Hip implants a bit more likely to fail in women

CHICAGO (AP) — Hip replacements are slightly more likely to fail in women than in men, according to one of the largest studies of its kind in U.S. patients. The risk of the implants failing is low, but women were 29 percent more likely than men to need a repeat surgery within the first three years.

The message for women considering hip replacement surgery remains unclear. It's not known which models of hip implants perform best in women, even though women make up the majority of the more than 400,000 Americans who have full or partial hip replacements each year to ease the pain and loss of mobility caused by arthritis or injuries.

"This is the first step in what has to be a much longer-term research strategy to figure out why women have worse experiences," said Diana Zuckerman, president of the nonprofit National Research Center for Women & Families. "Research in this area could save billions of dollars" and prevent patients from experiencing the pain and inconvenience of surgeries to fix hip implants that go wrong.

Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. The research, published Monday in JAMA Internal Medicine, was funded by the U.S. Food and Drug Administration.

After an average of three years, 2.3 percent of the women and 1.9 percent of the men had undergone revision surgery to fix a problem with the original hip replacement. Problems included instability, infection, broken bones and loosening.

"There is an increased risk of failure in women compared to men," said lead author Maria Inacio, an epidemiologist at Southern California Permanente Medical Group in San Diego. "This is still a very small number of failures."

Women tend to have smaller joints and bones than men, and so they tend to need smaller artificial hips. Devices with smaller femoral heads — the ball-shaped part of the ball-and-socket joint in an artificial hip — are more likely to dislocate and require a surgical repair.

That explained some, but not all, of the difference between women and men in the study. It's not clear what else may have contributed to the gap. Co-author Dr. Monti Khatod, an orthopedic surgeon in Los Angeles, speculated that one factor may be a greater loss of bone density in women.

The failure of metal-on-metal hips was almost twice as high for women than in men. The once-popular models were promoted by manufacturers as being more durable than standard plastic or ceramic joints, but several high-profile recalls have led to a decrease in their use in recent years.

"Don't be fooled by hype about a new hip product," said Zuckerman, who wrote an accompanying commentary in the medical journal. "I would not choose the latest, greatest hip implant if I were a woman patient. ... At least if it's been for sale for a few years, there's more evidence for how well it's working."

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Online:

Journal: http://www.jamainternalmed.com

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Philippine, Aussie shares at new peaks; yen firms

TOKYO (Reuters) - Philippine and Australian shares scaled new heights on Tuesday but other Asian shares were mixed, with worries about the risk of an inconclusive outcome in Italy's election and about U.S. budget talks limiting the upside after strong rallies in early February.

European markets looked set to inch higher, with financial spreadbetters predicting London's FTSE 100 <.ftse>, Paris's CAC-40 <.fchi> and Frankfurt's DAX <.gdaxi> would open up 0.1 percent. <.l><.eu/>

U.S. stock futures rose 0.1 percent to suggest Wall Street will reopen with a firmer tone after the President's Day holiday on Monday. <.n/>

"Markets have become top-heavy after rallying through early February on signs of economic recovery in the United States and Europe, and investors now await fresh factors to push prices higher from here," said Tomomichi Akuta, senior economist at Mitsubishi UFJ Research and Consulting in Tokyo.

"The broad sentiment is underpinned by a lack of tail risks, but investors are turning to some potentially worrying elements such as Italian elections and U.S. budget talks," he said.

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> edged up 0.1 percent. Earlier in the day it had touched a 18-1/2-month high. The index has gained 3.5 percent this year.

Shares in the Philippines <.psi>, where a strong economic growth has led to rising interest in the country as an investment destination, hit a record. The Thai index <.seti> was also up 0.3 percent after recent data showed robust fourth-quarter economic numbers.

Australian shares ended 0.4 percent up at a 4-1/2 year high, continuing a recent rally on better-than-expected corporate earnings.

But Hong Kong shares <.hsi> fell 0.2 percent and Shanghai shares <.ssec> shed 1.1 percent, with real estate and financials leading the declines on concerns that rising property prices would lead to fresh restrictions on the sector.

Tokyo's Nikkei stock average <.n225> ended down 0.3 percent, after surging on Monday to approach its highest level since September 2008 of 11,498.42 tapped on February 6. <.t/>

The concerns about Italy's election this weekend and the talks in Washington over a package of budget cuts set to kick in March 1, also helped limit gains in commodities and also weighed on the euro.

The dollar's strength against a basket of currencies <.dxy> capped gains in gold, with the spot price up 0.2 percent at $1,613.01 an ounce.

London copper steadied at $8,122.50 a metric ton as Monday's three-week low drew bargain hunting given prospects for a slowly improving global economic recovery. Unease over China's limp return to the market from a week-long break held back upside momentum, however.

"I think we've already had the nicest rally that we're going to get this year," Singapore-based Credit Suisse analyst Ivan Szpakowski said. "You can still get some more mild upturns, but frankly as you move to the second half of the year industrial metals are going to trend down.

U.S. crude fell 0.5 percent to $95.43 a barrel while Brent steadied around $117.37.

The euro was steady around $1.3348.

YEN JITTERY

Bank of Japan minutes revealed board members had discussed buying longer-dated government debt at their January meeting, sending the yield on five-year Japanese government bonds to record low.

The yen firmed, however, after Finance Minister Taro Aso told reporters Japan has no plans to buy foreign currency bonds as part of monetary easing and as attention remained focused on who will be the next Bank of Japan governor.

The dollar fell 0.3 percent to 93.61 yen, but remained near its highest since May 2010 of 94.465 hit on February 11. The euro eased 0.4 percent to 125.00 yen, below its peak since April 2010 of 127.71 yen touched on February 6

The yen, which has dropped 20 percent against the dollar since mid-November, fell further at the start of the week after financial leaders from the G20 promised not to devalue their currencies to boost exports and avoided singling out Japan for any direct criticism.

The choice of the next BOJ governor and two deputies has drawn attention as a gauge of how strongly Prime Minister Shinzo Abe is committed to reflating the economy. The G20's message was that as long as Japan pursues aggressive monetary easing to achieve that goal, a weaker yen as a result of such domestic monetary policy will be tolerated, analysts say.

"But that means that some other economy's monetary conditions have been tightened," said Barclays Capital in a note.

"Japan hasn't even changed its policy stance thus far, and the effect of expectations of a looser setting have led to limited moves in domestic interest rates, but the sell-off of the JPY has been marked and has clearly caused unease in other economies," the note said.

(Additional reporting by Melanie Burton in Singapore; Editing by Edwina Gibbs)

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IHT Rendezvous: Romanian Film Takes Top Prize at the Berlinale

10:46 a.m. | Updated

BERLIN — “Child’s Pose,” a film by the Romanian director Calin Peter Netzer, took the top prize, the Golden Bear, at the 63rd Berlin International Film Festival on Saturday.

The story of a privileged woman whose maternal instincts kick into overdrive when her son kills a teenage boy in a car accident, “Child’s Pose” shares several hallmarks of the recently revitalized Romanian cinema, not least a focus on institutional malaise and corruption. It was written by Mr. Netzer and Razvan Radulescu, who also collaborated on the screenplays of many other acclaimed Romanian films, including “The Death of Mr. Lazarescu” and “4 Months, 3 Weeks, 2 Days.”

The runner-up prize, the Silver Bear, went to another Eastern European social drama, “An Episode in the Life of an Iron Picker.” Directed by the Bosnian filmmaker Danis Tanovic (best known for the Oscar-winning “No Man’s Land”) and based on actual events, the film recounts an impoverished Roma family’s struggles with an unjust health care system, and enlists the real-life couple to re-enact their plight. The male lead, Nazif Mujic, won the best actor prize.

Paulina García, the star of Sebastián Lelio’s “Gloria,” about the romantic reawakening of a Chilean divorcee, won the tightly contested best actress category. David Gordon Green won best director for “Prince Avalanche,” a buddy comedy starring Paul Rudd and Emile Hirsch. And best screenplay went to Jafar Panahi and Kamboziya Partovci for one of the most talked-about films in the competition, “Closed Curtain,” a confessional, self-reflexive drama about an artist and his demons. It is the second movie, after “This Is Not a Film” (2010), that Mr. Panahi has made in defiance of a ban on filmmaking by the Iranian authorities.

The Alfred Bauer Prize for innovation, named for the founder of the Berlinale, went to perhaps the most eccentric film in the competition, the French Canadian director Denis Côté’s “Vic and Flo Saw a Bear,” a darkly comic and melodramatic lesbian love story. The Australian director Kim Mordaunt won the best first feature award for “The Rocket.” And the Teddy Award for best gay-themed film went to the Polish director Malgoska Szumowska’s “In the Name of …,” about a Catholic priest struggling with his homosexuality.

Led by the Hong Kong director Wong Kar-wai, whose new film, “The Grandmaster,” opened the festival, this year’s Berlinale jury included the actor Tim Robbins; the filmmakers Susanne Bier, Andreas Dresen and Athina Rachel Tsangari; the cinematographer Ellen Kuras; and the artist Shirin Neshat.

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Downton Abbey's Season 3 Finale: Shocking, Says PEOPLE's TV Critic

Downton Abbey

By Tom Gliatto

02/17/2013 at 10:00 PM EST

Downton Abbey season 3 cast

Carnival Film & Television/PBS

Downton Abbey's third season finale on PBS's Masterpiece was, to say the least, a spoiler's paradise. The episode, which saw the Granthams and servants going on holiday in the Scottish Highlands, started on a joyful note – Lady Mary was pregnant! – and ended with a shock that would have knocked the hat off Lady Violet wobbling head.

SPOLIER ALERT: Major plot points to be revealed immediately.

Cousin Matthew (Dan Stevens) died in a car accident. He was driving back to Downton, so happy he was practically whistling, just after Lady Mary (Michelle Dockery) had given birth to their son – the male Downton heir everyone has been so obsessed with since Season 1.

Many viewers probably saw this coming: For one thing, Stevens had said he was thinking of decamping before season 4 started shooting. And after the finale had its premiere broadcast in Britain in December, he blabbed all about it, including for an interview posted online by The New York Times.

Even so, the death was almost sadistically abrupt and arbitrary, especially after the soft tenderness and growing love between Mary and Matthew in recent episodes. Now we saw dead poor Matthew dumped on the cold mossy ground, eyes wide open.

You can never be sure Downton writer-creator Julian Fellowes won't pull some shameless stunt to kick-start a story – in season 2 Matthew, paralyzed during the war, suddenly leaped out of his wheelchair – but he seemed to want us to be sure that Matthew was 100% gone. I wouldn't have been surprised if the car backed over the corpse.

So ended a terribly sad season of Downton.

We already suffered the loss in childbirth of Lady Sybil (Jessica Brown Findlay). Her deathbed scene was unflinching and deeply moving as she gasped for breath and called for help. Her poor mother (Elizabeth McGovern) sobbed in despair, and the doctors couldn't agree on what to do.

Millions of viewers cried, too, and sighed for a long time afterward. Those who didn't are probably evil.

That scene was the heart of the season: Sybil was so beautiful and kind and gracious and spirited, and so different from her fractious sisters. It was if one were to discover a rare, transcendent soul among the Kardashians. Her death robbed the show of a lovely presence, and also brought out the best moments yet from McGovern and Maggie Smith, as Lady Violet.

It never ceases to annoy me, to be honest, that Lady Violet's feeble witticisms are treated as if they were Oscar Wilde one-liners on loan, like Harry Winston jewels. If you want real witticisms, try any contemporary American sitcom, including FX's Archer.

But this season, as Violet grieved, we saw how much depth Smith can invest in a single moment. At one point in the finale, she looked up as dinner was announced, and in her enormous eyes you saw a woman who wished she could just chuck the whole damn thing and dwell on her memories.

I wish I could say I will miss Matthew, but all in all an unattached Lady Mary is better than a married one. She was never sexier than in the first season, when she sneaked off to bed with velvety, sensual Mr. Pamuk, who unfortunately kicked the bucket while they made love.

Mary is a wonderful creation – the show's most original, complex character – capable of bouncing from romance to sorrow to sarcasm. You could say her love for Matthew transformed her, but it also had the potential to dull her.

Matthew was blandly handsome and good and patient and full of improving notions, but not terribly exciting. He was like a Bachelor from a much earlier period.

There isn't much else to say about the finale. Fellowes worked through a number of plots with his usual tangy glibness. The performances were all delightful, tart, full of emotion, humor and regret.

For now, we can look forward to Lady Mary at her most beautiful, because most woeful, in season 4.

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Study: Better TV might improve kids' behavior

SEATTLE (AP) — Teaching parents to switch channels from violent shows to educational TV can improve preschoolers' behavior, even without getting them to watch less, a study found.

The results were modest and faded over time, but may hold promise for finding ways to help young children avoid aggressive, violent behavior, the study authors and other doctors said.

"It's not just about turning off the television. It's about changing the channel. What children watch is as important as how much they watch," said lead author Dr. Dimitri Christakis, a pediatrician and researcher at Seattle Children's Research Institute.

The research was to be published online Monday by the journal Pediatrics.

The study involved 565 Seattle parents, who periodically filled out TV-watching diaries and questionnaires measuring their child's behavior.

Half were coached for six months on getting their 3-to-5-year-old kids to watch shows like "Sesame Street" and "Dora the Explorer" rather than more violent programs like "Power Rangers." The results were compared with kids whose parents who got advice on healthy eating instead.

At six months, children in both groups showed improved behavior, but there was a little bit more improvement in the group that was coached on their TV watching.

By one year, there was no meaningful difference between the two groups overall. Low-income boys appeared to get the most short-term benefit.

"That's important because they are at the greatest risk, both for being perpetrators of aggression in real life, but also being victims of aggression," Christakis said.

The study has some flaws. The parents weren't told the purpose of the study, but the authors concede they probably figured it out and that might have affected the results.

Before the study, the children averaged about 1½ hours of TV, video and computer game watching a day, with violent content making up about a quarter of that time. By the end of the study, that increased by up to 10 minutes. Those in the TV coaching group increased their time with positive shows; the healthy eating group watched more violent TV.

Nancy Jensen, who took part with her now 6-year-old daughter, said the study was a wake-up call.

"I didn't realize how much Elizabeth was watching and how much she was watching on her own," she said.

Jensen said her daughter's behavior improved after making changes, and she continues to control what Elizabeth and her 2-year-old brother, Joe, watch. She also decided to replace most of Elizabeth's TV time with games, art and outdoor fun.

During a recent visit to their Seattle home, the children seemed more interested in playing with blocks and running around outside than watching TV.

Another researcher who was not involved in this study but also focuses his work on kids and television commended Christakis for taking a look at the influence of positive TV programs, instead of focusing on the impact of violent TV.

"I think it's fabulous that people are looking on the positive side. Because no one's going to stop watching TV, we have to have viable alternatives for kids," said Dr. Michael Rich, director of the Center on Media and Child Health at Children's Hospital Boston.

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Online:

Pediatrics: http://www.pediatrics.org

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Contact AP Writer Donna Blankinship through Twitter (at)dgblankinship

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Euro, dollar gain after G20, stocks weaker

LONDON (Reuters) - The euro and the dollar gained against the yen on Monday after the G20 decided not to criticize Japan for its expansionary policies, but Europe's weak growth outlook and the approach of Italian elections capped the moves.

Financial leaders from the world's 20 biggest economies promised in their final statement after a weekend meeting not to devalue their currencies to boost exports, in a bid to defuse talk of currency wars among major nations.

The euro gained 0.15 percent to 125.20 yen, edging up toward a 34-month high of 127.71 yen hit earlier this month, while the dollar rose 0.5 percent to 93.99 yen, closer to its highest since May 2010 of 94.46 hit on February 11.

"Future yen direction will continue to be driven by domestic monetary policy from the Bank of Japan and improving international investor confidence, which are both driving the yen weaker," said Lee Hardman, currency analyst at Bank of Tokyo-Mitsubishi UFJ.

With the G20 meeting over, the focus in European markets is switching to the release of euro area Purchasing Managers' Indexes for February and German sentiment indices due later in the week, and the upcoming general elections in Italy.

Analysts expect the euro area flash PMI indices, which point to economic activity around six months out, to show growth stabilizing rather than a clear end to the current recession across the region.

The FTSEurofirst 300 index <.fteu3> of top European shares opened down 0.1 percent at 1,159.87 points, with Germany's DAX <.gdaxi>, the UK's FTSE <.ftse> and France's CAC-40 <.fchi> flat to slightly weaker. <.l><.eu/>

Earlier, the effect of the G20 statement and further announcements from Japan's Prime Minister Shinzo Abe indicating a renewed drive to stimulate the economy lifted the Nikkei stock index <.n225> by 2.1 percent, near to its highest level since September 2008.

Meanwhile U.S. stock futures were barely changed and are expected to stay little changed as Wall Street will be closed on Monday for the Presidents' Day holiday. <.n/>

In the commodity markets, copper fell 0.7 percent to $8,150 a tonne as traders played catch up after a week-long holiday in China last week, with worries about the euro zone economy weighing on sentiment.

U.S. crude fell 34 cents to $95.50 a barrel but Brent inched up six cents $117.70.

Gold rebounded by 0.3 percent from a six-month low to be $1,614 an ounce as jewelers in China returned to the physical market after the Lunar New Year holiday.

(Reporting by Richard Hubbard. Editing by Giles Elgood)

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IHT Rendezvous: In Singapore's Immigration Debate, Sign of Asia's Slipping Middle Class?

BEIJING — Immigration is a hot-button issue nearly everywhere in the world, though the contours of the debate vary from place to place. In the United States, sweeping changes to the law may offer legal residency for millions of people who have entered the country illegally, my colleague Ashley Parker reports.

Here in Asia, in the nation of Singapore, the debate looks somewhat different: The government plans to increase the population from just over five million to a possible high of nearly seven million by 2030, via regulated, legal immigration. It’s provoking opposition.

So much so that on Saturday, about 3,000 people turned out for what some commentators said was one of the biggest demonstrations in the nation’s history. (If the number seems small, it reflects the tight political control exerted over Singapore life by the People’s Action Party, which has run the country for about half a century and discourages public protest.)

What are the contours of the debate in Singapore?

Concern over booming immigration, often focused on new arrivals from increasingly rich China, has been simmering in the nation, with many feeling that the immigrants don’t play by the same rules, that their manners are poor and that they are pushing up prices. That feeling crystallized last year when a wealthy Chinese man driving a Ferrari at high speed killed three people (including himself) in a nighttime accident.

(Similar sentiments are found in Hong Kong, as my colleagues Bettina Wassener and Gerry Mullany wrote.)

Vividly illustrating the resentment, Singaporeans sometimes call the wealthy immigrants “rich Chinese locusts,” according to an article in the Economic Observer’s Worldcrunch.

Less controversially, the article quoted Peng Hui, a professor of sociology at National Singapore University, as saying: “Singaporeans do not discriminate against the Chinese. On the contrary, they very much identify with their Chinese ancestry.” (Of course, rich Chinese are not the only new immigrants, but they are a major group, many commentators have pointed out.) “What the local people do not appreciate is the fact that Chinese people talk loudly in public, eat on the subway and like to squeeze through in a crowd or grab things,” Mr. Peng was quoted as saying.

So the Singapore government’s Population White Paper that passed in Parliament earlier this month, just before Chinese New Year, was bound to stir things up.

The government is presenting the rise in immigration as a target that is needed if Singapore, where immigrants already make up about 40 percent of the population, and which has the highest concentration of millionaires in the world, is to continue to flourish, reports said. Singaporeans just aren’t having enough children, said the prime minister, Lee Hsien Loong.

“In my view, in 2030, I think 6 million will not be enough to meet Singaporeans’ needs as our population ages because of this problem of the baby boomers and bulge of aging people,” Mr. Lee said in Parliament, adding that 6.9 million was not a target but a number to be used to help plan for infrastructure.

“Do we really need to increase our population by that much?” wrote a person called Chang Wei Meng in a letter to The Straits Times, according to Reuters. “What happened to achieving the Swiss standard of living?”

Gilbert Goh, a main organizer of the rally Saturday at Singapore’s Speaker’s Corner in a public park, said the protesters had a message: “They want to tell the government, please reconsider this policy. The turnout is a testimony that this policy is flawed and unpopular on the ground,” The Associated Press quoted Mr. Goh as saying.

Yet amid the familiar rhetoric about immigrants, heard around the world – they don’t fit in, they’re rude, they’re different – might something more important be going on here?

In a blog post on Singapore News Alternative, Nicole Seah, a politician who has run for Parliament and comments on social issues, wrote: “Along with many other Singaporeans, I oppose the White Paper.”

Why? She is looking for “a society that lives in harmony, rather than tense and overcrowded conditions,” she writes.

“Not the Singapore Inc. that has been aggressively forced down our throats the past few years – a Singapore which is in danger of becoming a transient state where people from all over, come, make their fortunes, and leave.”

Not “a Singapore that has become a playground for the rich and the people who can afford it. A Singapore where the middle class is increasingly drowned out because they do not have the social clout or sufficient representatives in Parliament to voice their concerns.”

Ms. Seah’s statements raise an interesting question: Is this part of a phenomenon that the columnist Chrystia Freeland has written about so ably for this newspaper, the ascendancy of a wealthy, “plutocrat” class and the slipping status of the middle class?

As Ms. Freeland wrote last week: “The most important fact about the United States in this century is that middle-class incomes are stagnating. The financial crisis has revealed an equally stark structural problem in much of Europe.” Is it hitting Asia, too, and does Singapore’s protest speak, at least in part, to this? Hong Kong’s dissatisfaction too?

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Beyoncé's Life Is But a Dream: The Best Moments

TV Watch

By Aaron Parsley

02/16/2013 at 11:05 PM EST

I am ... still singing!

Beyoncé's HBO documentary, Life Is But a Dream, aired Saturday night and it was a 90-minute whirlwind of music, dance and emotion. And though the singer, 31, has been everywhere recently (the Inauguration, the Super Bowl halftime show, Oprah's Next Chapter), the film was full of new and exciting moments. Here are my favorites:

Baby Bey: A home movie of Beyoncé as a little girl playing with bees made my jaw drop. The scene seems to prove what her fans believe: that she was born to be a superstar known as Queen B. I also loved seeing her singing – and being a typical, giggling teenager – with her sister Solange and Kelly Rowland.

The Heartbreak: From her frank discussion of firing her father as a manager to hearing "the saddest song" she's ever written after having miscarriage, the film – which Beyoncé produced and directed herself – had raw, emotional moments.

Mrs. Carter: Life is like a dream for Beyoncé and husband Jay-Z, who surprisingly shared intimate moments together – giddy over her pregnancy, singing Coldplay's "Yellow" to each other, enjoying solitude on a boat in an undisclosed, exotic location. You could feel the love when she toasted him on his birthday.

Blue Ivy: How cute is she?! When Beyoncé and Jay's baby girl, who turned 1 in January, appeared on the screen at the premiere of Life Is But a Dream at New York's Ziegfeld Theater, the crowd gasped and then let out a collective "aww." And I jammed my fingers on the TV screen the first time I watched, trying to pinch those cheeks. Seeing Beyoncé at home with a baby on her hip was a powerful reminder that the fierce superstar is human afterall.

The Music: Of course! Seeing her sing "Listen" with a gorgeously altered ending in a car convinced me of one thing: Beyoncé is definitely not human! I also loved seeing everything that went into her epic Billboard Music Awards performance of "Run the World (Girls)." I just wish I could do that dance. And is it me or does "Resentment" get grittier and angrier every time she performs it?

Praise Beysus and long live the Queen B!

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UN warns risk of hepatitis E in S. Sudan grows

GENEVA (AP) — The United Nations says an outbreak of hepatitis E has killed 111 refugees in camps in South Sudan since July, and has become endemic in the region.

U.N. refugee agency spokesman Adrian Edwards says the influx of people to the camps from neighboring Sudan is believed to be one of the factors in the rapid spread of the contagious, life-threatening inflammatory viral disease of the liver.

Edwards said Friday that the camps have been hit by 6,017 cases of hepatitis E, which is spread through contaminated food and water.

He says the largest number of cases and suspected cases is in the Yusuf Batil camp in Upper Nile state, which houses 37,229 refugees fleeing fighting between rebels and the Sudanese government.

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After decent rally, perhaps time for a pause

NEW YORK (Reuters) - Stocks could struggle to extend their seven-week winning streak as the quarterly earnings period draws to a close and the market bumps into strong technical resistance.

Many analysts say the market could spend the next few weeks consolidating gains that have lifted the benchmark Standard & Poor's 500 <.spx> by 6.6 percent since the start of the year.

The S&P 500 ended up 0.1 percent for the week, recovering from a late sell-off on Friday after a Bloomberg report about slow February sales at Wal-Mart triggered a slide in the retailer's shares. It was the index's seventh week of gains.

Odds of a pullback are increasing, with the market in slightly overbought territory, said Bruce Zaro, chief technical strategist at Delta Global Asset Management in Boston.

"I do suspect the closing of the earnings season will lead to at least a pause and possibly a pullback," Zaro said. The S&P 500 could shave 3 to 5 percent between now and early April, he said.

Fourth-quarter earnings have mostly beaten expectations. Year-over-year profit growth for S&P 500 companies is now estimated at 5.6 percent, up from a January 1 forecast for 2.9 percent growth, and 70 percent of companies are exceeding analyst profit expectations, above the 62 percent long-term average, according to Thomson Reuters data.

On Thursday, Wal-Mart, the world's largest retailer, is due to report results, unofficially closing out the earnings period. Investors will be keen to see its quarterly numbers, especially after the Friday's news report that rattled investors.

The S&P 500 has gained 4.3 percent since Alcoa kicked off the earnings season on January 8.

The approaching March 1 deadline for across-the-board federal budget cuts unless Congress reaches a compromise adds another reason for caution, especially with recent economic data indicating the recovery remains bumpy.

Manufacturing output fell 0.4 percent last month, the Federal Reserve said on Friday, but production in November and December was much stronger than previously thought.

TESTING RESISTANCE

The S&P 500 has been trading near five-year highs, and it notched its highest level since November 2007 this week. But the gains have pushed the benchmark index almost as far as it is likely to go in the near term, with strong resistance hovering around 1,525 and 1,540, one analyst said.

As a result, the index is set to move sideways, said Dave Chojnacki, market technician at Street One Financial in Huntington Valley, Pennsylvania. "We just don't have the volume or the catalyst right now" to go above those levels, he said.

At the same time, other analysts say, the market has not shown significant signs of slowing, including a break below 15- and 30-day moving averages.

Such moves would be needed to show that momentum is slowing or that the market is at risk of a correction, said Todd Salamone, director of research for Schaeffer's Investment Research in Cincinnati, Ohio. The S&P 500's 14-day moving average is at 1,511 while the 30-day is at 1,494. The index closed Friday at 1,519.

Recent M&A activity, including news this week of a merger between American Airlines and US Airways Group , helped provide some strength for the market this week and optimism that more deals may be on the way.

In the coming days, the market will focus on minutes from the latest Federal Reserve meeting, due to be released on Wednesday, which could provide support if they suggest the Fed will remain on its current course of aggressive monetary easing.

The Fed minutes released in January spooked markets a bit when they revealed that some Fed officials thought it would be appropriate to consider ending asset purchases later in 2013. U.S. Treasury yields rose on that news, though market worries about a near-term end to quantitative easing have since faded.

Among other companies expected to report earnings next week are Nordstrom , Hewlett-Packard and Marriott International

(Reporting By Caroline Valetkevitch; Editing by Leslie Adler)

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