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ObjectivesTo analyse the influence of geolocation and ethnicity on the clinical presentation of primary Sjögren's syndrome (SjS) at diagnosis.MethodsThe Big Data Sjögren Project Consortium is an international, multicentre registry designed in 2014. By January 2016, 20 centres from five continents were participating. Multivariable logistic regression analyses were performed.ResultsWe included 7748 women (93%) and 562 men (7%), with a mean age at diagnosis of primary SjS of 53 years. Ethnicity data were available for 7884 patients (95%): 6174 patients (78%) were white, 1066 patients (14%) were Asian, 393 patients (5%) were Hispanic, 104 patients (1%) were black/African-American and 147 patients (2%) were of other ethnicities. SjS was diagnosed a mean of 7 years earlier in black/African-American compared with white patients; the female-to-male ratio was highest in Asian patients (27:1) and lowest in black/African-American patients (7:1); the prevalence of sicca symptoms was lowest in Asian patients; a higher frequency of positive salivary biopsy was found in Hispanic and white patients. A north-south gradient was found with respect to a lower frequency of ocular involvement in northern countries for dry eyes and abnormal ocular tests in Europe (OR 0.46 and 0.44, respectively) and Asia (OR 0.18 and 0.49, respectively) compared with southern countries. Higher frequencies of antinuclear antibodies (ANAs) were reported in northern countries in America (OR=1.48) and Asia (OR=3.80) while, in Europe, northern countries had lowest frequencies of ANAs (OR=0.67) and Ro/La (OR=0.69).ConclusionsThis study provides the first evidence of a strong influence of geolocation and ethnicity on the phenotype of primary SjS at diagnosis.

Spirituality is vital to holistic patient care and should be proactively addressed by healthcare providers as unmet spiritual needs are a major source of suffering for patients living with chronic illnesses. However, spiritual concerns are seldom referenced by clinicians during disease-related treatment discussions, particularly for minority and under-resourced patients. This paper outlines a protocol for administering and evaluating a culturally-responsive spiritual care intervention conducted with chronically ill African Americans receiving care at a community safety net health service. A total of 60 African American patients who have chronic conditions and are aged 50 or older will be recruited for this study and randomly assigned to either the intervention (spiritual care program delivered by a board-certified chaplain) or the control group. All participants will complete a baseline interview that encompasses demographic information, religiosity, spiritual well-being, quality of life, and perception of care. Follow-up surveys will be conducted 12 weeks post-baseline, and participants assigned to the intervention group will also undergo a semi-structured acceptability and feasibility interview. Effect size measures and bivariate tests will be used to compare pre- and post-test outcomes while the interviews will be analyzed using constant comparative and thematic analysis. Study findings will assess the feasibility and effectiveness of a culturally-responsive spiritual care intervention for under-resourced African American patients with chronic illnesses. Furthermore, the provision of spiritual care may help patients clarify their healthcare values and decision making priorities.

The purpose of this study was to identify correlates of perceived stress among older African Americans. Guided by the National Institute on Aging's (NIA) Health Disparities Research Framework, we grouped correlates into four levels-environmental, sociocultural, behavioral, and biological, and performed a cross-sectional analysis using ordinal logistic regression models. Participants included 722 African Americans [mean age = 73.61 years (SD = 6.33)] from the Minority Aging Research Study (MARS). Several protective correlates from environmental (e.g., larger life space), sociocultural (e.g., larger social network size), behavioral (e.g., more purpose in life), and biological (e.g., higher global cognition) levels were associated with a lower odds of having higher levels of perceived stress. Perceived stress was associated with established and novel correlates from every level. Future research is needed to examine how changes in these correlates may impact perceived stress in older African Americans.

The purpose of this study was to identify correlates of perceived stress among older African Americans. Guided by the National Institute on Aging's (NIA) Health Disparities Research Framework, we grouped correlates into four levels-environmental, sociocultural, behavioral, and biological, and performed a cross-sectional analysis using ordinal logistic regression models. Participants included 722 African Americans [mean age = 73.61 years (SD = 6.33)] from the Minority Aging Research Study (MARS). Several protective correlates from environmental (e.g., larger life space), sociocultural (e.g., larger social network size), behavioral (e.g., more purpose in life), and biological (e.g., higher global cognition) levels were associated with a lower odds of having higher levels of perceived stress. Perceived stress was associated with established and novel correlates from every level. Future research is needed to examine how changes in these correlates may impact perceived stress in older African Americans.

The purpose of this study was to identify correlates of perceived stress among older African Americans. Guided by the National Institute on Aging's (NIA) Health Disparities Research Framework, we grouped correlates into four levels-environmental, sociocultural, behavioral, and biological, and performed a cross-sectional analysis using ordinal logistic regression models. Participants included 722 African Americans [mean age = 73.61 years (SD = 6.33)] from the Minority Aging Research Study (MARS). Several protective correlates from environmental (e.g., larger life space), sociocultural (e.g., larger social network size), behavioral (e.g., more purpose in life), and biological (e.g., higher global cognition) levels were associated with a lower odds of having higher levels of perceived stress. Perceived stress was associated with established and novel correlates from every level. Future research is needed to examine how changes in these correlates may impact perceived stress in older African Americans.

African American older adults living in disadvantaged communities are disproportionately burdened by disabling pain. To address their needs, we tested the feasibility and potential effects of a cognitive-behavioral chronic pain self-management program delivered by community health workers. A single-group, pre-post evaluation of the STEPS-2 (Seniors using Technology to Engage in Pain Self-management) intervention, in which participants learned pain-management skills through web-based videos. They were also given wearable activity trackers to facilitate incremental increases in walking. In weekly telephone calls, community health workers helped participants apply skills and set goals. Thirty-one adults in Detroit, Michigan (97% African American, 97% female, mean 68.7 years), with chronic musculoskeletal pain. Participants completed telephone surveys at baseline and eight weeks. We measured changes in PROMIS pain interference and pain intensity, as well as Patient Global Impression of Change in pain and functioning. Feasibility indicators included participant engagement and satisfaction, and fidelity to session protocols by community health workers. Participants on average completed 6.6/7 sessions, and 100% agreed or strongly agreed that they improved their understanding of pain management. Average community health worker fidelity score was 1.79 (0 to 2 scale). Pain interference decreased from baseline to post-program (T-score 61.6 to 57.3, P=.000), as did pain intensity (0 to 10 scale, 6.3 to 5.1, P=.004). Approximately 90% of participants reported that pain and function were at least \"a little better\" since baseline. An intervention combining mobile health tools with support from community health workers holds promise for improving pain outcomes among underserved older adults.