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Knowledge of a patient’s medication is important in treating hyperlipidemia; however, little is known about this in practice. We carried out a repeated cross-sectional study to analyze a nationally representative sample of US adult statin users from the National Health and Nutrition Examination Survey, 1999–2018. We used medication bottle checks and self-reported survey data to estimate the percentage of individuals who are unaware of their hypercholesterolemia, type of medication, or how to take their medication. We used logistic regression to examine their characteristics. We included 8798 statin users; however, 17.6% were unaware of their hypercholesterolemia or statin use. Being older, male, non-Hispanic Black, taking a wider range of prescription medications, and previous diabetes or cardiovascular disease diagnosis were associated with lack of awareness. Serum low-density lipoprotein cholesterol level was lower among those lacking awareness (85.5 vs. 100.7 mg/dL; p < 0.001). Many of those unaware of drug type had been given little information about statins; 34.0% had no diagnosis of diabetes or cardiovascular disease, and of these, 27.1% were >75 years old. Roughly one in six lacked awareness, but no association was found with hypercholesterolemia control. Healthcare providers should ascertain a patient’s understanding and consider the risks and benefits of statin medication.

Background: Due to their experiences of major stressful life events, including post-displacement stressors, refugees and asylum seekers are vulnerable to developing mental health problems. Yet, despite the availability of specialized mental health services in Western European host countries, refugees and asylum seekers display low mental healthcare utilization. Objective: The aim of this study was to explore structural and socio-cultural barriers to accessing mental healthcare among Syrian refugees and asylum seekers in Switzerland. Method: In this qualitative study, key-informant (KI) interviews with Syrian refugees and asylum seekers, Swiss healthcare providers and other stakeholders (e.g. refugee coordinators or leaders) were conducted in the German-speaking part of Switzerland. Participants were recruited using snowball sampling. Interviews were audiotaped and transcribed, and then analysed using thematic analysis, combining deductive and inductive coding. Results: Findings show that Syrian refugees and asylum seekers face multiple structural and socio-cultural barriers, with socio-cultural barriers being perceived as more pronounced. Syrian key informants, healthcare providers, and other stakeholders identified language, gatekeeper-associated problems, lack of resources, lack of awareness, fear of stigma and a mismatch between the local health system and perceived needs of Syrian refugees and asylum seekers as key barriers to accessing care. Conclusions: The results show that for Syrian refugees and asylum seekers in Switzerland several barriers exist. This is in line with previous findings. A possible solution for the current situation might be to increase the agility of the service system in general and to improve the willingness to embrace innovative paths, rather than adapting mental healthcare services regarding single barriers and needs of a new target population.

IntroductionIt is known that early withdrawal can lead to a worsening of mental health. This is particularly relevant for depressive patients with clinical high-risk for psychosis (CHR) for whom the recommended duration of treatment has not been established.ObjectivesAnalyze the actual treatment duration of depressive patients at CHR after their discharge from hospital and compare it with the group of depressive patients without CHR.MethodsA comparative study of 124 depressive patients with CHR and 27 depressive patients without CHR was conducted within a year after discharge from hospital to assess the therapy duration and treatment compliance.ResultsWithin a year after discharge only 12.1% depressive patients with CHR and 29.6% ones without CHR continued to receive the therapy. The average duration of treatment after discharge was 7.4 months in the first group and 11.7 months in the second group. The majority of patients stopped treatment for the following reasons (in descending order of importance): lack of awareness of their mental condition (51.9% vs 40.3%), side effects (38.7% vs 11.1%), and negative attitudes towards the treatment on the part of patients’ immediate family members (8.9% vs 7.4%).ConclusionsIt has been found out that depressive patients with CHR are less likely to follow medical prescriptions than ones without CHR, they are more likely to have the lack of awareness of their mental condition, they are more likely to have side effects of the therapy. These findings require the development of a universal approach to the treatment of such patients after discharge from hospital.DisclosureNo significant relationships.

This paper introduces clinicians to sustainability as it relates to dentistry. There are seven papers in the series. These include this introduction, followed by papers on energy, procurement, travel, waste, biodiversity and engagement and embedding sustainability into current dental practice. A sustainable world aims to ensure the basic needs and quality of life of everyone are met, now and for future generations. The current delivery of healthcare in the modern world is not sustainable due to rising financial costs, increasing demands and a high environmental burden. Dentists, like their medical counterparts, need to consider the General Dental Council (GDC) standards and the relationship between planetary health and human health within their practice. There is increasing awareness of the problems associated with global warming but a lack of knowledge on how to become more environmentally sustainable. There are also financial and reputational benefits to becoming more sustainable for practices. The carbon footprint is one proxy of sustainability and is closely related to expenditure. In 2014-2015, the carbon footprint of dentistry was calculated to be 675 kilotonnes carbon dioxide equivalents (CO2e) with 64.5% related to travel, 15.3% from energy and 19% from procurement. The GDC should consider incorporating sustainability education into the undergraduate framework in line with student demands and similar moves by the General Medical Council.

Background Breast cancer is rapidly increasing worldwide. Pakistan has a high incidence rate of one in every nine women. The lack of awareness is the major reason for delayed diagnosis, thus resulting in high mortality. This study aimed to assess the impact of pharmacist-led breast cancer education at community pharmacies on promoting breast cancer awareness. Methodology A longitudinal pre-post intervention study was conducted on 319 participants using a self-designed questionnaire. During the pre-intervention phase, data were collected from participants at various community pharmacies employing questionnaire administration. The provision of a breast cancer educational session followed the session. After three months, the participants were contacted via telephone, and the questionnaires were filled in again during the post-intervention phase. Data was analyzed using SPSS version 25. Results The pre-post phase data evaluation reported improved breast cancer awareness among the study participants, with a significant increase ( p  = 0.000) in awareness of breast cancer symptoms, risk factors, and diagnostic techniques. There was a statistical increase in breast self-examination practice during the post-intervention phase (2.5% to 93.8%). Knowledge about clinical breast examination improved from 8.5% (pre-intervention phase) to 84.4% (post-intervention phase). Additionally, understanding mammography as a vital screening technique improved significantly, with approximately 34.7% of eligible women having undergone mammography in the post-intervention phase. Conclusion A notable improvement in breast cancer awareness and self-examination was observed through pharmacist-led education. Leveraging pharmacist-led services in community pharmacies could effectively contribute to breast cancer control efforts. Utilizing pharmacists nationwide could facilitate the implementation of comprehensive strategies to elevate public breast cancer awareness nationally.

Glacial lake outburst floods (GLOFs) are catastrophic events that disproportionately affect vulnerable downstream communities. While there has been a boom of research into physical risk assessments, such as glacial lake mapping, change detection analysis, hazard modelling and risk analysis, there has been little practical implementation on the ground, with only a few structural measures in place. This article emphasises the importance of social factors in GLOF mitigation, which should complement physical assessments. Empowering downstream communities through workshops, training programs, and awareness campaigns can help to increase local disaster preparedness. Community-based approaches, such as participatory hazard mapping, localised early warning systems, and frequent evacuation drills, offer realistic and highly effective alternatives to mitigate GLOF impacts. This study further highlighted the importance of bridging the gap between scientific research on GLOFs and the downstream communities most at risk, stressing the need for increased community involvement, improved communication, and the redistribution of resources to enhance disaster preparedness and resilience. The paper also identifies recurring gaps in current GLOF mitigation frameworks, including inadequate institutional support, limited funding, and the marginalization of vulnerable communities. By incorporating social strategies into current frameworks, we may assure more sustainable, inclusive, and effective GLOF risk management, eventually reducing the vulnerability of at-risk communities. Clinical trial number Not applicable.

Background: Antiplatelet therapy (APT) is an integral part of secondary stroke prevention. Noncompliance to APT is an important factor in stroke recurrence. In this study, we have evaluated the reasons for noncompliance to APT. Objective: The aim of this study was to identify the various causes of nonadherence to APT in recurrent stroke patients. Material and Methods: The study was conducted in a tertiary care hospital in south India with a huge stroke burden. The study period was from October 2017 to September 2018. A total of 60 consecutive patients of recurrent stroke who were nonadherent to antiplatelet therapy were evaluated for various factors that prevented compliance. Results: During the 12-month study period among 604 ischemic stroke patients, 128 (21%) had recurrent strokes. Of this 128, 60 (46.8%) were due to discontinuation of APT. The main factor for nonadherence to APT was lack of awareness about the need for lifelong medication (41/60; 68.3%). 10 patients (16.7%) stopped treatment as they opted for alternative therapy and 4 (6.7%) discontinued antiplatelets due to side effects. A small proportion of the patients (3.3%) cited financial constraints and forgetfulness as the issue, while 1.7% had difficulty in finding assistance to administer medicine. 27 (45%) patients had recurrent stroke within 2-15 days of stopping APT. Conclusions: The main reason for nonadherence to antiplatelet therapy is lack of awareness about the need for lifelong antiplatelet therapy. Stroke patients should be educated about the importance of lifelong antiplatelet therapy to prevent recurrent strokes.

Remote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies. This study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it. This was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ≥18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM. In total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (306/507, 60.4%), non-Hispanic (483/507, 95.3%), and White (429/507, 84.6%). A little over half of the respondents reported having had hypertension for 5 years or more (287/507, 56.6%). About one-third of participants were aware of RBPM (165/507, 32.5%), and 11.8% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (247/447, 55.3%) and their lack of awareness of RBPM (190/447, 42.5%). Most respondents in the RBPM group measure their BP at home (55/60, 91.7%), and 61.7% (37/60) engage in daily BP measurement, compared with 62.6% (280/447) and 25.1% (112/447), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; 37/60, 61.7%) than those in the non-RBPM group (70/447, 15.6%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95% CI 11.35-150.31; P<.001) and sharing health information electronically with a health provider (AOR 4.90, 95% CI 1.39-21.64; P=.01) among all participants. However, the significant predictor of participation in RBPM among participants who were aware of RBPM was sharing health information electronically with a health provider (AOR 6.99, 95% CI 1.62-47.44; P=.007). Participation in RBPM is likely to increase with increased awareness, health providers' recommendations, and tailoring RBPM services to patients' preferred electronic communication channels.

Voluntary approaches to environmental policy can contribute to stemming environmental degradation in developing countries with weak institutions. We evaluate the role of a lack of awareness of a law in explaining the voluntary adoption of environmental certification by small and medium enterprises (SMEs) in the food and beverage industry in Vietnam. We find that firms, where owners or managers were unaware of the law were 38 percentage points less likely to receive environmental certification. Moreover, this effect is larger for firms that exported, had internet access or paid bribes, and it is weaker for household enterprises. Our results suggest that increasing legal awareness can weaken informational constraints for SMEs, where weak institutions and a lack of information often hamper the uptake of environmental policy initiatives.

Noncommunicable diseases (NCDs) are by far the major cause of death in lower-middle, upper-middle, and high-income countries; by 2015, they will also be the leading cause of death in low-income countries.