Western Occupational & Environmental Medical Association
Leading Occupational & Environmental Medicine

e-Newsletter – January/February 2010

Welcome to WOEMA’s new monthly 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 full version of the newsletter via email every other month and may also access contents on this website. It includes links to pertinent information.  — Peter Swann, MD, FAAFP, Newsletter Editor 

In this issue:
• Message from the President
• Save the Date for WOHC 2010

• News You Can Use from Dr. Gean
• Highlights of WOEMA Board of Directors Meeting

Message from WOEMA’s New President
by Paul Papanek, MD

Now, at the beginning of 2010, a year that’s likely to be WOEMA’s most successful year ever for reasons I’ll mention below, I think it’s appropriate to think back to WOEMA’s great successes of this past year, and to reflect on the great debt of gratitude that WOEMA’s members owe to our outgoing President, Dr. Steve Schumann.

Under Steve’s diligent and truly strategic leadership, WOEMA had one of its most successful conferences in history (WOHC – 2009 in Scottsdale, chaired by Dr. Peter Vasquez), and we climbed a very high hill in becoming accredited to provide Category I CME credit by the Institute of Medicine. It’s worth pointing out that no other ACOEM component has such an achievement. Armed with this new accreditation WOEMA has launched a series of educational webinars, which are slated to expand this year.

WOEMA also made important gains in our advocacy for laws and regulations to strengthen the practice of Occupational Medicine in our member states, including an agreement in California to move to a Workers’ Comp fee schedule that will be fairer to primary care providers. More to come in future newsletters.

So, please join me in a round of grateful and heartfelt applause for Dr. Schumann.

Now for a membership pitch. We need you. We need your support. WOEMA strives to bring value to our members, but we cannot succeed without the strong backing of our community of Occupational and Environmental physicians and other professionals. So, if you haven’t renewed your membership, please click onto the ACOEM website and continue to join with us, and succeed with us.

All the best to all of you for a healthy, safe, exciting, and prosperous 2010.

Save the Date…

Western Occupational Health Conference
September 30 – October 2, 2010
Directions for a New Decade”

Newport Beach Marriott Hotel & Spa

WOHC is widely respected as one of the premier national meetings focusing on the complex and evolving field of occupational medicine. Registration brochure coming soon! Hotel accommodations: $189 per night.

News You Can Use
by Constantine Gean, MD, MBA, MS, FACOEM

The age-adjusted rate of death from prescription opioid-related overdoses
 was 30.8 /100,000 in the Medicaid-enrolled population, vs. 4.0 /100,000 in the non-Medicaid population (RR = 5.7) in Washington State, 2004-2007, where 1,668 persons died from prescription opioid-related overdoses during the period (6.4 deaths /100,000 /year). 58.9% of decedents were male, and the highest percentage of deaths (34.4%) was among 45–54 year olds. 45.4% of deaths were among persons enrolled in Medicaid. Methadone, oxycodone, and hydrocodone were involved in 64.0%, 22.9%, and 13.9% of deaths, respectively. Methadone on death certificates was recorded nearly three times more often than the next most common opioid, oxycodone. More broadly, the number of poisoning deaths in the US nearly doubled, 1999–2006, and coincided with a nearly fourfold increase in the use of prescription opioids nationally. MMWR, Oct. 30, 2009/ 58(42);1171-1175 [Read more]

Five of 23 patients diagnosed as being in a vegetative state showed signs of consciousness on brain-imaging tests with functional magnetic resonance imaging tests on a study of 54 patients with disorders of consciousness (the 31 others were diagnosed as having a minimally conscious state and did not show a response). 5 were able to willfully modulate their brain activity (i.e., exhibited brain activity in the same areas as healthy control subjects when asked to perform mental visualization tasks). In 3 of these patients, additional bedside testing revealed some sign of awareness. New England Journal of Medicine February 3, 2010 [Epub]. [Read more]
A statistically significant association between angiotensin receptor blocker (“ARB”) use and the prevention of dementia
 (HR = 0.76) per a prospective cohort analysis with 800,000+ individuals, primarily males, over age 65. ARB use in patients with pre-existing Alzheimer’s disease were associated with a significantly lower risk of admission to a nursing home (HR = 0.51) and death (HR = 0.83, and showed dose-response as well as additive effects in combination with angiotensin converting enzyme inhibitors. Minor differences were shown in mean systolic and diastolic blood pressures between the groups. BMJ 2010 20:340:b5465 [Read more]

No evidence for greater effectiveness of spinal cord stimulation (SCS) vs. alternative treatments was found after 6 months in patients with failed back surgery syndrome (chronic back and leg pain after spine surgery), per a prospective, population-based controlled cohort study of 51 SCS-implanted patients vs. patients 39 evaluated at a multidisciplinary pain clinic and 68 patients with neither SCS nor pain clinic evaluation. Outcomes measured pain, function, medication use, and work status at baseline and 6, 12, and 24 months and work time loss over 24months. At 6 months, the SCS group showed modestly greater improvement in leg pain and function, but with higher rates of daily opioid use. These differences disappeared by 12 months. Patients who received a permanent spinal cord stimulator did not differ from patients who received some pain clinic treatment on the primary outcome at any follow-up (<10% successful in each group at each follow-up) and 19% had them removed within 18months. PAIN, Vol 148, Issue 1, pp 14-25 (January 2010) [Read more]

The single tests of painful arc, external rotation resistance, and empty can are helpful to confirm subacromial impingement syndrome (SAIS) and the single tests of painful arc, external rotation resistance, and Neer are useful screening tests to rule out subacromial impingement syndrome (SAIS), per receiver operating characteristic (ROC) curve and sensitivity, specificity, positive (+LR), and negative likelihood (-LR) ratios calculated for 55 patients with shoulder pain with ave. age = 40.6y. ArchPhysMedRehabil Vol 90, November2009 [Read more]

Consuming modest amounts of soy protein has little effect on bone loss in postmenopausal women, per a 3 year double-blind, randomized controlled trial of healthy postmenopausal women (45.8-65.0 y/0) ingesting either 80-mg daily or 120-mg soy isoflavone tablets, vs. to placebo tablets (all received 500 mg Ca and 600 IU Vit. D3). Outcomes of total proximal femur, femoral neck, and whole-body BMD showed no significant differences. The trial used compressed tablets of isoflavones extracted from soy protein. Am J Clin Nutr 91: 218-230, 2010 [Read more]

Patients with uncontrolled diabetes mellitus (DM) who underwent joint replacement surgery had increased odds of stroke (OR = 3.42), wound infection (OR = 2.28), and death (OR = 3.23), as well as UTI, ileus, transfusion, postop hemorrhage, and increased hospital stay (~ 1 day) when compared with patients with controlled DM- per a study of 3973 patients with uncontrolled DM, 105,485 with controlled DM, and 920,555 without DM. Control was assessed via American Diabetes Association guidelines. J Bone Joint Surg Am. 2009 Jul;91(7):1621-9. [Read more]

39% of pre-packaged salads contained more than 10,000 total coliforms, and 23% had more than 10,000 colony forming units (CFU) per gram enterococcus, per tests of tested on 208 pre-packaged salads (representing 16 brands) sold in either bags or plastic clamshell containers. Bacteria levels varied widely, with some samples containing undetectable levels and others containing more than 1 million CFUs per gram. Packaged produce tested at least six days from their use-by date tended to have lower levels of the bacteria than produce tested within five days of the use-by date. Salad mixes that included spinach tended to have higher bacteria levels than those without spinach. Consumer Reports, March, 2010. / WebMD Health News

Researchers identified selective outcome reporting and changed primary outcomes for trials of off-label use of gabapentin, based on analysis of 20 clinical trials for which internal documents were available from Pfizer and Parke-Davis; of these trials, 12 were reported in publications. For 8 of the 12 reported trials, the primary outcome defined in the published report differed from that described in the protocol. Sources of disagreement included (1) introduction of a new primary outcome (6 trials), failure to distinguish between primary and secondary outcomes (2 trials), relegation of primary outcomes to secondary outcomes (2 trials), and failure to report one or more protocol-defined primary outcomes (5 trials). Of the 21 primary outcomes described in the protocols of the published trials, 6 were not reported at all and 4 were reported as secondary outcomes. NEJM Volume 361:1963-1971November 12, 2009 Number 20 [Read more]

Individuals with excellent school performance had a nearly four fold increased risk of later bipolar disorder compared with those with average grades (HR = 3.79) per an analysis of individual school grades from all individuals finishing compulsory schooling in Sweden between 1988 and 1997 (over 700,000 subjects), and compared scholastic achievement at age 15-16 with hospital admission for psychosis between ages 17 and 31, adjusting for potential confounders. Students with the poorest grades were also at moderately increased risk of bipolar disorder (HR = 1.86). This association appeared to be confined to males. The British Journal of Psychiatry (2010) 196: 109-115 [Read more]

A 29 y/o woman off work due to depression lost benefits over Facebook photos depicting her showing her having a good time at a Chippendales bar show, at her birthday party and on a sun holiday. This was taken as evidence that she was no longer depressed. Insurance companies must weigh information found on such sites, said Claude Distasio, a spokeswoman for the Canadian Life and Health Insurance Association. Canadian Broadcasting Company News, Saturday, November 21, 2009 | 12:11 AM ET [Read more]

Macaques might be appropriate sentinels for human exposures to certain toxic materials, as they are synanthropic (ecologically associated with humans) and likely come into contact with anthropogenic toxicants, such as lead and mercury. Researchers measured lead (Pb) and mercury (Hg) levels in hair from three groups of free-ranging macaques populations that have contact with humans. Hair lead levels were significantly higher among young macaques and differed among the three groups and lead levels were not associated with diet. Authors concluded that behavioral and/or physiologic factors may play a significant role in determining exposure to lead and Macaques may function as a potential early indicator (animal sentinels) and young macaques that share the same ecological niche with humans may be one of the best indicators that their human neighbors, especially children, are being exposed to lead and other toxic metals. Am J Phys Anthropol 2010. (c) 2009 [Read more]

WOEMA Board of Directors meets in San Francisco
Highlights of the meeeting by Peter Swann, MD

The WOEMA Board had their biannual meeting in San Francisco on 01/30/2010. What follows is a brief summary of the meeting highlights:

Chairman’s report — Dr. Schumann reflected on some of WOEMA’s significant achievements in 2009:
• A very successful Western Occupational Health Conference (WOHC) in Scottsdale, Arizona
• WOEMA CME certification — any major achievement!
• A successful campaign by WOEMA member, Dr. Jim Seward, resulting in his election to the ACOEM Board.
• Augmentation of WOEMA’s E-communication abilities through Twitter, Facebook and are outstanding website
• Ongoing solid organizational finances with conservative fiscal management

Presidents report — Dr. Papanek’s report emphasized the overall WOEMA goal for 2010 is to continue to create value for membership. Other goals include:
• Formalizing a written strong legislative agenda.
• Expanding our work with other groups when mutually beneficial (e.g. Occupational Nursing Groups etc.)
• exploring the formation of a WOEMA Advisory Group composed of emeritus WOEMA leaders

Treasurer’s report — Dr. Govindarao emphasized WOEMA’s ongoing solid financial position and conservative financial management. Much discussion ensued concerning gradually increasing costs and the possible need to increase dues to cover these.
DECISION: Given the country’s ongoing economic difficulties and its implications for membership, decision was made not to raise dues in 2010, but instead delay until 2011.

WOHC 2011 — consideration being given to holding our conference in Las Vegas at the Bellagio. Analysis of possible locations continuing…STAY TUNED!

Selected Committee Reports:

Nominating Committee/Leadership Development:
• WOEMA member Dr. Dean Gean nominated to run for ACOEM Board. WHEN THE TIME COMES PLEASE SUPPORT DR. GEAN!
• It was also emphasized that all committees could use more members. Please consider joining at committee. We could use your talents.

Website Committee
• new content was added this year in the form of “Journal Watch” and “Test Your OCC-Qs”. Go to the website and see these new areas!

Education Committee
• the education committee developed and put on several occupational medicine Webinars this year. They were well received and more are planned.

The WOEMA Board of Directors and Committee Chairs following their January 30, 2010 meeting in San Francisco.