Satisfacción con la atención en urgencias pediátricas: influencia del funcionamiento familiar y la alteración emocional / Satisfaction with care received in pediatric emergency services: impact of family interaction and emotional disturbance

Resumen Este estudio aborda la relación entre dos elementos clave en la satisfacción con los servicios sanitarios de urgencias pediátricas: la afectación emocional y el funcionamiento familiar. El objetivo general es determinar si la cohesión, la adaptabilidad familiar y la ira pueden asociarse a niveles diferenciales de satisfacción en progenitores cuyos hijos eran atendidos en urgencias pediátricas. Se trata de un estudio descriptivo transversal para el que se trabajó con una muestra de 711 progenitores que habían sido atendidos en 6 servicios de urgencias pediátricas. Se utilizaron respectivamente las versiones españolas del Inventado de Expresión de Ira Estado-Rasgo-2 (STAXI-2), la Escala de Satisfacción con los Servicios Sanitarios y la Escala de Evaluación de la Cohesión y Adaptabilidad Familiar (Faces). El análisis de datos incluyó un análisis de correlaciones bivariadas de Spearman, pruebas de Kruskal Wallis, pruebas de Mann-Whitney y un path-analysis mediante un modelo de ecuaciones estructurales. Los resultados soportan la idea de que mayores niveles de cohesión y adaptabilidad familiar así como menores niveles de ira, se asocian a mayores niveles de satisfacción en los padres. Nuestros datos no reflejan diferencias significativas en ira entre padres y madres.

Abstract This study addresses the relationship between two key elements in satisfaction with pediatric emergency services, namely emotional disturbance and family interaction. The main goal is to determine whether family cohesion and adaptability and anger may be associated with differential levels of satisfaction among parents whose children were attended in pediatric emergency units. It is a descriptive study for which a sample of 711 parents whose children were attended in 6 pediatric emergency services was studied. The Spanish version of the State-Trait Anger Expression Inventory-2 (Staxi-2), the Satisfaction with Healthcare Services Scale and the Family Adaptability and Cohesion Evaluation Scale (Faces) were used respectively. Data analysis included a Spearman bivariate correlations analysis, Kruskal Wallis, Mann-Whitney test and path-analysis using a structural equations model. The results support the hypothesis that higher levels of family cohesion and adaptability as well as lower levels of anger are associated with higher levels of satisfaction among parents.

Alteración emocional en atención primaria y urgencias pediátricas. ¿Se enfadan los padres durante la atención pediátrica? / Emotional alteration in Primary Health Care and paediatric emergencies. Do parents get angry during paediatric care?

En el presente trabajo nos proponemos estudiar la presencia de ansiedad e ira en atención pediátrica, explorando posibles diferencias entre atención primaria y urgencias pediátricas. Es objetivo adicional determinar cuáles de las variables estudiadas predicen en mayor grado ansiedad en la muestra de progenitores estudiados. En este estudio participaron un total de 1517 progenitores cuyos hijos habían sido atendidos en servicios de pediatría. El método se basa en un estudio descriptivo transversal mediante encuesta, donde los participantes contestaron el Inventario de Expresión de Ira Estado-Rasgo (STAXI-2) y el Inventario de Ansiedad Estado-Rasgo de Spielberger (STAI). Nuestros resultados indican una asociación significativa entre ansiedad y las diferentes dimensiones de ira consideradas, y también con el nivel de gravedad percibido por los padres en el estado de salud del menor. De las dimensiones de ira consideradas, la expresión como sentimiento es la que más predice la presencia de ansiedad en los padres. Las alteraciones emocionales en contextos de atención sanitaria pediátrica deben ser prevenidas, detectadas cuando ocurren y atendidas de manera eficaz para evitar consecuencias negativas de diverso tipo.

A study was conducted in order to determine the presence of anxiety and anger in paediatric health care, exploring possible differences between primary health care and paediatric emergencies. The study also sought to determine which of the variables studied better predict anxiety in the sample of parents studied. A total of 1.517 parents whose children had been attended in paediatric department participated in this study. The method was based on a cross-sectional descriptive study using a questionnaire, where all the participants answered the State-Trait Anger Expression Inventory and the Spielberger State-Trait Anxiety Inventory. The results indicate a significant association between anxiety and both the considered dimensions of anger and the level of severity perceived by parents in the child's health status. From the anger dimensions considered, anger as a feeling is the most predictive expression of parental anxiety. Emotional alterations in paediatric health care settings should be prevented, detected when they occur, and effectively treated to avoid different negative consequences.

Ansiedad durante pruebas de evaluación académica: influencia de la cantidad de sueño y la agresividad / Influence of sleep quantity and aggressiveness on anxiety during academics evaluation tests

The situation of academic evaluation has often been studied in relation to emotional alterations such as anxiety, stress or even fear. Possibly, aggressiveness may be another variable present in these situations. Aggressiveness seems to be present in different teaching activities as well as in all levels of the educational context, showing even more clearly in students with academic difficulties and especially when exposed to stressful situations. Various classical investigations have indicated for some time now that physical and verbal aggressiveness is more frequent in men than in women, and also more intense. The execution of academic tests is perceived as an aversive situation and often even as a threat, which may explain why they would be the cause of anxiety or stress. In fact, an intense emotional alteration could be present in nearly 25% of the students during the examination procedure; furthermore, exams are the most frequent evaluation method used in all educational levels. According to some studies, women seem to show higher levels of resources for coping with stressful situations, which would also be applied to circumstances of academic evaluation. Nevertheless, again in relation to gender differences, higher levels of anxiety have been found in women in comparison to men among university students before exams are carried out. In this situation the presence of aggressiveness does not seem to be clear. Although in the psychological environment there is no doubt of the negative effect which sleep deprivation has on different types of performance, we have observed with some frequency that university students tend to reduce sleep time days before an exam. The studies centred in the population of university students' quality of sleep have found that it quite often drops during this period. Thus, for example, in normal circumstances (not during exam periods), poor sleep quality can be found in approximately 30% of the university students. With this, we may suppose that the quality and the quantity could be even worse in exam periods. The quality of sleep has been studied frequently and also in relation to difficulties and psychological alterations. In the case of test anxiety, the correlation with the reduction of the quantity of sleep the previous night seems to be positive. Although multiple investigations have centred on the disrupting role that anxiety plays on the performance of exams, not many have focused on the relation between test-anxiety and aggressiveness in that situation, and even less so in circumstances of reduction of sleep hours. In the present work, we intend to determine first the possible presence of aggressiveness during the execution of exams in a sample of university students. At the same time, it was of our interest to establish a possible relation between sleep hours and the level of aggressiveness in that situation, keeping in mind that many students reduce sleep hours during this time, and specially the night before an exam. A second objective is to determine if different levels of aggressiveness may be related to different levels of test-anxiety. Thirdly, we try to seek differences between men and women's levels of aggressiveness while test circumstances, differences in aggressiveness in function of different age levels, as well as in function of different amount of time dedicated to sleep. In this study, 143 students aged 19-48 participated. The average age was 21.67, with a 3.79 standard deviation. Forty-two of the participants were men, 98 women and three of them did not consign their gender. All of them participated in the study just before beginning the execution of a final test in diverse subjects when they were already seated in the classroom. Aggressiveness was assessed with the reduced Spanish version of the Aggression Questionnaire (AQ). For the anxiety assessment, the Spanish version of the Spiel berger State-Trait Anxiety Inventory (STAI) was used, applying only the state scale. Additionally, participants were asked to note the hours of sleep they had had the previous night. The collection of data was carried out during a final exam, which assigned the final qualification in that subject. Several studies have shown the poor sleep quality in university students, being this significant characteristic a variable with possible and important implications in their quality of life, health, or even in their performance. Our data show that the average number of hours of sleep on the previous night to an exam was 6.43 (S.D. = 1.55), which indicates that the tendency to reduce the hours of sleep in this situation is a frequent habit among the university students being analyzed. Our descriptive results indicated that the levels of aggressiveness are not too high, although a certain degree does exist before the evaluation tests. The correlation analysis carried out indicates that having less hours of sleep the previous night is not associated with a higher level of aggressiveness [r = -.066 (p = .437)]. Nevertheless, when the sample was divided into two groups in function of the aggressiveness level, we found significative differences in the hours of sleep the previous night. The amount of sleep was higher in subjects with less aggressiveness. This result agreed with other studies that have found a relation between sleep deprivation and emotional alterations, specifically anxiety, or other psychological alterations. According to our data, the quantity of sleep had the previous night is related to the latter aggressiveness, and possibly with other aspects of this situation, like sensation of threat or anger. On the other hand, our data has shown significant differences in test-anxiety when we compared subjects with low and high levels of aggressiveness. The result indicates that subjects with high levels of aggressiveness showed higher levels of test-anxiety. This result agrees with those studies that have found an association between some varieties of emotional alterations, for example, social anxiety and aggressiveness and even one acceptable mediator role of social anxiety on social aggression. It has surprised us not to find significant differences between men and women's levels of aggressiveness, keeping in mind that this result goes against most studies that have verified these types of differences. Perhaps this result shows that in a specific threatening and aversive situation, such as an exam, women are able to show levels of latent aggressiveness as high those of as men. Furthermore, in the same way, this situation could create higher levels of aggressiveness in women students than many other daily situations could. Nevertheless, this conclusion is no more than a preliminary one and needs to be further investigated in the future. No significant differences were found between younger and older students' levels of aggressiveness. Although this result matches those obtained by other authors, in our case the reason for this might be the reduced number of age groups within the subjects. We interpret our results in the sense that sleeping less hours before an exam would perhaps be able to imply a worse performance in the test, even the possible presence of emotional alterations such as stress or anxiety, but would not imply significant differences in aggressiveness. The situation of examination in a university context, in function of our results, seems to be a quite specific context. Our study shows different results in contrast with the data on the effects sleep deprivation has on the psychological operation, as well as the patterns of latent aggressiveness found in other populations. The results of this line of investigation have practical implications on the teaching-learning processes, specifically in relation to evaluation as a fundamental element of them, as well as of the role that some psychological variables would perform in these procedures.

La agresividad parece estar presente en diversas actividades docentes así como en todos los grados y niveles del contexto educativo. Igualmente, diversas investigaciones clásicas han señalado desde hace tiempo la agresividad física y verbal como más intensa y frecuente en hombres que en mujeres. Por otra parte, con cierta frecuencia observamos que los estudiantes universitarios suelen reducir el tiempo que dedican al sueño en fechas previas a un examen. Los estudios centrados en el sueño de la población de estudiantes universitarios han encontrado con cierta frecuencia una relativa baja calidad del mismo. La realización de pruebas académicas suele ser percibida como una situación aversiva y frecuentemente incluso como amenazante, por lo que podría ser generadora de alteraciones emocionales como por ejemplo ansiedad o estrés. En el caso de la ansiedad a los exámenes, la correlación con la reducción en la cantidad de sueño la noche anterior parece ser positiva. En el presente trabajo se pretende determinar, en primer lugar, la posible presencia de agresividad durante la realización de exámenes en una muestra de estudiantes universitarios. Paralelamente es de interés establecer una posible relación entre horas de sueño la noche anterior y agresividad. Un segundo objetivo se centra en determinar si diferentes niveles de agresividad pueden relacionarse con ansiedad a los exámenes. En tercer lugar intentamos determinar si variables como el género, la edad, la ansiedad y la duración del sueño, pueden predecir diferencias en agresividad en nuestra muestra. Participaron 143 estudiantes con edades comprendidas entre 19-48 años. La media de edad fue de 21.67 años con una desviación estandar de 3.79. Cuarenta y dos de los participantes eran hombres, 98 mujeres, y tres de ellos no indicaron su género. La agresividad se evaluó con la versión española reducida del Aggression Questionnaire (AQ). Para la valoración de la ansiedad se utilizó la versión española del cuestionario de Ansiedad Estado-Rasgo de Spielberger (STAI), aplicándose únicamente la escala de evaluación de la ansiedad-estado. Adicionalmente se les pidió a los participantes que anotaran las horas de sueño que habían dormido la noche anterior al examen. Los datos se obtuvieron durante un examen final, donde estaba en juego la calificación definitiva de esa asignatura. Los datos muestran la tendencia a reducir las horas de sueño en los estudiantes universitarios estudiados, encontrándose un cierto grado de agresividad latente ante la realización de pruebas de evaluación. El análisis de correlación llevado a cabo indica que a mayores niveles de agresividad parece asociarse menor cantidad de sueño la noche anterior al examen, aunque esta relación no resultó significativa. Sin embargo, cuando dividimos a la muestra en grupos según el nivel de agresividad, sí se observan diferencias significativas en la cantidad de sueño la noche anterior al examen, siendo ésta menor en los sujetos más agresivos. Este resultado concuerda con aquellos otros estudios que sí han encontrado una relación entre pocas horas de sueño y alteraciones emocionales, específicamente ansiedad u otras alteraciones psicológicas. Se han encontrado diferencias significativas en ansiedad a los exámenes cuando comparábamos a sujetos con niveles bajos y altos de agresividad. La prueba de diferencia de medias confirma que los estudiantes más agresivos manifiestan mayores niveles de ansiedad a los exámenes en comparación con los estudiantes menos agresivos. Ha resultado sorprendente no encontrar diferencias significativas entre hombres y mujeres en los niveles de agresividad, teniendo en cuenta que este resultado va en contra de la mayor parte de estudios revisados. Quizá este resultado pueda deberse a que en una situación de amenaza tan específica como es un examen, las mujeres podrían mostrar niveles de agresividad latente tan elevados como los hombres. Este punto merece mayor investigación y atención futura. La asociación entre agresividad y baja duración del sueño se corresponde con un escenario bastante específico que se acerca en cierto sentido a los datos encontrados en otras poblaciones en cuanto a las repercusiones de la duración del sueño sobre el funcionamiento psicológico, así como en cuanto a los patrones de agresividad latente.

Opinión Profesional sobre la Hospitalización Infantil de Inmigrantes de Origen Latinoamericano en Andalucía, España / Professional opinion about hospitalising Latin-American immigrant children in Andalucía, Spain

Objetivo En los últimos años se ha evidenciado un incremento de la atención hospitalaria pediátrica a pacientes inmigrantes de origen latinoamericano en España. El objetivo de este trabajo es conocer la opinión de diversos profesionales sobre las necesidades específicas y diferenciales de esta población durante dicho proceso. Métodos La investigación se desarrolló a través de un estudio cualitativo de tipo fenomenológico, basado en entrevistas semiestructuradas a informantes clave en Andalucía (España). Los sujetos del estudio son profesionales de servicios de pediatría de centros hospitalarios andaluces. Resultados Entre los más relevantes destacan, como aspectos positivos, que la población inmigrante latinoamericana es la que menores dificultades de funcionamiento hospitalario presenta, en comparación con otros grupos de inmigrantes. Conclusiones Entre los aspectos psicológicos que más inciden durante la hospitalización, estarían las alteraciones emocionales, tales como la presencia de ansiedad y estrés o aspectos como la desconfianza durante el mismo.

Objective There has been an increase in paediatric hospital attention being provided for Latin-American immigrant patients in Spain during the recent years. This work was aimed at ascertaining professionals' opinion regarding this population's specific and differential needs concerning Latin-American immigrant children being hospitalised. Methods The study consisted of a qualitative, phenomenological type of investigation, based on semi-structured interviews of key informers in Andalusia (Spain). The subjects of the study were professionals from paediatric services in hospital centres in Andalusia. Results One of the most prominent (positive) results revealed that the Latin-American immigrant population presented less difficulties regarding hospital functioning when compared to other immigrant groups. Conclusions The psychological aspects which had most impact on paediatric hospitalisation would be emotional alterations, such as the presence of anxiety and stress, or other aspects, like a lack of trust when being hospitalised.