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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Pistorius Shots Said to Come From High Angle

At the second day of a bail hearing for Olympian Oscar Pistorius, a South African investigator who arrived at the scene of the Feb. 14 fatal shooting said that Reeva Steenkamp was shot from a high angle, which prosecutors say contradicts the runner's account that he was not wearing his prosthetics when he shot his girlfriend to death.

Pistorius, a double-amputee who runs on carbon-fiber blades, appeared in court for the second day in a row after his arrest in the death of girlfriend Steenkamp at his gated home in Pretoria, South Africa.

Read Oscar Pistorius' Full Statement to the Court

PHOTOS: Paralympic Champion Charged in Killing

Arresting officer Hilton Botha told the court today that the 26-year-old was standing in the master bathroom when he shot the supermodel, who was crouched in a defensive position behind a locked door in a smaller powder room. He also said that the bullets that were fired had been fired from high up, and the bullets seemed to be coming in a downward direction.

"[The angle] seems to me down. Fired down," Botha told the court.

Pistorius said Tuesday that he went to the bathroom and fired through the door before putting on his prosthetic legs.

Oscar Pistorius: Defense Presents New Evidence Watch Video

'Blade Runner' Appears in Court to Hear Murder Charges Watch Video

He said he mistakenly shot his girlfriend, thinking she was an intruder.

Prosecutors also said that they found two boxes of testosterone in the bedroom, although the defense disputes that, saying it's just herbal supplements.

The court also heard that a witness, someone about 2,000 feet away from Pistorius' home, heard nonstop fighting the morning of the shooting.

"We have a witness who says she heard non-stop shouting and fighting between 2 and 3 a.m.," said prosecutor Gerrie Nel, who added that another witness saw lights on at the time of the gunshots.

Pistorius says he spent a quiet night with Steenkamp before the shooting.

Nel said that Pistorius' actions and phone calls on the night indicate pre-planning, and that there was a "deliberate aiming of shots at the toilet from about 1.5 meters [about 5 feet]."

He says Steenkamp was shot on the right side of her body.

Officer Botha also said Pistorius should be considered a flight risk because investigators discovered that he has offshore bank accounts and a house in Italy.

"I think it would be hard to get him back," Botha told the court. "This is a very serious crime, shooting an unarmed woman behind closed door."

Prosecutors also say they may file more charges for unlicensed ammunition, after a special-caliber .38 round was found in a safe in Pistorius' home.

Botha told the court today that he arrived at Pistorius' home at 4:15 a.m. Valentine's Day to find Steenkamp already dead, dressed in a white shorts and a black vest, and covered in towels. The only thing that Pistorius said was, 'I thought it was a burglar,'" according to Botha.

The 26-year-old sprinter Tuesday denied that he willfully killed Steenkamp, telling the court that he shot the woman through his bathroom door because he believed she was an intruder.

Botha said today that he attended Steenkamp's postmortem, and that she had three entrance wounds: one on the head, one in the elbow and one in the hip.

Describing the scene to the court, Botha said that the shots fired into the bathroom were aimed at the toilet bowl.

The shooter "would have to walk into the bathroom and turn directly at the door to shoot at the toilet the way the bullets went," he said.

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Venezuela's Maduro would win if Chavez goes: poll

CARACAS (Reuters) - Venezuelan Vice President Nicolas Maduro would comfortably win a presidential election should his boss Hugo Chavez's cancer force him out of power, according to an opinion poll.

The first survey on such a scenario, by local pollster Hinterlaces, gave Maduro a potential 50 percent of votes, compared to 36 percent for opposition leader Henrique Capriles.

Chavez returned to Venezuela on Monday after a long stay in Cuba to continue treatment at home for the disease that is jeopardizing his 14-year socialist rule of the South American OPEC nation.

He has named 50-year-old former bus driver and union activist Maduro as his preferred successor. But Capriles, 40, a center-left state governor who lost to Chavez in a presidential vote last year, would likely run again.

Chavez still has not said a word in public since his December 11 operation in Cuba, and Venezuelans were debating on Tuesday the various possible scenarios after his homecoming - from full recovery, to resignation, or even death from the cancer.

Should Chavez be forced out, Venezuela's constitution stipulates an election must be held within 30 days.

Capriles, who crossed swords with Hinterlaces at various points during the presidential election, again mocked its director, Oscar Schemel, as being biased against him.

"That man is not a pollster, he's on the government's payroll," Capriles told local TV.

"He said in December I would lose the Miranda governorship," he added, referring to his defeat of government heavyweight Elias Jaua, now foreign minister, in that local race.

Opinion surveys are notoriously controversial and divergent in Venezuela, with both sides routinely accusing pollsters of being in the pocket of the other.

Hinterlaces surveyed 1,230 people between January 30-February 9.

(Editing by Bill Trott)

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Foul smelling tap water at Yishun HDB block

SINGAPORE: Residents at an HDB block in Yishun Avenue 11 reported that their tap water has been giving off a foul smell.

Water agency PUB said tests on water samples from the block show the water is safe for drinking.

It has since given the block's three water tanks a thorough cleaning.

Residents said the problem started on February 14.

One resident who stayed at the ninth floor said she developed rashes.

"On Friday, I found rashes on my body, and it got worse on Sunday. It was very itchy. On Monday, I went to see a doctor," said Lin Hui Min.

- CNA/fa

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Centre not releasing funds on time, alleges Akhilesh Yadav

LUCKNOW: Uttar Pradesh chief minister Akhilesh Yadav on Tuesday accused the Union government of not releasing funds of the centrally-aided projects and schemes in time, thus slackening the development process in the state.

Interacting with reporters after presenting the Budget for the financial year 2013-2014, Akhilesh Yadav said the Union government was delaying funds not only for Uttar Pradesh but for several other states too.

He cited the case of the irrigation sector in which the Union government had committed itself to give Rs 1,700 crore but had only released Rs 45 crores. Similarly, he claimed that funds had not been completely released for the rural job guarantee scheme.

Responding to charges leveled by the opposition that 45 per cent of the last Budget outlay was yet to be spent, the chief minister said this time he would physically verify for himself that schemes are on time and that the money allocated for them is properly utilized.

He also said that after the last budget, his government has only got some seven to eight months to work and hence there were some problems. "In this year's Budget, special focus has been given to social sector and poverty alleviation schemes," he added.

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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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Oscar Pistorius Charged With Premeditated Murder

A South Africa magistrate has charged Olympian Oscar Pistorius with a Schedule 6 offense, meaning that the alleged murder of his girlfriend was preplanned or premeditated.

Pistorius, a double-amputee who gained worldwide fame for running on carbon-fiber blades, allegedly shot his girlfriend, Reeva Steenkamp, four times at his gated home in Pretoria, South Africa, Feb. 14. South African prosecutors laid out part of their case against the 26-year-old athlete at today's bail hearing.

"[Pistorius] shot and killed an innocent woman," Gerrie Nel, the senior state prosecutor, said in court, adding that there is "no possible explanation to support" the notion that Pistorius thought Steenkamp was an intruder.

PHOTOS: Paralympic Champion Charged in Killing

Pistorius denied in court today that he intentionally shot her.

Police responding to neighbors' calls about shouting and gunshots at Pistorius' home in the guarded and gated complex in the South African capital discovered Steenkamp's body. A 9-mm pistol was recovered at the home.

At the hearing, for which Pistorius arrived early at the courthouse this morning in a gray suit and tie,
the state made it clear it would be asking for the alleged crime to be categorized as preplanned or premeditated.

Oscar Pistorius: Was Shooting Premeditated? Watch Video

Conflicting Theories Muddle Oscar Pistorius Murder Case Watch Video

Oscar Pistorius Allegedly Fought the Night of Shooting Watch Video

Prosecutors said Steenkamp had arrived at the house with the expectation of spending the night with Pistorius. They said that Steenkamp was shot while in the bathroom, which is about 21 feet from the main bedroom, and that the two rooms are linked by a passage. The door to the toilet was broken down from the outside, prosecutors said, inferring that the bathroom door had been locked.

Prosecutors believe it's a case of premeditated murder because, they say, Pistorius had to stop, put on his prosthetic legs, grab a gun and then walk 21 feet to a bathroom.

The premeditated murder charge means that he would be sentenced to life in prison if convicted, and that he is likely to be denied bail, which is expected to be decided later today.

South Africa has moved away from the jury system, in light of its brutally racist past, so Pistorius' fate will rest in the hands of a judge and two magistrates.

The prosecution said that the defense will no doubt argue for the charge to be downgraded to a Schedule 5 murder, but that was clearly wrong, according to the prosecution.

In a Schedule 5 offense, the onus is on the prosecution to prove that it would be in the interest of justice to keep the accused behind bars and not release him on bail. A Schedule 6 offense is a more serious category, wherein the defense has to prove that it would be in the interest of justice to release the accused person on bail.

The defense made it clear today that it is going to argue that Pistorius thought a burglar was inside that bathroom. The defense said prosecutors have no way to prove that he knew who was in there, and that they are prepared to submit evidence of other men who have shot wives and children, mistaking them for burglars.

News reports in local papers have said that police are investigating whether Pistorius had an anger-management problem that led to the incident. They focused on a bloody cricket bat that might have been used when Steenkamp died.

Meanwhile, the Steenkamp family planned a private memorial service at Victoria Park crematorium in the south coast city of Port Elizabeth today. As Pistorius stood before the court, Steenkamp's body was being transported to Port Elizabeth.

The Associated Press contributed to this report.

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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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Iberia strikers clash with police at Madrid airport

MADRID: Strikers at Spanish airline Iberia clashed with police at Madrid-Barajas airport on Monday as they launched a five-day action against job cuts.

Thousands of strikers tried to force their way into one of the terminals at the airport before being pushed back by police, an AFP reporter at the scene said.

After several charges by police armed with batons, the Iberia staff finally entered the terminal where they carried on a protest during the strike action, which led to hundreds of flight cancellations.

Iberia's cabin crew, ground staff and maintenance workers were striking from Monday to Friday in the first of a series of three five-day strikes to protest plans to axe 3,800 jobs.

The flag carrier said it scrapped 415 flights across Spain and Europe for the week including 81 on Monday alone. The airline said it expected to operate 135 flights on Monday.

Iberia's offshoots were hard hit. Iberia Express chopped 20 flights on Monday alone and regional carrier Air Nostrum cut another 57.

Iberia ground crew service flights for budget carrier Vueling, forcing that airline, also, to curb operations.

Vueling said it had cut 354 flights for the five days - 39 percent of its usual service. A list posted on the airline's web site showed 78 cancellations for Monday alone.

Iberia workers also plan to strike from March 4-8 and again from March 18-22 to protest against the job cuts announced by International Airlines Group (IAG), which owns Iberia and British Airways.

IAG announced last week that it would axe 3,800 jobs at Iberia to save costs but said it was still open to talks with unions during a formal 30-day consultation process.

Iberia executives say the airline accumulated 850 million euros ($1.1 billion) in losses between 2008 and September 2012.

The airline aims to cut its capacity by 15 percent this year, eliminating some loss-making routes to Latin America and trimming its fleet by 25 aircraft, including five long-haul jets

Iberia said there were no significant incidents during the first day of the strike action, with 85 percent of passengers already put on other flights and the other 15 percent reimbursed.

- AFP/de

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Advani best PM for NDA, Modi could be home minister: Govindacharya

BHOPAL: Former BJP ideologue and RSS thinker KN Govindacharya said on Sunday night that veteran BJP leader LK Advani and the UPA government defence minister AK Antony would be the most suitable candidates to run for Prime Ministerial post. Amidst the clamour for Gujarat chief minister Narendra Modi's prime ministerial candidature within the BJP and allied saffron organisations, Govindacharya thought differently.

Speaking to TOI, he argued: If the NDA has to come to power, then LK Advani should be leading the 2014 Lok Sabha as PM candidate while Narendra Modi should be assisting him.'' Reminded that LK Advani has already been the BJP's Prime Ministerial candidate in 2009, Govindacharya explained that in 1984, the party's tallest leader Atal Behari Vajpayee lost his seat from Gwalior. Vajpayee was defeated by Madhavrao Scindia. But Vajpayee became the Prime Minister of the country 13 years later,'' he reasoned.

The national scenario at the moment is such that we need more seasoned leaders to be at the helm of affairs. If the party wants to utilise the popularity of Narendra Modi, then he should be involved in the process of government functioning. Instead of trying yet another experiment, the party should put its trust in tried and proven leaders,'' Govindacharya said. Narendra Modi, he said, could be given the post of Home minister so he can learn the ropes of government functioning at the centre.

Talking about the Congress party, he argued that AICC vice-president Rahul Gandhi has a lot more to learn'' and suggested the name of AK Antony. Had Pranab Mukherjee not been the President, he would have been the best option for the Congress. The culture of sycophancy has so gripped the Congress party that it should be abhorred. And someone has to call and spade a spade in that party,'' he said.

He said that if inexperienced leaders like Narendra Modi or Rahul Gandhi are made Prime Minister then it would be unfair for them, their parties and injustice to the nation.'' Talking on the 2014 General elections, he argued for a change: The stalemate and stagnancy has to be broken and this regime at the Centre should go. And we have to churn for a fresh start in politics.''

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