Drug overdose deaths up for 11th consecutive year

CHICAGO (AP) — Drug overdose deaths rose for the 11th straight year, federal data show, and most of them were accidents involving addictive painkillers despite growing attention to risks from these medicines.

"The big picture is that this is a big problem that has gotten much worse quickly," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, which gathered and analyzed the data.

In 2010, the CDC reported, there were 38,329 drug overdose deaths nationwide. Medicines, mostly prescription drugs, were involved in nearly 60 percent of overdose deaths that year, overshadowing deaths from illicit narcotics.

The report appears in Tuesday's Journal of the American Medical Association.

It details which drugs were at play in most of the fatalities. As in previous recent years, opioid drugs — which include OxyContin and Vicodin — were the biggest problem, contributing to 3 out of 4 medication overdose deaths.

Frieden said many doctors and patients don't realize how addictive these drugs can be, and that they're too often prescribed for pain that can be managed with less risky drugs.

They're useful for cancer, "but if you've got terrible back pain or terrible migraines," using these addictive drugs can be dangerous, he said.

Medication-related deaths accounted for 22,134 of the drug overdose deaths in 2010.

Anti-anxiety drugs including Valium were among common causes of medication-related deaths, involved in almost 30 percent of them. Among the medication-related deaths, 17 percent were suicides.

The report's data came from death certificates, which aren't always clear on whether a death was a suicide or a tragic attempt at getting high. But it does seem like most serious painkiller overdoses were accidental, said Dr. Rich Zane, chair of emergency medicine at the University of Colorado School of Medicine.

The study's findings are no surprise, he added. "The results are consistent with what we experience" in ERs, he said, adding that the statistics no doubt have gotten worse since 2010.

Some experts believe these deaths will level off. "Right now, there's a general belief that because these are pharmaceutical drugs, they're safer than street drugs like heroin," said Don Des Jarlais, director of the chemical dependency institute at New York City's Beth Israel Medical Center.

"But at some point, people using these drugs are going to become more aware of the dangers," he said.

Frieden said the data show a need for more prescription drug monitoring programs at the state level, and more laws shutting down "pill mills" — doctor offices and pharmacies that over-prescribe addictive medicines.

Last month, a federal panel of drug safety specialists recommended that Vicodin and dozens of other medicines be subjected to the same restrictions as other narcotic drugs like oxycodone and morphine. Meanwhile, more and more hospitals have been establishing tougher restrictions on painkiller prescriptions and refills.

One example: The University of Colorado Hospital in Aurora is considering a rule that would ban emergency doctors from prescribing more medicine for patients who say they lost their pain meds, Zane said.

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Stobbe reported from Atlanta.

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Online:

JAMA: http://www.jama.ama-assn.org

CDC: http://www.cdc.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com

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Chavez back in Venezuela, on Twitter with four million followers

CARACAS (Reuters) - After Hugo Chavez spent two months out of the public eye for cancer surgery in Cuba, the Venezuelan government hailed his homecoming on Monday and said the president had achieved another milestone - four million followers on Twitter.

The 58-year-old flew back from Havana before dawn and was taken to a military hospital. No new details were given on his health, and there were no images of his arrival. Officials say his condition remains delicate.

The normally loquacious socialist leader, who is struggling to speak as he breathes through a tracheal tube, took to Twitter with a passion back in April 2010, tweeting regularly and encouraging other leftist Latin American leaders to do likewise.

His @chavezcandanga account quickly drew a big mixed following of fans, critics and others just curious to see how his famously long speeches and fiery anti-U.S. invective would work within the social media network's 140-character limit.

But as he fought the cancer and underwent weeks of grueling chemotherapy and radiation therapy, he began to tweet less and less frequently, before stopping altogether on November 1.

Early on Monday morning, he made his reappearance.

"It was 4:30, 5 a.m. He got to his room and surprised everyone: rat-tat-tat, he sent three or four messages, and at that moment fireworks began to go off around the country," Vice President Nicolas Maduro said in a televised cabinet meeting.

During the day, Maduro added, the president's number of followers had shot up to well over four million.

"It's incredible, in just a few hours ... he's the second most-followed president in the world (after Barack Obama), and the first if we make the comparison by per capita," he said.

Obama has more than 27 million Twitter followers and is No. 5 most followed globally. Chavez is Twitter's No. 190 globally.

4TH MILLION FOLLOWER

Maduro said Chavez's four millionth follower was a 20-year-old single Venezuelan woman named Alemar Jimenez from the gritty San Juan neighborhood in downtown Caracas, near the military hospital where the president arrived earlier in the day.

"She's one of the golden generation of youth who support the fatherland and have been waiting with growing love for commander Hugo Chavez," Maduro said, before presenting a dazzled-looking Jimenez to the cameras and giving her a bunch of flowers.

"We were really emotional" she said, recounting how she was with her mother when they heard Chavez had returned. "I sent him a message on Twitter saying he must get better."

There are still big questions over the president's health. He could have come back to govern from behind the scenes, or he may be hoping to ease political tensions and pave the way for a transition to Maduro, his preferred successor.

Chavez has often ordered followers to fight back against opposition critics of his self-styled revolution by using social media, leading from the front himself on Twitter and referring to the Internet as a "battle trench."

As his ranks of followers grew, Chavez said he hired 200 assistants to help him respond to messages - which he said were a great way to receive first-hand the requests, demands, complaints and denunciations of citizens in the thousands.

During his re-election campaign last year, the government launched an SMS text message service that forwards his tweets to cellphones that lack Internet service, broadening their reach to the poorest corners of the South American country.

"He's a communication revolution!" Maduro said, later unbuttoning his shirt on TV to show he was wearing a T-shirt bearing Chavez's eyes emblazoned across his chest.

For the tens of thousands who signed up on Monday to follow Chavez on Twitter, it is unclear how much will be posted there in the weeks and months ahead. Venezuela's 29 million people are mostly wondering something similar.

(Additional reporting by Diego Ore; Editing by Todd Eastham)

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S'pore's fiscal surplus for FY2012 expected to surpass govt's estimates: economists

SINGAPORE: Despite booking a slower GDP growth of 1.2 percent last year, economists expect Singapore's fiscal surplus to surprise on the upside for FY 2012.

The projections, which range from S$1.6 billion to nearly S$5 billion, surpass the government's estimates of a S$1.27 billion surplus for the year.

The record number of new homes sold last year despite additional cooling measures and the high property prices are likely to prop up government revenue for FY2012.

Vishnu Varathan, market economist at Mizuho Corporate Bank, said: "If you are looking at adding to the coffers by 30 to 40 per cent, that is not unimaginable given how heated activity was in the property market. Overall, the surplus should come up much stronger than expected and I think that reinforces that Singapore runs a pretty strong budget position year after year."

In addition, economists say motor vehicle taxes, rising COE premiums as well as higher foreign worker levy will all add to the state's coffers.

Meanwhile, corporate and personal income taxes and the Goods & Services tax will remain top revenue generators, accounting for more than half of total operating revenue.

Taking into account higher expenditure outlays due to higher than expected inflation, DBS Bank forecasts a S$1.62 billion overall fiscal surplus for 2012.

Meanwhile, OCBC Bank projects a S$4.96 billion overall surplus while keeping expenditure unchanged from initial estimates.

Economists say with the higher surplus, the government could offer some incentives help lower income households and businesses cope with rising cost.

However, it is unlikely to do a U-turn on foreign manpower policies. In fact, economists expect the government to further tighten foreign labour rules, albeit at a more moderate pace to allow more time for companies to restructure.

Broadly, they expect Budget 2013 to focus on boosting productivity and fostering inclusive growth.

Some economists say the upcoming budget could also focus on interim projects that will be undertaken over the next few years to complement the longer term objectives and targets set out in the Population White Paper.

Among the government's future plans are the doubling of rail networks in Singapore and building another 700,000 homes by 2030 to support a larger population.

Social expenditure could also increase to cater for an ageing population

Irvin Seah, senior economist at DBS Bank, explained: "As the population continues to age in the next 10 to 20 years, social expenditure would continue to rise. Furthermore, the government is embarking on infrastructure capacity expansion exercise. This would be the most extensive and most comprehensive infrastructure expansion exercise ever since independence.

"Those two considerations will definitely take a toll on the fiscal position therefore there is a need to raise the tax revenues. Hiking GST is out of the question due to political concerns. The only area where there is room for increase in tax rate would be income tax rate so we expect a hike of one to two percentage point for income tax for the top income brackets in the upcoming budget."

Different tax rates apply for Singapore residents at between two per cent and 20 per cent depending on the chargeable income for the year.

Currently, Singapore has one of the most competitive personal income tax rate in the world.

The government will announce the Budget on February 25.

- CNA/fa

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UPA won't return to power, Sharad Yadav says

BHOPAL: The Congress-led UPA government was "mired in corruption" and had "failed on all fronts", and there was no way it could return to power at the Centre after next general elections, NDA convener Sharad Yadav said on Tuesday.

"The UPA government has been hit by one scam after another during its second tenure. There is no doubt that it has failed on all fronts and it would not return to power after next year's general elections," Yadav, who had come here for a private visit, told reporters.

Yadav said various issues including scams, corruption and rising prices would be discussed in the Budget session of Parliament starting on February 21.

Asked if Parliament would be allowed to run smoothly, he said he was hopeful that there would be no problem in its functioning this time.

Referring to the alleged choppergate, Yadav, who is also president of Janata Dal(United), said the Indian government did not know anything about the scandal till it became an issue in Italy where the media highlighted it in a big way.

Right from Bofors in the 80s to the bribery in helicopter deal, initial reports about scams first appeared in media abroad, he said.

About controversial remarks by Union home minister Sushilkumar Shinde on saffron terror, Yadav said, "It would be better if Shinde concentrates only on his job and does not waste his time in making meaningless statements".

Responding to a query, he said the CBI's credibility had sunk to a new low thanks to the manner in which the UPA government was handling the investigation agency.

On the unity of NDA, Yadav said, "It was united, it is united and it will remain united in future as well," and added that some more parties may join it before the polls.

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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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Russian Meteor: Close Encounter, Preventing Impacts

Feb 18, 2013 7:03pm

MOSCOW — As if Friday’s massive meteor explosion over central Russia weren’t enough, just hours later a large asteroid buzzed dangerously close to Earth.

And that evening, the California sky was lit up by a fireball, apparently entering Earth’s atmosphere.

It’s a barrage from space that has people asking: Are we ready for the big one?

Nearly 100 tons of space debris enters Earth’s atmosphere every day. Most of it burns up or falls harmlessly into the ocean, but experts still worry that eventually something big will come our way.

PHOTOS: Meteorite Crashes in Russia

Image credit: Chelyabinsk Region Branch of Russian Interior Ministry/HO/EPA

The prospect of Earth getting hit by a giant hunk of space rock is concerning enough that the United Nations is gathering top minds in Italy this week to discuss it.

Scientists say the idea of blowing up an asteroid — as Bruce Willis’ character did in the movie “Armageddon” — is pure Hollywood fantasy. Even if we could hit it, it’s unlikely to stop it.

Existing sky-watching programs run by NASA and others can only spot the biggest asteroids, not the small ones that sneak up on us.

But fear not, citizens of Earth. Scientists have a plan.

RELATED: Russian Meteor: Rushing to Cash in on the Blast

One group, the non-profit B612 Foundation, proposes sending a telescope, called Sentinel, into space to detect incoming objects decades before their orbits intersect ours. Then, unmanned spacecraft could fly to them and nudge them clear of Earth’s path.

The group is trying to raise $200 million to make it happen and hopes to launch the telescope by 2016.

Another project, proposed by the University of Hawaii, aims to give earthlings a heads-up when necessary, starting by 2015.

RELATED: Meteor Events: Rare, but Dangerous

It is called the Atlas program, and the plan is to deploy a string of telescopes that would search for even smaller objects in the sky, hoping to be able to give people at least a few day’s notice that could allow time for an evacuation.

Until then, better keep Bruce Willis on speed dial.

SHOWS: World News

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U.N. says has list of Syrian war crimes suspects

GENEVA (Reuters) - Syrians in "leadership positions" who may be responsible for war crimes have been identified, along with units accused of perpetrating them, United Nations investigators said on Monday.

Both government forces and armed rebels are committing war crimes, including killings and torture, spreading terror among civilians in a nearly two-year-old conflict, they said.

The investigators' latest report, covering the six months to mid-January, was based on 445 interviews conducted abroad with victims and witnesses, as they have not been allowed into Syria.

The independent team, led by Brazilian Paulo Pinheiro, called on the U.N. Security Council to "act urgently to ensure accountability" for grave violations, possibly by referring the violators to the International Criminal Court for prosecution.

"The ICC is the appropriate institution for the fight against impunity in Syria. As an established, broadly supported structure, it could immediately initiate investigations against authors of serious crimes in Syria," the 131-page report said.

It added: "Individuals may also bear criminal responsibility for perpetuating the crimes identified in the present report. Where possible, individuals in leadership positions who may be responsible were identified alongside those who physically carried out the acts."

Karen Konig AbuZayd, one of the four commissioners on the team of some two dozen experts, told Reuters: "We have information suggesting people who have given instructions and are responsible for government policy. People who are in the leadership of the military, for example."

"It is the first time we have mentioned the ICC directly. The Security Council needs to come together and decide whether or not to refer the case to the ICC. I am not optimistic."

But its third list of suspects, building on lists drawn up in the past year, remains secret. It will be entrusted to U.N. High Commissioner for Human Rights, Navi Pillay, upon expiry of its current mandate at the end of March, the report said.

Pillay, a former judge at the ICC, said on Saturday that Syrian President Bashar al-Assad should be probed for war crimes and called for immediate action by the international community, including possible military intervention.

"The evidence collected sits in the safe in the office of the High Commissioner against the day it might be referred to a court and evidence would be examined by a prosecutor," said a European diplomat.

The death toll in Syria is likely approaching 70,000 people, Pillay told the Security Council last week in a fresh appeal for it to refer Syria to the ICC, the Hague-based war crimes court.

Government forces have carried out shelling and aerial bombardment across Syria including Aleppo, Damascus, Deraa, Homs and Idlib, the independent U.N. investigators said, citing corroborating evidence gathered from satellite images.

"In some incidents, such as in the assault on Harak, indiscriminate shelling was followed by ground operations during which government forces perpetrated mass killing," it said, referring to a town in the southern province of Deraa where residents told them that 500 civilians were killed in August.

"SPREADING TERROR"

"Government forces and affiliated militias have committed extra-judicial executions, breaching international human rights law. This conduct also constitutes the war crime of murder. Where murder was committed as part of a widespread or systematic attack against a civilian population, with knowledge of that attack, it is a crime against humanity," the U.N. report said.

They have targeted queues at bakeries and funeral processions, in violence aimed at "spreading terror among the civilian population", it said.

"Syrian armed forces have implemented a strategy that uses shelling and sniper fire to kill, maim, wound and terrorize the civilian inhabitants of areas that have fallen under anti-government armed group control," the report said.

Government forces had used cluster bombs, it said, but it found no credible evidence of either side using chemical arms.

Rebel forces fighting to topple Assad in the protracted and increasingly sectarian conflict have committed war crimes include murder, torture, hostage-taking and using children under age 15 in hostilities, the U.N. report said.

"They continue to endanger the civilian population by positioning military objectives inside civilian areas," it said. Rebel snipers had caused "considerable civilian casualties".

"The violations and abuses committed by anti-government armed groups did not, however, reach the intensity and scale of those committed by government forces and affiliated militia."

Foreign fighters, many of them from Libya, Tunisia, Saudi Arabia, Lebanon, Iraq and Egypt, have radicalized the rebels and helped detonate deadly improvised explosive devices, it said.

The two other commissioners are former chief ICC prosecutor Carla del Ponte and Vitit Muntarbhorn of Thailand.

"It is an investigative mechanism and its evidence can be given to relevant judicial authorities when the time comes. In the interim, it is the one piece of U.N.-approved machinery shining a light on abuses," the European diplomat said.

Referring to del Ponte, who joined in September, the diplomat said: "She brings a harder-edged prosecutorial lens so when they are looking at the evidence she is very well placed to know what sort of evidence would assist a later judicial process."

(Reporting by Stephanie Nebehay; Editing by Alistair Lyon)

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India's first monorail in Mumbai to open by August

MUMBAI: India's first monorail will be opened to the public in the next six months in Mumbai.

Built at a cost of half a billion US dollars, it will be the world's second longest monorail which aims to improve the city's rapid transport systems.

India is undergoing an infrastructure building boom.

The government recently approved a budget of one trillion US dollars on infrastructure development over the next five years.

After the successful launch of Metro trains in India, Mumbai is all set to be the country's first city to have a monorail.

An official test run of the monorail was recently conducted and the Mumbai Metropolitan Region Development Authority (MMRDA) is hopeful the service will be operational by August.

Rahul Asthana, Chief of Mumbai Metropolitan Region Development Authority, said: ''Although the commissioning of the Mumbai monorail project has been delayed, we are confident that the Mumbai monorail will get commissioned by the end of August for commercial operations.''

The first phase of the monorail is 8.8 kilometres long and during the test run, it took just over 15 minutes to cover that distance.

The monorail is expected to complement the local railway services and offer faster connectivity, which is good news for residents.

Surendra Vishwakarma, a resident, said: ''For the common Mumbaikars... you see too much crowd in local (trains) and every suburb in Mumbai. But this Mumbai monorail would be very effective, compared to safety (standards) and all... comparing the prices also. It'll be very effective for common men."

The coaches of the monorail are sleek and have an ultra modern design.

Each train will have four coaches with a total carrying capacity of 560 passengers.

MMRDA officials said that special provisions have been made so that women can travel safely and comfortably.

The Mumbai monorail has been commissioned under the Indian Tramways Act.

It will cost around 1.5 times the amount it takes to travel by a local bus.

Most stations will have staircases instead of escalators, which could prove to be a problem for senior citizens and children.

It remains to be seen whether more monorail projects will be commissioned in the future. That will depend on the success of this one.

- CNA/de

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British PM David Cameron seeks 'special' relationship with India

MUMBAI: British Prime Minister David Cameron on Monday began his India visit seeking a "special relationship" between the two countries, saying it is "about the future and not the past" for which sky is the limit.

"I want Britain and India to have a special relationship...this is a relationship about the future, not the past," Cameron said in his first public engagement here-- an interaction with the staff of Hindustan Unilever, the Indian unit of British consumer products' giant, Unilever.

Describing India as one of the "great phenomena" of the century, Cameron, who is on a three-day visit to India, his second since assuming office in May 2010, said the enormous growth of the country is going to make it the third largest economy by 2030.

"I am heading the biggest-ever business delegation to leave British shores. India's rise is going to be one of the great phenomena of the century and it is incredibly impressive to see the vibrancy of your democracy, the great strength of your diversity and the enormous power of your economy that is going to be one of the top three economies by 2030," he said.

"As far as I am concerned, sky is the limit.. it's about business, economy and trade. But it is also about culture, politics, diplomacy. India is going to be one of the leading nations in this century and we will be partners and that's why I am here today," he said.

Britain wants to be India's partner of choice, the visiting premier said, adding the two countries have a lot in common such as history, language, culture.

"You are the largest democracy in the world, and we are the oldest," he said.

He also said both India and Britain face the extraordinary challenge of fighting terrorism.

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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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