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.

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.

Organic redox-initiated polymerization process for the fabrication of hydrogels for colon-specific drug delivery.

Organic-redox initiated polymerization technique based on the co-initiators system comprising benzoyl peroxide and N-phenyldiethanolamine was used at ambient temperature to fabricate pH-responsive hydrogels. The effects of changes in the concentration of the co-initiators system, the ratio in which the co-initiators combined, the type of the polymerization solvent, the pH of the hydrating medium, the concentration of the cross-linking agent based on azo-bond and the pH-sensitive cross-linking agent on the properties of the hydrogels were investigated. Increasing the concentration of the co-initiators system, decreasing the concentration of the two types of cross-linking agents, and replacing DMSO by ethanol as the polymerization solvent resulted in hydrogels with increased equilibrium swelling ratio and increased molecular weight between cross-links at pH 7.4. Increasing the concentration of N-phenyldiethanolamine while keeping the concentration of benzoyl peroxide constant gave hydrogels with increased equilibrium swelling ratios. The equilibrium swelling ratios of the hydrogels at pH 2.0 were not affected by the factors investigated. The polymerization technique may be suitable for the design of drug delivery systems containing thermolabile bioactive agents like peptides and proteins.