Context Uncontrolled hypertension remains a widely prevalent cardiovascular risk factor in the U.S. team-based care, established by adding new staff or changing the roles of existing staff such as nurses and pharmacists to work with a primary care provider and the patient. Team-based care has the potential to improve the quality of hypertension management. The goal of this Community Guide systematic review was to examine the effectiveness of team-based care in improving blood pressure (BP) outcomes. Evidence acquisition An existing systematic review (search period, January 1980–July 2003) assessing team-based care for BP control was supplemented with a Community Guide update (January 2003–May 2012). For the Community Guide update, two reviewers independently abstracted data and assessed quality of eligible studies. Evidence synthesis Twenty-eight studies in the prior review (1980–2003) and an additional 52 studies from the Community Guide update (2003–2012) qualified for inclusion. Results from both bodies of evidence suggest that team-based care is effective in improving BP outcomes. From the update, the proportion of patients with controlled BP improved (median increase=12 percentage points); systolic BP decreased (median reduction=5.4 mmHg); and diastolic BP also decreased (median reduction=1.8 mmHg). Conclusions Team-based care increased the proportion of people with controlled BP and reduced both systolic and diastolic BP, especially when pharmacists and nurses were part of the team. Findings are applicable to a range of U.S. settings and population groups. Implementation of this multidisciplinary approach will require health system–level organizational changes and could be an important element of the medical home.

Context Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children. They are more often chronically stressed, tired, and hungry, and more likely to have impaired vision and hearing—obstacles to lifetime educational achievement and predictors of adult morbidity and premature mortality. If school-based health centers (SBHCs) can overcome educational obstacles and increase receipt of needed medical services in disadvantaged populations, they can advance health equity. Evidence acquisition A systematic literature search was conducted for papers published through July 2014. Using Community Guide systematic review methods, reviewers identified, abstracted, and summarized available evidence of the effectiveness of SBHCs on educational and health-related outcomes. Analyses were conducted in 2014–2015. Evidence synthesis Most of the 46 studies included in the review evaluated onsite clinics serving urban, low-income, and racial or ethnic minority high school students. The presence and use of SBHCs were associated with improved educational (i.e., grade point average, grade promotion, suspension, and non-completion rates) and health-related outcomes (i.e., vaccination and other preventive services, asthma morbidity, emergency department use and hospital admissions, contraceptive use among females, prenatal care, birth weight, illegal substance use, and alcohol consumption). More services and more hours of availability were associated with greater reductions in emergency department overuse. Conclusions Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.

Cancer fatalism--the belief that death is inevitable when cancer is present--has been identified as a barrier to participation in cancer screening, detection, and treatment. Yet this literature has not been reviewed in a comprehensive and systematic manner. Therefore, this literature review addressed (1) philosophical and theoretical underpinnings of cancer fatalism; (2) relationships among demographic factors, cancer fatalism, and cancer screening; (3) the role of cancer fatalism for patients diagnosed with cancer; and (4) intervention strategies. Most of the reviewed studies were descriptive or correlational, did not have an explicit theoretical framework, had varied definitions of fatalism, and reported screening as "intent to screen" or as "past screening behaviors." Review of the studies suggests that cancer fatalism develops over time and is most frequently reported among medically underserved persons and those with limited knowledge of cancer. Cancer fatalism may be modified through culturally relevant interventions that incorporate spirituality. Emphasis must be placed on recognizing the role of cancer fatalism when planning health promotion activities. Future studies should focus on the consistent measurement of cancer fatalism and testing intervention strategies.

Summaryobjective To identify factors causing delayed diagnosis and treatment for tuberculosis in high tuberculosis (TB) ⁄ HIV burden African countries.methods We searched Ovid Medline, CINAHL, PsychInfo, Scopus and Sabinet-South African journals and reference lists, Google, Google Scholar and Google SA for reports in English, ‡1992, of original data from sub-Saharan countries on patient or system delay in TB diagnosis or treatment with populations ‡15 years old. Two reviewers extracted data independently for each study. We categorized independent variables as predisposing, enabling or reinforcing (PRECEDE model). Meta-analysis was conducted for factors associated with delay in ‡2 studies.results Of 20 eligible studies, 12 assessed both sources of delay; 1, system delay; and 7, patient delay only. Most were cross-sectional surveys (k = 13) with samples of consecutive patients (k = 13) and bivariate analyses (k = 11). Starting and endpoints for patient delay were consistent, but not system delay. Patient characteristics were studied frequently; HIV stigma and enabling factors were studied infrequently, although the last were most often associated with delay. Consulting traditional healers first -usually by rural residents -consistently led to patient delay; OR = 3.45 (1.91-6.21). Travel time for the return visit was consistently associated with system delay OR = 1.87 (1.378-2.531).conclusions We recommend partnerships with traditional healers and research emphasizing HIV and system factors, standard definitions of delay and qualitative and cohort studies to identify enabling and reinforcing factors related to delay.keywords tuberculosis, sub-Saharan Africa, health care-seeking behaviour, delivery of health care

Background Consideration of categories related to reading comprehension—beyond reading level—is imperative to reach low literacy populations effectively. “Suitability” has been proposed as a term to encompass six categories of such factors: content, literacy demand graphics, layout/typography, learning stimulation, and cultural appropriateness. Our purpose was to describe instruments used to evaluate categories of suitability in cancer education materials in published reports and their findings. Methods We searched databases and reference lists for evaluations of print and Web-based cancer education materials to identify and describe measures of these categories. Studies had to evaluate reading level and at least one category of suitability. Results Eleven studies met our criteria.. Seven studies reported inter-rater reliability. Cultural appropriateness was most often assessed; four instruments assessed only surface aspects of cultural appropriateness. Only two of seven instruments used, the Suitability Assessment of Materials (SAM) and the Comprehensibility Assessment of Materials (SAM + CAM), were described as having any evidence of validity. Studies using SMOG and Fry reported higher average reading level scores than those using FK. Most materials failed criteria for reading level and cultural appropriateness. Conclusions We recommend more emphasis on the categories of suitability for those developing cancer education materials and more study of these categories and reliability and validity testing of instruments.