Western Occupational & Environmental Medical Association
Leading Occupational & Environmental Medicine

e-Newsletter – July 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 

– WOEMA Announces Candidates for 2012 Board Election
– Providers Question Changes to General Criteria and Provisions
– News You Can Use from the Literature
– Journal Watch– Upcoming Continuing Medical Education
– Legislative Fund Donors
– Electronic Health Records (EHR) Physician Desk Reference (FREE download)

WOEMA Announces Candidates for 2012 Board Election

Western Occupational & Environmental Medical Association — In accordance with the WOEMA bylaws, the Nominating Committee chaired by Steve Schumann, MD, submitted the proposed slate below for the 2012 Board of Directors and Officers. The WOEMA Board of Directors approved the proposed slate on June 26, 2011. Next, it will be presented to the WOEMA membership at the Annual Business Meeting on Friday, September 9, 2011 at 2 PM at the Bellagio Resort in Las Vegas during the Western Occupational Health Conference.Chairman of the Board 
Roger Belcourt, MD, MPH, FACOEM (2012)
UC Davis, Davis, CAPresident 
Walter Newman, Jr., MD (2012)
Newman Medical Group, San Jose, CA


Leslie Israel, DO, MPH, FACOEM (2012)
UC Irvine, Irvine, CAFirst Vice President 
Ellyn McIntosh, MD, MPH, FACOEM (2012)
ExxonMobil Corporation, Torrance, CA

Second Vice President 
Peter Vasquez, MD (2012)
Intel Health for Life Center, Chandler, AZ

Secretary/Newsletter Editor
Sachin Kapoor, DO, MBA, MPH, FACOEM (2013)
The Permanente Medical Group

Ramon J. Terrazas, MD, MPH., FACOEM (2012)
San Francisco Fire Department, San Francisco

Board of Directors Positions:

Contested Position #1 (2014): 

Robert C. Blink, MD, MPH
Worksite Partners Medical Group, Inc., San Francisco, CA

Steven D. Feinberg, MD, MPH
Feinberg Medical Group, Palo Alto, CA

Contested Position #2 (2014): 

Anne Searcy, MD
Zenith Insurance, Pleasanton, CA

Bryce Breitenstein, MD, MPH, FACOEM
Concentra Medical Clinics, Placentia, CA

Uncontested Position #3 (2012): 

William R. Lewis, MD (to complete an unexpired term)
Concentra, Phoenix, AZ

Continuing Terms:
Rupali Das, MD, MPH, FACOEM, CA Dept. of Public Health, Richmond, CA (2012)
Scott Levy, MD, MPH, FACOEM, Kaiser Permanente, San Rafael, CA (2013)
Paula Lenny, MD, MPH, FACOEM, Kaiser Permanente, Paia, HI (2013)
Kerry Parker, CAE, Executive Director, WOEMA (Ex-Officio)

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Providers Question Changes to General Criteria and Provisions

The CA State Compensation Insurance Fund (SCIF) recently contacted its MPN providers (in a letter dated June 10) with a request that they sign and return a revised General Criteria and Provisions (GPC) document as a condition for remaining in the Network. This document was due to be returned by June 30. Several members contacted WOEMA to express concerns and questions about this, and therefore, WOEMA has initiated a meeting with SCIF to open a dialogue on this topic. If you are part of the SCIF MPN or have concerns about the planned changes and wish to have your comments/questions included in this meeting, please send to: woema@woema.org  by no later than July 7.

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.

Social rejection activates the same areas of the brain that support the sensory components of physical pain
(secondary somatosensory cortex; dorsal posterior insula) per an fMRI study of 40 individuals who each performed two counterbalanced tasks during functional MRI (fMRI) scanning: (1) a Social Rejection task (comparing intense ex-partner break-up/rejection experiences to positive friend experiences) and a Physical Pain task: Hot trials(comparing noxious ‘hot trials’ thermal forearm stimulation to non-noxious ‘warm trials’). The authors conclude that powerfully elicited experiences of social rejection recruit brain regions involved in both the affective and sensory components of physical pain and share a common somatosensory representation. PNAS 2011 Apr 12;108(15):6270-5. Epub 2011 Mar 28. [Read Here]

As of Tuesday, 6/14/11, the had infected 3,335 people, 817 with HUS, 37 dead (including a 2-year old boy) from the E. coli strain causing a large outbreak of hemolytic uremic syndrome (HUS) and bloody diarrhea in Germany in May and June 2011. The organism possesses an unusual combination of pathogenic features typical of enteroaggregative E. coli (EAggEC) together with the capacity to produce Shiga toxin. Data from the genome sequencing of the rare E. coli serotype O104 were instantly released via the Internet to researchers around the world, and significant information sharing was credited with the rapid identification of the organism and identification of the likely source of the outbreak. [Read Here] – and – [Read Here]
A 10 ppb decrease in ozone concentrations increases worker productivity by 4.2 percent
per a study done by the NATIONAL BUREAU OF ECONOMIC RESEARCH utilizing a payroll collection database, (the Payroll Employee Tracking (PET) Tiger software system) for agricultural employees in the Central Valley of California. Time card entry, agriculture product output and Air resources board measurements gave highly quantified and relevant measures of ~1,600 workers intermittently over 155 days. [Read Here]
For cervical stenosis and lumbar spondylolysis only ~50% of surgeons agreed that surgery was needed
, while 76% of surgeons agreed on the need for surgery in 4 other kinds of cases
 – lumbar degenerative spondylolisthesis with stenosis, cervical herniated nucleus pulposus, lumbar spondylosis, and lumbar herniated nucleus pulposus. This per a review of the same 6 clinical vignettes done by each of 19 orthopedist or neurosurgeon members of the Degenerative Spine Study Group (Univ. of Pittsburgh and other University Medical Centers). The same vignettes were sent out 2 months later and 17 (17.7%) of 96 recommendations were changed by the reviewers when told the surgery would be on a close family member. When surgery was recommended, there was poor agreement among reviewers regarding what procedure to perform if surgery was recommended. SPINE Volume 36, Number 3, pp E203-E212, 2011. [Read Here]

Completion of at least one year of non-operative care that includes physical and cognitive therapy was formally declared one of the criteria for lumbar fusion in a patient with low back pain and degenerative disc disease per a 12/15/10 statement to BlueCross BlueShield of North Carolina signed by the presidents of the American Association of Neurological Surgeons, the American Association of Orthopaedic Surgeons, the North American Spine Society, the Pediatric Orthopaedic Association of North America, the Congress of Neurological Surgeons and others. Additional criteria included single or two level disc degeneration, inflammatory endplate changes (i.e., Modic changes), moderate to severe disc space collapse, absence of significant psychological distress or psychological comorbidities (e.g. depression, somatization disorder) and absence of litigation or compensation issues.[Read Here]

Patients at higher risk of predicted long-term, severe, back-related functional limitations can be predicted by a five-item clinical prediction rule consisting of only five items (feeling everything is an effort, trouble getting breath, hot/cold spells, numbness/tingling in parts of body, and pain in heart/chest), per a study of 1,262 participants assessed before medical consultation for nonspecific back pain in a large emergency room and assessed for functional limitations at 2 years. The five-item clinical prediction rule’s predictive validity was greater than that of the original 17-item version and was superior to the physician’s prediction. Journal of Clinical Epidemiology 64 (2011 54e66)[Read Here]

The U.S. FDA approved Pradaxa (dabigatran etexilate) 10/19/10 for the prevention of stroke and blood clots in patients with atrial fibrillation. Atrial fibrillation affects more than 2 million Americans. Pradaxa is an anticoagulant that inhibits thrombin and patients taking Pradaxa had fewer strokes than those on warfarin. The FDA noted that, “Unlike warfarin, which requires periodic blood tests, such monitoring is not necessary for Pradaxa”. [Read Here]

FDA approved Victrelis (boceprevir) 5/15/11 to treat hepatitis C virus (HCV); it is a direct acting antiviral drug (protease inhibitor), and is the first new drug for HCV in 20 years. Boceprevir is approved for the treatment of chronic HCV genotype 1 infection, in combination with peginterferon alfa and ribavirin, in patients aged 18 years and older with compensated liver disease, including cirrhosis, who are previously untreated or in whom previous interferon and ribavirin therapy have failed. Victrelis was evaluated in two phase 3 clinical trials with 1,500 adult patients. In both trials, two-thirds of patients receiving Victrelis in combination with pegylated interferon and ribavirin experienced a significantly increased sustained virologic response (i.e., hep C virus was no longer detected in the blood 24 weeks after stopping treatment), compared to pegylated interferon and ribavirin alone, the current standard of care. Victrelis is a pill taken 3 times a day with food. Most common side effects in patients receiving Victrelis was low red blood cell count (anemia), nausea, headache and taste distortion (dysgeusia). [Read Here]

CDC has issued a summary guide of infection prevention recommendations for outpatient (ambulatory care) settings. The document, GUIDE TO INFECTION PREVENTION IN OUTPATIENT SETTINGS: Minimum Expectations for Safe Care, is a 16 page summary of other documents and is dated 4/2011. It is an evidenced-based update and summary and 1) provides basic infection prevention recommendations for outpatient (ambulatory care) settings; 2) reaffirms Standard Precautions as the prevention foundation; 3) provides links to full guidelines and source documents. [Read Here]

Non-steroidal anti-inflammatory agents such as aspirin and ibuprofen appear to decrease the effectiveness of chronically prescribed SSRI-type antidepressants including Prozac and Celexa. In addition to identifying a biochemical marker of depressive-like states and antidepressant responses, the researchers examined data from an already-completed 4,000-patient large clinical trial of depressed patients ( STAR*D), and found depressive symptoms-such as feeling down, crying more frequently than usual or having decreased appetite-in patients who took Celexa went away 55% of the time, but that rate dropped to 45% in individuals who reported they also had taken an anti-inflammatory. 253 million prescriptions for antidepressants in the U.S. in 2010. PNAS 2011 108 (22) 8923-8924; published ahead of print May 18, 2011. [Read Here]

For 102 single-level anterior cervical discectomy/fusion during a single year at one institution, total hospital charges per patient ranged from $26,653 to $129,220 (a factor of 4.8) and in-patient hospital charges ranged from $15,113 to $76,687 (a factor of 5.0). Hospital charges were influenced by differing LOS (1-11 days); surgical charges were attributable to the surgeon’s choice of instrumentation ( this ranged from $4062 to $40,409 (a factor of 10)). Spine, 2011 May 15;36(11):905-9. [Read Here]

Antibody complement blockade successful in treatment of in Severe Shiga-Toxin-Associated HUS per a report of three 3-year-old patients with severe STEC-HUS that required hemodialysis who were administered eculizumab at 7-day intervals, twice in Patients 1 and 3 and four times in Patient 2. The neurologic status in all three patients improved dramatically within 24 hours after the first eculizumab infusion, with rapid normalization of disease markers – platelet counts normalized, and lactate dehydrogenase levels decreased within 5 days in all patients NEJM, May 25, 2011 (10.1056/NEJMc1100859) [Read Here]

Intervertebral disc herniation patients with diabetes did not benefit from surgical intervention; whereas, diabetic patients with spinal stenosis and degenerative spondylolisthesis benefited from surgery, per a secondary analysis comparing 199 diabetic patients with 2405 nondiabetic patients enrolled in the Spine Patient Outcomes Research Trial. Spine, 2011 Feb 15;36(4):290-307. [Read Here]

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 Journal Watch
by Hong Zhang, MD, FACOEM

This special feature brings you a concise review of a current topic pertaining to the field of Occupational and Environmental Medicine. Targeted at front-line practitioners, these reviews provide the tools to stay abreast of our ever evolving field. This month’s topic: Cauda Equina Syndrome: A Systemactic Review” 

Once you review the journal article, test your Occ-Q by taking the short “Test Your OCC-Q” quiz.

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Upcoming WOEMA CME Events

Register now to attend the Western Occupational Health Conference (WOHC): Improving Your Odds of Practice Success – September 8 – 10, 2011 at the Bellagio in Las Vegas [Watch WOHC Video]. 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. Register now to avoid late fees, andbook your hotel. The $139 rate at the Bellagio is close to sold out and higher rates on peak nights may apply. Tickets to Cirque du Soleil are still available, and there are slots still open for the golf and tennis tournaments. But don’t delay, we are expecting a “full house”! WOHC registration, schedule at a glance and conference details 

WOEMA CME WebinarsAir at 12:00PM Pacific Time on the 3rd Thursday every other month Next FREE CME Webinar: August 18 – “Fibromyalgia” – [view past webinars(Free participation is a benefit of membership in WOEMA)

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FREE: Electronic Health Record (EHR) Desk Reference for Physicians

Electronic Health Record (EHR) adoption, implementation, and achieving Meaningful Use can be challenging. To help guide you and your staff toward successful implementation, a free resource is now available: The Electronic Health Records (EHRs) Desk Reference. The guide was developed through a grant from the Physicians Foundation with the goal of promoting efficiency and quality improvement in healthcare. It can be used at any step of the implementation process. [Download PDF] [return to top]

WOEMA Legislative Affairs Fund – thank you donors!

Through the generous support of the members listed below, WOEMA continues to increase its footprint in the legislative and regulatory arena. WOEMA is the only ACOEM Component that employs its own legislative advocate to monitor and assist on issues of concern to the OEM field. The following members responded in 2011 to WOEMA’s annual appeal for contributions to support this work:

State Donation
 Dan Azar, MD, MPH CA $100
 Clarissa Burkey, MD, MPH HI $50
 D. Winston Cheshire, MD, CIME CA $200
 John Endicott, MD, MPH HI $200
 Andrew Horpeniuk, MD, MPH CA $100
 Leslie Israel, DO, MPH, FACOEM CA $50
 Roman Kownacki, MD, MPH, FACOEM CA $500
 Scott Levy, MD, MPH, FACOEM CA $100
 Stephen Mandaro, MD, MPH, FACOEM CA $50
 Sheilaja Mittal, MD CA $50
 Walter Newman, MD CA $200
 Robert Orford, MD, MS, MPH, FACOEM AZ $100
 Paul Papanek, MD, MPH, FACOEM CA $200
 Jonathan Rutchik, MD, MPH CA $50
 Steven Schumann, MD CA $200
 James Seward, MD, MPP, MMM, FACOEM CA $100
 Pete Thomas, DPM CA $50