Migraine association with mouth, gut bacteria discovered

The American Society for Microbiology published a 2016 study showing an alarming difference in mouth and gut bacterial flora when comparing subjects with and without migraines. It’s estimated that approximately 12 percent of the United States population suffers from migraines and much blame on this problem has been placed on food triggers. However, when examining the bacteria from the subjects, it was found that those suffering with migraine symptoms have a much higher concentration of mouth bacteria. The bacteria is responsible for converting nitrates in foods into nitrites. This conversion creates an abundance of nitric oxide in the bloodstream – a cause of migraines. This explains why foods high in nitrates such as hot dogs, bacon, sausage and processed lunch meat are common triggers for migraines. Bacterial genes that reduce nitrates to nitrites have been found in migraine patients, according to ‘The American Gut Project’.  This recent study suggests strong clinical correlation.

If you treat patients who suffer from migraines, this information may be worth bringing to their attention, especially if they experience food-triggered migraines.

Outsourcing PHI-related functions? What you need to know about HIPAA

Choosing to outsource various office activities that involve Protected Health Information (PHI) requires diligence to ensure compliance with federal HIPAA regulations. Many offices choose to outsource business activities such as billing, clinical record storage, or shredding. A covered entity, as defined by HIPAA, is responsible to ensure that the vendors handling patients’ PHI are HIPAA-compliant. This can be achieved through a Business Associate Agreement, often referred to as a “BAA”.

Once a BAA is in place with a vendor, HIPAA does not require the covered entity to monitor or oversee the privacy safeguards the vendor has in place. However, if the vendor violates HIPAA regulations and the terms of the BAA, the covered entity is required to take “reasonable steps” to cure the breach or end that violation and, if unsuccessful, must terminate the contract with that business associate (vendor). A great way to review a vendor’s compliance with HIPAA is to perform pre-contract due diligence. This might include asking key leadership about their HIPAA policies and procedures (which is required by HIPAA) or inquiring about any past HIPAA breaches. Ensuring that the BAA includes the right to audit the vendor for HIPAA compliance is another excellent strategy.

Need more information about HIPAA? The Centers for Medicare and Medicaid Services (CMS) has an abundance of information relating to HIPAA including a Business Associate Agreement Template that meets HIPAA requirements. Another great information source is healthit.gov which covers electronic health records, privacy, security including mobile device guidance, and offers a sample customizable Notice of Privacy Practices template.

Alcohol harm achieves parity in both genders

Alcohol substance abuse programs have typically been aimed at the male population due to statistical prevalence of use and abuse. However, new research published in the BMJ shows good evidence to suggest providers should look at the young female population as an equal target to reduce harmful abuse. More than 68 studies with over 4 million subjects shows 20th century impact for abuse, achieves parity with women and men. Three search strategies were used to obtain this information.

  1. Amount and frequency of use.
  2. Prevalence and frequency of heavy use or ‘binge drinking’.
  3. Age of onset of alcohol use.

Given that the heavy users are relatively young, and have an early stage of alcohol abuse, providers should be encouraged to discover this via ‘basic health/wellness’ questions on a well-developed intake form. Questions about alcohol use, age of onset, and amount used, should be standard on every intake, to help change this alarming development in patient populations.

Statin use linked to increased Parkinson’s risk

Statins have been widely used to decrease blood levels of certain types of cholesterol. A very large, new study presented by the American Neurological Association (ANA), in their 2016 Annual Meeting, from researchers at MarketScan Commercial Claims and Encounter database, of information on 30,343,035 subjects from age 40-65, identified 21,559 Parkinson’s disease (PD) patients within this group. While high cholesterol has been shown to be a risk for PD, Dr. Huang at Penn State College of Medicine in Hershey, Pennsylvania told Medscape Medical News, “(We) in fact found an increased risk with statin use…” Currently, it’s known that higher cholesterol levels have a protective effect, reducing risk of Parkinson’s disease. Researchers have hypothesized that lowering cholesterol may be detrimental to this population. PD patients with hyperlipidemia are at a much higher risk when statins are introduced. This finding is worth noting when treating PD patients.

Wash your hands!

Handwashing_SmallThe age-old “five-second rule” about food on the floor isn’t entirely about how long something sits on a surface – such as food on the floor – but more about how much bacteria is on that surface. As Aaron Carroll, MD, writing for  The Upshot column in The New York Times discusses the relative bacterial colonization of different surfaces in the home, he points out that the kitchen counter has more than double the level of bacteria compared to the floor. The kitchen sponge is likely to be the most dirty thing in the kitchen. Everything we touch is dirty including the money we use to pay for food which we then consume with the hands we paid for the food with!

As Dr. Carroll suggests, this should remind us all to wash our hands before we eat!

Don’t let falling leaves take you out this autumn

Autumn leavesThe autumn leaves produce a scene of changing colors that is beautiful to behold. When they have fallen to the ground and jumping in the piles is done, they need to be raked up. There are a number of possible injuries that can occur during this process and many of them can be avoided with the following basic advice suggested in MedlinePlus’ to Leave Those Raking Injuries Behind: warm up and cool down, clear debris and consider footwear to avoid falling down, avoid twisting motions, take breaks, use proper equipment, and protect your back. Good advice for providers and patients alike!

Farm living is the life for me – to avoid asthma?

A study published in the New England Journal of Medicine recently demonstrates tendencies to develop allergies and asthma may be diminished by early exposure to pooled bacterial dust samples found on family farms combined with low antibiotic use. Conversely, there appeared to be a higher rate of asthma and allergies in subjects exposed to antibiotic use and avoidance of bacterial dust samples. The study included comparison between two insular groups: single family farming with the Amish of Indiana and the highly industrialized farming of Hutterites in South Dakota. Although degree of exposure has not been established, the inverse link has been seen between the groups.

More evidence for adding exercise inquiries when talking with patients

The September 15, 2016 Morbidity and Mortality Weekly Report published an article online about a survey showing that 1 in 4 people in the US 50 years and older engage in no exercise other than that occurring during the work hours. Manual labor workers often feel they don’t need exercise, not realizing heavy manual labor may be the type of exercise that breaks down a body, rather than builds it up. There is great value in and the need to encourage and educate patients to understand how physical activity, including the lack thereof, affects the human body. This article highlights the need to ask patients about their exercise habits and to encourage patients over 50 to begin exercise programs.