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This study aims to investigate the relationship between the reading motivation and reading comprehension self-efficacy perceptions of fourth-grade students. The research model is the correlational survey model, one of the quantitative research methods. The study group of the research consists of 571 students studying in the fourth grade. The 'Reading Motivation Scale' and the 'Reading Comprehension Self-efficacy Perception Scale' were used as data collection tools. The SPSS statistical software program was used for the analysis of the data. Independent Samples T-Test and ANOVA, which are parametric tests, were used in the analysis of the data. When the results obtained in the study were examined, it was seen that the students' reading motivation total scores were at a 'good' level, and that there was no significant difference in their total scores according to the gender and Turkish report card grade variables. Similarly, it was concluded that the students' reading comprehension self-efficacy perception total scores were also at a 'good' level, and that there was no difference between students depending on the gender and Turkish report card grade variables. Finally, it was determined that there was a 'moderate' positive relationship between the students' reading motivations and their reading comprehension self-efficacy perceptions.

The aim of this study is to examine the relationship between reading anxiety, digital reading motivation, Turkish lesson attitude and reading comprehension levels of fourth grade primary school students. The design of the research is relational research model. The study group consists of 123 students studying in the fourth grade of primary school. Digital reading motivation scale, reading anxiety scale, Turkish lesson attitude scale and reading comprehension tests were used as data collection tools. SPSS 26 program was used in the analysis of the data. According to the results of the research; there is a significant negative relationship between reading anxiety and reading comprehension and a significant positive relationship between Turkish lesson attitude and digital reading motivation. There is no significant relationship between Turkish lesson attitude and reading comprehension and between digital reading motivation and reading comprehension. Relational analyses can be expanded by studying the psychological factors that affect students' reading with different study groups. Thus, arrangements can be made to improve students' reading regardless of grade level.

The aim of this study was to examine the handwriting legibility and writing errors of first grade primary school students who were learning early literacy through distance education during the pandemic period, according to various variables. The research was designed according to the survey method, and the study group consisted of 211 students studying in the first grade of primary school. The "Multidimensional Legibility Scale", "Writing Errors Form", "Dictation Text" and "Copying Text" were used as data collection tools in the research. For the analysis of the research data, the legibility of the first grade primary school students' handwriting was analysed according to the "Multidimensional Legibility" scale. According to the results of the research, female students wrote more legibly than male students. Students made more writing errors in the dictation writing task than in the copying writing task. Students at state schools made more errors in their writing than students at private schools. Considering that the distance education process will also be a part of education life in later periods, research studies on the adequacy of the distance education process for fostering basic skills can be included in order to advance this process more beneficially, especially in primary school. The effect of distance education on handwriting legibility and writing errors at other grade levels can be investigated. Within the framework of the results obtained, different activities can be designed for writing skills in distance education.

This study deals with the effects of applying drama method in the teaching of environmental issues in science courses on the achievement, retention of learning, student interest and attitudes of primary school students and also whether these effects are dependent on teachers. The study was designed on the basis of the Solomon Four-Group Design. The study is a two group pre- and post-test experiment in two parts, each part having an experimental and control group. The courses were delivered to both groups by the researcher in the first part and drama teacher in the second. The experimental groups received 144 hours of teaching for six weeks, during which a drama course outline was employed, while in the control groups the courses followed the course outlines covered in the curricula. The data were collected using the Environmental Achievement Test, Interest Scale towards the Environment and Attitude Scale towards Science. The findings suggest that the teachers had some effects on the methods, but the significant differences in scores were due to the drama method, which was found to improve the achievement of the third-grade students and the interest towards environment and attitudes towards science of both third- and fourth-grade students.

Objective: This study was conducted to explore the effect of motor coordination on repetitive behaviors in children with Autism Spectrum Disorder (ASD) aged 5-15 years. Methods: The study employed the causal-comparative design, one of the correlational survey designs. The study was carried out with data obtained from parents of 241 children with ASD. The parents were administered the measurement tools of "Gilliam Autism Rating Scale-2-Turkish Version" to confirm the diagnosis of ASD, Demographic Information Form to obtain information about the child and the parent, "Repetitive Behavior Scale-Revised-Turkish Version" to evaluate the repetitive behaviors, and "Developmental Coordination Disorder Questionnaire-07-Turkish Version" to evaluate the motor coordination performance. The data were analyzed MANCOVA in the R package program. Results: The study results revealed that 72% of children with ASD had a risk of Developmental Coordination Disorder (DCD). The repetitive behaviors of children with and without DCD risk differed significantly. The severity and intensity of the repetitive behaviors of children with DCD risk were higher than those without DCD risk when age, gender, and comorbidity were taken under control. Conclusion: The motor coordination problems in children with ASD are effective on repetitive behaviors.

Author(s): Fabio Paglialonga [sup.1] , Rukshana Shroff [sup.2] , Ilona Zagozdzon [sup.3] , Sevcan A. Bakkaloglu [sup.4] , Ariane Zaloszyc [sup.5] , Augustina Jankauskiene [sup.6] , Alejandro Cruz Gual [sup.7] [...], Background Sodium (Na) balance is unexplored in dialyzed children. We assessed a simplified sodium balance (sNaB) and its correlates in pediatric patients receiving maintenance dialysis. Methods Patients < 18 years old on hemodialysis (HD) or peritoneal dialysis (PD) in six European Pediatric Dialysis Working Group centers were recruited. sNaB was calculated from enteral Na, obtained by a 3-day diet diary, Na intake from medications, and 24-h urinary Na (uNa). Primary outcomes were systolic blood pressure and diastolic blood pressure standard deviation scores (SBP and DBP SDS), obtained by 24-h ambulatory blood pressure monitoring or office BP according to age, and interdialytic weight gain (IDWG). Results Forty-one patients (31 HD), with a median age of 13.3 (IQR 5.2) years, were enrolled. Twelve patients (29.3%) received Na-containing drugs, accounting for 0.6 (0.7) mEq/kg/day. Median total Na intake was 1.5 (1.1) mEq/kg/day, corresponding to 60.6% of the maximum recommended daily intake for healthy children. Median uNa and sNaB were 0.6 (1.8) mEq/kg/day and 0.9 (1.7) mEq/kg/day, respectively. The strongest independent predictor of sNaB in the cohort was urine output. In patients receiving HD, sNaB correlated with IDWG, pre-HD DBP, and first-hour refill index, a volume index based on blood volume monitoring. sNaB was the strongest predictor of IDWG in multiple regression analysis ([beta] = 0.63; p = 0.005). Neither SBP SDS nor DBP SDS correlated with sNaB. Conclusions Na intake is higher than uNa in children on dialysis, and medications may be an important source of Na. sNaB is best predicted by urine output in the population, and it is a significant independent predictor of IDWG in children on HD. Graphical abstract

Author(s): Marjolein Bonthuis [sup.1] [sup.2] , Sevcan A. Bakkaloglu [sup.3] , Enrico Vidal [sup.4] , Sergey Baiko [sup.5] , Fiona Braddon [sup.6] , Carmela Errichiello [sup.7] , Telma Francisco [sup.8] [...], Background Associations between anthropometric measures and patient outcomes in children are inconsistent and mainly based on data at kidney replacement therapy (KRT) initiation. We studied associations of height and body mass index (BMI) with access to kidney transplantation, graft failure, and death during childhood KRT. Methods We included patients < 20 years starting KRT in 33 European countries from 1995-2019 with height and weight data recorded to the ESPN/ERA Registry. We defined short stature as height standard deviation scores (SDS) 1.88. Underweight, overweight and obesity were calculated using age and sex-specific BMI for height-age criteria. Associations with outcomes were assessed using multivariable Cox models with time-dependent covariates. Results We included 11,873 patients. Likelihood of transplantation was lower for short (aHR: 0.82, 95% CI: 0.78-0.86), tall (aHR: 0.65, 95% CI: 0.56-0.75), and underweight patients (aHR: 0.79, 95%CI: 0.71-0.87). Compared with normal height, patients with short and tall statures showed higher graft failure risk. All-cause mortality risk was higher in short (aHR: 2.30, 95% CI: 1.92-2.74), but not in tall stature. Underweight (aHR: 1.76, 95% CI: 1.38-2.23) and obese (aHR: 1.49, 95% CI: 1.11-1.99) patients showed higher all-cause mortality risk than normal weight subjects. Conclusions Short and tall stature and being underweight were associated with a lower likelihood of receiving a kidney allograft. Mortality risk was higher among pediatric KRT patients with a short stature or those being underweight or obese. Our results highlight the need for careful nutritional management and multidisciplinary approach for these patients. Graphical abstract

Metacognition is important for learners of all ages. Therefore, this situation raises all important questions about how to develop metacognitive skills and habits in the classroom regardless of primary, secondary and high school. The aim of this study is to investigate the metacognitive awareness of primary and secondary school students according to the variables of gender, grade level and region. The model of this research, which was conducted to determine the metacognitive awareness levels of the students in primary and secondary school, is a survey model. Metacognitive Awareness Scale was administered to 399 students (195 girls, 204 boys) in third, fourth and fifth grade. The research shows that the metacognitive awareness scores of primary and secondary school students do not differentiate in gender. According to another result obtained in the research; metacognitive awareness scores of pirmary and secondary school students differentiate in locality. The students' metacognitive awareness is higher than that of the urban local. When the metacognitive awareness scores were examined according to the grade level, it was seen that the metacognitive awareness scores of the fifth grade students were higher than the other groups. However, there is no significant difference between the metacognitive awareness scores of the third and fourth grade students. Similar studies aiming to examine the development of metacognitive awareness of students are thought to be useful in planning the education process in this direction.

Author(s): Justine Bacchetta [sup.1] [sup.2] [sup.3] , Claus Peter Schmitt [sup.4] , Sevcan A. Bakkaloglu [sup.5] , Shelley Cleghorn [sup.6] , Maren Leifheit-Nestler [sup.7] , Agnieszka Prytula [sup.8] , Bruno [...], Background Infants with chronic kidney disease (CKD) form a vulnerable population who are highly prone to mineral and bone disorders (MBD) including biochemical abnormalities, growth retardation, bone deformities, and fractures. We present a position paper on the diagnosis and management of CKD-MBD in infants based on available evidence and the opinion of experts from the European Society for Paediatric Nephrology (ESPN) CKD-MBD and Dialysis working groups and the Pediatric Renal Nutrition Taskforce. Methods PICO (Patient, Intervention, Comparator, Outcomes) questions were generated, and relevant literature searches performed covering a population of infants below 2 years of age with CKD stages 2-5 or on dialysis. Clinical practice points (CPPs) were developed and leveled using the American Academy of Pediatrics grading matrix. A Delphi consensus approach was followed. Results We present 34 CPPs for diagnosis and management of CKD-MBD in infants, including dietary control of calcium and phosphate, and medications to prevent and treat CKD-MBD (native and active vitamin D, calcium supplementation, phosphate binders). Conclusion As there are few high-quality studies in this field, the strength of most statements is weak to moderate, and may need to be adapted to individual patient needs by the treating physician. Research recommendations to study key outcome measures in this unique population are suggested. Graphical Abstract

Author(s): Bahar Büyükkaragöz [sup.1] , Sevcan A. Bakkaloglu [sup.1] Author Affiliations: (1) grid.25769.3f, 0000 0001 2169 7132, Department of Pediatric Nephrology, Gazi University, , 06560, Besevler, Ankara, Turkey Introduction Maintenance [...], Serum osmolality is the sum of the osmolalities of every single dissolved particle in the blood such as sodium and associated anions, potassium, glucose, and urea. Under normal conditions, serum sodium concentration is the major determinant of serum osmolality. Effective blood osmolality, so-called blood tonicity, is created by the endogenous (e.g., sodium and glucose) and exogenous (e.g., mannitol) solutes that are capable of creating an osmotic gradient across the membranes. In case of change in effective blood osmolality, water shifts from the compartment with low osmolality into the compartment with high osmolarity in order to restore serum osmolality. The difference between measured osmolality and calculated osmolarity forms the osmolal gap. An increase in serum osmolal gap can stem from the presence of solutes that are not included in the osmolarity calculation, such as hypertonic treatments or toxic alcoholic ingestions. In clinical practice, determination of serum osmolality and osmolal gap is important in the diagnosis of disorders related to sodium, glucose and water balance, kidney diseases, and small molecule poisonings. As blood hypertonicity exerts its main effects on the brain cells, neurologic symptoms varying from mild neurologic signs and symptoms to life-threatening outcomes such as convulsions or even death may occur. Therefore, hypertonic states should be promptly diagnosed and cautiously managed. In this review, the causes and treatment strategies of hyperosmolar conditions including hypernatremia, diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, hypertonic treatments, or intoxications are discussed in detail to increase awareness of this important topic with significant clinical consequences.

Author(s): Bahriye Uzun Kenan [sup.1] , Beltinge Demircioglu Kilic [sup.2] , Mehtap Akbalik Kara [sup.3] , Aysel Taktak [sup.4] , Aysun Karabay Bayazit [sup.5] , Zeynep Nagehan Yuruk Yildirim [sup.6] [...], Background Automated peritoneal dialysis (APD) is increasingly preferred worldwide. By using a software application (Homechoice with Claria sharesource system (CSS)) with a mod-M added to the APD device, details of the home dialysis treatment become visible for PD nurses and physicians, allowing for close supervision. We aimed to evaluate the perceptions of patients/caregivers, PD nurses, and physicians about the advantages and disadvantages of CSS. Methods Three different web-based questionnaires for patients/caregivers, nurses, and physicians were sent to 15 pediatric nephrology centers with more than 1 year of experience with CSS. Results Respective questionnaires were answered by 30 patients/caregivers, 22 pediatric nephrologists, and 15 PD nurses. Most of the nurses and physicians (87% and 73%) reported that CSS improved patient monitoring. A total of 73% of nurses suggested that CCS is not well known by physicians, while half of them reported reviewing CSS data for all patients every morning. Sixty-eight percent of physicians thought that CSS helps save time for both patients/caregivers and healthcare providers by reducing visits. However, only 20% of patients/caregivers reported reduced hospital visits. A total of 90% of patients/caregivers reported that being under constant monitoring made them feel safe, and 83% stated that the patient&apos;s sleep quality improved. Conclusions A remote monitoring APD system, CSS, can be successfully applied with children for increased adherence to dialysis prescription by giving shared responsibility and may help increase the patient&apos;s quality of life. This platform is more commonly used by nurses than physicians. Its potential benefits should be evaluated in further well-designed clinical studies with larger patient groups. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

Imitation has an important place in the observational learning process. Children with autism spectrum disorder (ASD) may experience limitations in imitation ability. These limitations are associated with deficits in abilities associated with ASD including understanding intention. In this study, the imitation skills and intention understanding levels of children with ASD and typically developing (TD) children were compared. Relationships between imitation, intention understanding levels and symptom severity in children with ASD, and the predictive status of these variables on symptom severity were examined. Findings showed that children with ASD experienced limitations in spontaneous imitation and in different areas of understanding intention, compared to their TD peers. There were significant relationships between imitation, intention understanding levels and symptom severity; the level of spontaneous imitation and intention understanding predicted symptom severity.

Author(s): Burcu Yazicioglu [sup.1] , Sevcan A. Bakkaloglu [sup.1] , M. Abranches, S. Akman, H. Alpay, G. Ariceta, B. Atmis, A. Bael, S. A. Bakkaloglu, U. S. Bayrakçi, R. Bhimma, [...], Background Coronavirus disease-2019 (COVID-19) has been challenging for patients and medical staff. Radical changes have been needed to prevent disruptions in patient care and medical education. Methods A web-based survey was sent to European Society for Pediatric Nephrology (ESPN) members via the ESPN mailing list to evaluate the effects of the COVID-19 pandemic on delivery of pediatric nephrology (PN) care and educational activities. There were ten questions with subheadings. Results Seventy-six centers from 24 countries completed the survey. The time period was between the beginning of the pandemic and May 30, 2020. The number of patients admitted in PN wards and outpatient clinics were significantly decreased (2.2 and 4.5 times, respectively). Telemedicine tools, electronic prescriptions, online applications for off-label drugs, and remote access to laboratory/imaging results were used in almost half of the centers. Despite staff training and protective measures, 33% of centers reported COVID-19 infected staff, and 29% infected patients. Difficulties in receiving pharmaceuticals were reported in 25% of centers. Sixty percent of centers suspended living-related kidney transplantation, and one-third deceased-donor kidney transplantation. Hands-on education was suspended in 91% of medical schools, and face-to-face teaching was replaced by online systems in 85%. Multidisciplinary training in PN was affected in 54% of the centers. Conclusions This survey showed a sharp decline in patient admissions and a significant decrease in kidney transplantation. Telemedicine and online teaching became essential tools, requiring integration into the current system. The prolonged and fluctuating course of the pandemic may pose additional challenges necessitating urgent and rational solutions. Graphical abstract