The Next Generation of Dietitians: Implementing Dietetics Education and Practice in Integrative Medicine

Integrative medicine is a quickly expanding field of health care that emphasizes nutrition as a key component. Dietitians and nutritionists have an opportunity to meet workforce demands by practicing dietetics and integrative medicine (DIM). The purpose of this article is to describe a DIM education program and practicum. We report the results of an interprofessional nutrition education and practicum program between the University of Kansas Medical Center (KUMC) Department of Dietetics and Nutrition and KU Integrative Medicine. This partnered program provides training that builds on the strong foundation of the Nutrition Care Process and adds graduate-level educational and practicum experiences in foundational integrative medicine knowledge, including nutritional approaches from a systems biology perspective, nutrigenomics, and biochemistry as the core knowledge to understand the root cause of a chronic disorder and to choose appropriate nutritional tools for interventions. This interprofessional KUMC program provides a dietetic internship, master's degree, and graduate certificate in DIM and fulfills a need for dietitians and nutritionists who seek careers practicing in an integrative medicine setting. The program fulfills expanding workforce needs to provide quality health care for patients with chronic illnesses.     

临床营养师与近代临床营养

在近代医学发展的过程中，逐步形成专门从事临床营养治疗的营养师。营养师遍布所有与饮食营养相关的领域，对保证患者乃至健康人营养具有至关重要的作用。国内因历史原因，营养师队伍薄弱，没有与营养师相关的立法，管理紊乱，影响治疗效果。我国已从2000年起实行营养师资格考试制度，目前正在制订《营养改善法》，相信在未来的临床营养治疗中，临床营养师将发挥更大的作用。     

Medicare: past, present and future

The history of the Medicare program, including changes that have been enacted over the years in an effort to control spiraling costs, is reviewed. Medigap insurance and preventive medical care for the elderly are examined, as is the impact of Medicare coverage for the terminally ill. Trends indicate that the Medicare system as presently structured is not financially viable. The question is: what will replace it?     

Saccharin: past, present, and future

Saccharin, first synthesized in 1879 by Fahlberg, has been used as a non-caloric sweetener with several advantages. It is sweet, non-caloric, and stable, can now be synthesized with relatively few impurities, and is inexpensive. Its toxicity, imagined and real, has long been a source of concern and debate. Intensive studies on the potential carcinogenicity of saccharin have been performed, extending the limits of our technology to evaluate carcinogenic risk of chemicals. Saccharin has been found to be a carcinogen only in rats and only if administered over two generations. The effect seems to be directed primarily to the lower urinary tract and is greater in males than in females. Also, saccharin has been found to enhance or promote the carcinogenic process in rat models. The form of saccharin administered in the diet or drinking water has been the sodium salt. No effects have been found with acid saccharin. Epidemiological studies in human beings have not found an increased risk of developing bladder cancer with exposure to saccharin.     

Risk estimates: past, present, and future

Risk estimates for genetic disease developed over the past 30 y have been reviewed. The influence of dose rate and nonlinear dose-response curves on low dose estimates are discussed, and a reevaluation of doubling dose from acute irradiation is presented. The issue of differential sensitivity between human and mouse data are discussed with respect to the lack of an observable induced mutation rate in the offspring of A-bomb survivors. It is concluded that the "presumably" more sensitive mouse-derived risk estimates would not predict a significant increase in F1 abnormalities in humans. Therefore, it may be premature to accept the interpretation that man is less radiosensitive than the mouse.