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author:("schulman, Jay")
1.  Racial and Ethnic Disparities in Breastfeeding 
Breastfeeding Medicine  2015;10(4):186-196.
This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority women, conduct a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they can help increase rates among minority women. In order to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers among minority women was reviewed, and a systematic review of breastfeeding interventions among minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are still needed to improve breastfeeding initiation and duration rates among minority women in the United States. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the future health of the mother and child.
PMCID: PMC4410446  PMID: 25831234
2.  The role of the hospitalist and Maternal Fetal Medicine physician in obstetrical inpatient care 
American journal of perinatology  2015;33(2):123-129.
Our objective was to evaluate the role of hospitalists and Maternal Fetal Medicine (MFM) subspecialists in obstetrical inpatient care.
Study Design
This electronic survey study was offered to members of the American College of Obstetrics & Gynecology (ACOG; n=1,039) and the Society for Maternal-Fetal Medicine (SMFM; n=1813).
607 (21%) respondents completed the survey. Thirty-five percent reported that hospitalists provided care in at least one of their hospitals. Compared with ACOG respondents, a higher frequency of SMFM respondents reported comfort with hospitalists providing care for all women on Labor and Delivery (74.4 vs. 43.5%, p=0.005) and women with complex issues (56.4 vs. 43.5%, p=0.004). The majority of ACOG respondents somewhat/completely agreed that hospitalists were associated with decreased adverse events (69%) and improved safety/safety culture (70%). Seventy-two percent of ACOG respondents have MFM consultation available with 53% having inpatient coverage. Of these, 85% were satisfied with MFM availability.
Over one third of respondents work in units staffed with hospitalists and more than half have inpatient MFM coverage. It is important to evaluate if and how hospitalists can improve maternal and perinatal outcomes, and the types of hospitals that are best served by them.
PMCID: PMC4849875  PMID: 26340518
Hospitalist; inpatient obstetrical care; laborist; Maternal Fetal Medicine
3.  Patterns of Preconception, Prenatal and Postnatal Care for Diabetic Women by Obstetrician-Gynecologists 
To assess barriers to and quality of care received by diabetic pregnant women from obstetrician-gynecologists.
A questionnaire was mailed to 1,000 representative practicing Fellows of the American College of Obstetricians and Gynecologists; 74 did not treat pregnant patients and 510 (55.1%) returned completed surveys. Respondents were divided into 3 groups: maternal-fetal medicine specialists, physicians with high minority/low insurance patient populations, and physicians with low minority/high insurance patient populations.
Reported preconception and prenatal care was generally consistent with guidelines. Regarding gestational diabetes mellitus patients the 3 physician groups differed in assessing postpartum glycemic status, counseling about lifestyle changes, and counseling patients to consult a doctor before their next pregnancy. Patient demographics and perceived barriers to care were similar between maternal-fetal medicine specialists and physicians with high minority/low insurance patient populations. These two physician groups were more likely to agree that lack of educational materials, arranging specialist referrals, patient compliance with recommendations, and patients’ ability to afford healthful food were barriers to quality care.
According to physician self-report, pregnant diabetic patients with access to an obstetrician receive quality care regardless of insurance status. Post-partum care is more variable. Physicians with high minority/low insurance patient populations may lack access to resources.
PMCID: PMC4768718  PMID: 23447912
clinical care; diabetes; pregnancy
4.  Survey of Obstetrics and Gynecology Residents Regarding Pneumococcal Vaccination in Pregnancy: Education, Knowledge, and Barriers to Vaccination 
Objective. The 23-valent pneumococcal vaccine is recommended for adults over 65 years of age and younger adults with certain medical conditions. The Centers for Disease Control and Prevention (CDC) state insufficient evidence to recommend routine pneumococcal vaccination during pregnancy, but the vaccine is indicated for pregnant women with certain medical conditions. We designed this project to gauge obstetrics and gynecology (OB/GYN) resident knowledge of maternal pneumococcal vaccination. Methods. We administered a 22-question survey to OB/GYN residents about maternal pneumococcal vaccination. We performed descriptive analysis for each question. Results. 238 OB/GYN residents responded. Overall, 69.3% of residents reported receiving vaccination education and 86.0% reported having ready access to vaccine guidelines and safety data. Most residents knew that asplenia (78.2%), pulmonary disease (77.3%), and HIV/AIDS (69.4%) are indications for vaccination but less knew that cardiovascular disease (45.0%), diabetes (35.8%), asthma (42.8%), nephrotic syndrome (19.7%), and renal failure (33.6%) are also indications for vaccination. Conclusion. OB/GYN residents are taught about vaccines and have ready access to vaccine guidelines and safety data. However, knowledge of indications for pneumococcal vaccination in pregnancy is lacking. Likely, the opportunity to vaccinate at-risk pregnant patients is being missed.
PMCID: PMC4754486  PMID: 26949324
5.  Efforts to Improve Immunization Coverage during Pregnancy among Ob-Gyns 
Background. Influenza and Tdap vaccines are vital factors for improving maternal and neonatal health outcomes. Methods. A prospective, longitudinal study was conducted to determine whether the American College of Obstetricians and Gynecologists' (ACOG's) efforts to increase ob-gyn use of their immunization toolkits and vaccination administration were successful. Pre- and postintervention questionnaires were mailed to a random sample of 1,500 ACOG members between August 2012 and July 2015. Results. Significantly more postintervention survey ob-gyns reported that they received the immunization toolkits than preintervention survey ob-gyns (84.5% versus 67.0%, p < .001). The large majority of ob-gyns from both surveys (76.9% versus 78.9%) reported that they offered or planned to offer influenza vaccinations to their patients for the 2012-2013 and 2014-2015 flu seasons. Postintervention survey respondents were significantly more likely than preintervention survey participants to report that they routinely offer Tdap vaccinations to all patients during pregnancy (76.8% versus 59.3%, p < .001). Conclusion. ACOG's efforts to improve ob-gyn use of immunization toolkits and vaccine administration appear to have been successful in several ways. ACOG's toolkits are an example of an effective intervention to overcome barriers to offering vaccines and help improve influenza and Tdap immunization coverage for pregnant women.
PMCID: PMC4746379  PMID: 26924918
6.  Regulation of bed nucleus of the stria terminalis PACAP expression by stress and corticosterone 
Single nucleotide polymorphisms (SNP) in the genes for pituitary adenylyl cyclase-activating peptide (PACAP) and the PAC1 receptor have been associated with stress-related psychiatric disorders. Although from recent work we have argued that stress-induced PACAP expression in the bed nucleus of the stria terminalis (BNST) may mediate stress-related psychopathology, it is unclear whether stress-induced increases in BNST PACAP expression require acute or repeated stressor exposure, and whether increased BNST PACAP expression is related to stress-induced increases in circulating glucocorticoids. In the current work, we have used quantitative real-time polymerase chain reaction (qPCR) to assess transcript expression in brain punches from rats after stressor exposure paradigms or corticosterone injection. BNST PACAP and PAC1 receptor transcript expression was increased only after 7 days of repeated stressor exposure; no changes in transcript levels were observed 2 or 24 hours after a single restraint session. Moreover, repeated corticosterone treatment for 7 days was not sufficient to reliably increase BNST PACAP transcript levels, suggesting that stress-induced elevations in corticosterone may not be the primary drivers of BNST PACAP expression. These results may help clarify the mechanisms and temporal processes that underlie BNST PACAP induction for intervention in stress-related anxiety disorders.
PMCID: PMC4162870  PMID: 24614974
pituitary adenylate cyclase-activating peptide (PACAP); bed nucleus of the stria terminalis (BNST); stress; corticosterone; glucocorticoids
7.  Attitudes and Practices of Obstetrician–Gynecologists Regarding Influenza Vaccination in Pregnancy 
Obstetrics and gynecology  2011;118(5):1074-1080.
To assess knowledge, attitudes, and practices of obstetrician–gynecologists (ob-gyns) regarding vaccination of pregnant women during the 2009 H1N1 pandemic.
From February to July 2010, a self-administered mail survey was conducted among a random sample of American College of Obstetricians and Gynecologists (the College) members involved in obstetric care. To assess predictors of routinely offering influenza vaccination, adjusted prevalence ratios and 95% confidence intervals (CIs) were calculated from survey data.
Among 3,096 survey recipients, 1,310 (42.3%) responded to the survey, of whom 873 were eligible for participation. The majority of ob-gyns reported routinely offering both seasonal and 2009 H1N1 influenza vaccination to their pregnant patients (77.6% and 85.6%, respectively) during the 2009–2010 season; 21.1% and 13.3% referred patients to other specialists. Reported reasons for not offering vaccination included inadequate reimbursement, storage limitations, or belief that vaccine should be administered by another provider. Seasonal and 2009 H1N1 influenza vaccination during the first trimester was not recommended by 10.6% and 9.6% of ob-gyns, respectively. Predictors of routinely offering 2009 H1N1 influenza vaccine included: considering primary care and preventive medicine a very important part of practice (adjusted prevalence ratio 1.2, CI 1.01–1.4); observing serious conditions attributed to influenza-like illness (adjusted prevalence ratio 1.1, CI 1.02–1.1); personally receiving 2009 H1N1 influenza vaccination (adjusted prevalence ratio 1.2, CI 1.1–1.4); and practicing in multispecialty group (adjusted prevalence ratio 1.1, CI 1.1–1.2). Physicians in solo practice were less likely to routinely offer influenza vaccine (adjusted prevalence ratio 0.8, CI 0.7–0.9).
Although most ob-gyns routinely offered influenza vaccination to pregnant patients, vaccination coverage rates may be improved by addressing logistic and financial challenges of vaccine providers.
PMCID: PMC4608446  PMID: 22015875
8.  Screening practices and attitudes of obstetricians-gynecologists toward new and emerging tobacco products 
We examined screening practices and attitudes of obstetricians-gynecologists toward the use of noncombustible tobacco products (chewing tobacco, snuff/snus, electronic cigarettes, and dissolvables) during pregnancy.
The authors mailed a survey in 2012 to 1024 members of the American College of Obstetricians and Gynecologists, including Collaborative Ambulatory Research Network (CARN) and non-CARN members. Stratified random selection was used to generate CARN and non-CARN samples.
Response rates were 52% and 31% for CARN and non-CARN members, respectively. Of 252 total eligible respondents (those currently providing obstetrics care) 53% reported screening pregnant women at intake for noncombustible tobacco product use all or some of the time, and 40% reported none of the time. Respondents who reported that noncombustible products have adverse health effects during pregnancy, but are safer than cigarettes, ranged from 20.2% (dissolvables) to 29% (electronic cigarettes) and that the health effects are the same as those of cigarettes from 13.5% (electronic cigarettes) to 53.6% (chewing tobacco). Approximately 14% reported that electronic cigarettes have no adverse health effects; <1% reported no health effects for the remaining products. Two-thirds of the respondents wanted to know more about the potential health effects of noncombustible tobacco products; only 5% believed themselves to be fully informed.
A large proportion of obstetrician-gynecologists reported never or inconsistently screening their pregnant patients for the use of noncombustible tobacco products. Responses regarding the harms of these products relative to cigarettes were mixed and most respondents wanted more information. Development and dissemination of guidance for providers is needed to improve decision-making regarding noncombustible tobacco products.
PMCID: PMC4602388  PMID: 24881828
electronic cigarette; obstetrician-gynecologist; pregnancy; smokeless tobacco
9.  Clinicians’ awareness of the Affordable Care Act mandate to provide comprehensive tobacco cessation treatment for pregnant women covered by Medicaid 
Preventive medicine reports  2015;2:686-688.
The Affordable Care Act (ACA) requires states to provide tobacco-cessation services without cost-sharing for pregnant traditional Medicaid-beneficiaries effective October 2010. It is unknown the extent to which obstetricians–gynecologists are aware of the Medicaid tobacco-cessation benefit. We sought to examine the awareness of the Medicaid tobacco-cessation benefit in a national sample of obstetricians–gynecologists and assessed whether reimbursement would influence their tobacco cessation practice. In 2012, a survey was administered to a national stratified-random sample of obstetricians–gynecologists (n = 252) regarding awareness of the Medicaid tobacco-cessation benefit. Results were stratified by the percentage of pregnant Medicaid patients. Chi-squared tests (p < 0.05) were used to assess significant associations. Analyses were conducted in 2014. Eighty-three percent of respondents were unaware of the benefit. Lack of awareness increased as the percentage of pregnant Medicaid patients in their practices decreased (range = 71.9%–96.8%; P = 0.02). One-third (36.1%) of respondents serving pregnant Medicaid patients reported that reimbursement would influence them to increase their cessation services. Four out of five obstetricians–gynecologists surveyed in 2012 were unaware of the ACA provision that required states to provide tobacco cessation coverage for pregnant traditional Medicaid beneficiaries as of October 2010. Broad promotion of the Medicaid tobacco-cessation benefit could reduce treatment barriers.
PMCID: PMC4600045  PMID: 26457245
Smoking cessation; Pregnancy; Medicaid; Insurance; Obstetricians–gynecologists
10.  Bridging progestogens in pregnancy and pregnancy prevention 
Endocrine Connections  2015;4(4):R81-R92.
Steroid hormones have been in use for more than a half a century as contraceptive agents, and only now are researchers elucidating the biochemical mechanisms of action and non-target effects. Progesterone and synthetic progestins, critical for women's health in the US and internationally, appear to have important effects on immune functioning and other diverse systems. Apart from the contraceptive world is a separate field that is devoted to understanding progesterone in other contexts. Based on research following a development timeline parallel to hormonal contraception, progesterone and 17-hydroxyprogesterone caproate are now administered to prevent preterm birth in high-risk pregnant women. Preterm birth researchers are similarly working to determine the precise biochemical actions and immunological effects of progesterone. Progesterone research in both areas could benefit from increased collaboration and bringing these two bodies of literature together. Progesterone, through actions on various hormone receptors, has lifelong importance in different organ systems and researchers have much to learn about this molecule from the combination of existing literatures, and from future studies that build on this combined knowledge base.
PMCID: PMC4653318  PMID: 26581227
progestogens; pregnancy; contraception; preterm birth; collaborative research
11.  Importance of CRF Receptor-Mediated Mechanisms of the Bed Nucleus of the Stria Terminalis in the Processing of Anxiety and Pain 
Neuropsychopharmacology  2014;39(11):2633-2645.
Corticotropin-releasing factor (CRF)-mediated mechanisms in the bed nucleus of the stria terminalis (BNST) have a pivotal role in stress-induced anxiety and hyperalgesia. Although CRF is known to activate two receptor subtypes, CRF1 and CRF2, attempts to delineate the specific role of each subtype in modulating anxiety and nociception have been inconsistent. Here we test the hypothesis that CRF1 and CRF2 receptor activation in the anteriolateral BNST (BNSTAL) facilitates divergent mechanisms modulating comorbid anxiety and hyperalgesia. Microinfusions of the specific antagonists CP376395 and Astressin2B into the BNSTAL were used to investigate CRF1 and CRF2 receptor functions, respectively. We found that CRF1 and CRF2 receptors in the BNSTAL had opposing effects on exploratory behavior in the elevated plus-maze, somatic mechanical threshold, and the autonomic and endocrine response to stress. However, CRF1 or CRF2 receptor antagonism in the BNSTAL revealed complementary roles in facilitating the acoustic startle and visceromotor reflexes. Our results suggest that the net effect of CRF1 and CRF2 receptor activation in the BNSTAL is pathway-dependent and provides important insight into the CRF receptor-associated circuitry that likely underpins stress-induced pathologies.
PMCID: PMC4207343  PMID: 24853772
12.  Clinicians' awareness of the Affordable Care Act mandate to provide comprehensive tobacco cessation treatment for pregnant women covered by Medicaid 
Preventive Medicine Reports  2015;2:686-688.
The Affordable Care Act (ACA) requires states to provide tobacco-cessation services without cost-sharing for pregnant traditional Medicaid-beneficiaries effective October 2010. It is unknown the extent to which obstetricians–gynecologists are aware of the Medicaid tobacco-cessation benefit. We sought to examine the awareness of the Medicaid tobacco-cessation benefit in a national sample of obstetricians–gynecologists and assessed whether reimbursement would influence their tobacco cessation practice. In 2012, a survey was administered to a national stratified-random sample of obstetricians–gynecologists (n = 252) regarding awareness of the Medicaid tobacco-cessation benefit. Results were stratified by the percentage of pregnant Medicaid patients. Chi-squared tests (p < 0.05) were used to assess significant associations. Analyses were conducted in 2014. Eighty-three percent of respondents were unaware of the benefit. Lack of awareness increased as the percentage of pregnant Medicaid patients in their practices decreased (range = 71.9%–96.8%; P = 0.02). One-third (36.1%) of respondents serving pregnant Medicaid patients reported that reimbursement would influence them to increase their cessation services. Four out of five obstetricians–gynecologists surveyed in 2012 were unaware of the ACA provision that required states to provide tobacco cessation coverage for pregnant traditional Medicaid beneficiaries as of October 2010. Broad promotion of the Medicaid tobacco-cessation benefit could reduce treatment barriers.
•Medicaid provides no cost tobacco-cessation services for pregnant patients.•We surveyed obstetricians–gynecologists' awareness of the tobacco-cessation benefit.•Majority (83%) of obstetricians–gynecologists were unaware of the benefit.•One-third may increase cessation services because of reimbursement.•Broad promotion of the Medicaid tobacco-cessation benefit is needed.
PMCID: PMC4600045  PMID: 26457245
Smoking cessation; Pregnancy; Medicaid; Insurance; Obstetricians–gynecologists
13.  Evaluation of bleeding disorders in women with menorrhagia: a survey of obstetrician-gynecologists 
To better understand the current evaluation of unexplained menorrhagia by obstetrician-gynecologists and the extent to which a bleeding disorder diagnosis is being considered in this population.
A total of 1200 Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were invited to participate in a survey on blood disorders. Respondents completed a questionnaire regarding their patient population and their evaluation of patients with unexplained menorrhagia.
The overall response rate was 42.4%. Eighty-two percent of respondents reported having seen patients with menorrhagia caused by a bleeding disorder. Seventy-seven percent of physicians reported they would be likely or very likely to consider a bleeding disorder as causing menorrhagia in adolescent patients; however, only 38.8% would consider bleeding disorders in reproductive age women.
The current data demonstrate that obstetrician-gynecologists seem to have a relatively high awareness of bleeding disorders as a potential underlying cause of menorrhagia.
PMCID: PMC4410699  PMID: 22901979
bleeding disorder; menorrhagia; physician survey; practice patterns; von Willebrand disease
14.  Smoking Cessation During Pregnancy and Postpartum: Practice Patterns Among Obstetrician-Gynecologists 
Journal of addiction medicine  2014;8(1):14-24.
To assess current obstetrician-gynecologist (ob-gyn) practice patterns related to the management of and barriers to smoking cessation during pregnancy and postpartum.
A smoking cessation questionnaire was mailed to 1024 American College of Obstetricians and Gynecologists Fellows in 2012. χ2 analyses were used to assess for categorical differences between groups, Pearson r was used to conduct correlational analysis, and analysis of variance was used to assess for mean differences between groups.
The analyses included 252 practicing ob-gyns who see pregnant patients who returned a completed survey. Ob-gyns estimated that 23% of their patients smoke before pregnancy, 18% smoke during first trimester, 12% during second trimester, and 11% during third trimester. They approximated that 32% quit during pregnancy, but 50% return to smoking postpartum. A large majority of ob-gyns feel that it is important for pregnant and postpartum women to quit smoking, and report asking all pregnant patients about tobacco use at the initial prenatal visit. Fewer ob-gyns follow-up on tobacco use at subsequent visits when the patient has admitted to use at a prior visit. The primary barrier to intervention was reported as time limitations, though other barriers were noted that may be addressable through the provision of additional training and resources offered to physicians.
Compared with findings from a similar study conducted in 1998, physicians are less likely to adhere to the 5 As smoking cessation guideline at present. As we know that brief intervention is effective, it is imperative that we work toward addressing practice gaps and providing additional resources to address the important public health issue of smoking during pregnancy and postpartum.
PMCID: PMC4346356  PMID: 24317354
obstetrician-gynecologists; pregnancy; practice patterns; smoking cessation
15.  Need to know: the need for cognitive closure impacts the clinical practice of obstetrician/gynecologists 
Need for cognitive closure (NFCC) has been shown to be a consistent and measurable trait. It has effects on decision making and has been associated with more rapid decision making, higher reliance on heuristics or biases for decision making, reduced tolerance for ambiguity, and reduced interest in searching for alternatives. In medical practice, these tendencies may lead to lower quality of decision making.
This study measured NFCC in 312 obstetrician/gynecologists using a survey-style approach. Physicians were administered a short NFCC scale and asked questions about their clinical practice.
Obstetrician/gynecologists with high NFCC were found to be less likely to address a number of clinical questions during well-woman exams, and were more likely to consult a greater number of sources when prescribing new medications.
NFCC of physicians may have an important impact on practice. It is possible that increased training during residency or medical school could counteract the detrimental effects of NFCC, and steps can be taken through increased use of electronic reminder systems could orient physicians to the appropriate questions to ask patients.
Electronic supplementary material
The online version of this article (doi:10.1186/s12911-014-0122-6) contains supplementary material, which is available to authorized users.
PMCID: PMC4297425  PMID: 25540033
Need for Cognitive Closure; Obstetricians/gynecologists; Medical decision making; Uncertainty
16.  Revisiting shyness and sociability: a preliminary investigation of hormone-brain-behavior relations 
Frontiers in Psychology  2014;5:1430.
Shyness and sociability are two fundamental personality dimensions that are conceptually and empirically orthogonal and are conserved across cultures, development, and phylogeny. However, we know relatively little regarding how shyness and sociability are represented and maintained in the brain. Here we examined neural responses to the processing of different types of social threat using event-related fMRI, the salivary cortisol awakening response (CAR), and sociability in young adults selected for high and low shyness. Shy adults who exhibited a relatively higher CAR displayed neural activity in putative brain regions involved in emotional conflict and awareness, and were more sociable. In contrast, shy adults who displayed a relatively lower CAR exhibited neural activity in putative brain regions linked to fear and withdrawal, and were unsociable. Results revealed no systematic brain responses to social threat processing that correlated with the CAR in non-shy adults. These preliminary results suggest that individual differences in waking morning cortisol levels may influence neural processes that facilitate either social approach or withdrawal among people who are shy. Findings are discussed in relation to their theoretical and clinical implications for moving beyond longstanding descriptive to explanatory models of shyness and sociability and for understanding individual differences in social behavior in general.
PMCID: PMC4274875  PMID: 25566117
shyness; sociability; fMRI; temperament; cortisol; partial least squares (PLS)
17.  An anatomically comprehensive atlas of the adult human brain transcriptome 
Nature  2012;489(7416):391-399.
Neuroanatomically precise, genome-wide maps of transcript distributions are critical resources to complement genomic sequence data and to correlate functional and genetic brain architecture. Here we describe the generation and analysis of a transcriptional atlas of the adult human brain, comprising extensive histological analysis and comprehensive microarray profiling of ~900 neuroanatomically precise subdivisions in two individuals. Transcriptional regulation varies enormously by anatomical location, with different regions and their constituent cell types displaying robust molecular signatures that are highly conserved between individuals. Analysis of differential gene expression and gene co-expression relationships demonstrates that brain-wide variation strongly reflects the distributions of major cell classes such as neurons, oligodendrocytes, astrocytes and microglia. Local neighbourhood relationships between fine anatomical subdivisions are associated with discrete neuronal subtypes and genes involved with synaptic transmission. The neocortex displays a relatively homogeneous transcriptional pattern, but with distinct features associated selectively with primary sensorimotor cortices and with enriched frontal lobe expression. Notably, the spatial topography of the neocortex is strongly reflected in its molecular topography— the closer two cortical regions, the more similar their transcriptomes. This freely accessible online data resource forms a high-resolution transcriptional baseline for neurogenetic studies of normal and abnormal human brain function.
PMCID: PMC4243026  PMID: 22996553
Neuroscience; Genetics; Genomics; Databases
18.  Obstetrician-Gynecologists’ knowledge of sickle cell disease screening and management 
Although obstetrician/gynecologists (OB/GYNs) play an important role in sickle cell disease (SCD) screening and patient care, there is little information on knowledge of SCD or sickle cell trait (SCT) or related practices in this provider group. Our objective was to assess SCD screening and prenatal management practices among OB/GYNs.
Twelve hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (the College)a were invited to complete a mailed survey, of which half (n = 600) belonged to the Collaborative Ambulatory Research Network.b Participants answered questions regarding appropriate target patient groups for prenatal SCD screening, folic acid requirements, practice behaviors and adequacy of their medical school and residency training.
A total of 338 CARN members (56.3%) and 165 non-CARN members (27.5%) returned a survey. Of the 503 responders, 382 provided obstetric services and were included in the analyses. Forty percent of these respondents (n = 153) reported seeing at least 1 patient with SCD in the last year. Of these, 97.4% reported regularly screening people of African descent for SCD or SCT, whereas 52.9% reported regularly screening people of Mediterranean descent and 30.1% reported regularly screening people of Asian descent. Only 56.2% knew the correct recommended daily dose of folic acid for pregnant women with SCD. The proportion of respondents that rated training on SCD screening, assessment and treatment as barely adequate or inadequate ranged from 19.7% to 39.3%.
The practice of many OB/GYNs who care for patients with SCD are not consistent with the College Practice Guidelines on the screening of certain target groups and on folic acid supplementation. There may be an opportunity to improve this knowledge gap through enhanced medical education.
PMCID: PMC4287569  PMID: 25311876
Sickle cell disease; Physician practice patterns; Obstetrics
19.  Statistical Literacy of Obstetrics-Gynecology Residents 
Residents' ability to interpret statistics is important for scholarly pursuits and understanding evidence-based medicine. Yet there is limited research assessing residents' statistical literacy and their training in statistics.
In 2011 we surveyed US obstetrics-gynecology residents participating in the Council for Resident Education in Obstetrics and Gynecology In-Training Examination about their statistical literacy and statistical literacy training.
Our response rate was 95% (4713 of 4961). About two-thirds (2980 of 4713) of the residents rated their statistical literacy training as adequate. Female respondents were more likely to rate their statistical literacy training poorly, with 25% (897 of 3575) indicating inadequate literacy compared with 17% (141 of 806) of the male respondents (P < .001). Respondents performed poorly on 2 statistical literacy questions, with only 26% (1222 of 4713) correctly answering a positive predictive value question and 42% (1989 of 4173) correctly defining a P value. A total of 51% (2391 of 4713) of respondents reported receiving statistical literacy training through a journal club, 29% (1359 of 4713) said they had informal training, 15% (711 of 4713) said that they had statistical literacy training as part of a course, and 11% (527 of 4713) said that they had no training.
The findings suggest that statistical literacy training for residents could still be improved. A total of 37% (1743 of 4713) of obstetrics-gynecology residents have received no formal statistical literacy training in residency. Fewer residents answered the 2 statistical literacy questions correctly compared with previous studies.
PMCID: PMC3693693  PMID: 24404272
20.  Metabolic consequences of the early onset of obesity in common marmoset monkeys 
Obesity (Silver Spring, Md.)  2013;21(12):10.1002/oby.20462.
We assess the common marmoset as a model of early obesity. We test the hypotheses that juvenile marmosets with excess adipose tissue will display higher fasting glucose, decreased insulin sensitivity, and decreased ability to clear glucose from the blood stream.
Design and Methods
Normal and Obese (body fat > 14%) common marmoset infants (N = 39) were followed from birth until one year. Body fat was measured by quantitative magnetic resonance. Circulating glucose was measured by glucometer; insulin, adiponenctin and leptin by commercial assays. The QUICKI (a measure of insulin sensitivity) was calculated for subjects with fasting glucose and insulin measures. Oral glucose tolerance tests were conducted at 12 months on 35 subjects.
At 6 months Obese subjects already had significantly lower insulin sensitivity (mean QUICKI = .378±.029 versus .525±.019, N=11, p=.003). By 12 months Obese subjects also had higher fasting glucose (129.3±9.1 mg/dL versus 106.1±6.5 mg/dL, p=.042) and circulating adiponectin tended to be lower (p=.057). Leptin was associated with percent body fat; however, birth weight also influenced circulating leptin. The OGTT results demonstrated that Obese animals had a decreased ability to clear glucose.
Early onset obesity in marmosets results in impaired glucose homeostasis by one year.
PMCID: PMC3855166  PMID: 23512966
insulin sensitivity; glucose; leptin; adiponectin
21.  Attitudes and Practices Regarding Late Preterm Birth Among American Obstetrician-Gynecologists 
Journal of Women's Health  2013;22(2):167-172.
Late preterm birth (LPTB) accounts for most preterm births and has been increasing, associated with increases in cesarean sections and inductions at this gestational age.
A self-administered survey, consisting of questions about opinions, knowledge, and practices regarding LPTB, was mailed to 1232 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in Practice in May–July 2010.
Surveys were returned by 520 practicing obstetricians. Two thirds of respondents correctly defined LPTB (34–36 weeks completed gestation). Most responding physicians (87%) were aware of the evidence regarding morbidity and mortality of infants born at 34–36 weeks; 81% considered such evidence sufficient to make a clinical judgment. Although 84% were concerned about long-term health problems in these infants, many disagreed that LPTB infants were at increased risk of long-term neurodevelopmental outcomes. Most agreed that the increase in LPTB in the United States is due to increasing rates and complications of multifetal pregnancies and maternal disorders. Almost all responding physicians agreed that certain clinical indications (e.g., severe preeclampsia, placental abruption, premature rupture of the membranes [PROM]) were appropriate reasons for early delivery, and most disagreed with delivering late preterm infants for logistical reasons or convenience. Half of responding physicians reported that concerns about malpractice risks contribute to their decision to induce labor or perform a cesarean section at 34–36 weeks.
Many obstetricians underestimate long-term neurodevelopmental outcomes among infants born late preterm and may have a lower threshold to deliver some infants late preterm for indications that are not evidence based. Additional educational efforts regarding LPTB are needed.
PMCID: PMC3573726  PMID: 23350861
22.  The evolution of music and human social capability 
Music is a core human experience and generative processes reflect cognitive capabilities. Music is often functional because it is something that can promote human well-being by facilitating human contact, human meaning, and human imagination of possibilities, tying it to our social instincts. Cognitive systems also underlie musical performance and sensibilities. Music is one of those things that we do spontaneously, reflecting brain machinery linked to communicative functions, enlarged and diversified across a broad array of human activities. Music cuts across diverse cognitive capabilities and resources, including numeracy, language, and space perception. In the same way, music intersects with cultural boundaries, facilitating our “social self” by linking our shared experiences and intentions. This paper focuses on the intersection between the neuroscience of music, and human social functioning to illustrate the importance of music to human behaviors.
PMCID: PMC4166316  PMID: 25278827
music; evolution; social capability; cognitive capability; communication
23.  The development of obesity begins at an early age in captive common marmosets (Callithrix jacchus) 
American journal of primatology  2012;74(3):261-269.
Animal models to study the causes and consequences of obesity during infancy in humans would be valuable. In this study we examine the patterns of fat mass gain from birth to 12 months in common marmosets (Callithrix jacchus). Lean and fat mass was measured by quantitative magnetic resonance at 1, 2, 6, and 12 months for 31 marmosets, 15 considered Normal and 16 considered Fat (>14% body fat) at 12 months. Animals were fed either the regular colony diet mix or a high-fat variation. Subjects classified as Fat at 12 months already had greater lean mass (198.4±6.2g vs 174.0±6.8g, p=.013) and fat mass (45.5±5.0g vs 24.9±3.4g, p=.002) by 6 months. Body mass did not differ between groups prior to 6 months, however, by 1 month Fat infants had greater percent body fat. Percent body fat decreased between 1 and 12 months in Normal subjects; in Fat subjects it increased. The high-fat diet was associated with body fat >14% at 6 months (p=.049), but not at 12 months. This shift was due to 3 subjects on the normal diet changing from Normal to Fat between 6 and 12 months. Although maternal prepregnancy adiposity did not differ, overall, between Normal and Fat subjects, the subjects Normal at 6 and Fat at 12 months all had Fat mothers. Therefore, diet and maternal obesity appear to have potentially independent effects that may also vary with developmental age. Although birth weight did not differ between groups, it was associated with fat mass gain from 1 to 6 months in animals with >14% body fat at 6 months of age (r=.612, p=.026); but not in 6 month old animals with < 14% body fat (r=-.012, p=.964). Excess adiposity in captive marmosets develops by 1 month. Birth weight is associated with adiposity in animals vulnerable to obesity.
PMCID: PMC3767183  PMID: 24006544
Primates; body composition; adiposity; childhood obesity
24.  Paternal deprivation affects the functional maturation of corticotropin-releasing hormone (CRH)- and calbindin-D28k-expressing neurons in the bed nucleus of the stria terminalis (BNST) of the biparental Octodon degus 
Brain Structure & Function  2013;219(6):1983-1990.
While the critical role of maternal care on the development of brain and behavior of the offspring has been extensively studied, our knowledge about the importance of paternal care for brain development of his offspring is still comparatively scarce. The aim of this study in the biparental caviomorph rodent Octodon degus was to analyze the impact of paternal care on the development of corticotropin-releasing hormone (CRH)-expressing neurons in the bed nucleus of the stria terminalis (BNST) and hypothalamic paraventricular nucleus (PVN). Both brain areas are key players in neuronal circuits that regulate hypothalamic–pituitary–adrenal axis (HPA) activity. At the age of postnatal day (PND) 21, we found that paternal deprivation resulted in a decreased density of CRH-containing neurons in the medial, but not in the lateral BNST, whereas no changes were observed in the PVN. These deprivation-induced changes were still prominent in adulthood. At PND 21, the density of Ca-binding protein calbindin D28K (CaBP-D28K)-expressing neurons was specifically increased in the medial, but not lateral BNST of father-deprived animals. In contrast, adult father-deprived animals show significantly decreased density of CaBP-D28K-expressing neurons in the lateral, but not medial BNST. Taken together, these results may have important implications for our understanding of the experience-driven development of neural circuits that regulate HPA activity mediating acute responses to stress and chronic anxiety.
PMCID: PMC4223576  PMID: 23913254
Parental behavior; Development; Corticotropin-releasing factor; Quantitative immunocytochemistry
25.  Importance of Stress Receptor-Mediated Mechanisms in the Amygdala on Visceral Pain Perception in an Intrinsically Anxious Rat 
Stress worsens abdominal pain experienced by patients with irritable bowel syndrome (IBS), a chronic disorder of unknown origin with comorbid anxiety. We have previously demonstrated colonic hypersensitivity in Wistar-Kyoto rats (WKYs), a high-anxiety strain, that models abdominal pain in IBS. In low-anxiety rats, we have demonstrated that the central nucleus of the amygdala (CeA) regulates colonic hypersensitivity and anxiety induced by selective activation of either glucocorticoid receptors (GR) or mineralocorticoid receptors (MR), which is also mediated by the corticotropin releasing factor (CRF) type-1 receptor. The goal of the present study was to test the hypothesis that the CeA through GR, MR and/or CRF-1R regulates colonic hypersensitivity in WKYs.
One series of WKYs had micropellets of a GR antagonist, an MR antagonist or cholesterol (control) stereotaxically implanted onto the CeA. Another series were infused in the CeA with CRF-1R antagonist or vehicle. Colonic sensitivity was measured as a visceromotor response (VMR) to graded colorectal distension (CRD).
Key Results
The exaggerated VMR to graded CRD in WKYs was unaffected by GR or MR antagonism in the CeA. In contrast, direct CeA infusion of CRF-1R antagonist significantly inhibited the VMR to CRD at noxious distension pressures.
Conclusions & Inferences
Stress-hormones in the CeA regulate colonic hypersensitivity in the rat through strain-dependent parallel pathways. The colonic hypersensitivity in WKYs is mediated by a CRF-1R mechanism in the CeA, independent of GR and MR. These complementary pathways suggest multiple etiologies whereby stress hormones in the CeA may regulate abdominal pain in IBS patients.
PMCID: PMC3461498  PMID: 22364507
amygdala; corticotropin releasing factor; colon; visceral hypersensitivity; IBS; Wistar-Kyoto rat

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