PHILADELPHIA - MedPage Today disclosed a checklist for prospective surgical outpatients the most likely to be surgical inpatients.  The list includes those who are older, set for longer surgery, who will have regional or general anesthesia, or have one or more of five co-morbidities, scientists say.  Those with at least four risk factors were more than 30 times more likely to require hospitalization than those with one risk factor or none, said Dr. Lee Fleisher, of the University of Pennsylvania, and colleagues in the Archives of Surgery.  Determining the risk score preoperatively may help clinicians and patients set the most appropriate setting for a procedure, they said.  "This isn’t to suggest patients with an outpatient surgery admission index of four or higher should universally undergo inpatient surgery," they wrote.  The study included 783,539 procedures at hospital-based and free-standing ambulatory surgery centers in New York in 1997, recorded in an Agency for Healthcare Research and Quality database.  Researchers excluded cardiac catheterizations, endoscopies, cataract operations, and discharges other than routine or short-term hospitalization.  Most procedures were done in a hospital-based facility (95%).

CHICAGO - The Associated Press reported a surprising study of elderly people suggests those who see themselves as self-disciplined, organized achievers have a lower risk for Alzheimer's than less conscientious people.  A purposeful personality may somehow protect the brain, perhaps by raising neural connections that can be a reserve against mental decline, said study co-author Robert Wilson, of Rush University Medical Center.  Astoundingly, the brains of some of the dutiful people in the study were examined after their deaths and found to have lesions that would meet accepted criteria for Alzheimer's, even though they had shown no signs of dementia.  "This adds to our knowledge that lifestyle, personality, how we think, feel, and behave are tied up very importantly with risk for this terrible illness," Wilson said.  "It may suggest new ideas for trying to delay the onset of this illness."

ROCKVILLE, MD - The Agency for Healthcare Research and Quality has checklists to help men and women understand which checkup tests they need to stay healthy at any age.  Your Checklist for Health has what the U.S. Preventive Services Task Force urges on screening, preventive medicine, and other lifestyle behaviors.  Dr. Carolyn Clancy, AHRQ director, said, "The checklists provide patients with a scientific understandable reference tool."  In English and Spanish, the pocket-size checklists go with patients on visits to healthcare providers to discuss which screening they might need.  The checklist for men includes ideas about cholesterol checks, tests for high blood pressure, colorectal cancer screening, and screening for abdominal aortic aneurysm, HIV, and obesity.  The list for women includes plans for screening for high cholesterol; breast, cervical, and colorectal cancers, and osteoporosis.  It has thoughts on obesity and HIV screening for pregnant women.

WASHINGTON - Monday Morning in Washington, DC noted the Big Sky project coordinated by United Cerebral Palsy is a national effort to create a vision of the future for people with disabilities.  The project is designed to raise public awareness about the serious challenges that remain for people with disabilities and develop strategies, initiatives, programs, and public policy to address them (www.ucp.org/ucp_general.cfm/1/16243).

BOSTON - HealthDay News disclosed patients with bipolar disorder get no treatment benefit adding an antidepressant to a standard mood stabilizer such as lithium, a study found.  Results show using a mood stabilizer alone is preferable and against common practice.  "We really think at the beginning of treatment, it’s very reasonable to have this 'mood-stabilizer-optimized' kind of approach.  What we've learned from this study is it makes sense to give that time to work," said Dr. Gary Sachs, lead author of the study, director of the bipolar clinic and research program at Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School.  He said, "We didn’t show any group gained from having antidepressants added."  Doubling the medications didn’t confer any risk, Dr. Sachs' team noted in the New England Journal of Medicine.  Treating bipolar disorder is never a one-size-fits-all situation.

DURHAM, NC - MedPage Today noted biopsies may underestimate severity of prostate cancer in obese men.  In a study of biopsies and surgical specimens of more than 1,100 men who had radical prostatectomy, obese men were significantly more likely than normal weight men to have cancers that became higher grade, said Dr. Stephen Freedland, of Duke University, and colleagues in Urology.  "We know it's more difficult to diagnose prostate cancer in obese men because they have lower levels of prostate-specific antigen … and their larger-sized prostates make it more likely for a biopsy to miss the cancer," he said.  "These findings suggest we could be missing even more high-grade disease among obese men."  He and colleagues used the Shared Equal Access Regional Cancer Hospital database, a large-scale, multi-center, multi-ethnic database on men at the Veterans Affairs Medical Centers in Los Angeles, Palo Alto, and San Francisco, in Augusta, GA, and at San Diego Naval Hospital.

SUTTON, ENGLAND - Reuters Health noted adding chemotherapy to estrogen-blocking drug tamoxifen improves survival of early breast cancer, two studies by the Adjuvant Breast Cancer (ABC) Trials Collaborative Group found.  By contrast, preventing estrogen secretion from the ovaries seems to offer no benefit for most women.  In the trial, Dr. Judith Bliss, of the Institute of Cancer Research, and her team assessed outcomes of 1,991 patients ages 28-81, who received five years of tamoxifen therapy with or without standard chemotherapy.  Some pre-menopausal women were treated with ovarian removal or suppression, which stops hormone secretions.  The chemotherapy group experienced fewer recurrences of cancer, but the difference fell short of statistical significance, stated the Journal of the National Cancer Institute report.  Still, chemotherapy did cut the overall risk of death 17%.  Analysis showed chemotherapy gave the greatest survival benefit in women younger than 50, especially pre-menopausal women not treated with ovarian ablation or suppression.

JACKSONVILLE, FL - Denial is a common response to stress, an important coping and defense mechanism, or delay appropriate response to circumstances.  Mayo Clinic Women’s HealthSource noted how denial can help or be a roadblock to good health.  Denial in the broad sense is refusing to acknowledge painful/overwhelming external circumstances, avoiding facts, or minimizing consequences.  Denial - or healthy skepticism - can help withhold judgment until all the facts are in.  It prevents obsession with minor pains.  A cough doesn’t mean pneumonia until it’s properly diagnosed by a doctor.  When patients hear bad news, denying or suppressing it can offer needed time to grip challenges ahead.  Gradually adjusting to major changes can lead to better decisions.  Denial that prevents seeking treatment or leads to misuse of alcohol or drugs becomes harmful response.  A woman who finds a lump in her breast and ignores it misses the benefit of early diagnosis and best chance for cure.  Denying consequences of smoking or staying in an abusive relationship can jeopardize long-term health.  It all comes down to finding a healthy balance.

BOSTON - Dry eye syndrome (DES) is characterized by an insufficient amount or quality of tears.  In most people, a constant tear film lubricates and protects eyes.  In DES people, a lower output of fluid can weaken tear film, causing the eye to become dry, irritated, and uncomfortable.  In an American Journal of Ophthalmology study, scientists found DES can have considerable and detrimental effect on everyday life.  The study of about 700 people found sufferers of DES were more likely to report problems with daily life, including reading, using a computer, driving, and watching TV than people without DES.  It was found DES may be more of a public health woe than thought.  Women are about 2-3 times more likely to get DES than men.  "We don’t know all of the reasons why," said Dr. Debra Schaumberg, study author and ophthalmic epidemiology director at Brigham and Women’s Hospital.  "There is speculation one chief reason might be sex steroid hormones are involved in the pathogenesis of the disease."  Other reasons include the balance of female and male sex hormones.

PORTLAND, ME - U.S. worker disabilities are growing faster, forcing employers to accommodate more workplace maladies, studies show.  More often this reflects poor nutrition and lack of exercise, researchers say.  An aging workforce and expanding obesity lead to woes such as back pain, knee and hip injuries, and diabetes.  Improved treatments for diseases such as cancer and heart disease mean some patients who would have died survive - with disabilities.  Working women are becoming disabled faster than men; only 36% of employees have disability insurance.  The Council for Disability Awareness, an insurance group, found more than 500,000 people received long-term disability payments from council members in 2006, up 4.4% from 2005, when claims rose 1.4%.  Insurers paid $7.5 billion in claims last year, up 7.5% from 2005.  Recipients of Social Security Disability Income grew 4.4% last year and grew 51% in 10 years, with women filing claims at nearly twice the rate as men.  Such claims will grow due to labor shortages in an aging population as more baby boomers work past 65 or 70 and develop impairments requiring workplace accommodations to be productive.