Kenya hospital imprisons new mothers with no money


NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he's accused of: detaining mothers who can't pay their bills. Lazarus Omondi says it's the only way he can keep his medical center running.


Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.


Now, a New York-based group has filed a lawsuit on the women's behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.


"We hold you and squeeze you until we get what we can get. We must be self-sufficient," Omondi said in an interview in his hospital office. "The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers."


"They stay there until they pay. They must pay," he said of the 350 mothers who give birth each week on average. "If you don't pay the hospital will collapse."


The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi's poorest with hardly anyone to stand up for them.


Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi's slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn't pay the $60 bill, and was held with what she believes was about 60 other women and their infants.


"We were sleeping three to a bed, sometimes four," she said. "They abuse you, they call you names," she said of the hospital staff.


She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor's 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family's 50-square-foot shack, where rent is $18 a month. She says she was released after 20 days after Nairobi's mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.


A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.


"I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me," said Anyoso, a vegetable seller and a single mother with five children who makes $5 on a good day.


Anyoso said she didn't have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.


One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.


Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.


___


Associated Press reporter Tom Odula contributed to this report.


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Wall Street skids as U.S. heads for "fiscal cliff"

NEW YORK (Reuters) - Stocks fell on Friday, putting the S&P 500 on track for a fifth straight decline, as President Barack Obama and top congressional leaders were to make a last-ditch attempt to steer the United States away from driving off the "fiscal cliff."


Obama and lawmakers will meet at the White House Friday afternoon for talks before a New Year's deadline to keep large tax hikes and spending cuts from taking effect and threatening the economy with recession.


Investors' pessimism about achieving anything more than a stop-gap deal by the deadline showed in the benchmark S&P index's 1.6 percent decline this week. The broad index was on pace for its worst weekly performance since the U.S. elections.


With time running short, members of Congress may attempt to pass a retroactive fix on tax rises and spending cuts soon after the automatic fiscal policies come into effect on January 1.


"It doesn't matter which side wins, but at this point nobody wants to play a game where there aren't rules," said Joe Costigan, director of equity research at Bryn Mawr Trust in Bryn Mawr, Pennsylvania.


"So everybody is talking about what the prospects are for changes in the rules, but at the end of the day nothing is happening."


Highlighting Wall Street's sensitivity to developments in Washington, stocks took a dive of more than 1 percent on Thursday after Senate Majority Leader Harry Reid warned a deal was unlikely before the deadline. But later the index rebounded after the House of Representatives said it hold an unusual Sunday session to work on a fiscal solution.


With many market participants away for the holiday-shortened week, volume is expected to remain light, which could exacerbate market swings.


The Dow Jones industrial average <.dji> dropped 90.70 points, or 0.69 percent, to 13,005.61. The Standard & Poor's 500 Index <.spx> lost 9.74 points, or 0.69 percent, to 1,408.36. The Nasdaq Composite Index <.ixic> fell 16.25 points, or 0.54 percent, to 2,969.66.


Market breadth was skewed to the negative, with declining stocks outnumbering gainers on the NYSE by 2,044 to 690, while on the Nasdaq, decliners outnumbered advancers 1,466 to 707.


Positive economic data failed to alter the market's downtrend.


The National Association of Realtors said contracts to buy previously owned U.S. homes rose in November to their highest level in 2-1/2 years, while a report from the Institute for Supply Management-Chicago showed business activity in the U.S. Midwest expanded in December.


Barnes & Noble Inc rose 8.2 percent to $15.55 after the company said Pearson had agreed to make a strategic investment in its Nook Media subsidiary, but the Nook business will also not meet the bookseller's prior projection for fiscal year 2013.


MagicJack Vocaltec Ltd forecast over $39 million in GAAP revenue and over 70 cents per share in operating income for the fourth quarter and appointed Gerald Vento president and CEO, effective January 1. Shares jumped 6.9 percent to $17.40.


Aeterna Zentaris Inc U.S.-listed shares surged 18.4 percent to $2.57 after the company said it had reached an agreement with the U.S. Food and Drug Administration on a special protocol assessment by the FDA for phase 3 registration trial in endometrial cancer with AEZS-108 treatment.


(Reporting by Chuck Mikolajczak; Editing by Kenneth Barry)



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Jenna von Oy Blogs: The Teething Twilight Zone

Jenna von Oy's Blog: The Teething Twilight Zone
Cuddling with Gray – Courtesy Jenna von Oy


Celebrity blogger Jenna von Oy is a new mama!


Best known for her roles as Six on Blossom and Stevie on The Parkers, von Oy is also a musician who has released two albums and is set to publish a book, The Betweeners.


von Oy, 35, wed Brad Bratcher on Oct. 10, 2010, and resides in Nashville with her husband and five dogs.


They welcomed their first child, daughter Gray Audrey, on May 21. She is now almost 7 months old.


In her latest blog, von Oy reflects on the trials and tribulations of teething.


You can find her on Facebook and Twitter @JennavonOy, as well as posting on her weekly blog, The Cradle Chronicles.


Author’s Note: The tragedy on December 14th in my hometown of Newtown, Conn. continues to weigh heavily on my heart, as it always will. In light of it, I considered leaving my mommy blog unpublished this month; it is difficult to look beyond the grief and sorrow right now. Though I wrote this post well before the horrific incident at Sandy Hook, I wasn’t sure I was ready to offer you fun, tongue-in-cheek anecdotes about my daughter’s teething woes in the midst of such a trying time.


It is hard not to let the profound sadness overshadow everything else. But it dawns on me that this is when we need love and laughter most. It’s one of the ways we pick ourselves up and move forward, even when it appears impossible. It is one of the ways we show one another support. So I’m doing my best to find the little things that make me smile through the pain, and my daughter has been a stunning light in all of the darkness. I treasure these moments with her now, even more than before.


My heart is forever with those who lost their lives in such a violent and senseless act. As parents, I imagine every one of us is grieving in our own way right now, so I hope this month’s blog will make you smile in the middle of your pain too … if even for a moment. — Jenna


We have entered the Twilight Zone, more popularly known as: teething. It is a warped world of twisted tales and meltdowns, where one never knows if something sinister is hiding around an otherwise innocuous corner. What lurks in the shadows is often scarier than the threat one can see. For example, consider our flight to Los Angeles in October. We were preparing to head west for my little sister’s wedding, and the plane ride loomed over us menacingly.


For three evenings prior to our trip, my daughter was in teething hell, beginning at around 6 p.m. … exactly the hour our flight was scheduled to depart. Go figure! And we’re talking epic saga screaming sessions here; the poor girl wailed until she passed out from exhaustion. It was devastating for my husband and I, because there’s only so much a parent can do to ease aching gums. We felt helpless. At some point we had to take a deep breath, check our sanity at the door, and realize it’s all part of the growth process — ours as well as hers.


Needless to say, the prospect of being in a confined space (for just shy of five hours), with a potentially screaming baby, was less than thrilling. In all honesty, I’d rather have a root canal than deal with fellow passengers who are furious over a fussy baby … make that my fussy baby. Sure, I’ve heard about the folks who dole out candy to their cabin-mates as a preemptive strike. Truthfully, I’m lucky I made it out the door with my matron-of-honor dress in tow, much less a dispensable goodie bag for people I’ve never met and will likely never see again.


I’m not suggesting I don’t care about their feelings — I probably care TOO much, in fact. But there’s something about bribing folks to pretend they don’t hear my child moaning in misery that disturbs me. I have to hope the simple words, “My daughter is in pain right now” accompanied by a sincere, “Thank you for your understanding” will suffice. But I digress.


The apprehension was overwhelming as we counted down the minutes until the impending debacle. But you know what? My sweet little girl surprised us by sleeping the whole way to California. And she smiled the entire way back home! My pre-flight paranoia stressed me out far more than the flight itself. As I said before, you just never know what’s lurking in the shadows. Every now and then, I guess it winds up being something better than expected.


It amazes me just how much a few little teeth can alter the reality I’ve come to know over the last seven months. The child who was (miraculously) allowing us to sleep through the night is suddenly waking up three or four times to comfort nurse. Or, as I prefer to call it, she has begun “whining and dining.”


Though I’ve tried offering diversions, Gray isn’t interested in any of it. She’s got a one-track mind and it’s focused on the milk dispenser. That said, I’m happy to let her nurse more often if it’s reducing her suffering. The side effect of this is, of course, that I tend to resemble a zombie for the majority of the morning … or at least until I’ve had a large enough dose of caffeine to sufficiently resurrect my brain function.


Jenna von Oy's Blog: The Teething Twilight Zone
Gray’s giraffe affinity – Courtesy Jenna von Oy


Another byproduct of the seemingly endless teething adventure seems to be a serious bout with separation anxiety. Gray has unexpectedly become very vocally opposed to being left with anyone else, which often includes my husband. And by that, I mean that I can’t walk out of the room without her bellowing like a banshee. Those moments typically give way to macaroni and cheese dinners, since they don’t easily allow for easy meal preparation. Or showering. Or writing a blog, for that matter.


When being more than two feet away from the “breastaurant” sends your child into spasmodic fits of shrieking and squawking, one tends to stick close to home and find every possible way to avoid the social purgatory.


There are definitely moments when no remedy, homeopathic or otherwise, seems to satisfy the teething demons. Other times, I find it merely requires the art of distraction. We’ve taken to trying every silly antic we can conjure up. This includes, but certainly isn’t limited to: making ridiculous faces, speaking in wacky cartoon voices, banging pots and pans and wildly dancing around our kitchen. I’m becoming the one-woman show no one wants to see.


So that I can reserve some of my “entertainment skills” for career opportunities, we recently invested in one of those baby activity walkers. This is much to the dismay of our pups, who bolt out of the room as soon they hear our daughter plunking away on the plastic piano keys. Our house is now filled with the cacophony of tinny children’s songs, farm noises, and dogs howling. Investing in a decent set of earplugs is sounding better and better every day.


Not that they would save me from myself, mind you … I currently have an obsession with turning everything into a catchy ditty. Brushing my teeth has become a performance worthy of Carnegie Hall, and you should hear my diaper changing song — there are multiple verses! Clearly, if I’m aggravating myself with my made up tunes, my poor husband must have the patience of Mother Teresa.


On the slightly less annoying side, we’ve strung up a bouncy seat in our kitchen doorframe, and Gray jumps around to her heart’s content. It’s as if we’ve given birth to our very own kangaroo.


Our house isn’t exempt from the fun either — every surface is coated with a thin layer of drool and, for once, I can’t credit our Basset Hound. Each room is currently strewn with a plethora teething toys, all of which somehow seem to be giraffe-related, and which my husband and I lunge for at the slightest whimper of crankiness. Gray doesn’t seem to discriminate.


In a pinch, we’ve found that an ice-cold washcloth is just as soothing to her as its more expensive, store-bought counterparts. You know when your child seems more preoccupied by the box the toy came in than the toy itself? It’s the same idea.


I recently Tweeted that dealing with a teething baby is the equivalent of playing badminton with firecrackers. I can’t say I’ve changed my mind about that. At times, it can be unpredictably explosive. That said, though the teething process is anxiety-laden for everyone involved, I must say my daughter is a trooper. More often than not, she is in good spirits and smiles through it all. I’m exceedingly thankful for that. She’s one stubborn kid, that’s for sure!


I’d like to think she knows we’re in this thing together … even when I do the crazy chicken dance, or sing stupid songs about tying my shoes.


Until next time,


– Jenna von Oy


More from Jenna’s PEOPLE.com blog series:


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Kenya hospital imprisons new mothers with no money


NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he's accused of: detaining mothers who can't pay their bills. Lazarus Omondi says it's the only way he can keep his medical center running.


Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.


Now, a New York-based group has filed a lawsuit on the women's behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.


"We hold you and squeeze you until we get what we can get. We must be self-sufficient," Omondi said in an interview in his hospital office. "The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers."


"They stay there until they pay. They must pay," he said of the 350 mothers who give birth each week on average. "If you don't pay the hospital will collapse."


The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi's poorest with hardly anyone to stand up for them.


Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi's slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn't pay the $60 bill, and was held with what she believes was about 60 other women and their infants.


"We were sleeping three to a bed, sometimes four," she said. "They abuse you, they call you names," she said of the hospital staff.


She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor's 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family's 50-square-foot shack, where rent is $18 a month. She says she was released after 20 days after Nairobi's mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.


A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.


"I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me," said Anyoso, a vegetable seller and a single mother with five children who makes $5 on a good day.


Anyoso said she didn't have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.


One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.


Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.


___


Associated Press reporter Tom Odula contributed to this report.


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Wall Street falls as senator sees "fiscal cliff" fall

NEW YORK (Reuters) - Stocks declined on Thursday after the leader of Senate Democrats warned the United States appeared headed over the "fiscal cliff" and data showed consumer confidence fell to a four-month low.


With only a few days left before devastating tax hikes and spending cuts go into effect, Senate Majority Leader Harry Reid said about the fiscal cliff, "It looks like where we're headed."


Reid criticized Republicans for refusing to go along with any tax increases as part of a compromise solution with Democrats to avoid the fiscal cliff, which economists warn will knock the economy into recession.


President Barack Obama was flying back to Washington from a Christmas holiday to push for more talks, while the top Republican in Congress planned to speak with House lawmakers to avoid the year-end deadline. Still, gaps remained between the two sides.


The benchmark S&P 500 index is on track for its fourth straight decline and is down 2 percent as negotiations over the budget crisis stalled. A four-day decline would mark the longest losing streak for the index in three months.


The Conference Board, an industry group, said its index of consumer attitudes in December fell to 65.1 as the budget crisis took the steam out of a growing sense of optimism about the economy. The gauge fell more than expected from a downwardly revised 71.5 in November.


Initial claims for unemployment benefits dropped 12,000 to a seasonally adjusted 350,000 last week and the four-week moving average fell to the lowest since March 2008.


"Unfortunately, a term all of us are sick of hearing - the fiscal cliff - appears to be dominating all aspects of the financial market and consumer confidence," said Joe Heider, principal at Rehmann Financial in Cleveland Ohio.


"What has happened here is even though the consumer confidence number had a sharp decline, most people write it off as a result of what is happening in Washington rather than economic reality that is occurring in people's everyday lives."


Treasury Secretary Timothy Geithner announced the first of a series of measures that should push back the government's debt ceiling by around two months.


The Dow Jones industrial average <.dji> dropped 77.41 points, or 0.59 percent, to 13,037.18. The Standard & Poor's 500 Index <.spx> lost 9.71 points, or 0.68 percent, to 1,410.12. The Nasdaq Composite Index <.ixic> fell 18.36 points, or 0.61 percent, to 2,971.80.


Marvell Technology Group fell 3.4 percent to $7.15 after it said it would seek to overturn a jury's finding of patent infringement. The stock had fallen more than 10 percent in the prior session after a federal jury found the company infringed two patents held by Carnegie Mellon University and ordered the chipmaker to pay $1.17 billion in damages.


The PHLX semiconductor index <.sox> lost 0.7 percent.


(Reporting by Chuck Mikolajczak; Editing by Kenneth Barry)



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Syrian General Defects in a Public Broadcast


Aref Heretani/Reuters.


Mannequins were set up to confuse snipers loyal to Syrian President Bashar al-Assad in the old city of Aleppo on Sunday.







Syria’s embattled leadership suffered a new setback on Wednesday with the publicly broadcast defection of its military police chief, the highest-ranking officer to abandon President Bashar al-Assad since the uprising against him began nearly two years ago.




The defector, Maj. Gen. Abdul Azia Jassem al-Shallal, announced his move in a video broadcast by Al Arabiya, saying that he had taken the step because of what he called the Syrian military’s deviation from “its fundamental mission to protect the nation and transformation into gangs of killing and destruction.”


Al Arabiya, a Saudi-owned pan-Arab broadcaster heavily critical of the Syrian government, said General Shallal had made the video on Tuesday somewhere on the Turkish-Syrian border, implying that he was now inside Turkey, where other Syrian military defectors have sought refuge in the conflict. Many have regrouped there to join the Free Syrian Army, the main insurgent force fighting Mr. Assad.


Reading from a prepared statement while sitting at a desk, dressed in a camouflage uniform with red epaulets, the general did not specify in his message when he had decided to defect but said that he had been “waiting for the right circumstances to do so.” He also said “there are other high-ranking officers who want to defect, but the situation is not suitable for them to declare defection.”


General Shallal’s statement came as Syrian insurgents were claiming new territorial gains against Mr. Assad in the northern and central parts of the country and as a special envoy from the United Nations and the Arab League was visiting Damascus as part of an effort to reach a political settlement that would halt the conflict, the most violent of the Arab Spring revolutions that began in the winter of 2010-2011. More than 40,000 people have been killed since protests against Mr. Assad began in March 2011.


There has been speculation that the special envoy, Lakhdar Brahimi, presented Mr. Assad with proposals for relinquishing his authority and possibly leaving the country. But Mr. Assad, whose Alawite minority has ruled Syria for more than four decades, has consistently said he will not leave the country, even as his control over it seems to be slipping further away.


Dozens of lower-ranking Syrian military officers and hundreds of soldiers have fled Syria over the past two years, but General Shallal, the head of the military police division of the Syrian Army, is the highest-ranking military defector so far. He outranked Brig. Gen. Manaf Tlass, a boyhood friend of Mr. Assad’s, who fled last July. General Tlass is now believed to be living in France.


Among civilians who have abandoned Mr. Assad, the highest-ranking defector so far has been the prime minister, Riyad Farid Hijab, who fled to Jordan on Aug. 6. In the past few weeks, unconfirmed reports also have abounded about the possible defection of Syria’s Foreign Ministry spokesman, Jihad Makdissi, a smooth-talking English speaker who had numerous foreign contacts and who disappeared from public view in early December. The Lebanese television channel Al Manar, which is sympathetic to Mr. Assad, said Mr. Makdissi had been fired.


The Guardian reported this week that Mr. Makdissi had fled to the United States and was cooperating with American intelligence. Officials in Washington have not responded to requests for comment on that report.


In Lebanon, Syria’s interior minister, Mohammed al-Shaar, who had been recovering at a Beirut hospital from wounds said to have been received in a Dec. 12 suicide bombing attack outside his offices in Damascus, was on his way back to the Syrian capital on Wednesday. The Associated Press quoted Beirut airport officials as saying the minister flew home on a private jet.


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Kim Kardashian Tries a New Hair Color







Style News Now





12/26/2012 at 11:30 AM ET











Kim Kardashian Hair
SPW/Splash News Online. Inset: Startraks


The bangs may have been fake (turns out they were just clip-ins), but Kim Kardashian‘s new hair shade is definitely for real.


Just before Christmas, the reality star decided to go back to her roots — literally — and color her mane a super-deep brown, almost black hue.


For the past few months (while filming Kim and Kourtney Take Miami) the star had been sporting light caramel locks, but Kardashian was clearly ready for a change.


“After Miami I was honestly just soooo over it being light and listened to the suggestions to take my hair back to my natural color!” the star wrote on her website.


Hmm, wonder who it was that offered up the suggestions … Her boyfriend and occasional stylist Kanye West, perhaps? After all, he’s supposedly the one responsible for getting her to wear so much black in her wardrobe.


The last time Kardashian had hair this dark was in August, and we’re happy to see her go back to her natural color. Tell us: Do you prefer Kardashian with dark or light hair?


–Jennifer Cress


PHOTOS: SHARE YOUR THOUGHTS ON 2012′s CELEBRITY HAIR MAKEOVERS!




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Predicting who's at risk for violence isn't easy


CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.


Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.


But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.


"They're yellow flags. They only become red flags once the blood is spilled," he said.


Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.


Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)


Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.


Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.


"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."


The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."


In a guidelines for families, the academy lists several risk factors for violence, including:


—Previous violent or aggressive behavior


—Being a victim of physical or sexual abuse


—Guns in the home


—Use of drugs or alcohol


—Brain damage from a head injury


Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.


Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.


Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.


According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.


Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.


Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.


And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.


All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.


Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.


Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.


Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.


___


Online:


American Academy of Child & Adolescent Psychiatry: http://www.aacap.org


___


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


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Wall Street down on soft retail data, "cliff" worries suspected


NEW YORK (Reuters) - Socks fell on Wednesday as retailers dropped sharply after a report that showed holiday shoppers were less enthusiastic than last year, with investors saying worries about the "fiscal cliff" may have kept them away from stores.


The Dow Jones industrial average <.dji> dropped 29.08 points, or 0.22 percent, to 13,110.00. The Standard & Poor's 500 Index <.spx> dropped 6.41 points, or 0.45 percent, to 1,420.25. The Nasdaq Composite Index <.ixic> dropped 20.63 points, or 0.68 percent, to 2,991.97.


(Reporting by Edward Krudy; Editing by Chizu Nomiyama)



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No Easy Route If Assad Opts to Go, or Stay





BEIRUT, Lebanon — President Bashar al-Assad of Syria sits in his mountaintop palace as the tide of war licks at the cliffs below.




Explosions bloom over the Damascus suburbs. His country is plunging deeper into chaos. The United Nations’ top envoy for the Syrian crisis, Lakhdar Brahimi, met with Mr. Assad in the palace on Monday in an urgent effort to resolve the nearly two-year-old conflict.


How Mr. Assad might respond to Mr. Brahimi’s entreaty depends on his psychology, shaped by a strong sense of mission inherited from his iron-fisted father and predecessor, Hafez al-Assad; his closest advisers, whom supporters describe as a hard-line politburo of his father’s gray-haired security men; and Mr. Assad’s assessment, known only to himself, about what awaits him if he stays — victory, or death at the hands of his people.


From his hilltop, Mr. Assad can gaze toward several possible futures.


East of the palace lies the airport and a possible dash to exile, a route that some say Mr. Assad’s mother and wife may have already taken. But the way is blocked, not just by bands of rebels, but by a belief that supporters say Mr. Assad shares with his advisers that fleeing would betray both his country and his father’s legacy.


He can stay in Damascus and cling to — even die for — his father’s aspirations, to impose a secular Syrian order and act as a pan-Arab leader on a regional and global stage.


Or he can head north to the coastal mountain heartland of his minority Alawite sect, ceding the rest of the country to the uprising led by the Sunni Muslim majority. That would mean a dramatic comedown: reverting to the smaller stature of his grandfather, a tribal leader of a marginalized minority concerned mainly with its own survival.


Mr. Brahimi was closemouthed about the details of his meeting, but has warned in recent weeks that without a political solution, Syria faces the collapse of the state and years of civil war that could dwarf the destruction already caused by the conflict that has taken more than 40,000 lives.


A Damascus-based diplomat said Monday that Mr. Assad, despite official denials, was “totally aware” that he must leave and was “looking for a way out,” though the timetable is unclear.


“More importantly,” said the diplomat, who is currently outside Syria but whose responsibilities include the country, “powerful people in the upper circle of the ruling elite in Damascus are feeling that an exit must be found.”


Yet others close to Mr. Assad and his circle say any retreat would clash with his deep-seated sense of himself, and with the wishes of increasingly empowered security officials, whom one friend of the president’s has come to see as “hotheads.”


Mr. Assad believes he is “defending his country, his people, and his regime and himself” against Islamic extremism and Western interference, said Joseph Abu Fadel, a Lebanese political analyst who supports Mr. Assad and met with government officials last week in Damascus.


Analysts in Russia, one of Syria’s staunchest allies, say that as rebels try to encircle Damascus and cut off escape routes to the coast, the mood in the palace is one of panic, evinced by the erratic use of weapons: Scud missiles better used against an army than an insurgency, naval mines dropped from the air instead of laid at sea.


But even if Mr. Assad wanted to flee, it is unclear if the top generals would let him out alive, Russian analysts say, since they believe that if they lay down arms they — and their disproportionately Alawite families — will die in vengeance killings, and need him to rally troops.


“If he can fly out of Damascus,” Semyon A. Bagdasarov, a Middle East expert in Moscow, said — at this, he laughed dryly — “there is also the understanding of responsibility before the people. A person who has betrayed several million of those closest to him.”


Many Syrians still share Mr. Assad’s belief that he is protecting the Syrian state, which helps explain how he has held on this long. At a lavish lunch hosted by a Lebanese politician outside Beirut in September, prominent Syrian backers of Mr. Assad — Alawites, Sunnis and Christians — spoke of the president, over copious glasses of Johnnie Walker scotch, as the bulwark of a multicultural, modern Syria.


Reporting was contributed by Kareem Fahim and David D. Kirkpatrick from Beirut, Ellen Barry from Moscow, Sebnem Arsu from Istanbul, Rick Gladstone from New York, and an employee of The New York Times from Tartus, Syria.



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