AMA Guides® Newsletter

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The AMA Guides® Newsletter, a publication of the American Medical Association, provides you with crucial updates, authoritative guidance, practical information and rationales for proper use of the AMA Guides in assessing impairment, work ability, causation, and other case issues. 

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Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California



Silicosis associated with inhalation of respirable crystalline silica among engineered stone countertop fabrication workers is an emerging health concern.


To describe clinical, socioeconomic, and occupational characteristics of patients diagnosed with silicosis associated with engineered stone in California.

Design, Setting, and Participants

This case series included reported cases of silicosis associated with fabrication of engineered stone countertops, as identified by statewide surveillance by the California Department of Public Health (2019–2022). Data analysis was performed from October 2022 to March 2023.


Patient interviews and medical record abstractions were used to assess occupational exposure to respirable crystalline silica, including duration of work tenure and preventive measures undertaken.

Main Outcomes and Measures

Demographics, clinical characteristics, health care utilization, and clinical outcomes were obtained, including vital status, hypoxia, and lung transplant.


This case series identified 52 male patients meeting inclusion criteria; median (IQR) age was 45 (40–49) years, and 51 were Latino immigrants. Ten (19%) were uninsured, and 20 (39%) had restricted-scope Medi-Cal; 25 (48%) presented initially to an emergency department. A delay in diagnosis occurred in 30 (58%) patients, most commonly due to alternative initial diagnoses of bacterial pneumonia (9 [30%]) or tuberculosis (8 [27%]). At diagnosis, 20 (38%) patients had advanced disease (progressive massive fibrosis) with severely or very severely reduced forced expiratory volume in 1 second in 8 (18%) and 5 (11%), respectively. Of the cases, 10 (19%) were fatal; median (IQR) age at death was 46 (38–51) years, and 6 patients (12%) were alive with chronic resting hypoxia. Eleven were referred for lung transplant: 3 underwent transplant with 1 fatality; 7 were declined transplant, with 6 fatalities; and 1 died prior to listing. Median (IQR) work tenure was 15 (10–20) years; 23 (45%) reported use of water suppression for dust mitigation, and 25 (48%) continued to fabricate stone after being diagnosed with silicosis.

Conclusions and Relevance

In this case series performed in California, silicosis associated with occupational exposure to dust from engineered stone primarily occurred among young Latino immigrant men. Many patients presented with severe disease, and some cases were fatal.

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A Primer for Workers' Compensation


Background Context:

A physician's role within a workers' compensation injury extends far beyond just evaluation and treatment with several socioeconomic and psychological factors at play when compared to similar injuries occurring outside of the workplace. Although workers' compensation statutes vary among states, all have several basic features with the overall goal of returning the injured worker to maximal function in the shortest time period, with the least residual disability and shortest time away from work.


To help physicians unfamiliar with the workers' compensation process accomplish these goals.

Study Design:



Educational review.


The streamlined review addresses the topics of 1) Why is Workers' Compensation Necessary? 2) What does Workers' Compensation Cover? 3) Progression following Work Injury 4) Impairment and Maximum Medical Improvement (MMI), including how to use the 6th edition of American Medical Association's (AMA) Guides, 5) Completion of Work Injury Claim after Impairment Rating, 6) Independent Medical Evaluation, and 7) Causation.


In the ‘no-fault’ workers' compensation system, physicians play a key role is progressing the claim along and, more importantly, getting the injured worker back to work as soon as safely possible. Physicians should remain familiar with the workers' compensation process, along with how to properly utilize the AMA Guides.

AMA Guides® Newsletter Advisory Board


James B. Talmage, MD 
Cookeville, Tennessee 


Gunnar B.J. Andersson, MD, PhD 
Chicago, Illinois 

Robert J. Barth, PhD 
Chattanooga, Tennessee 

Charles N. Brooks, MD 
Bellevue, Washington 

Stephen L. Demeter, MD, MPH 
Las Vegas, Nevada 

Lorne K. Direnfeld, MD, FRCP(C) 
Kahului, Hawaii 

Dwight K. Dowda, MB BS, MPH 
Sydney, Australia 

Lee H. Ensalada, MD, MPH 
Tucson, Arizona 

Marjorie Eskay-Auerbach, MD, JD 
Tucson, Arizona 

Steve Feinberg, MD 
Palo Alto, California 

LuAnn Haley, JD 
Tucson, Arizona 

Richard T. Katz, MD 
St. Louis, Missouri 

Les Kertay, PhD 
Chattanooga, Tennessee 

J. Mark Melhorn, MD 
Wichita, Kansas 

Kathryn L. Mueller, MD, MPH 
Denver, Colorado 

Mohammed I. Ranavaya, MD, JD, MS 
Huntington, West Virginia 

Robert D. Rondinelli, MD, PhD 
Des Moines, Iowa 

E. Randolph Soo Hoo, MD, MPH 
Honolulu, Hawaii

AMA Staff

Lori Prestesater
Senior Vice President 
Health Solutions

Erin Kalitowski
Director, Print, Digital and Impairment Guides

Lisa Chin-Johnson 
Senior Developmental Editor 

About the AMA Guides® Newsletter

Get the latest developments in impairment issues with the AMA Guides® Newsletter, the source for constant updates on the latest evaluations from experienced practitioners in medicine, law and policy. 

The AMA Guides® Newsletter provides updates, authoritative guidance and interpretations of rationales for those using the fourth, fifth and sixth editions of AMA Guides. Published six times annually, it features articles on overarching topics and issues regarding disability evaluation. Highlights include:

  • Original peer-reviewed articles  
  • Case studies 
  • Causation 
  • Questions and answers 
  • Legal and legislative updates 
  • Book reviews 
  • Calendar of training events


Download a list of a cumulative index of articles.

Recent Issues
cover image Volume 28, Issue 6
Nov/Dec 2023
  • Letter of Appreciation and Acknowledgment
  • Impairment and Disability: A Journey of Understanding
  • Stress and Cardiovascular Disorders: A Review and Suggested Impairment Rating Methodology
  • Comprehensive Medical History Interview: Practical Guidance
  • Q&A: Impairment Ratings From Nontreating Physician
cover image Volume 28, Issue 5
Sep/Oct 2023
  • Artificial Intelligence: Revolutionizing the Medicolegal Field
  • Should Injuries—What's Normal? Part 1
  • Introduction to Artificial Intelligence (AI) and AI-Related Concepts
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