London, England ( CNN) - - An experimental vaccine for cocaine addicts can help some users kick the habit, according to a new study. Researchers at Yale School of Medicine have tested a vaccine that makes people produce antibodies to cocaine. The theory is that high levels of anti- cocaine antibodies can inactivate cocaine before it enters the brain, preventing users from getting high. Dr Thomas Kosten worked on the study at Yale, before moving to Baylor College of Medicine, in Texas.

He told CNN that this is the first time a cocaine vaccine has been tested in people, and that the vaccine approach would be suitable for all kinds of addictive substances, except alcohol. & quot; Antibodies are very large proteins and when the cocaine attaches to those antibodies it can' t get into the brain or heart, so people don' t get high from it, & quot; Kosten told CNN. Because users don' t get high, the thinking is that they will eventually stop taking cocaine. & quot; What was surprising was that we got patients who had limited motivation for stopping cocaine use to basically just run out of money, & quot; said Kosten. Participants received five vaccinations over a 24- week period and their urine was tested for cocaine three times a week. The study, published in the journal of the American Medical Association, found that the vaccine only achieved the desired antibody level of at least 43 micrograms per milliliter in 38 per cent of subjects, and that level was maintained for two months of the study period.

Of the subjects who achieved desired antibody levels, 53 per cent reduced their cocaine use by half, compared to 23 per cent of those with low antibody levels, and significantly more produced cocaine- free urine samples between weeks nine and 16 of the 24- week study than those who were given a placebo, or had low antibody levels. But Kosten told CNN that 75 per cent of subjects had high enough antibody levels to block one or two doses of cocaine, and that should be enough to prevent occasional lapses leading back to addiction.

Icro Maremmani, professor of addiction medicine at the University of Pisa and University of Siena, told CNN he believes the vaccine will be useful, but only for highly motivated patients. & quot; Hard users of cocaine probably will not accept this kind of treatment, & quot; he said. & quot; The situation risks being similar to the use of naltrexone for heroin addicts - - a perfect drug but poor clinical results. & quot; Maremmani said there is also a risk that some patients will increase their intake of cocaine to overcome the antibody effect. Kosten says it usually takes about two years for addicts to become drug- free, and that patients would have to be vaccinated every three months for that period to maintain antibody levels. He says that while the vaccine can stop relapses leading back to addiction, it doesn' t solve the issues that lead to drug use. & quot; The vaccine doesn' t get you new friends, change your depression, get you out of jail, or all the other things that people have trouble with. People could conceivably be on it for the rest of their life if they can' t get it together. & quot;

( CNN) - - Soon after Paul Coskie' s bicycle collided with a car, it became clear to his mother that her son would be sick for a very long time, and indeed he was. The 13- year- old boy went into a coma for a month and spent six months total in the hospital. What his mother didn' t know at the time was that Paul' s collision would eventually claim another victim - - one who was nowhere near the accident scene. After taking care of her son for a year, Dixie Fremont- Smith Coskie started to lose her balance, stumbling at times when she walked. Then she became so weak she couldn' t get out of bed. & quot; I had tingling down my arm and terrible pain in my neck, & quot; remembers Coskie, 50, who lives in Upton, Massachusetts. & quot; I thought I had Lou Gehrig' s disease, but was so frightened I couldn' t even tell my husband. & quot; After performing a battery of tests, her doctor concluded she didn' t have Lou Gehrig' s.

What she had was a reaction to stress. & quot; The tingling in my arm and the pain in my neck - - the doctor explained it was because I had the weight of the world on my shoulders, & quot; says Coskie, who was also tending to the needs of her six other children while caring for Paul. More than 65 million people - - nearly a third of the U. S. population, provide care for a friend or family member during any given year, according to the National Family Caregivers Association. In an editorial in the May issue of the Journal of the American Geriatrics Society, psychologist Peter Vitaliano explains that many of these people suffer just as Coskie did. & quot; Thousands of articles have reported greater psychological and physical health problems in caregivers than in noncaregivers, & quot; writes Vitaliano, a professor in the department of psychiatry and behavioral sciences at the University of Washington School of Medicine.

In the same issue, a team led by researchers at the University of Utah studied 1, 221 elderly married couples and found someone was six times more likely to develop dementia if his or her spouse had dementia. It' s not entirely clear why caregiving can make you sick, but researchers believe depression and chronically high levels of the stress hormone cortisol, both of which often accompany caregiving, take a toll on the body' s immune and cardiovascular systems. Coskie says she never dreamed stress could wreak such havoc on her body, but in retrospect it makes sense. For six months, she and her husband, Steven, drove an hour back and forth from their home to Paul' s hospital in Boston.

Then after his discharge, she needed to feed, bathe and dress her son at home. She says she didn' t really feel the stress effects of Paul' s accident until Paul was finally able to go back to school and the demands decreased. & quot; My body just allowed itself to freak out, & quot; she says.

For tips on how to recognize when you' re experiencing caregiver burnout, see Four months of physical therapy put her on the road to recovery, and Coskie didn' t think much more about the physical effects of stress - - until she was forced to about two years later. In 2005, Paul got a diagnosis of leukemia. Once again, she and her husband didn' t know whether Paul would live or die.

Once again, they took daily one- hour trips back and forth to Boston, where Paul spent three months at Children' s Hospital receiving a bone marrow transplant. Then after he came home, the Coskies had to keep Paul' s surroundings sterile because of his depleted immune system. Plus, there was a new stress, one that wasn' t there after the bike accident: in 2004, the couple had a baby, their eighth child. & quot; I knew what happened to me the first time, and this second time around I didn' t want it to happen again, & quot; Coskie says. & quot; My husband and I sat down and decided we needed to do things differently. & quot; In her book, & quot; Unthinkable, & quot; Coskie explains how she and her family minimized stress with Paul' s second illness. Here are some of her tips, along with advice from experts on stress and caregiving. Control the carbs There' s no question: Stress can make you fat, and being fat takes a toll on your health. & quot; Excess cortisol increases insulin, and that changes the way carbohydrates are metabolized, & quot; says Dr.

Christiane Northrup, who writes about caregiving in & quot; Women' s Bodies, Women' s Wisdom, & quot; a new edition of which is being released later this month. & quot; You crave sweets, and that' s why every nurses' station I' ve ever seen has doughnuts and chocolate sitting around. Constant caregiving, so constant sugar cravings, & quot; she says. Eating sweets may make you feel less stressed out temporarily. & quot; Eating sugars and starches has an opiate- like effect on the brain, & quot; Northrup says. & quot; It dulls the pain for a while. & quot; But eventually ( and obviously) a diet of doughnuts will make you gain weight. In his editorial, Vitaliano notes that caregivers had greater calorie and fat intake and were more likely to be obese compared to noncaregivers. After Paul' s leukemia diagnosis, his mother made a deliberate decision to eat better. & quot; The first time, after his accident, I practically lived on coffee and junk food, & quot; Coskie remembers. & quot; When he had cancer, I made sure I actually sat down and ate meals. & quot; 2.

Get rid of the guilt Guilt, like stress, can send your stress hormones skyrocketing, creating a double whammy, Northrup explains. & quot; I' ve had patients who felt so guilty about leaving their loved one they wouldn' t even come in for their own annual exams, & quot; says Northrup, who practiced obstetrics and gynecology for 25 years.

Coskie remembers how after her son' s accident she felt too guilty to do simple things such as go to the movies or take a walk. & quot; How could I possibly think about taking a walk on a beach to escape for a moment when my son could not even walk? & quot; she says. & quot; To feel joy or pleasure or any type of happiness while my son lay incapacitated on a hospital bed just did not feel right. & quot; The University of California, San Francisco, has advice for caregivers - - . Resist & quot; helpless hopeless& quot; That' s Northrup' s term for feeling like you' re stuck and no one can help. & quot; You should assume that help is available, but you just don' t know what form it will take, & quot; she says. When she was 8 years old, Northrup' s baby brother, Bill, was born. He wouldn' t eat, and at a year old weighed just 10 pounds. Northrup' s mother exhausted herself caring for Bill and her four other children. & quot; He needed feedings every hour on the hour, & quot; Northrup remembers. & quot; One day a woman named Edna appeared at our door and said, ' I heard you need help. ' She had the same name and birthday as my mother. & quot; Bill put out his arms and smiled at Edna, who spent years helping care for him.

The key here: Northrup' s mother had been open with people in their community about her tough situation, which is how Edna knew she needed help. Sometimes, it' s hard to say & quot; yes& quot; to help, even when you need it most. & quot; People would say, ' What can I do? ' and I' d think to myself, ' My God, there' s 110 things you could do, ' but I' d say ' Oh no, that' s OK. ' & quot; With Paul' s second illness, Coskie made a deliberate decision to change her ways. & quot; I let down my pride. I knew that if I tried to do this by myself, I' d collapse again, & quot; she says. Coskie advises making a list of the things you need so you can have a quick answer when friends asked what they could do. & quot; You might need help with baby- sitting or carpooling or bringing over a few necessities like milk or bread or eggs. Give them suggestions because they don' t know what to do. & quot; 4.

Reject & quot; hamster head& quot; & quot; Hamster head, & quot; according to psychologist David Coon, is when unhelpful thoughts, worries and anxieties go around and around in your mind. & quot; Write them down and think about positive thoughts you can replace them with, & quot; advises Coon, a professor in the college of nursing and health innovation at Arizona State University who studies caregiving for people with dementia. & quot; Instead of thinking, ' Dad' s really going downhill, ' think about a pleasant interchange you just had with Dad, or remind yourself how you' re doing a great job creating a safe, caring environment for him, & quot; he says. For more advice on caring for someone with dementia, see these strategies from the and the 5. & quot; Surrender, Dorothy& quot; This one is for people who might have disagreements with a parent who needs care. & quot; Right now you have baby boomers caring for people in the World War II generation, and there' s a huge generation gap, because boomers are much more likely to question a doctor' s authority, & quot; Northrup says. For example, a boomer might want a parent to try taking vitamins or some other form of alternative medicine, or to get a second opinion from another doctor, but the parent resists. & quot; It gets abrasive. It' s like sandpaper, & quot; she says. Northrup' s solution: Don' t argue with your parent. & quot; It' s like ' Surrender, Dorothy, ' in ' The Wizard of Oz. ' Just let it go, & quot; she says.

Today, Paul Coskie is 22. His leukemia went into remission and then returned in 2008. He' s receiving daily chemotherapy and his speech is slow and his left side sometimes shakes from his head injury. His mother' s big lesson from her caregiving experience: Try to take time for yourself and meditate. & quot; Be more aware of yourself, & quot; she says. & quot; Be more conscious. & quot; CNN' s Sabriya Rice contributed to this report.

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Dear Sheeza, I am sorry to hear of your difficulties - - you are far from alone in your struggles with postpartum depression. Indeed, up to 20 percent of women become depressed in the six months following delivery, but company doesn' t help much when it comes to depression - - or at least the company we typically provide in the U.

Traditional cultures understood the vulnerability of new mothers and would often surround them with family and friends to help with the significant emotional and practical burdens of coping with the newborn. I am going to make some general recommendations about what you might want to consider doing, based only on the information you have provided above. As always, this should not be taken as specific advice for your actual situation. That kind of advice can come only from a clinician who knows you and is involved in your care.

First and most important, it is very important to continue medication when one is still depressed, so given what you describe, I would counsel against stopping the antidepressant.

It is not clear how long you have been on the Paxil ( generic: paroxetine) , but let' s assume you' ve been on it for at least six weeks. You are on a low dose. A reasonable first step would be to talk with your doctor about raising the dose to 40 mg a day and trying this dose for at least several weeks.

If you see no benefit, there are in general two paths your doctor might recommend ( and I say doctor in the generic sense, given that many folks nowadays see physician assistants or nurse practitioners who often - - in my experience - - do a better job diagnosing and treating depression than do MDs) .

First, your doctor might add a second antidepressant or an atypical antipsychotic to your Paxil. Although they are called & quot; antipsychotics, & quot; these agents ( for example Seroquel, Abilify, Zyprexa) are also widely used to help with severe depression and anxiety and are often quite effective. Second, your doctor might switch you from the Paxil to another antidepressant.

Unfortunately, we have no scientific way of knowing which agent you should switch to - - our best data suggest that they are all about equal. But one thing is clear: Many people who don' t do well with one antidepressant will have a great response to a different one. Anxiety and panic are quite common when one has a bad depression, and they can be more miserable to endure than the feeling of depression itself.

It is unlikely that the low dose of Buspar ( generic: buspirone) you are taking is of much benefit. You might want to discuss with your doctor raising the dose to at least 10 mg three times a day or discontinuing it. The best immediate way to relieve disabling anxiety is through the use of benzodiazepines ( for example lorazepam or clonazepam) .

These medications can be lifesavers, but if you take them for more than three or four weeks your body will become dependent upon them, and should you want to stop, you will have to reduce them slowly under the supervision of a doctor. Let me say a word about exercise. Yes, exercise has been shown in many studies not only to raise a person' s mood immediately, but also to work over time as an antidepressant. Therefore, I strongly recommend adding regular exercise to your treatment regimen.

Try to exercise in the morning, especially when it is sunny.

To get the best effect you will need to work up a sweat.

I find that it is even better if you can exercise in a place with some natural beauty - - as being in nature is itself quite comforting for most of us. I don' t have an answer to your question about how long the depression will last and whether it will ever go away. Everyone is different. We do know, however, that the longer one stays depressed and/ or the more episodes one has had, the harder it is to treat the condition. This is just the frightening truth of the disease, and it really highlights how important it is for you to really get aggressive about your treatment.

My sincere hope is that whatever specific treatment route you follow, you will start feeling like yourself again as quickly as possible.

Finally, whenever I talk about specific pharmacologic treatments I need to disclose that in addition to my academic work I have given lectures for two pharmaceutical companies in the last year: Lilly and Wyeth. I have also served on an advisory board for Lilly in the last 12 months.

Should political debate be about jobs not debt? Lobbyists battle amid deficit cuts Piers Morgan blasts British MP' s ' lie' Geyser of water lifts car into air Cops: Son parties with parents' bodies in house Migraines a deal breaker for Bachmann? Gay man turns himself ' straight' Murray to blame for Jackson' s death? Cops: Mom admits having teen sex parties Chihuahua chases off robbers Fallout after Murdoch testimony Geyser of water lifts car into air Bolden: NASA is very busy Are fast food calorie counts accurate? Hacking groups' possible agendas Astronauts aboard Atlantis reflect UK vs.

US tabloid culture Talking to teens about health, obesity Welcome home to U. Womens soccer team Could eye exams detect Alzheimer' s? Legal analysis of phone hacking scandal Man faked his identity for decades Murdoch in the hot seat Ex- nuclear plant operator speaks out CNN' s new video experience on i. Pad The Shot: Caption casts spell on Cooper Report: Murdoch to step down as CEO? Prioritizing federal spending Tea Party leader on default threat Could Rick Perry shake up GOP W.

H. race? GOP pushes ' cut, cap, and balance' Anderson Cooper answers your questions Marcus Bachmann defends clinic Famine strikes Somalia 11 million starving in Somalia 9/ 11 families to meet with Justice Dept.

PM Cameron addresses hacking allegations Bachmann questions farmers' claims Mrs.

Murdoch to the rescue Granderson: Debt talks need more women Debt talks - what' s the solution? Murdoch' s wife stands by her man James Murdoch discusses 9/ 11 victims Counting calories while eating out Hacking: ' Who signed the checks? ' Dr. Drew Murray to blame for Jackson' s death? Casey interview: Bonanza or backlash? Preview: Dr.

Drew with Bristol Palin Is Casey Anthony mentally ill? Summers on America' s growth prospects Fareed' s Take: Afghanistan' s future What in the World: Brazil overheating? Most expensive city in the world Lawmakers fighting like cats and dogs Fareed Zakaria answers your questions Bernard- Henri Levy speaks out on DSK Peter Godwin on Sudan Getting a Picasso into a war zone Debt crisis: Whatever happened to jobs? House vote ' one way of herding the cats' Experts skeptical of Murdoch' s ignorance Campbell: Cameron should admit ' error' ' Revolving door' guarded Murdoch paper?

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Former editor cites Murdoch son, Brooks Gay man turns himself ' straight' Can Casey Anthony ever be forgiven? Roseanne: I' m not good at marriage Chubby teen becomes beauty queen Shannon Tweed walks out on Gene Simmons Would Casey' s attorney let her babysit? Larry David: I want to do standup again My father was ' The Grim Reaper' Fergie: I' m addicted to being liked Will migraines impact Bachmann campaign? Murdoch acting like himself?

Gadhafi: Brega will be ' hell' Republican social issues in 2012 Murray' s defense wants jury sequestered Tot mom allegedly spotted at airport Cops: Son kills parents, throws party Where is Casey Anthony? Piers Morgan blasts Mensch' s ' lie' Trump: Bachmann is ' highly underrated' Murdoch takes pie in the face Piers Morgan: CNN host, ' AGT' judge Tom Arnold discusses his dark past Nancy Grace opens up on fiance' s murder Tom Arnold talks Arnold Schwarzenegger Piers Morgan believes Murdoch Murdoch done with newspapers?

Nancy Grace: Jury wasn' t listening to me Nancy Grace speaks about fiance' s murder Claustrophobic fighter pilot Impact of concussions to brain Ex- players sue NFL over concussion risks Brain injury patient back on the road Bounty hunter wants to sue Casey Anthony Khloe Kardashian' s Twitter outrage Hollywood hacking outrage J.

Lo and Marc Anthony split shocker Justin and Selena: Wedding crashers? Casey Anthony in disguise? Kim Kardashian' s mom gets facelift Lobbyists battle amid deficit cuts Debt debate gets ugly New TSA body scan less invasive Hackers turn tables on Murdoch empire Migraines a deal breaker for Bachmann? ' Nobody proved Murdoch was involved' Computer hackers attack ' Sun' Congressman battles home intruder Murdoch scandal: Who' s next? Herman Cain against proposed mosque?

Bachmann backs ' cut, cap and balance' Warren: " I Really Don' t Get it" Politicos agree: GOP field leaderless Sound of Sunday with Candy Crowley How Giuliani would negotiate debt talks How Giuliani would negotiate debt talks Giuliani: ' Not sure' I could win in NH Candy' s post- show analysis Graham has no confidence in compromise WH Budget chief: Time to act is now Rudy Giuliani on Murdoch, 9/ 11 and more Candy' s pre- show rundown

Treatment depends on the type of thyroid nodule you have.

Treating benign nodules If a thyroid nodule isn' t cancerous, there are several treatment options: Watchful waiting. If a biopsy shows that you have a benign thyroid nodule, your doctor may suggest simply watching your condition, which usually means having a physical exam and thyroid function tests at regular intervals. You' re also likely to have another biopsy if the nodule grows larger. If a benign thyroid nodule remains unchanged, you may never need treatment beyond careful monitoring.

Thyroid hormone suppression therapy.

This involves treating a benign nodule with levothyroxine ( Levoxyl, Synthroid, others) , a synthetic form of thyroxine that you take in pill form. The idea is that supplying additional thyroid hormone will signal the pituitary to produce less TSH, the hormone that stimulates the growth of thyroid tissue. Although this sounds good in theory, levothyroxine therapy is a matter of some debate. There' s no clear evidence that the treatment consistently shrinks nodules or even that shrinking small, benign nodules is necessary. Surgery.

Occasionally, a nodule that' s clearly benign may require surgery, especially if it' s so large that it makes it hard to breathe or swallow. Surgery is also considered the best option for people with large multinodular goiters, particularly when the goiters constrict airways, the esophagus or blood vessels. Nodules diagnosed as indeterminate or suspicious by a biopsy also need surgical removal, so they can be examined more thoroughly for signs of cancer.

Treating nodules that cause hyperthyroidism If a thyroid nodule is producing thyroid hormones, overloading your thyroid gland' s normal hormone production levels, your doctor may recommend treating you for hyperthyroidism. This may include: Radioactive iodine. Doctors often use radioactive iodine to treat hyperfunctioning adenomas or multinodular goiters. Taken as a capsule or in liquid form, radioactive iodine is absorbed by your thyroid gland, causing the nodules to shrink and signs and symptoms of hyperthyroidism to subside, usually within two to three months. Anti- thyroid medications.

In some cases, your doctor may recommend an anti- thyroid medication such as methimazole ( Tapazole) to reduce symptoms of hyperthyroidism. Treatment is generally long- term and can have serious side effects on your liver, so it' s important to discuss the treatment' s risks and benefits with your doctor. Surgery. If treatment with radioactive iodine or anti- thyroid medications isn' t an option, you may be a candidate for surgery to remove your thyroid gland. Surgery also carries certain risks that should be thoroughly discussed beforehand.

Treating cancerous nodules Treatment for a nodule that' s cancerous usually involves surgery. Surgery. The usual treatment for malignant nodules is surgical removal, often along with the majority of thyroid tissue & mdash; a procedure called near- total thyroidectomy.

Risks of thyroid surgery include damage to the nerve that controls your vocal cords and damage to your parathyroid glands & mdash; four tiny glands located on the back of your thyroid gland that help control the level of calcium in your blood. After thyroidectomy, you' ll need lifelong treatment with levothyroxine to supply your body with normal amounts of thyroid hormone. & copy; 1998- 2011 Mayo Foundation for Medical Education and Research ( MFMER) .

( CNN) - - President Obama embarked Thursday on his first presidential visit to Asia, an eight- day journey that will take him to five cities in four countries. Throughout the trip to Japan, Singapore, China and South Korea, Obama will emphasize the importance of Asian nations as vital U. S. partners on major issues such as economic growth, nuclear nonproliferation, the war in Afghanistan and climate change, three officials said in a briefing this week. The presidential itinerary includes formal talks with Asian leaders as a group and individually, a bilateral meeting with Russian President Dmitry Medvedev, and the first participation by a U.

S. president in a summit of the 10- member Association of Southeast Asian Nations economic alliance. The itinerary also reflects Obama' s personal ties to Asia, where he spent part of his childhood. He will have a bilateral meeting with President Susilo Bambang Yudhoyono of Indonesia, where Obama lived from 1967 to 1971. As the first U. S. president with & quot; an Asia- Pacific orientation, & quot; Obama & quot; understands that the future of our prosperity and our security is very much tied to this part of the world, & quot; said Ben Rhodes, deputy national security adviser for strategic communications.

It won' t be all diplomatic meetings, though. Obama' s first trip to China will include a & quot; town hall& quot; style meeting in Shanghai and sightseeing in Beijing. While in Japan he' ll meet the emperor and empress, according to Rhodes. Obama' s departure was delayed one day to allow his attendance at Tuesday' s memorial service at Fort Hood Army Post in Texas for the 13 people killed in a mass shooting there last week.

The revised itinerary cut a day from the stop in Singapore, White House Press Secretary Robert Gibbs said earlier this week. En route to Tokyo, Obama will take time in Anchorage, Alaska, to speak to troops at Elmendorf Air Force Base during a two- hour layover.

The president will meet with new Japanese Prime Minister Yukio , Chinese President Hu Jintao and Premier Wen Jiabao, Singapore Prime Minister Lee Hsien Loong, South Korean President Lee Myung- bak, Medvedev and Yudhoyono, and also will take part in an Asia- Pacific Economic Cooperation summit.

APEC consists of 21 Pacific Rim nations that make up more than 50 percent of the world' s economic output. The forum sees its goal as & quot; facilitating economic growth, cooperation, trade and investment in the Asia- Pacific region. & quot; Hatoyama and Obama have said they will affirm a strengthening of the bilateral alliance.

But the U. S. president will be greeted by a Japanese leadership that has pledged more independence from the United States and has said it is reviewing a bilateral deal to relocate a U.

Marine Corps base on Okinawa. The agreement was met with fierce local opposition. Increasing U.

S. exports to a region expected to grow by more than 7 percent next year will also be an important topic, said Michael Froman, deputy national security adviser for international economic affairs. Asia & quot; already takes about a quarter of our exports, and those exports are expected to increase as the region grows& quot; Froman said. The result could be an increase of & quot; hundreds of thousands& quot; in the current 1.

6 million U. S. jobs linked to Asian exports, he said.

The officials were careful to avoid any perception that Obama' s presence at the ASEAN meeting would amount to a bilateral discussion with the prime minister of Myanmar, who also will attend. After years of refusing direct talks with Myanmar, also known as Burma, the United States has indicated a possible re- engagement with the military regime it considers repressive for cracking down on political opposition, including the National League for Democracy led by detained Nobel Peace Prize winner Aung San Suu Kyi. & quot; The statement we' re trying to make here is that we' re not going to let the Burmese tail wag the ASEAN dog, & quot; said Jeffrey Bader, the National Security Council' s senior director for East Asian affairs. & quot; We' re going to meet with all 10 and we' re not going to punish the other nine simply because Burma is in the room, but this is not a bilateral [ meeting] . & quot; In China, Obama will continue efforts to define and strengthen the relationship with the world' s largest emerging economy, which has a growing influence in Asia, Bader said. & quot; We see it as a relationship where we' re obviously going to have differences, where we are going to be competitors in certain respects, & quot; he said. & quot; But we want to maximize areas where we can work together because the global challenges will simply not be met if we don' t. & quot; Bader cited North Korea' s nuclear weapons program, the economy, climate change, human rights and Afghanistan as among the top issues for the China swing. On human rights, Bader said Obama is likely to address & quot; freedom of expression, access to information, freedom of religion, rule of law, and certainly Tibet. & quot; will make clear to Hu that he intends to meet in the future with the Dalai Lama, the exiled Tibetan spiritual leader, Bader said.

China, which rejects Tibetan aspirations for autonomy, opposes such high- level contacts with the Dalai Lama.

On North Korea, the State Department announced Tuesday that U. S. officials will travel to the country by the end of the year to seek a resumption of broader talks on ending the Pyongyang government' s nuclear program. The Obama administration has claimed initial progress in its strategy of forging an international effort including China, South Korea and other countries to put pressure on North Korea to abandon its nuclear weapons ambitions.

Japan has been asking for a comprehensive solution to North Korea' s missile tests and the abduction of Japanese citizens in the 1970s. North Korea and South Korea reported an encounter Tuesday involving gunfire between two of their naval ships off the Korean Peninsula. No casualties were reported, and a State Department spokesman downplayed the significance of the incident.

CNN' s Tom Cohen, Kyung Lah and Ed Payne contributed to this report.

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Observing some kids after a head injury may help doctors decide which ones need a head x- ray, according to a new study published in Pediatrics. That' s important because researchers still aren' t sure whether too many of those x- rays, called computed tomography, or CT scans, might trigger cancer years later. CT scans can help doctors recognize more serious head injuries that need treatment.

But observation is probably a good strategy for kids who have some risk of a serious brain injury, but aren' t showing serious symptoms, said Dr. Lise Nigrovic of Children' s Hospital Boston, who worked on the study.

If a kids shows up at the ER very soon after a head injury, " you may just not have had enough time for symptoms to develop, " she told Reuters Health. Or, a kid " may have some symptoms that make you a little concerned, but you just want some time" before making a decision about doing an x- ray. " We all want to make sure that we use CT scanning in the cases where it' s likely to be positive and that we save children from the radiation for those that we know are very unlikely to be positive, " Dr. Martin Osmond, of the Children' s Hospital of Eastern Ontario, told Reuters Health. " This study adds important new information about who to observe" before making that decision, added Osmond, who has no ties to the new study. Nigrovic and her colleagues reviewed data on over 40, 000 kids with a head injury who were taken to one of 25 different emergency rooms. The original data had been collected by the Pediatric Emergency Care Applied Research Network.

Doctors treating the kids made a note in their records about whether each kid was kept in the hospital and observed by doctors and nurses before they decided whether or not to perform a CT scan. About 5, 400 kids - or 1 in 7 - were observed. Those kids were slightly less likely to get a CT scan: 31 percent of them had the head x- ray, versus 35 percent of kids when doctors made that decision right away. In both groups, fewer than 1 of every hundred kids had a serious brain injury. Twenty- six kids who were observed and sent home without a CT scan came back later for an x- ray - and 1 of them ended up having a brain injury diagnosed by the x- ray.

The research team concluded from that finding that observing some kids before making the decision about a CT scan might be a safe and effective way to cut back on the number of those scans. Nigrovic gave the example of a 4- year- old who fell off a swing. " They' re complaining of a headache ( and) they vomited once at home, " she said.

But, they are awake and talking 2 hours after the injury, making doctors less fearful. " That' s a great patient for observation, " she said. Osmond thinks the study is an accurate picture of how doctors are now treating these patients: In severe cases doctors will get a scan right away, in cases where they believe the symptoms are sufficiently mild, they' re likely to send the patients home, but in cases of doubt they' ll observe the child to see if there are any changes, he explained. Still, Osmond added, a few questions remain.

For example, it' s unclear just how long it makes sense for doctors to observe kids before deciding whether or not to do a CT scan or send them home. That, as well as how safe it is to put off CT scans while observing an injured kid, will be the focus of future research, Nigrovic said.