiction. This is especially true when a concerned family member or friend tries to convince the compulsive gamer to stop playing. This may cause agitation, anxiety, aggression, and other emotional changes. Sleep deprivation has several psychological effects on compulsive gamers. Hormones help control the normal sleep-awake cycle. One of the most important hormones responsible for normal sleep is melatonin. The pineal gland produces melatonin in response to biological and environmental cues. When a compulsive gamer avoids sleep in order to play video games, the pineal gland does not produce melatonin at the right times. This can lead to significant disruptions in the normal sleep cycle.

Chronic sleep deprivation leads to decreased reaction times, difficulty paying attention, inability to concentrate, loss of motivation, symptoms of depression, mood swings, anxiety, irritability, forgetfulness, and poor judgment. Poor judgment and an inability to concentrate are a dangerous combination. This is why sleep deprivation leads to more than 100,000 motor vehicle accidents each year, as reported by the National Sleep Foundation. There is a huge hype surrounding the launch of every new game system - Game Cube, XBox, and Sony Playstation 2 being just few of the latest. Affecting children age 4 all the way to 45 year-old adults, these video games have called for concern in our society regarding issues such as addiction, depression, and even aggression related to the playing of video games. A recent study of children in their early teens found that almost a third played video games daily, and that 7% played for at least 30 hours a week. In the second study, 210 college students were allowed to play Wolfenstein 3D, an extremely violent game, or Myst, a nonviolent game. After a short time, it was found that the students who played the violent game punished an opponent for a longer period of time compared to the students who played the non violent game. Dr. Anderson concluded by saying, "Violent video games provide a forum for learning and practicing aggressive solutions to conflict situations. It the short run, playing a violent video game appears to affect aggression by priming aggressive thoughts." Despite the fact that this study was for a short term effect, longer term effects are likely to be possible as the player learns and practices new aggression-related scripts that can become more and more accessible for the real-life conflict that may arise. Calvert and Tan compared the effects of playing versus observing violent video games on young adults' arousal levels, hostile feelings, and aggressive thoughts. Results indicated that college students who had played a violent virtual reality game had a higher heart rate, reported

more dizziness and nausea, and exhibited more aggressive thoughts in a posttest than those who had played a nonviolent game do. A study by Irwin and Gross sought to identify effects of playing an "aggressive" versus "nonaggressive" video game on second-grade boys identified as impulsive or reflective. Boys who had played the aggressive game, compared to those who had played the nonaggressive game, displayed more verbal and physical aggression to inanimate objects and playmates during a subsequent free play session. Moreover, these differences were not related to the boys' impulsive or reflective traits. Thirdly, Kirsh also investigated the effects of playing a violent versus a nonviolent video game. After playing these games, third- and fourth-graders were asked questions about a hypothetical story. On three of six questions, the children who had played the violent game responded more negatively about the harmful actions of a story character than did the other children. These results suggest that playing violent video games may make children more likely to attribute hostile intentions to others. Violent video games can lead to desensitization to violence which ultimately will lead to more aggressive behavior. This is more common in boys, perhaps because boys play violent games more than girls. "One study reveals that young men who are habitually aggressive may be especially vulnerable to the aggression-enhancing effects of repeated exposure to violent games," said psychologists Craig A. Anderson, Ph.D., and Karen E. Dill, Ph.D. "The other study reveals that even a brief exposure to violent video games can temporarily increase aggressive behavior in all types of participants." The first study involved 227 college students who completed a measure of trait aggressiveness and reported their actual aggressive behaviors (delinquency) in the recent past. They also reported their video game playing habits. "We found that students who reported

playing more violent video games in junior and high school engaged in more aggressive behavior," said lead author Anderson, of Iowa State University. "We also found that amount of time spent playing video games in the past was associated with lower academic grades in college." In the second study, 210 college students played either a violent (Wolfenstein 3D) or nonviolent video game (Myst). A short time later, the students who played the violent video game punished an opponent (received a noise blast with varying intensity) for a longer period of time than did students who had played the nonviolent video game. Video game addiction has significant effects on a compulsive gamer's social life. Some compulsive gamers avoid their friends and family members because they do not want to hear that they play video games too much. Excessive gaming cuts into time that could be spent dating, socializing, and forming new friendships. This activity is extremely isolating, as some video game addicts prefer to play alone. This allows them to maintain a specific gaming routine without having to account for the playing habits of other people. Romantic relationships may not survive video game addiction because the romantic partner may feel neglected or unappreciated. Academic performance can further isolate compulsive gamers from their peers. While classmates are celebrating good grades, gaming addicts are thinking about the next time they can play video games. Adult video game addicts may have difficulty participating in office social activities and performing their duties with an acceptable level of competence. They may even call in sick to work just so they have more time to play their video games. If addiction is not addressed in a timely manner, compulsive gamers may lose their jobs or receive poor performance reviews. This has a significant impact on earning ability and job satisfaction.

COMPUTER ADDICTION /STATISTICS Kids spending too much time playing video games may exhibit impulsive behavior and have attention problems. This is according to a new study published in the February 2012 issue of the Journal of Psychology and Popular Media Culture. For the study, attention problems were defined as difficulty engaging in or sustaining behavior to reach a goal. Statistics show that men and boys are more likely to become addicted to video games versus women and girls. Recent research has found that nearly one in 10 youth gamers (ages 818) can be classified as pathological gamers or addicted to video-gaming.

9 - 15 million people in the United States use the internet every day. Every three months the rate of use increases by 25%. Wieland et al., 2005

Internet users in Greece have an internet addiction prevalence rate of 8.2%. Most internet addicts are males who play online games and access internet cafs. Konstantinos et al., 2008

10% of South Korean youth are considered to be at high risk for internet addiction. Park et al., 2009

In addition to demonstrating other criteria, it has been proposed that a diagnosis of internet addiction must include symptoms for at least 3 months and at least 6 hours of non-essential internet use per day. Tao et al., 2010

96% of teenagers in China use IM and 10% can be classified as IM addicts. Leund et al., 2009

41% of self-selected online gamers play video games to escape and 7% are classified as being at risk of developing a psychological and behavioral dependence on online computer games. Hussain et al., 2009

1% of Norwegians are addicted to the internet. An additional 5% are at risk of developing internet addiction. The highest rate of addiction is in the 16-29 year old group (4% addicted, 19% at risk). Bakkan et al., 2008

11% of South Korean students are considered to be at risk for internet addiction. Park et al., 2008

The prevalence of problematic internet use among South African technology workers is 4% (compared to 2% of a control group of non-IT workers). Thatcher et al., 2008

7% of Chinese elementary and middle school students suffer from internet addiction. The rate is higher in males (10%) than in females (4%). The rate is higher for rural students (8%) than for city students (5%). Liu et al., 2010

Only 1% of college-level introductory and abnormal psychology books make reference to internet addiction. Mossbarger, 2008

Adolescents who play more than one hour of console or Internet video games may have more or more intense symptoms of ADHD or inattention than those who do not Chan et al., 2006

15% of MMORPG players meet the criteria for Internet addiction. Less than 1% of the players surveyed indicated that they have sought professional help for Internet addiction. Parson, 2005

18% of British students were considered to be pathological internet users, whose excessive use of the internet was causing academic, social, and interpersonal problems. Students addicted to the internet were found to have lower self-esteem than other students. Niemz et al., 2005

84% of college counselors "agree" or "strongly agree" that Internet Addiction Disorder is a legitimate disorder. 93% of college counselors have "some, but not sufficient training" or "no training" on diagnosing internet addiction disorder. 94% of college counselors have "no training" or "some, but not sufficient training" on the treatment of internet addiction disorder. Venturini, 2005

Among daily users of the internet, 5% of boys and girls from Finland were classified as being addicted to the internet. Kaltiala-Heino et al., 2004 ACADEMIC PERFORMANCE Academic achievement may be negatively related to over-all time spent playing video games. Studies have shown that the more time a kid spends playing video games, the poorer is his performance in school. A study by Argosy University's Minnesota School on Professional Psychology found that video game addicts argue a lot with their teachers, fight a lot with their friends, and score lower grades than others who play video games less often. Other studies show

that many game players routinely skip their homework to play games, and many students admitted that their video game habits are often responsible for poor school grades. According to Weaver, "almost half of college students who play video, computer or online games admit that it keeps them from studying 'some' or 'a lot." TIME SPENT ON COMPUTER GAMES While video game sales dropped 8 percent in 2009, the time spent playing online video games has risen 10 percent.

Market researcher NPD Group said that the average number of hours spent on online gaming has risen for the third consecutive year. That bodes well for this fast-growing segment of the game industry, which includes everything from casual online poker games to hardcore multiplayer online matches on the game consoles.

An average of 20 percent of all games purchased by online gamers were digitally downloaded in 2009, up from 19 percent a year ago and 18 percent in 2008. About 54 percent of gamers interviewed said they play games online, down slightly from 56 percent in 2009 and 55 percent in 2008.

The average number of hours per week, however, has gone up from 7.3 hours in 2009 to 8 hours in 2010. This means that, despite the slight dip in overall incidence of online game play, those who are playing are spending more time playing online than they did last year.

The report says that 71 percent of online gamers reported they bought or received a game during the 2009 holiday season. The number wasnt that different from 2009 or 2008, suggesting that online gamers did not significantly change their purchasing behavior in the recession.

In a recent survey of over 600 eighth and ninth grade students, children averaged 9 hours per week of video game play overall, with boys averaging 13 hours per week and girls averaging 5 hours per week (Gentile, Lynch, Linder, & Walsh, in press). Thus, while sexcorrelated differences in the amount of time committed to playing video games continue to exist, the rising tide has floated all boats. Even very young children are playing video games. PHYSICAL CHANGES Given the fact that video games are able to have several positive effects, it should come as no surprise that they also can have negative effects. Research has documented negative effects of video games on children's physical health, including obesity, video-induced seizures, and postural, muscular and skeletal disorders, such as tendonitis, nerve compression, and carpal tunnel syndrome. However, these effects are not likely to occur for most children. The research to date suggests that parents should be most concerned about two things: the amount of time that children play, and the content of the games that they play. EYE PROBLEM Over 270 million people in the United States use computers (2011). More than 50 percent experience eyestrain, headaches, blurred vision and other visual symptoms related to sustained use of the computer. This type of stress on the visual system can also cause body fatigue and reduced efficiency at work. Blurred vision and headaches can also be a sign of eye problems

Dr. G. John Lach, president of the MOA and an optometrist with Carlson-Tillisch, Mankato, Minnesota, says that CVS can result from personal computer use for work as well as for video gaming. Constant eye movement and eye refocusing often strains the eye muscles. According to Dr. Lach, CVS may involve eye irritation, dry eyes,headaches, pain in the eyes or surrounding facial muscles, squinting, excessive blinking, increased sensitivity to light and difficulty focusing. Research shows computer eye problems are common. Somewhere between 50% and 90% of people who work at a computer screen have at least some symptoms of eye trouble. In addition, working adults aren't the only ones vulnerable to computer vision syndrome. Kids who stare at portable video games or who use computers throughout the day at school also can experience eye problems related to computer use, especially if the lighting and computer position are less than ideal.

Many pediatric computer vision eye doctors believe that heavy computer use among children puts them at risk for early myopia. They point to several recent studies as evidence that computers can have a negative impact on a child's vision:

25% to 30% of computer-using children need corrective eyewear to work comfortably and safely at the computer at home or in school, says a study at the University of California at Berkeley School of Optometry.

The percentage of first-graders with myopia has increased from 12.1% to 20.4%, according to a study by the Department of Health in Taiwan.

A similar study in Singapore found that in three years the percentage of seven- to nine year olds with myopia had doubled, to 34%. Sitting for hours in front of a computer screen stresses a child's eyes because the computer forces the child's vision system to focus and strain a lot more than any other task. Twenty years ago, most children played outside, and their distant vision was more important.

Today, most children work at a computer either at home or school each day. Sitting in front of a computer and staring at a computer screen is causing vision problems that were not known years ago. Today it is a "near-point world," and parents need to be aware of the vision problems associated with computer work.

According to Deniz Ince (2009) 171 children who participated, more than half were girls. The average age of kids in the study was 9.3 years, and 80 percent of them reported playing with a console or handheld. Almost half of participants reported using these games and devices for less than an hour each day. One-third reported one to two hours of game play daily. Seven percent reported two to three hours per day, and 6.4 percent reported more than three hours each day. The findings of the study, which were presented this week at the 2009 annual meeting of the American College of Rheumatology in Philadelphia, determined that playing with a video game console, which is an interactive entertainment computer or electronic device, or a handheld video game, is in fact associated with increased joint pain in young children.

In particular, 12 percent of children reported finger pain, and nearly 10 percent reported wrist pain that limited the amount of time they were able to play video games. MUSCLE PAIN Computers are a necessity in today's world for work and leisure. As more people spend long hours in front of the computer, certain health problems have become widespread. Awkward postures while sitting, using the mouse for extended hours and constant use of the keyboard can cause hand, arm, shoulder, neck and back problems. People who spend long hours working on computers can benefit from a suitable desk and chair and using proper posture to reduce the risk of injuries to various parts of the body, such as the back and shoulders, according to the American Academy of Orthopaedic Surgeons.

According to univariate analyses factors showing p-value < 0.2 were neck extension range of motion, right upper limb tension outcome, positions of elbows, knees, and ankles during computer use, upper back and elbow support, positions of computer screen, keyboard, and mouse and percent duration of mouse use. Thus these factors were selected for further analysis. Multivariable logistic regression analyses revealed that positions of computer screen and mouse were associated with new-onset neck pain . Students reporting that computer screen position was not level with the eyes were at greater risk of developing neck pain than those reporting that computer screen position was level with the eyes (adjusted OR, 1.64; 95%CI, 1.13-2.36). Students reporting that the mouse position was too low were at lower risk of developing neck pain than those reporting mouse position suitable (adjusted OR, 0.52; 95%CI, 0.28-0.99).

Computer use for entertainment included activities such as chatting, playing games, listening to music, and watching movies. Hakala et al suggested that the basic mechanism of computer game playing mostly required repetitive hand motion in sitting position and dynamic action where players change postures freely, thereby minimizing loading of the upper extremities. Thus computer use for entertainment may not require the user to be in static postures for prolonged periods. It is also plausible that computer use for entertainment reduces mental stress. Bongers et al suggested that psychosocial demands can exceed an individual's coping capabilities, resulting in a stress response that in turn could produce muscle tension, static loading of muscles, or generate other physiological responses that may result in musculoskeletal symptoms. Low back pain and neck pain are significant health problems not only in adults but also in the young. In studies exploring populations of 300 children or more, the lifetime prevalence of Lower back pain has ranged from 30% to 51%. Neck pain has emerged as one of the most common pain symptoms and the most persistent musculoskeletal pain symptom. In adolescence, 1530% suffers from weekly Neck and 115% from weekly Lower back pain. Co-morbidity of the symptoms has been reported. Studies on adult work life support a hypothesis that computer-related activities can cause Neck pain and Lower back pain in the young. Neck symptoms have been associated with low or high screen position, shoulder symptoms with high screen position and shoulder elevation in computer mouse users, and the risk of Neck pain with poor placement of keyboard. Use of keyboard for 4 h during a working day has been associated with shoulder, wrist, or hand pain but not with Neck pain. Further, work exceeding 15 h/week at visual display units presented as a risk factor for Neck pain .An obvious reduction in musculoskeletal discomfort in the shoulder,

neck, and upper back areas has been observed after instructed computer users' sitting posture and workstations.

The result showed that the most complained problems are low back pain, neck pain and wrist pain. Foot and knee pain are the least complained pain when operating on computer systems. Pains are more severe in people with more than four years working experience on the computer system. Practically, the result of this study can help in preventing occupational injury associated with the use of computer with emphasis on good posture, workstation design and making of computer hardware. HEADACHE

The study of 1025 13-17 year olds found no association between the use of electronic media and headaches.

Astrid Milde-Busch, from Ludwig-Maximilians-University Munich, Germany, and colleagues studied the links between exposure to electronics and the prevalence and type of headaches.

"Excessive use of electronic media is often reported to be associated with long-lasting adverse effects on health like obesity or lack of regular exercise, or unspecific symptoms like tiredness, stress, concentration difficulties and sleep disturbances," she said.

"Studies into the occurrence of headaches have had mixed results and for some types of media, in particular computer games, are completely lacking," she added.

The researchers interviewed 489 teenagers who claimed to suffer from headaches and 536 who said they did not.

When the two groups were compared, no associations were found for television viewing, electronic gaming, mobile phone usage or computer usage.

SEIZURES Video games are a common environmental trigger, and game manufacturers acknowledge the risk of seizures in warnings that unfortunately many consumers tend to disregard Studies have shown that video games can trigger complex partial seizures that are subtle and therefore can occur undetected (Piccioli et al. 2005). But nearly all the research on video game seizures and photosensitivity has been conducted in Europe and Japan, and in the United States awareness remains quite limited. Unfortunately, when there is little awareness that these seizures can happen, people who are vulnerable dont realize they may be at risk, dont limit their exposure, and as a consequence they may experience repeated disabling seizures that most likely could have been prevented. Neurologists without expertise in reflex seizures who are not familiar with the most recent research may apply strict diagnostic criteria that rule out correct identification of the condition. We now know that for at least three years Alice experienced complex partial seizures nearly every day, usually several per day, trapping her in a constant post-seizure state. At the time, though, she had no idea that the fleeting sensations she never mentioned were probably auras, and that the irritability, odd behaviors, fatigue, inability to concentrate, and dysregulation of

sleep, mood, and appetite were being caused by her long sessions in front of a video screen. We had no idea, either. We consulted specialists for a variety of medical, psychiatric, and neuropsychiatric issues, not realizing the symptoms were likely related, until she was thirteen, when a physician friend suggested maybe she was having seizures. I did a little reading and very soon learned that her complicated clinical history was highly consistent with complex partial seizures and that video games are the most common precipitant of reflex seizures. Alice had developed a serious addiction to video games at age eleven. (I dont use the term addiction lightly.) What had begun as a way to unwind after school had developed into an uncontrollable force and a frightful ordeal that was repeated every day. Efforts to control the amount of time she played caused constant volatile struggles at home. To avoid distractions, she preferred to play alone, so there was rarely anyone in the room with her when the seizures happened. When left alone to play a video game for as little as five minutes, Alices mood would shift, and we would see a variety of autonomic symptoms (for example, her pupils would get huge). Shed become extremely irritable, hypersensitive to sensory stimuli (lower tolerance for noise and light, and the feeling on her skin of water in the shower was painful), and she often seemed spaced out. By the end of the day, Seizures Triggered by Video Games Solodar a low seizure threshold around time of their menstrual cycle. If something that might provoke their seizure say, sleep deprivation--happens around the menstrual cycle, then a seizure can occur. But at other times with a higher seizure threshold, sleep deprivation might not produce a seizure. Fifteen patients who experienced epileptic seizures while playing video games are described together with a review of 20 cases in the English literature. Nine of the 15 cases and all but two of the reported cases experienced their first seizure while playing video games. Two thirds of patients had idiopathic generalized epilepsy and mainly reported generalized tonic

clonic seizures, but some had typical absence seizures and myoclonic jerks while playing video games. In this series, 30% with idiopathic generalized epilepsy had juvenile myoclonic epilepsy. Overall, 70% of patients with idiopathic generalized epilepsy were photosensitive to intermittent photic stimulation and the mechanism of seizure provocation was probably similar to that of television induced seizures, although sensitivity to specific patterns was sometimes important. Two children had self induced video game seizures. Non-photic factors such as excitement, fatigue, sleep deprivation, cognitive processing, and diurnal variation in susceptibility seemed to be important seizure precipitants, particularly in non-photo-sensitive patients. Twenty nine per cent of patients had partial (mainly occipital) video game associated seizures. Occipital spikes were common in the EEG of these patients. Photosensitivity to intermittent photic stimulation may have been important in two patients but in the others, who all played arcade video games, other mechanisms need to be considered. Video game associated seizures are a feature of several epileptic syndromes and differ in precipitants and appropriate management. OBESITY Every hour children play video games or watch television may double their risk of obesity, a new study suggests. It's not the first study to link childhood obesity with time spent in front of the television or playing video games, but researchers say this study offers new insight into the scope of the problem. "To our knowledge this study provides the strongest evidence for an independent association between time spent playing electronic games and childhood obesity," says Nicolas Stettler, MD,

pediatric nutrition specialist at the Children's Hospital of Philadelphia, in a news release. "Our findings suggest that the use of electronic games should be limited to prevent childhood obesity." The study looked at factors associated with obesity in 872 schoolchildren in Switzerland. Researchers found that each hour the children played video games or watched television doubled the likelihood that the child was obese. Other factors that increased the risk of childhood obesity to a lesser extent were having a mother who worked outside the home or a father who smoked. The researchers speculate that unsupervised children may be more likely to eat large quantities of snack food after school. They also add that parental smoking may reflect a less health-conscious family environment. Factors that lowered the risk of obesity among the children included physical activity and eating breakfast. In addition, the study showed that children from other countries living in Switzerland were about twice as likely to be obese as Swiss children. They say non-Swiss children watched more television and had less physical activity than Swiss children. They add that differences in social economic status also played a part. Researchers say the disparity in obesity rates among these children suggests the need for culturally sensitive prevention programs that target the risk factors identified by this study. "Because obesity is difficult to treat once it has been established, obesity prevention during childhood is an essential component of the efforts to combat this global epidemic, and further research on obesity prevention is necessary," says Stettler.

INSOMIA Playing a video game or finishing up some work on computer before bed may keep you awake long after you turn the computer off. A new study shows that the bright light of a computer screen may alter the body's biological clock and suppress the natural production of melatonin that's critical to the normal sleep-wake cycle. Melatonin is a hormone in the body that helps regulate a person's sleeping and waking hours. Researchers say exposure to light is thought to alter the amount of melatonin produced, and a decline in melatonin production is often blamed for sleep problems in the elderly.

In this study, published in the May issue of the Journal of Applied Physiology, researchers tested the effects of computer use at night on melatonin production as well as a variety of other factors known to affect a person's biological clock, such asbody temperature and heart rate that are known to drop during sleep. Seven healthy male computer users with an average age of 25 were told to wake up between 8 and 9 a.m. and go to bed between midnight and 1 a.m. for a week before the start of the experiment. They were then asked to perform either an exciting task (a video shooting game) or a boring task (simple math) using a computer with either a bright or dark display monitor on alternating nights between 11:30 p.m. and 2 a.m. before going to bed. Researchers Shigekazu Higuchi and colleagues at the Akita University School of Medicine in Akita, Japan, found that melatonin production was significantly affected by the brightness of the computer screen as well as the type of task performed. Melatonin levels were

lower after performing the exciting task in front of a bright display than in front of a darker one. But there was no difference in melatonin levels during the boring tasks. Although the body temperature dropped at night under all conditions, working in front of a bright computer screen caused the computer user's body temperature to be significantly higher than when it was performed using a dimmer monitor. Researchers say those results show that computer users who work or play at night in front of a bright display might lose sleep because performing an exciting task late at night may alter the normal nocturnal changes in melatonin and body temperature associated with a person's biological clock.