Women's weight linked to memory loss

Excess Weight in Older Women Linked to Diminished Memory

Middle-aged women who are overweight may have yet another motivation to take off those excess pounds: The more a postmenopausal woman weighs, the worse her memory, researchers have found.

What's more, the negative impact on memory was more pronounced in "pear-shaped" women who carry excess weight around their hips, and less of a factor in "apple-shaped" women who carry it around their waists, the study authors noted.

In the new study, researchers found that for every one point increase in a woman's body mass index (BMI), her score on a standard memory test -- though still in the normal range -- dropped by one point. BMI is a measurement that takes into account height and weight.

The study, which was based on data from nearly 9,000 women who were enrolled in the Women's Health Initiative, a large government-sponsored study of postmenopausal women, was released online July 14 in advance of publication in the August print issue of the Journal of the American Geriatrics Society.

"This study really underscores the importance of maintaining an ideal body weight," said lead researcher Dr. Diana Kerwin, assistant professor of medicine in the division of geriatrics at Northwestern University's Feinberg School of Medicine in Chicago. "Even if a woman feels that she's generally healthy because her blood pressure and cholesterol levels are good, what these findings suggest is that she also needs to pay attention to her weight, because it's not only good for her heart, it's also good for her brain."

For the study, Kerwin and her colleagues examined data on 8,745 women between the ages of 65 and 79 who had no signs of dementia or other brain abnormalities. In addition to looking at BMI and waist and hip measurements (to determine body fat distribution), they also reviewed the women's scores on a 100-point cognitive functioning test known as the Modified Mini-Mental Status Examination. Roughly 70 percent of the women were overweight or obese.

After controlling for age, level of education and vascular diseases that have been shown to raise the risk of dementia, such as stroke, the researchers found that the association between obesity and poorer memory and brain function persisted. Kerwin, who conducted the study while a geriatrics researcher at the Medical College of Wisconsin, added that although the women's scores were still in the normal range, the added weight clearly had a detrimental effect.

Kerwin said more studies are needed to confirm and explain the apparent disparity between pear- and apple-shaped women. But one possibility is that the type of fat that's deposited on the hips is more likely to release hormones that are detrimental to brain function, she said. A follow-up study now in the planning stages will involve conducting MRIs of women's bodies, "so we can look at how much abdominal fat they have versus hip fat, and see if there's any difference in their brain functioning," Kerwin explained.

This study expands on several others involving body shape, in which obese apple-shaped women -- but not pear-shaped women -- were found to be at higher risk of diabetes, heart disease and dementia.

"What this study is really telling us is that there's something about obesity that puts you at risk for dementia, and it's independent of other factors such as vascular disease," said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City.

Kennedy added that he hoped the results would coax more older women to exercise regularly in order to maintain a healthy weight. "This is really a call for women to make an effort to get more active, find an exercise partner, and do something every day," he said.

Ranking the best hospitals in America

Best Hospitals 2010-11: the Honor Roll

It's no secret that all hospitals are not equal. The special quality shared by the 152 that made it into the new 2010-11 Best Hospitals rankings (out of nearly 5,000 that were considered), and even more so by the 14 in this year's Honor Roll, is their ability to take on and meet the most difficult challenges. Their operating rooms showcase delicate, demanding procedures—excising a cancerous portion of a pancreas without destroying the rest of the fragile organ, say, or restoring function to an arthritis-ravaged hand through a creative blend of fusing joints and splicing tendons. They are referral centers for ill patients with multiple risks—advanced age plus heart failure plus diabetes, perhaps.

Patients at these centers are not free from hospital-based infections or immune from getting the wrong drugs or becoming victims of other medical errors. No matter how skilled or deep their expertise, even "best hospitals" don't do everything right. But when the stakes are high, calling for unusual capabilities, they are hospitals that can save lives that might otherwise be lost or preserve quality of life that might otherwise be sacrificed. That is why U.S. News has published the Best Hospitals rankings for 21 years: to help guide patients who need high-stakes care because of the complexity or difficulty of their condition or procedure. For 2010-11 we analyzed 4,852 hospitals, virtually every one in the United States, in 16 specialties from cancer and heart disease to respiratory disorders and urology. Only 152 centers appear in even one of the 16 specialty rankings. Fourteen ultra-elite Honor Roll hospitals had very high scores in six or more specialties.

In 12 of the 16 specialties, the quality of hospital care can determine life or death. Therefore the largest part of each hospital's score in those 12 specialties came from death rates and other hard data on patient safety, volume, and various care-related factors such as nursing and patient services. The rest of the score was derived from a reputational survey of specialists. The 50 highest scorers were ranked. Scores and complete data for another 1,740 unranked hospitals are also available. In the four other specialties—ophthalmology, psychiatry, rehabilitation, and rheumatology—hospitals were ranked on reputation alone. The number of deaths in these specialties is so low that mortality data and certain other categories of data are not relevant factors.

A detailed description of the analysis in the 12 specialties is available. In brief, death rate, care-related factors, and patient safety added up to slightly more than two-thirds of each hospital's score. The reputation portion of the score used responses from nearly 10,000 physicians, who were surveyed in 2008, 2009, and 2010 and asked to name five hospitals they consider among the best in their specialty for difficult cases, ignoring cost or location.

The Honor Roll requirements were so stiff that 99.7 percent of all centers in the nation were excluded. A hospital had to be ranked in at least six specialties, but ranking alone was insufficient for inclusion. It also had to have an extremely high score (in statisticians' terms, at least 3 standard deviations above the mean). That earned 1 point per specialty. Reaching the top of the Honor Roll called for even higher scores (4 or more standard deviations above the mean), earning 2 points, in far more specialties. The highest-ranked hospitals on the Honor Roll, which is ordered by points, had high scores in 15 of the 16 specialty rankings. Johns Hopkins stands at No. 1—as it has for the last 20 years.
Rank
Hospital
Points
Specialties

1
Johns Hopkins Hospital, Baltimore
30
15

2
Mayo Clinic, Rochester, Minn.
28
15

3
Massachusetts General Hospital, Boston
27
15

4
Cleveland Clinic
26
13

5
Ronald Reagan UCLA Medical Center, Los Angeles
24
14

6
New York-Presbyterian University Hospital of Columbia and Cornell
21
11

7
University of California, San Francisco Medical Center
20
11

8
Barnes-Jewish Hospital/Washington University, St. Louis
17
10

9
Hospital of the University of Pennsylvania, Philadelphia
16
12

10
Duke University Medical Center, Durham, N.C.
16
10

11
Brigham and Women's Hospital, Boston
14
10

12
University of Washington Medical Center, Seattle
14
8

13
UPMC-University of Pittsburgh Medical Center
13
8

14
University of Michigan Hospitals and Health Centers, Ann Arbor
12
8

Five keys to the World Cup title game

Netherlands-Spain: Five things to watch


Spain fields two of the best players at the World Cup in David Villa, left, and Xavi Hernandez.
JOHANNESBURG – So after 30 days, 30 sad goodbyes, 63 matches and a million storylines, Sunday will be it – the game that will bring four years of joy and an eternal place in history.

The World Cup final.

More than one billion people will be tuning in around the globe to see soccer’s ultimate prize battled for on the field of Soccer City. And it will all be decided by a small group of men from the Netherlands and Spain who know that their greatest moment and a permanent spot in soccer’s folklore await them.

There is no more cherished feat in soccer than this. The performances of one night can shape the legacy of the combatants and the mood of two nations. Here is what you should be watching out for Sunday.

1. Historical hurt

Few nations have experienced soccer suffering like these two. Decade upon decade of disappointment and frustration have marred their history. Spain did ease some of that by winning the European Championships two years ago, but this is the prize it really craves.

The Netherlands has been agonizingly close before, taking the lead in the 1974 final before losing to West Germany and being just inches away from triumph late in the 1978 final against Argentina.

Look out for: Who’s buckling under pressure. Both teams know exactly how much this means to the folks back home and how long the wait has been. Years of underachievement can be wiped away over the course of 90 minutes, yet success will go to the side that best handles the weight of expectation.

2. Beauty and the Beast

The midfield battle between the tournament’s best player and its most rugged will go a long way toward determining the eventual champion. Spain’s Xavi, arguably the finest player on the planet right now, will look to work his creative magic once more and make his side tick. Dutch enforcer Mark van Bommel will be charged with shutting him down and could use some pretty physical tactics to do so.

Xavi doesn’t always have the eye-catching tricks of Lionel Messi or Cristiano Ronaldo, but he is exceptionally talented and may have the sharpest soccer mind of all. Van Bommel will find life tough against him, and his timing and positioning on tackles must be perfect.

Look out for: Rough stuff. Van Bommel won’t need anyone to tell him just how dangerous Xavi is and how intrinsic the little man will be to Spain’s chances. Expect some ferocious early challenges aimed at slowing down the Barcelona superstar.

3. The money men


The Netherlands' Wesley Sneijder. David Villa and Wesley Sneijder are two of the most valuable players in world soccer, with Villa having cost Barcelona $50 million this summer and Sneijder being the target of a $42 million bid by Manchester United. They have been “money” at this World Cup, too, each man helping carry his team through to Sunday’s showdown.

Villa’s contribution to Spain has been about far more than his five goals – his electric presence terrifies opposing defenders – while Sneijder stood tall when it counted most, spearheading the Dutch comeback from a goal down to beat Brazil in the quarterfinals.

Look out for: Their offensive arsenal. Villa is direct and determined, preferring to charge into the heart of a defense and cause panic. Sniejder attacks from a little wider and a little deeper position and likes to send sneaking crosses behind the backline. If either man gets a sight of goal, though, get ready for them to take deadly aim.

4. The workhorses

Workhorse is an unflattering phrase for Andres Iniesta, who’s a great talent for Spain and one of the 10 players shortlisted for the tournament MVP award. The Spanish midfielder is gifted, too, but it has been his industry and drive that has been most valuable to his side over the past few weeks.


The Netherlands' Dirk Kuyt.

(Lars Baron/Getty Images)
For the Dutch, much of that grunt work is left to Dirk Kuyt, who covers enormous tracts of turf and offers himself as an unselfish servant to the likes of Sneijder and Arjen Robben. Kuyt’s efforts are not spectacular but are mightily important to his team.

Look out for: The fuel gauges. Not many players have expended as much energy as these two during the World Cup and it must be questioned how much is left in the tank. Neither man likes to take a backward step and will be desperate for one more huge performance. Their minds are strong, but how are the bodies?

5. The defensive titans

Each side has its Hercules at the back with Spanish defender Carlos Puyol and Dutch center back Joris Mathijsen charged with keeping things tight and organized. Puyol has been as strong and courageous as ever and even got the goal that put Spain into the final.

Mathijsen sat out the quarterfinal against Brazil due to injury, but he bounced back in the last four and helped keep Diego Forlan under wraps. He doesn’t get forward much but brings stability and calm to the Netherlands defensive structure.

Look out for: Tough tasks. Mathijsen is still experiencing discomfort from a knee injury and the quick turns of Villa will be a challenge. Puyol also will have a battle on his hands trying to outmuscle Dutch striker Robin van Persie, who’s a much taller man.

Simple ways to lower your electric bill

Beating the heat this summer is an expensive proposition as temperatures soar into the triple digits in some parts of the U.S.

Cities along the East Coast endured record-setting highs Tuesday, with more than half a dozen topping temperatures not seen since 1999, according to Accuweather.com. (Baltimore topped 105 degrees, compared with 101 in 1999; and Warwick, R.I., hit 103, up from 97 in 1999.) Power demand during the heat wave is also expected to hit record highs, with many utilities warning of brownouts and blackouts.

Here's how to stay cool and keep electricity bills reasonable:

Fine-Tune Your Equipment

Arrange an HVAC inspection. Anyone can hire a certified technician for an annual check that their home's heating, ventilation and air-conditioning system is operating at peak efficiency. Leaking ducts, for example, could reduce energy efficiency by up to 20%, says Ronnie Kweller, a spokeswoman for the Alliance to Save Energy. Inspections usually cost $50 to $100, but that could be offset by the energy savings over time.

Shop for size. Consumers in the market for a new room or window air conditioner should use Energy Star guidelines to determine how powerful a unit they need. A too-powerful unit not only wastes energy, it's also less effective at reducing humidity.

Keep it clean. Clean air filters monthly for central air and individual window or wall units. Dirt and dust hinder air flow, reducing efficiency.

Program the thermostat. Give the air conditioner a break during the work day. Shifting the settings to allow higher daytime temperatures could cut the average household's electric bill by $180 a year, according to Energy Star.

Seek out incentives on appliances. Investing in a new energy-efficient unit can cut long-term bills -- and be cheaper upfront, too. Through the end of 2010, qualifying central air conditioners are eligible for a federal tax credit of 30% of the cost, including installation, up to a total of $1,500 for all projects. Plenty of states also still have rebates available under the 2009 American Recovery and Reinvestment Act. A Maine resident, for example, can get $100 back on a qualifying central air conditioner, while Georgia offers $30 for room units and $99 on central units. Check for other government and utility deals in the Database of State Incentives for Renewables and Efficiency.

Hunt Down Heat Sources

Seal up the house. Cooled air can leak through cracks along window and door frames. Invest in some caulk and weather-stripping to plug up these drafts. A home that's properly insulated and sealed improves energy efficiency by up to 20% year-round, according to the Alliance to Save Energy. (Insulation materials are also eligible for the 30% energy efficiency federal tax credit, up to $1,500 for all improvements combined.)

Avoid chores. The hotter the space, the harder an air conditioner must work to keep things cool. Limit the use of heat-generating appliances such as the oven, dishwasher and clothes dryer during the daytime hours when temperatures are hottest, says Steve Rosenstock, manager of energy solutions for the Edison Electric Institute, an industry group. "That just makes more of a load for your air conditioner," he says.

Change light bulbs. Swapping incandescent bulbs for compact fluorescent ones can cut a home electric bill, Kweller says. Switching one incandescent for a CFL saves $35 in energy costs over the projected 10-year life of the bulb. Not only do CFLs use less energy than conventional bulbs, but they also generate less heat.

Close the blinds. Rooms get hotter without shades or curtains to block the sunlight, especially with south- and west-facing windows. Put this idea to work more effectively with insulated window treatments.

Use fans. A breeze makes the room feel a few degrees cooler. Just be sure to turn it off when leaving. "Fans cool people, not rooms," Kweller says.

Unplug. Gadgets like a cellphone charger or microwave suck energy -- and generate heat -- as long as they're attached to a power source. Standby power for appliances not in use typically accounts for 5% to 10% of residential electricity use, according to the Lawrence Berkeley National Laboratory. Plug those devices into a power strip that can be turned off when not in use.

Assess Utility Suppliers

Check alternate suppliers. Residents of states where the electric industry is deregulated can shop around for their energy provider, says Rosenstock. Depending on the options, some residents could save 5% to 15% a month. Many alternative companies use renewable energy, so they're much less dependent on volatile oil, coal and natural gas prices. Most will also fix billing rates for a year or more -- a bonus if energy prices creep up. The state's public service commission should keep a list of options. Just be aware that most providers require a commitment of at least a year and charge a hefty fee for ducking out early, Rosenstock says.

Consider time-of-use plans. A growing number of electric companies are offering so-called time-of-use plans, which offer lower rates for energy consumption during off-peak hours (usually from mid-evening to early morning). The catch is that users often pay more for peak-hours use, so consider the daily schedule before signing up. Arizona-based SRP, for example, regularly charges 10.64 to 12.12 cents per kilowatt hour during July and August, based on the amount used in a billing period. On the time-of-use plan, it charges a flat 21.30 cents for on-peak hours (1 p.m. to 8 p.m. weekdays) and 6.65 cents during the rest of the day, on weekends and holidays.

Fix the bill. Ask the utility company about fixed-bill plans, which charge the same amount every month for a set period, regardless of electricity use. Users pay a premium rate per kilowatt hour to hedge against price increases and seasonal spikes, so make sure to crunch the numbers to confirm the savings, Kweller says. Also, keep in mind that these plans periodically reconcile, which can leave users with a big bill if they've used more than the supplier anticipated. Check with the utility to see if it alerts customers using more power than they anticipated and whether users can pay extra as they go.

Mani the Fortunetelling Parakeet Picks Netherlands in World Cup Final

A crowd of soccer fans leans forward as Mani, Singapore's World Cup-forecasting parakeet, creeps out of his small wooden cage and chooses between two white cards — one hiding the flag of the Netherlands, the other Spain.

If the bird's many new believers are right, Holland will win its first World Cup championship Sunday. Mani grabbed a card in his beak Friday and flipped it over to reveal the Dutch flag.

The 13-year-old parakeet has become a local celebrity after its owner, M. Muniyappan, claimed Mani accurately forecast the World Cup's four quarterfinal games and Spain's semifinal victory over Germany.

Paul the Psychic Octopus has some competition—a 13-year-old Singaporean parakeet named Mani has picked the Netherlands to beat Spain in the World Cup championship game on Sunday. Mani was right about the quarterfinals and Spain beating Germany.

Mani's owner, an 80-year-old Indian fortuneteller named M. Muniyappan, who lives in Singapore, told the AP: "People usually want help picking the lottery numbers, or when to get married. Then gamblers started asking about the World Cup." Muniyappan said Mani's popularity has risen from about 10 visitors per day to 30, and people generally pay around $7 for him to predict their future.

Octopus oracle picks Spain to win World Cup

Eyes around the world were on Germany’s octopus oracle Paul on Friday as he made his biggest prediction yet in the World Cup: Spain will beat the Netherlands in the final.

Paul’s prescient picks in the World Cup—he has yet to predict a match wrong—have propelled him to international fame from obscurity a month ago in an aquarium in the western city of Oberhausen.

TV stations in Germany, Great Britain, Taiwan and elsewhere broadcast live pictures, complete with breathless commentary, of his final decision for the tournament. Millions watched as the world-famous octopus descended upon on a tank marked with a Spanish flag, sitting for only a few minutes before grabbing a mussel and devouring it, while completely ignoring the Dutch tank—indicating a Spanish victory in Sunday’s final match in Sunday’s final.

It was the first time he’d been tasked to pick a game in which Germany wasn’t involved, as the Oberhausen Sea Life aquarium bowed to overwhelming demand to see who he would choose in the final.

Paul correctly predicted Germany’s wins over Argentina, England, Australia and Ghana and the country’s loss to Spain and Serbia.

He also predicted earlier on Friday that Germany will win over Uruguay in Saturday’s match for third and fourth place.

His handlers say he is coping with fame well.

“Paul is such a professional oracle—he doesn’t even care that hundreds of journalists are watching and commenting on every move he makes,” said Stefan Porwoll, the Sea Life aquarium manager. “We’re so proud of him.”

Paul first developed his abilities during the 2008 European Championship in which he predicted five out of six games involving Germany correctly. But while he had only a community of local fans two years ago, his World Cup prognostications have brought him international stardom.

Speain’s defeat of Germany in the semifinals as predicted by Paul prompted many Germans to wonder about how he would taste grilled for dinner. Spanish Prime Minister Jose Luis Rodriguez Zapatero fretted about the safety of “El Pulpo Paul,” as he’s known in Spain, and offered Paul protection.

“I am concerned about the octopus,” Zapatero said. “I’m thinking about sending in a team to protect the octopus because obviously it was very spectacular that he should get Spain’s victory right from there.”

In response to hundreds of angry e-mails from disappointed German football fans who sent in recipe suggestions for the 2 1/2 year-old floppy mollusk, the aquarium actually did take extra precautions, Porwoll said.

“I even told our guards and people at the entrance to keep a close look at possible for football fans coming after Paul for revenge,” Porwoll said. He added, however, that the number of love declarations the aquarium is receiving from Paul’s fans far outweighed the hate mail.

“We’ve been getting tons of requests from around the globe about Paul’s visionary capabilities,” said Porwoll. “People want to ask Paul about their marriage prospects, the gender of their future baby or the outcome of upcoming elections.”

One reporter from Greece asked if Paul could predict the end of the financial crisis and German TV stations have offered the eight-legged psychic lucrative contracts for his post-World Cup life, he said.

Paul has even made waves in the business world.

Gary Jenkins, an economist with London’s Evolution Securities, hedged his market analysis note on Friday, conceding “unless Paul says differently.”

He added that “we did try and hire Paul the Octopus but we understand he is Goldman’s bound,” referring to the bank Goldman Sachs.

While Paul is no doubt the world’s most famous animal oracle these days, he is facing competition. In Singapore, Mani, a World Cup-forecasting parakeet, predicted a different outcome of Sunday’s final match.

Creeping out of his small wooden cage and choosing between two white cards— one hiding a Dutch flag, the other Spanish—the bird predicted the Netherlands will win its first World Cup championship, setting up a Mani-Paul showdown for Sunday.

Companies brace for end of cheap made-in-China era

Costlier labor, currency are ending cheap made-in-China era; manufacturers struggle to adapt

Factory workers demanding better wages and working conditions are hastening the eventual end of an era of cheap costs that helped make southern coastal China the world's factory floor.

A series of strikes over the past two months have been a rude wakeup call for the many foreign companies that depend on China's low costs to compete overseas, from makers of Christmas trees to manufacturers of gadgets like the iPad.

Where once low-tech factories and scant wages were welcomed in a China eager to escape isolation and poverty, workers are now demanding a bigger share of the profits. The government, meanwhile, is pushing foreign companies to make investments in areas it believes will create greater wealth for China, like high technology.

Many companies are striving to stay profitable by shifting factories to cheaper areas farther inland or to other developing countries, and a few are even resuming production in the West.

"China is going to go through a very dramatic period. The big companies are starting to exit. We all see the writing on the wall," said Rick Goodwin, a China trade veteran of 22 years, whose company links foreign buyers with Chinese suppliers.

"I have 15 major clients. My job is to give the best advice I can give. I tell it like it is. I tell them, put your helmet on, it's going to get ugly," said Goodwin, who says dissatisfied workers and hard-to-predict exchange rates are his top worries.

Beijing's decision to stop tethering the Chinese currency to the U.S. dollar, allowing it to appreciate and thus boosting costs in yuan, has multiplied the uncertainty for companies already struggling with meager profit margins.

In an about-face mocked on "The Daily Show with Jon Stewart," Wham-O, the company that created the Hula-Hoop and Slip 'n Slide, decided to bring half of its Frisbee production and some production of its other products back to the U.S.

At the other end of the scale, some in research-intensive sectors such as pharmaceutical, biotech and other life sciences companies are also reconsidering China for a range of reasons, including costs and incentives being offered in other countries.

"Life sciences companies have shifted some production back to the U.S. from China. In some cases, the U.S. was becoming cheaper," said Sean Correll, director of consulting services for Burlington, Mass.-based Emptoris.

That may soon become true for publishers, too. Printing a 9-by-9-inch, 334-page hardcover book in China costs about 44 to 45 cents now, with another 3 cents for shipping, says Goodwin. The same book costs 65 to 68 cents to make in the U.S.

"If costs go up by half, it's about the same price as in the U.S. And you don't have 30 days on the water in shipping," he says.

Even with recent increases, wages for Chinese workers are still a fraction of those for Americans. But studies do show China's overall cost advantage is shrinking.

Labor costs have been climbing about 15 percent a year since a 2008 labor contract law that made workers more aware of their rights. Tax preferences for foreign companies ended in 2007. Land, water, energy and shipping costs are on the rise.

In its most recent survey, issued in February, restructuring firm Alix Partners found that overall China was more expensive than Mexico, India, Vietnam, Russia and Romania.

Mexico, in particular, has gained an edge thanks to the North American Free Trade Agreement and fast, inexpensive trucking, says Mike Romeri, an executive with Emptoris, the consulting firm.

Makers of toys and trinkets, Christmas trees and cheap shoes already have folded by the thousands or moved away, some to Vietnam, Indonesia or Cambodia. But those countries lack the huge work force, infrastructure and markets China can offer, and most face the same labor issues as China.

So far, the biggest impact appears to be in and around Shenzhen, a former fishing village in Guangdong province, bordering Hong Kong, that is home to thousands of export manufacturers.

That includes Taiwan-based Foxconn Technology, a supplier of iPhones and iPads to Apple Inc. Foxconn responded to a spate of suicides at its 400,000-worker Shenzhen complex with pay hikes that more than doubled basic monthly worker salaries to $290. Strike-stricken suppliers to Honda Motor Co. and Toyota Motor Corp., among many others, also have hiked wages.

Foxconn refused repeated requests for comment on plans to move much of its manufacturing capacity to central China's impoverished Henan province, where a local government website has advertised for tens of thousands of workers on its behalf.

But among other projects farther inland, Foxconn is teaming up with some of the biggest global computer makers to build what may be the world's largest laptop production hub in Chongqing, a western China city of 32 million where labor costs are estimated to be 20 to 40 percent lower than in coastal cities.

Given the intricate supply chains and logistics systems that have helped make southern China an export manufacturing powerhouse, such changes won't be easy.

But for manufacturers looking to boost sales inside fast-growing China, shifting production to the inland areas where many migrant workers come from, and costs are lower, offers the most realistic alternative.

"The new game is to find a way to do the domestic market," says Goodwin.

Many factories in Foshan, another city in Guangdong that saw strikes at auto parts plants supplying Japan's Honda, have left in the past few months, mostly moving inland to Henan, Hunan and Jiangxi, said Lin Liyuan, dean at the privately run Institute of Territorial Economics in Guangzhou.

Massive investments in roads, railways and other infrastructure are reducing the isolation of the inland cities, part of a decade-old "Develop the West" strategy aimed at shrinking the huge, politically volatile gap in wealth between city dwellers and the country's 600 million farmers.

Gambling that the unrest will not spill over from foreign-owned factories, China's leaders are using the chance to push investment in regions that have lagged the country's industrial boom.

They have little choice. Many of today's factory workers have higher ambitions than their parents, who generally saved their earnings from assembling toys and television sets for retirement in their rural hometowns. They are also choosier about wages and working conditions. "The conflicts are challenging the current set-up of low-wage, low-tech manufacturing, and may catalyze the transformation of China's industrial sector," said Yu Hai, a sociology professor at Shanghai's Fudan University.