Does the place of residence influence your risk of being hypertensive? A study-based on Nepal Demographic and Health Survey.

Even though several studies have examined various risk factors for hypertension, residential influence is poorly explored especially in the low-income countries. We aim to investigate the association between residential characteristics and hypertension in resource limited and transitional settings like Nepal. A total of 14,652 individuals aged 15 and above were selected from 2016-Nepal Demographic and Health Survey. Individuals with blood pressure ≥140/90 mmHg or a history of hypertension (as identified by physicians/health professionals) or under antihypertensive medication were defined as hypertensive. Residential characteristics were represented by area level deprivation index, with a higher score representing higher level of deprivation. Association was explored using a two-level logistic regression. We also assessed if residential area modifies the association between individual socio-economic status and hypertension. Area deprivation had a significant inverse association with the risk of hypertension. Individuals from the least deprived areas had higher odds of hypertension compared to highly deprived areas 1.59 (95% CI 1.30, 1.89). Additionally, the association between literacy a proxy of socio-economic status and hypertension varied with a place of residence. Literate individuals from highly deprived areas were likely to have a higher odds of hypertension compared to those with no formal education. In contrast, literate from the least deprived areas had lower odds of hypertension. These results identify counterintuitive patterns of associations between residential characteristics and hypertension in Nepal, as compared with most of the epidemiological data from high-income countries. Differential stages of demographic and nutritional transitions between and within the countries might explain these associations.

Emotional well-being in children with epilepsy: Family factors as mediators and moderators.

OBJECTIVE: Our objective was to examine the relationships of factors associated with children's emotional well-being 2 years after diagnosis, and to examine if these relationships are mediated or moderated by family factors. METHODS: Data came from a multicenter prospective cohort study of children with newly diagnosed epilepsy from across Canada (Health-Related Quality of Life in Children with Epilepsy Study; HERQULES, n = 373). Emotional well-being was assessed using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55). The relationships between clinical factors, family factors, and emotional well-being were assessed using multiple regression analyses. RESULTS: Family functioning, family stress, and repertoire of resources that the families had to adapt to stressful events were significantly associated with poor emotional well-being 2 years after diagnosis (p < 0.05) in the multivariable analysis. The effect of parental depressive symptoms was partially mediated by family functioning and family stress (p < 0.01 and p = 0.02, respectively). Family resources acted as a moderator in the relationship between severity of epilepsy and emotional well-being (p < 0.05). SIGNIFICANCE: Based on our findings, efforts to strengthen the family environment may warrant attention. We suggest that clinicians take a family centered care approach by including families in treatment planning. Family centered care has been shown to improve family well-being and coping and in turn may reduce the impact of clinical factors on emotional well-being to improve long-term health-related quality of life.

Examination of the properties of the Modified Checklist for Autism in Toddlers (M-CHAT) in a population sample.

This study examines the following properties of the Modified Checklist for Autism in Toddlers (M-CHAT) in an unselected low-risk sample: (a) the maximum age for screen administration; (b) the positive screen rate in the absence of follow-up telephone interviews and; (c) the distributional properties of positive screens. Data came from a prospective cohort study (n = 1,604). Results suggest that the M-CHAT can appropriately be administered to children aged 20-48 months. Documented explanations provided by mothers during screening, appear to effectively identify potential screen misclassifications in the absence of the follow-up telephone interviews. This further emphasizes the importance of clinician expertise in verifying positive M-CHAT screens. Results have implications for the administration of the M-CHAT in clinical and research settings.

Development and psychometric properties of the Thinking about Epilepsy questionnaire assessing children's knowledge and attitudes about epilepsy.

OBJECTIVE: Epilepsy is the most common neurological disorder in the world, yet it is still widely misunderstood. A lack of knowledge and negative attitudes about epilepsy are largely blamed for the stigma felt by people with epilepsy and their families. Recent calls for research into stigma have been made by the World Health Organization and international epilepsy organizations. Our objective is to describe the development, structure, and psychometric properties of the Thinking about Epilepsy questionnaire. METHODS: A 36-item questionnaire was designed to assess Grade 5 (ages 9-11) students' knowledge of and attitudes about epilepsy and to evaluate changes in knowledge and attitudes following an epilepsy education program. The questionnaire contains 18 knowledge, 10 attitude, and 8 demographic questions. RESULTS: Psychometric properties of the Thinking about Epilepsy questionnaire were ascertained using data from 783 Grade 5 students. Three items (one knowledge item and two attitude items) were removed prior to the factor analysis due to their low extraction communalities. Factor analysis revealed a bidimensional structure (knowledge and attitudes) with five knowledge factors and two attitude factors. The questionnaire was found to have good internal consistency reliability (Cronbach's alpha=0.74 for knowledge and 0.82 for attitudes). Both the knowledge and attitude measures were deemed to have acceptable face, content, and construct validity. CONCLUSION: The final 33-item Thinking about Epilepsy questionnaire demonstrates adequate reliability for the knowledge measure, good reliability for the attitude measure, and excellent validity for both measures. The Thinking about Epilepsy questionnaire offers a viable option for assessing elementary school students' knowledge and attitudes regarding epilepsy in general or in conjunction with its affiliated Thinking about Epilepsy education program.