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Biomedical subjects

J Schulkin

Publications and source records attributed to J Schulkin.

At least 55 records · Page 3Linked to original sources
PubMed1999

Genetics in obstetricians' offices: a survey study.

OBJECTIVE: To investigate obstetricians' genetic knowledge base and practice trends. METHODS: A questionnaire survey was sent to 1003 ACOG Fellows, 554 (55%) of whom responded. Results from the 446 respondents practicing obstetrics are reported. RESULTS: The majority of obstetricians surveyed (85.6%) reported completing standardized genetic-history forms for prenatal patients, and about half (48%) performed their own invasive diagnostic procedures. Most (87%) had access to genetic counselors. For aneuploidy risks associated with advanced maternal age, up to 69% of respondents provided at least some patient counseling in their offices. Physician knowledge of risk assessment and diagnostic testing in the areas of aneuploidy and neural tube defects was very good; however, for single-gene disorders such as cystic fibrosis, Tay-Sachs disease, and sickle cell disease, correct risk assessment or appropriate test selection presented difficulties for at least half of the respondents. Respondents cited the rapidity of changes in genetic testing as the greatest obstacle to providing genetic information to patients. CONCLUSION: Obstetricians' knowledge of inheritance and test selection pertaining to single-gene disorders was more limited than that for aneuploidy and neural tube defects. Comparable deficits were noted in patient-education efforts for single-gene disorders.

Congenital Abnormalities↗
PubMed1998

Assessment of office-based care of sexually transmitted diseases and vaginitis and antibiotic decision-making by obstetrician-gynecologists.

OBJECTIVE: Survey office-based obstetric-gynecologic practitioners regarding their knowledge of infectious disease care and antibiotic use. METHODS: A survey questionnaire of multiple-choice questions was mailed to Fellows of the American College of Obstetricians and Gynecologists about clinical entities for which recommendations have undergone recent changes or about which there was a lack of consensus in a prior similar survey (Gibbs RS, McGregor JA, Mead PB, et al.: Obstet Gynecol 83:631-636, 1994). RESULTS: Respondents indicated that oral metronidazole was their most frequent choice to treat bacterial vaginosis. Ampicillin (57%) was used more often than penicillin (39%) for intrapartum group B streptococcus prophylaxis. Azithromycin was preferred (61%) over erythromycin-base (38%) for chlamydia treatment during pregnancy. There were several modes of practice that deviated from accepted care: 27% and 29% did not screen for chlamydia and gonorrhea, respectively, in pregnancy; 17% used cultures for Gardnerella vaginalis to diagnose bacterial vaginosis; 25% considered quinolones to be safe in pregnancy; 93% felt metronidazole should never be used in pregnancy; and the majority (66%) would send a patient treated successfully for pelvic cellulitis home with an oral antibiotic. CONCLUSION: Respondents' infectious disease knowledge and practices in obstetrics and gynecology is appropriate in treating sexually transmitted diseases, bacterial vaginosis, and group B streptococcus. Numerous deficiencies still exist in screening for sexually transmitted diseases in pregnancy and diagnosing bacterial vaginosis, as well as in the choice of antibiotics to use or avoid for certain infections.

Adult↗
PubMed1998

Management of diabetes by obstetrician-gynecologists.

OBJECTIVE: To examine the rates of diagnosis and treatment of diabetes mellitus by ACOG Fellows in pregnant and nonpregnant patients. METHODS: We sent a questionnaire to 1250 ACOG Fellows. Thirty-nine percent responded. Responses were examined for potential differences between recently and less recently trained obstetrician-gynecologists. RESULTS: Ninety-six percent of obstetricians routinely screen for gestational diabetes mellitus (GDM). Fifty-five percent of obstetrician-gynecologists screen for diabetes in nonpregnant patients if there is a history of diabetes in the patient's family. Moreover, 33% care for women with type-1 diabetes mellitus, and 39% for women with type-2 diabetes mellitus who are not pregnant. Sixty-two percent believed that their patients with GDM are at increased risk for developing nongestational diabetes later in life, and 71% will recommend an evaluation of glucose tolerance in the future for these women. Finally, 99% are willing to prescribe oral contraceptives to women diagnosed previously with GDM. CONCLUSION: Obstetrician-gynecologists are aware of the need to screen for GDM and the importance of postpartum follow-up in GDM patients to detect type-2 diabetes mellitus. This practice is important because half of the 14 million people with type-2 diabetes mellitus are unaware they have this disorder, and many learn about it only after a serious complication has occurred.

Diabetes Mellitus↗
PubMed1998

Domestic violence screening practices of obstetrician-gynecologists.

OBJECTIVE: To ascertain the current knowledge base and screening practices of obstetrician-gynecologists in the area of domestic violence. METHODS: We mailed a survey to 189 ACOG Fellows who are members of the Collaborative Ambulatory Research Network. Questionnaires were also mailed to a random sample of 1250 nonmember Fellows. RESULTS: Obstetrician-gynecologists are aware of the nature of domestic violence and are familiar with common symptomatology that may be associated with domestic violence. For pregnant patients, 39% of respondents routinely screen at the first prenatal visit; 27% of respondents routinely screen nonpregnant patients at the initial visit. Screening is most likely to occur when the obstetrician-gynecologist suspects a patient is being abused, both during pregnancy (68%) and when the patient is not pregnant (72%). Only 30% of obstetrician-gynecologists received training on domestic violence during medical school; 37% received such instruction during residency training. The majority (67%) have received continuing education on the subject. Years since training and personal experiences with intimate-partner violence were associated with increased screening practices. CONCLUSION: Routine screening of all women for domestic violence has been recommended by ACOG for more than a decade. The majority of obstetrician-gynecologists screen both pregnant and nonpregnant patients when they suspect abuse. However, with universal screening, more female victims of violence can be identified and can receive needed services.

Adult↗
PubMed1998

Induction of corticotropin-releasing hormone gene expression by glucocorticoids: implication for understanding the states of fear and anxiety and allostatic load.

Evidence supports the idea of two distinct corticotropin-releasing hormone (CRH) systems in the brain: one which is constrained by glucocorticoids and the other which is not. It is this latter system that includes two primary sites (central nucleus of the amygdala and the lateral bed nucleus of the stria terminalis) in which the regulation of CRH gene expression can be disassociated from that of the paraventricular nucleus of the hypothalamus. It is this other system that we think is linked to fear and anxiety and to clinical syndromes (excessively shy fearful children, melancholic depression, post-traumatic stress disorder and self-administration of psychotropic drugs). The excess glucocorticoids and CRH, and the state of anticipatory anxiety, contribute to allostatic load, a new term that refers to the wear and tear on the body and brain arising from attempts to adapt to adversity.

Adaptation, Psychological↗
PubMed1998

From normal fear to pathological anxiety.

In this article the authors address how pathological anxiety may develop from adaptive fear states. Fear responses (e.g., freezing, startle, heart rate and blood pressure changes, and increased vigilance) are functionally adaptive behavioral and perceptual responses elicited during danger to facilitate appropriate defensive responses that can reduce danger or injury (e.g., escape and avoidance). Fear is a central motive state of action tendencies subserved by fear circuits, with the amygdala playing a central role. Pathological anxiety is conceptualized as an exaggerated fear state in which hyperexcitability of fear circuits that include the amygdala and extended amygdala (i.e., bed nucleus of the stria terminalis) is expressed as hypervigilance and increased behavioral responsivity to fearful stimuli. Reduced thresholds for activation and hyperexcitability in fear circuits develop through sensitization- or kindling-like processes that involve neuropeptides, hormones, and other proteins. Hyperexcitability in fear circuits is expressed as pathological anxiety that is manifested in the various anxiety disorders.

Amygdala↗
PubMed1998

Evidence for induction of a phosphate appetite in juvenile rats.

This study examined whether dietary phosphate (Pi) restriction stimulates an appetite for Pi in the juvenile rat, which normally has a high metabolic Pi demand for growth. Juvenile Wistar rats were placed in individual cages with unrestricted access to tap water and a low (LPD, 0.02% Pi) or normal Pi diet (NPD, 0.6% Pi) for 7 days. On day 8, both groups of rats were given unlimited access to a solution of 0.3 M potassium phosphate water (PiH2O) for 8 additional days. Rats fed LPD consumed 70-100% more PiH2O then those rats fed NPD (P < 0.001). The increase in PiH2O intake resulted in a marked rise in the growth rate of rats fed LPD during days 8-15. A similar Pi intake was inducible after only 2 days of LPD and was associated with significant reductions in both plasma and cerebrospinal fluid (CSF) Pi levels; these levels remained low throughout Pi restriction, despite a significant PiH2O intake. Furthermore, the renal adaptation to enhance Pi reabsorption (TmPi) during Pi deprivation remained elevated despite enhanced PiH2O intake. Replenishment with a high-Pi diet rapidly quenched the PiH2O appetite and was associated with restoration of both plasma and CSF Pi levels. These findings suggest that an appetite for Pi can be induced in juvenile rats, perhaps through lowered plasma and CSF Pi levels. This behavioral response may serve as an additional mechanism to maintain an adequate supply of Pi necessary for growth and development of the animal.

Age Factors↗
PubMed1998

Prolactin microinjections into the amygdalar central nucleus lead to decreased NREM sleep.

Prolactin administered systemically, intracerebroventricularly or locally into the lateral hypothalamus enhances rapid eye movement sleep (REM) when given diurnally and decreases REM when given nocturnally. The amygdala is being recognized as an important modulator of behavioral state, and the central nucleus of the amygdala (CNA) has a high concentration of prolactin fibers and receptors. We microinjected prolactin (10, 100, 250 ng/0.2 microliter saline) or saline alone into CNA of rats and measured the effect on behavioral state. Prolactin produced a dose-dependent decrease in non-REM (NREM), with the effect becoming significant at the high (250 ng) dose. REM was not significantly affected at any dosage. The results indicate a role for prolactin in CNA in the control of NREM. The results are discussed in terms of the amygdala having a broad role in the regulation of behavioral state.

Amygdala↗
PubMed1997

Behavioral and neuroendocrine responses in shy children.

Previous research has shown that infants who display a high frequency of motor activity and negative affect at 4 months of age are likely to be behaviorally inhibited toddlers. We examined social behaviors, maternal report of temperament, salivary cortisol, and baseline startle responses at age 4 in a sample of children, some of whom displayed a high frequency of motor activity and negative affect at 4 months of age. Infants who displayed this temperamental profile were reported by their mothers as more shy at age 4 compared with other children. We also found that 4-year-olds who displayed a high frequency of wary behavior during peer play exhibited relatively high morning salivary cortisol, were reported as contemporaneously shy by their mothers, and were behaviorally inhibited at 14 months of age. There were no significant relations found between baseline startle and morning salivary cortisol and measures of shyness at age 4. We speculate that high levels of cortisol in shy children may induce changes in the amygdala, exacerbating their fearfulness.

Affect↗
PubMed1997

Obstetrician-gynecologists as primary care physicians: the perspectives of health maintenance organization medical directors and obstetrician-gynecologists.

OBJECTIVE: To survey the interest of obstetrician-gynecologists in serving as primary care physicians and their perceived preparedness for that role from the view points of managed care plans and obstetrician-gynecologists. METHODS: A sample of obstetrician-gynecologists was asked to describe their preferred physician roles in managed care plans. Managed care medical directors were asked to define the obstetrician-gynecologist's role in their health plans. The mailed survey questions focused on 1) obstetrician-gynecologists' interest in serving as primary care physicians and/or gatekeepers, 2) direct access to obstetrician-gynecologists, and 3) additional training needed to serve as primary care physicians. RESULTS: Thirty-seven percent of obstetrician-gynecologists expressed little or no interest in serving as primary care physicians, and 37% had some or high interest. Fifty-six percent were not interested in serving as gatekeepers, and 45% believed that physicians in the specialty should not do so. Almost all believed women should be allowed direct access to obstetrician-gynecologists. Over half of the managed care plans allowed women to refer themselves to obstetrician-gynecologists, and one-third allowed these physicians to serve as primary care gatekeepers. Most plans believed that extensive additional training is needed for obstetrician-gynecologists to serve as gatekeepers, whereas 70% of specialists believed that little or no additional training is needed. CONCLUSION: Obstetrician-gynecologists do not all agree on their appropriate and preferred role as physicians in the managed care environment; 37% see themselves as primary care physicians, whereas 37% would rather act as consultative specialists. Nearly all, however, support direct access to obstetrician-gynecologists. Most (69.7%) believe that they are capable of serving as primary care gatekeepers with little or no additional training, but managed care plans believe otherwise.

Adult↗
PubMed1997

Treatment of depression by obstetrician-gynecologists: a survey study.

OBJECTIVE: We performed an exploratory survey of depression diagnosis, treatment, and patient referral patterns by Fellows of ACOG. We also examined obstetrician-gynecologists' professional training in the management of clinical depression. METHODS: We sent a questionnaire to a total of 1370 ACOG Fellows. Sixty percent of the surveys were returned. RESULTS: As a group, obstetrician-gynecologists reported diagnosing an average of four new cases of depression per month. Within the overall sample, the number of new diagnoses of depression made each month was significantly greater for those defining themselves as primary care physicians than for those defining themselves as specialists. When treating depression pharmacologically, obstetrician-gynecologists reported that they overwhelmingly (74% of the time) chose selective serotonin reuptake inhibitor antidepressants. Ninety-five percent of obstetrician-gynecologists reported that they referred severely depressed patients to a mental health professional. A majority of respondents neither received residency training (80%) nor completed a continuing medical education course (60%) on the treatment of clinical depression in women. CONCLUSION: Obstetrician-gynecologists who describe themselves as primary care physicians make significantly more diagnoses of depression than those considering themselves specialists. Studies further to assess obstetrician-gynecologists' management of depression and better to define needs for professional education are warranted.

Adult↗
PubMed1996

Hyperexcitability: exaggerated fear-potentiated startle produced by partial amygdala kindling.

The present study asked whether partial amygdala kindling would affect the expression of conditioned fear-potentiated startle. Rats were conditioned to be fearful of a light. They were then stimulated bilaterally in the amygdala or hippocampus on 2 consecutive days (partial kindling). Rats were tested 24 hr later for fear-potentiated startle. Amygdala-kindled rats had exaggerated fear-potentiated startle compared to sham-kindled rats. Hippocampus-kindled rats also displayed fear-potentiated startle, but no greater than that of sham-kindled rats. Partial amygdala kindling induced c-fos messenger RNA (mRNA) expression, a marker for neuronal activation, throughout the limbic and neocortices. In contrast, partial hippocampus kindling induced c-fos mRNA in the hippocampus only. The data suggest that kindled-induced hyperexcitability of the amygdala and limbic cortices produced exaggerated conditioned fear-potentiated startle.

Amygdala↗
PubMed1996

Pragmatism and the cognitive and neural sciences.

Two prominent intellectual disciplines dominate the discipline of psychology, the cognitive and neural sciences. Separate departments for both are now commonplace at major universities across America. I suggest, however, that the discipline of psychology asks key questions about experience, mind, or central states not found in other disciplines. Psychology is embodied in both the cognitive and neural sciences, and an important common thread is the Jamesian-Deweyian emphasis on experience. The Jamesian-Deweyian tradition emphasized the sense of experience in problem-solving and functional adaptations. The pragmatists' sense of experience is the way by which one engages the world, is inherently cognitive, and orchestrated by central states of the brain. Any attempt within the neural and cognitive sciences to capture human experience will need to resurrect this tradition.

Cognition↗
PubMed1995

Corticosterone effects on rat calretinin mRNA in discrete brain nuclei and the testes.

Calretinin is an EF-hand calcium binding protein found predominantly in discrete sets of neurons in the central system, and in the sex hormone producing cells of the gonads. Calretinin mRNA levels were measured in discrete brain areas from vehicle and corticosterone treated rats (subcutaneous injections of 0, 0.1, 1, or 10 mg, 7 days) using a micropunch ribonuclease protection assay. Treatment with high dose corticosterone (10 mg) caused a 93% decrease in calretinin mRNA levels in the hypothalamic paraventricular nucleus compared to controls. Two other brain regions, the medial amygdaloid nucleus and the nucleus reuniens, demonstrated an approximately 40% decrease in calretinin mRNA following high dose corticosterone. In separate experiments, adrenalectomy and diurnal corticosterone variations had no effect on calretinin mRNA in the brain areas examined. In the testes, corticosterone treatment decreased calretinin protein in a dose dependent fashion (to 81%, 68%, and 39% of controls at doses of 10, 1, and 0.1 mg/day, respectively). Low dose corticosterone treatments decreased testicular but not neuronal calretinin mRNA, whereas high dose corticosterone reduced calretinin mRNA in testes and several discrete brain areas. This suggests that corticosterone's effects on brain calretinin may be due to its pathological effects, e.g. energy depletion of brain cells or interference with the normal support functions of glia.

Amygdala↗
PubMed1995

The ingestion of calcium in multiparous and virgin female rats.

The present experiments demonstrate that multiparous females ingest more calcium that virgin females. In two experiments, we demonstrated that multiparous females ingested more calcium than virgin females, and both ingested larger amounts than males. The biological basis for this enhanced avidity for calcium lie in the greater needs for calcium during reproduction.

Animals↗
PubMed1995

Regulation of corticotropin-releasing hormone receptor messenger ribonucleic acid in the rat brain and pituitary by glucocorticoids and stress.

Glucocorticoids and stress are known to influence the synthesis of corticotropin-releasing hormone (CRH) at a variety of sites in brain, including the hypothalamus and amygdala. The recent cloning of the CRH receptor (CRH-R) enabled us to determine whether glucocorticoids or stress influenced CRH action via regulation of CRH-R. We, therefore, used in situ hybridization to measure CRH-R messenger RNA (mRNA) levels in the hypothalamic paraventricular nucleus (PVN), anterior pituitary (AP), amygdala, and bed nucleus of the stria terminalis (BNST) under several conditions. Systemic corticosterone (CORT) treatment, both daily injection (5 mg/rat.day) up to 14 days and pellet implant (200 mg) for 14 days, decreased CRH-R mRNA in the PVN and lateral and basolateral nucleus of the amygdala (BLA). Corticosterone injection (10 mg/rat.day, for 7 days) decreased CRH-R mRNA in the AP. Adrenalectomy also decreased CRH-R mRNA in the PVN and AP, but did not alter it in the BLA. In both sham and adrenalectomized rats with CORT pellet replacement (39 mg; ADX+CORT rats), acute (2-h) and repeated (2 h daily for 14 days) immobilization stress (which produced a large increase in plasma CORT in sham rats) increased CRH-R mRNA in the PVN and decreased it in the AP, but did not affect CRH-R mRNA in the BLA. However, ADX+CORT rats consistently had higher levels of CRH-R mRNA in both the PVN and AP than sham rats after stress. Brain stem hemisection, which damaged all ascending catecholaminergic fibers with the exception of the locus ceruleus, attenuated immobilization stress-induced up-regulation of CRH-R mRNA ipsilaterally in the PVN. None of the treatments affected CRH-R mRNA levels in the central and medial nucleus of the amygdala or the BNST. These results suggest that high concentrations of CORT or CRH synergistically decrease CRH-R mRNA levels in the AP, and that at least high CORT has an inhibitory effect on PVN CRH-R mRNA levels. However, stress input can override such inhibitory effects and thus up-regulate CRH-R mRNA in the PVN. The extrahypothalamic regions, such as amygdala and BNST may have different sensitivities to CORT or CRH for the regulation of CRH-R mRNA.

Adrenocorticotropic Hormone↗
PubMed1994

Effect of corticosterone on the enhancement of the acoustic startle reflex by corticotropin releasing factor (CRF).

The present study evaluated the effects of adrenalectomy and chronic administration of corticosterone on the ability of CRF given intraventricularly to increase the amplitude of the acoustic startle reflex in rats. Experiment 1 showed that CRF-enhanced startle was not affected by adrenalectomy, indicating a central effect independent of the integrity of the hypothalamic-pituitary-adrenal axis. In Experiment 2, chronic injection of corticosterone augmented CRF-enhanced startle using a dose of CRF (0.25 micrograms) that normally is ineffective in increasing startle amplitude. Chronic injection of corticosterone by itself did not increase startle amplitude (Experiment 3). We suggest that the potentiation of CRF-enhanced startle by corticosterone may result from an activation of CRF in the central nucleus of the amygdala.

Acoustic Stimulation↗