Bird flu kills 4-year-old boy in Indonesia

JAKARTA, Indonesia (AP) — A 4-year-old Indonesian boy has died from bird flu, bringing the death toll to 160 in the country hardest-hit by the deadly virus, a health official said Tuesday.
While the H5N1 bird flu virus has killed relatively few people, scientists have been closely monitoring it for its potential to mutate and affect humans worldwide.
The boy died Dec. 6 in Tangerang city, just west of Jakarta, the capital, said Health Ministry official Rita Kusriastuti. He developed symptoms of a cold and fever on Nov. 30 and was treated at a public health center before being hospitalized the same day he died.
Kusriastuti said the boy, from the West Java district of Bogor, was believed to have been infected with the H5N1 virus after having direct contact with dead fowl around his house.
Bird flu has killed at least 360 people worldwide since 2003. It remains hard for people to catch, but experts fear it could mutate into a more deadly form that spreads easily from person-to-person. So far, most human cases have been linked to contact with infected poultry.
Last week, Kusriastuti said a form of the H5N1 virus not previously detected in Indonesia had killed hundreds of thousands of ducks on the main island of Java. The type of virus has been found circulating in a number of other countries and does not indicate any change that makes humans more susceptible.
The new form of the virus is believed to have entered Indonesia through imported ducks, but Kusriastuti said it's also possible it may have evolved on its own from existing strains.
Bird flu remains entrenched in Indonesia and elsewhere. It typically flares up during the winter months in affected countries with increases in poultry outbreaks and human cases.

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Merck, GE to collaborate on Alzheimer's drug development

 Merck & Co and General Electric Co's healthcare unit have agreed to collaborate on an experimental drug for Alzheimer's disease, the companies said on Tuesday.
GE Healthcare will supply Flutemetamol, an investigational imaging agent, to Merck for use with its experimental Alzheimer's disease drug MK-8931.
The companies hope GE's imaging agent will help identify patients who might benefit from a therapy such as Merck's, which targets beta amyloid, a protein that can clump together and form plaques in the brain. Such plaques have been found in the brains of patients with Alzheimer's disease.
MK-8931 is Merck's lead Alzheimer's drug candidate and is designed to modify progression of the disease as well as improve symptoms. Alzheimer's robs patients of their memory and can cause other cognitive disturbances.
Based on promising results from an early-stage clinical trial of MK-8931, Merck plans to move forward with a larger trial, called EPOCH, at multiple sites around the world.
Flutemetamol is a positron emission tomography (PET) imaging agent that has been able, in clinical trials, to detect beta amyloid in the brain.
GE Healthcare will supply Flutemetamol to help select patients for clinical trials and evaluate the agent as a companion diagnostic tool. Financial and other terms of the agreement between the companies were not disclosed.

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Diabetes remission possible with diet, exercise

 One in nine people with diabetes saw their blood sugar levels dip back to a normal or "pre-diabetes" level after a year on an intensive diet and exercise program, in a new study.
Complete remission of type 2 diabetes is still very rare, researchers said. But they added that the new study can give people with the disease hope that through lifestyle changes, they could end up getting off medication and likely lowering their risk of diabetes-related complications.
"Kind of a long-term assumption really is that once you have diabetes there's no turning back on it, and there's no remission or cure," said Edward Gregg, the lead author on the report from the Centers for Disease Control and Prevention.
The research, he told Reuters Health, "is a reminder that adopting a healthy diet, physically-active lifestyle and reducing and maintaining a healthy weight is going to help manage people's diabetes better."
His team's study can't prove the experimental program - which included weekly group and individual counseling for six months, followed by less frequent visits - was directly responsible for blood sugar improvements.
The original goal of the research was to look at whether that intervention lowered participants' risk of heart disease (so far, it hasn't).
But the diabetes improvements are in line with better weight loss and fitness among people in the program versus those in a comparison group who only went to a few annual counseling sessions, Gregg's team reported Tuesday in the Journal of the American Medical Association.
IS IT COST-EFFECTIVE?
About eight percent of people in the United States have diabetes, according to the American Diabetes Association. The new study included 4,503 of them who were also overweight or obese.
People randomly assigned to the intensive program had diet and exercise counseling with a goal of cutting eating and drinking back to 1200 to 1800 calories per day and increasing physical activity to just under three hours per week.
After one year, 11.5 percent of them had at least partial diabetes remission, meaning that without medication their blood sugar levels were no longer above the diabetes threshold. That compared to just two percent of participants in the non-intervention group who saw their diabetes improve significantly.
People who'd had diabetes for fewer years were more likely to have blood sugar improvements, as were those who lost more weight or had stronger fitness gains during the study.
However, less than one-third of people whose diabetes went into remission during the program managed to keep their blood sugar levels down for at least four years, the researchers found.
"Clearly lifestyle intervention is good for people with diabetes," said Dr. John Buse, a diabetes researcher from the University of North Carolina at Chapel Hill School of Medicine.
"The question is how cost-effective is it, what are the long-term consequences (and) how would it really compare with alternative approaches like bariatric surgery and drug therapy?" Buse, who wasn't involved in the new study, told Reuters Health.
Dr. David Arterburn, from Group Health Research Institute in Seattle, said some studies of weight-loss surgery, for instance, have found two-thirds of people who start out with diabetes have complete remission.
Arterburn, who co-wrote an editorial published with the new study, said anyone with diabetes - or at high risk - should consider either lifestyle interventions or surgery, if they're eligible, to reduce future health risks.
Gregg said his team was working on a cost-analysis of the current program, but that it was fairly "resource-intensive."
"If people have access to the support to make these sorts of changes, they may have the benefits that we've seen here," he said. But, "What we should remember is that more modest changes in lifestyle are also effective."

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Intensive Weight Loss Programs Might Help Reverse Diabetes

Type 2 diabetes has long been thought of as a chronic, irreversible disease. Some 25 million Americans are afflicted with the illness, which is associated with obesity and a sedentary lifestyle, as well as high blood pressure. Recent research demonstrated that gastric bypass surgery--a form of bariatric surgery that reduces the size of the stomach--can lead to at least temporary remission of type 2 diabetes in up to 62 percent of extremely obese adults. But can less drastic measures also help some people fight back the progressive disease?
A new randomized controlled trial found that intensive weight loss programs can also increase the odds that overweight adults with type 2 diabetes will see at least partial remission. The findings were published online December 18 in JAMA, The Journal of the American Medical Association. "The increasing worldwide prevalence of type 2 diabetes, along with its wide-ranging complications, has led to hopes that the disease can be reversed or prevented," wrote the authors of the new paper, led by Edward Gregg of the Centers for Disease Control and Prevention.
The study tracked 4,503 overweight adults with type 2 diabetes for four years. About half of the subjects received basic diabetes support and education (including three sessions per year that covered diet, physical activity and support). The other half received more intensive lifestyle-intervention assistance. This second group received weekly individual and group counseling for six months, followed by three-sessions each month for the next six months, and refresher group sessions and individual contact for the subsequent three years. The interventions aimed to help individuals limit daily calories to 1,200 to 1,800--in particular by reducing saturated fat intake--and to help them get the recommended 175 minutes per week of physical activity.
After two years about one in 11 adults in the intervention group experienced at least partial remission of their diabetes, meaning that a patient's blood sugar levels reverted to below diabetes diagnosis levels without medication. Only about one in 60 in the control group, which received only basic support and education, saw any remission after two years. The findings suggest that "partial remission, defined by a transition to prediabetic or normal glucose levels without drug treatment for a specific period, is an obtainable goal for some patients with type 2 diabetes," the researchers noted.
The improvement, however, was not indefinite for everyone. After four years, only about one in 30 people in the intervention group were still seeing an improvement in their condition. Researchers think that regaining weight and falling behind on diet and physical activity goals increase the risk that people will return to a diabetic state.
About one in 75 in the intervention group saw complete remission of their diabetes, in which glucose levels returned to normal without medication.
The study did not find, however, that individuals in the lifestyle intervention group had lower risks for heart trouble, stroke or death than did those in the control group. "This recently led the National Institutes of Health to halt the [trial]," noted David Arterburn, of Group Health Research Institute in Seattle, and Patrick O'Connor, of HealthPartners Institute for Education and Research in Minneapolis, in an essay in the same issue of JAMA. Similar results have come out of studies looking at more intensive medical treatment of diabetes. "A more potent intervention--bariatric surgery--already appears to achieve what intensive medical and lifestyle interventions cannot: reducing cardiovascular events and mortality rates among severely obese patients with type 2 diabetes," they noted.
As with any disease, however, prevention is the best strategy. "The disappointing results of recent trials of intensive lifestyle and medical management in patients with existing type 2 diabetes also underscore the need to more aggressively pursue primary prevention of diabetes," Arterburn and O'Connor noted. One recent study found that compared with no treatment at all, lifestyle interventions reduced the onset of type 2 diabetes by 58 percent in people with pre-diabetes (and the medication metformin reduced the onset rate by 31 percent). Bariatric surgery seemed to reduce the onset of diabetes in obese patients by 83 percent, Arterburn and O'Connor pointed out in their essay.
For people who already have diabetes, however, those who are still in the early stages and those with the biggest weight loss and/or fitness improvement had the best odds for beating the disease. And even if lifestyle interventions aren't capable of dialing back the disease entirely, any reduction--whether through lifestyle or other changes-in the need for medication and in medical complications due to diabetes can be considered an improvement in managing the disease, which already costs the U.S. health system $116 billion each year and is estimated to affect 50 million Americans by 2050.

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9/11 cancer study won't settle debate over risks

 The most comprehensive study of potential World Trade Center-related cancers raises more questions than it answers and won't end a debate over whether the attacks were really a cause.
The study suggests possible links with prostate, thyroid and a type of blood cancer among rescue and recovery workers exposed to toxic debris from the terrorist attacks. But there were few total cancers and even the study leaders say the results "should be interpreted with caution."
The study involved nearly 56,000 people enrolled in a registry set up to monitor health effects from those exposed to the aftermath of the trade center attacks. Most participants volunteered for enrollment, which could skew the results if people who already had symptoms were more likely to enroll than healthier people.
Cancers diagnosed through 2008 were included in the study, but that's just seven years after the 2001 attacks, and cancer often takes longer to develop. People diagnosed with cancer before the attacks were excluded from the study.
Cancer rates were compared with those in the general New York state population. But the researchers had no data on whether people in the study had risk factors for getting cancer, including a strong family history, or if they had existing cancer that wasn't detected until after the disaster. Participants are being monitored for health issues and may have gotten more cancer screening than other people, which also could skew the results.
The increased risks were seen only in rescue and recovery workers, who likely had more direct, sustained contact with potential cancer-causing substances in the dust, smoke and debris from the attacks. But cancers weren't more common in workers who had the most exposure — a finding that would seem to contradict the theory that contact was the cause.
The study comes just a few months after the federal government added dozens of types of cancer to a list of illnesses related to the trade center attacks that will be covered by a program to pay for health coverage.
The study results "won't settle the question because it's still too early," said Dr. Thomas Farley, New York City's health commissioner. "People are very, very interested in this topic and we thought it was important to get the data out that we have even though it is early."
Marijo Russell O'Grady, dean of students at Pace University's New York City campus, was at her office near the trade center during the attacks. She also lives nearby, and said she worries about how exposure to choking dust, ash and an "overwhelming burnt plastic smell" might affect her family, including her then 1 1/2 year-old son. They are all enrolled in the health registry.
Cancer is her greatest concern and it's "always present in the back of my mind," she said.
Researchers from the city's health department led the study, which was partly paid for by the National Institute for Occupational Safety and Health. NIOSH spokesman Fred Blosser said the agency welcomes the results and that longer follow-up is needed to examine risks for cancers with that take a long time to develop.
The study appears in Wednesday's Journal of the American Medical Association.
Earlier research from the same registry linked the attacks with respiratory problems including asthma and symptoms of post-traumatic stress.
The new study involved a broader array of people, including firefighters and other emergency workers, along with residents and employees of workplaces near ground zero, Farley said.
In the new study, possible links were mainly seen with cancers diagnosed in 2007 and 2008 in rescue and recovery workers. These included 67 cases of prostate cancer, 13 thyroid cancer cases, and seven cases of multiple myeloma — all at rates higher than in the New York state population.
Donald Berry, a biostatistics professor at the University of Texas MD Anderson Cancer Center in Houston, said the study has too many limitations to draw any definitive conclusions.
"There's no evidence that 9/11 caused any of these cancers," Berry said.
He pointed out that no increased risks were found for lung cancer — a cancer that might seem plausible after breathing lots of toxic dust and smoke.

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Italy's lower house approves Monti's budget plans

 Italy's lower house of parliament on Thursday approved a package of budget measures including a sales tax hike and a cut in some payroll taxes, aimed at helping the government reach its deficit-cutting targets.
Approval was expected after Prime Minister Mario Monti's government won three confidence votes on Wednesday that it had called to speed up passage of the budget.
The measures will now move to the Senate for approval, which is expected before Christmas.
The Chamber of Deputies approved the plans by 372 votes against 73.
The budget, enshrined in a so-called Stability Law, is central to Monti's efforts to lower Italy's public deficit to 1.8 percent of output next year from a targeted 2.6 percent in 2012.
Monti agreed at the end of October to overhaul the first draft of the budget legislation by replacing a planned income tax cut with a reduction in payroll taxes paid by employers.
The package still includes a one percentage point rise in the highest value-added tax (VAT) rate, which will go into effect next July, bringing it to 22 percent. The lower 10 percent rate will not be increased as previously planned.
The Stability Law is expected to be one of the final pieces of major legislation approved under Monti before Italy gears up for a national election.

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Kan. agency posting tax guidance ahead of new law

The Kansas Department of Revenue is posting guidance regarding two provisions of the state income tax law ahead of changes that take effect in January.
Spokeswoman Jeannine Koranda said Tuesday that the guidance lets accountants, tax attorneys and residents know how the agency will be interpreting inconsistencies within the law. One of the items deals with how the taxpayers will be able to use itemized deductions to reduce their tax liability.
The state also sent out mailers earlier this year to 146,000 businesses to inform them about the new tax law and how it could apply to them.
"The reason for that is that they are the ones who really have to take any action before Jan. 1," Koranda said, such as changing how the business is organized for tax purposes. "Most people won't have to deal with the new law before next year when we send out the tax forms."
Koranda says the revenue department will ask the 2013 Legislature to make changes to the law to codify the guidance.
The state will reduce individual income tax rates, drop the top tax rate to 4.9 percent from 6.45 percent and increase the standard deductions claimed by married couples and heads-of-household. The state also will exempt the owners of 191,000 partnerships, sole proprietorships and other businesses from taxes.
Koranda said the impact will vary depending on each individual taxpayer and how they file their return, including marital status, number of children and how many other deductions or exemptions that are claimed. For example, a married head-of-household tax filer earning $52,000 a year should see about $12 more in a biweekly paycheck.
"One of the other places that people will see is the change in 2014 when they get the higher standard deduction that doubles to $9,000 for married and single head-of-household payers," she said.
Legislative researchers have estimated that the cuts will be worth $4.5 billion over the next six years. But the researchers also project that the cuts will create collective budget shortfalls approaching $2.5 billion during the same period. A group of state officials and economists estimate legislators will have to close a projected shortfall of more than $327 million next spring when they draft the state budget for fiscal year 2014.
Koranda didn't know how many existing businesses might be changing their classification to take advantage of the tax changes.
"Honestly, we won't know if businesses were changing their structures until they file their taxes in 2014 more than a year from now," she said.

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Harbinger Group returns to profit in 4th quarter

 Harbinger Group it returned to a profit in its fiscal fourth quarter, buoyed by a large income tax benefit and improved revenue for both its consumer products business and its financial services and insurance segment.
For the three months ended Sept. 30, the New York-based holding company earned $159.1 million, or 78 cents per share. That compares with a loss of $107.1 million, or 77 cents per share, a year ago.
The quarter included an income tax benefit of $135.9 million compared with gain of $13.4 million in the prior-year period.
Revenue shot up 35 percent to $1.2 billion from $888.5 million.
Revenue climbed for the consumer products unit, which includes Spectrum Brands, the company behind products ranging from Rayovac Batteries to George Foreman grills, edged up less than 1 percent to $832.6 million. Revenue for its insurance and financial services segment rose nearly sixfold, to $364.3 million.
Harbinger Group Inc., which is run by hedge fund manager Philip Falcone, said Tuesday said its full fiscal year net income climbed 35 percent to $29.9 million, or 15 cents per share, from $22.2 million, or 9 cents per share, in the previous year.
Annual revenue increased 29 percent to $4.48 billion from $3.48 billion, helped by a full-year of results from Fidelity & Guaranty Life Holdings Inc. Fidelity & Guaranty was acquired in April 2011. In addition, revenue for the consumer products unit, climbed 2 percent.
Fiscal 2012 results included an $85 million income tax benefit and a $41 million gain related to the reduced contingent purchase price of Fidelity & Guaranty. This was somewhat offset by a charge tied to its preferred stock.
Harbinger shares closed Monday at $8.70, and has more than doubled since the start of the year.

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NH health agency seeks $321M more in next budget

 New Hampshire's biggest agency asked Tuesday for $321 million more from state tax sources in the two-year state budget Gov.-elect Maggie Hassan must present to lawmakers in February.
Health and Human Services Commissioner Nicholas Toumpas testified at a hearing on the request that one of the biggest increases is due to a change in how the state pays nursing homes for Medicaid care. He said the state now must pay nursing homes based on rates, not on what lawmakers budget to spend.
Toumpas is requesting a 25 percent increase in the portion of the agency's budget that's supported by state tax sources. It would increase the funding to $1.6 billion from the current two-year appropriation of $1.3 billion.
The agency's current total budget is $3.7 billion, most of which from federal funds.
"The department — like all state agencies — is in the middle of a storm," Toumpas said.
He said people continue to seek help from the state as a result of the recession, but the numbers have leveled off in all but those needing food stamps. About 25 percent of those who apply for the federal food help are rejected, but the state must provide the staff to make the determination regardless whether they are denied, he said.
Overall, the number of caseloads has risen 15 percent since July 2009. At the same time, the number of filled jobs at his agency dropped 15 percent, he said. In addition, key members of the staff will be eligible for retirement soon, he said. That has caused stress on the staff, he said.
Toumpas said he knows the state has limited funds to provide services to everyone who is in need and promised to continue to try to find savings.
He said he included money cut from the current budget to boost payments to hospitals caring for the poorest residents. Ten hospitals sued over the budget cut in a case still pending in federal court.
Toumpas said a managed care program for Medicaid that was supposed to save $15 million in the current budget still is not operating due to slow negotiations between contractors and the health care providers needed to build a network.
On Monday, Hassan opened the budget hearings with a caution that agency requests are unrealistic. Agencies requested $3.3 billion in spending from state tax sources — a 26 percent increase over the current budget — and $11.9 billion from all funding sources or a 19 percent increase.

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First cracks in GOP resolve on tax rates

 The first cracks are developing among Republicans over whether to accept a quick deal with President Barack Obama on allowing the top two income tax rates to expire, even as an administration official said the White House was stepping up behind-the-scenes negotiations.
Conservative Oklahoma GOP Rep. Tom Cole told GOP colleagues in a private meeting Tuesday that it's better to make sure that tax cuts for the 98 percent of taxpayers who make less than $200,000 or $250,000 a year are extended than to battle it out with Obama and risk increasing taxes on everyone.
Cole's remarks are noteworthy because he's a longtime GOP loyalist and a confidant of House Speaker John Boehner, R-Ohio. They were made in a meeting of the House GOP Republican whip team, which is a sounding board for GOP leaders.
"If we don't believe taxes should go up on anybody, why can't we accept a deal that takes 98 percent out and still leaves us free to fight on the other grounds," Cole said in an interview on Wednesday. "I'm not for using the American people for leverage or as a hostage."
Meanwhile, an administration official speaking on grounds of anonymity told The Associated Press that two of Obama's top negotiators on the fiscal issues will meet separately Thursday with leading lawmakers.
The sessions are seen as an important step in determining how the government will avoid a year-end package of tax increases and spending cuts that could throw the economy into recession.
Treasury Secretary Timothy Geithner and White House legislative chief Rob Nabors will meet with House Speaker John Boehner of Ohio, Senate Republican leader Mitch McConnell of Kentucky, Senate Majority Leader Harry Reid of Nevada and House Democratic leader Nancy Pelosi of California, said the official, who said he could not speak on the record because the meetings had not yet been publicly announced.
Some Republicans on the Hill have been worried that the GOP would lose a bargaining advantage by separating tax cuts for the highest earners from everyone else, but Cole said he believes the reverse is true. "I think we have the winning argument," he said. "Most Americans intuitively understand that raising taxes on small business is costing them jobs."
Cole's comments drew a rebuke from Boehner, who is standing firm against Obama's demand that tax rates go up for top earners.
"He's a wonderful friend of mine and a great supporter of mine, but raising taxes on the so-called top 2 percent — half of those taxpayers are small business owners," Boehner said. "You're not going to grow the economy if you raise the top two rates. It'll hurt small business. It'll hurt our economy."
Reaction was mixed to his idea at a Wednesday morning meeting of House Republicans, Cole said. Conservative Rep. Raul Labrador, R-Idaho, who said he opposed Cole's idea, said he believed a majority of House Republicans also opposed it.
Cole said he expects to support whatever deficit-cutting deal Boehner is eventually able to negotiate with the White House as the two sides wrangle over how to avoid the "fiscal cliff" mix of tax increases and spending cuts that will occur automatically in January unless lawmakers avert them.
"This is a tactical argument, this is not a theological argument," Cole said. "We don't disagree on what we're trying to do."
Cole's comments were first reported by Politico.
There has been little evident progress between Obama and Boehner in talks aimed at striking a deal to avoid the fiscal train wreck. Republicans are worried that Democrats seem to be taking a harder line on cutting popular benefit programs like Medicare and Medicaid.
"We have not seen any good faith effort on the part of this administration to talk about the real problem that we're trying to fix," House Majority Leader Eric Cantor, R-Va., told reporters.
But House Democratic Leader Nancy Pelosi, D-Calif., said Wednesday that the starting point for talks should be a framework discussed by Obama and Boehner in the summer of 2011. Then, Democrats were willing to consider curbing the inflation adjustment for Social Security and lifting the eligibility age for Medicare — ideas that other top Democrats have taken off the table.
"We can all be there and start with that and go from there to reach an agreement," Pelosi said.
Pelosi made her remarks as she met with prominent business executives and Erskine Bowles, the chairman of Obama's 2010 deficit commission. Bowles and the executives also met with House GOP leaders.
Asked if he sensed Democrats could be more flexible on curbing so-called entitlement programs like Medicare, Bowles said: "I think we will see give in all areas if we're going to get a deal done. If not, we're going to go over this cliff, and I think everybody realizes that would be a disaster."
Obama said Wednesday he still believes that members of both parties can reach a framework agreement on a debt-cutting deal before Christmas.
He made a public statement, joined by about a dozen middle-class Americans who have raised concerns about their taxes going up at the end of the year. He said lawmakers face important deadlines in the coming weeks but the voices of the American people need to be a part of the debate.
The president said that officials need to "approach this problem with the middle-class in mind."
Obama could be in position to blame Republicans if an impasse results in the government going over the so-called fiscal cliff, an economy-rattling set of automatic spending cuts and tax increases from the expiration of longstanding tax cuts made in 2001 and 2003 during the Bush administration.
Democrats already are portraying GOP lawmakers as hostage-takers willing to let tax rates rise on everyone if lower Bush-era tax rates are not extended for the top 2 percent to 3 percent of earners — those with incomes above $200,000 for individuals and $250,000 for joint filers.
"Right now, as we speak, Congress can pass a law that would prevent a tax hike on the first $250,000 of everybody's income. Everybody's," Obama said. "And that means that 98 percent of Americans and 97 percent of small businesses wouldn't see their income taxes go up by a single dime."

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