Gluten-free diet triples in Americans

GlutenFreeCakeAccording to a report published online September 6th in JAMA Internal Medicine and covered in PracticeUpdate, between 2009 and 2014, the number of gluten-free Americans has tripled but the number of individuals with celiac disease has remained unchanged.  The rise in popularity of this diet in the absence of celiac disease is suggested to include the following: the perception that gluten-free diets are healthier and may benefit nonspecific gastrointestinal problems, gluten-free choices are much easier to find in stores and restaurants, increased population who have self-diagnosed sensitivity to gluten and have improved gastrointestinal symptoms after going gluten-free.

Section 1557 final rule effective October 17

The final rule implementing Section 1557 of the ACA will be effective October 17, 2016. Below are some frequently asked questions about Section 1557 and links to more info.

What is the history of this rule?

Section 1557 has been in effect since its enactment in 2010 and the HHS Office for Civil Rights has been enforcing the provision since it was enacted.  This year the Department of Health and Human Service finalized this rule after completing the public comment process.

What does Section 1557 cover?

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. Section 1557 builds on long-standing and familiar federal civil rights laws.

How does it impact providers?

The final rule prohibits discriminatory practices by health care providers, such as hospitals that accept Medicare or doctors who participate in the Medicaid program.

 What is the effective date?

Beginning on October 17, 2016, covered entities will be required to post notices of nondiscrimination and taglines that alert individuals with limited English proficiency (LEP) to the availability of language assistance services. In advance of the approaching deadline, the HHS OCR website has been updated with new information to assist covered entities. Click here for translated materials.

“Stop running, it’ll ruin your knees…”

Young woman running on red dirt trail, rear view, low section

For as long as we’ve been told, “don’t cross your eyes or they’ll stay that way”, we have also been told running is bad for our knees. It turns out this is not true as reported in a new study in the journal of Arthritis Care and Research from June 22, 2016 which demonstrated that runners do not have an increased risk of symptomatic arthritis in their knees.  The study was not designed to show cause and effect but speculation as to why this is true included the following: runners tend to be lean so there is less weight on the knees, there may be some additional mechanical benefit to the action of running that prevents arthritis from developing, the general lifestyles of runners tend to be healthier which could decrease their risk for disease like arthritis.

Are common e-mail security mistakes putting you at risk?

Close-up of female hands touching buttons of black computer keyboard

The latest issue of “OUCH!”, a monthly security awareness newsletter from Securing the Human, a division of SANS Institute, is devoted to common e-mail security mistakes that any people might

be making. It details four security issues that can come up when using e-mail features such as auto-complete or reply all functions. For the full list of security risks and how to stay e-mail safe, check out the September 2016 “OUCH!”.


Is surgery the only option?

In the August 3, 2016 “The Upshot” column in The New York Times, author Gina Kolata reports on the rationale behind common surgeries, from meniscus to spinal fusion to vertebroplasty. When compared to drug trials, she reports, surgeries lack similar checks and balances. Outcomes have relied heavily on provider and patient impression of success, rather than statistical measures. This impression may be a type of placebo, as either the provider or patient has such a strong desire for improvement. Spinal fusion is one type of spine surgery that did not meet the test of statistical improvement and is now denied by many insurers. Conservative care options such as physical therapy (PT), chiropractic, acupuncture, massage, exercise therapy can be suggested to patient as a first line of care before surgery is considered.

Mechanical low back pain facts and differential diagnosis

Did you know two thirds of all Americans experience low back pain at some point in their lives? Or that low back pain is the second most common complaint in ambulatory care? Or is the third most expensive with only heart disease and cancer surpassing it?

When a patient is experiencing low back pain diagnoses range from the common sprain to the rare and serious cauda equina syndrome. Differential diagnosis of these conditions is critical, so it’s good practice for providers who regularly treat low back pain to offer patients some cautionary advice such as: “If you experience bladder or bowel incontinence, saddle type numbness in the buttocks or profound weakness, you should go to emergency room immediately.” Symptoms, like these indicating cauda equine syndrome, if ignored can produce devastating outcomes with permanent paralysis.

The Agency for Healthcare Research and Quality (AHRQ) has published ACR Appropriateness Criteria® for low back pain on their website. To take the Medscape quiz on low back pain and test your knowledge, click here.

Safe travels

The U.S. has succeeded at significantly reducing the number of deaths due to car crashes from 2000-2013, however our level of improvement is significantly lower than that of 19 other high-income countries. In a recent report by the Centers for Disease Control and Prevention (CDC), the areas where the U.S. needs to make progress to further reduce these preventable deaths are highlighted as follows:

  • Use a seat belt in every seat on every trip
  • Don’t drive impaired by drugs or alcohol
  • Obey speed limits
  • Follow child safety recommendations for their age, height, and weight
  • Drive without distractions such as cell phone use (texting, talking, etc.)

Integrative healthcare providers can provide an important contribution to this important public health effort by supporting these measures in their everyday interactions with their patients.  A copy of the CDC Vital Signs for motor vehicle crash deaths provides additional information on how providers can help.

Is your practice at risk from ransomware?

Ransomware is a type of malicious software designed to block access to a computer system until a sum of money is paid.  The HIPAA Security Rule requires covered entities (such as CHP providers) to implement security measures that can help prevent the introduction of malware, including ransomware. The Department of Health and Human Services Office of Civil Rights has recently issued preliminary guidance on the issue of ransomware attacks and preventive measures. They note that a recent U.S. government interagency report indicates that, on average, there have been 4,000 daily ransomware attacks since early 2016 (a 300% increase over the 1,000 daily ransomware attacks reported in 2015). Click here to visit the HHS website and learn more.

Sleep disturbances and stroke link

Sleep apnea and/or poor sleep habits may increase stroke risk according to a recent large literature reviews. Meta-analysis of 29 studies and 2,343 patients with an ischemic or hemorrhagic stroke or transient ischemic attack showed that more than 72% had sleep disordered breathing (SBD). Insomnia, hypersomnia, and restless leg were also cited as increasing stroke risk. Poor sleep may relate to more than slow healing. Asking patients about sleep patterns should be included in basic intake forms.

Tri-Cities CE event registration now open!

The CHP Group (CHP) is excited to announce our upcoming continuing education and networking event for integrative healthcare providers in the Tri-Cities area!

We invite you to join your friends and colleagues for two hours of free continuing education followed by hosted drinks and appetizers!

Boundaries for Integrative Healthcare Providers

Our clinical expert, Dr. Minga Guerrero, CHP’s Regional Medical Director and past president of the Oregon Board of Chiropractic Examiners, has created an engaging two-hour continuing education program specifically for integrative healthcare providers in Washington. Dr. Guerrero will use this two-hour session to:

  • Explore the various aspects of the provider/patient relationship, explain situations that may cause concern, and how to proactively prevent situations from escalating to a complaint.
  • Review recently-updated Washington state laws and regulations regarding provider/patient boundaries and how these updated regulations impact all providers.
  • Present boundaries violations drawn from real practice situations and discuss how such situations can be avoided.

The CHP Group has been working with integrative healthcare (IH) providers and providing IH-targeted continuing education for over 25 years in the Pacific Northwest. We look forward to seeing you in Tri-Cities!

This course has been approved by the NCCAOM for two (2) PDA points in Ethics.

Click here to register!

Bonus – Networking Event!

Stay for hosted drinks and appetizers after the continuing education concludes and visit with fellow providers and CHP staff! If you’ve attended one of our networking events in the past, you know what a great time is had by all!


3:30 – 4:00 pm | Doors open and attendee check-in

4:00 – 6:00 pm | Boundaries for Integrative Healthcare Providers

6:00 – 7:30 pm | Networking event with hosted drinks and appetizers!