Valley Fever: Diagnosis and Treatment

Benjamin J. Park, MD


screen shot of Valley Fever video from CDC
Click to play video

Valley fever can be a debilitating and costly respiratory disease that is increasingly common in some areas, such as the southwestern United States. Nearly three quarters of valley fever patients miss work or school because of their illness, for an average of 2 weeks, and more than one third of patients require hospitalization. In 2011, more than 20,000 cases of valley fever were reported in the United States, and many more cases likely went undiagnosed.[1]

Hello. I am Dr. Benjamin Park, a medical officer in the Mycotic Diseases Branch at the Centers for Disease Control and Prevention (CDC). I’m pleased to speak with you today about valley fever as part of the CDC Expert Video Commentary Series on Medscape.

Valley fever is caused by Coccidioides, a fungus that lives in soil in the southwestern United States and parts of Mexico, Central America, and South America. Inhaling the airborne fungal spores can cause a respiratory infection called coccidioidomycosis, also known as “valley fever.” The infection cannot spread from person to person.

More than 65% of valley fever cases in the United States occur in Arizona, and 30% occur in California. Of note, in recent years, the incidence of reported valley fever has been increasing by approximately 15% per year,[2] which could be because of:

• More people being exposed to Coccidioides because of increased travel or relocation to endemic areas;

• Changes in the way cases are detected and reported; or

• Changes in environmental factors, such as temperature and rainfall, which can affect the growth and distribution of Coccidioides.

Continue reading Valley Fever: Diagnosis and Treatment

Telehealth Programs Expand in U.S.

Doctor's hand reaching out of computer holding a stethoscopeNote: California has been on the forefront on broadening regulations to enable more widespread use of telemedicine, especially in underserved rural areas where distance to healthcare providers is a major concern. Programs like “Text for Baby,” successfully pioneered in San Diego and adopted by other providers, including Community Health Centers right here on the Central Coast, have already proven their efficacy.

July 19, 2013 | Eric Wicklund – Senior Editor

Missouri and Kentucky have enacted legislation expanding telemedicine coverage those states, according to the American Telemedicine Association (ATA).

Missouri became the 19th state to mandate that private insurers reimburse healthcare providers for telehealth services on the same basis that they would for in-person services, while also prohibiting them from denying coverage for telehealth services.

Kentucky, meanwhile, has expanded telehealth coverage for its Medicaid beneficiaries to include a variety of physical and mental health evaluations, counseling and chronic disease monitoring (though still limiting reimbursement for providers to interactive video-conferencing).

[See also: Telemedicine shows ROI at ATA]

“This is a true win-win scenario,” said Jonathan Linkous, the ATA’s chief executive officer, in a press release. “First, it is a big victory for patients in Kentucky and Missouri, who now have greater access to the best-possible healthcare. It’s also a win for the treasury and taxpayers in those states, who will save significantly on public healthcare costs.”

Linkous last week cautiously gave credit to the Centers for Medicare & Medicaid Services for expanding some telemedicine coverage nationwide for Medicare recipients. He made that point again in this week’s announcement.

“While states and private payers are making big strides forward to improve access to care and reduce costs, [CMS is] still dragging their feet,” he said. “The federal government places unnecessarily strict barriers and restraints on how Medicare patients are served when they deserve access to quality healthcare, regardless of geographic location and technology used.”

The Missouri/Kentucky announcement continues a busy six months in state legislative action, according to the ATA, which maintains a matrix on its website listing each state’s activities. Since January, Mississippi, Montana, Maryland, Florida, Kansas, North Carolina, Vermont, Massachusetts, Texas, New York, New Mexico and Arizona have introduced or enacted legislation regarding telemedicine coverage. In addition, Virginia – one of the front-runners in enacting legislation – is testing a capitated payment model for Medicare and Medicaid dual-eligibles.

– See more at:

Heat Safety Tool [App] in English & Spanish

graphic of Heat Safety Tool app from OSHAHEAT SAFETY TOOL  [En español]download button for Android app By U.S. Department of Labor (DOL), Occupational Safety and Health Administration (OSHA)

When you’re working in the heat, safety comes first. With the OSHA Heat Safety Tool, you have vital safety information available whenever and wherever you need it – right on your mobile phone.

The App allows workers and supervisors to calculate the heat index for their worksite,  and, based on the heat index, displays a risk level to outdoor workers.

download button for iPhone app

Then, with a simple “click,” you can get reminders about the protective measures that should be taken at that risk level to protect workers from heat-related illness-reminders about drinkingenough fluids, scheduling rest breaks, planning for and knowing what to do in an emergency, adjusting work operations,

gradually building up the workload for new workers, training on heat illness signs and symptoms, and monitoring each other for signs and symptoms of heat-related illness.

Stay informed and safe in the heat, check your risk level. Graphic for Campaign to Prevent Heat Illness in Outdoor Workers

For more information about safety while working in the heat, see OSHA’s heat illness webpage, including new online guidance about using the heat index to protect workers.

The source code for this app is available for download:
• Android: English [9 MB ZIP*] | Spanish [6 MB ZIP*]
• iPhone: All-in-One [1 MB ZIP*]

Accessibility Assistance: Contact the OSHA Directorate of Technical Support and Emergency Management at (202) 693-2300 for assistance with accessing the application or ZIP materials.


Wellness Programs Help Reduce Costly Impact of Obesity, Chronic Illness in Workplace

Prevention Ave. road sign for employee wellness programsBy 

Phoenix, AZ ( – Wellness programs are increasingly important as employers scramble to comply with the Affordable Care Act. By implementing wellness programs, employers may reduce the financial impact of ill or absentee employees, in addition to trimming the hidden expenses of recruiting and hiring temporary or new workers.

According to “Workplace Health Protection and Promotion,” a discussion article by theAmerican College of Occupational and Environmental Medicine (ACOEM), business owners are facing big challenges as negative health trends impact both the workplace and healthcare systems:

Chronic health conditions, on the rise across all age groups, continue to add to health care costs as workers develop diabetes, heart disease and cancer.

An estimated 50% of Americans have one chronic health condition; nearly half of that group has multiple chronic conditions.

Obesity: the Centers for Disease Control and Prevention (CDC) reports the percentage of the population considered obese increased from 12% in 1990 to more than 26% in 2007. By the year 2020, should this trend continue, 40% of men and 43% of women are predicted to be obese. Obesity can lead to cardiovascular disease and diabetes, as well as related conditions such as kidney failure and infections. Diabetes cost employers 138 million days of productivity last year.

To fight these expensive trends, employers may want to create and implement effective wellness programs that dovetail with workplace safety policies.

Continue reading Wellness Programs Help Reduce Costly Impact of Obesity, Chronic Illness in Workplace

OSHA Announces Outreach Campaign To Protect Health Care Workers From Hazards Causing Musculoskeletal Disorders


cover of Guide to Safe Patient HandlingThe U.S. Department of Labor’s Occupational Safety and Health Administration today announced a campaign to raise awareness about the hazards likely to cause musculoskeletal disorders among health care workers responsible for patient care. These disorders include sprains, strains, soft tissue and back injuries.

“The best control for MSDs is an effective prevention program,” said MaryAnn Garrahan, OSHA regional administrator in Philadelphia. “Our goal is to assist nursing homes and long-term care facilities in promoting effective processes to prevent injuries.”

As part of the campaign, OSHA is providing 2,500 employers, unions and associations in the health care industry in Delaware, Pennsylvania, West Virginia and the District of Columbia with information about methods used to control hazards, such as lifting excessive weight during patient transfers and handling. OSHA is also providing information about how employers can include a zero-lift program, which minimizes direct patient lifting by using specialized lifting equipment and transfer tools.

In 2010, there were 40,030 occupational MSD cases in private industry nationwide where the source of injury or illness was a health care patient or resident of a health care facility.
For MSD cases involving patient handling, 99 percent were the result of overexertion, resulting in sprain, strain, or tear injuries. Nursing aides, orderlies and attendants incurred occupational injuries or illnesses in 49 percent of the MSD cases involving health care patients. Registered nurses accounted for 17 percent, and home health aides for another six percent.

Detailed information on safe patient handling can be found at

For more information about the campaign, or to ask questions, obtain compliance assistance, file a complaint, or report workplace hospitalizations, fatalities or situations posing imminent danger to workers, the public should call OSHA’s toll-free hotline at 800-321-OSHA (6742).

Urgent Care Centers Divert Patients From PCPs, EDs Alike

Signs: Emergency Dept. $500, Urgent Care $50by Robert Lowes

Urgent care centers (UCCs) save money by treating patients who otherwise may land in a more costly hospital emergency department (ED), but they also boost healthcare spending by diverting patients from primary care practices (PCPs), according to a new study published online today by the Center for Studying Health System Change (HSC).

Given these findings, UCC executives, ED directors, and health plan network managers interviewed in the study are uncertain about the overall effect of UCCs on cost, write lead author Tracy Yee, PhD, and coauthors. On a more positive note, these healthcare industry figures generally perceive UCCs as improving access to some services for privately insured patients “without significantly disrupting continuity of care,” according to the study, which focused on 6 metropolitan areas.

The number of UCCs has grown rapidly during the last 20 years, giving patients an alternative to crowded EDs as well as booked-up PCPs. UCCs are not designed to handle car accidents or resuscitate patients at death’s door, but they do treat minor injuries such as cuts and minor fractures, as well as the ear infections and strep throats of primary care. The Urgent Care Association of America puts the number of UCCs at 9000, with physicians or physician groups owning 35% of them. In addition, corporations own 30%, hospitals own 25%, and nonphysician individuals or franchisors own 7%.

The authors of the HSC study found that UCCs mostly treat patients covered by Medicare and private insurance and tend to avoid Medicaid patients. Lately, private insurers have tried to steer patients from EDs to UCCs by making co-pays for the latter less than ED co-pays. At the same time, however, insurers have begun to price UCC co-pays higher than those for primary care office visits.

Continue reading Urgent Care Centers Divert Patients From PCPs, EDs Alike

How to Evaluate Health Websites


Samsung S4 with stethoscope

recent survey found that 60 percent of adults have gone online at least once in the past year to look up health information. Unfortunately, finding high-quality health websites is a challenge. Several years ago, a review of 79 studies published in the Journal of the American Medical Association concluded that online health information for consumers is frequently flawed, inaccurate, or biased. Based on my experience, the situation isn’t any better today.

Why do some health websites contain misleading information? One reason is that the group or organization running the site may have a hidden agenda. Drug companies often create consumer demand for expensive new drugs by financing groups that promote awareness of a previously unrecognized health condition, a sales tactic known as “disease mongering.” (For example, Dartmouth Medical School researchers have argued that restless leg syndrome became a disease only when a drug was developed to treat it.) Unfortunately, a study published in 2011 in the American Journal of Public Health found that most health advocacy groups that receive drug-company funding don’t disclose that on their websites.

Another reason that websites may contain misinformation is that some groups willfully disregard scientific evidence to promote certain health beliefs. For example, even though the U.S. Institute of Medicine found in 2004, after an exhaustive review of the medical literature, that there is no relationship between childhood vaccines and autism, it’s easy to find websites that claim otherwise. Similarly, although most researchers have concluded that Morgellons disease—a bizarre skin condition that sufferers believe to be caused by an undiagnosed parasitic infestation—is likely to be a psychiatric delusional disorder, you wouldn’t know it by simply Googling “Morgellons.”

Continue reading How to Evaluate Health Websites

Allsup Study of Workplace Injuries Compares Rates State-by-State

Each year, more than 1 million U.S. workers experience an injury that causes them to miss a day or more of work.
In this study, Allsup used data provided by the Bureau of Labor Statistics to compare serious workplace injury rates across states and within industries. Allsup found rates of serious workplace injury vary significantly between states—even for workers in the same industries.

state by state graph of work related injuries occurrences

Full report (PDF)  
Why It Matters Now
A recent SSA report identified injuries as the sixth-leading cause of Social Security Disability Insurance (SSDI) claims, and many claims not filed as injuries involve conditions that can be job-related. At a time when nearly 9 million workers are receiving SSDI benefits—many of whom were originally injured on the job—this report should draw attention to the widely varying rates of worker injury across states.
For More Information
(800) 854-1418, ext. 65065
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About Allsup
Allsup is a nationwide provider of Social Security disability, veterans disability appeal, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Allsup professionals deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. Founded in 1984, the company is based in Belleville, Ill., near St. Louis. Visit or connect with Allsup at

Food Safety for the Fourth

Fourth of July red, white and blue kabobsFollow 4 on the 4th

With the 4th of July comes outdoor eating at picnics and barbecues. It’s estimated that Americans will enjoy 81 million barbecues this year. Join us in making more of them food safe. Remind consumers to Follow 4 on the 4th: Clean, Separate, Cook and Chill to reduce their risk of foodborne illness.

A recent survey reveals that only 6% of home cooks use a food thermometer to cook hamburgers. This 4th of July, remind consumers that you can’t tell if a hamburger is cooked to a safe internal temperature by looking at it. This video, Ugly Bug, reminds families how to cook hamburgers safely.

Food safety is on the go with our Food Safety on the Move Flyer. It’s ready for you to print and share with consumers so they can easily remember how to stay food safe this 4th of July! Get it here!

Have a happy and food safe 4th of July!

Do Health Apps Live Up to Their Hype?

photo of BJ Fogg, PhDThere are said to be over 40,000 health, fitness, and medical apps. They range from references to calculators to diaries to tracker apps, such as diabetes managers and heart rate monitors. Although they generate much “gee-whiz” fanfare, evidence that smartphone applications actually work to promote healthy behaviors in users is scant.[1]

Some medical researchers are reaching the same conclusion. For example, a study of iPhone® apps for smoking cessation found that these apps “rarely adhere to established guidelines for smoking cessation.”[2]

A not-yet-published study of 222 smartphone apps that offer tips, advice, and treatment for pain found that many of these apps lacked a scientific foundation,[3] and that most showed no evidence of healthcare professional involvement.

Nor are health app users oblivious to app shortcomings. According to one report, 26% of people who download health apps use them only once.[4]

For psychologist BJ Fogg, PhD, improving their content is not what would make health apps more effective. What would make them more effective is designing apps from the ground up to change specific behaviors from bad to good, using what he terms “persuasive technology,” a marriage of mobile technology and the psychological theories and techniques of behavior modification. For Fogg, an app that evokes the desired behavior change is an app that works.

A pioneer in the use of technology to change human behavior, Fogg is listed as one of “10 new gurus you should know” by Fortune. [5] He has one foot in academia and the other in industry. He’s Founder and Director of the Persuasive Technology Lab at Stanford University and the author of Persuasive Technology: Using Computers to Change What We Think and Do (Morgan Kaufmann, 2002).

Fogg says it isn’t technology that’s holding back the design of apps that could help patients (particularly those with chronic conditions) adopt healthy behaviors. The capability is here. Evidence-based data on how behavior change works is also here. What’s needed, he says, is for the possessors of these 2 disparate fields of knowledge — software engineers and cognitive scientists, whose paths don’t normally cross — to seek each other out and collaborate.

If they did, how would apps change? What would they do? Medscape interviewed Fogg to find out.

3 Keys to Changing Behavior

Medscape: You have a theoretical model that can be expressed as an equation: Behavior equals motivation plus ability plus a trigger occurring at the same moment. What does this mean? How could it inform health app design?

Dr. Fogg: The real key to changing behavior, not just in healthcare but in any consumer experience, is to help people do what they already want to do. That’s motivation. There’s no way you can browbeat someone to do something they don’t want to do. You can just take that one off the table. To help them to do what they want to do, you have to make it really easy to do that thing. That’s ability. And then you need a trigger, a reminder, to prompt behavior.

That’s the overall recipe. If you don’t have any one of those things — motivation, ability, and trigger — I guarantee the app will fail. You have to do them all.

Continue reading Do Health Apps Live Up to Their Hype?