Medical schools should be prioritising nutrition and lifestyle education
Would you expect a junior doctor to be confident giving basic advice and care for the most common and fatal diseases? Of course you would. The National Institute for Health and Care Excellence guidelines state that a first line intervention for diabetes, obesity, and high cholesterol is to give ‘lifestyle advice’—but this phrase is so vague that it is left up to doctors and patients to define it and, potentially, ignore it.

In 2008 and 2009, more than 75% of American junior physicians felt inadequately trained to counsel patients on diet and physical activity.1 The picture is reportedly similar in the UK.2 In Tomorrow’s Doctors, the General Medical Council requires qualifying medical students to understand the role of diet in health promotion and disease prevention, which includes being nutritionally competent. Internationally, this knowledge is lacking in medical training. Just 27% of US medical schools provided the agreed minimum of 25 hours of nutrition education in 2008.3 A recent study of European medical schools was slightly more optimistic, suggesting that nutrition education was a requirement in 68.8% of …
Dream recall, short term memory and a urine marker for pyrrole disorder - A pilot study
Background Nearly half of Australians between the age of 16 to 84 have suffered from mental illness [1]. Such health conditions can be chronic and require aggressive medication therapy leading to possible adverse drug reactions and further complications. The need for a holistic, lower risk health care approach has paved the way for the emerging, relatively lower risk therapies, such as advanced micronutrient therapy. Micronutrient therapy utilises vitamins and minerals to correct biochemical imbalances thought to be responsible for mental health conditions. Micronutrients have been investigated in over twenty placebo-controlled randomised control trials across a variety of mental health conditions including depression, anxiety, attention-deficit/hyperactivity disorder, autism, antisocial aggressive behaviour in prisoners [2]. Pyrrole disorder is an example of a biochemical imbalance that is treated with micronutrient therapy consisting primarily of Vitamin B6 (B6) and Zinc (Zn). A theorised mechanism of the pathophysiology of the disorder is the complexation of hydroxyhaemopyrrolin-2-one (HPL), an elevated marker in the pyrrole patients, with Zn and the active form of B6 leading to a deficiency these two nutrients in the body [3-6]. However, very little research has been done on the condition and the practice follows, mostly, anecdotal evidence. 
Pyrrole disorder is characterised by a specific cluster of symptoms, signs and traits. Some of the distinctive symptoms reported are little or no recall of dreams, recollection of nightmares only when dreaming, and poor short-term memory (STM) [5, 7]. The relationship between these symptoms, however, has not been clinically investigated. Thus, this pilot study aimed to explore pyrrole disorder and the relationship between the recollection of dreams, remembering nightmares exclusively, STM performance, and the micronutrient, vitamin B6. This study is also the first of its kind in assessing pyrrole disorder in a population of healthy participants. 
Methods 
Adult participants aged 18-75 years were recruited across two sites in South East Queensland, at the Clinical Trial Unit at Griffith University and Applied Analytical Laboratories, over a period of 6 months between July and November 2017. A questionnaire was designed and tested by experts in the field that consisted of questions relating to dream recall, nightmare recall, STM perception, B6 intake and the unique cluster of symptoms, signs and traits observed in pyrrole disorder. STM was also measured through use of an electronic, validated digit span test (DST). HPL levels were assayed at Applied Analytical Laboratories, an external medical laboratory specialising in HPL urine analysis. 
Statistical analyses of the data was conducted with IBM-SPSS statistics 24 software. Descriptive statistics were used for variables of interest which were assessed for normality through skewness and kurtosis. Parametric continuous variables were analysed and reported as mean ± standard deviation (SD) via T-tests or ANOVA. Non-parametric continuous variables were reported as median and range with minimum and maximum values through Mann-Whitney U and Kruskal-Wallis H tests with further post-hoc analysis for significance. Categorical variables are presented as case frequency, and percentage of prevalence, through Chi-square analyses for dichotomous results. Dichotomous variables with cells having an expected cell count ≤ 5 were tested and reported as Fisher's exact test p-value. Results were considered significant if p < 0.05. 
Results 
Two hundred twenty-nine adults were assessed though an expression of interest. One hundred eighty-five (mean = 37.96 ± standard dev 13.54 years) participants attended the clinic visit and completed the assessments with one urine sample excluded due to contamination. DST scores were evaluated for 176 participants. Participants were split into “pyrrole” (n = 44) and “non-pyrrole” (n = 141) groups based on the symptoms and traits of pyrrole disorder reported in the survey. 
The pyrrole participants reported significantly less dreams (χ2 = 6.140; p = 0.046), recalled more nightmares when remembering they dream (χ2 = 0.128; p < 0.001), and scored lower on DST (t = 2.310; p = 0.022) than the non-pyrrole participants. For those participants taking B6 supplements, no significant effects were observed for B6 intake and dream recall frequency (χ2 = 1.423; p = 0.491), the recall of nightmares only when remembering dreams (χ2 = 0.128; p = 0.720), or DST scores (t = 0.416; p = 0.678). B6 did not control HPL values on its own (U = 2438.500; p = 0.242), however the combination treatment for pyrrole disorder (B6+Zn) did demonstrate control on HPL values with lower median, maximum, and the elimination of elevated outliers in comparison to those participants on no supplements (U = 1643.500; p = 0.080). 
Conclusion 
This pilot study explored a controversial condition that has lacked thorough clinical investigation due to the early misidentification of HPL and the mystery behind its origins. The study investigated key symptoms, signs and traits of the condition, including little to no dream recall, the recall of nightmares exclusively, and poor STM. The objectives of this thesis were achieved through the use of a novel questionnaire and digital DST. Pyrrole participants had significantly less dream recall, recalled nightmares only when dreaming, and had poor STM based on DST scores. Additionally, the treatment for pyrrole, namely B6 and Zn, was shown to control HPL values. 
The study, therefore, supports anecdotal evidence for this condition and paves the way for a new approach in treating mental health conditions with a more favourable risk-benefit ratio. Important implications for future practice and research were also identified.
Physicians' attitudes about obesity and their associations with competency and specialty: A cross-sectional study
BackgroundPhysicians frequently report negative attitudes about obesity which is thought to affect patient care. However, little is known about how attitudes toward treating obese patients are formed. We conducted a cross-sectional survey of physicians in order to better characterize their attitudes and explore the relationships among attitudes, perceived competency in obesity care, including report of weight loss in patients, and other key physician, training, and practice characteristics.MethodsWe surveyed all 399 physicians from internal medicine, pediatrics, and psychiatry specialties at one institution regarding obesity care attitudes, competency, including physician report of percent of their patients who lose weight. We performed a factor analysis on the attitude items and used hierarchical regression analysis to explore the degree to which competency, reported weight loss, physician, training and practice characteristics explained the variance in each attitude factor.ResultsThe overall response rate was 63%. More than 40% of physicians had a negative reaction towards obese patients, 56% felt qualified to treat obesity, and 46% felt successful in this realm. The factor analysis revealed 4 factors–Physician Discomfort/Bias, Physician Success/Self Efficacy, Positive Outcome Expectancy, and Negative Outcome Expectancy. Competency and reported percent of patients who lose weight were most strongly associated with the Physician Success/Self Efficacy attitude factor. Greater skill in patient assessment was associated with less Physician Discomfort/Bias. Training characteristics were associated with outcome expectancies with newer physicians reporting more positive treatment expectancies. Pediatric faculty was more positive and psychiatry faculty less negative in their treatment expectancies than internal medicine faculty.ConclusionPhysician attitudes towards obesity are associated with competency, specialty, and years since postgraduate training. Further study is necessary to determine the direction of influence and to explore the impact of these attitudes on patient care.