Doc groups issue list of overused tests, therapies

WASHINGTON (AP) — Don't be afraid to question your doctor and ask, "Do I really need that?"

That's the advice from leading medical groups who came up dozens of tests and treatments that physicians too often prescribe when they shouldn't.

No worrisome stroke signs? Then don't screen a healthy person for a clogged neck artery, the family physicians say. It could lead to risky surgery for a blockage too small to matter.

Don't routinely try heartburn medicine for infants with reflux, the pediatric hospitalists say. It hasn't been proven to work in babies, and could cause side effects.

Don't try feeding tubes in people with advanced dementia, say the hospice providers. Helping them eat is a better option.

These are examples of potentially needless care that not only can waste money and time, but sometimes can harm, says the warning being issued Thursday from medical specialty groups that represent more than 350,000 doctors.

Too many people "think that more is better, that more treatment, more testing somehow results in better health care," said Dr. Glen Stream, former president of the American Academy of Family Physicians, which contributed to the list. "That really is not true."

The recommendations are part of a coalition called Choosing Wisely, formed by the American Board of Internal Medicine Foundation. Participating medical societies were asked to identify five tests or treatments that are commonly overused in their specialty. The list is aimed at doctors and includes references to published studies. Consumers Reports and other consumer groups are publicizing the information in more patient-friendly terms.

Last year, the coalition listed 45 overused tests and treatments. It included some of the best known examples, such as too much imaging for back pain and repeating colonoscopies too frequently.

This year's list adds 90 more overused kinds of care. Some are the result of doctors' habits, hard to overcome despite new evidence, Stream said. Others come about because patients demand care they think they need.

Some other examples:

—Don't use opioid painkillers for migraines except as a last resort, say the neurologists. There are better, more migraine-specific drugs available without the addictive risk of narcotics. Plus, frequent use of opioids actually can worsen migraines, a concept known as rebound headache.

—Just because a pregnant woman misses her due date, don't race to induce labor if mom and baby are doing fine, say the obstetricians. Inducing before the cervix is ready often fails, leading to an unneeded C-section. "Just being due by the calendar doesn't mean your body says you're due," Stream notes.

—Don't automatically give a child a CT scan after a minor head injury, say the pediatricians. About half of children who go to the ER with head injuries get this radiation-heavy scan, and clinical observation first could help some who don't really need a CT avoid it.

—And don't leave an implanted heart-zapping defibrillator turned on when a patient is near death, say the hospice providers. This technology clearly saves lives by guarding against an irregular heartbeat. But if someone is dying of something else, or is in the terminal stages of heart disease, it can issue repeated painful shocks, to no avail. Yet fewer than 10 percent of hospices have formal policies on when to switch off the implants.

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French general urges EU to equip "impoverished" Mali army

BAMAKO, Mali (Reuters) - The European Union should complement a mission to train Mali's army, routed by rebels last year, by providing equipment from uniforms to vehicles and communications technology, a French general said on Wednesday.

General Francois Lecointre, appointed to head the EU training mission to Mali (EUTM) that was formally launched this week, said in Bamako equipping the "very impoverished" and disorganized Malian army was as important as training it.

Europe, along with the United States, has backed the French-led military intervention in Mali which since January 11 has driven al Qaeda-allied Islamist insurgents out of the main northern towns into remote mountains near Algeria's border.

European governments have ruled out sending combat troops to join French and African soldiers pursuing the Islamist rebels.

But the EU is providing a 500-strong multinational training force that will give military instruction to Malian soldiers for an initial period of 15 months at an estimated cost of 12.3 million euros ($16.45 million).

While hailing what he called the EU's "courageous, novel, historic" decision to support Mali, Lecointre told a news conference the Malian army's lack of equipment was a problem.

"I know the Malian state is poor, but the Malian army is more than poor," the French general told a news conference, adding that it urgently needed everything from uniforms and weapons to vehicles and communications equipment.

Last year, when Tuareg separatist forces swelled by weapons and fighters from the Libyan conflict swept out of the northern deserts, a demoralized and poorly-led Malian army collapsed and fled before them, abandoning arms and vehicles.

Mali's military was further shaken by a March 22 coup by junior officers who toppled President Amadou Toumani Toure, sowing division among rival army factions. Islamist radicals allied to al Qaeda later hijacked the victorious Tuareg rebellion to occupy the northern half of the country.

In a fast-charging military campaign led by Paris, French and African troops have driven the jihadists out of principal northern towns like Gao and Timbuktu, and are fighting the rebels in the Adrar des Ifoghas mountains.

HUMAN RIGHTS INSTRUCTION

Flanked by Mali's armed forces chief, General Ibrahima Dembele, Lecointre said he was disappointed that a meeting of international donors last month pledged funds for an African military force, known as AFISMA, being deployed in Mali, but included "very few" contributions for the Malian army itself.

"The European Union needs to invest today in the equipping of the Malian army and not just in its training," the general said, adding he would make this point strongly in a report to EU member state representatives early next month.

Asked how much re-equipping the army would cost, he said it would be "much more" than the 12 million euros of EU financing for the training mission, but could not give a precise estimate.

Starting early in April, the EU mission will start instructing Malian soldiers with a plan to train four new battalions of 600-700 members each, formed from existing enlisted men and new recruits.

Lecointre said the EU training would include instruction in human rights. Demands for this increased after allegations by Malian civilians and international human rights groups that Malian soldiers were executing Tuaregs and Arabs accused of collaborating with Islamist rebels.

The European training contingent is drawn from a range of European countries, but the main contributors would be France, Germany, Italy, Spain and Britain, EUTM officers said.

Mali's army has received foreign training before - several battalions that fled before the rebels last year were trained by the U.S. military and the leader of the March 22 coup, Captain Amadou Sanogo, attended training courses in the United States.

Dembele said U.S. training failed to forge cohesion among Malian units and he hoped the EU training would achieve this.

The United States, which halted direct support for the Malian military after last year's coup, could eventually resume aid if planned national elections in July fully restore democracy to the West African country.

Washington is providing airlift, refuelling and intelligence support to the French-led military intervention in Mali. ($1 = 0.7479 euros)

(Reporting by Pascal Fletcher; Editing by Jason Webb)

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Sony shows PlayStation 4 capabilities, but no box

NEW YORK (AP) — Sony wants you to know that the PlayStation 4 is coming this holiday season, but not what it will look like.

The Japanese electronics giant talked about its upcoming console for the first time Wednesday and showed what it can do, without actually revealing the device itself during the two-hour event. Presenters played games that were projected on screens in a converted opera house, but the PlayStations themselves were hidden backstage.

“I don’t know that the box is going to be something that’s going to have a dramatic impact on people’s feelings about the game. It will be a color and a size fairly comparable to previous consoles,” said Jack Tretton, CEO of Sony Computer Entertainment of America, the U.S.-based arm of the PlayStation business.

“There’s a big story to tell here, and it’s going to take between now and the holiday season to get all the details out there,” Tretton said in an interview.

Tretton said the price of the PS4 hasn’t been decided yet, but hinted that it wouldn’t be as high as the PlayStation 3 was initially. The PS3 debuted in 2006 with two models for $ 500 and $ 600. It now sells for about $ 300.

The PS4 will be jostling for attention this holiday season with Microsoft’s successor to the Xbox. Details on that device are expected in June. Xbox 360 came out a year before PS3 and has been more popular, largely because of its robust online service, Xbox Live, which allows people to play games with others online. Having an event this early allows Sony to grab the spotlight for a few months, though the lack of an actual device was noted by many people on Twitter and elsewhere.

Sony did reveal that the insides of the PS4 will essentially be a “supercharged PC,” much like an Xbox. That’s a big departure from the old and idiosyncratic PlayStation design and should make it easier for developers to create games. Sony Corp. is using processing chips made by Advanced Micro Devices Inc.

“One of the big challenges we faced in the past was that we created great technology that we handed over to the development community, and they had to go through a learning curve before they could harness it. And when they did, we saw some phenomenal games,” Tretton said. “We wanted to lower that barrier of entry and really give them the ability to create tremendous gaming experiences from Day One.”

The adoption of PC chips also means that the new console won’t be able to play games created for any of the three previous PlayStations, even though the PS4 will have a Blu-ray disc drive, just like the PS3. Instead, Sony said gamers will have to stream older games to the PS4 through the Internet.

Other new features revolve around social networking and remote access. With one button, you can broadcast video of your game play so friends can “look over your shoulder virtually,” said David Perry, co-founder of the Sony-owned Internet game company Gaikai. With remote play, you can run a game on the PS4 to stream over the Internet to Sony’s mobile gaming device, the PlayStation Vita, which debuted last year.

The goal is to make the PS4 so good at figuring out what games and other content you want that it can download it without being asked, so that it’s available when you realize you do want it, Sony said.

“Our long-term vision is to reduce download times of digital titles to zero,” said Mark Cerny, Sony’s lead system architect on the PS4.

The PS4 is arriving amid declines in video game hardware, software and accessory sales. Research firm NPD Group said game sales fell 22 percent to $ 13.3 billion in 2012. With the launch of the PS4, Sony is looking to attract people who may have shifted their attention to games on Facebook, tablet computers and mobile phones.

Forrester analyst James McQuivey said Sony is missing the point by building what amounts to an upgraded PS3.

“Sony believes the future will be like the past and has built the game console to prove it,” he said. “Tablets and smartphones now engage more people in more minutes of gaming than consoles will ever achieve.”

Sony showed an updated controller that adds a touchpad and a “share” button. The controller also features a light bar, which means a new PlayStation camera can more easily track the device for motion control.

The bulk of Wednesday’s event was devoted to demos of games for the PS4, including a realistic team racing simulator, “Drive Club,” super-powered action sequel “Infamous: Second Son,” artsy puzzler “The Witness” and several first-person shooter games, including “Killzone: Shadow Fall.” Beyond games, the PS4 will let people create animation in 3-D using a Move motion controller — all in real time.

Last fall, Nintendo launched the next generation of gaming consoles with the Wii U, which comes with a tablet-like controller called the GamePad. The controller allows two people playing the same game to have different experiences depending on whether they use the GamePad or a traditional Wii remote, which itself was revolutionary when it came out because of its motion-control features.

Judging by Wednesday’s event, Sony seeks to improve but not revolutionize game play. The games were updates to existing ones, with improved graphics.

“At the end of the day, this is a device by gamers for gamers,” Tretton said. “The games that people go out and spend billions of dollars on are your traditional shooters.”

The original Wii has sold more units since its launch than both its rivals, but it has lost momentum in recent years as the novelty of its motion controller faded. Nintendo said it sold 3.1 million Wii Us by the end of 2012. It was a disappointing start for the first of a new generation of gaming systems.

In some ways, notably its ability to display high-definition games, the Wii U was just catching up to the PS3 and the Xbox 360, the preferred consoles to play popular games such as “Call of Duty.”

All three console makers are trying to position their devices as entertainment hubs that can deliver movies, music and social networking as they try to stay relevant in the age of smartphones and tablets. The PlayStation online network will have access to Sony’s video and music services, as well as Netflix, Hulu and Amazon, with paid subscriptions to those services. People will also be able to access Facebook.

___

Lang contributed from Los Angeles.

Gaming News Headlines – Yahoo! News

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American Idol: Women Face Sudden-Death Round

American Idol

By Jamie Bufalino

02/20/2013 at 11:00 PM EST

Mariah Carey

Mario Anzuoni/Reuters/Landov

American Idol threw yet another new twist at its 40 remaining contestants: a sudden-death round.

"One song, one chance, no mercy," Ryan Seacrest said as the first group of 10 female contestants gathered in Las Vegas to try to finally sing their way – in front of a boisterous studio audience – through to the "America votes" phase of the competition.

Five women moved on, five went home.

Kentucky high school junior Jenny Beth Willis, whose rendition of a Trisha Yearwood song earned mixed reviews from the judges, was the first up. Although Keith Urban appreciated her "effortless confidence," Nicki Minaj said her performance lacked excitement (a comment that elicited the first audience boos of the season). Final result: It was the end of the road for Willis.

Tenna Torres, 28, – who attended Mariah Carey's camp for kids as a youngster – took the stage next and impressed the judges with her take on the Natasha Bedingfield's "Soulmate." But she lost style points with Minaj, who didn't like one particular aspect of her look. "Lose the hair," said Minaj, who felt the contestant's coif aged her. Final result: She made it through to the Top 20.

The three most powerful performances of the night all made it to the next round: Nashville's Kree Harrison, who despite taking a decidedly plain-Jane approach to styling, wowed the judges with her version of Patty Griffin's "Up to the Mountain." "You sang the hell out of that song," said Carey.

Angela Miller, 18, of Massachusetts, belted out Jessie J's hit "Nobody's Perfect." But she pretty much was.

And Amber Holcomb, an assistant teacher from Texas, closed the show with a rousing (and well received) rendition of "My Funny Valentine."

For the final spot of the night, it came down to Anchorage, Alaska, resident Adriana Latonio, 17, who tackled Aretha Franklin's "Ain't No Way," and Shubha Vedula, a Michigan high school senior who sang Lady Gaga's "Born This Way."

Although the judges saw potential in both contestants, they ultimately picked Lantonio's powerhouse vocals in a final emotional moment.

Thursday will bring out the guys. The first round of 10 will take the stage to try to make the top 20 – but once again, five will go home.

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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.

___

Stobbe reported from Atlanta.

___

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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Asian shares hit 18-month high on growth hopes

TOKYO (Reuters) - Asian shares rose to their highest since August 2011 on Wednesday after an improving global economic outlook boosted world equities overnight, encouraging investors to take on risk.

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> added 0.7 percent, rose for a third day in a row, led by a 1.7 percent gain in its technology sector <.miapjit00pus>. The index has risen 4 percent so far this year.

Asian shares have been on an uptrend as risks from the euro zone debt crisis the U.S. fiscal crisis abated and signs of tepid recovery emerged in major economies including China. Corporate earnings have also been generally positive.

"A shift to cyclicals from defensives has come to a full circle and investors are now looking at sector-specific factors within an asset class, selecting those with a tight supply/demand outlook," said Naohiro Niimura, a partner at research and consulting firm Market Risk Advisory.

News of possible fresh mergers boosted U.S. stocks on Tuesday, pinning the benchmark Standard & Poor's 500 Index <.spx> near a five-year high, while a stronger-than-expected rise in the German ZEW investor sentiment index to a three-year high supported European stocks.

Australian shares rose 0.4 percent, extending a rally that has taken the market to 4-1/2 year highs, with financials and retailers supporting prices. The Australian market has risen nearly 10 percent this year.

"There's a few good earnings reports but I think it's this hunt for yield that continues to push our market higher," Weston said. "I think that's keeping the support; the market doesn't want to go down and you just don't want to be missing out."

South Korean shares <.ks11> outperformed with a 1.5 percent jump to hit a one-month high, as foreigners stepped up buying and a pause in the yen's falling trend soothed sentiment.

"The KOSPI had decoupled with global equities in January because of currency moves and foreign selling. But this is changing with the pace of currency changes easing," Shawn Oh, an analyst at Daishin Securities, said of Seoul shares.

Positive growth in Southeast Asia has drawn foreign investors, keeping regional stocks robust. The Philippines stock market <.psi> extended gains to a record high while Bangkok's SET index <.seti> hit a fresh 18-year high.

The rise in equities weighed on assets perceived as safe-haven, such U.S. Treasuries and gold on Tuesday. Spot gold inched up 0.2 percent to $1,607.94 an ounce, but hovered near a six-month low hit the day before.

London copper climbed 0.6 percent to $8,095 a metric ton, off Tuesday's three-week lows.

Tokyo's Nikkei stock average <.n225> added 0.7 percent, after touching a 52-month high. <.t/>

The yen remained jittery, swinging in narrow ranges on concerns Japan may not be able to pursue as strong a reflationary policy mix as previously thought.

A week-long delay in the government nominating a new Bank of Japan governor fuelled talk of friction between the prime minister and the finance minister over who should run a central bank charged with taking bold action to reignite the economy.

The dollar eased 0.1 percent to 93.49 yen, still near its highest since May 2010 of 94.465 hit on February 11. The euro was up 0.1 percent to 125.36 yen. It touched a peak since April 2010 of 127.71 yen on February 6.

Sterling was under pressure on growing speculation the UK could soon lose its prized triple-A credit rating. Sterling traded at $1.5444, having plumbed a seven-month low at $1.5414 in New York.

"Markets continued to consolidate while reallocation trades helped risky assets to outperform and the USD to come under some pressure," said Sebastien Galy, strategist at Societe Generale, said in a note to clients.

"Fears regarding the UK are steadily rising, reinforcing a bearish tendency...We remain short GBP, CHF, JPY and AUD," he said, adding that the market will use any bearish excuse to sell the yen.

Japan logged its biggest monthly trade deficit on record in January, underscoring the country's deteriorating trade balances and accenting the yen's weak fundamental trend.

Investors remained wary of the possible U.S. federal spending cuts and outcome of the upcoming Italian election, limiting losses in sovereign bonds.

The ZEW report was a positive sign ahead of the more important euro zone flash PMIs on Thursday and Germany's IFO business sentiment on Friday, said Vassili Serebriakov, a strategist at BNP Paribas.

U.S. crude steadied around $96.70 a barrel but Brent eased 0.2 percent to $117.34.

(Additional reporting by Thuy Ong in Sydney and Hyunjoo Jin in Seoul; Edting by Eric Meijer)

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The U.S. Postal Service Is Getting into the ‘Wearable Electronics’ Business?

Yes, you read that headline right. Strapped for cash and obviously desperate, the United States Postal Service is launching a new line of “‘smart apparel,’ — also known as wearable electronics.” The mailmen-turned-fashionistas will call the new line Rain Heat & Snow, first for men and later for women, and while it’s unclear exactly how smart the apparel gets, reports suggest that you’ll  be able to plug your iPod into your new Postal Service jacket. The agency’s licensing manager, Steven Mills, says that the new line “will put the Postal Service on the cutting edge of functional fashion.” Which is basically true. When was the last time you plugged your iPod into your jacket? That said, when was the last time you used an iPod? Or the U.S. Postal Service?

RELATED: Snail Mail Is Still Too Fast for the U.S. Postal Service

It’s hard to not to give the old USPS a slow clap for this one. It would be one thing if the Postal Service wanted to sell some t-shirts and Dad ties with pictures of stamps on them — they actually tried that back in the 80s, and it didn’t work — but it sounds like they’re actually going after serious outerwear brands like North Face and Burton Snowboards with this one. It’s unclear if the Postal Service can keep up, though. Burton, for one, has a head start, since it partnered with Motorola and released a Bluetooth-enabled snowboarding jacket with a matching, headphone studded beanie back in 2005. The geeks at the Consumer Electronics Show (CES) loved it, called it “space age.” The Postal Service, by contrast, opted not to take the fancy brand-name strategy, instead teaming up with the Cleveland-based Wahconah Group. You might know them from their Legends line of men’s clothing, but you probably don’t.

RELATED: The U.S. Postal Service Lost $ 3.3 Billion Last Quarter

The big question remains: Will it work? The Postal Service lost $ 16 billion last year and plans to halt Saturday mail service in an attempt to cut costs and dig itself out of debt. Unfortunately, the drastic measure will cut 22,000 jobs, but it will only save the agency $ 2 billion a year. Suffice it to say that the Postal Service needed to get creative with their revenue streams — and you can’t get much more creative than cyborg jackets. After all, the new ad campaign last year didn’t work, and the Simpson’s stamp venture definitely didn’t work. So why not get into the outdoor gear business? If anybody knows anything about being outside, it’s those letter carriers, right? You know the riff: “Neither snow nor rain nor heat nor gloom of night stay these couriers from the swift completion of their appointed rounds.”

RELATED: Your Pants Are Lying to You

Here’s a little bit of encouraging news. Other companies have tried the apparel route in the past, albeit without the whole sexy wearable electronics angle. Apple released its own clothing line in 1986, and look at where the company is now!

Gadgets News Headlines – Yahoo! News

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What's Next for Mindy McCready's Two Young Boys?

By Steve Helling

02/19/2013 at 07:00 PM EST

Mindy McCready's apparent suicide on Sunday has left her two young sons in custodial limbo.

The boys – Zander, 6, and Zayne, 10 months – had been in state custody since Feb. 7, when McCready called police to ask for help in making her father and stepmother leave her home. When police arrived, McCready appeared to be intoxicated, according to a Department of Human Services report.

In a subsequent petition, the singer's father, Tim McCready, asked the court to order her to undergo mental health and substance abuse evaluation and treatment, alleging that his daughter, who had recently lost her boyfriend, "hasn't had a bath in a week ... screams about everything ... [is] very verbally abusive to Zander."

After a judge granted the petition, the children were quickly removed and placed into foster care. Although McCready was released from treatment, the boys remained in state custody.

At the time, Zander's father, Billy McKnight, requested custody of his son. "My son needs me," he told PEOPLE on Feb. 8. "I'm married, working and successful. I'm on the right track and proud of it. I've been sober for years. I just want my son."

But McCready's mother and stepfather, Gayle and Michael Inge, also want custody of the children – and authorities seem to agree.

In a proposed order sent to Circuit Judge Lee Harrod, the Department of Human Services proposed that the Inges might be a better fit for the children, claiming that they have "a substantial relationship." The Inges had custody of Zander for much the past few years, during McCready’s rehab and jail stints.

With McCready's death, the judge will have to determine what is in the children's best interest. A custody hearing has been scheduled for April 5.

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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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Asian shares listless, yen firmer but near lows

TOKYO (Reuters) - Most Asian shares barely moved on Tuesday as a holiday in the U.S. overnight and a lack of catalysts kept many investors on the sidelines.

Concerns about the euro zone economy, U.S. fiscal talks and Chinese appetite limited gains in commodities and also weighed on the euro.

The dollar's strength against a basket of currencies <.dxy> also weighed on commodities and capped gains in gold.

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

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

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> was flat after briefly touching a 18-1/2-month high. The index has gained 3.5 percent this year.

Disappointing earnings pushed European shares lower on Monday for a third straight session while U.S. markets were closed for the President's Day holiday.

The risk of an inconclusive outcome in Italy's election this weekend added to concerns while investors kept eyes on Washington where policymakers are discussing a package of budget cuts set to kick in March 1, which analysts warn could hurt the economy.

"We didn't have a lead from Wall St overnight, we also had weakness coming through from European markets overnight, so we were never expecting a strong day," said Juliette Saly, stock market analyst at Commonwealth Securities in Sydney.

Australian shares <.axjo> edged up 0.1 percent as investors focused on local corporate earnings for direction after a three-month rally that has taken the market to 4-1/2 year highs.

The Nikkei stock average <.n225> eased 0.2 percent, after closing up 2.1 percent on Monday to approach its highest level since September 2008 of 11,498.42 tapped on February 6. <.t/>

Spot gold was up 0.3 percent at $1,614.01 an ounce.

London copper inched up 0.3 percent to $8,144 a tonne as Monday's three-week low drew bargain hunting given prospects for a slowly improving global economic recovery. Unease over China's limp return to the market from a week-long break held back upside momentum, however.

U.S. crude fell 0.3 percent to $95.59 a barrel while Brent inched up 0.1 percent to $117.48.

The euro was steady around $1.3344. The currency eased slightly on Monday after European Central Bank President Mario Draghi said in a speech at the European Parliament that "the exchange rate is not a policy target but is important for growth and price stability" and that its rise is "a risk."

YEN JITTERY

The yen remained near recent lows on Tuesday, as attention turned to the appointment of a new Bank of Japan governor.

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

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

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

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

Market reaction was muted to the release of the minutes of the BOJ's January 21-22 meeting, when the bank set a 2 percent inflation target and pledged an open-ended quantitative easing from 2014. But the yen was bought when Finance Minister Taro Aso told reporters Japan has no plans to buy foreign currency bonds as part of monetary easing, a trader said.

The dollar was down 0.2 percent to 93.73 yen, but remained near its highest since May 2010 of 94.465 hit on February 11. The euro also eased 0.3 percent to 125.05 yen, below its peak since April 2010 of 127.71 yen touched on February 6.

(Additional reporting by Maggie Lu Yueyang and Thuy Ong in Sydney; Editing by Richard Borsuk)

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