Clinical Nutrition Education of Doctors and Medical Students: Solving the Catch 22.

There is a well-documented pandemic of malnutrition. It has numerous sequelae, including physical and psychological ill health, early death, and socioeconomic burden. The nutrition landscape and dynamics of the nutrition transition are extremely complex, but one significant factor in both is the role of medical management. Doctors have a unique position in society from which to influence this scenario at global, public, and personal levels, but we are failing to do so. There are several reasons for this, including inadequate time; historical educational bias towards disease and therapeutic intervention-rather than diet, lifestyle, and prevention; actual or perceived incompetency in the field of nutrition; confusion or deflection within medicine about whose role(s) it is on a medical team to address nutrition; and public confusion about whom to turn to for advice. But the most fundamental reason is that current doctors (and thus the trainers of medical students) have not received-and future doctors are thus still not receiving-adequate training to render them confident or competent to take on the role. A small number of important educational approaches exist aimed at practicing doctors and medical students, but the most effective methods of teaching are still being evaluated. Without properly trained trainers, we have no one to train the doctors of tomorrow. This is a "catch 22." To break this deadlock, there is an urgent need to make appropriate nutrition training available, internationally, and at all levels of medical education (medical students, doctors-in-training, and practicing doctors). Until this is achieved, the current pandemic of nutrition-related disease will continue to grow. Using important illustrative examples of existing successful nutrition education approaches, we suggest potential approaches to breaking this deadlock.

Can traditional "cupping" treatment cause a stroke?

The case study of a patient who developed haemorrhagic stroke after 'cupping' to the cervical area is presented. We consider the various manners in which cupping might induce haemorrhagic or ischemic stroke with particular reference to the relevant pathologies of the major cervical arteries. The other possible causes due to the induced cupping stresses are also examined using a computer based simulation study. Cupping of the cervical area may cause a haemorrhagic stroke by an acute rise in blood pressure. The tensile radial stresses generated by cupping may potentially facilitate the development of a dissection in the presence of an intimal tear. Moreover, the possible presence of micro-inclusions can intensify the local stress concentration for a thin cap.