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OBJECTIVE: Metformin is the most common treatment for type 2 diabetes (T2D). However, there have been no pharmacogenomic studies for T2D in which a population of color was used in the discovery analysis. This study sought to identify genomic variants associated with metformin response in African American patients with diabetes. RESEARCH DESIGN AND METHODS: Patients in the discovery set were adult, African American participants from the Diabetes Multi-omic Investigation of Drug Response (DIAMOND), a cohort study of patients with T2D from a health system serving southeast Michigan. DIAMOND participants had genome-wide genotype data and longitudinal electronic records of laboratory results and medication fills. The genome-wide discovery analysis identified polymorphisms correlated to changes in glycated hemoglobin (HbA1c) levels among individuals on metformin monotherapy. Lead associations were assessed for replication in an independent cohort of African American participants from Kaiser Permanente Northern California (KPNC) and in European American participants from DIAMOND. RESULTS: The discovery set consisted of 447 African American participants, whereas the replication sets included 353 African American KPNC participants and 466 European American DIAMOND participants. The primary analysis identified a variant, rs143276236, in the gene ARFGEF3, which met the threshold for genome-wide significance, replicated in KPNC African Americans, and was still significant in the meta-analysis (P = 1.17 × 10−9). None of the significant discovery variants replicated in European Americans DIAMOND participants. CONCLUSIONS: We identified a novel and biologically plausible genetic variant associated with a change in HbA1c levels among African American patients on metformin monotherapy. These results highlight the importance of diversity in pharmacogenomic studies. [ABSTRACT FROM AUTHOR]

Water use of Thompson Seedless grapevines during the first 3 years of vineyard establishment was measured with a large weighing lysimeter near Fresno, California. Two grapevines were planted in a 2×4×2 m deep lysimeter in 1987. The row and vine spacings in the 1.4-ha vineyard surrounding the lysimeter were approximately 3.51 and 2.15 m, respectively. Vines in the lysimeter were furrow-irrigated from planting until the first week of September in 1987. They were subsequently irrigated with subsurface drip-irrigation whenever they had used 2 mm of water, based upon the area of the lysimeter (equivalent to 8 liters per vine). The trellis system, installed the second year, consisted of a 2.13 m long stake, driven 0.45 m into the soil with a 0.6 m cross-arm placed at the top of the stake. Crop coefficients (Kc) were calculated using measured water losses from the lysimeter (ETc) and reference crop evapotranspiration (ETo) obtained from a CIMIS weather station located 2 km from the vineyard. Water use of the vines in 1987 from planting until September was approximately 300 mm, based on the area allotted per vine in the vineyard surrounding the lysimeter. Daily water use just subsequent to a furrow-irrigation event exceeded ETo (>6.8 mm day-1). Water use from budbreak until the end of October in 1988 and 1989 was 406 and 584 mm, respectively. The initiation of subsurface drip-irrigation on 23 May 1988 and 29 April 1989 doubled ETc measured prior to those dates. Estimates of a 'basal' Kc increased from 0.1 to 0.4 in 1987. The seasonal Kc in 1988 increased throughout the season and reached its peak (0.73) in October. The highest Kc value in 1989 occurred in July. It is suggested that the seasonal and year-to-year variation in the Kc was a result of the growth habit of the vines due to training during vineyard establishment. The results provide estimates of ETc and Kc for use in scheduling irrigations during vineyard establishment in the San Joaquin Valley of California and elsewhere with similar environmental conditions. [ABSTRACT FROM AUTHOR]

Women Veterans are the largest veteran population yet have significant mental health disparities, greater than both civilian women and veteran men. This article used constructivist grounded theory methods to explore the experiences of women Veterans that led to mental health outpatient service use. Twelve women Veterans revealed meaningful stories on their experiences of trauma and their use of mental health services. A broader grounded theory process model emerged, linking the categories of Trauma, Transitions, Identity, and Structure. This research provides key insight into how women Veterans make health care-related choices and process traumatic events such as military sexual trauma.

We sought to describe the cardiovascular profile of veteran men before beginning androgen deprivation therapy (ADT), with the eventual benefit of targeting treatments to manage harmful cardiovascular side effects. We performed a secondary analysis with chi-square and Fisher's exact tests for associations between demographics and cardiovascular comorbidities on 375 veteran men diagnosed with prostate cancer. Those who were overweight and current smokers were more likely to be younger, whereas men with a systolic blood pressure >120 mmHg were more likely to be older (all P < 0.05). Men with total cholesterol 180 mg/dL were more likely to be identified in the Hispanic/other/unknown ethnicity category. Interventions to manage cardiovascular risk should focus on preventive lifestyle changes for younger men, and chronic disease management for older men. Men in the smaller Hispanic/other/unknown category are at risk for marginalization within the Veteran Administration system owing to their low numbers and should be closely monitored for cholesterol levels when receiving ADT., (Published by Mosby, Inc.)

African-American women are twice as likely as women from other ethnic groups to have babies with low birth weights and to experience the loss of infant death. The problem is so endemic in black communities in Alameda County, California, that numerous programs have been developed over the past decade to reduce maternal risk factors and eliminate barriers to prenatal care. Despite these efforts, African-American ethnicity continues to be a major risk factor for infant mortality for reasons that are poorly understood. We take a critical look at 3 types of studies characteristic of infant mortality research: epidemiologic, studies that advocate prenatal care, and ethnomedical (cultural). We argue that the assumptions informing this research restrict the thinking about infant mortality and the political issues involved in how prevention programs are developed and structured. The persistent focus on maternal behavioral characteristics limits more in-depth analysis of the micropolitics of perinatal bureaucracies established in response to this ongoing crisis.

This study concerns the psychosocial aspects of treatment for chronically ill children. The English-speaking parents of 44 children 5-13 years of age being seen at five specialty clinics at a large county hospital in Los Angeles, and their attending physicians, were the subjects in this study. The parents were interviewed concerning their expectations for the current visit, and the doctor-patient interaction was tape-recorded. Identical categories of information were abstracted from the tape recording and from a chart review of the patients' medical records. Although parents expected 76% of the psychosocial aspects of care to be covered by the doctor, only one fourth were actually discussed in the visit. These unfulfilled expectations were associated with lower satisfaction with medical care received (r = .47, p less than 0.01). Finally, while doctors recorded about 80% of discussions of symptoms and physical examinations in the patient's medical record, they recorded only 25% of discussion of psychosocial problems.