A Review of Racial and Ethnic Disparities in Immunizations for Elderly Adults.

Vaccine preventable diseases are responsible for a substantial degree of morbidity in the United States as over 18 million annual cases of vaccine preventable disease occur in the U.S. annually. The morbidity due to vaccine preventable disease is disproportionately borne by adults as over 99% of the deaths due to vaccine preventable diseases occur within adults, and national data indicates that there racial disparities in the receipt of vaccines intended for elderly adults. A literature review was conducted by using the PubMed database to identify research articles that contained information on the vaccination rates among minority populations for selected vaccines intended for use in elderly populations including those for herpes zoster, tetanus, diphtheria, pertussis, hepatitis A, and hepatitis B. A total of 22 articles were identified, 8 of which focused on tetanus related vaccines, 2 of which focused on hepatitis related vaccines, and 12 of which focused on herpes zoster. The findings indicate that magnitude of the disparity for the receipt of tetanus and herpes related vaccines is not decreasing over time. Elderly patients having a low awareness of vaccines and suboptimal knowledge for when or if they should receive specific vaccines remains a key contributor to suboptimal vaccination rates. There is an urgent need for more intervention-based studies to enhance the uptake of vaccines within elderly populations, particularly among ethnic minorities where culturally sensitive and tailored messages may be of use.

The Economic Impact of Herpes Zoster Vaccine Disparities in Elderly United States Blacks.

There are persistent disparities with regard to receipt of herpes zoster vaccine among elderly blacks, but no data is available regarding the public health or economic impact of these disparities. A decision tree was constructed with multiple Markov nodes in order to estimate the preventable cases of herpes zoster occurring among elderly blacks due to disparities in receipt of herpes zoster vaccine and to quantify the economic costs associated with these disparities. The model was constructed to examine the number of herpes zoster cases occurring among elderly blacks from the age of 60 to 84 over a 20 year period and also calculated costs due to herpes zoster complications and lost productivity. Achievement of health equity would prevent over 34,500 cases of herpes zoster from occurring in the future and avert over $180 million in lost productivity and treatment costs as a result of these cases of herpes zoster. These results help to show that thousands of cases of herpes zoster could be prevented if blacks were vaccinated at the same frequency as whites and help to show the benefit of implementing viable strategies to achieving this goal.

A Qualitative Study to Explore the Male Nursing Student's Coping with Experiences in a Maternal-Newborn Nursing Course.

Nursing today is predominantly a female profession; however, men are reentering the profession in record numbers and challenging the perspective that they are inappropriate in caregiver roles, or incapable of providing compassionate and sensitive care. This study investigated the perceptions and experiences of male nursing students in a maternal-newborn nursing course and their coping strategies in dealing with the clinical rotation role stress. A purposive sample included 11 male nursing students who completed a survey, and 6 out of the 11 participated in individual interviews. Written responses and verbatim audio narratives were analyzed using qualitative content analysis to identify themes that described their perceptions and experiences. The results identified 7 themes, suggesting a need for nurse educators to develop theory-guided instructional strategies to support male nursing students' academic goals, which may be at stake because of the maternity learning environment.

Knowledge and perceptions of prostate cancer among Nigerian male immigrants.

Studies focusing on prostate cancer in the Nigerian population, especially Nigerian male immigrants residing in the United States, are limited. Nigerian immigrants are one of the fastest growing populations of Africans currently residing in the United States. According to a report from Migration Policy Institute in Washington DC, 1.4 million African immigrants live in the United States, of which 13.1% or 185,787 are Nigerian-born individuals (Terrazas, 2009). A great number of these African immigrants (159,928/11.3%) currently reside in the Washington metropolitan area. Similar to African American males in the United States, Nigerian men are at high risk for developing prostate cancer. In Nigeria, prostate cancer constitutes 11% of all male cancers making it the #1 ranking cancer among Nigerian men.

Commentary on collaboration: the key to interdisciplinary research.

Researchers seeking federal and other sources of funding for their proposed studies have found the request for applications are for those developed by multidisciplinary teams including but not limited faith based and grass root organizations. Nurses, pharmacist, physicians, allied health providers, students, clergy and lay organizations are working together to decrease health disparities. Academic settings have the infrastructure and human resources that can promote interdisciplinary opportunities for partnerships across campus, within their school, colleges and community. The author provides recommendations for building a multidisciplinary research team.

African-American men and their reflections and thoughts on prostate cancer.

The purpose of this study was to assess African-American males' knowledge, attitudes, and beliefs regarding prostate cancer and early detection methods. This was a cross sectional study conducted with 67 (N = 67) African-American men to assess their knowledge, attitudes, and beliefs regarding prostate cancer and prostate cancer early detection methods Data collection occurred at several urban churches in the Washington, D.C., metropolitan area. Findings from this study suggest that 91% of the men did not consider prostate cancer screening embarrassing or painful; 86.9% agreed that their physician would think they should have a Digital Rectal Exam (DRE) and Prostate Specific Antigen (PSA) tests performed, and believed in the efficacy of early prostate cancer screening However, 30% of the men would not want to know if they had prostate cancer, and 53.2% did not believe they were likely to get prostate cancer in the future. The implications and results of this study support the need for ongoing prostate education and screening programs for African-American men.

HIV risk behaviors in African American males.

Human immunodeficiency virus/acquired immune syndrome (HIV/AIDS) infection is the fifth leading cause of death for people who are 25-44 years in the United States, and is the leading cause of death for African American men ages 35-44. The incidence rates for HIV among African Americans are steadily increasing, despite wide-spread campaigns to educate the public about the disease. The purpose of this article is to review the epidemiology and statistics related to HIV/AIDS, as well as changes in the epidemic among African American males. A review of the literature was conducted which specifically focused on HIV risk behaviors, changing patterns of behavior, and risk modification among African American males. Opportunities for future research are also detailed.

Treatment perceptions and attitudes of older human immunodeficiency virus-infected adults.

OBJECTIVE: To apply the Health Belief Model (HBM) in assessing the association of health beliefs, perceived benefits, perceived barriers, alternative therapy use, and sexual risk behaviors in relation to the treatment of human immunodeficiency virus (HIV) in a group of older HIV-infected patients. METHODS: A convenience sample of 100 older (50 years and above) HIV-infected patients in 2 Washington, DC, clinics was enrolled. A cross-sectional methodology used structured interviews to investigate the association among antiretroviral adherence, use of alternative therapies, treatment perceptions, and risk behaviors. Student t tests were conducted to examine significant relationships between HBM perceptions and demographic characteristics. Logistic regressions were conducted to assess likelihood of antiretroviral and alternative therapy use. RESULTS: The majority of the participants were black and had a high school education. Although participants believed that HIV was a severe disease, they did not perceive themselves to be susceptible to early progression to acquired immunodeficiency syndrome. Participants believed that antiretrovirals were beneficial, and they were not particularly burdened by perceived costs of antiretrovirals. The perceived costs (or barriers) of antiretrovirals were inversely associated with CD4 count (r=-0.25, P=.01) and positively associated with viral load (r=0.33, P < .01). Overall 21% of patients in this population indicated use of alternative therapies. Patients who tended to have a higher perception of severity of HIV and a higher perceived burden in using antiretrovirals were more likely to use alternative therapy. There was no difference in HBM perceptions among antiretroviral users and nonusers. CONCLUSIONS: In general, the benefits of taking antiretrovirals were clear to most patients, and the same patients did not view access to antiretrovirals as a significant barrier to treatment. Many patients, although aware of the severity of HIV disease, were not seeking modifications to sexual behavior. Furthermore, the actual medication-taking behavior of these patients resulted in significant impacts to their clinical status. Study results can be applied in the development of specific interventions that are intended to decrease HIV transmission among older adults and to improve medication-taking behavior among those who are already infected with HIV.

Assessment and predictors of antiretroviral adherence in older HIV-infected patients.

Advances in the diagnosis and treatment of HIV disease have resulted in increased survival for HIV-infected patients. Strict adherence to antiretroviral therapy is required to obtain these benefits, however. This holds true for older patients who often are diagnosed later in their disease course and who have shorter survival periods than younger patients. Although there have been few studies of antiretroviral adherence in older HIV patients, this article reviews the literature regarding antiretroviral adherence in younger HIV-infected adults as well as studies of medication adherence in older patients with other disease states. It then discusses the application of adherence interventions in these other populations to older HIV-infected adults. Several methods have been used in measuring antiretroviral adherence, including electronic monitoring, self-report, pill counts, viral load, therapeutic drug monitoring, and several other techniques. The advantages and disadvantages of these methods also are presented as well as recommendations for future adherence research in older HIV-infected adults. Finally, this article details areas of unmet research need concerning HIV medication adherence in older adults.

Complementary and alternative medicine instruction in nursing curricula.

With an ever-increasing number of consumers reportedly using non-conventional methods of disease management, nurses have now been recognized as key providers in education on complimentary and alternative medicine (CAM). The risk of herb-drug interactions secondary to consumer use of alternative medicines further increases the need for nurses to assume the role of patient educators in the area of CAM. Many nurses, however, feel rather ill-prepared to properly care for patients using CAM due to inadequate instruction on the subject matter during their training. Many nursing educators have now moved to address such concerns by considering including education on CAM therapies in the nursing school curriculum. This study evaluated CAM education in US nursing schools to gain a perspective on how nursing students are currently being trained. A survey questioning CAM education was administered to 148 nursing schools and collected over a 3-month period. The results indicate that nearly half of the responding schools offered some form of education on CAM in their curriculum with electives being the primary form of instruction. Teaching methodologies on CAM instruction in the curriculum included group discussion on CAM topics, lectures, and review of case studies. The majority of faculty respondents in this study held Ph.D. degrees followed by instructors holding a MS, DNS, and/or MSN degree.

Socioeconomic status and African Americans' perceptions of cancer.

A descriptive study was conducted with 139 (N=139) African-Americans (AA) to determine the relationship of socioeconomic status (SES) to the perceptions held by these individuals regarding cancer screening and early cancer detection, cancer risk factors, susceptibility to cancer and thoughts about cancer prevention. Findings from this study suggest that among these African-Americans, both gender (p = 0.03) and SES (p = 0.01) were significant predictors of participants' perceptions regarding cancer risk factors, early cancer detection (p = 0.0001), and cancer prevention (p = 0.0001). However there was no significant relationship between age, gender SES, and past experience with cancer and participants' perceptions of cancer screening and susceptibility to cancer. When age and gender were statistically controlled, SES was significantly related to participants' perceptions of cancer risk factors, early detection, prevention, screening and susceptibility. The findings from this study suggest a need for additional research about the relationships between higher SES African-Americans and their perceptions of cancer.

What we thought we knew: African American males' perceptions of prostate cancer and screening methods.

This study applied the Health Belief Model in determining African American male's knowledge, attitudes and perceptions of prostate cancer and early detection methods. The ultimate value of the information assessed from this population was used to design specific theory-based, culturally relevant interventions which may decrease mortality in this high-risk population. Two focus groups were conducted with African-American men whose ages ranged from 38-80 years. After consenting to audio-taping, participants completed a survey questionnaire and viewed a culturally appropriate video on prostate cancer. Results indicate that, on average, the men believed in the efficacy of prostate cancer early detection methods. Study participants felt physicians did not adequately screen or suggest that they be screened for prostate cancer. Men between 40 and 50 years of age expressed concern about possible changes in their sex life if diagnosed with prostate cancer. Despite having limited knowledge of prostate cancer they considered a digital rectal examination to be embarrassing and uncomfortable. However, they were not opposed to having the procedure done.