Hospitals crack down on workers refusing flu shots

CHICAGO (AP) — Patients can refuse a flu shot. Should doctors and nurses have that right, too? That is the thorny question surfacing as U.S. hospitals increasingly crack down on employees who won't get flu shots, with some workers losing their jobs over their refusal.

"Where does it say that I am no longer a patient if I'm a nurse," wondered Carrie Calhoun, a longtime critical care nurse in suburban Chicago who was fired last month after she refused a flu shot.

Hospitals' get-tougher measures coincide with an earlier-than-usual flu season hitting harder than in recent mild seasons. Flu is widespread in most states, and at least 20 children have died.

Most doctors and nurses do get flu shots. But in the past two months, at least 15 nurses and other hospital staffers in four states have been fired for refusing, and several others have resigned, according to affected workers, hospital authorities and published reports.

In Rhode Island, one of three states with tough penalties behind a mandatory vaccine policy for health care workers, more than 1,000 workers recently signed a petition opposing the policy, according to a labor union that has filed suit to end the regulation.

Why would people whose job is to protect sick patients refuse a flu shot? The reasons vary: allergies to flu vaccine, which are rare; religious objections; and skepticism about whether vaccinating health workers will prevent flu in patients.

Dr. Carolyn Bridges, associate director for adult immunization at the federal Centers for Disease Control and Prevention, says the strongest evidence is from studies in nursing homes, linking flu vaccination among health care workers with fewer patient deaths from all causes.

"We would all like to see stronger data," she said. But other evidence shows flu vaccination "significantly decreases" flu cases, she said. "It should work the same in a health care worker versus somebody out in the community."

Cancer nurse Joyce Gingerich is among the skeptics and says her decision to avoid the shot is mostly "a personal thing." She's among seven employees at IU Health Goshen Hospital in northern Indiana who were recently fired for refusing flu shots. Gingerich said she gets other vaccinations but thinks it should be a choice. She opposes "the injustice of being forced to put something in my body."

Medical ethicist Art Caplan says health care workers' ethical obligation to protect patients trumps their individual rights.

"If you don't want to do it, you shouldn't work in that environment," said Caplan, medical ethics chief at New York University's Langone Medical Center. "Patients should demand that their health care provider gets flu shots — and they should ask them."

For some people, flu causes only mild symptoms. But it can also lead to pneumonia, and there are thousands of hospitalizations and deaths each year. The number of deaths has varied in recent decades from about 3,000 to 49,000.

A survey by CDC researchers found that in 2011, more than 400 U.S. hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees.

At Calhoun's hospital, Alexian Brothers Medical Center in Elk Grove Village, Ill., unvaccinated workers granted exemptions must wear masks and tell patients, "I'm wearing the mask for your safety," Calhoun says. She says that's discriminatory and may make patients want to avoid "the dirty nurse" with the mask.

The hospital justified its vaccination policy in an email, citing the CDC's warning that this year's flu outbreak was "expected to be among the worst in a decade" and noted that Illinois has already been hit especially hard. The mandatory vaccine policy "is consistent with our health system's mission to provide the safest environment possible."

The government recommends flu shots for nearly everyone, starting at age 6 months. Vaccination rates among the general public are generally lower than among health care workers.

According to the most recent federal data, about 63 percent of U.S. health care workers had flu shots as of November. That's up from previous years, but the government wants 90 percent coverage of health care workers by 2020.

The highest rate, about 88 percent, was among pharmacists, followed by doctors at 84 percent, and nurses, 82 percent. Fewer than half of nursing assistants and aides are vaccinated, Bridges said.

Some hospitals have achieved 90 percent but many fall short. A government health advisory panel has urged those below 90 percent to consider a mandatory program.

Also, the accreditation body over hospitals requires them to offer flu vaccines to workers, and those failing to do that and improve vaccination rates could lose accreditation.

Starting this year, the government's Centers for Medicare & Medicaid Services is requiring hospitals to report employees' flu vaccination rates as a means to boost the rates, the CDC's Bridges said. Eventually the data will be posted on the agency's "Hospital Compare" website.

Several leading doctor groups support mandatory flu shots for workers. And the American Medical Association in November endorsed mandatory shots for those with direct patient contact in nursing homes; elderly patients are particularly vulnerable to flu-related complications. The American Nurses Association supports mandates if they're adopted at the state level and affect all hospitals, but also says exceptions should be allowed for medical or religious reasons.

Mandates for vaccinating health care workers against other diseases, including measles, mumps and hepatitis, are widely accepted. But some workers have less faith that flu shots work — partly because there are several types of flu virus that often differ each season and manufacturers must reformulate vaccines to try and match the circulating strains.

While not 100 percent effective, this year's vaccine is a good match, the CDC's Bridges said.

Several states have laws or regulations requiring flu vaccination for health care workers but only three — Arkansas, Maine and Rhode Island — spell out penalties for those who refuse, according to Alexandra Stewart, a George Washington University expert in immunization policy and co-author of a study appearing this month in the journal Vaccine.

Rhode Island's regulation, enacted in December, may be the toughest and is being challenged in court by a health workers union. The rule allows exemptions for religious or medical reasons, but requires unvaccinated workers in contact with patients to wear face masks during flu season. Employees who refuse the masks can be fined $100 and may face a complaint or reprimand for unprofessional conduct that could result in losing their professional license.

Some Rhode Island hospitals post signs announcing that workers wearing masks have not received flu shots. Opponents say the masks violate their health privacy.

"We really strongly support the goal of increasing vaccination rates among health care workers and among the population as a whole," but it should be voluntary, said SEIU Healthcare Employees Union spokesman Chas Walker.

Supporters of health care worker mandates note that to protect public health, courts have endorsed forced vaccination laws affecting the general population during disease outbreaks, and have upheld vaccination requirements for schoolchildren.

Cases involving flu vaccine mandates for health workers have had less success. A 2009 New York state regulation mandating health care worker vaccinations for swine flu and seasonal flu was challenged in court but was later rescinded because of a vaccine shortage. And labor unions have challenged individual hospital mandates enacted without collective bargaining; an appeals court upheld that argument in 2007 in a widely cited case involving Virginia Mason Hospital in Seattle.

Calhoun, the Illinois nurse, says she is unsure of her options.

"Most of the hospitals in my area are all implementing these policies," she said. "This conflict could end the career I have dedicated myself to."

__

Online:

R.I. union lawsuit against mandatory vaccines: http://www.seiu1199ne.org/files/2013/01/FluLawsuitRI.pdf

CDC: http://www.cdc.gov

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

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Analyst calls Brown's budget 'reasonable' but has some concerns

SACRAMENTO — Gov. Jerry Brown's budget proposal may be too optimistic, but California's finances still have shown dramatic improvement, the Legislature's top financial advisor said Monday.

Legislative Analyst Mac Taylor said the state is likely to generate $2.1 billion less in revenue and savings than the governor is counting on. But after years of catastrophic deficits, that's a relatively small gap in an estimated $97.7-billion proposal, he said.

"That's not a startling difference," said Taylor, who called the governor's plans "reasonable."

Brown and Taylor both see California's finances on the upswing, but they've differed on how fast the finances are improving. The governor says the state's deficit already has been wiped out; in November, the analyst projected a $1.9-billion budget gap this year.

Taylor did not back away from that estimate in his Monday report but described it as a "small problem" — "not big enough at this point to worry too much."

H.D. Palmer, spokesman for Brown's Department of Finance, said the analyst's report is proof the governor is taking the right approach. "Living within our means, paying down debt and strengthening education are the right policy choices for California," Palmer said in a statement.

Taylor raised some concerns. The end of the federal payroll tax cut could lower economic activity, taking a bite out of tax revenue. A drawn-out fight in Congress over raising the debt ceiling could cause a slump in the stock market.

He also noted that Brown's proposal "does nothing" to address mounting costs for teacher pensions and retiree healthcare. "There's no plan as to how we pay those off," Taylor said.

Unfunded obligations in the teachers' pension fund were estimated at $64.5 billion over 30 years. For retiree healthcare, the estimate was $62.1 billion.

In addition, Taylor said, Brown's plan could burn through much of California's potential surplus, leaving the state without a cushion. Then, "if you get to the point where you have a downturn," he said, "you'll need to go back on those spending commitments."

Assemblyman Jeff Gorrell (R-Camarillo), vice chairman of the Assembly budget committee, said California will need financial breathing room when the temporary taxes that voters passed in November expire in 2019. Otherwise, Gorrell said, the state could face "another massive deficit."

Palmer said the administration's own estimates show the state having healthy surpluses through 2017.

Taylor's most pointed criticism involved Brown's plan to use new revenue from Proposition 39, which changed how corporate taxes are calculated, to make schools more energy-efficient.

Because the ballot measure said projects would be selected based on energy savings and job creation, devoting the money to schools may not give the state the most bang for its buck, according to the report.

"The governor's proposal very likely would not maximize state energy and job benefits," it said.

Taylor did not offer alternatives.

chris.megerian@latimes.com

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Verizon may be prepping a new mid-range Samsung smartphone with a 720p display

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Bachelor Sean Lowe: My Girl Must Love Dogs

For any of the 25 women looking to win over this season's Bachelor, Sean Lowe, here's a tip straight from the source: "The girl I'm dating must be into my dogs," he tells PEOPLE.

The proud pet parent to two pooches, a boxer named Lola and a chocolate Labrador named Ellie, Lowe says, "For so long it's just been me and my two dogs, and I'm certainly not going to replace them with any woman."

Having had both animals for the past six years, the hunk has developed a special bond with the duo – though he admits his quest for love has forced him to make some changes.

"For many years, my dogs would sleep in the bed with me," he says. "I'm a big guy and I've got two good-sized dogs, so it's a full bed. Then I just realized one day, 'Alright, if I get married and a woman's going to join me in the bed, there's not going to be enough room.' I had to break the dogs of the habit of sleeping in the bed."

Luckily for Lowe, the pair have taken to their new accommodations easily.

"They're very intelligent dogs; they pick up on things really quickly," he says. "They learn pretty fast."

To hear more from Sean Lowe – including how his dogs help him navigate the dating world – check out the video above.

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French Say They ‘Blocked’ Rebel Advance in Mali

PARIS — The French defense ministry said on Monday that a town in central Mali had fallen to Islamist rebels from the north, hours after Foreign Minister Laurent Fabius said his country’s dramatic intervention there had succeeded in blocking a rebel advance that could have had “appalling consequences.”

At the same time, an Islamist leader in Mali said France had “opened the gates of hell” for all its citizens by intervening, reinforcing concerns that the far-flung military operation in Africa could inspire vengeance in mainland France.

French forces, Mr. Fabius said in a radio interview late Sunday, were now “taking care” of rear bases used by Islamists who took control of much of the north of the country last year after a military coup in the capital, Bamako. The duration of the French operation was “a question of weeks,” Mr. Fabius said, unlike the American-led military campaign in Afghanistan.

But within hours, reports began to emerge of a rebel counterattack in the small town of Diabaly — the first indication that the insurgents had regrouped after a wave of French airstrikes. The fighting in the town pitted rebels against government forces.

Reuters quoted residents and Malian military officials as saying that Islamists counterattacked after the insurgents infiltrated overnight across a river in small groups. The French defense minister, Jean-Yves Le Drian, said the rebels "took Diabaly after fierce fighting and resistance from the Malian Army that couldn’t hold them back.”

The setback for government forces seemed to embolden the rebels who had already struck a defiant postured on Monday.

Oumar Ould Hamaha, an insurgent leader, said the French intervention had “opened the gates of hell for all the French.”

He taunted French forces to launch a ground offensive, saying French warplanes had bombed from high altitude. “Let them come down onto the ground, if they are men,” he said. “We will greet them with open arms.”

France, he told Europe 1 radio, “has fallen into a trap which is much more dangerous than Iraq, Afghanistan or Somalia. And that is only the beginning.”

The French intervention began on Friday and continued over the weekend. French airstrikes appeared to have halted an Islamist rebel advance, as West African nations authorized what they said would be a faster deployment of troops in support of the weak government.

French aircraft dropped bombs and fired rockets from helicopter gunships and jet fighters after the Islamists, who already control the north of Mali, pressed southward and overran the village of Konna, which had been the de facto line of government control.

The French struck two columns of Islamist fighters, the French Defense Ministry said. The first was in and around Konna, driving out the rebels from the village, and the second was across a river, heading south toward the southern Mali town of Ségou, north of Bamako.

On Sunday evening, French jets attacked the northern town of Gao, an insurgent stronghold.

Abdheramane Oumarou, a local counselor in Gao reached late Sunday after a day of French airstrikes, said: “We are in the best of all possible worlds. The planes have been circling Gao since five this morning. All the of the sites they targeted, they hit. The airport. The warehouses, they destroyed them. These were all sites occupied by the Islamists, and they have been totally destroyed.”

“The Islamists are in hiding. There were many dead,” he said. For the first time since the insurgents overran the town last year, “the population of Gao will sleep soundly, and will even snore.”

Despite concerns that supporting France could provoke terrorist reprisals on its soil, Britain announced late on Saturday that it would help to transport foreign troops and equipment to Mali, though would not send its own soldiers to fight. Two British military transport planes were expected to head for Mali on Monday with equipment including French armored vehicles from a base in Normandy, the British Defense Ministry said.

“There is a very dangerous Islamist regime allied to Al Qaeda in control of the north of that country,” Prime Minister David Cameron said on Monday. “It was threatening the south of that country and we should support the action that the French have taken.”

“So we were first out of the blocks, as it were, to say to the French, ‘We’ll help you, we’ll work with you and we’ll share what intelligence we have with you and try to help you with what you are doing,’” Mr. Cameron told the BBC in a radio interview.

Foreign Minister Fabius said the military effort had three goals: to “block the advance of the terrorists, which is done,” to restore Mali’s territorial integrity “which will take more time,” and to secure the implementation of United Nations Security Council resolutions on the Mali crisis.

“If France had not intervened,” he said, the rebels “could have reached Bamako, with appalling consequences” not only for the Malian population but also for the 6,000 French and other Western citizens living in the capital of the former French colony.

Mr. Le Drian, the defense minister, said Sunday that the rebels could have reached Bamako in “three or four days” if France had not intervened.

"We will strengthen our operation depending on the situation," he said on a political talk show.

France now has more than 400 troops in Bamako, mainly to ensure the safety of French citizens and to send a signal to the Islamists, out of a total of 550 troops in Mali. The others, including some special forces, are in the town of Mopti in the south. It has also deployed Rafale jet fighters to attack rebel positions.

A French analyst, who is briefed on the situation but declined to be identified by name, said France believed the United States would deliver on promises of in-flight refueling the air campaign, logistical support and reconnaissance.

The analyst said the dilemma facing French forces is now whether to maintain a United Nations schedule for West African and Malian troops to seek to recapture the north in the fall after seasonal rains, “which given the current dynamic seems hard to imagine” or to “speed things up and try to clear the north in the next eight weeks” before the rainy season.

That could extend the duration of the French intervention, the analyst said.

Steven Erlanger reported from Paris, Adam Nossiter from Bamako, Mali, and Alan Cowell from London.

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Flu more widespread in US; eases off in some areas

NEW YORK (AP) — Flu is now widespread in all but three states as the nation grapples with an earlier-than-normal season. But there was one bit of good news Friday: The number of hard-hit areas declined.

The flu season in the U.S. got under way a month early, in December, driven by a strain that tends to make people sicker. That led to worries that it might be a bad season, following one of the mildest flu seasons in recent memory.

The latest numbers do show that the flu surpassed an "epidemic" threshold last week. That is based on deaths from pneumonia and influenza in 122 U.S. cities. However, it's not unusual — the epidemic level varies at different times of the year, and it was breached earlier this flu season, in October and November.

And there's a hint that the flu season may already have peaked in some spots, like in the South. Still, officials there and elsewhere are bracing for more sickness

In Ohio, administrators at Miami University are anxious that a bug that hit employees will spread to students when they return to the Oxford campus next week.

"Everybody's been sick. It's miserable," said Ritter Hoy, a spokeswoman for the 17,000-student school.

Despite the early start, health officials say it's not too late to get a flu shot. The vaccine is considered a good — though not perfect — protection against getting really sick from the flu.

Flu was widespread in 47 states last week, up from 41 the week before, the Centers for Disease Control and Prevention said on Friday. The only states without widespread flu were California, Mississippi and Hawaii.

The number of hard-hit states fell to 24 from 29, where larger numbers of people were treated for flu-like illness. Now off that list: Florida, Arkansas and South Carolina in the South, the first region hit this flu season.

Recent flu reports included holiday weeks when some doctor's offices were closed, so it will probably take a couple more weeks to get a better picture, CDC officials said Friday. Experts say so far say the season looks moderate.

"Only time will tell how moderate or severe this flu season will be," CDC Director Dr. Thomas Frieden said Friday in a teleconference with reporters.

The government doesn't keep a running tally of adult deaths from the flu, but estimates that it kills about 24,000 people in an average year. Nationally, 20 children have died from the flu this season.

Flu vaccinations are recommended for everyone 6 months or older. Since the swine flu epidemic in 2009, vaccination rates have increased in the U.S., but more than half of Americans haven't gotten this year's vaccine.

Nearly 130 million doses of flu vaccine were distributed this year, and at least 112 million have been used. Vaccine is still available, but supplies may have run low in some locations, officials said.

To find a shot, "you may have to call a couple places," said Dr. Patricia Quinlisk, who tracks the flu in Iowa.

In midtown Manhattan, Hyrmete Sciuto got a flu shot Friday at a drugstore. She skipped it in recent years, but news reports about the flu this week worried her.

During her commute from Edgewater, N.J., by ferry and bus, "I have people coughing in my face," she said. "I didn't want to risk it this year."

The vaccine is no guarantee, though, that you won't get sick. On Friday, CDC officials said a recent study of more than 1,100 people has concluded the current flu vaccine is 62 percent effective. That means the average vaccinated person is 62 percent less likely to get a case of flu that sends them to the doctor, compared to people who don't get the vaccine. That's in line with other years.

The vaccine is reformulated annually, and this year's is a good match to the viruses going around.

The flu's early arrival coincided with spikes in flu-like illnesses caused by other bugs, including a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." Those illnesses likely are part of the heavy traffic in hospital and clinic waiting rooms, CDC officials said.

Europeans also are suffering an early flu season, though a milder strain predominates there. China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo have also reported increasing flu.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

Most people with flu have a mild illness. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms.

Some shortages have been reported for children's liquid Tamiflu, a prescription medicine used to treat flu. But health officials say adult Tamiflu pills are available, and pharmacists can convert those to doses for children.

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Associated Press writers Dan Sewell in Cincinnati, Catherine Lucey in Des Moines, and Malcolm Ritter in New York contributed to this report.

___

Online:

CDC flu: http://www.cdc.gov/flu/index.htm

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3 suspects arrested in Nordstrom Rack robbery, captive situation

Los Angeles police have arrested two men and a woman on suspicion of carrying out a brazen robbery at the Nordstrom Rack in Westchester and holding 14 employees captive last week.

The LAPD released few details Sunday evening other than to confirm they had arrested at least two suspected gang members, including at least one at a Phoenix motel Saturday.

Police would not release the suspects' identities, nor would they detail how they were taken into custody or their alleged roles in the robbery and captive situation. Sources familiar with the investigation said the man arrested in Phoenix appeared to be the principal suspect but would provide no other information.

Sources said police had strong evidence linking the men to the crime, including physical evidence and security camera video. Prosecutors will decide this week whether to file charges.

The incident began around 11 p.m. Thursday at the Promenade at Howard Hughes Center, near the 405 Freeway. The LAPD called a tactical alert and closed off the area around the shopping center.

When the Police Department's SWAT officers arrived, they surrounded the store. At one point, one suspect exited, saw the police and ran back inside.

A second suspect walked out with an unidentified woman, saw police and also headed back inside. The suspects apparently fled in a while SUV, which police said they lost sight of. The officers entered the store at 3:30 a.m. and freed the captives.

At least three of the employees were wounded, including one woman who was sexually assaulted. Another woman was stabbed in the neck and sustained non-life-threatening wounds, and a third employee was pistol-whipped, police said.

It was unclear whether the robbers hid in the store or gained entrance after it closed. It was also not clear precisely how long they remained in the store before fleeing, and police would not say how much cash was stolen.

At least two employees hid in the restroom, LAPD officials said. The rest of the group was herded into a storage room by the robbers, except for one woman who was taken separately and sexually assaulted, police said.

To help identify the suspects, LAPD Robbery-Homicide detectives conducted numerous witness interviews and examined surveillance video from inside and outside the Nordstrom Rack as well as from surrounding businesses.

andrew.blankstein@latimes.com

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E-Ink on a Smartphone? This Android Phone Has 2 Displays

Times Up

You can use the rear of the YotaPhone as a clock, or to display wallpapers.

Click here to view this gallery.

[More from Mashable: Hands On With Pebble, the Internet’s Favorite Smart Watch]

LAS VEGAS — What if your phone had two displays? Announced in mid-December, YotaPhone aims to change how people use their smartphones by bringing together a full-color LCD display on one side of the phone and an e-ink display on the other.

I caught up with Yota Device’s Vladislav Martynov at CES to give the phone a closer look.

[More from Mashable: 5 Chinese Tech Brands You’ll Be Hearing From in 2013]

In essence, the two displays on the handset each have their own unique purpose. The front display is used just as you might your traditional smartphone screen to run apps, browse the web or watch videos.

The rear display on the YotaPhone is what makes it stand out. An electronic paper display, it shows content you push to it from the front of the device. Less for interacting with and more for reference information, you can use the display for a map to your next destination, a clock, or a place to keep the boarding pass for your flight handy.

Martynov showed me a few applications designed specifically to use with the screen as well, including an app that shows low long you’ve kept a particular goal, such as not smoking. The company plans to release an API for other developers to make applications that take advantage of the dual-screen functionality as well.

Running Android 4.1 Jelly Bean, Martynov says that he plans to keep Android as vanilla as possible, something he feels is very important. He also wants to make sure that the phone is on-par with high-end Android smartphones, spec-wise. The current iteration uses the Qualcomm Snapdragon MSM 8960 platform, and Corning’s 3D Gorilla Glass. It’s also a multi-band LTE handset that can run on LTE networks anywhere in the world.

YotaPhone is expected to go one sale during the second half of 2013.

What uses do you see for an e-ink second screen? Let us know your thoughts in the comment.

This story originally published on Mashable here.

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Justin Timberlake Returns with Hot New Single

By Kevin O'Donnell

01/14/2013 at 07:25 AM EST

What a comeback!

After announcing on Thursday his plans to return to music, Justin Timberlake has finally let fans hear what he's been cooking up in the studio: a new single titled "Suit & Tie," which he posted on his website Sunday night.

And if the news of his first song in years wasn't enough, the track – a funky, futuristic R&B number about hitting the dance floor with a special lady – also features a guest spot from Jay-Z.

Timberlake, 31, marked the release of "Suit & Tie" by posting an open letter to fans. And the singer says he'll release a new album this year – his first since 2006's FutureSex/Lovesounds. The title: The 20/20 Experience.

"Back in June of last year, I quietly started working on what is now, my next journey with the thing I love called MUSIC," he writes. "The inspiration for this really came out of the blue and to be honest, I didn't expect anything out of it."

"Suit & Tie" is available for download on iTunes now.

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Thousands of Russians Rally Against Adoption Ban

MOSCOW – Thousands of Russians marched on Sunday in condemnation of the Russian Parliament’s move to ban adoption of Russian children by American families, an event dubbed a “March Against Scoundrels,” where participants chanted, “Take your hands off children,” and carried posters showing the faces of lawmakers stamped with the word “Shame.”

Marchers flooded tree-lined boulevards for many blocks on a bitterly cold day. The police estimated the turnout for the march, which was sanctioned by city authorities, at 9,500; a group of activists who made a count told Interfax that there were about 24,000 participants.

The sight gags and clever slogans of last year’s anti-government rallies were gone Sunday, and many participants had emotional answers for why they had come to march. Many questioned the moral principles of a ban on adoptions by Americans in a country with so many children in foster care or orphanages.

“Even I can’t afford to adopt, and I’m supposedly middle class,” Yekaterina Komissarova, 31, said, adding that perhaps the issue angered her so deeply because she was the mother of two children.

Marina Lukanova, a teacher, said many of her friends had tried to adopt and found it nearly impossible. “What they found was endless bureaucracy – they fill out forms and nothing happens,” she said. “And now they have given up.”

The adoption ban has underlined a growing division in Russian society, as the government has embraced conservative rhetoric tailored to voters in the heartland, and turned away from prosperous city-dwellers who have mobilized over the Internet. State-controlled television has regaled Russians with reports of American parents who abuse or neglect Russian children, and a top official derided the marchers as “child-sellers.”

“I am especially surprised to see people gather at such a large action in support of American business — because for them, our children, Russian children, are factually, let’s put it this way, an object of trade,” said Yekaterina Lakhova, the United Russia lawmaker who sponsored the ban, in an interview with Kommersant FM radio station shortly after Sunday’s march began.

“Economically developed countries – and we do not consider ourselves a third-world country, we are in the top 20 – do not give up their children to foreign adoption as much as we do,” she said. “Excuse me, but in the past years, we have given the United States a small city with a population of up to 100,000, that is how many children we have given up to foreign adoptions.”

President Vladimir V. Putin approved the adoption ban in late December, as part of a broader law retaliating against the United States for the so-called Magnitsky Act, an effort to punish Russian officials accused of human rights violations.

Russian leaders have complained bitterly for years about light sentences handed down in cases where American adoptive parents abused or neglected children adopted from Russia, and named the ban after Dmitri Yakovlev, a toddler who died of heatstroke in Virginia in 2008 after his adoptive father left him in a parked car for nine hours.

But the decision has proven divisive in Russia, even within government circles. More than 650,000 children live in foster care or orphanages in Russia, of whom about 120,000 are eligible for adoption. Many children in orphanages are sick or disabled, and most have little hope of finding permanent homes.

“We hope that these people, who came out to express their opinion, are aware of the plans of our nation’s leaders to bring order to the adoption process, and the implementation of a range of measures aimed to improve the lives of orphans,” Dmitri S. Peskov, the Kremlin press secretary, said.

The protesters on Sunday, however, were not likely to be convinced. One woman carried a sign that read, “Stop the repressions, you’re making revolutionaries out of us.” Many said they support the Magnitsky Act, which was passed by the American Congress late last year, as a way to hold Russian officials accountable for crimes that would otherwise never be punished.

“I truly think they have lost touch with society, and they use these laws to divert society’s anger toward ‘our enemies,’ the Americans,” said Boris Komberg, a physicist who was distributing a poem he had written.

A series of high-ranking officials openly expressed their disagreement before the ban was enacted, and figures from the art and entertainment world have recorded emotional messages of dissent and published them on the Internet. Opposition groups have hoped that outrage sparked by the adoption ban would reinvigorate a Moscow-based protest movement that has sagged in recent months, as the government began to prosecute and impose tough sentences on street activists.

A poll released in December by the Public Opinion Foundation showed that 56 percent of Russians approved of the adoption ban. A top official from United Russia, Andrei Isayev, last week described Sunday’s protest as a “March of Child-Sellers,” and tried to refocus attention on the Magnitsky Act, which he described as a “public, demonstrative humiliation of the Russian Federation.”

“All the enemies of Russian sovereignty showed themselves the ardent supporters of American adoption,” Mr. Isayev wrote on a party Web site.

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