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Publisher: Elsevier Science Inc

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    Barriers to and Facilitators of Phosphate Control in Children with CKD
    (Elsevier Science Inc, 2025) Mcalister, Louise; Shaw, Vanessa; Pugh, Pearl; Joyce, Triona; Snauwaert, Evelien; Bathgate, Fionna; Lambert, Kelly
    Introduction: Managing mineral and bone disorder in children with chronic kidney disease (CKD) requires control of serum phosphate levels. However, hyperphosphatemia is common, particularly in adolescents, reflecting suboptimal adherence to phosphate-binder medications and a reduced phosphate diet. We explored phosphate-related knowledge and adherence barriers in children, and their caregivers, using a sequential explanatory mixed-methods study design. Methods: Children aged 8 to 18 years with CKD stages 4 and 5, on dialysis or post-transplantation, and caregivers, were recruited from 3 UK pediatric kidney centers. The Phosphate Understanding and Knowledge Assessment questionnaire was used to assess knowledge. Online focus groups explored real-world challenges to phosphate control. Results: Forty-eight children and 43 caregivers were recruited; 44 (92%) children and 33 (75%) caregivers completed the questionnaire. Median knowledge scores were 64.3% (interquartile range, 55.3-78.6) for children and 72.7% (interquartile range, 64.3-85.7) for caregivers (P = 0.04). Older children scored higher (P = 0.01, R 2 = 0.13), but knowledge did not correlate with serum phosphate. Dietary restriction was perceived as more challenging than using phosphate-binders (59% children; 71% caregivers). Forty-six participants, including 30 child-caregiver dyads, joined focus groups. The following 5 themes were identified encapsulating the experiences of families: practical advice and support are valued; personalized strategies are preferred to facilitate sense-making; the social environment of the child and family is disrupted; education and self-management skills can influence success; and the journey requires acceptance, adaptation, and perseverance. Conclusions: In pediatric CKD, poor adherence to phosphate advice originates more from social and practical barriers than knowledge deficits. Our findings can inform personalized strategies to improve adherence in real-world settings.
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    Citation - WoS: 1
    Citation - Scopus: 1
    The Association Between Respiratory Functions, Pain Tolerance and Body Awareness in Obstructive Lung Diseases
    (Elsevier Science Inc, 2025) Vardar-Yagli, Naciye; Saglam, Melda; Firat, Merve; Inal-Ince, Deniz; Calik-Kutukcu, Ebru; Kilic, Kubra; Coplu, Lutfi
    Purpose: There are only a limited number of studies in the literature evaluating body awareness, pain perception, and the relationship between clinical parameters and respiratory functions in patients with obstructive lung disease (OLD) and compared with healthy individuals. Therefore, this study aimed to evaluate respiratory functions, pain tolerance, and body awareness in patients with OLD and compare these findings with those of healthy individuals. Methods: The study included 33 patients and 30 healthy individuals. The respiratory function (spirometer), respiratory muscle strength (mouth pressure device), endurance (threshold loading device), pain level and tolerance (short-form McGill Pain Questionnaire and algometer), posture, and body awareness (Body Awareness Questionnaire-BAQ) were evaluated. Results: The pain threshold and tolerance of the biceps, triceps, trapezius, and quadriceps muscles were significantly lower and BAQ scores were higher in patients with OLD compared with healthy individuals (p < .05). There was a significant relationship between FEV1 (%) and pain tolerance of the triceps (r = 0.371, p = .047) and gastrocnemius muscles (r = 0.419, p = .024); FVC (%) and pain threshold of the gastrocnemius (r = 0.413, p = .023), triceps muscles (r = 0.394, p = .034), and pain tolerance of the gastrocnemius muscle (r = 0.549, p = .002). Conclusions: Patients with OLD have a marked increase in pain perception and body awareness levels and a decrease in pain threshold and tolerance compared with healthy controls. Future studies should assess the effectiveness of pain management interventions as a part of pulmonary rehabilitation for patients with chronic respiratory diseases. Clinical Implications: Pain management is important for planning pulmonary rehabilitation programmes. (c) 2024 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.