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Jay Schulkin

Publications and source records attributed to Jay Schulkin.

At least 55 records · Page 3Linked to original sources
PubMed2004

Multiple pregnancy: knowledge and practice patterns of obstetricians and gynecologists.

OBJECTIVE: We sought to assess knowledge and practices of obstetricians regarding multiple gestation. METHODS: A questionnaire investigating knowledge and practice patterns pertaining to multiple gestation was mailed to randomly selected American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in January 2003. Fifty-one percent (589/1,146) of the surveys were returned. RESULTS: Statistical analysis included the responses from 430 practicing obstetricians. More than 60% rated their training regarding management of multiples as adequate. Men (56.5%) were older and had been in practice longer than females. Sixty-two percent of general obstetrician-gynecologists managed twins without input from a maternal-fetal medicine specialist. An understanding of chorionicity was less than anticipated. The majority of practitioners managed twins according to recent ACOG educational materials. They did not use prophylactic cerclage, home uterine-activity monitoring, or tocolytics. Fort-six percent encouraged prophylactic bed rest. The management of breech second twins varied. CONCLUSION: Most obstetricians manage multiples according to current ACOG educational materials independent of maternal-fetal medicine specialists. This survey identified knowledge gaps, specifically in chorionicity, indicating the need to develop educational strategies addressing these insufficiencies.

Adult↗
PubMed2004

Contemporary clinical issues in outpatient obstetrics and gynecology: findings of the Collaborative Ambulatory Research Network, 2001-2004: part I.

Obstetrician/gynecologists are taking on more primary care responsibilities and thus are expected to have a wider base of medical knowledge on a variety of women's health issues. The Collaborative Ambulatory Research Network (CARN) was created in 1990 to investigate issues pertinent to women's health and to the practice of obstetrics and gynecology in the outpatient setting. This article summarizes the findings of CARN studies from 2001 to 2004, covering topics of infectious diseases, cancer screening, and metabolism and nutrition. Each study provides a glimpse into the current practice patterns, attitudes, and knowledge of the practicing obstetrician/gynecologist. Although aggregate results suggest that clinicians are consistent and knowledgeable in traditional areas of practice, there appears to be a need for comprehensive educational programs to increase clinicians' comfort level with and knowledge of many contemporary primary care issues.

Adult↗
PubMed2004

Contemporary clinical issues in outpatient obstetrics and gynecology: findings of the Collaborative Ambulatory Research Network, 2001-2004: part II.

Obstetrician/gynecologists are taking on more primary care responsibilities and thus are expected to have a wider base of medical knowledge on a variety of women's health issues. The Collaborative Ambulatory Research Network (CARN) was created in 1990 to investigate issues pertinent to women's health and to the practice of obstetrics and gynecology in the outpatient setting. This article summarizes the findings of CARN studies from 2001 to 2004, covering topics of abnormal pregnancy outcomes, complications of pregnancy, and psychologic disorders. Each study provides a glimpse into the current practice patterns, attitudes, and knowledge of the practicing obstetrician/gynecologist. Although aggregate results suggest that clinicians are consistent and knowledgeable in traditional areas of practice, there appears to be a need for comprehensive educational programs to increase clinicians' comfort level with and knowledge of many primary care issues.

Adult↗
PubMed2004

Induction of a phosphate appetite in adult male and female rats.

We have reported that dietary inorganic phosphate (Pi) deprivation induces a Pi-seeking behavior in juvenile male rats. The purpose of the present study was to determine whether the Pi appetite is present in adult animals, and if so, whether it is altered during times of increased demand for Pi, such as pregnancy and lactation. Both male and female animals fed a low-phosphate diet (LPD) ingested significantly greater amounts of PiH(2)O daily than their normal phosphate diet (NPD) controls, and per 100 g of body weight (BW), the female animals fed LPD tended to ingest greater amounts of PiH(2)O than male rats fed LPD. Pregnant and lactating rats fed LPD ingested significantly more PiH(2)O than those fed NPD, however, neither group displayed a Pi appetite different than virgin females. However, lactation further reduced Pi levels in plasma and cerebral spinal fluid compared with control values. Despite the additional Pi from the PiH(2)O in the mothers fed LPD, pup birth weight was significantly lower than in NPD litters, and this was exacerbated 9 days after birth. This attenuated BW gain was associated with lower plasma Pi levels in the pups. In conclusion, a mild but consistent Pi-seeking behavior is induced in adult male and female rats after only 2 days of dietary Pi restriction. On a relative basis, the amount of PiH(2)O ingested is greater in female than in male animals, but does not increase further during pregnancy and lactation.

Animals↗
PubMed2004

Diagnosing and managing thyroid disorders during pregnancy: a survey of obstetrician-gynecologists.

OBJECTIVE: To document the knowledge and clinical practice of obstetrician-gynecologists regarding their diagnosis and management of thyroid disorders during pregnancy. STUDY DESIGN: We surveyed 1,392 practicing obstetrician-gynecologists about their knowledge and clinical practice of treating thyroid disorders during pregnancy; 569 of the surveys were returned. Of those, 441 respondents treated pregnant women and completed the entire survey. RESULTS: A majority of respondents had treated patients for hypothyroidism (88.7%) and hyperthyroidism (60.5%) within the previous year. In general, respondents appeared to be well versed in the symptoms of hypothyroidism and hyperthyroidism. Most respondents correctly predicted the likely results for thyroid-stimulating hormone, free thyroxine and total thyroxine for pregnant euthyroid, hyperthyroid and hypothyroid women, but about 50% appeared uncertain of the meaning of free thyroxine index. A majority (53.1%) of respondents considered their training during residency concerning thyroid disorders during pregnancy to be adequate, but few (7.5%) considered it to be comprehensive, and the remainder considered it barely adequate at best. Self-assessment of training and confidence regarding diagnosing and managing thyroid disorders during pregnancy were in concordance (r = .462 and r = .464, respectively; P < .001 in both cases). CONCLUSION: Thyroid disorders are commonly treated by obstetrician-gynecologists, and in general their practices for diagnosis and management conform to accepted practices. A sizable minority of responding obstetrician-gynecologists indicated that they considered their training to be inadequate and their confidence in diagnosing and managing thyroid disorders to be low.

Adult↗
PubMed2003

Ventral medial prefrontal cortex and emotional perseveration: the memory for prior extinction training.

Several years ago, we found that lesions of ventral medial prefrontal cortex (mPFCv) disrupted performance during the extinction component of a classical fear conditioning task without affecting acquisition performance. We called this emotional perseveration, hypothesizing that mPFCv may normally act to inhibit fear responses to a conditioned stimulus (CS) when the CS no longer signals danger. Subsequent studies have supported this hypothesis, showing that mPFCv is crucial for the memory of prior extinction training. The present study examined the effects of mPFCv lesions made after training. Such lesions resulted in reduced freezing to contextual stimuli and normal responding to the CS presented alone during a retention test. Rats were then subjected to extinction trials (CS without US) over multiple days. In contrast to pre-training lesions, post-training lesions had little effect on extinction rate. All rats were given additional training. Lesioned rats expressed greater fear reactions than controls, indicating that prior extinction was less effective in them. Lesioned rats also showed resistance to extinction during reextinction trials, confirming our earlier finding that lesions made before training weaken the effectiveness of extinction trials. These results suggest three conclusions. First, an intact mPFCv during acquisition may protect the animal from prolonged responding during extinction trials following brain insult. Second, changes in mPFCv may predispose subjects toward enhanced fear reactions that are difficult to extinguish when reexposed to fearful stimuli, due to a diminished capacity to benefit from the fear-reducing impact of prior extinction experience. Third, contextual cues processed by mPFCv may influence extinction performance.

Acoustic Stimulation↗
PubMed2003

Central control of renal sodium-phosphate (NaPi-2) transporters.

Regulation of phosphate (Pi) reabsorption occurs through the up- and downregulation of the renal type-II sodium Pi cotransporters (NaPi-2). Recently, renal NaPi2-type expression has been identified in areas of the brain. The present study determined whether brain NaPi-2 is regulated by dietary Pi and whether the behavioral and renal adaptations to low-dietary Pi are controlled centrally. NaPi-2-like expression in the third ventricle (3V) and amygdala of juvenile Wistar rats was regulated by dietary Pi, as in the kidneys. When cerebrospinal fluid (CSF) Pi concentration was elevated by 3V injections of Pi in rats fed low-Pi diet (LPD), the behavioral and renal adaptations to LPD were abolished. Most importantly, NaPi-2 expression was markedly reduced not only in the brain, but also renal proximal tubules, despite the low plasma Pi milieu. This was confirmed by the significant reduction in the transport maximum for Pi (from 8.1+/-0.2 in LPD + veh 3V to 1.7+/-0.1 micromol Pi/ml glomerular filtration rate in LPD + 3V Pi, P < 0.001). These findings indicate that NaPi-2-like transporters in the brain are regulated by both dietary Pi and CSF Pi concentrations, and most significantly, that the central Pi milieu can regulate renal NaPi-2 expression. We hypothesize that central 3V NaPi-2 transporters may act as Pi sensors and help regulate both brain and whole body Pi homeostasis.

Adaptation, Physiological↗
PubMed2003

Neonatal encephalopathy and cerebral palsy: a knowledge survey of Fellows of The American College of Obstetricians and Gynecologists.

OBJECTIVE: To assess practicing obstetricians' knowledge of the etiology and pathophysiology of neonatal encephalopathy and its relationship to cerebral palsy. METHODS: A questionnaire designed to test both knowledge and practice patterns was mailed to 413 members of the Collaborative Ambulatory Research Network of The American College of Obstetricians and Gynecologists (ACOG), as well as 600 randomly selected non-Network ACOG Fellows. The questionnaire was composed of 15 knowledge questions and three clinical scenarios containing seven knowledge questions. Six of the questions directly assessed knowledge of cerebral palsy. RESULTS: Of those who returned the questionnaire, 351 practiced obstetrics and were included in the statistical analyses. For the majority of questions, "Don't know" was the most frequent response. The next most frequent response for 8/13 questions was the correct answer. Performance was strongest as regarded actual clinical practice and relatively weak regarding the antecedents of neonatal encephalopathy and cerebral palsy. The physicians' actual knowledge scores showed a significant correlation with their self-assessments of knowledge (r =.41, P <.001). The majority of physicians rated their training on this topic in medical school, residency, and through continuing medical education as marginal or inadequate. CONCLUSION: The results of this survey identified large knowledge gaps in this area, suggesting a need to develop educational projects to address these deficits by both professional organizations and individual teachers.

Adult↗
PubMed2003

Vaccination and perinatal infection prevention practices among obstetrician-gynecologists.

OBJECTIVE: To assist efforts to improve adult vaccination coverage by characterizing vaccination and infectious disease screening practices of obstetrician-gynecologists. METHODS: A written survey of demographics, attitudes, and practices was mailed to 1063 American College of Obstetricians and Gynecologists Fellows, including the Collaborative Ambulatory Research Network (n = 413) and 650 randomly sampled Fellows. RESULTS: Seventy-four percent of Collaborative Ambulatory Research Network members and 44% of nonmembers responded. A majority (Collaborative Ambulatory Research Network members: 60%; nonmembers: 49%) considered themselves primary care providers. Fewer than 60% routinely obtained patient vaccination or infection histories. Most screened prenatal patients for hepatitis B surface antigen (89%) and rubella immunoglobulin G antibody (85%). Sixty-four percent worked in practices that offered at least one vaccine; the most common were rubella (52%) and influenza (50%). Ten percent worked in practices that offered all major vaccines recommended for pregnant or postpartum women. Despite recommendations to provide influenza vaccine to pregnant women during influenza season, only 44% did so; among those who did not, 14% reported a belief that pregnant women do not need influenza vaccine. Provision of vaccine was associated with working in a multispecialty practice (adjusted odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6, 4.1) and identifying as a primary care provider (adjusted OR 1.9; 95% CI 1.3, 2.7). The most common reasons for not offering vaccines were cost (44%) and a belief that vaccines should be provided elsewhere (41%). CONCLUSION: The high proportion of obstetrician-gynecologists who do not offer vaccines or screen for vaccine and infection histories suggests missed opportunities for prevention of maternal and neonatal infections.

Communicable Disease Control↗
PubMed2003

Cervical cytology screening practices among obstetrician-gynecologists.

OBJECTIVE: To estimate the current cervical cytology screening practices of American College of Obstetricians and Gynecologists (ACOG) Fellows, to establish a baseline for tracking future changes in practice. METHODS: Questionnaires were mailed to a random sample of ACOG Fellows (n = 599) and to a group of Fellows who have regularly participated in past ACOG surveys (n = 409). The questionnaires asked about current cytology screening and evaluation practices and presented clinical practice vignettes with additional questions. Descriptive statistical methods were used to evaluate the responses. RESULTS: Questionnaires were returned by 651 physicians (64.6%); 624 were complete. More than 94% of the respondents start cytology testing at age 18 years. Almost three fourths (74.2%) continue screening indefinitely. More than 80% use a liquid-based method of collection. Almost two thirds (65.1%) order human papillomavirus testing occasionally, usually (81.9%) for reports of atypical squamous cells of undetermined significance (ASCUS). Most Fellows in the sample perform colposcopy for an ASCUS result. Reports of atypical glandular cells resulted in variable approaches to further evaluation. Patient age and history were important variables for all test reports. Legal concerns were mentioned as important determinants of practice patterns. CONCLUSION: In this sample of ACOG Fellows, most perform cervical cytology and evaluate abnormal results in accord with guidelines in place before the recommended changes in screening and evaluation were published in 2003.

Adult↗
PubMed2003

Duty hours and pregnancy outcome among residents in obstetrics and gynecology.

OBJECTIVE: To assess the present status of resident duty hours in obstetrics and gynecology, identify existing policies concerning work schedules during pregnancy, and evaluate pregnancy outcome in female house officers. METHODS: A questionnaire-based study was administered to residents taking the 2001 Council on Residency Education in Obstetrics and Gynecology examination. RESULTS: More than 90% of the residents reported that their institution had a maternity leave policy. The leave was usually 4-8 weeks long and was paid. Nearly 95% of residents reported that they had to take over the work of residents on maternity leave. Most women residents worked more than 80 hours weekly throughout pregnancy, and few took time off before delivery. Most pregnancies occurred during the fourth year of training and did not seem to be adversely affected by the long work hours. CONCLUSION: This study, performed before the institution of the new Accreditation Council for Graduate Medical Education resident duty hour policies, demonstrated that, although women house officers continued to work more than 80 hours per week during pregnancy, most had a good pregnancy outcome. Nevertheless, there was a higher frequency of preterm labor, preeclampsia, and fetal growth restriction in female residents than in spouses or partners of male residents.

Adult↗
PubMed2003

Calcium taste preference and sensitivity in humans. I. Gender comparisons.

Calcium is an essential nutrient, particularly during growth and during reproduction, and the latter is probably why the avidity for calcium may be greater in females of some species. However, in humans, despite widespread belief in calcium appetite, it has not been studied experimentally. Here we compared the hedonic responses of 17 men and 24 women to test whether women show a greater avidity for calcium in line with its greater biological significance for them. We find no gender difference in the hedonic response to calcium, and no change with the menstrual cycle.

Adult↗
PubMed2003

Calcium taste preference and sensitivity in humans. II. Hemodialysis patients.

Calcium is an essential nutrient. However, in humans, despite widespread belief in a calcium appetite, it has hardly been studied experimentally. Here, we compared the avidity for calcium in 10 hemodialysis patients and 10 healthy controls to test whether disturbed calcium metabolism alters the preference for calcium. Hemodialysis patients did not differ from controls in their taste responses to CaCl(2) solution. However, they found high levels of CaCl(2) in cheese tastier. Our findings are indicative of a possible increased calcium appetite related to perturbed calcium metabolism in humans. The findings also suggest that for hemodialysis patients calcium added to foods might increase their palatability.

Analysis of Variance↗
PubMed2003

Glucocorticoid regulation of diverse cognitive functions in normal and pathological emotional states.

The glucocorticoid hormone cortisol is essential for many forms of regulatory physiology and for cognitive appraisal. Cortisol, while associated with fear and stress response, is also the hormone of energy metabolism and it coordinates behavioral adaptation to the environmental and internal conditions through the regulation of many neurotransmitters and neural circuits. Cortisol has diverse effects on many neuropeptide and neurotransmitter systems thus affecting functional brain systems. As a result, cortisol affects numerous cognitive domains including attention, perception, memory, and emotional processing. When certain pathological emotional states are present, cortisol may have a role in differential activation of brain regions, particularly suppression of hippocampal activation, enhancement of amygdala activity, and dendritic reshaping in these regions as well as in the ventral prefrontal cortex. The coordinated actions of glucocorticoid regulation on various brain systems such as those implicated in emotional processing can lead to perceptual and cognitive adaptations and distortions of events that may be relevant for understanding mood disorders.

Adaptation, Physiological↗
PubMed2003

Demythologizing the emotions: adaptation, cognition, and visceral representations of emotion in the nervous system.

This article highlights four issues about the neurobiology of emotions: adaptation vs. dysfunction, peripheral and central representations of emotion, the regulation of the internal milieu, and whether emotions are cognitive. It is argued that the emotions evolved to play diverse adaptive roles and are biologically vital sources of information processing. They were not designed as pieces of pathology, though they certainly can underlie some psychophathologies. Emotions are, in part, appraisal systems that are operative at numerous level of the nervous system from the brainstem to the cortex. Like other information processing systems they are not perfect cognitive systems. Emotional systems often utilize somatic and visceral information for appraisals of events to facilitate decisions of whether to approach or avoid objects. The neural systems of emotions traverse the entire neural axis and are linked to the regulation of the internal milieu. Thus, in addition to the experiential aspects of emotions, emotions embody appraisal systems that are pervasive to all levels of the brain to facilitate function, adaptation, and survival.

Adaptation, Psychological↗
PubMed2003

Facial expressions of emotion: a cognitive neuroscience perspective.

Facial expressions are one example of emotional behavior that illustrate the importance of emotions to both basic survival and social interaction. Basic facial responses to stimuli such as sweet and bitter taste are important for species fitness and governed by simple rules. Even at this basic level, facial responses have communicative value to other species members. During evolution simple facial responses were extended for use in more complex nonverbal communications; the responses are labile. The perception and production of facial expressions are cognitive processes and numerous subcortical and cortical areas contribute to these operations. We suggest that no specific emotion center exists over and above cognitive systems in the brain, and that emotion should not be divorced from cognition.

Affect↗