Biomedical subjects

Jay Schulkin

Publications and source records attributed to Jay Schulkin.

At least 19 recordsLinked to original sources

PubMed2007

Cesarean delivery on maternal request: obstetrician-gynecologists' knowledge, perception, and practice patterns.

OBJECTIVE: To examine obstetrician-gynecologists' knowledge, opinions, and practice patterns related to cesarean delivery on maternal request. METHODS: Questionnaires were mailed to 1,031 American College of Obstetricians and Gynecologists Fellows in February 2006, with a response rate of 68%. The questionnaire queried respondents' demographic characteristics, practices and attitudes surrounding vaginal and cesarean deliveries, knowledge and beliefs regarding the risks and benefits of elective and nonelective cesarean delivery, and counseling practices and department policies for cesarean delivery on maternal request. RESULTS: About half of respondents believe women have the right to cesarean delivery on maternal request, and a similar percentage acknowledge having performed at least one cesarean delivery on maternal request. Fifty-eight percent of respondents note an increase in patient inquiries regarding cesarean delivery over the past year, yet most of their practices do not have a policy regarding this procedure. Respondents attribute the increase in inquiries to the increase of information from the media and to convenience. Respondents cited more risks than benefits of cesarean delivery on maternal request, and nearly all discuss these risks with patients who are considering one. Females were more negative toward cesarean delivery on maternal request than males and endorsed more risks and fewer benefits. There were no relationships between assessment of risks and benefits or practice with clinician age or patient characteristics. CONCLUSION: Most obstetrician-gynecologists in this study recognized an increased demand for cesarean delivery on maternal request within their practices, while believing that the risks of this procedure outweigh the benefits. Clinicians would benefit from strong evidence regarding risks and benefits, evidence that is crucial to guiding policy making with regard to cesarean delivery on maternal request. LEVEL OF EVIDENCE: III.

Cesarean Section↗

PubMed2006

Chronically elevated corticosterone in the amygdala increases corticotropin releasing factor mRNA in the dorsolateral bed nucleus of stria terminalis following duress.

Elevated corticosterone in the amygdala leads to cautious avoidance behaviors on the elevated plus maze. The current study examined the effect of elevated corticosterone in the amygdala on corticotropin releasing factor (CRF) mRNA levels in the bed nuclei of stria terminalis (BNST). Exposure to the elevated plus maze increased CRF mRNA in both the dorsolateral and ventrolateral BNST. Corticosterone implants in the amygdala potentiated this effect in the dorsolateral, but not ventrolateral BNST. Corticosterone also resulted in an increased number of neurons expressing CRF in the dorsolateral BNST in response to the behavioral stimuli.

Amygdala↗

PubMed2006

Do we practice what we preach? A review of actual clinical practice with regards to preconception care guidelines.

OBJECTIVES: To review what past studies have found with regard to existing clinical practices and approaches to providing preconception care. METHODS: A literature review between 1966 and September 2005 was performed using Medline. Key words included preconception care, preconception counseling, preconception surveys, practice patterns, pregnancy outcomes, prepregnancy planning, and prepregnancy surveys. RESULTS: There are no current national recommendations that fully address preconception care; as a result, there is wide variability in what is provided clinically under the rubric of preconception care. CONCLUSIONS: In 2005, the Centers for Disease Control and Prevention sponsored a national summit regarding preconception care and efforts are underway to develop a uniform set of national recommendations and guidelines for preconception care. Understanding how preconception care is presently incorporated and manifested in current medical practices should help in the development of these national guidelines. Knowing where, how, and why some specific preconception recommendations have been successfully adopted and translated into clinical practice, as well as barriers to implementation of other recommendations or guidelines, is vitally important in developing an overarching set of national guidelines. Ultimately, the success of these recommendations rests on their ability to influence and shape women's health policy.

Female↗

PubMed2006

Obstetrician-gynecologists' practice and knowledge regarding spina bifida.

The purpose was to assess practicing obstetrician-gynecologists' knowledge about the prenatal diagnosis and postnatal prognosis of spina bifida. Written questionnaires designed to assess practicing obstetrician-gynecologists' knowledge of spina bifida were mailed to 1000 randomly selected American College of Obstetricians and Gynecologists Fellows. More than 50% did not identify many of the sonographic features indicative of an open neural tube defect in the fetus and more than one third overestimated the risks of stillbirth, whereas more than two thirds overestimated the risk for premature delivery in a pregnancy complicated by fetal spina bifida. Just more than 50% correctly estimated the 1-year survival rate and just less than 50% correctly estimated survival at 6 years. Sixty-six percent overestimated the incidence of mental retardation associated with spina bifida. Maternal-fetal medicine specialists returning the survey exhibited a much better understanding of the prenatal issues and prognostic and outcome factors related to spina bifida. There are gaps in obstetrician-gynecologists' knowledge about the diagnostic features of and prognosis for fetal spina bifida. It is important for them to take advantage of continuing medical education opportunities to learn more about the management of pregnancies complicated by fetal spina bifida and about the prognosis for affected individuals.

Adult↗

PubMed2006

The influence of physician gender on practice satisfaction among obstetrician gynecologists.

OBJECTIVE: A survey was conducted to investigate the hypothesis that female gender would positively affect job satisfaction among obstetrician gynecologists. STUDY DESIGN: A survey was sent to 500 randomized, age matched American College of Obstetrics and Gynecology members, 50% each men and women: 49.8% responded. Data were analyzed with the chi2 contingency test, Cochran's test for linear trends, Student t tests, and multiple regression. RESULTS: Women considered their gender an asset in deciding on a career in obstetrics and gynecology, in obtaining jobs, and in maintaining their practices. Men considered that their gender limited their practice options and were more likely to report that they would not choose a career in obstetrics and gynecology if they could choose again. The only significant difference between men and women in measures of obtaining and maintaining a practice was that men were more likely to practice in small urban or rural settings. Men reported higher incomes. Both genders were equally satisfied with their jobs. CONCLUSION: Although both genders considered female gender to be an asset in obstetrics and gynecology, this survey showed no difference in their ratings of overall career satisfaction.

Adult↗

PubMed2006

Nucleus accumbens corticotropin-releasing factor increases cue-triggered motivation for sucrose reward: paradoxical positive incentive effects in stress?

BACKGROUND: Corticotropin-releasing factor (CRF) is typically considered to mediate aversive aspects of stress, fear and anxiety. However, CRF release in the brain is also elicited by natural rewards and incentive cues, raising the possibility that some CRF systems in the brain mediate an independent function of positive incentive motivation, such as amplifying incentive salience. Here we asked whether activation of a limbic CRF subsystem magnifies the increase in positive motivation for reward elicited by incentive cues previously associated with that reward, in a way that might exacerbate cue-triggered binge pursuit of food or other incentives? We assessed the impact of CRF microinjections into the medial shell of nucleus accumbens using a pure incentive version of Pavlovian-Instrumental transfer, a measure specifically sensitive to the incentive salience of reward cues (which it separates from influences of aversive stress, stress reduction, frustration and other traditional explanations for stress-increased behavior). Rats were first trained to press one of two levers to obtain sucrose pellets, and then separately conditioned to associate a Pavlovian cue with free sucrose pellets. On test days, rats received microinjections of vehicle, CRF (250 or 500 ng/0.2 microl) or amphetamine (20 microg/0.2 microl). Lever pressing was assessed in the presence or absence of the Pavlovian cues during a half-hour test. RESULTS: Microinjections of the highest dose of CRF (500 ng) or amphetamine (20 microg) selectively enhanced the ability of Pavlovian reward cues to trigger phasic peaks of increased instrumental performance for a sucrose reward, each peak lasting a minute or so before decaying after the cue. Lever pressing was not enhanced by CRF microinjections in the baseline absence of the Pavlovian cue or during the presentation without a cue, showing that the CRF enhancement could not be explained as a result of generalized motor arousal, frustration or stress, or by persistent attempts to ameliorate aversive states. CONCLUSION: We conclude that CRF in nucleus accumbens shell amplifies positive motivation for cued rewards, in particular by magnifying incentive salience that is attributed to Pavlovian cues previously associated with those rewards. CRF-induced magnification of incentive salience provides a novel explanation as to why stress may produce cue-triggered bursts of binge eating, drug addiction relapse, or other excessive pursuits of rewards.

Animals↗

PubMed2006

Long-term expression of corticotropin-releasing factor (CRF) in the paraventricular nucleus of the hypothalamus in response to an acute colonic inflammation.

This study examined the long-term effects of an acute colitis on central corticotropin-releasing factor (CRF) expression. An increase in CRF mRNA in the paraventricular nucleus of the hypothalamus (PVN) and the central nucleus of the amygdala (CeA) was observed during active colitis, and the effect in the PVN was maintained following recovery. In summary, hypothalamic gene expression of CRF persists in the PVN despite resolution of an acute colitis.

Animals↗

PubMed2006

Pattern of maternal serum corticotropin-releasing hormone concentration during pregnancy in the common marmoset (Callithrix jacchus).

Corticotropin-releasing hormone (CRH), a potent neuropeptide, is produced by the placenta of anthropoid primates. No other mammals, including prosimian primates, are known to produce placental CRH. In humans, placental CRH appears to play an important role in the progression of pregnancy to parturition. Maternal circulating CRH begins to rise early in pregnancy and increases until parturition. Gorillas and chimpanzees share this pattern of increasing maternal CRH during pregnancy with humans. In humans, chimpanzees, and gorillas, maternal CRH and estradiol concentrations are correlated, consistent with the hypothesis that CRH is involved in the biosynthetic pathway for placental estrogen production. In contrast, in baboons, maternal circulating CRH rises precipitously early in pregnancy and then declines, though CRH is detectable until birth. This research was designed to investigate the pattern of maternal circulating CRH in the common marmoset during pregnancy. Blood samples were taken across gestation from nine subjects over 11 pregnancies, and the plasma was assayed for CRH. The pattern of maternal circulating CRH in the common marmoset was similar to that of the baboon, with a rapid rise starting at about 50 days postconception and a peak at approximately 70 days postconception. By 110 days postconception, CRH concentration had plateaued at a significantly lower value. The peak and mean values for CRH were associated with fetal number (e.g., females gestating triplets had higher values than females gestating twins). Urinary estradiol showed no association with plasma CRH concentration. Marmosets appear to differ from the great apes in this regard, and to share a pattern of maternal CRH during pregnancy with the baboon, indicating that the baboon and marmoset pattern may be ancestral. The function of the early rapid rise of CRH in baboons and marmosets, and the significance of this difference between monkeys and apes, are not known.

Animals↗

PubMed2006

Obstetrician-gynecologists and self-identified depression: personal and clinical.

A survey was designed to explore the effect of obstetrician-gynecologists' subjective awareness of depression in themselves and close family/friends on screening patients for depression and on assessing and treating depression in three scenarios describing hypothetical patients during the adolescence, postpartum, and perimenopausal periods. Questionnaires were mailed to 397 members of the American College of Obstetricians and Gynecologists (ACOG) who participate in the Collaborative Ambulatory Research Network (CARN). Fifty-five percent of the questionnaires were returned. One third of physicians reported having suffered from depression occasionally (28.1%), often (3.8%), or all the time (2.4%) during the past year. Having personally suffered from depression was associated with elevated assessment of depression in the scenarios but not with elevated rates of screening for depression in actual practice, nor with aggressiveness of treatment choices in the scenarios. Awareness that a close friend suffered from depression was not associated with lowered mood as measured, but was associated with increased rates of screening for depression in adolescent, postpartum, and perimenopausal patients, and with elevated assessment of depression and more aggressive treatment practices for depression in hypothetical patients at these three life stages. As such, physicians' practices regarding depression may be influenced by something other than reactivity to their own emotional state.

Adult↗

PubMed2006

What obstetrician-gynecologists think of preconception care.

OBJECTIVES: To describe obstetrician-gynecologists' opinions of preconception care (PCC) and ascertain patient uptake for this service. METHODS: A questionnaire was mailed to 1105 ACOG members in August 2004. RESULTS: There was a 60% response rate. Most physicians think PCC is important (87%) and almost always recommend it to women planning a pregnancy (94%); 54% do so with women who are sexually active. Around a third (34%) thought their patients usually do not plan their pregnancies and 49% said very few pregnant patients came in for PCC. Of those who obtain PCC, they were believed to do so more likely to assure a healthy pregnancy (83%) than because of an elevated risk for birth defects (20%). Of 11 issues presented, cigarette smoking and folic acid supplementation were rated the most important for PCC counseling; exercise and environmental concerns were the least important. CONCLUSIONS: Physicians are willing to provide PCC but few patients are accessing such services.

Adult↗

PubMed2006

Postterm pregnancy: practice patterns of contemporary obstetricians and gynecologists.

The purpose of this study was to determine the management of postterm pregnancy by contemporary practicing obstetricians. A questionnaire investigating practice patterns pertaining to postterm pregnancy was mailed to 1000 randomly selected American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in March 2004. The response rate was 52.2% (522/1000). Statistical analysis included the answers from the 420 practicing obstetricians. Males comprised 55.7% (234/420) of the responding obstetricians. The majority of responding obstetricians (95.4%) rated their residency training regarding management of postterm pregnancy as adequate or comprehensive. Forty-eight percent define postterm pregnancy as 42 weeks gestation or greater, whereas 43.1% consider 41 weeks gestation or greater to be postterm. Seventy-three percent routinely induce low-risk patients with singletons at 41 weeks gestation. If patients decline induction at 41 weeks or if the practitioner does not induce patients until after 41 weeks gestation, the majority of respondents (64.8% and 65.0%, respectively) start postterm pregnancy fetal testing in singletons at 41 weeks and obtain testing twice weekly. Most (64.6%) use cervical ripening agents when inducing both nulliparous and multiparous patients with unfavorable cervices. The majority of practitioners (97.3%) do not use prostaglandins when inducing postterm patients with one previous cesarean delivery. Although most respondents manage postterm pregnancy according to recent ACOG educational materials with regard to antenatal fetal surveillance and methods of induction, the majority induce patients with singleton postterm pregnancies at 41 weeks gestation rather than at 42 weeks gestation.

Female↗

PubMed2006

Screening for Down syndrome: practice patterns and knowledge of obstetricians and gynecologists.

OBJECTIVE: To assess obstetricians' practice patterns and knowledge regarding screening for Down syndrome. METHODS: A questionnaire was mailed to 1,105 American College of Obstetricians and Gynecologists Fellows and Junior Fellows in 2004. RESULTS: Sixty percent of questionnaires were returned. Statistical analyses were limited to the 532 practicing obstetricians. Greater than 80% felt their training and experience qualified them to counsel patients about genetic issues in pregnancy. However, 45% rated their residency training regarding prenatal diagnosis as barely adequate or nonexistent. American College of Obstetricians and Gynecologists publications were rated by 86% as an important source of information on genetic counseling. Seventy-eight percent of practitioners counsel all obstetric patients about risks for fetal aneuploidy, and 67% provide counseling for heritable genetic abnormalities. Although the majority (99%) offer second-trimester Down syndrome screening, only 55% also offer first-trimester screening for Down syndrome. Almost one half (49%) use the quad screen, and 6% offer integrated first- and second-trimester screening. The majority (88%) routinely offer amniocentesis to patients who are at elevated risk for genetic abnormalities, whereas 44% also offer chorionic villus sampling. Few (2%) perform chorionic villus sampling. CONCLUSION: Most obstetricians manage patients at risk for fetal genetic abnormalities according to American College of Obstetricians and Gynecologists educational materials. This survey identified deficiencies related to Down syndrome screening, including a limited number of practitioners performing chorionic villus sampling and physicians' own perception that training regarding genetic counseling should be improved. Educational strategies are needed to address these deficiencies before first-trimester screening programs are widely implemented. LEVEL OF EVIDENCE: III.

Amniocentesis↗

PubMed2006

Obesity prevention and treatment practices of U.S. obstetrician-gynecologists.

OBJECTIVE: To describe obesity prevention and treatment practices of U.S. obstetrician-gynecologists. METHODS: A cross-sectional survey was mailed to 1,806 practicing members of the American College of Obstetricians and Gynecologists (ACOG) in February-April 2005. RESULTS: Of the 900 respondents who returned questionnaires, 82% reported using body mass index (BMI) to assess obesity; 80% reported counseling patients about weight control and 84% about physical activity "most of the time" or "often." Most reported counseling patients about diet; the most frequently recommended dietary strategies were changing eating patterns, limiting intake of specific foods, and controlling portion size. About 27% reported referring their patients for behavioral therapy "most of the time" or "often," and 35% reported ever prescribing weight loss medications to obese patients. More than 85% counseled patients about pregnancy weight gain, and 64% used the patients' prepregnancy BMI to modify their recommendations "most of the time" or "often." Respondents who completed their residency after 1996 were more likely to use patients' BMI to screen for obesity than those who finished earlier. Respondents who believed that they could help their patients lose weight (44%) were more likely to counsel their patients to do so (P < .001). CONCLUSION: A majority of obstetrician-gynecologists appear to use BMI to screen for obesity and to counsel their patients about weight control, diet, and physical activity. Many, however, do not prescribe weight loss medications or refer patients to behavioral weight loss therapy. Obstetrician-gynecologists who believe they can help patients lose weight are more likely to follow recommendations for the treatment of obesity. LEVEL OF EVIDENCE: III.

Adult↗

PubMed2006

Clinical approach to mental health issues among obstetrician-gynecologists: a review.

UNLABELLED: In recent years, obstetrician-gynecologists have taken on a greater role in the provision of primary care. Mental health has been a topic worthy of further exploration as a result of the high prevalence rates of women presenting in gynecologic settings with depressive, anxiety, or eating-disordered symptoms. The detrimental effects of psychopathology have been well documented in the literature, especially if present during pregnancy. This article provides a review of the literature in the area of clinical practice related to mental health among obstetrician-gynecologists based on searches of the Psyc Info and MEDLINE databases. Lack of recognition and underdiagnosis are common problems that need to be addressed by focused educational initiatives. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall the importance of screening for various types of mental disease during an ob/gyn visit; describe the detrimental effects of psychopathology, especially during pregnancy; and explain the importance of educational initiatives in detecting and treating mental disorders.

Adult↗

PubMed2006

Assessment and management of obesity.

UNLABELLED: Obesity is a serious medical condition that significantly impacts the health of pregnant and nonpregnant women. Although obstetrician-gynecologists have reported that they are knowledgeable of the health risks associated with obesity, they have also reported that their knowledge of weight assessment and management is inadequate. The purpose of this article is to review the proper procedures for assessing and managing obesity. By properly assessing obesity and constructing individualized weight management plans for those affected, obstetrician-gynecologists can help reduce the prevalence of obesity in women of childbearing ages. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to explain the impact of obesity on the health of nonpregnant and pregnant women, summarize the methods of distinguishing overweight from obesity, and recall the proper weight management programs for and assessments of obesity in women.

Anti-Obesity Agents↗

PubMed2006

Obstetrician-gynecologists' patients' knowledge of and attitudes toward hormone therapy: a survey.

OBJECTIVE: To investigate the opinions of obstetrician-gynecologists' patients toward hormone therapy (HT). STUDY DESIGN: Survey questionnaires for patients were mailed to obstetrician-gynecologists who belong to the Collaborative Ambulatory Research Network. RESULTS: Surveys were returned by 1,659 patients from 39 states and the District of Columbia. Women over 50 years old and postmenopausal women of all ages were more likely to report being well informed. Perimenopausal and postmenopausal women were significantly more likely than premenopausal women to have extensively considered the risks and benefits of HT (p<0.001). More highly educated women were more likely to be aware of the results of the recent clinical trials of HT and to have formed an opinion about the risks and benefits of HT. Women who had formed an opinion were essentially divided over whether HT use after menopause would be helpful or harmful. Less than half the women thought that physicians know enough about HT to give appropriate advice. CONCLUSION: There was little consensus regarding the risks and benefits of HT. Postmenopausal and more educated women considered themselves more informed and were more likely to have reached a decision regarding HT but were as evenly divided regarding the risks and benefits.

Adult↗

PubMed2005

Glucocorticoid receptor antagonism in the basolateral amygdala and ventral hippocampus interferes with long-term memory of contextual fear.

The binding of glucocorticoids to the type II or glucocorticoid receptor (GR) is known to play a role in memory consolidation and long-term memory. The present series of studies investigated the locus for GR effects on learning and memory of contextual fear conditioning. The GR antagonist RU 38486 was administered peripherally (10, 20, or 30 mg/kg/ml), as well as centrally into the lateral ventricle (75 or 150 ng/2 microL), basolateral amygdala (BLA; 0.3, 3, or 30 ng/0.2 microL), dorsal hippocampus (DH; 30 ng/microL) or ventral hippocampus (VH; 30 ng/microL) prior to contextual fear conditioning. Peripheral administration of RU 38486 did not affect fear-related levels of freezing immediately following a footshock or in a long-term memory test 24 h later. However, administration into the lateral ventricle, BLA, or VH decreased freezing in a 24 h retention test, while leaving post-shock levels of freezing intact. Both post-shock and retention levels of freezing were unaffected in rats that received RU 38486 in the DH compared to vehicle controls; however, vehicle rats also displayed low levels of freezing during retention. The data indicate that GR activation within the BLA and VH is important for the establishment of long-term memory for contextual fear conditioning.

Amygdala↗

PubMed2005

A neuroendocrine mechanism for sustaining fear.

Fear is an adaptive response to recognition of a potentially dangerous event. Glucocorticoids are essential for maintaining a wide variety of behavioral events by their regulation of numerous genes; one such gene encodes corticotrophin-releasing hormone (CRH). CRH is involved in diverse behavioral responses to changing environmental demands. In this review, we focus on one aspect of glucocorticoid regulation of CRH--namely, fear-related responses to diverse classes of adverse events, such as those represented by contextual and cue-specific stimuli. Three extra-hypothalamic forebrain sites appear crucial for fear-related behavioral responses: the amygdala and the bed nucleus of the stria terminalis for sustaining adaptive fear-related behaviors, and the medial prefrontal cortex for modulating fear-related behaviors. Central regulation of CRH by glucocorticoids is important for adaptive and sustained fear-related behaviors, and its aberration is associated with anxiety and depressive disorders.

Animals↗