Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

___

Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

Read More..

School Shooting Victims Were Shot Multiple Times

The gunman who massacred 20 children in a Connecticut elementary school riddled them with bullets, shooting some of them as many as 11 times, the medical examiner said today.

"I've been at this for a third of a century so my sensibilities may not be the that of the average man, but it's probably the worst I've ever seen," said Chief Medical Examiner H. Wayne Carver II, who has been a medical examiner for 36 years.

A team of 14 medical technicians worked through the night to complete the grisly job of identifying the children killed by Adam Lanza, 20, in the Sandy Hook Elementary School massacre so their names could be released today.

Several weapons were found in the school, including a semi-automatic rifle.

"All the wounds that I know of at this point were caused by the long weapon," Carver said, and many were shot at close range.

CLICK HERE for full coverage of the tragedy at the elementary school.

"I believe many of them were hit more than once," and he said the wounds were "all over" the children's bodies.

"I only did seven of the autopsies. The victims I had ranged from 3 to 11 wounds a piece," Carver said.

The names of the children slain Friday in the Newtown, Conn., school were released today.

To carry out the identifications, Carver said they "did not bring the families and the bodies into contact." He said the identifications were made through photographs of the children's faces. "It's easier on the families," he said.

Additional work is needed to complete the autopsies and identifications of the seven adults slain in Lanza's killing spree.

Emmanuel Dunand/AFP/Getty Images

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Fresh details of the massacre emerged including the fact that all of the young victims were first graders in two rooms.

Based on the Sandy Hook school directory, all the kids killed were in the first grade and were in two classrooms.

In one class, 15 of the 16 students listed were killed. In the other class, five of the 16 students died along with their teacher Victoria Soto. Also, nine of the deceased students have siblings in the school.

At a nearby firehouse that has become a center for the town a makeshift memorial and vigil has emerged under a sign that reads "Sandy Hook School." People have left flowers, candles, signs that read "Rest in Peace" and "God Bless Sandy Hook Elementary," as well as a cross made of blue flowers and a wreath of teddy bears

With the tally of Lanza's carnage complete, authorities and the grieving people of Newtown, Conn., are left to wonder why he turned the elementary school in this quaint New England town into a slaughter house.

Connecticut State Police Lt. Paul Vance said the investigation "did produce some very good evidence" about motive, but he would not go into further detail.

He indicated the evidence came from the shooting scene at the school as well as at the home where Lanza's mother, Nancy, was slain.

Also key will be the lone person shot by Lanza who wasn't killed. The female teacher has not been publicly identified.

"She is doing fine," Vance said at a news conference today. "She has been treated and she'll be instrumental in this investigation."

Vance said it appears that reports of an altercation involving Lanza at the school in the days before the mass slaying are not checking out.

Vance said that Lanza forced his way into the school, but did not say how.

Evidence emerged today that Lanza's rampage began in the office of school principal Dawn Hochsprung while the school intercom was on. It's not clear whether it was turned on to alert the school or whether it was on for morning announcements, but the principal's screams and the cries of children heard throughout the school gave teachers time to take precautions to protect their children.

Hochsprung was among those killed in the Friday morning killing spree.

READ: Connecticut Shooter Adam Lanza: 'Obviously Not Well'

Authorities have fanned out to New Jersey, Connecticut and Massachusetts to interview Lanza's relatives, ABC News has learned.

According to sources, Lanza shot his mother in the face, then left his house armed with at least two semi-automatic handguns, a Glock and a Sig Sauer, and a semi-automatic rifle. He was also wearing a bulletproof vest.

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Football: Benteke rampant as Aston Villa curb Liverpool's revival

LIVERPOOL, United Kingdom: Christian Benteke scored twice and made another goal as Aston Villa checked Liverpool's recent resurgence with a 3-1 win at Anfield in the Premier League on Saturday.

Liverpool were bidding for a fourth consecutive win in all competitions but failed to convert a string of first-half chances and were punished when goals from Benteke and Andreas Weimann put Villa 2-0 up at half-time.

Benteke struck again early in the second half and although Steven Gerrard pulled one back, it was too late to prevent Paul Lambert's side - the youngest Villa team ever to start a Premier League game - from extending their unbeaten run to five league games.

Victory eased Villa's relegation fears by carrying them up to 14th place, four days after they beat Norwich City 4-1 to reach the League Cup semi-finals, while Liverpool slipped two places to 12th.

Liverpool manager Brendan Rodgers had talked up his side's chances of a top-four finish in the build-up to the match and they certainly began the game with ambition.

Villa goalkeeper Brad Guzan had to be alert after visiting defender Eric Lichaj diverted Stewart Downing's low cross towards his own goal, while Gerrard could only shoot straight at Guzan from just inside the penalty area.

Downing and Joe Allen fired narrowly wide for the hosts, before Nathan Baker had to produce a last-ditch challenge to thwart Jonjo Shelvey.

Luis Suarez returned to the Liverpool line-up after suspension and he spurned a fine chance in the 27th minute, placing a tame half-volley within Guzan's reach from Shelvey's lay-off.

The hosts were punished for their wastefulness two minutes later, when Benteke gathered possession in the inside-left channel before arrowing a low drive into the bottom-left corner from 25 yards.

It was almost 2-0 shortly afterwards, Weiman lobbing onto the roof of the net following a miscued header from Glen Johnson, but five minutes before the interval, the Austrian made no mistake.

A sweeping move culminated in Weimann rolling a pass into the box for Benteke, whose cute back-heel found Weimann rushing in to dispatch a crisp shot across Pepe Reina.

Rodgers introduced Joe Cole at half-time but he was to play an unwitting role in Villa's third goal in the 51st minute.

After the former England man was robbed in midfield, Benteke collected possession and the Belgian striker was allowed to advance deep into the Liverpool box before prodding the ball past Reina.

Johnson had a penalty appeal turned down when his header seemed to strike Baker's arm, before Gerrard stooped to head home Johnson's left-foot shot to give the hosts an 87th-minute consolation.

English Premier League results:

Liverpool 1 Aston Villa 3
Manchester Utd 3 Sunderland 1
Newcastle 1 Manchester City 3
Norwich 2 Wigan 1
QPR 2 Fulham 1
Stoke 1 Everton 1

- AFP/de

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Sushil Kumar Shinde, Rehman Malik operationalise new visa regime

NEW DELHI: Travel between India and Pakistan will become easier with the operationalisation of a new visa regime on Friday that allows multi-city visas for up to five cities, visitor visas for two years for senior citizens and children below 12 years, visa on arrival for senior citizens, and group tourist visa, besides exempting specified categories of businessmen from police reporting.

The visa agreement was operationalised by home minister Sushil Kumar Shinde and visiting Pakistani interior minister Rehman Malik, both of whom agreed that it would promote people-to-people contact between the two countries. The visa agreement was signed by the two sides on September 8. Malik said the new visa agreement was not only historic but a step forward for peace.

Outlining the key features of the new visa regime, Shinde said visas can now be granted for five places as against the earlier restriction of three cities. Visitor visas can be issued for up to two years where the applicant is above 65 years of age, where a national of one country is married to a national of the other country and children below 12 years accompanying their parents.

Senior citizens (above 65 years of age) can now avail of visa on arrival, to be issued at Attari/Wagah post for 45 days with a single entry. This will, however, take effect only from January 15, 2013.

In a move aimed at promoting economic ties between the neighbours, business visa norms have been eased, with businessmen with income above 5 million Pakistani rupees or having an annual turnover above 30 million Pakistani rupees now exempt from police reporting.

Indians and Pakistanis can travel to each other's country in groups comprising 10-50 members. The groups, organized by approved tour operators and travel agents, will be issued group tourist visas for 30 days. Group visas will, however, be issued from March 15, 2013.

Entry and exit from different designated check-posts has been allowed, if indicated in the application, though a person can exit from Attari/Wagah on foot only if he had also made the entry on foot from the same check-post.

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Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

___

Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

Read More..

20 Children Killed at Conn. Grade School, 7 Adults

Twenty children died today when a heavily armed man invaded a Newtown, Conn., elementary school and sprayed staff and students with bullets.

The gunman, identified as Adam Lanza, 20, was found dead in the school.

Lt. Paul Vance said 18 children died in the school and two more died later in a hospital. Six adults were also slain, bringing the total to 26.

In addition to the casualties at the school, a body was also found in the shooter's home, officials said.

Among the dead was Lanza's mother, although it's not clear where she was killed.

In the early confusion surrounding the investigation, federal sources initially identified the suspect as Adam's older brother Ryan Lanza, 24. He is being questioned by police.

LIVE UPDATES: Newtown, Conn., School Shooting

Sources said the shooter was armed with a Glock semi automatic handgun and a Sig Sauer semi automatic handgun, law enforcement sources told ABC News. Additionally, .223 caliber shell casings--a rifle caliber--were also found at the scene. He was wearing a bullet-proof vest when he opened fire in the elementary school.

First grade teacher Kaitlin Roig, 29, locked her 14 students in a class bathroom and listened to "tons of shooting" until police came to help.

"It was horrific," Roig said. "I thought we were going to die."

She said that the terrified kids were saying, "I just want Christmas…I don't want to die. I just want to have Christmas."

Shannon Hicks/The Newtown Bee

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A tearful President Obama said there's "not a parent in America who doesn't feel the overwhelming grief that I do."

The president had to pause to compose himself after saying these were "beautiful little kids between the ages of 5 and 10." As he continued with his statement, Obama wiped away tears from each eye.

He has ordered flags flown as half staff.

The alert at the school ended when Vance announced, "The shooter is deceased inside the building. The public is not in danger."

The massacre prompted the town of Newtown to lock down all its schools and draw SWAT teams to the school, authorities said today. Authorities initially believed that there were two gunmen and were searching cars around the school, but authorities do not appear to be looking for another gunman.

It's unclear how many people have been shot, but 27 people, mostly children, are dead, multiple federal and state sources tell ABC News. That number could rise, officials said.

CLICK HERE for more photos from the scene.

It is the second worst mass shooting in U.S. history, exceeded only by the Virginia Tech shooting in 2007 when 32 were killed before the shooter turned the gun on himself. Today's carnage exceeds the 1999 Columbine High School shooting in which 13 died and 24 were injured.

The Newtown shooting comes three days after masked gunman Jacob Roberts opened fire in a busy Oregon mall, killing two before turning the gun on himself.

Today's shooting occurred at the Sandy Hook Elementary School, which includes 450 students in grades K-4. The town is located about 12 miles east of Danbury.

State Police received the first 911 call at 9:41 a.m. and immediately began sending emergency units from the western part of the state. Initial 911 calls stated that multiple students were trapped in a classroom, possibly with a gunman, according to a Connecticut State Police source.

Lt. Paul Vance said that on-duty and off-duty officers swarmed to the school and quickly checked "every door, every crack, every crevice" in the building looking for the gunman and evacuating children.

A photo from the scene shows a line of distressed children being led out of the school.

Three patients have been taken to Danbury Hospital, which is also on lockdown, according to the hospital's Facebook page.

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I'll answer crime questions in neutral country: McAfee

MIAMI: Anti-virus software pioneer John McAfee said in a TV interview Friday that he was willing to answer questions about the murder of his neighbor in Belize in a neutral country.

McAfee, who insists he is innocent, also admitted that he was worth "less than" US$5 million -- a day after saying he was broke -- though it was unclear how he would access that money.

"I've said in any neutral country I will meet and answer any questions you want," McAfee told the CNBC business TV network.

"I'm certainly not going to turn myself into the authorities who have been trying to lay their hands on me for months now. I will not go back to Belize," he said.

Authorities in Belize want to question McAfee about the death of Gregory Faull, a 52-year-old Florida expatriate who was found by his housekeeper with a 9-mm bullet in his head, lying in a pool of his own blood.

McAfee fled Belize to Guatemala with his 20 year-old girlfriend, but was then deported to the United States. He says he went on the run because he feared for his life, claiming corruption among Belizean police and politicians.

Belize has an extradition treaty with the United States, so if murder charges are filed he could be sent back to the Central American nation.

McAfee, who is staying in a popular Miami Beach hotel, has become a local attraction. A cloud of reporters and TV news crews follow his every step.

"If I am charged, of course, I'll go through the process, but they are not going to charge me. Let me be clear: I had nothing to do with the murder of Gregory Faull," McAfee said.

McAfee was evasive when CNBC asked him about his fortune, which was once estimated at more than US$100 million.

"My accountant may know what I'm worth. I have not asked him recently ... I'm 67 years old. I eat well and have enough money for food. And clothes. I really don't have a clue, sir," McAfee said.

When further pressed, McAfee said he was worth "less than US$5 million, certainly."

And where is that money?

"I believe it's in the pockets of the politicians in Belize now. I think they're in the process of doing an acquisition of my resources," he said.

On Thursday, McAfee told ABC television in Miami that he has "nothing now" beyond some clothes, shoes, and cash a friend dropped off for him.

McAfee, who says a book and a movie is in the works as he sells his life story, earlier told AFP his immediate focus was getting his girlfriend Sam and another friend, Amy, into the United States.

- AFP/jc

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Russia says Syrian rebels might win

MOSCOW/BEIRUT (Reuters) - Syrian rebels are gaining ground and might win, Russia's Middle East envoy said on Thursday, in the starkest such admission from a major ally of President Bashar al-Assad as the 20-month-old civil war closes in on Damascus.

Moscow was "finally waking up to reality", the United States said and it called on Russia to withdraw all support for Assad, who NATO and the rebels' new political leader forecast was heading for collapse.

"One must look the facts in the face," Russia's state-run RIA quoted Mikhail Bogdanov as saying. "Unfortunately, the victory of the Syrian opposition cannot be ruled out."

Bogdanov, a deputy foreign minister and the Kremlin's special envoy for Middle East affairs, said the Syrian government was "losing control of more and more territory" and Moscow was preparing to evacuate Russian citizens if necessary.

In Washington, State Department spokeswoman Victoria Nuland said: "We want to commend the Russian government for finally waking up to the reality and acknowledging that the regime's days are numbered.

"The question now is, will the Russian government join those of us in the international community who are working with the opposition to try to have a smooth democratic transition?"

Syria has relied on war planes and helicopters to bombard rebel districts but Damascus denied accusations by U.S. and NATO officials that it had fired Scud missiles in recent days.

The foreign ministry said the long-range missiles were not used against "terrorist groups," a term it uses for the rebels, who now hold an almost continuous arc of territory from the east to the southwest of Damascus.

The head of NATO said he thought Assad's government was nearing collapse and the new leader of Syria's opposition told Reuters the people of Syria no longer needed international forces to protect them.

"The horrific conditions which the Syrian people endured prompted them to call on the international community for military intervention at various times," said Mouaz al-Khatib, a preacher who heads Syria's National Coalition.

"Now the Syrian people have nothing to lose. They handled their problems by themselves. They no longer need international forces to protect them," he added in the interview on Wednesday night, accusing the international community of slumbering while Syrians were killed.

He did not specify whether by intervention he meant a no-fly zone that rebels have been demanding for month, a ground invasion - which the opposition has warned against - or arms.

He said the opposition would consider any proposal from Assad to surrender power and leave the country, but would not give any assurances until it saw a firm proposal.

In the latest blow to the government, a car bomb killed at least 16 men, women and children in Qatana, a town about 25 km (15 miles) southwest of Damascus where many soldiers live, activists and state media said.

The explosion occurred in a residential area for soldiers in Qatana, which is near several army bases, said Rami Abdelrahman, head of the pro-opposition Syrian Observatory for Human Rights.

He put the death toll as 17, including seven children and two women. State news agency SANA said 16 people had died.

State television showed soldiers walking by a partly collapsed building, with rubble and twisted metal on the road.

The pro-government Al-Ikhbariya TV said a second car bomb in the Damascus suburb of al-Jadideh killed eight, most of them women and children.

Apart from gaining territory in the outskirts of Damascus in recent weeks, rebels have also made hit-and-run attacks or set off bombs within the capital, often targeting state security buildings or areas seen as loyal to Assad, such as Jaramana, where twin bombs killed 34 people in November.

The Pakistani Foreign Office said security concerns had prompted it to withdraw the ambassador and all Pakistani staff from the embassy in the central suburb of East Mezzeh, a couple miles from the Interior Ministry.

BACK TO THE WALL

With his back to the wall, Assad was reported to be turning ever deadlier weapons on his adversaries.

"I think the regime in Damascus is approaching collapse," NATO Secretary-General Anders Fogh Rasmussen said on Thursday.

Human Rights Watch said some populated areas had been hit by incendiary bombs, containing flammable materials such as napalm, thermite or white phosphorous, which can set fire to buildings or cause severe burns and respiratory damage.

The British-based Syrian Observatory said war planes were bombing rebel-held eastern suburbs of Damascus on Thursday and artillery was hitting Daraya and Moadamiyeh, southwestern areas near the centre where rebels have been fighting for a foothold.

At least 40,000 people have been killed in Syria's uprising, which started in March 2011 with street protests which were met with gunfire by Assad's security forces, and which spiraled into the most enduring and destructive of the Arab revolts.

The United States, European powers and Arab states bestowed their official blessing on Syria's newly-formed opposition coalition on Wednesday, despite increasing signs of Western unease at the rise of militant Islamists in the rebel ranks.

Western nations at "Friends of Syria" talks in Marrakech, Morocco rallied around a new opposition National Coalition formed last month under moderate Islamist cleric al-Khatib.

Russia, which along with China has blocked any U.N. Security Council measures against Assad, criticized Washington's decision to grant the coalition formal recognition, saying it appeared to have abandoned any effort to reach a political solution.

Bogdanov's remarks were the clearest sign yet that Russia is preparing for the possible defeat of Assad's government.

"We are dealing with issues of preparations for an evacuation. We have mobilization plans and are clarifying where our citizens are located," Bogdanov said.

The fall of Damascus to the rebels was not a prospect Moscow relished: "The fighting will become even more intense and (Syria) will lose tens of thousands and, perhaps, hundreds of thousands of civilians," Bogdanov told Russia Today television.

"If such a price for the removal of the president seems acceptable to you, what can we do? We, of course, consider it absolutely unacceptable."

Nuland said Russia should now back away from Assad: "They can withdraw any residual support for the Assad regime, whether it is material support (or) financial support," she said.

"They can also help us to identify people who might be willing inside of Syria to work on a transitional structure."

A British Foreign Office spokesperson said the Russian position remained largely unchanged but the situation on the ground gave Moscow an interest in finding an agreed solution, even if the chances of such a solution remained slim.

"If Russia's position on Syria had been a brick wall, it is now a brick wall with a crack in it," the spokesperson said.

(Additional reporting by Dominic Evans in Beirut, Samia Nakhoul and Khaled Yacoub Oweis in Marrakech, Andrew Quinn in Washington and Mohammed Abbas in London; Editing by Philippa Fletcher and Alastair Macdonald)

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Govt seeks Trai's opinion on cable monopolies

NEW DELHI: The government has sought broadcast regulator Trai's views to prevent monopolistic operations by cable operators and multi-system operators, expressing concern that it might have serious implications in terms of competition, pricing and healthy growth of the cable TV sector in the market.

In a statement, the information and broadcasting (I&B) ministry said, "It has been observed that cable TV distribution is virtually monopolized in some states as operation of the entire cable TV network is dominated by a single entity. At present, there are no restrictions on the issue of accumulation of interest in terms of market share in a city, district, state or country by individual MSOs and LCOs in the cable sector."

MSOs and cable operators are free to operate in any area of their choice after obtaining registration from the ministry. "It is felt that such monopolies may not be in the interest of consumers and may have serious implications in terms of competition, pricing and healthy growth of cable TV sector in that market," the ministry said.

The ministry has requested Trai to provide its recommendations on whether "in order to ensure fair competition, improved quality of service, and equity, should any restriction be imposed on MSOs/LCOs to prevent monopolies/accumulation of interest? If yes, what restrictions should be imposed and what should be the form, nature and scope of such restrictions?" The regulator will also explore the necessity of amending the Cable Television Networks (Regulation) Act, 1995.

MSOs and cable operators are required to be registered with local post offices to be able to operate in the permitted areas of registration. However, as per recent amendments in the Cable Television Networks (Regulation) Amendment Rules 2012, it has become mandatory for MSOs to register with the I&B ministry to operate.

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Study: People worldwide living longer, but sicker

LONDON (AP) — Nearly everywhere around the world, people are living longer and fewer children are dying. But increasingly, people are grappling with the diseases and disabilities of modern life, according to the most expansive global look so far at life expectancy and the biggest health threats.

The last comprehensive study was in 1990 and the top health problem then was the death of children under 5 — more than 10 million each year. Since then, campaigns to vaccinate kids against diseases like polio and measles have reduced the number of children dying to about 7 million.

Malnutrition was once the main health threat for children. Now, everywhere except Africa, they are much more likely to overeat than to starve.

With more children surviving, chronic illnesses and disabilities that strike later in life are taking a bigger toll, the research said. High blood pressure has become the leading health risk worldwide, followed by smoking and alcohol.

"The biggest contributor to the global health burden isn't premature (deaths), but chronic diseases, injuries, mental health conditions and all the bone and joint diseases," said one of the study leaders, Christopher Murray, director of the Institute of Health Metrics and Evaluation at the University of Washington.

In developed countries, such conditions now account for more than half of the health problems, fueled by an aging population. While life expectancy is climbing nearly everywhere, so too are the number of years people will live with things like vision or hearing loss and mental health issues like depression.

The research appears in seven papers published online Thursday by the journal Lancet. More than 480 researchers in 50 countries gathered data up to 2010 from surveys, censuses and past studies. They used statistical modeling to fill in the gaps for countries with little information. The series was mainly paid for by the Bill & Melinda Gates Foundation.

As in 1990, Japan topped the life expectancy list in 2010, with 79 for men and 86 for women. In the U.S. that year, life expectancy for men was 76 and for women, 81.

The research found wide variations in what's killing people around the world. Some of the most striking findings highlighted by the researchers: — Homicide is the No. 3 killer of men in Latin America; it ranks 20th worldwide. In the U.S., it is the 21st cause of death in men, and in Western Europe, 57th.

— While suicide ranks globally as the 21st leading killer, it is as high as the ninth top cause of death in women across Asia's "suicide belt," from India to China. Suicide ranks 14th in North America and 15th in Western Europe.

— In people aged 15-49, diabetes is a bigger killer in Africa than in Western Europe (8.8 deaths versus 1 death per 100,000).

— Central and Southeast Asia have the highest rates of fatal stroke in young adults at about 15 cases per 100,000 deaths. In North America, the rate is about 3 per 100,000.

Globally, heart disease and stroke remain the top killers. Reflecting an older population, lung cancer moved to the 5th cause of death globally, while other cancers including those of the liver, stomach and colon are also in the top 20. AIDS jumped from the 35th cause of death in 1990 to the sixth leading cause two decades later.

While chronic diseases are killing more people nearly everywhere, the overall trend is the opposite in Africa, where illnesses like AIDS, malaria and tuberculosis are still major threats. And experts warn again shifting too much of the focus away from those ailments.

"It's the nature of infectious disease epidemics that if you turn away from them, they will crop right back up," said Jennifer Cohn, a medical coordinator at Doctors Without Borders.

Still, she acknowledged the need to address the surge of other health problems across Africa. Cohn said the agency was considering ways to treat things like heart disease and diabetes. "The way we treat HIV could be a good model for chronic care," she said.

Others said more concrete information is needed before making any big changes to public health policies.

"We have to take this data with some grains of salt," said Sandy Cairncross, an epidemiologist at the London School of Hygiene and Tropical Medicine.

He said the information in some of the Lancet research was too thin and didn't fully consider all the relevant health risk factors.

"We're getting a better picture, but it's still incomplete," he said.

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Online:

www.lancet.com

http://healthmetricsandevaluation.org

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