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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Stock futures point to modest gains at open

NEW YORK (Reuters) - Stock index futures pointed to slight gains at the open on Wednesday, suggesting the market would continue a recent advance that lifted benchmark indexes to multi-year highs.

Equities have been strong performers of late, buoyed largely by healthy growth in corporate earnings, with the S&P 500 gaining 6.5 percent so far this year. The Dow is about 1 percent from an all-time intraday high, reached in October 2007.

Those gains could leave the market vulnerable to a pullback as investors take profit amid a dearth of new trading catalysts. While analysts continue to see an upward bias in markets, recent daily moves have been small and trading volumes have been light, with the S&P near its highest since November 2007.

"This is a market that refuses to go down, and the trend suggests that we'll not only hit a new high on the Dow, but move well beyond it," said Adam Sarhan, chief executive of Sarhan Capital in New York.

The S&P 500 was well over its 50-day moving average of 1,460.92, which was a sign the market was overbought, he said.

"A light-volume pullback should be expected and embraced at these levels," Sarhan said.

Industrial and construction shares will be in focus following President Barack Obama's State of the Union address on Tuesday, during which he called for a $50 billion spending plan to create jobs by rebuilding degraded roads and bridges. He also backed higher taxes for the wealthy.

Investors have cheered strength in recent company results, even as economic data, including recent reads on gross domestic product, have indicated weakening conditions.

Deere & Co reported earnings that beat expectations and raised its full-year profit outlook. After initially rallying in premarket trading, the stock turned 0.9 percent lower to $93.15.

S&P 500 futures rose 2.5 points and were above fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures added 13 points and Nasdaq 100 futures rose 8 points.

Comcast Corp agreed late Tuesday to buy General Electric Co's remaining 49 percent stake in NBC Universal for $16.7 billion. Comcast jumped 8.9 percent to $42.43 in premarket trading while Dow component GE was up 3.1 percent to $23.27.

Yahoo Inc Chief Executive Marissa Mayer said Tuesday the company's search partnership with Microsoft Corp was not delivering the market share gains or the revenue boost that it should.

Companies scheduled to report quarterly results on Wednesday include MetLife Inc , Applied Materials and Whole Foods Market .

According to the latest Thomson Reuters data, of 353 companies in the S&P 500 that have reported results, 70.3 percent have exceeded analysts' expectations, above a 62 percent average since 1994 and 65 percent over the past four quarters.

Fourth-quarter earnings for S&P 500 companies are estimated to have risen 5.3 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.

Retail sales rose 0.1 percent in January, as expected, as tax increases and higher gasoline prices restrained spending. The data barely moved the futures market.

Also in economic news, business inventories are seen rising 0.3 percent in December, a repeat of the November increase. The data will be released at 10:00 a.m. ET (1500 GMT).

U.S. stocks closed modestly higher Tuesday as investors awaited President Barack Obama's State of the Union address.

(Editing by Bernadette Baum)

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The Female Factor: Dancing on Behalf of a Billion

LONDON — Anyone who happens to be passing through Westminster at 11 o’clock on Valentine’s Day may — if things go as planned — catch an unusual glimpse of a few members of Parliament gathered somewhere in the shadow of Big Ben, dancing along the footpath.

The actress Thandie Newton will be leading members of the public and a few politicians in a flash mob dance on Thursday to mark the One Billion Rising day of action, highlighting violence against women. Rossana Abueva, the British event’s organizer, says she hopes a couple of baronesses from the House of Lords will also take part.

Some participants have been rehearsing moves for the newly composed anthem, “Break the Chain,” for weeks, but the occasion is meant to be inclusive. “People who don’t know the moves can sway,” Ms. Abueva said. Demonstrators will release 109 red balloons in memory of the 109 women killed in Britain last year as a result of male violence.

Elsewhere in London, volunteer dance troupes will be popping up in museums, at a spot near the London Eye, at theaters and at train stations, performing bursts of flamenco and contemporary dance, wearing One Billion Rising T-shirts, and trying to educate passers-by about the scale of domestic violence in Britain and abroad. Dancers aim to draw attention to the United Nations’ assessment that one in three women in the world suffers some kind of violence at the hands of men during her lifetime (a figure they have loosely rounded down to a billion).

While supermarket shelves bend beneath the weight of heart-shaped, praline-filled chocolates, campaigners internationally have co-opted Feb. 14 to highlight the global problem of violence against women. If the link between Valentine’s Day and violence seems somewhat puzzling, organizers explain that campaigning against violence toward women is a good way of showing women you like them.

The initiative comes from Eve Ensler, author of “The Vagina Monologues,” and aims to be a “feminist tsunami.” There will be events all over Britain, as well as 190 countries across the world, places as varied as the Democratic Republic of Congo, the Philippines and the United States. In India, the raw anger over the gang rape of a 23-year-old physical therapy student has given extra energy to the campaign. In Los Angeles, Jane Fonda will be dancing; Yoko Ono is also on board.

Ms. Ensler describes dancing as “a way of being very powerful and a little dangerous without being violent.” Promotional material promises that by participating in the Valentine’s Day dance, women “will join in solidarity, purpose and energy and shake the world into a new consciousness,” adding that dance is “contagious, and it spreads quickly.”

It is easy to feel dubious about whether this optimistic vision of the transformative power of dance will take off in London, which remains at heart reserved and staid in character. It is possible that, rather than making the not-totally-obvious connection between flash mobs and the complex issue of violence against women, most bystanders here will not be shaken into a new consciousness but will simply be bemused by the spectacle.

Organizers have thought about this. While they are cheerfully enthusiastic about the impact of celebratory dancing, there is also a drive to make sure the occasion ends up being more than an ephemeral day of protest, and a determination to combine the event with something practical and more enduring. Campaigners in most participating countries are also attempting to improve legislation protecting women against violence.

A Labour member of Parliament, Stella Creasy, who will be dancing outside the House of Commons on Thursday morning, has joined colleagues from all parties to organize a debate in Parliament later that day, calling for compulsory sex and relationship education in British schools.

“We need to do more than simply wring our hands and say violence against women is wrong. We need to do something about it,” Ms. Creasy said. After workshops held here in the autumn by the One Billion Rising campaign, there was agreement that a concerted effort to improve and expand sex education in Britain would be a pragmatic step toward preventing future violence.

The motion calls on the British government to “make personal, social and health education, including a zero-tolerance approach to violence and abuse in relationships, a requirement in schools.”

Currently, sex education does not embrace any discussion of relationships, and parents are at liberty to request that their children opt out of classes. Campaigners are proposing that lessons should include mandatory discussion not only of biology, but of relationships, discussing with children what kind of behavior is and is not acceptable, spelling out that there should be zero tolerance of violence in relationships.

Explaining why the vote matters, the campaign Web site says recent academic research has uncovered “worrying trends of increased sexual exploitation of young people by their peers.” It cites a 2010 YouGov poll that found that almost a third, or 29 percent, of 16- to 18-year-old girls said they had been “subjected to unwanted sexual touching at school,” as well as a finding by the National Society for the Prevention of Cruelty to Children that a third of girls in relationships ages 13 to 17 had “experienced physical or sexual violence in relationships.”

The debate will not have the power to bring about legislation, but campaigners hope it will help focus politicians’ minds on a part of the curriculum that is due to be reviewed.

Will dance protests and the global day of action make a difference? The answer may be clearer on Friday. But as a romantic gesture, 10 minutes’ participation in a flash mob is certainly more original than a dozen roses.

Amelia Gentleman is a journalist with The Guardian. Katrin Bennhold is on sabbatical leave.

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The Bachelor's Sean Lowe Blogs About His Dates in St. Croix

Sean Lowe and Tierra on The Bachelor

Sean Lowe is the star of season 17 of The Bachelor, which airs Mondays on ABC. The hunky Dallas businessman and entrepreneur is blogging about his romantic journey for PEOPLE.com.

I'd developed really strong feelings for the final six women on The Bachelor – and I could hardly wait to take them to St. Croix. Our previous week in Canada was great! My heart and head were back on track, and I felt as though the women put their focus back on me. And because of that, each of my relationships grew stronger.

But it was time to leave the cold weather behind and move on to some sandy beaches. This was a huge week for all of us because I would have to decide whose family I was ready to meet.

I had three one-on-one dates and one group date in St. Croix. I decided to give the one-on-one dates to women I had questions for – and the group date went to the women whose hometowns I was ready to visit.

My first date was with AshLee, who was a front-runner in my mind since we visited the theme park back in Los Angeles. She is sweet, loving and compassionate, and I knew she truly wanted to give her heart over to me. But I was still left with doubts about our relationship because I didn't seem to have as much fun with her as I did with the other women.

Given her traumatic childhood, it's understandable why AshLee has control issues. But I think that was preventing her from really letting go and allowing herself to have fun. I really want a partner that I can laugh uncontrollably with and someone who can make even mundane tasks feel exciting. I hoped AshLee had that quality in her, or that I brought it out in her, and I was ready to find out.

After taking the catamaran to the island, AshLee decided to take one for the team and tell me everything I needed to know about Tierra. Until that point, I had only heard the women say they didn't like Tierra, but they never gave specific reasons. It was actually a huge relief to hear all that AshLee had to say. It took a lot of courage for her to bring it up.

That evening, we ended our date with an oceanside dinner where she screamed her love for me while standing on a chair. For the first time, I felt like AshLee was finally letting go and stepping out of her comfort zone for me. I left that date thinking once again that AshLee might be the woman for me.

Connecting with Tierra

Next was my long-awaited date with Tierra. I had a lot of fun with her that day walking around the streets of St. Croix, but I couldn't shake what AshLee had told me. That night, as we had a romantic dinner in an old sugar mill, I tried to really figure out what my feelings were for Tierra, and if I could see a future for us.

I was nervous that if I ended up with Tierra, drama would follow her into our everyday lives. But when she told me she was falling in love with me, I softened a bit. She was always kind when she was with me, and I wanted to believe that the drama was circumstantial and that once she wasn't around a bunch of girls dating the same guy, she would be drama-free. I still ended the evening with questions, but remembering that my connection with Tierra was strong.

Group Date

The following day was the group date with Des, Lindsay and Catherine. I didn't have a lot of questions for these three women. They all have one thing in common: I always have fun with them. Since the beginning I've said that I want to marry my best friend, and they definitely fit that criterion.

We spent the day traveling and touring the island in a Jeep. At the end of the day, I really didn't know who I would give the rose to because they were all so deserving. But I decided to give it to Lindsay because she was so supportive, patient and encouraging throughout this entire journey.

My last date of the week was with Lesley. She was another person who fit the best-friend criteria, but I needed to see more from her. Lesley had a wall up and I always felt like she couldn't be completely vulnerable with me.

Our date was fun, but I needed more than fun. I desperately wanted to see her open up emotionally and allow me to see her true feelings, but that never happened. I was shocked to hear her say on TV that she loved me, and I was left confused as to why she didn't tell me that during our date. Had she told me, it could have changed everything.

Sisterly Advice

I flew my sister, Shay, to St. Croix for her birthday. She loves the show (she signed me up for The Bachelorette!), and I thought it would be a cool present for her. She is also a great judge of character and she knows me better than anyone else.

My sister's advice before I left Dallas for L.A. was to avoid the girl whom drama surrounded. After hearing everything that AshLee had to say about Tierra, I thought it would be a good idea to have my sister sit down and visit with Tierra so I could get her opinion.

I had no idea what I was walking into upon entering the women's suite. I was not aware of the big blowout AshLee and Tierra just had. I found Tierra crying on her bed with her head in her hands. I had already figured by this point that Tierra was not the woman I was going to marry, so when I saw how distraught she was, I knew I had to end it right then and there.

I still believe Tierra has more good in her than people see, but I also recognize that she doesn't have the maturity or social skills necessary to make it on The Bachelor.

When it came time to send someone home at the rose ceremony, I felt confident in my decision. As much as I enjoyed spending time with Lesley, I knew I had to send her home because she never allowed herself to open up emotionally.

I was sad to see Lesley leave, but I felt so confident in my final four. Knowing hometown dates were right around the corner, I was incredibly excited. I loved bringing Emily home to meet my family, and it changed everything for me, so I had really high hopes for the coming week. On to hometowns!

Thanks for watching!
Sean

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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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Stock futures dip before Obama speech, Coca-Cola shares off

NEW YORK (Reuters) - Stock futures dipped in low volume on Tuesday, hovering near multi-year highs as traders awaited President Barack Obama's State of the Union address.

The economy will be one of the main themes of Obama's speech at 9 p.m. (0200 GMT Wednesday). Investors will listen for any clues on a deal with Republicans in Congress to avert automatic spending cuts due to take effect March 1.

"Things are really quiet, waiting to see what the marching orders are for the next four years," said Kim Forrest, senior equity research analyst at Fort Pitt Capital Group in Pittsburgh.

Equities were mostly flat on Monday but the trend for the S&P 500, after six straight weeks of gains, has been upward. The index is up 6.4 percent so far this year.

S&P 500 futures fell less than 1 point and were below fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures dipped 4 point and Nasdaq 100 futures fell 3 points.

Coca-Cola Co shares dipped 0.5 percent to $38.42 in premarket trading after the world's largest soft drink maker reported quarterly earnings that were slightly better than expected as strength in emerging markets offset a decline in its European business.

Goodyear Tire & Rubber shares fell 1.9 percent in premarket trading after it posted a stronger-than-expected quarterly profit but cut its 2013 forecast due to weakness in the European automotive market.

Fossil Inc shares rose 3.5 percent after the fashion accessory maker and retailer reported a rise in quarterly profit.

On Monday, the Dow Jones industrial average <.dji> fell 21.81 points, or 0.16 percent, to 13,971.16. The S&P 500 <.spx> dipped 0.92 points, or 0.06 percent, to 1,517.01 and the Nasdaq Composite <.ixic> edged down 1.87 points, or 0.06 percent, to 3,192.00.

(Reporting by Rodrigo Campos; Editing by Chizu Nomiyama and Kenneth Barry)

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The Lede: Latest Updates on Pope's Resignation

The Lede is providing updates on Pope Benedict XVI’s announcement on Monday that he intends to resign on Feb. 28, less than eight years after he took office, the first pope to do so in six centuries.

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Pink Trades Grammys for Mommy Time with Daughter Willow

By Maggie Coughlan

02/11/2013 at 08:00 AM EST

Grammys, schammys!

Even though she was nominated for best pop vocal album, Pink was absent from the awards show on Sunday.

Instead, the 33-year-old singer spent the evening on Twitter, sharing her musings about the broadcast – and her busy day.

"I'm sorry honey @hartluck but every time Johnny Depp speaks with that low voice, I can't find my clothes. Oops there they are. #brrrrr," she Tweeted to her husband Carey Hart when the actor introduced Mumford & Sons.

Then, after Kelly Clarkson charmed the audience with an adorable acceptance speech for best pop vocal album, Pink offered her congratulations.

"Congrats to Kelly Clarkson for the award and that lovable speech. You made me laugh. Can't wait to hear that song with Miguel," she wrote.

While much of the music world spent the day getting primped for the Grammys, Pink shared she had spent it with her daughter, Willow.

"I had the most incredible day. Pancakes, willow, train rides, park, arts and crafts, nap time, baking, kisses. Dancing, music. Life is good," she Tweeted, sharing a photo.

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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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Stock futures higher in low volume, Fed's Yellen to speak

NEW YORK (Reuters) - Stock index futures edged higher on Monday, suggesting equities will extend multiyear highs, while low volume and the absence of economic data could make trading volatile and exaggerate moves.

Upbeat U.S. and Chinese data last week helped extend the winning streak of the S&P 500 index to six weeks. The benchmark index is up 6.4 percent so far this year after a steep rally in January that has stalled as the index nears a record high.

No economic data or major earnings reports are scheduled, but Federal Reserve Vice Chairwoman Janet Yellen is due to speak about the economic recovery at 1 p.m.

Technical indicators are "looking very good" and could give the market a floor Monday, according to Peter Cardillo, chief market economist at Rockwell Global Capital in New York.

He said the market will pay attention to Yellen's speech, but he doesn't expect any deviation from her traditionally dovish monetary policy stance.

S&P 500 futures rose 4 points but were slightly below fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures rose 36 points, and Nasdaq 100 futures added 4.25 points.

Google shares dipped 0.9 percent in premarket trading after it said in a filing former chief executive Eric Schmidt is selling roughly 42 percent of his stake in the Internet search company, a move that could potentially net him $2.51 billion.

Celgene Corp shares rose 2.1 percent in premarket trading to $102.21 after U.S. regulators approved its new drug for patients with multiple myeloma whose disease has worsened after being treated with other cancer drugs.

US Airways shares gained 2.9 percent to $15.18 as an $11 billion merger with AMR Corp appeared closer, people familiar with the matter said. A combination would create the world's largest airline by passenger traffic.

Opposition grew to the $24.4 billion buyout of Dell Inc , the No. 3 personal computer maker, as three of the largest investors joined Southeastern Asset Management on Friday in raising objections. Dell said in a regulatory filing it had considered many strategic options before opting to go private. The buyout is being led by Chief Executive Michael Dell.

Loews Corp could be hit after the hotels, energy and financial services conglomerate reported a fourth-quarter loss. CNA Financial Corp , its largest holding, suffered losses linked to superstorm Sandy.

(Reporting by Rodrigo Campos; Editing by Chizu Nomiyama and Kenneth Barry)

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