Study questions kidney cancer treatment in elderly

In a stunning example of when treatment might be worse than the disease, a large review of Medicare records finds that older people with small kidney tumors were much less likely to die over the next five years if doctors monitored them instead of operating right away.

Even though nearly all of these tumors turned out to be cancer, they rarely proved fatal. And surgery roughly doubled patients' risk of developing heart problems or dying of other causes, doctors found.

After five years, 24 percent of those who had surgery had died, compared to only 13 percent of those who chose monitoring. Just 3 percent of people in each group died of kidney cancer.

The study only involved people 66 and older, but half of all kidney cancers occur in this age group. Younger people with longer life expectancies should still be offered surgery, doctors stressed.

The study also was observational — not an experiment where some people were given surgery and others were monitored, so it cannot prove which approach is best. Yet it offers a real-world look at how more than 7,000 Medicare patients with kidney tumors fared. Surgery is the standard treatment now.

"I think it should change care" and that older patients should be told "that they don't necessarily need to have the kidney tumor removed," said Dr. William Huang of New York University Langone Medical Center. "If the treatment doesn't improve cancer outcomes, then we should consider leaving them alone."

He led the study and will give results at a medical meeting in Orlando, Fla., later this week. The research was discussed Tuesday in a telephone news conference sponsored by the American Society of Clinical Oncology and two other cancer groups.

In the United States, about 65,000 new cases of kidney cancer and 13,700 deaths from the disease are expected this year. Two-thirds of cases are diagnosed at the local stage, when five-year survival is more than 90 percent.

However, most kidney tumors these days are found not because they cause symptoms, but are spotted by accident when people are having an X-ray or other imaging test for something else, like back trouble or chest pain.

Cancer experts increasingly question the need to treat certain slow-growing cancers that are not causing symptoms — prostate cancer in particular. Researchers wanted to know how life-threatening small kidney tumors were, especially in older people most likely to suffer complications from surgery.

They used federal cancer registries and Medicare records from 2000 to 2007 to find 8,317 people 66 and older with kidney tumors less than 1.5 inches wide.

Cancer was confirmed in 7,148 of them. About three-quarters of them had surgery and the rest chose to be monitored with periodic imaging tests.

After five years, 1,536 had died, including 191 of kidney cancer. For every 100 patients who chose monitoring, 11 more were alive at the five-year mark compared to the surgery group. Only 6 percent of those who chose monitoring eventually had surgery.

Furthermore, 27 percent of the surgery group but only 13 percent of the monitoring group developed a cardiovascular problem such as a heart attack, heart disease or stroke. These problems were more likely if doctors removed the entire kidney instead of just a part of it.

The results may help doctors persuade more patients to give monitoring a chance, said a cancer specialist with no role in the research, Dr. Bruce Roth of Washington University in St. Louis.

Some patients with any abnormality "can't sleep at night until something's done about it," he said. Doctors need to say, "We're not sticking our head in the sand, we're going to follow this" and can operate if it gets worse.

One of Huang's patients — 81-year-old Rhona Landorf, who lives in New York City — needed little persuasion.

"I was very happy not to have to be operated on," she said. "He said it's very slow growing and that having an operation would be worse for me than the cancer."

Landorf said her father had been a doctor, and she trusts her doctors' advice. Does she think about her tumor? "Not at all," she said.

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Online:

Kidney cancer info: http://www.cancer.net/cancer-types/kidney-cancer

and http://www.cancer.gov/cancertopics/types/kidney

Study: http://gucasym.org

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Firmer yen boosts Korean shares, underpins Asia stocks

TOKYO (Reuters) - Asian shares outside of Japan rose on Wednesday, led by South Korean exporters as the yen firmed amid conflicting interpretations of G7 comments about the currency's recent weakness.

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> gained 0.9 percent.

Seoul shares <.ks11> outperformed with a 1.5 percent jump while Australian shares jumped 0.9 percent after record first-half earnings from the Commonwealth Bank of Australia boosted sentiment.

The Nikkei stock average <.n225> slumped 1.1 percent as the firming yen prompted investors to take profits on exporters. <.t/>

China, Taiwan and Hong Kong markets remain closed for the Lunar New Year holiday.

European markets will be mixed, with financial spreadbetters predicting London's FTSE 100 <.ftse>, Paris's CAC-40 <.fchi> and Frankfurt's DAX <.gdaxi> would open between a 0.1 percent fall and a 0.4 percent gain. U.S. stock futures were up 0.1 percent to suggest a somewhat firmer Wall Street open. <.l><.eu><.n/>

Investors continued to seek cues from currency markets before a meeting of the Group of 20 finance ministers and central bankers in Moscow on Friday and Saturday, with growing international tensions over exchange rates.

At the center of the debate is Japan, where Prime Minister Shinzo Abe's government has made it clear that it will push for aggressive policies to beat stubborn deflation through drastic monetary expansion. Anticipation of much bolder Bank of Japan monetary policy has sent the yen into a steady decline, helping boost Japanese stocks to 33-month highs.

"The Japanese stock market may have rallied too strongly on expectations alone. I don't believe the Japanese government is manipulating currency rates, but it is maybe time that an equilibrium point may be sought for the yen's level given that some other countries may see weaker currencies as beneficial to their economies," said Yuuki Sakurai, CEO at Fukoku Capital Management in Tokyo.

The yen's respite from heavy selling eased concerns for investors in South Korea.

"The main board's rebound was driven by a break in the yen's weakness, following signs that the won's strength has abated somewhat," said Lim Dong-rak, an analyst at Hanyang Securities in Seoul.

The yen rallied on Tuesday, reversing the previous day's late selloff against the dollar and euro, after an official with the Group of Seven said it is worried about excess moves in the Japanese currency.

G7 governors and ministers reaffirmed their commitment that fiscal and monetary policies would not be directed at devaluing currencies, a statement meant to reassure investors that Tokyo was not aiming to guide the yen lower with its aggressive expansion of monetary policy.

"All these comments are merely stating the obvious and are not to be taken in the context of whether they are endorsing a weaker yen or not," said Yuji Saito, director of foreign exchange at Credit Agricole in Tokyo.

"What is being said is that monetary policy should be used to achieve domestic objectives and Japan is undertaking reflationary policies, not manipulating currency rates, and the result of that is a weak yen. What is asked for from Japan is to explain its policy clearly at the G20," Saito said.

The dollar dropped 0.6 percent to 92.95 yen after marking its highest level since May 2010 of 94.465 on Monday. The euro tumbled 0.6 percent to 125.01 yen, moving further away from its highest since April 2010 of 127.71 yen touched last week.

The BOJ ends a two-day policy meeting on Thursday, with markets expecting no fresh easing steps this time. But expectations are running high that further unprecedented measures will be taken under a new BOJ regime due to start next month after the terms of current top officials end.

"So far, the yen has been weakening on expectations for a bold monetary policy, and from now, Japan has to implement actual policy to justify such expectations," said Naohiko Baba, Japan chief economist at Goldman Sachs.

The euro steadied around $1.3450, keeping overnight gains made after European Central Bank President Mario Draghi said talk of a currency war was overdone, and that Spain was on the right track toward economic recovery.

In his annual State of the Union address, U.S. President Barack Obama proposed on Tuesday to hike the minimum wage by more than 20 percent, invest $50 billion on crumbling roads and bridges and spend $15 billion on a construction jobs program in a bid to boost economic growth.

U.S. crude was up 0.1 percent to $97.60 a barrel and Brent was steady around $118.61.

Palladium extended gains to a 17-month high as supply concerns sparked speculative buying, while gold edged up on demand from jewellers.

(Additional reporting by Joyce Lee in Seoul; Editing by Eric Meijer & Kim Coghill)

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North Korea Is Suspected of Conducting 3rd Nuclear Test

Lee Jin-Man/Associated Press

A South Korean watched news reporting about a possible nuclear test conducted by North Korea on a TV screen in Seoul on Tuesday.

WASHINGTON — North Korea confirmed on Tuesday that it had conducted its third, long-threatened nuclear test, according to the official KCNA news service, posing a new challenge for the Obama administration in its effort to keep the country from becoming a full-fledged nuclear power.

The KCNA said it used a “miniaturized and lighter nuclear device with greater explosive force than previously” and that the test “did not pose any negative impact on the surrounding ecological environment.”

Many nations initially detected the test as seismic activity centered near the same location where the North conducted tests in 2006 and 2009. The United States Geological Survey said it was only a kilometer underground, an indication consistent with a nuclear blast. And in Vienna, the organization that monitors the Comprehensive Nuclear Test Ban Treaty said that tremor had “clear explosionlike characteristics.”

Preliminary estimates suggested a test far larger than the previous two conducted by the North, though probably less powerful than the first bomb the United States dropped on Japan, in Hiroshima, in 1945.

If confirmed, the test would be the first under the country’s new leader, Kim Jong-un, and an open act of defiance to the Chinese, who urged the young leader not to risk open confrontation by setting off the weapon. In the past few days a Chinese newspaper that is often reflective of the government’s thinking said the North must “pay a heavy price” if it proceeded with the test. But it was unclear how China would act at the United Nations Security Council, which was heading into emergency session as news of the suspected blast played out.

The Obama administration has already threatened to take additional action to penalize the North if it conducts a test, through the United Nations. But the fact is that there are few sanctions left to apply against the most unpredictable country in Asia. The only penalty that would truly hurt the North would be a cutoff of oil and other aid from China. And until now, despite issuing warnings, the Chinese have feared instability and chaos in the North more than its growing nuclear and missile capability, and the Chinese leadership has refused to participate in sanctions.

Mr. Kim, believed to be about 29, appears to be betting that even a third test would not change the Chinese calculus.

The apparent test set off a scramble among Washington’s Asian allies to assess what the North Koreans had done.

The United States sent aloft aircraft equipped with delicate sensors that may, depending on the winds, be able to determine whether it was a plutonium or uranium weapon. The Japanese defense minister, Itsunori Onodera, said Japan had ordered the dispatch of an Air Self-Defense Force jet to monitor for radioactivity in Japanese airspace.

Japan’s new prime minister, Shinzo Abe, told Parliament that “based on precedents, Japan believes that this quake was triggered by a North Korean nuclear test,” and said the country was considering “its own actions, including sanctions, to resolve this and other issues.”

But the threat may be largely empty, because trade is limited and the United States and its allies have refrained from a naval blockade of North Korea or other steps that could revive open conflict, which has been avoided on the Korean Peninsula since an armistice was declared 60 years ago.

It may take days or weeks to determine if the test, if that is what it proves to be, was successful. American officials will also be looking for signs of whether the North, for the first time, conducted a test of a uranium weapon, based on a uranium enrichment capability it has been pursuing for a decade. The past two tests used plutonium, reprocessed from one of the country’s now-defunct nuclear reactors. While the country has only enough plutonium for a half-dozen or so bombs, it can produce enriched uranium well into the future.

David E. Sanger reported from Washington, and Choe Sang-hun reported from Seoul, South Korea. Jane Perlez contributed reporting from Beijing and Hiroko Tabuchi from Tokyo.

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Pope shows lifetime jobs aren't always for life

The world seems surprised that an 85-year-old globe-trotting pope who just started tweeting wants to resign, but should it be? Maybe what should be surprising is that more leaders his age do not, considering the toll aging takes on bodies and minds amid a culture of constant communication and change.

There may be more behind the story of why Pope Benedict XVI decided to leave a job normally held for life. But the pontiff made it about age. He said the job called for "both strength of mind and body" and said his was deteriorating. He spoke of "today's world, subject to so many rapid changes," implying a difficulty keeping up despite his recent debut on Twitter.

"This seemed to me a very brave, courageous decision," especially because older people often don't recognize their own decline, said Dr. Seth Landefeld, an expert on aging and chairman of medicine at the University of Alabama at Birmingham.

Age has driven many leaders from jobs that used to be for life — Supreme Court justices, monarchs and other heads of state. As lifetimes expand, the woes of old age are catching up with more in seats of power. Some are choosing to step down rather than suffer long declines and disabilities as the pope's last predecessor did.

Since 1955, only one U.S. Supreme Court justice — Chief Justice William Rehnquist — has died in office. Twenty-one others chose to retire, the most recent being John Paul Stevens, who stepped down in 2010 at age 90.

When Thurgood Marshall stepped down in 1991 at the age of 82, citing health reasons, the Supreme Court justice's answer was blunt: "What's wrong with me? I'm old. I'm getting old and falling apart."

One in 5 U.S. senators is 70 or older, and some have retired rather than seek new terms, such as Hawaii's Daniel Akaka, who left office in January at age 88.

The Netherlands' Queen Beatrix, who just turned 75, recently said she will pass the crown to a son and put the country "in the hands of a new generation."

In Germany, where the pope was born, Chancellor Angela Merkel, who is 58, said the pope's decision that he was no longer fit for the job "earns my very highest respect."

"In our time of ever-lengthening life, many people will be able to understand how the pope as well has to deal with the burdens of aging," she told reporters in Berlin.

Experts on aging agreed.

"People's mental capacities in their 80s and 90s aren't what they were in their 40s and 50s. Their short-term memory is often not as good, their ability to think quickly on their feet, to execute decisions is often not as good," Landefeld said. Change is tougher to handle with age, and leaders like popes and presidents face "extraordinary demands that would tax anybody's physical and mental stamina."

Dr. Barbara Messinger-Rapport, geriatrics chief at the Cleveland Clinic, noted that half of people 85 and older in developed countries have some dementia, usually Alzheimer's. Even without such a disease, "it takes longer to make decisions, it takes longer to learn new things," she said.

But that's far from universal, said Dr. Thomas Perls, an expert on aging at Boston University and director of the New England Centenarians Study.

"Usually a man who is entirely healthy in his early 80s has demonstrated his survival prowess" and can live much longer, he said. People of privilege have better odds because they have access to good food and health care, and tend to lead clean lives.

"Even in the 1500s and 1600s there were popes in their 80s. It's remarkable. That would be today's centenarians," Perls said.

Arizona Sen. John McCain turned 71 while running for president in 2007. Had he won, he would have been the oldest person elected to a first term as president. Ronald Reagan was days away from turning 70 when he started his first term as president in 1981; he won re-election in 1984. Vice President Joe Biden just turned 70.

In the U.S. Senate, where seniority is rewarded and revered, South Carolina's Strom Thurmond didn't retire until age 100 in 2002. Sen. Robert Byrd of West Virginia was the longest-serving senator when he died in office at 92 in 2010.

Now the oldest U.S. senator is 89-year-old Frank Lautenberg of New Jersey. The oldest congressman is Ralph Hall of Texas who turns 90 in May.

The legendary Alan Greenspan was about to turn 80 when he retired as chairman of the Federal Reserve in 2006; he still works as a consultant.

Elsewhere around the world, Cuba's Fidel Castro — one of the world's longest serving heads of state — stepped down in 2006 at age 79 due to an intestinal illness that nearly killed him, handing power to his younger brother Raul. But the island is an example of aged leaders pushing on well into their dotage. Raul Castro now is 81 and his two top lieutenants are also octogenarians. Later this month, he is expected to be named to a new, five-year term as president.

Other leaders who are still working:

—England's Queen Elizabeth, 86.

—Abdullah bin Abd al-Aziz al-Saud, king of Saudi Arabia, 88.

—Sabah al-Ahmad al-Jaber al-Sabah, emir of Kuwait, 83.

—Ruth Bader Ginsburg, U.S. Supreme Court associate justice, 79.

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Associated Press writers Paul Haven in Havana, Cuba; David Rising in Berlin; Seth Borenstein, Mark Sherman and Matt Yancey in Washington, and researcher Judy Ausuebel in New York contributed to this report.

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Yen near fresh lows versus dollar, Asian shares steady

TOKYO (Reuters) - The yen hovered near fresh lows against the dollar and Tokyo stocks jumped back near a 33-month high on Tuesday after markets took comments from a U.S. official as giving Japan the green light to pursue policies that weaken the yen as long as they help beat deflation.

Asian shares were steady, with many regional bourses shut for holidays. Encouraging trade data from China late last week was lending support but non-Japan markets lacked momentum as investors awaited key events such as the U.S. president's State of the Union address for trading cues.

While Japan has faced some criticism from German and other European officials that it is intentionally trying to weaken the yen with monetary easing, rhetoric about a so-called currency war was dialled back ahead of a Group of 20 meeting in Moscow on Friday and Saturday.

U.S. Treasury Undersecretary Lael Brainard said on Monday the United States supports Japanese efforts to end deflation. But she also mentioned that the G7 has long committed to exchange rates determined by market forces, "except in rare circumstances where excess volatility or disorderly movements might warrant cooperation.

European Central Bank council member Jens Weidmann also said the euro was not overvalued at current levels.

The dollar was trading at 94.22 yen after marking on Monday its highest level since May 2010 of 94.465. The euro was trading at 126.28 yen after the yen fell 2 percent against the euro on Monday, pushing it back towards 127.71 yen hit last week, its highest level since April 2010.

"I think the yen's weakening is a function of (playing)catch-up," and not Japan resorting to deliberate devaluation of its currency, said Andrew Wilkinson, chief economic strategist at Miller Tabak & Co. in New York.

"It's the market's way of saying: we're convinced there is a movement afoot to reinflate Japan."

The weaker yen in turn helped bolster sentiment for Japanese stocks, sending the Nikkei average <.n225> 2.6 percent higher. <.t/>

"While currency moves have been sensitive to officials' comments in general, people thought any comment from the G20 would trigger yen buying," said Hiroichi Nishi, an assistant general manager at SMBC Nikko Securities.

"But such worries are receding as she (Brainard) said she supports Japan's efforts to end deflation."

The yen is expected to stay under pressure on expectations that Prime Minister Shinzo Abe will endorse a far more dovish Bank of Japan regime when the current leadership's term ends next month. The BOJ is expected to refrain from taking fresh easing steps when it meets this week.

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> was little changed. Australian shares inched up 0.1 percent led by financials, as investors waited for corporate earnings results.

Trading resumed in Japan and South Korea but markets remained closed in Singapore, Hong Kong, mainland China, Malaysia and Taiwan.

G20 officials said on Monday the Group of Seven nations are considering a statement this week reaffirming their commitment to "market-determined" exchange rates.

Currency and equities markets were also looking ahead to President Barack Obama's State of the Union address later on Tuesday, for any signs of a deal to avert automatic spending cuts due to take effect on March 1.

"We believe that the G20's take on currency wars, Mr. Obama's upcoming state of the union address, and data on the current condition of the US economy should help markets assess where the global recovery stands and where we are heading," Barclays Capital said in a research report.

Wall Street and world equity markets were little changed in light volume on Monday as a lack of major economic news gave investors little incentive to push prices higher after a robust performance last week.

U.S. and Chinese data last week lifted the tech-focused Nasdaq Composite Index <.ixic> to a 12-year closing high and the Standard & Poor's 500 Index <.spx> to a five-year peak on Friday.

U.S. crude futures edged down 0.2 percent to $96.88 a barrel while Brent steadied around $118.12.

Spot gold stayed near a one-month low.

(Additional reporting by Ayai Tomisawa and Lisa Twaronite in Tokyo; Editing by Edwina Gibbs)

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‘Les Militaribles,’ South Korean Video Spoof, Goes Viral

SEOUL, South Korea — The “Gangnam Style” video has spawned seemingly endless remakes; there are even sites that allow viewers to insert photos of themselves onto the animated bodies of people performing the famous horse dance.

Now the viral video has inspired another South Korean blockbuster, a parody of the movie musical “Les Misérables” featuring members of the air force. After just five days on YouTube, the video had been viewed almost three million times. (It probably did not hurt that one of the stars of the Hollywood movie,Russell Crowe, reposted a tweet with a link to the video.)

The video, “Les Militaribles,” opens by spoofing the dramatic first scene of the movie version of Victor Hugo’s epic novel, set in a jail where men live under the tyranny of the guards.

Video by rokafplay

Les Miserables ROK Air Force Parody Les Militaribles / 공군 레미제라블 '레밀리터리블'

In the 13-minute South Korean version, the nemesis is a taskmaster officer who keeps his exhausted conscripts clearing snow — a chore that many young South Korean men face while serving mandatory time in a military on guard against a militaristic North Korea.

“Dig down, dig down, raise your shovels high. Dig down, dig down, and clear the snow below,” the airmen chant as they struggle to clear a runway. “There is no end to this accursed snow. Dig down, dig down, you still have two service years to go.”

At first glance, the video — based on a novel about an often unfeeling bureaucracy — would appear to be the work of young men unhappy with their lot, serving in a hierarchical military that has been accused of sometimes brutal treatment of conscripts in the past.

But “Les Militaribles” was produced by the South Korean Air Force’s official blog team, and is a celebration of sorts of airmen’s shared sacrifice during two years of service.

“Clearing snow is especially important for the air force,” said First Lt. Chung Da-hoon, 26, who directed the video. “We must keep our runways free of snow so our jets can take off any time to deal with North Korean threats.”

“Through this parody,” he said, “we wanted to tell our families, our girlfriends and the people that what we do in the military is hard work, but is necessary for national defense.”

His boss, Maj. Cheon Myeong-nyeong, the planning officer for the air force’s Media Content Team, said, “Our ‘Les Militaribles’ triggered nostalgia among millions of people who have served in the military.”

With nearly all male adults having served in the armed forces, there is a fair amount of nostalgia for time in the service, and the months spent in military barracks in remote parts of the country are a common theme in jokes and daily conversation.

But public relations efforts like “Les Militaribles” also reflect the military’s increasing difficulty in inspiring a sense of duty among those who are serving or awaiting their call-up. After six decades of peace on the divided peninsula, many young men regard their service as an inconvenient interruption of civilian life, rather than a “sacred duty,” as their fathers’ generation did.

The air force’s media team gathered talent for the video from air bases across the country. The director majored in video arts in graduate school and many of the singing airmen were music school students.

The airmen said “Gangnam Style” (at 1.3 billion views) raised hopes that their video might gain at least a small international following, and they included subtitles in English to help it gain popularity.

The creators also were careful to include a several-minute love story.

In a divergence from the Hugo plot, “Airman Jean Valjean” can spend only 10 minutes with his girlfriend “Cosette,” a beauty who came to visit him despite a heavy snowfall. He begs for more time, but “Lieutenant Javert” says snow shoveling cannot wait.

As it turns out, that plot twist has a foothold in South Korean reality: one of conscripts’ greatest fears is that their girlfriends will not wait for their return. With an eye toward the lovelorn, the makers of the video billed it as “a super military blockbuster” about “the choices Airman Valjean has to make between snow and love, the love story that the heavens forbid!”

Shreeya Sinha contributed reporting from New York.

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How'd They Make Carrie Underwood's Glowing Gown?

Stylewatch
Style News Now

02/11/2013 at 12:25 AM ET

Kevork Djansezian/Getty; John Shearer/Invision/AP (2)

We can’t say we were surprised to see that Carrie Underwood had ditched her form-fitting Roberto Cavalli number for a princess-y silver gown to perform her song “Blown Away” at the Grammys Sunday night. When glowing paisley details began to unscroll across her full skirt, however? We definitely didn’t see that coming.

“We wanted it to be artful and dramatic,” Underwood told reporters backstage. “I just like to stand still and sing sometimes, so this seemed like the best way I could do that and still create something visually attention-capturing.” On the technology behind it, she was a little more tight-lipped, saying “I guess I probably shouldn’t tell my secret, should I?” — but luckily, we’ve already got the inside info.

To perform the song that won her best solo country performance, the superstar donned a custom Theia gown designed specifically for the vivid light show. The line’s creative director Don O’Neill sourced fabric for the 4 feet 5 inches-wide skirt that had to be approved by both Underwood’s stylist, Trish Townsend, as well as the video team creating the special effects.

With only three days to create the gown, O’Neill’s team worked around the clock, stitching together 10 yards of Duchesse satin, 100 yards of tulle and crinoline and thousands of Swarovski crystals onto the bodice. Meanwhile, the production team created the effects that were projected onto her gown, including sparkling stars, rose petals and butterflies.

And was all that work worth it? Judging by your overwhelmingly positive reactions on Twitter, absolutely. And O’Neill was thrilled with the result too, especially because he took the line’s name from the Greek goddess of light. “There couldn’t be a more perfect opportunity to fuse light in a literal sense with one of my gowns,” he says in a statement, “and have it showcased on a national stage by Carrie Underwood, the first celebrity to wear a Theia dress four years ago when we launched.”

Tell us: What did you think of Underwood’s high-tech couture?

–Alex Apatoff

PHOTOS: SEE MORE GRAMMY RISK-TAKERS!

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What heals traumatized kids? Answers are lacking

CHICAGO (AP) — Shootings and other traumatic events involving children are not rare events, but there's a startling lack of scientific evidence on the best ways to help young survivors and witnesses heal, a government-funded analysis found.

School-based counseling treatments showed the most promise, but there's no hard proof that anxiety drugs or other medication work and far more research is needed to provide solid answers, say the authors who reviewed 25 studies. Their report was sponsored by the federal Agency for Healthcare Research and Quality.

According to research cited in the report, about two-thirds of U.S. children and teens younger than 18 will experience at least one traumatic event, including shootings and other violence, car crashes and weather disasters. That includes survivors and witnesses of trauma. Most will not suffer any long-term psychological problems, but about 13 percent will develop symptoms of post-traumatic stress, including anxiety, behavior difficulties and other problems related to the event.

The report's conclusions don't mean that no treatment works. It's just that no one knows which treatments are best, or if certain ones work better for some children but not others.

"Our findings serve as a call to action," the researchers wrote in their analysis, published online Monday by the journal Pediatrics.

"This is a very important topic, just in light of recent events," said lead author Valerie Forman-Hoffman, a researcher at the University of North Carolina-Chapel Hill.

She has two young children and said the results suggest that it's likely one of them will experience some kind of trauma before reaching adulthood. "As a parent I want to know what works best," the researcher said.

Besides the December massacre at Sandy Hook Elementary School in Connecticut, other recent tragedies involving young survivors or witnesses include the fatal shooting last month of a 15-year-old Chicago girl gunned down in front of a group of friends; Superstorm Sandy in October; and the 2011 Joplin, Mo., tornado, whose survivors include students whose high school was destroyed.

Some may do fine with no treatment; others will need some sort of counseling to help them cope.

Studying which treatments are most effective is difficult because so many things affect how a child or teen will fare emotionally after a traumatic event, said Dr. Denise Dowd, an emergency physician and research director at Children's Mercy Hospitals and Clinics in Kansas City, Mo., who wrote a Pediatrics editorial.

One of the most important factors is how the child's parents handle the aftermath, Dowd said.

"If the parent is freaking out" and has difficulty controlling emotions, kids will have a tougher time dealing with trauma. Traumatized kids need to feel like they're in a safe and stable environment, and if their parents have trouble coping, "it's going to be very difficult for the kid," she said.

The researchers analyzed 25 studies of treatments that included anti-anxiety and depression drugs, school-based counseling, and various types of psychotherapy. The strongest evidence favored school-based treatments involving cognitive behavior therapy, which helps patients find ways to cope with disturbing thoughts and emotions, sometimes including talking repeatedly about their trauma.

This treatment worked better than nothing, but more research is needed comparing it with alternatives, the report says.

"We really don't have a gold standard treatment right now," said William Copeland, a psychologist and researcher at Duke University Medical Center who was not involved in the report. A lot of doctors and therapists may be "patching together a little bit of this and a little bit of that, and that might not add up to the most effective treatment for any given child," he said.

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Online:

Pediatrics: http://www.pediatrics.org

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Euro dips, oil steady in holiday-thinned trade

SINGAPORE (Reuters) - Oil and equities dawdled on Monday near multi-month highs scaled after robust Chinese trade data last week, while the euro slipped to a two-week low as uncertainty surrounded a political scandal in Spain and a looming election in Italy.

With the Lunar New Year holiday shutting most Asian financial centers, including those in Japan, China, Hong Kong, Singapore and South Korea, trading was light and potentially volatile on those exchanges that remained open.

Australian shares <.axjo> were flat after closing at a 34-month high on Friday following positive data from China, the most important consumer of Australia's commodity exports.

S&P 500 index futures inched up 0.1 percent after the Wall Street benchmark reached a five-year high on Friday.

Brent crude oil, which touched its highest in nine months on Friday, was unchanged just below $119 a barrel.

Foreign exchange trading was choppy in thin volumes, with what traders interpreted as slightly dovish comments from the European Central Bank last week also weighing on the euro, which has shed around 2.5 percent since reaching a 15-month high above $1.37 on February 1.

The euro briefly fell to $1.3325 on Monday, after stop-loss selling was triggered below $1.3340, traders said, before recovering to stand little changed around $1.3370.

There are growing worries about Spain as a scandal on secret cash payments engulfs the prime minister, while confidence in Italy has been shaken in the run-up to a February 24-25 election. "The euro's upside is likely to be limited and short-lived," said Aroop Chatterjee, an analyst at Barclays Capital.

"Better financial conditions are likely to be offset by rising political risks, market positioning and a weaker economy. We expect the euro to be on a declining trend beginning in Q2."

(Reporting by Alex Richardson and Ian Chua in Sydney; Editing by Shri Navaratnam)

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New Focus in Mali Is Finding Militants Who Have Fled Into Mountains

Tyler Hicks/The New York Times

A fish market in Konna, Mali, that had been occupied by Islamist rebels. It was the seizure of Konna, in the Mopti region, that provoked France’s military intervention last month.

DAKAR, Senegal — Just as Al Qaeda once sought refuge in the mountains of Tora Bora, the Islamist militants now on the run in Mali are hiding out in their own forbidding landscape, a rugged, rocky expanse in northeastern Mali that has become a symbol of the continued challenges facing the international effort to stabilize the Sahara.

Expelling the Islamist militants from Timbuktu and other northern Malian towns, as the French did swiftly last month, may have been the easy part of retaking Mali, say military officials, analysts and local fighters. Attention is now being focused on one of Africa’s harshest and least-known mountain ranges, the Adrar des Ifoghas.

The French military has carried out about 20 airstrikes in recent days in those mountains, including attacks on training camps and arms depots, officials said. On Thursday, a column of soldiers from Chad, versed in desert warfare, left Kidal, a diminutive, sand-blown regional capital, to penetrate deep into the Adrar, said a spokesman for the Tuareg fighters who accompanied them.

“These mountains are extremely difficult for foreign armies,” said the spokesman, Backay Ag Hamed Ahmed, of the National Movement for the Liberation of Azawad, in a telephone interview from Kidal. “The Chadians, they don’t know the routes through them.”

These areas of grottoes and rocky hills, long a retreat for Tuareg nomads from the region and more recently for extremists from Al Qaeda in the Islamic Maghreb, will be the scene of the critical next phase in the conflict. It will be the place where the Islamist militants are finally defeated or where they slip away to fight again, military analysts say.

French special forces are very likely already operating in the Adrar des Ifoghas, performing reconnaissance and perhaps preparing rescue operations for French hostages believed to be held in the area, said Gen. Jean-Claude Allard, a senior researcher at the Institute for International and Strategic Relations in Paris. But African forces are likely to be assigned the brunt of the combat operations, going “from well to well, from village to village,” General Allard said.

The few Westerners who have traveled in this inaccessible region bordering Algeria say it differs from Afghanistan in that the mountains are relatively modest in size. But its harsh conditions make it a vast natural fortress, with innumerable hide-outs.

“The terrain is vast and complicated,” said Col. Michel Goya of the French Military Academy’s Strategic Research Institute. “It will require troops to seal off the zone, and then troops for raids. This will take time.”

The number of militants who remain is in dispute, with estimates varying from a few hundred fighters to a few thousand. They are becoming more dispersed and are hiding themselves ever more effectively, Western military officials say.

The French military has been flying fewer sorties over the region in recent days, “from which I deduce a lack of targets,” said a Western military attaché in Bamako, Mali’s capital, who was not authorized to speak on the record. “They are just not finding the same targets. Clearly they are hiding better and dispersing more widely.”

A ranking Malian officer stationed in the northern town of Gao said: “We don’t know how many there are. They have learned to hide where the French can’t find them.”

The militants are versed in survival tactics in the hills, supplying themselves from the nomads who pass through and getting water from the numerous wells and ponds, said Pierre Boilley, an expert on the region from the Sorbonne. Still, the sources of water are an opportunity for the French and Chadian forces, as they can be monitored without too much difficulty, experts said.

“It’s a sort of observation tower on the whole of the Sahara,” General Allard said. The fighters have had years to build installations, modify caves, and stock food, weapons and fuel, he said, and the precise locations of their refuges remain a mystery.

Even if the bulk of the militants have retreated into the mountains, pockets remain around the liberated towns of Timbuktu and Gao, said a French military spokesman, Col. Thierry Burkhard. Last week, French forces patrolling the area around Gao engaged in firefights with militants, some of whom fired rockets, officials said.

“We’re encountering residual jihadist groups that are fighting,” said Jean-Yves Le Drian, France’s defense minister.

On Friday, a suicide bomber blew himself up at a military checkpoint in Gao, wounding a soldier, an act that provided further evidence of the continued threat of the militants.

Adam Nossiter reported from Dakar, and Peter Tinti from Gao, Mali. Eric Schmitt contributed reporting from Washington, and Scott Sayare and Steven Erlanger from Paris.

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