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MADRID –– Fanatical players forking out money to get ahead in games such as Candy Crush Saga or Angry Birds are driving explosive growth in the multi-billion-dollar mobile gaming business.

Once hooked on free-to-download smartphone and tablet games, millions of not-so-brilliant or simply impatient gamers are ready to pay cash to obtain extra moves or new lives, or to avoid time delays standing between them and the next level.

It is a lucrative model for businesses such as Candy Crush developer King Digital Entertainment, which announced Tuesday it had filed a request for a US initial public offering worth up to $500 million (364 million euros) and an ensuing listing on the New York Stock Exchange.

Indeed, the so-called “freemium” phenomenon pushed up spending on mobile games, most of it devoted to such in-app purchases, by more than 60 percent to $16.5 billion in 2013, according to research house IHS.

Double-digit annual growth is anticipated in the next three to five years.

“The way the games are set up is that there is no real limit on how much someone will spend within a single game,” said Jack Kent, British-based mobile analyst at IHS.

“You are encouraged to keep going back and spend more,” he said in an interview ahead of the February 23-27 World Mobile Congress in Barcelona gathering industry players including top app developers.

Each in-app purchase may cost from $1 to $60 for anything from a few extra moves in the wildly popular Candy Crush game to “green Gem” currency in the strategy game Clash of Clans, or even a combined pack of in-game advantages on other titles, Kent said.

Though games account for about 40 percent of all mobile app downloads, they make up about 80 percent of the revenues, the analyst said.

The size of the smartphone and tablet games market is now more than twice that of traditional handheld consoles, such as the Sony PSP and Nintendo DS, he estimated.

Technology research group Gartner Inc. predicts overall mobile game revenue will surge from $13.2 billion in 2013 to $17 billion in 2014 and $22 billion in 2015.

This month, the Vietnamese creator of smash-hit mobile game Flappy Bird, Nguyen Ha Dong, actually withdrew his app from sale saying its runaway success had ruined his simple life.

In an interview with Forbes, he said the game, where the aim is to direct a flying bird between oncoming sets of pipes and which reportedly raked in about $50,000 a day, had become an “addictive product”.

‘The app hooks you’

Such qualms are unlikely to spread widely.

As developers try to cash in, there are now more than a million mobile gaming apps available, making it hard for individual games even to be noticed.

Lawrence Lundy, analyst at Frost & Sullivan technology research house, said mobile messaging providers in Asia were now teaming up with developers to offer games directly to their users.

Japanese mobile messaging company LINE or South Korea’s KakaoTalk, for example, have effectively become games platforms, analysts said, allowing users to challenge their friends.

“They prove it can be done and you can make a lot of money from those sources,” Lundy said.

The mechanics of the in-app purchase are key, said Brian Blau, consumer technology analyst at Gartner.

“You either get the app for free or you pay a very low price. Then, the app hooks you, gets you interested,” he said.

SAN FRANCISCO –– Google on Tuesday gave early adopters of its Internet-connected eyewear a bit of advice: don’t be “Glassholes”.

It was the final suggestion in a recommended code of conduct posted online for software developers and others taking part in an Explorer programme providing early access to Google Glass.

The California-based Internet titan appeared intent on avoiding the kinds of caustic run-ins that have seen some Glass wearers tossed from eateries, pubs or other establishments due to concerns over camera capabilities built into devices.

Don’t be “creepy or rude (aka, a “Glasshole”),” Google said in a guide posted online for Explorer program members.

“Respect others and if they have questions about Glass don’t get snappy.”

Google suggest Glass wearers be polite and offer demonstrations to possibly win over the wary. Glass fans were advised it is proper to follow the same rules set down for smartphone use in businesses.

“If you’re asked to turn your phone off, turn Glass off as well,” Google said.

“Breaking the rules or being rude will not get businesses excited about Glass and will ruin it for other explorers.”

In the wake of one early adopter claiming Glass gave him headaches, Google told users not to “Glass-out” by starring into the inset prism screen for long periods at a time.

Glass was designed to deliver helpful bursts of information conveniently to let wearers get back to doing things in the real world, according to the technology firm. “If you find yourself staring off into the prism for long periods of time you’re probably looking pretty weird to the people around you,” Google said.

“So don’t read War and Peace on Glass. Things like that are better done on bigger screens.”

Google also advised against wearing Glass while playing impact sports, or being foolish enough to think the eyewear won’t draw attention.

The “do” list included venturing about, using voice commands, asking permission to take pictures, and employing screen locks to prevent use if Glass is lost or stolen.

Google last month unveiled a partnership with US vision insurer VSP to make prescription Glass and to reimburse some of the costs under health benefits.

That does not include the $1,500 price for Google Glass, which is in a test phase with a small number of “explorers” ahead of a wider release sometime this year.

Glass connects to the Internet using Wi-Fi hot spots or, more typically, by being wirelessly tethered to mobile phones. Pictures or video are may be shared through the Google Plus social network.

During the testing phase, developers are creating apps for the eyewear, which can range from getting weather reports to sharing videos to playing games.

WASHINGTON –– Thanks to smartphones, e-mail, video games and photo sharing are available at the touch of a finger.

But attach a special case and that same phone can produce an electrocardiogram (EKG) from the electrical impulses in your hand and send it to a doctor.

“It’s a neat little device,” says E.B. Fox, who uses a heart monitor and app from AliveCor to keep track of his arrhythmia.

The 57-year-old North Carolina resident says he has been using the device since October. If he thinks there is a problem, he can e-mail a reading to his doctor for an evaluation.

“I have no doubt it’s saved me one doctor’s visit at least,” said Fox.

The heart monitor is just one example of progress in the booming mobile health –– or mHealth –– industry, which is changing both the way doctors practise medicine, and the way patients handle medical decisions.

“Mobile apps are one of many mHealth tools that are helping to engage consumers and patients in their own health care,” David Collins, senior director of the mobile division at the nonprofit Healthcare Information and Management Systems Society, told AFP.

Slashing health

care costs

Doctors and developers alike are hoping that these mobile apps and devices will lead to lower health care costs.

Health care businesses such as hospitals and insurance companies traditionally focus on quantity, counting the number of patients seen and procedures done.

But as the system shifts and firms try to quantify the quality of care, factors such as whether a patient returns to the hospital within 30 days of treatment come into play, and can affect insurance payouts for care.

The idea is that if patients track their own health, using mobile apps and other tools, the extra data can reduce the number of doctor’s visits, and make each one more effective.

The Scripps Translational Science Institute in California is in the middle of a study examining the relationship between medical costs and mobile medical devices, specifically in patients with chronic conditions

Participants receive an iPhone and either a blood pressure monitor, heart monitor, or glucose meter to track their high blood pressure, arrhythmia, or diabetes for six months.

Lead researcher Cinnamon Bloss said the team will be looking to see if by monitoring their own symptoms, patients can avoid unnecessary trips to the doctor or emergency room, as Fox has.

Patient compliance

not easy

A few months into the study, Bloss has already noticed one longstanding problem that persists despite the ease of using mobile apps — patient compliance.

“We’re offering a free phone and device for a disease they already have, but many people don’t want to be bothered, don’t want to take the time,” Bloss said.

And according to Iltifat Husain, the founder of the app review website iMedicalApps.com, a lack of adherence to treatment plans can have significant financial and health-related consequences.

“Patients who are non-compliant end up costing us billions of dollars in the healthcare system. I see it on a daily basis,” he said at an event at the Brookings Institution in Washington.

“I’ll see it in patients who come in in essentially a diabetic coma because they weren’t taking their medications appropriately.”

Better apps

As smartphones are increasingly a part of everyday life, even for older Americans, Husain says mobile health tools are improving.

“The quality of medical apps has grown tremendously in the last year or two, due to people having a higher medical app literacy,” he told AFP.

That’s also due to the guidelines released by the US Food and Drug Administration in September last year, which Husain said were helping to ward off the release of dodgy apps that could put patients at risk.

“Initially you had the Wild West –– now you have a sheriff who’s come to town,” Husain said.

But in a rapidly growing field that allows massive amounts of data to be collected, Husain offered a few words of caution.

“Just because we can monitor vital signs and other things doesn’t necessarily mean we should. It doesn’t necessarily mean that it leads to a better outcome,” he warned.

“As a society, we need to figure out if we’re willing to change the fundamental physician-patient relationship.”

LONDON — A saliva test for teenage boys with mild symptoms of depression could help identify those who will later develop major depression, a new study says.

Researchers measured the stress hormone cortisol in teenage boys and found that ones with high levels coupled with mild depression symptoms were up to 14 times more likely to suffer clinical depression later in life than those with low or normal cortisol levels.

The test was tried on teenage boys and girls, but found to be most effective with boys.

About one in six people suffer from clinical depression at some point in their lives, and most mental health disorders start before age 24. There is currently no biological test to spot depression.

“This is the emergence of a new way of looking at mental illness,” Joe Herbert of the University of Cambridge and one of the study authors said at a news conference on Monday. “You don’t have to rely simply on what the patient tells you, but what you can measure inside the patient,” he said.

Herbert compared the new test to ones done for other health problems, such as heart disease, which evaluate things such as cholesterol and high blood sugar to determine a patient’s risk.

Herbert and colleagues at the University of Cambridge observed more than 1,800 teenagers aged 12 to 19 and examined their cortisol levels with saliva tests. The researchers also collected the teens’ own reports of depression symptoms and tracked diagnoses of mental health disorders in them for up to three years later.

The boys who had high cortisol levels and mild depression symptoms were up to 14 times more likely to suffer from clinical depression when compared to other teens with normal levels, while girls with similarly elevated cortisol levels were only up to four times more likely to develop the condition. The study was paid for by the Wellcome Trust and the results were published online Monday in the journal Proceedings of the National Academies of Science.

Experts suggested that cortisol might affect boys and girls differently.

“All hormones, including sexual hormones, influence brain function and behaviour,” said Dr Carmine Pariante, a professor of biological psychiatry at the Institute of Psychiatry at King’s College London. He was not linked to the study.

Pariante said the gender-specific hormones — androgen for males and oestrogen and progesterone for females — might react differently to cortisol and could explain the difference in risk for teenage boys and girls.

Pariante said the saliva test was promising and could help target psychological help such as talk therapy for boys at risk of developing depression. Scientists are increasingly searching for physical markers in the body of psychiatric illnesses instead of relying exclusively on a diagnosis based on a patient consultation.

“This gives us a biological model to understand mental health problems the way we understand other medical conditions,” he said, comparing it to how doctors might diagnose a broken leg based on an X-ray or identify heart disease patients based on high blood pressure or cholesterol readings. “It will help us identify patients at risk so we can try to help them as soon as possible.”

NEW YORK –– For Australians over age 65 included in a new study, being obese raised the risk of experiencing a fall by 31 per cent.

“Falls are one of the most common causes of injury for older individuals and as the world population ages, the number of fall-related injuries are projected to increase rapidly,” said lead author Rebecca Mitchell.

“Likewise, rates of overweight and obesity among older individuals are also increasing,” added Mitchell, a researcher with Neuroscience Research Australia at the University of New South Wales.

Mitchell and her colleagues wanted to determine whether overweight and obesity added to the risk of falling among older adults, as well as the risk of being injured in a fall.

The researchers used information from the New South Wales Prevention Baseline Survey, a large Australian population study started in 2009.

A total of 5,681 people 65 years of age and older were asked about their history of falling, their perception of their own risk of falling, their general health status, medication use and activity levels.

Participants who had fallen one or more times in the previous 12 months as a result of accidentally losing their balance, tripping or slipping were also asked how many of those falls resulted in injury and how many required medical attention or led to hospital admission.

According to the results published in the Australian and New Zealand Journal of Public Health, 23 per cent of healthy-weight respondents had fallen once during the previous 12 months and 34 per cent had fallen more than once.

About 30 per cent of obese respondents fell once and another 45 per cent fell more than once, making the overall fall risk 31 per cent higher in the obese group.

The obese participants who fell didn’t have any higher risk of fall-related injuries compared to healthy-weight people who fell, but they were more likely to have other health conditions — such as heart disease, diabetes and high blood pressure — and to report being in moderate or extreme discomfort.

Those who were obese and fell were also more likely to be taking four or more prescription medications.

“It is difficult to know for certain why the risk of falling increases for obese individuals, but it is likely to be as a result of reduced peripheral sensation, general physical weakness and instability when standing or walking,” Mitchell said.

There are a number of common risk factors that can increase any older person’s risk of falling, she added.

“These can include individual factors such as: poor health, instability when standing or walking, some health conditions, such as poor vision or dementia, lack of physical activity, use of multiple medications that can affect balance, and a poor diet,” Mitchell said.

Risks can also be in an older person’s environment, including “uneven or slippery floors, unsecured floor coverings, such as rugs, inappropriate footwear or eyewear, or inadequate lighting,” she said.

“As to why fall-related injuries do not increase for obese individuals this is likely to be as a result of adipose tissue (fat) protecting bone,” Mitchell said.

Compared to the healthy-weight group, the obese participants in the study were more likely to be sedentary for eight or more hours a day, to walk less, to have problems walking and to believe that nothing could be done to prevent falls.