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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Dollar, euro ease against yen on G7 policy doubts

LONDON (Reuters) - The yen rose against the dollar and the euro on Wednesday as investors reconsidered a G7 statement on exchange rates aimed at soothing concerns of a currency war but instead provoked a fresh bout of volatility.

The G7 reaffirmed its commitment to market-determined exchange rates and said that fiscal and monetary policies must not be directed at devaluing currencies in its statement which was interpreted as condoning the recent weakness in the yen.

However, an official from the group later said Tuesday's statement was meant to signal concerns about excessive yen moves, prompting a vicious reversal in the currency.

"It appears there is a lack of consensus at the G7 level in tackling the unintended weakening of currencies, due to the adoption of expansionary domestic monetary policies," analysts at Barclays said in a note clients.

In early European trading the dollar and the euro had both fallen by 0.3 percent against the yen to 93.20 yen and 125.42 yen respectively.

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 deflation through drastic monetary expansion. Anticipation of a bolder Bank of Japan policy has sent the yen down nearly 20 percent against the dollar since November.

Dealers said the market was likely to trade cautiously ahead of the outcome of a Bank of Japan meeting ending on Thursday and before a meeting of the Group of 20 finance ministers and central bankers in Moscow on Friday and Saturday.

Markets are also awaiting the Bank of England's quarterly inflation report which should show whether there's any realistic chance of further asset purchases in coming months which would add to pressure on sterling.

The euro zone will publish industrial production data for December at 1000 GMT, seen as likely to confirm that output in final quarter was very weak.

The data comes out a day ahead of flash estimates of fourth quarter GDP for the whole euro area which is forecast to show growth contracted by around 0.4 percent in the final three months of the year - the steepest quarter-on-quarter decline since the first quarter of 2009.

Ahead of the data Europe's share markets were little changed with the FTSE Eurofirst 300 index <.fteu3> of top companies opening flat but near the top of a six-day trading range, with the focus on corporate earnings reports.

London's FTSE 100 <.ftse>, Paris's CAC-40 <.fchi> and Frankfurt's DAX <.gdaxi> were between 0.1 percent higher and 0.2 percent down.

Debt markets were also little changed as investors await the results of an auction of long-term Italian debt which is seen as a test of demand before elections later this month.

Italian debt has been under pressure in recent weeks as a comeback in the opinion polls by former Prime Minister Silvio Berlusconi's party has raised the prospect of a fragmented parliament that could hamper the next government's reform efforts.

Germany also plans to sell 5 billion euros of two-year bonds.

(Editing by Anna Willard)

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North Korea Conducts Nuclear Test

Ahn Young-Joon/Associated Press

South Korean army soldiers patroled along a barbed-wire fence at the Imjingak Pavilion, near the demilitarized zone of Panmunjom, in Paju, South Korea, 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.”

The test led to a crescendo of international condemnation Tuesday, with President Obama calling it a “highly provocative act” that demands “swift and credible action by the international community” against North Korea. Russia, Britain, South Korea and the United Nations similarly swiftly condemned the blast. The United Nations Security Council scheduled an emergency meeting at 9 a.m. New York time to take up the matter.

Preliminary estimates by South Korea suggested the test was much more powerful than the previous two conducted by the North.

Kim Min-seok, a spokesman for South Korea’s Defense Ministry, said Tuesday’s blast generated an explosive yield of between six and seven kilotons, far greater than the yield of less than one kiloton detected in the North’s 2006 test and an estimated yield of two to six kilotons in its 2009 test. But it appeared less powerful than the first bomb the United States dropped on Japan, in Hiroshima in 1945, which had an explosive yield of 15 kilotons.

The test is 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 a statement issued several hours after the blast, China expressed its “staunch opposition” to the test but called for “all parties concerned to respond calmly.” And it was unclear how China would act at the United Nations Security Council as it convenes Tuesday.

The nuclear test came the same day President Obama is to use his State of the Union address to call for drastically reducing nuclear arms around the world, potentially bringing the number of deployed American weapons to roughly 1,000 from the current 1,700.

Even before Pyongyang conducted Tuesday’s test, the Obama administration had already threatened to take additional action to penalize the North 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 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 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 independently if the test, 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, Hiroko Tabuchi from Tokyo, and Chris Buckley and Gerry Mullany contributed from Hong Kong.

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It's a Girl for John Cho

Mom & Babies
Celebrity Baby Blog

02/11/2013 at 06:30 PM ET

Paul Drinkwater/NBC

Surprise: Actor John Cho is a dad again!

The Go On star and his wife welcomed a daughter recently, Cho’s rep confirms to PEOPLE exclusively.

Baby girl is the second child for the couple, who are also parents to a son. No further details are available.

Cho currently stars alongside Jason Bateman in Identity Thief and will reprise his role as Hikaru Sulu in Star Trek Into Darkness in May.

He is also well known for his roles in American Pie and the Harold and Kumar films.

– Anya Leon with reporting by Julie Jordan

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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.

__

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 lows vs dollar, Asian shares ease in subdued trade

TOKYO (Reuters) - The yen hovered near its lows against the dollar and Tokyo stocks jumped closer to a 33-month high on Tuesday after markets took comments from a U.S. official as approval for Japan to pursue anti-deflation policies that weaken the yen.

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

"Her (Brainard's) comments gave confidence to the market. It was surprising, and was taken as the Obama administration giving a green light to 'Abenomics'," said Takuya Takahashi, a market analyst at Daiwa Securities.

Japan has faced some overseas criticism that it is intentionally trying to weaken the yen with monetary easing, but talk of a so-called currency war was dialled back ahead of a Group of 20 meeting in Moscow on Friday and Saturday.

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

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

The dollar slipped 0.3 percent to 94.185 yen after marking its highest level since May 2010 of 94.465 on Monday. The euro eased 0.3 percent to 126.12 yen after rising more than 2 percent on Monday. It hit its highest since April 2010 of 127.71 yen last week.

"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 yen is pressured by anticipation that Prime Minister Shinzo Abe will endorse a far more dovish Bank of Japan regime when the current leadership's term ends next month, although the BOJ is expected to refrain from taking fresh easing steps when it meets this week.

Share trading was subdued with many regional bourses shut for holidays. Encouraging trade data from China late last week was lending support to sentiment 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.

European markets are seen inching lower, with the Euro STOXX 50 index futures down 0.1 percent. A 0.2 percent drop in U.S. stock futures also suggested a soft Wall Street start. <.l><.eu><.n/>

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> fell 0.1 percent, with Australian shares closing flat ahead of corporate earnings due this week.

The weaker yen in turn hoisted the Nikkei stock average <.n225> to close 1.9 percent higher on improving earnings prospects for exporters. <.t/>

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

STATE OF UNION ADDRESS

Currency and equities markets were also looking ahead to President Barack Obama's State of the Union address later on Tuesday night, for any signs of a deal to avert automatic spending cuts due to take effect 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 U.S. economy should help markets assess where the global recovery stands and where we are heading," Barclays Capital said in a research report.

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.

Financial markets showed a muted reaction to the news that North Korea has conducted a nuclear test.

"The test was not something that makes your heart pound as much as a pressing situation between Iran and Israel," said Kaname Gokon, research manager at brokerage Okato Shoji, referring to the threat of possible military action to prevent Iran from developing nuclear weapons.

U.S. crude futures edged down 0.1 percent to $96.90 a barrel while Brent steadied around $118.

Spot gold stayed near a one-month low.

(Additional reporting by Ayai Tomisawa, Lisa Twaronite and Osamu Tsukimori in Tokyo; Editing by Chris Gallagher)

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India Ink: Message From a Sadhu: Detach From Family to Avoid Sadness

ALLAHABAD, Uttar Pradesh — Do your duty, but stop worrying so much about parents, wife and children.

That was the message of the 60-year-old Hindu mystic Maheshanand Giri from the Shri Panchayati Mahanirvani Akhara as he sat outside of a yellow and red tent set up on the vast grounds of the Kumbh Mela in Allahabad this weekend.

Attachments bring sadness, he said.

“Getting rid of attachments is the first step to salvation,” he said, sitting beside a small wood fire. “If your family is sick, if your father dies, then you will feel sadness.”

The mystics who come to the Kumbh are part of religious orders that were once mercenary armies that terrified parts of northern India centuries ago, according to William Pinch, a professor of history at Wesleyan University in Connecticut.

“They are the ghosts of armies past,” Dr. Pinch said in an interview. “And they were often employed as assassins.”

These armies often stole or bought children to fill their ranks, Dr. Pinch said. And the rituals of joining the orders usually involved cutting all ties to family, he said.

“The rituals that they undergo when they join the order are a separation from caste society, which involves a social death,” Dr. Pinch said. “The order becomes your family.”

Ascetics are often thought by Westerners to be peace-loving monks, but Hindu sadhus generally revere Lord Shiva, who could lift mountains with one finger and was known to sever heads. At the Kumbh, the sadhus brandished ceremonial tridents, swords and spears. Some waved around baseball bats, and their celebrations during the procession to the Ganges were decidedly warlike.

But in his tent, Mr. Giri’s message to those who had little appetite for abandoning their family was to take a somewhat more detached view of loved ones.

“With your wife, you should stop having sex after you have your children,” he said. “And with your children, you should do your duty but draw a line in your attachment. If you are too attached, you will not be happy.”

He said he was particularly angry about the proliferation of pornography through cell phones and the Internet. “The government should do something to stop this,” he said.

But a fondness for coffee is allowed, he said, even though some may call it an unhealthy addiction.

“Drinking coffee is your choice. It’s not an attachment,” he said. “It’s O.K. to drink coffee.”

Hari Kumar contributed reporting from Allahabad.

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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 edges up, shares and oil slide in choppy trade

LONDON (Reuters) - The euro edged up from a two-week low, while oil and European equities slipped from multi-month highs on Monday, with markets checked by ongoing worries over the euro zone, offsetting signs of a pickup in world trade.

Trading is expected to be light and choppy in the absence of any major economic drivers, a looming meeting of euro area finance ministers and the Lunar New Year holiday shutting most Asian financial centers.

The euro briefly touched a two-week low of $1.3325 in Asian trade, extending a sell-off that saw the common currency shed about 2.5 percent last week, but it has since steadied to be little changed around at around $1.3370.

Analysts were not expecting much new from a euro zone finance ministers meeting later in the day, though markets will be on watch for any discussion on the strength of the euro ahead of the G20 meeting at the end of the week.

Since hitting a 15-month high of $1.3711 on February 1, sentiment towards the euro has shifted after European Central Bank president Mario Draghi suggested any further strength could result in an interest rate cut. Nervousness over political developments in Spain and Italy has also unsettled the currency.

"The euro has stabilized at lower levels following last week's verbal intervention from ECB President Draghi, which was a subtle attempt to dampen the pace of euro appreciation in the near term," said Lee Hardman, currency analyst at Bank of Tokyo-Mitsubishi UFJ.

The pan-European FTSEurofirst 300 index <.fteu3> traded down 0.3 percent at 1,157.97 points in early trade, having added 1.2 percent on Friday on data showing a narrowing trade deficit in the United States and growing demand for Chinese exports, which bolstered hopes the global economy would strengthen.

Brent crude prices dipped slightly but remain not far from the nine-month high of just over $119 per barrel hit on Friday as the Chinese trade data revealed a big jump in oil imports.

Brent crude had dipped 40 cents to $118.50 per barrel, having peaked at $119.17 on Friday, the highest since May. U.S. crude futures fell 126 cents to $95.46.

Oil markets could get some support from stormy weather in the heavily populated U.S. Northeast, where a blizzard dumped up to 40 inches (1 meter) of snow with hurricane force winds, leaving hundreds of thousands of people without power.

(Reporting by Richard Hubbard; Editing by Will Waterman)

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