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Article 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, KellyIntroduction: 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.Master Thesis William Blake ve William Wordsworth Şiirlerinde Çocuk İmgesi(2016) Altahhan, Asmaa Raafat Noori; Aras, GökşenBu tezin amacı, William Blake ve William Wordsworth şiirlerinde çocuk imgesini tarihsel ve kuramsal çerçevede tartışmaktır. Tezin başlangıç noktası çocuk imgesi kavramının romantik algıyla bağlantısını incelemektir. Çocuk imgesinin kavramsal analizi adı geçen iki Romantik şairin bu kavramı hayal gücünün kaynağı şeklinde ifade ettiğini ortaya koymaktadır. Çocuk imgesi, William Blake'in Songs of Innocence and of Experience başlıklı eserinden seçilen şiirlerine ve William Wordsworth'ün Intimations of Immortality from Recollections of Early Childhood ve The Prelude eserlerine göndermeler yaparak Jung'un çocuk arketipi kuramı açısından ele alınmaktadır. Birinci bölümde, Romantik dönemin sosyal, tarihsel gelişimi ve Romantik şiirde çocuk imgesi kavramları incelenmektedir. Jung'un kolektif bilinçdışı ve çocuk arketipi kuramlarının William Blake ve William Wordsworth'ün şiirlerinde nasıl yansıtıldığı analiz edilmektedir. Tezin ikinci bölümü, William Blake şiirlerinde çocuk imgesini ve bu imgenin bir bütünleşme ve hayal gücü kaynağına dönüşümünü incelemektedir. William Blake, çocuk imgesini masumiyet ve deneyim gibi birbirine zıt iki kavram açısından ele almaktadır. Üçüncü bölümde William Wordsworth'ün Intimations of Immortality from Recollections of Early Childhood başlıklı eserinde çocuk imgesi ve ölümsüzlük kavramını nasıl ifade ettiği üzerinde durulmaktadır. Bu bölümde ayrıca Wordsworth'ün The Prelude eserinde çocuk imgesi ve insan zihninin gelişimi arasındaki ilişki üzerinde durulmaktadır. Sonuç kısmında, William Blake ve William Wordsworth'ün şiirlerinde çocuk imgesini ele alış biçimleri arasındaki farklılıklar ve benzerlikler ortaya konmaktadır. Jung'un kuramı ışığında çalışılan bu tezde çocuk imgesinin ilham, hayal gücü ve bütünleşme kaynağı olarak söz konusu şairler ve eserlerinde önemli bir yeri olduğu sonucuna varılmıştır.Master Thesis Çocuğa Yönelik Pazarlamanın Ötesinde: Literatür ve Uygulama Arasındaki Fark için Bir Vaka Çalışması(2019) Dinç, Kamer; Üner, Mehmet MithatÇocuğa yönelik pazarlamanın ilk örnekleri 1800'lerde görülüyor olmasına rağmen araştırmacıların bu konuya değinmelerinin 1950'leri bulması dikkat çekici bir durumdur. Çünkü çocuklar göze çarpan bir tüketici demografisi oluşturur; ancak araştırmacıların çocukları dikkate almalarının gecikmesi, çocukların tüketici davranışlarını anlamayı de geçiktirmiştir. Bugün, çocuğa yönelik pazarlama anlayışını açıklamak için bazı araştırmalar yapılmış olsa da, referens alınan kaynaklar sınırlıdır. Bununla birlikte, uygulayıcılar kendilerini literatürle sınırlandırmayı tercih etmemiş, kendi yollarını keşfetmeyi tercih etmişlerdir. Hatta araştırmacılar bu konuda uygulayıcıları takip ederler. Bu vaka çalışması, çocuğa yönelik pazarlamanın literatür dışında, gerçek dünyada nasıl çalıştığını anlamak için tasarlanmıştır. Bu araştırmasının kapsamlı amacı, uygulayıcılar ve literatür arasındaki farkı ortaya koymaktır. Ayrıca bu çalışmada, önceki çalışmalara dayanan tanımları, yaklaşımları, stratejileri ve etik sorunları daha iyi anlamak da amaçlanmıştır. Bahsi geçen terimler, çocuğa yönelik pazarlama hakkında daha iyi bir fikir edinmeye yardımcı olmak için araştırılmış ve tartışılmıştır. Bu nedenle, bu vaka çalışması çocuğa yönelik pazarlamayı eleştirmek için uygulama örnekleriyle anlatı sorgulamaları kullanılarak tasarlandı. Çocuğa yönelik pazarlama alanındaki mesleklerle anlatı araştırması olarak görüşmeler yapıldı ve populer kültür belgelerinde uygulama örnekleri alındı. Bu eleştirel çalışma, literatüre ve pratik arasındaki farkı açıklamak için yapılmıştır, böylece bu örnek olay incelemesi çocuğa yönelik pazarlamanın devam eden işleyişi hakkında bilgi toplar ve konuyu detaylandırır.Article Citation - Scopus: 5Determining the Factors Affecting Chemotherapy-Induced Nausea and Vomiting in Children With Cancer(W.B. Saunders, 2023) Ay,A.; Boztepe,H.; Özbay,S.Ç.; Yılmaz,P.; Karadavut,B.; Burhanoğulları,D.; Akyüz,C.Purpose: We evaluated the factors affecting chemotherapy-induced nausea and vomiting (CINV) in children with cancer. Design and methods: This cross-sectional study was conducted with 62 children aged 9 to 18 years old with a solid tumor who received chemotherapy for the first time, and their parents. Data were collected using a data collection form, the State-Trait Anxiety Inventory for Children, the Beck Anxiety Inventory, the Spielberger State-Trait Anxiety Inventory, and the Baxter Retching Faces Scale. Data were analyzed using Spearman's correlation and logistic regression analyses. Results: Risk factors related to the child, treatment, and parent were examined. Child-related factors were determined as diagnosis (odds ratio [OR] = 5.5), time since diagnosis (OR = 1.9, OR = 4.7), pretreatment anxiety of the child (r = 0.439, r = 0.422), and past experience of nausea and vomiting before treatment (OR = 1.2). Treatment-related factors involved anti-emetic prophylaxis (OR = 4.9, OR = 9.2). Parent-related factors included pretreatment anxiety of the parent (r = 0.271, r = 0.287), accommodation (OR = 5.5), not eating (OR = 1.2, OR = 1.3), and bad smell (OR = 1.2), which were described amongst parents' as factors that trigger CINV. Conclusions: The occurrence of CINV is significantly affected by child-, treatment-, and parent-related risk factors. Practice implications: Pediatric nurses should create an environment for children and their parents to reduce their anxiety and provide basic knowledge and skills about the management of CINV. © 2023 Elsevier Inc.Article Challenges Faced by Pediatric Patients With Multiple Sclerosis During Disease Progression and Treatment: A Multicenter Cross-Sectional Study in Turkiye(Asean Neurological Assoc, 2025) Yuksel, Didem; Yardimci, FigenBackground & Objective: Multiple sclerosis is a chronic and progressive disease characterized by inflammation, demyelination and degeneration of the central nervous system. This study aimed to describe the sociodemographic and clinical characteristics of children with multiple sclerosis. Methods: The cross-sectional study was collected data from 120 children who met the research criteria and were under follow-up at 7 hospitals in T & uuml;rkiye between August 2021 and February 2022. Ethical approval was obtained from the Medical Research Ethics Committee of Ege University. The researchers developed the "The Sociodemographic Form "used in the study by based on a comprehensive literature review and previous research experiences. The form was used according to expert opinion. Results: The study included 120 eligible patients, of whom 71.2% were girls. The mean age (+/- SD) at disease onset was 13.6 +/- 2.2 years, while the mean age at the time of the study was 15.7 +/- 1.5 years. Most of the participants were high school students (84.2%), and 53.3% resided in metropolitan areas. All participants were receiving disease-modifying therapy. The study found that 67.5% of the children had school absenteeism due to the disease. Furthermore, 75% of the children experienced supratentorial symptoms, with 50% presented with optic symptoms, and 37.5% exhibiting brainstem symptoms prior to diagnosis. Drug-related side effects were reported in 58.3% of children. Additionally,99.2% of the children received information about the disease. Furthermore, 75% of the children experienced challenges during the disease and treatment process. Among these children who encountered difficulties, 52.5% reported psychological problems, 42.5% experienced side effects due to medication, 42.5% had difficulty accessing accurate and sufficient information about disease and treatment management, 32.5% encountered social and school-related issues, and 5.8% had concerns related to the clinical environment. Conclusion: Childhood multiple sclerosis is more prevalent among girls, particularly in the relapsing-remitting form. The most commonly used treatments for pediatric multiple sclerosis include interferon beta-1a and glatiramer acetate. The findings of this study indicate that a significant proportion of participating children encountered challenges during the disease and treatment process, with more than half experiencing drug-related side effects. These challenges underscore the potential negative impact on treatment adherence in this population.Article Citation - Scopus: 1Development of a Questionnaire To Assess Phosphate Knowledge in Children With Chronic Kidney Disease and Their Caregivers(John Wiley and Sons Inc, 2025) McAlister, L.; Shaw, V.; Pugh, P.; Joyce, T.; Snauwaert, E.; Bathgate, F.; Lambert, K.Introduction: Hyperphosphataemia is a common complication of paediatric chronic kidney disease (CKD), despite the use of phosphate binders and the numerous strategies employed to reduce dietary phosphate (P) intake. This article describes the development of two self-administered semi-structured Phosphate Understanding and Knowledge Assessment (PUKA) questionnaires. The purpose of these is to assess challenges with adherence and measure declarative nutrition and procedural knowledge of phosphate in children and young people (CYP) with CKD and their caregivers. The aim is to create questionnaires that will be used for future studies investigating the relationship between knowledge and blood P-levels. Methods: Questions were generated from a literature review, clinical experience and feedback from a survey sent to UK paediatric kidney dietitians. The content, format and style of the questions were adapted and validated via expert consensus (including a psychologist, play therapist, paediatric kidney dietitians and nephrologists from the international Paediatric Renal Nutrition Taskforce, and our Young Persons’ Advisory Group), two caregivers and two CYP. A draft questionnaire was piloted with five caregivers and CYP with CKD to ensure face and content validity. To allow utilisation in a planned multi-centre trial, it was translated into five languages (Dutch, French, German, Italian and Turkish). The final English version questionnaires were used in a sample of CYP with CKD stages 4–5 and on dialysis (CKD4-5D), and caregivers, from three UK paediatric kidney centres. Results: From an initial pool of 80 questions, 37 were included in the final PUKA questionnaire. Thirteen were knowledge-based, and a knowledge score was developed. An adult and a child-friendly format were designed. Pilot testing confirmed face validity to ensure the questions were understandable. Forty-four CYP with CKD4-5D and 33 caregivers completed the final English PUKA questionnaires, with over 80% rating it easy to complete. The median time required to complete it was 11:06 min (IQR: 7:22–16:31). Conclusions: The PUKA questionnaires are a valid and reliable tool for measuring P-related knowledge and experiences of managing phosphate in CYP with CKD and their caregivers. © 2025 The British Dietetic Association Ltd.
