Western Occupational & Environmental Medical Association
Leading Occupational & Environmental Medicine

e-Newsletter – April 2011

Welcome to WOEMA’s e-newsletter. After over 50 years, gone is WOEMA’s printed newsletter for this new electronic format. WOEMA is committed to providing on-going communications to members while reducing its carbon footprint by eliminating paper usage. WOEMA members receive the newsletter via email every other month with contents appearing on this website. This e-newsletter includes links to pertinent information. Contributions from members of articles, photos, links may be sent to:woema@woema.org  — Peter Swann, MD, FAAFP, Newsletter Editor 

President’s Message: WOEMA Briefs Members on Public and Worker Health Impact of Japan Crisis
– Contact Your Legislators NOW about Federal NIOSH-funded ERC / Ag Center Cuts
– News You Can Use from the Literature
– Class of 2011: Ten WOEMA Members Become ACOEM Fellows
– Upcoming CME Events

President’s Message: WOEMA Briefs Members on Public and Worker Health Impact of Japan Crisis
Roger Belcourt, MD, MPH, FACOEM

The 9.0-magnitude earthquake, which caused a massive tsunami of 30-foot walls of water to hit Japan, caused food, water, and power shortages for millions of people. The country continues its critical work to stabilize nuclear plants gravely damaged during the natural disaster. Arguably, an environmental disaster of this magnitude has not been seen since the end of WWII. On April 6, WOEMA provided a CME webinar to inform members about the public and worker health impacts of the disaster. The webinar, presented by James Seward, MD, MPP, FACOEM and Thomas McKone, PhD, “Public and Worker Health From the Fukushima Nuclear Plant Accident,” is available for download. Members receive 1.0 AMA PRA Category 1 Credit(s) free of charge by listening to the webinar and completing the on-line questionnaire for this webinar and others.

WOEMA urges members to take the the following actions, as the crisis continues:

  1. E-mail any OEM physician-colleagues in Japan to express our support and to offer our expertise.
  2. Consider a personal donation to any trusted agency or non-governmental organization with a proven track-record or responsiveness and accountability.
  3. E-mail woema@woema.org should you have any other ideas or suggestions for our response effort.

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Proposed Budget Cuts to NIOSH-funded ERCs and Ag Health Centers: Letters/E-Mails Needed NOW!

April 23, 2011 – WOEMA Member Alert
 — The President’s Fiscal 2012 budget signals the elimination of the Education and Research Centers (ERCs) and the Agricultural Health Centers, currently funded in large part by the National Institute for Occupational Safety and Health (NIOSH). These proposed cuts would in effect terminate these very important institutions nationwide, including the Northern California ERC, the Southern California ERC, the Utah ERC, and the Agricultural Health Center at the University of California, Davis.

The ERC and Ag Center budgets have been temporarily spared in the 2011 Federal Budget, however, these programs are still slated for elimination in the proposed 2012 Federal budget.  We must continue our efforts to reverse these proposed cuts–which in the context of the Federal budget deficit are triflingly small at about $43 million.  If these cuts go through, then next year nearly all of the 17 Education and Resource Centers (ERCs) in the nation would probably have to close, and further training of Occupational Health professionals would be drastically curtailed in the entire country.  In our own area, the ERCs at UCLA, UC Irvine, UC San Francisco, and in Utah, as well as the Agricultural Health Center at UC Davis, would be targeted for closure.  We have only a few more weeks to persuade Congress and the Administration to reverse these short-sighted proposed cuts.

On-going training of Occupational Safety and Health professionals, including Occupational Medicine residents and nurse practitioners, is crucial for the well being of our field, and is also pivotally important for the health and productivity of the American workforce. The United States currently has a shortage of Occupational Physicians by a factor of 10 to 50 per capita, compared with almost all other industrialized nations–and this finding is independent of the political leanings of the country. Why have other countries deployed so many more Occupational Physicians?   Simply put, they have discovered that the workplace is a very efficient site for delivering preventive services.  And their investment in Occupational Medicine has paid off in lower costs for national health care, as well as safer and more productive workplaces. Now, at this pivotal time for us as America begins to change our national healthcare system, we will need MORE Occupational physicians, not fewer.  Accordingly, we should be expanding the ERCs, not cutting them.  So, we need your help to send Congress a message —DO NOT CUT the very modest NIOSH budget for the ERCs, as the current 2012 Federal budget would propose to do. WOEMA urges our members to contact their Congressional Representatives and Senators once again, asking them to oppose these short-sighed proposed budget cuts.

In particular, we are aware that Representatives George Miller, Mike Thompson, and Jerry Lewisof California may be key voices in this debate.  WOEMA members living or working in the Districts of these House members may be especially influential in bringing this message to their elected officials. We would urge even a brief phone call to these Representatives:

George Miller: (202) 225-2095 (See attached support letter from Representative Miller to Director Jack Lew of the OMB)
Mike Thompson: (202) 225-3311
Jerry Lewis: (800) 233-1700

The voices of business leaders are likely to be especially persuasive with Congress.  If you have business contacts who might be willing to join with us in opposing these proposed cuts, we would ask that you use your influence to obtain additional business support for our position. ” Here is a draft letter/message you could send to your representative.

What does this mean? NIOSH supports 17 university-based ERCs whose mission is to reduce work-related injuries and illnesses in the U.S. by conducting prevention research and by educating Occupational Health professionals. The ERCs provide training and research resources to every Public Health Region in the United States. Many centers are collaborative efforts among several institutions in their region, training occupational health physicians, occupational health nurses, industrial hygienists, safety specialists, and other related professionals. America currently has a shortage of Occupational Health professionals, and in fact lags far behind other industrial nations in our per capita supply of Occupational Medicine physicians and nurses. With regard to America’s need for disaster preparedness, our attention has been recently drawn to the unimaginable environmental and workplace tragedy that has befallen the people of Japan. Now more than ever, we believe it is critically necessary to support both research and the training of occupational and environmental professionals.

Your help is needed. We need you to raise the alarm to your federal elected representatives about how NIOSH funding has benefited not just the training of occupational health professionals, butESPECIALLY how it has benefited companies/businesses/employers. In fact, the ERCs and Agricultural Health Centers deserve to be expanded, not cut — particularly at this time in history when our health care system is facing huge changes that will focus more than ever on public health prevention.

WOEMA MEMBERS: Use this template letter to send to your legislator [Template Letter]

Download copies of letters sent by ACOEM: [ACOEM letter to Congress] [ACOEM letter to Senate]

Write your member of congress an email today – simply enter your zip code and the system will address it directly to your representative.

Contact your own Senators via email using the links below:

Senator Dan Akaka
Senator Dan Inouye

Senator Diane Feinstein
Senator Barbara Boxer

Senator Orrin Hatch
Senator Mike Lee

Senator Jon Kyl
Senator John McCain

Senator John Ensign
Senator Harry Reid

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News You Can Use from the Literature
by Constantine J. Gean, MD, MS, MBA, FACOEM

A useful review of the latest journal articles of interest to the field of occupational medicine.

In adults with major depressive disorder (MDD), there was a 6.4 X increase in the frequency of suicidal behavior in patients (all ages) treated with paroxetine (Paxil) compared with placebo per an EU-mandated GSK pooled analysis of paroxetine (57 trials for all indications, 19 trials specific to MDD) compared with placebo (11/3455 [0.32%] versus 1/1978 [0.05%]). These MDD data suggest that the higher frequency observed in the younger adult population across psychiatric disorders may extend beyond the age of 24. Effect of Paroxetine Controlled Release Tablets and Paroxetine Tablets on suicidal Ideation and Behavior in Adults [Read More]

Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a WC setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor RTW status 2 years after the date of injury (for controls) or 2 years after date of surgery (for cases), per a historical cohort study of 725 workers’ compensation (WC) subjects with lumbar fusion and 725 randomly selected with chronic low back pain diagnoses.Specifically, two years after fusion surgery, 26% (n = 188) of fusion cases had RTW, while 67% (n = 483) of nonsurgical controls had RTW. The reoperation rate was 27% (n = 194) for surgical patients and permanent disability rates were 11% (n = 82) for cases and 2% (n = 11) for nonoperative controls. For lumbar fusion subjects, daily opioid use increased 41% after surgery, with 76% (n = 550) of cases continuing opioid use after surgery. Total number of days off work was more prolonged for cases compared to controls, 1140 and 316 days, respectively. The authors write, “This procedure is offered to improve pain and function, yet objective outcomes showed increased permanent disability, poor return to work status, and higher doses of opioids.” Spinal fusion should be “cautiously considered” in workers’ compensation patients-and then only for patients with diagnoses for which spinal fusion has proven specifically effective. Spine, 2011 Feb 15;36(4):320-31 [Read More]
Corticosteroid injections improve short-term outcomes in lateral epicondylalgia but are worse than no intervention or physiotherapy for intermediate- and long-term outcomes for some types of tendinopathy
, per a systematic pooled analysis review of treatment of 41 RCTs (total subjects = 2672) meeting selection criteria by Coombes and colleagues primarily evaluates corticosteroid injections for lateral epicondylalgia and rotator cuff tendinopathies, although other conditions are included. Lancet. 2010 Nov 20;376(9754):1751-67. [Read More]

Sensory ganglionopathy can be a manifestation of gluten sensitivity and may respond to a strict gluten-free diet, per a retrospective observational case series from a cohort of 409 patients with different types of peripheral neuropathies, 53 (13%) had clinical and neurophysiologic evidence of sensory ganglionopathy. Out of these 53 patients, 17 (32%) had serologic evidence of gluten sensitivity – of these, 15 patients went on a gluten-free diet, resulting in stabilization of the neuropathy in 11 (the remaining 4 had poor adherence to the diet and progressed). Autopsy tissue from 3 patients demonstrated inflammation in the dorsal root ganglia with degeneration of the posterior columns of the spinal cord. Neurology. 2010 Sep 14;75(11):1003-8. [Read More]

iPhone apps for smoking cessation rarely adhere to established guidelines for smoking cessation per a study set out to examine the content of the 47 iPhone applications (apps) for smoking cessation that were distributed through the iTunes store as of 6/24/09. Each app was independently coded by two reviewers for adherence to the U.S. Public Health Service’s 2008 Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Am J Prev Med. 2011 Mar;40(3):279-85. [Read More]

The ability of individual physical examination (PE) tests and test combinations to predict the presence or absence of MRI-documented nerve root impingement at midlumbar, low lumbar, and specific nerve root levels was quantitatively assessed in a cross-sectional study of 160 participants with a history of radicular pain in a L2 to S1 dermatome. to assess the ability of individual physical examination tests (and test combinations) to predict the presence or absence of nerve root impingement. For the diagnosis of low lumbar impingement, the Achilles reflex test demonstrated an LR ≥5.0 (LR 7.1). Test combinations did not increase LRs. For the diagnosis of midlumbar impingement, the femoral stretch test (FST), crossed FST, medial ankle pinprick sensation, and patellar reflex testing demonstrated LRs ≥5.0.For the diagnosis of level-specific impingement, LRs ≥5.0 were observed for anterior thigh sensation at L2 (LR=13); FST at L3 (LR=5.7); patellar reflex testing (LR=7.7), medial ankle sensation (LR=∞), or crossed FST (LR=13) at L4; and hip abductor strength at L5 (LR=11). [ NOTE: LRs ≥5.0 indicate moderate to large changes from pre-test probability of nerve root impingement to post-test probability, indicating a useful PE test.] Spine 2011;36:63-73. [Read More]

FDA approves Zostavax vaccine to prevent shingles in individuals 50 to 59 years of age(Zostavax is already approved for use in individuals 60 years of age and older). [Read More]

Success in a weight loss program was significantly correlated with increased sleep time and declines in stress and depression at entry per a nonrandomized intensive 6-month behavioral weight loss intervention to 472 obese (body mass index 30-50) adult participants. Intervention consisted of 22 group sessions led over 26 weeks by behavioral counselors – recommendations included reducing intake by 500 cal/d, adopting the DASH diet pattern and increasing physical exercise to at least 180_min per week. Authors concluded clinicians might target sleep, depression and stress as part of a behavioral weight loss intervention. Int J Obes (Lond). 2011 Mar 29 [Read More]

Subthalamic nucleus infusion of AAV2-GAD showed a 23.1% (vs. control 12.7%) improvement from baseline in Parkinson’s disease motor scores compared with controls per a double-blind, sham-surgery controlled, randomised trial of 66 patients aged 30-75 years who had progressive levodopa-responsive Parkinson’s disease. At the 6-month endpoint, Parkinson’s disease rating scale (UPDRS) for the AAV2-GAD group decreased by 8.1 points (23.1%) and by 4.7 points in the sham group (12.7%). [NOTE: the gene designated AAV2-GAD produces an enzyme that synthesizes the neurotransmitter, GABA. In PD, the loss of dopamine neurons causes other neurons involved in motor function to become excessively active. GABA neurotransmission reduces that overactivity.] Lancet Neurol. 2011 Apr;10(4):309-19 [Read More]

A new type of heart valve made with cow tissue and inserted by catheter for severe aortic stenosis lowered costs involved with rehospitalization in frail, elderly patients and was found to increase life expectancy by as much as 1.9 years, per a study of 699 patients ( median age 84), randomly assigned to transcatheter aortic valve replacement (TAVR) or open heart surgery to replace the aortic valve (AVR). The study also demonstrated improved death rate (3.4% vs. 6.4%), major bleeding (9.3% vs. 19.3%) and irregular heart rhythm (8.6% vs. 16%) in TAVR vs. open heart surgery patients. Major stroke risk was higher in TAVR patients (3.8% vs. 2.1% at 30 days and 5.1% vs. 2.4% after one year. [NOTE: aortic stenosis affects nine percent of Americans over 65. Without treatment, up to half of patients die within two years.] American College of Cardiology conference in New Orleans. [Read More]

The evidence is inconsistent and inconclusive as to causality that vitamin D reduces cancer incidence and mortality per an Institute of Medicine (IOM) panel that recently published a definitive report on vitamin D and health outcomes. The committee concluded that the majority of Americans and Canadians are receiving adequate amounts of both calcium and vitamin D. [Read More]

Initial oral steroid therapy followed by topical steroid therapy Chronic rhinosinusitis (CRS) with nasal polyposis seems to be more effective over 6 months than topical steroid therapy alone per a study where patients were randomly assigned to receive oral prednisolone, 25 mg/d, or placebo for 2 weeks, followed in both groups by fluticasone propionate nasal drops, 400 ug twice daily, for 8 weeks and then fluticasone propionate nasal spray, 200 ug twice daily, for 18 weeks. Decrease in polyp grade from baseline to 2 weeks was 2.1 units in the prednisolone group and 0.1 unit in the placebo group; the difference was -1.08 units at 10 weeks and -0.8 unit at 28 weeks. Prednisolone therapy resulted in transient suppression of adrenal function and increase in bone turnover after 2 weeks, with a return to baseline at 10 and 28 weeks. [Read More]

Dog ownership was associated with more physical activity among adolescents (mean age =14.6 yrs, 49% male), with physical activity assessed by ActiGraph accelerometers assessing min/day of moderate to vigorous activity. Am. J. of Prev. Med. 2011 Mar;40(3):334-7. [Read More]

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Members Gather at ACOEM Fellows Ceremony to Congratulate Ten Newly Inducted WOEMA Members


AOHC Fellows

Ten WOEMA members recently became new Fellows of the American College of Occupational & Environmental Medicine. They were recognized on March 29, 2011 at an induction ceremony held during the American Occupational Health Conference (AOHC) at the Grand Hyatt in Washington, DC. Members of WOEMA are shown heregathered around the podium at the conclusion of the event with one of the newly inducted Fellows: Dean Baker, MD, FACOEM (center).

The 2011 ACOEM Fellows Class:

Dean B. Baker, MD, MPH, FACOEM
Marion J. Fedoruk, MD, FACOEM
Don C. Fisher, MD, MS., FACOEM
Paul M. Johnson, MD, MPH, FACOEM
Paula T. Lenny, MD, MPH, FACOEM
Scott C. Levy, MD, MPH, FACOEM
Kaochoy Saechao, MD, FACOEM
Ramon Terrazas, MD, MPH, FACOEM
Craig M. Uejo, MD, MPH, FACOEM
Christina Y. Wang, MD, MPH, FACOEM

Learn more about earning ACOEM Fellow Status.

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Upcoming CME Events

REGISTER NOW TO ATTEND WOHC September 8-10, 2011 – Register on-line to attend theWestern Occupational Health Conference (WOHC). This year’s theme: “Improving Your Odds of Practice Success,” at the Bellagio Resort, Las Vegas. WOHC offers up to 20 AMA PRA Category 1 CreditsTM and MOC credit,stimulating lectures and workshops, exciting worksite tours, and sensational social events and activities. Matched with an incredible room rate of $139/night at theBellagio Resort. Some tours and special evevts have maximum attendee limits, so be sure to register early and make your travel plans to take full advantage of the early-bird rates, low room rate, and exciting activities being offered at WOHC 2011.

Upcoming and Past WOEMA CME WebinarsAir at 12:00PM Pacific Time on the 3rd Thursday every other month Next FREE CME Webinar: June 16 – “Obstructive Sleep Apnea”

UC Davis 29th Annual Occupational and Environmental Medicine Symposium will be held in Sacramento, California, May 7, 2011 at the UC Davis Education Building. Website: UC Davis Health System

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