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Biomedical subjects

J Schulkin

Publications and source records attributed to J Schulkin.

At least 37 records · Page 2Linked to original sources
PubMed2000

Knowledge and clinical practice regarding folic acid among obstetrician-gynecologists.

OBJECTIVE: To assess obstetrician-gynecologists' knowledge of and clinical practice concerning folate. METHODS: We mailed surveys on nutrition during pregnancy to the 230 ACOG Fellows who are members of the Collaborative Ambulatory Research Network and to a random sample of 800 Fellows who are not members of the Network. Our results focus on questions concerning folate. RESULTS: We analyzed 488 surveys (a 47.4% response rate). Approximately two thirds of respondents screen their pregnant patients for folate intake. Fewer (53%) screen their nonpregnant patients of childbearing age. Those who screened their patients for folate intake were more likely to counsel pregnant patients about diet. They also were more likely to believe that nutritional counseling would improve pregnancy outcomes (70.0% versus 56.5%) and overall patient health (77.5% versus 66.5%). Most Fellows were aware that macrocytic anemia was a manifestation of folate deficiency (90.4%) and that folic acid supplementation during preconception and the early prenatal period helps protect against neural tube defects (96.5%). They were aware that alcoholics (91.4%), smokers (61.3%), and lactating women (53.5%) are at increased risk of folate deficiency. They were less aware of other consequences of low folate intake, such as increased serum homocysteine (20.3%). Respondents who screen their pregnant patients for folate intake correctly answered more of the knowledge questions about folate than physicians who do not screen. CONCLUSION: Obstetrician-gynecologists are generally aware of the link between folate intake and neural tube defects, but are less aware of other aspects of folate metabolism.

Adult↗
PubMed2000

Gynecologists' training, knowledge, and experiences in genetics: a survey.

OBJECTIVE: To explore gynecologists' knowledge, training, and practice experience with genetic screening and DNA-based testing. METHODS: A questionnaire survey was sent to 1,248 ACOG Fellows, of whom 564 (45%) responded. One hundred thirty-four respondents (24%) reported that they do not order DNA-based tests or take family histories to screen for heritable diseases or disorders. Results from the 428 respondents who provide genetic screening services are reported. RESULTS: Most physicians (90%) knew that genetic tests are most informative when used in conjunction with family histories. Gynecologists gave more correct responses regarding genetic testing for breast and ovarian cancers than for colon cancer and other adult-onset diseases. Sixty-five percent of the respondents had not received formal training in DNA-based testing in gynecologic practice. Older physicians were less likely to have had training. Younger physicians generally gave more correct responses on the knowledge portion of the survey (r = -.165, P < .01). Physicians who had formal training in genetics gave more correct answers. Physicians who order DNA-based tests scored higher than those who do not and had no formal training, but not higher than those who had formal training and do not order DNA-based tests. CONCLUSION: Gynecologists were more knowledgeable about genetic issues pertaining to breast and ovarian cancer than to other cancers or certain adult-onset disorders. Training appeared to increase knowledge. Increased training and affiliation with genetic specialists and others could improve gynecologists' ability to use genetic screening in clinical practice.

Adult↗
PubMed2000

A survey of obstetrician-gynecologists on their patients' alcohol use during pregnancy.

OBJECTIVE: To examine knowledge, attitudes, current clinical practices, and educational needs of obstetrician-gynecologists regarding patients' alcohol use during pregnancy. METHODS: A 20-item, self-administered questionnaire on patients' prenatal alcohol use was sent to 1000 active ACOG fellows. Responses were analyzed using univariate and multivariate statistical techniques. RESULTS: Of the 60% of the obstetrician-gynecologists who responded to the survey, 97% reported asking their pregnant patients about alcohol use. When a patient reports alcohol use, most respondents reported that they always discuss adverse effects and always advise abstinence. One fifth of the respondents (20%) reported abstinence to be the safest way to avoid all four of the adverse pregnancy outcomes cited (ie, spontaneous abortion, central nervous system impairment, birth defects, and fetal alcohol syndrome); 13% were unsure about levels associated with all of the adverse outcomes; and 4% reported that consumption of eight or more drinks per week did not pose a risk for any of the four adverse outcomes. The two resources that respondents said they needed most to improve alcohol-use assessment were information on thresholds for adverse reproductive outcomes (83%) and referral resources for patients with alcohol problems (63%). CONCLUSION: Efforts should be made to provide practicing obstetrician-gynecologists with updates on the adverse effects of alcohol use by pregnant women and with effective methods for screening and counseling women who report alcohol use during pregnancy.

Abortion, Spontaneous↗
PubMed2000

Behavioral neuroscience: challenges for the era of molecular biology.

This is a great age to participate in biological inquiry. Behavioral neuroscience offers a rich perspective for molecular biologists. However, behavioral analysis is not simply an assay. Whereas molecular biology has become a unique tool in the armamentarium of behavioral neuroscience, the powerful methodology of molecular biology is no substitute for careful behavioral exploration.

Animals↗
PubMed2000

Obstetrician-gynecologists' opinions and attitudes on the role of genetics in women's health.

Our objective was to describe gynecologists' current practice patterns and opinions on genetic screening and their perceived importance of genetic screening within individual practices. A questionnaire survey was sent to 1248 American College of Obstetrics and Gynecology (ACOG) Fellows, of whom 564 (45%) responded. Results from the 428 respondents providing genetic screening for heritable diseases or disorders are reported. Forty-four percent of respondents believe advances in the treatment of genetic diseases are likely in the next 10 years. Currently, however, genetics in gynecological practice receives infrequent attention. Twenty-four percent of respondents do not routinely review family histories at gynecological visits, 39% rate genetic issues as last among priorities in the office, and only 14% obtain consent for the DNA tests that they initiate. Although 21.3% identified themselves as sole providers of genetic information and counseling to their patients, most (65.4%) note they are not confident of their knowledge of genetics, particularly concerning breast and ovarian cancer. For obstetrician-gynecologists to keep pace with the rapid changes in genetics, further education and assimilation of genetics into the routine office practice will need to occur. Not currently viewed as a priority among practitioners, issues of genetic knowledge, ethics, and test interpretation will soon need attention. National organizations, continuing medical education, and existing genetic centers will need to meet these recognized demands.

Adult↗
PubMed2000

Curt Richter and regulatory physiology.

Curt Richter made seminal contributions to our understanding of a number of issues regarding the relationships between physiology and behavior. He was the first to conceptualize behavior as an aspect of regulatory physiology. These ideas developed from his work on behavioral responses to a variety of physiological perturbations. The classic example is Richter's demonstration of the development of avid sodium ingestion in response to urinary sodium loss after adrenalectomy. Some of Richter's ideas on the nature and underlying physiology of specific appetites maintain their influence and continue to stimulate active investigation. Others, focused on abilities to self-select balanced diets, have not borne the test of time or experimental challenge. As current research takes a more molecular focus, Richter's ideas on behavior in the service of the internal milieu maintain their currency, and the search for the molecular bases for these relationships should serve as a research focus.

History, 20th Century↗
PubMed1999

Ingestion of calcium solutions by common marmosets (Callithrix jacchus).

Callithrix jacchus, the common marmoset, is a small New World primate that feeds on insects, fruit, and gum, and has a high reproductive rate for a primate. Insects are generally a poor source of dietary calcium, while gums may contain significant levels of calcium. Their high reproductive rate also suggests that reproductive female C. jacchus might be susceptible to calcium deficiency. Thus, we hypothesized that common marmosets might find solutions containing calcium to be palatable. We used choice experiments to examine this phenomenon in 14 male and 19 female common marmosets. Animals were presented with identical water bottles containing either deionized water or a calcium lactate solution (either 2% or 4% calcium lactate by weight) and intake was measured. Serum 25-OH-vitamin D was monitored in a subset of the animals in the experiment to examine the role of vitamin D in this behavior. Our results demonstrated that C. jacchus can distinguish between plain water and a calcium lactate solution, and that in general they prefer calcium solutions. Although animals with marginal vitamin D status did have strong preferences for calcium solutions, they did not ingest significantly more of the calcium solutions than animals that were vitamin D-replete. Nulliparous females and males did not differ in the amounts of calcium solutions ingested. Lactating females ingested the greatest volume of the calcium solutions.

Animals↗
PubMed1999

The role of calcium in health and disease.

Skeletal fragility at the end of the life span (osteoporosis) is a major source of morbidity and mortality. Adequate calcium intake from childhood to the end of the life span is critical for the formation and retention of a healthy skeleton. High intakes of calcium and vitamin D potentiate the bone loss prevention effects of hormone replacement therapy in postmenopausal women. Pregnancy and lactation are not risk factors for skeletal fragility, although lactation is associated with a transient loss of bone that cannot be prevented by calcium supplementation. Low calcium intake has been implicated in the development of hypertension, colon cancer, and premenstrual syndrome, and it is associated with low intakes of many other nutrients. Encouragement of increased consumption of calcium-rich foods has the potential to be a cost-effective strategy for reducing fracture incidence later in life and for increasing patients' dietary quality and overall health.

Animals↗
PubMed1999

A central theory of preterm and term labor: putative role for corticotropin-releasing hormone.

Near the end of human pregnancy the concentration of placental corticotropin-releasing hormone in maternal blood rises exponentially. The rate of elevation of corticotropin-releasing hormone and its duration through time have been linked to the time of onset of labor. Paradoxically, although glucocorticoids are known to inhibit corticotropin-releasing hormone production within the hypothalamic-pituitary-adrenal axis, cortisol actually increases corticotropin-releasing hormone levels in several areas outside the hypothalamus, including the placenta. Placental corticotropin-releasing hormone may be an important component of a system that controls the normal maturation of the fetus and signals the initiation of labor. Abnormal elevations in corticotropin-releasing hormone, which may be a hormonal response to stressors arising in either the mother, placenta, or fetus, may prove to participate in the premature onset of parturition.

Corticotropin-Releasing Hormone↗
PubMed1999

Knowledge and clinical practice regarding calcium nutrition among obstetrician-gynecologists.

OBJECTIVE: To survey the knowledge of and attitude toward nutrition among practicing obstetrician-gynecologists, using calcium as a specific example. METHODS: Our survey on calcium nutrition consisted of 29 questions divided into four categories: demographic information, professional interest and clinical practice, knowledge and opinions, and education. We mailed this survey to the 244 ACOG Fellows who are members of the Collaborative Ambulatory Research Network and to a random sample of 756 Fellows who are not members of the Collaborative Ambulatory Research Network. RESULTS: Most (75.4%) respondents considered making dietary recommendations an important part of their practice. Interest in nutrition was correlated significantly with its perceived importance in clinical practice and was associated with a greater self-reported likelihood of making dietary recommendations to patients and referring patients to nutritional counseling. Nutrition was of greater importance to women and to older respondents. Women were more likely to make dietary recommendations to patients. Men were more likely to recommend nonfoods and higher fat foods as sources of dietary calcium. The daily calcium intake that obstetrician-gynecologists recommended for different types of patients varied widely but did not differ between male and female respondents. The responses to the knowledge questions concerning calcium metabolism were predominantly "don't know." CONCLUSIONS: Although specific knowledge of calcium metabolism and regulation was incomplete, obstetrician-gynecologists generally recognized the importance of nutrition in their clinical practice. Being older and female independently increased the perceived importance of nutrition.

Adult↗
PubMed1999

Calcium hunger in the parathyroidectomized rat is specific.

Calcium ingestion consequent on a challenge to calcium homeostasis such as parathyroidectomy or calcium deficient diet often appears to be nonspecific: rats rendered calcium deficient by a calcium-deficient diet increase ingestion of many tastants besides calcium, including MgCl2 and in particular, NaCl. Rats rendered calcium deficient by parathyroidectomy (PTX) have also been reported to increase ingestion of magnesium. Thus, magnesium, a chemically related molecule, and NaCl, a preferred mineral, pose challenges to the notion of a specific calcium hunger in calcium-deficient rats. Here, we reexamine the specificity of calcium preference of rats rendered calcium hungry by PTX by allowing them to choose between CaCl2 and MgCl2, and between CaCl2 and NaCl. We find that PTX rats clearly prefer calcium to either tastant. A review of the literature on tastant selection by calcium-hungry rats suggests that, given the choice between calcium and other tastants, they prefer calcium. Our findings lend credence to the notion of a calcium specific appetite in calcium-deficient rats.

Animals↗
PubMed1999

Effects of acute prednisone administration on memory, attention and emotion in healthy human adults.

We conducted a double-blind study in order to examine the effects of high doses of prednisone on memory, attention and emotion in humans. A total of 24 healthy undergraduate males self-administered either 160 mg of prednisone (n = 12) or a placebo (n = 12) for 4 consecutive days. We examined group differences in mood, regional brain electrical activity (EEG), the startle eyeblink response, memory recall and performance on an attention task after 4 days of treatment. We found significant group differences on measures of mood and frontal EEG alpha activity on 4-day treatment. Subjects treated with prednisone exhibited a significantly greater increase in self-reported negative emotion and greater relative right frontal EEG alpha activity on 4-day treatment compared with adults in the placebo group. We also found that subjects treated with prednisone recalled fewer objects on the memory task following treatment. No significant group differences were found on posterior EEG activity, the startle eyeblink measure, or the attention measure. These findings suggest that administration of high doses of exogenous prednisone may facilitate the experience of negative emotion and shifts in frontal EEG activity, and impair some aspects of cognitive functioning in humans. The multiple roles of glucocorticoids in memory, attention and emotion are discussed.

Adolescent↗
PubMed1999

Continuing medical education for life: eight principles.

Continuing medical education (CME) is being pressured to change in response to increasing and changing educational needs of practicing physicians, fostered by technical innovations, evolution of practice styles, and the reorganization of health care delivery. Leadership in the reform of CME falls primarily to the medical specialty societies in light of their traditional responsibilities for accrediting CME and maintaining professional standards. To address the need for reform, the American College of Obstetricians and Gynecologists in 1997 organized a conference to assemble CME program administrators from several medical specialties and academicians with expertise in postgraduate learning. At the conference, issues facing CME were examined. The authors, who were conference participants, state and explain eight principles that emerged from conference discussions. (For example: "Educational activities should be supportive of and coordinated with the transition to evidence-based medicine.") The principles reflect the interspecialty and interdisciplinary consensus achieved by the conference participants and can serve as useful guideposts for educators as they work to improve CME in their institutions. The authors conclude by noting the need for a more systematic and rigorously analytic approach, where CME content is determined according to assessed needs and CME is evaluated by measuring outcomes; for this to happen, CME educators and faculty must be brought up to date through training, including the use of problem-based learning. CME must also instill collegiality, interaction, and collaboration into the learning environment instead of being a solitary learning activity. Finally, CME must not only emphasize the acquisition of knowledge but also instruct physicians in the process of decision making to help them better use their knowledge as they make clinical judgments.

Clinical Competence↗
PubMed1999

Corticotropin-releasing hormone signals adversity in both the placenta and the brain: regulation by glucocorticoids and allostatic overload.

Glucocorticoids regulate corticotropin-releasing hormone (CRH) gene expression in the placenta and the brain. In both the placenta and two extrahypothalamic sites in the brain (the amygdala and the bed nucleus of the stria terminalis), glucocorticoids elevate CRH gene expression. One functional role of the elevation of CRH by glucocorticoids may be to signal adversity. When CRH is over-expressed in the placenta, it may indicate that the pregnancy is in danger, and preterm labor may result. When CRH is over-expressed in the brains of animals, they may become more fearful. Both situations possibly reflect allostatic mechanisms and vulnerability to allostatic overload, a condition in which biological tissue may be compromised.

Amygdala↗
PubMed1999

Ontogeny of calcium preference in the parathyroidectomized rat.

The ontogeny of calcium ingestion and preference was examined in parathyroidectomized (PTX) rats. Sucklings were tested by means of oral infusion. Four-day-old neonatal rats increased ingestion of CaCl2 after PTX but the effect was not specific to calcium because intake of MgCl2 was also increased. After 6 days of age the increase was more specific to calcium. The response increased in potency until 20 days of age. Weanlings were tested by measuring intakes from two burets, one with CaCl2 and one with MgCl2. Twenty-six-day-old weanlings showed a mild preference for CaCl2, but by 30 days of age the preference for calcium was similar to that reported for adult rats.

Age Factors↗
PubMed1999

Behavioral and psychophysiological correlates of self-presentation in temperamentally shy children.

We examined temporal changes in behavior, regional brain electrical activity (EEG), heart rate, cardiac vagal tone, the startle eyeblink response, and salivary cortisol during a task designed to elicit self-presentation anxiety in a group of 7-year-olds, some of whom were classified as temperamentally shy. We found that temperamentally shy children displayed a significantly greater increase in anxious behavior, a greater increase in right, but not left, frontal EEG activity, and a greater increase in heart rate as the task became more demanding compared with their nonshy counterparts. However, the results failed to reveal any significant group differences on the startle eyeblink and salivary cortisol measures. The present findings extend our prior work, in which we found distinct patterns of psychophysiological activity on baseline measures, to differences on psychophysiological measures collected concurrently during a socially evaluative situation in temperamentally shy children.

Analysis of Variance↗