Biomedical subjects

Javier Escobar

Publications and source records attributed to Javier Escobar.

6 recordsLinked to original sources

PubMed2006

Interaction between cytokines and oxidative stress in acute pancreatitis.

Acute pancreatitis is an inflammation initially localized in the pancreatic gland which may lead to local and systemic complications. The development of severe acute pancreatitis is mediated by pathophysiological mechanisms involved in the systemic inflammatory response, cytokines and oxidative stress being their components of major importance. Nevertheless, it is still unknown why an episode of acute pancreatitis remains mild or progresses to a severe form. Activated leukocytes are the main source of cytokines. Interleukin 1beta and tumor necrosis factor alpha (TNF-alpha) initiate and propagate almost all the consequences of the systemic inflammatory response syndrome, leading to amplification of the inflammatory response. It is noteworthy that the systemic inflammatory response is restrained and the rate of mortality decreased in acute pancreatitis when TNF-alpha is blocked with specific antibodies or in knock-out mice deficient in its receptors. A synergy between pro-inflammatory cytokines and oxidative stress occurs in the development of the inflammatory response in acute pancreatitis. Pro-inflammatory cytokines and oxidative stress trigger common signal transduction pathways that lead to amplification of the inflammatory cascade, mainly through activation of mitogen-activated protein kinases (MAPK) and nuclear factor kappaB (NF-kappaB). Furthermore, pro-inflammatory cytokines, particularly TNF-alpha, and oxidative stress promote each other generating a vicious circle in acute pancreatitis. This cross-talk that arises between pro-inflammatory cytokines and oxidative stress greatly contributes to amplification of the uncontrolled inflammatory cascade through MAPK and NF-kappaB.

Acute Disease↗

PubMed2004

Considering context, place and culture: the National Latino and Asian American Study.

This paper provides a rationale for, and overview of, procedures used to develop the National Latino and Asian American Study (NLAAS). The NLAAS is nationally representative community household survey that estimates the prevalence of mental disorders and rates of mental health service utilization by Latinos and Asian Americans in the US. The central aims of the NLAAS are to: 1) describe the lifetime and 12-month prevalence of psychiatric disorders and the rates of mental health services use for Latino and Asian American populations using nationwide representative samples of Latinos and Asian Americans, 2) assess the associations among social position, environmental context, and psychosocial factors with the prevalence of psychiatric disorders and utilization rates of mental health services, and 3) compare the lifetime and 12-month prevalence of psychiatric disorders, and utilization of mental health services of Latinos and Asian Americans with national representative samples of non-Latino whites (from the National Comorbidity Study-Replication) (NCS-R) and African Americans (from the National Survey of American Life) (NSAL). This paper presents new concepts and methods utilized in the development of the NLAAS to capture and investigate ethnic, cultural and environmental considerations that are often ignored in mental health research.

Adolescent↗

PubMed2003

Psychopharmacological research ethics: special issues affecting US ethnic minorities.

RATIONALE: This article is intended to explore how minority status and cultural factors affect the participation of subjects in clinical psychopharmacology research. OBJECTIVES AND METHODS: A literature review was performed using key words "clinical psychopharmacology trials", "psychiatric ethics" and "minority groups". Major goals of this review were to examine current knowledge base and identify existing gaps in this fairly new area of psychiatric research. RESULTS: We found extremely few papers addressing the issue directly. Most references to minority groups were made peripherally, and many of these were extrapolated to psychiatric patients from work done on medical populations. We found no empirical studies done in psychiatric populations. CONCLUSIONS: Systematic, well-designed research studies are needed to elucidate how culture, race and ethnicity impact on such issues as accrual, retention, informed consent and safeguards against the potential exploitation of minority research subjects. On the basis of the literature review and our personal experience doing clinical research with minority patients, we provide several recommendations and specific suggestions to clinical researchers who include minority patients in their clinical trials.

Biomedical Research↗

PubMed2003

Diagnostic patterns in Latino, African American, and European American psychiatric patients.

BACKGROUND: The purpose of this study was to examine whether Latino patients presenting for behavioral health treatment showed major systematic differences in presenting symptoms, clinical severity, and psychiatric diagnosis compared with European American and African American patients. Documenting such differences should have important implications for evidence-based clinical practice. METHODS: Data were drawn from a large behavioral health service delivery system in New Jersey, and included administrative data, clinical diagnosis, a clinician-rated global level of functioning, and a self-reported symptoms and functioning scale. The study involved a clinical sample of all new admissions into the system between January 1, 2000, and August 31, 2001. To examine the main effects of ethnicity, in the context of other independent variables, logistic regression was performed for each of 3 dependent binary variables: presence or absence of major depression, a schizophrenia spectrum disorder, and bipolar disorder. RESULTS: Consistent with previous studies, we found that African Americans were diagnosed as having a disorder in the schizophrenic disorders spectrum more frequently than did Latinos and European Americans (odds ratio, 1.80; 95% confidence interval, 1.62-2.00). Latinos were disproportionately diagnosed as having major depression, despite the fact that significantly higher levels of psychotic symptoms were self-reported by Latinos (odds ratio, 1.74; 95% confidence interval, 1.56-1.93). CONCLUSIONS: Latinos in this study were more likely to be clinically diagnosed as having major depression than were other ethnic groups. Further research is needed to determine the reasons for these systematic differences. Possible explanations include (1) self-selection, (2) culturally determined expression of symptoms, (3) difficulties in the accurate application of DSM-IV diagnostic criteria to Latinos, (4) bias related to lack of clinicians' cultural competence, and (5) imprecision inherent in the use of unstructured interviews, possibly combined with clinician bias. Additional research is required to determine the generalizability, accuracy, and applicability of these findings and their possible mechanisms.

Adolescent↗

PubMed2002

Overcoming barriers to reducing the burden of affective disorders.

Affective disorders impose a substantial individual and societal burden. Despite availability of efficacious treatments and practice guidelines, unmet need remains high. To reduce unmet need and the burden of affective disorders, information is needed on the distribution of burden across stakeholders, on barriers to reducing burden, and on interventions that effectively reduce burden at the levels of practice, community, and policy. This article provides the report of the Working Group on Overcoming Barriers to Reducing the Burden of Affective Disorders, for the National Institute of Mental Health Strategic Plan on Mood Disorders. We review the literature, identify key gaps, and recommend new research to guide national efforts to reduce the burden of affective disorders.

Community Health Services↗

PubMed2002

Ethnic minorities.

Ethnic minorities have relatively similar rates of mood disorders as do white Americans, but they are much less likely to receive appropriate care. Barriers to care include lack of insurance, few minority providers' racism, and distrust of care providers. A priority in research is identifying practice interventions and policies that could eliminate disparities in care.

Cost of Illness↗