The candidate for this K-24 award has a track record of funding and publications that demonstrate his commitment to a career in patient-oriented research. The award will give him a period of intense focus on the 2 central research themes of his career: (1) Utilization and outcomes of total joint replacement among U.S. Hispanics; and (2) The disablement process in rheumatoid arthritis (RA). The first research project has 3 specific aims: 1) To determine, in the Medicare population, whether recipients of a primary total hip replacement are as likely to be Hispanic, as are age-, sex- and county of residence-matched controls; 2) To determine to what extent preoperative functional status differs between Hispanics and non-Hispanics having a joint replacement in Bexar County, Texas; and 3) To determine how preoperative functional status affects the outcome of joint replacement. The second project will test a biopsychosocial model of the disablement process in a cohort of 770, mostly Mexican American RA patients. Its 4 specific aims are 1) To define the sequence of events in disability due to articular damage; 2) To define the sequence of events due to pain; 3) To define the sequence related to depression; and 4) To determine to what extent the cultural and genetic characteristics of Mexican Americans influence the disablement process in RA. The award will also allow the candidate to build on his record of mentoring, with 5 outstanding junior investigators that have committed to work with him at his institution. Their levels of training range from an Internal Medicine resident pursuing a research pathway for Board Certification, to 2 new Assistant Professors who will collaborate on the candidates research. All 5 of them will participate in a formal clinical research training program developed by the candidate. The research and mentoring activities of this K24 awards will benefit from an outstanding environment that is highly favorable to patient-oriented research. Elements of this environment include: existence of sufficient funding to conduct the research; an established research team with experience studying the predominantly Mexican American population of the region; an NCRR-supported General Clinical Research Center; and an exceptional group of collaborators and consultants with expertise in epidemiology, research methods and biostatistics, all of whom have a record of collaboration with the candidate. With this K24 award, the candidate will extend what is known about the utilization of !joint replacements by Hispanics in the U.S., and will advance understanding of the influence of genetic, clinical and psychosocial factors in the outcome of PA. His mentoring role will also help create a critical mass of investigators focused on arthritis-related disability among the U.S. Hispanic population.
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