Workplace violence in hospital emergency departments and consequences for health care professionals and support staff: a cluster analysis. / Violencia laboral de usuarios y sus consecuencias sobre profesionales sanitarios y no sanitarios de los servicios de urgencias hospitalarios: análisis de clúster.

OBJECTIVES: Workplace violence of any type is influenced by multiple factors and leads to physiological, psychological, social, and organizational change. Emergency and other urgent care settings have assault rates up to 5-fold higher than other health care settings. This study aimed to analyze the consequences of physical and nonphysical violence on health care and support personnel in hospital emergency departments. MATERIAL AND METHODS: Cross-sectional descriptive analysis of responses to a 121-item survey of 584 health care and support workers in 12 Spanish hospital emergency departments. We analyzed the magnitude of the problem with a two-step self-clustering method and then assessed the associations between variables and workplace violence. RESULTS: Two groups were identified. The first consisted of 298 cases with high mean (SD) scores for nonphysical assaults (51.5 [7.9]) and low scores for physical violence (4.8 [2.9]). The second group consisted of 285 cases with intermediate scores for nonphysical assaults (27.1 [8.4]) and low scores for physical violence (3.4 [1.3]). CONCLUSION: Emergency departments have incidents of nonphysical workplace violence more often than physical violence. Emergency personnel with high exposure to workplace violence, particularly nonphysical assaults, experience physiological, psychosocial, and organizational changes.

OBJETIVO: La violencia laboral en cualquiera de sus modalidades se halla influenciada por múltiples factores, dando lugar a cambios fisiológicos, psicológicos, sociales y organizacionales, y los entornos de urgencias y emergencias presentan una incidencia de hasta cinco veces más con respecto al resto de servicios sanitarios. El objetivo de este estudio es analizar las características que desarrollan los profesionales sanitarios y no sanitarios de los servicios de urgencias hospitalarios (SUH) que sufren violencia laboral física y no física. METODO: Es un diseño trasversal, descriptivo-analítico mediante la aplicación de un formulario de 121 ítems a una muestra de 584 profesionales sanitarios y no sanitarios de 12 hospitales españoles con SUHS, se aplicó análisis estadístico para magnitud del evento y análisis de clúster mediante método stepwise con solución de autoclustering y posterior relación de variables del estudio con violencia laboral. RESULTADOS: Tras la aplicación inicial del método descrito, se conformaron 2 grupos, el primero de ellos incluye a 298 casos y se caracteriza por puntuaciones altas en violencia no física (media: 51,5, desviación estándar: 7,9) y bajas en física (4,8, 2,9). Por otro lado, el segundo grupo está compuesto por 285 casos y se caracteriza por puntuaciones intermedias en violencia no física (27,1, 8,4) y bajas en física (3,4, 1,3). CONCLUSIONES: En los SUH existen manifestaciones de violencia laboral no física que presentan una mayor incidencia que las manifestaciones de violencia física. Aquellos profesionales con elevada exposición a violencia laboral, y en concreto a violencia no física, presentan alteraciones biopsicosociales y organizacionales.

Violencia laboral de usuarios y sus consecuencias sobre profesionales sanitarios y no sanitarios de los servicios de urgencias hospitalarios: análisis de clúster / Workplace violence in hospital emergency departments and consequences for health care professionals and support staff: a cluster analysis

Introducción: La violencia laboral en cualquiera de sus modalidades se halla influenciada por múltiples factores, dando lugar a cambios fisiológicos, psicológicos, sociales y organizacionales, y los entornos de urgencias y emergencias presentan una incidencia de hasta cinco veces más con respecto al resto de servicios sanitarios. El objetivo de este estudio es analizar las características que desarrollan los profesionales sanitarios y no sanitarios de los servicios de urgencias hospitalarios (SUH) que sufren violencia laboral física y no física. Método: Es un diseño trasversal, descriptivo-analítico mediante la aplicación de un formulario de 121 ítems a una muestra de 584 profesionales sanitarios y no sanitarios de 12 hospitales españoles con SUHS, se aplicó análisis estadístico para magnitud del evento y análisis de clúster mediante método stepwise con solución de autoclustering y posterior relación de variables del estudio con violencia laboral. Resultados: Tras la aplicación inicial del método descrito, se conformaron 2 grupos, el primero de ellos incluye a 298 casos y se caracteriza por puntuaciones altas en violencia no física (media: 51,5, desviación estándar: 7,9) y bajas en física (4,8, 2,9). Por otro lado, el segundo grupo está compuesto por 285 casos y se caracteriza por puntuaciones intermedias en violencia no física (27,1, 8,4) y bajas en física (3,4, 1,3). Conclusiones: En los SUH existen manifestaciones de violencia laboral no física que presentan una mayor incidencia que las manifestaciones de violencia física. Aquellos profesionales con elevada exposición a violencia laboral, y en concreto a violencia no física, presentan alteraciones biopsicosociales y organizacionales. (AU)

Background and objective: Workplace violence of any type is influenced by multiple factors and leads to physiological, psychological, social, and organizational change. Emergency and other urgent care settings have assault rates up to 5-fold higher than other health care settings. This study aimed to analyze the consequences of physical and nonphysical violence on health care and support personnel in hospital emergency departments. Methods: Cross-sectional descriptive analysis of responses to a 121-item survey of 584 health care and support workers in 12 Spanish hospital emergency departments. We analyzed the magnitude of the problem with a two-step self-clustering method and then assessed the associations between variables and workplace violence. Results: Two groups were identified. The first consisted of 298 cases with high mean (SD) scores for nonphysical assaults (51.5 [7.9]) and low scores for physical violence (4.8 [2.9]). The second group consisted of 285 cases with intermediate scores for nonphysical assaults (27.1 [8.4]) and low scores for physical violence (3.4 [1.3]). Conclusions: Emergency departments have incidents of nonphysical workplace violence more often than physical violence. Emergency personnel with high exposure to workplace violence, particularly nonphysical assaults, experience physiological, psychosocial, and organizational changes. (AU)

Self-report Measures for Symptom Validity Assessment in Whiplash-associated Disorders

Background/Objective: Whiplash-Associated Disorders (WAD) are one of the most complex conditions to evaluate because several of its symptoms are not observable with current diagnostic methods and cannot be quantified or evaluated correctly. No method is currently available to assess the risk of malingering in the aforementioned condition efficiently. Our aim is to study the capacity of several biopsychosocial psychometric self-report instruments, such as the Brief Pain Inventory (BPI), the Cervical Disability Index (NDI), the SF-36 Health Questionnaire, the Beck Anxiety and Depression Inventories (BDI-II and BAI), or the Brief Illness Perception Questionnaire (BIPQ), to discriminate between patients diagnosed with WAD following a vehicle accident and non-clinical participants with malingering instructions. Method: A simulation design was used with 630 participants: 200 non-clinical controls with honest responding condition, 201 instructed malingerers, and 229 WAD clinical outpatients. Results: Our results showed an AUC range of .60 to .90, with the highest value being that of the BPI (.90), followed by the NDI (.88), and the lowest value that of the BIPQ (.60), followed by the BAI (.71). Conclusions: Overall, the BPI, the NDI, and SF-36 can correctly discriminate between groups with a good specificity (> 90%), while the BAI, BDI, and BIPQ showed a lower capacity, with a high rate of false positives in the case of the BDI and of false negatives in the other two. Practical and research implications are discussed. (AU)

Antecedentes/Objetivo: El Síndrome del Latigazo Cervical (WAD) es una de las condiciones más complejas de evaluar debido a que varios de los síntomas que presenta no son objetivables con los métodos diagnósticos actuales y no puede cuantificarse ni evaluarse correctamente. En la actualidad no se dispone de ningún método eficiente para valorar el riesgo de simulación en la citada condición. Nuestro objetivo es estudiar la capacidad de varios instrumentos psicométricos biopsicosociales de autoinforme, como el Inventario Breve de Dolor (BPI), el Índice de Discapacidad Cervical (NDI), el Cuestionario de Salud SF-36, los Inventarios de Ansiedad y Depresión de Beck (BDI-II y BAI) o el Cuestionario Breve de Percepción de la Enfermedad (BIPQ) para discriminar entre pacientes diagnosticados con WAD tras un accidente de circulación y participantes no-clínicos con instrucciones de simulación. Método: Se utilizó un diseño de simulación con 630 participantes: 200 controles no clínicos con condición de respuesta honesta, 201 simuladores instruidos y 229 pacientes clínicos con WAD. Resultados: Nuestros resultados mostraron un rango de AUC de .60 a .90, siendo el valor más alto el del BPI (.90), seguido del NDI (.88), y el valor más bajo el del BIPQ (.60), seguido del BAI (.71). Conclusiones: En general, el BPI, el NDI y el SF-36 pueden discriminar correctamente entre grupos con una buena especificidad (> 90%), mientras que el BAI, el BDI y el BIPQ mostraron una menor capacidad, con una alta tasa de falsos positivos en el caso del BDI y falsos negativos en los otros dos. Se discuten además las implicaciones prácticas y de investigación. (AU)

Profiles of lateral violence in nursing personnel of the Spanish public health system.

BACKGROUND: Workplace violence in healthcare settings has long been studied in scientific literature, particularly in the nursing profession. Research has explored mostly user violence probably for its high prevalence and impact on health and job satisfaction. Yet this focus may overshadow another dangerous type of workplace violence: coworker violence. Exerted by co-workers with similar status, lateral violence differs from that yielded by a co-worker with a higher rank, known as vertical. This study aims to deepen the knowledge about lateral violence perceived by nurses and its interaction with other variables commonly associated with workplace violence in healthcare: burnout, job satisfaction, and self-perceived health. METHOD: A random block sampling was performed, prompting a total sample of 925 nursing professionals from 13 public hospitals located in the southeast of Spain. The sample distribution (mean and standard deviation) and the response percentages according to the study variables of the ad-hoc questionnaire were analyzed and classified with cluster analysis. RESULTS: Through the cluster analysis, two subgroups were obtained: Cluster 1, composed of 779 participants, with low scores in the variables used for the classification, high levels of both extrinsic and intrinsic satisfaction, low levels of emotional exhaustion and cynicism, and low rates of somatization, anxiety, social dysfunction and depression; and Cluster 2, composed of 115 participants and characterized by moderate-high scores in the variables used for the classification, moderate extrinsic satisfaction, and low intrinsic satisfaction, high emotional exhaustion and cynicism and lower somatization, anxiety, social dysfunction, and depression scores. Excluded cases amounted to 31. CONCLUSION: Nursing professionals who experience lateral violence reveal a lower intrinsic satisfaction, feeling less self-accomplished in their job, and less positive work experience. Emotional exhaustion rises as a concerning progressive and long-term outcome of experiencing this type of violence.

Attitudes Towards School Violence: A Qualitative Study With Spanish Children.

School violence is a social issue of particular interest both for intervention and research. Attitudes towards violence have been reported in the literature as relevant variables for evaluation, prevention, and intervention in this field. This study aims to examine in-depth attitudes toward school violence. The sample consists of 96 participants from Spanish Elementary Education and Compulsory Secondary Education schools. A qualitative study was conducted through focus groups and thematic analysis of the data. The results identify a habitual set of attitudes towards violence in children. These are related to violence as a way to feel better or increase self-esteem, as leisure or fun, perceived as legitimate, when violence is exercised against those who are different, when it has no consequences, to resolve conflicts, to socialize, and to attract the attention of peers. These results could serve as a basis for the creation of evaluation tools, as well as the design of prevention and intervention plans based on attitude modification.

User violence in public mental health services. Comparative analysis of psychiatrists and clinical psychologists.

BACKGROUND: User violence toward health workers is a growing problem. Several studies report that it is increasing and there is also an increase in the number of complaints by these professionals. Within the health system, Mental Health services have been identified as a collective at special risk. AIMS: This study aims to examine in greater depth the differences in perceived user violence against health professionals, as well as its consequences, comparing two large groups: psychiatrists and clinical psychologists. METHODS: Using a cross-sectional design, self-reported questionnaires were applied to a sample of 138 professionals from all the public centers in the Region of Murcia (southwest of Spain) that have a Mental Health Unit. RESULTS: The results show that psychiatrists are significantly more exposed to user violence, both verbal and physical, revealing a relationship with job dissatisfaction, emotional exhaustion, professional effectiveness, and cynicism. CONCLUSIONS: The present study provides evidence on the differences in the perception of violence of users towards psychologists and psychiatrists, being those who show that they claim to be more exposed. Furthermore, this violence is associated with burnout, job dissatisfaction, somatic symptoms, anxiety, or depression, among other consequences.

[Violence of users towards health and non-health professionals in Hospital Emergency Services: descriptive-comparative cross-sectional study.] / Violencia de usuarios hacia profesionales sanitarios y no sanitarios en Servicios de Urgencias Hospitalarias. Estudio transversal descriptivo-comparativo.

OBJECTIVE: Workplace violence is a public health problem that affects professionals in the hospital emergency services, being this environment where there is an intense interaction with users and / or relatives who require critical and / or special care. Given this, the aim of this study was to evaluate the exposure to user violence perceived by different health and non-health professionals in Emergency Services belonging to eleven Spanish hospitals. METHODS: The design was an associative, descriptive-comparative cross-sectional strategy developed in 2019 with a sample of 584 healthcare and non-healthcare professionals from eleven Spanish hospital emergency services in eight Spanish autonomous communities. Non-parametric statistics were used for between-group comparisons, post-hoc analysis and the calculation of the effect size. RESULTS: 100% of respondents acknowledged having suffered workplace violence at least once in the last year. Specifically, at least eight out of every ten professionals were exposed to non-physical violence (range 85.1%-100%). The group that most perceived this violence was administration, followed by nursing, medicine and auxiliary nursing care technician (T.C.A.E) (H=28.881; p=0.001). While the manifestations of physical violence affected approximately three out of ten professionals (range 22.6%-29.5%), it is more present in the Auxiliary Nursing Care Technicians (T.C.A.E), followed by medical and nursing health professionals, as well as non-health professionals, orderlies and administration (H=9.800; p=0.05). CONCLUSIONS: Our study shows the high prevalence of a medium or low intensity violent behavior in spanish Emergency Services. In addition, it allows to deepen in the different manifestations of violence received by the main professional groups of these services.

OBJETIVO: La violencia laboral es un problema de Salud Pública que afecta a profesionales de los Servicios de Urgencias Hospitalarias, siendo este entorno donde existe una intensa interacción con los pacientes usuarios y/o familiares que precisan cuidados críticos y/o especiales. Con ello, el objetivo de este trabajo fue evaluar la exposición a la violencia de los usuarios percibida por los distintos profesionales sanitarios y no sanitarios de los Servicios de Urgencias pertenecientes a once hospitales españoles. METODOS: El diseño fue una estrategia asociativa, de corte transversal, resultando un estudio descriptivo-comparativo, desarrollado en 2019, con una muestra de 584 profesionales sanitarios y no sanitarios de once servicios españoles de Urgencias Hospitalarias de ocho comunidades autónomas españolas. Se utilizaron estadísticos no paramétricos para las comparaciones entre grupo, análisis post-hoc y el cálculo de la magnitud del efecto. RESULTADOS: El 100% de los encuestados reconocieron haber sufrido violencia laboral al menos una vez en el último año. Específicamente, en cuanto a violencia no física, al menos ocho de cada diez profesionales estuvieron expuestos (rango 85,1%-100%). El grupo que más percibió esta violencia fue administración, seguidos de los profesionales sanitarios de enfermería y medicina, así como de los técnicos de cuidados auxiliares de enfermería (T.C.A.E) (H=28,881; p=0,001). Por otro lado, las manifestaciones de violencia física afectaron aproximadamente a tres de cada diez profesionales (rango 22,6%-29,5%), estando más presente en T.C.A.E y seguidos de los profesionales sanitarios de medicina y enfermería, así como de los profesionales no sanitarios, celadores y administración (H=9,800; p=0,05). CONCLUSIONES: Nuestro estudio evidencia la alta prevalencia de conductas violentas de media o baja intensidad en los servicios de Urgencias y Emergencias españoles. Además, permite profundizar en las distintas manifestaciones de violencia recibidas por los principales grupos profesionales de estos servicios.

Rating criteria of the causal nexus in Whiplash Associated Disorders: A study of interrater reliability / Criterios para el establecimiento del nexo causal en síndrome de latigazo cervical: un estudio de concordancia interobservadores

Introducción: El diagnóstico del síndrome de latigazo cervical está sujeto a criterios ambiguos, algunos de ellos de naturaleza subjetiva, que impide un alto porcentaje de acuerdo interjueces, y compromete seriamente la replicabilidad de los diagnósticos. El objetivo de este estudio es evaluar la concordancia interjueces de 4 expertos en medicina legal, quienes establecen el nexo causal de los pacientes que han sufrido un accidente de tránsito. Material y método: Trescientos pacientes que sufrieron un accidente de circulación fueron evaluados por 4 expertos en medicina legal. Realizaron 2 valoraciones del nexo causal, una sin estudio de la biomecánica y otra con este estudio. El grado de concordancia de las valoraciones fue calificado con el coeficiente de correlación intraclase (ICC) y el índice de concordancia (IC). Resultados: Los resultados de la valoración previa al estudio biomecánico de la lesión arrojan valores moderados-altos (ICC=0,70; CI=0,60). Asimismo, los valores observados en la valoración con el estudio de la biomecánica también indican un acuerdo moderado-alto (ICC=0,78, CI=0,67). Conclusiones: El estudio de la biomecánica mejora la concordancia de forma leve. A pesar de ello, el citado estudio no ayuda a reducir la proporción de casos dudosos y la mejora no alcanza niveles aceptables. Se observan diferencias significativas entre las clasificaciones, lo que sugiere que la metodología de valoración propuesta no es lo suficientemente uniforme como para alcanzar consenso. (AU)

Introduction: The diagnosis of Whiplash Associated Disorders is subject to various criteria, some of a subjective nature, which impedes a high percentage of agreement among raters of the causal nexus. It is necessary to develop an evidence-based methodology to maximize the uniformity of this diagnosis. Our objective is to assess the interrater reliability of four experts in legal medicine who establish the causal nexus of traffic accident patients. Material and method: 300 traffic accident patients evaluated by 4 legal medicine experts. They conducted two ratings, one without and one with a study of the biomechanics of the accident. The degree of concordance of the ratings was studied by the intraclass correlation coefficient (ICC) and the concordance index (CI). Results: The results of both the intraclass correlation coefficient and the concordance index of the rating prior to the biomechanical study of the injury yield moderate-high values (ICC=.70; CI=.60). Likewise, the values observed in the rating with the study of biomechanics also indicate moderate-high agreement (ICC=.78, CI=.67). Conclusions: The study of biomechanics slightly improves concordance. However, the aforementioned study does not help to reduce the proportion of doubtful cases and the levels of improvement are not acceptable. There are significant differences between the classifications, suggesting that the proposed valuation methodology is not uniform enough to reach a consensus. (AU)

Users' Perception of Violence and Conflicts With Professionals in Primary Care Centers Before and During COVID-19. A Qualitative Study.

Background: Workplace violence is a social problem of special interest in both intervention and research. Among the sectors that most perceive this type of violence, health care professionals stand out. The most common type of violence for this professional group is the one perpetrated by the users or patients themselves. It has been reported that one out of every four acts of violence in the workplace occurs in the healthcare setting. Within the health sector, the Mental Health, Emergency and Primary Care services have been widely reported as being among the most vulnerable, with Primary Care being the least addressed of the three. Although the available literature is extensive, there are hardly any studies that explore from a qualitative perspective what are the sources of conflict in this sector from the perspective of the users, the most common being to work with professionals. Objective: The aim of this study is to examine those aspects derived from the organization, the professionals or the users of Primary Care that, from the users' point of view, cause violent situations and how they think these could be avoided. Method: The sample consisted of 80 users of the Primary Care services of the Health Service of Murcia. For data collection, a qualitative study was conducted through 10 focus groups and a subsequent thematic analysis of the data. Results: The results have allowed us to identify that, from an organizational point of view, the uncertainty in waiting times, the need to adapt the telematic or telephone appointment to the different types of users, or the management of emergencies in Primary Care are the aspects that cause most conflicts between users and professionals. In this sense, suggested improvements are aimed at providing information in the mobile application updated on the opening hours or maintaining the telephone appointment for those who need or request it, among many others. As for the professionals, users point out that the medical staff is perceived as distant and sometimes does not provide enough information on the health status of users. Another professional group widely addressed in the focus groups was the administrative staff, being described as lacking in communication skills, assertiveness, or empathy. Users recognize the existence of a demanding/aggressive profile among users, who makes instrumental use of violence to achieve privileges over users in general. We have also identified the profile of the user who makes use of Primary Care as a way of socializing or managing conflicts of a socioemotional nature. As proposals for this thematic block, users suggest group therapies, the use of audiovisual material complementary to the information provided by professionals or community interventions in psychoeducation. Conclusion: This study allows to explore conflicts between users and professionals from the Primary Care patients' perspective. Our results are complementary to the available evidence that has used the professional's approach to study the phenomenon of workplace violence. The identification of sources of conflict and the assessment and contribution of users on possible ways of improvement can serve as a basis for the design of prevention and intervention plans to improve the work environment in Primary Care centers.

Cues for feigning screening in whiplash associated disorders.

The objective of this work is to evaluate the ability of a series of possible feigning indicators, extracted from relevant literature in the field, to discriminate between clinical patients with genuine symptomatology and instructed malingerers. A sample of 273 participants divided into two groups was used for this study: 153 whiplash associated disorder patients who were evaluated at a multidisciplinary medical center in the region of Murcia (Spain), between December 2017 and March 2019 and 120 healthy controls with malingering instructions, students of the Faculty of Medicine of the University of Murcia. In order for researchers to evaluate the indicators included in the study, a 22-step checklist (CDS) was developed, consisting of 22 criteria divided into 5 dimensions. Our results show that 18 of 22 indicators could discriminate between groups. Dimension 2 "Attitude toward the situation of illness" presented the greatest capacity for discrimination. In general terms, malingerers express a much more negative experience of the condition than the clinical patients.

Attitudes towards School Violence Questionnaire, revised version: CAHV-28 / Cuestionario de Actitudes hacia la Violencia Escolar, versión revisada: CAHV-28

School coexistence/violence is often the subject of social alarm. There is no consensus on the prevalence of violent behavior in the classroom, but there does seem to be about its differences according to sex, socioeconomic level, or the importance of preventive interventions for its reduction. Models consider attitudes towards violence as an indicator of risk for its expression. The objectives of this study are to explore the psychometric properties of the revised version of Cuestionario de Actitudes Hacia la Violencia [Attitudes towards Violence Questionnaire] (CAHV-25) in primary and secondary education students, proposing a version of four scales and a total of 28 items, along with the exploration of their significance as a function of sex and academic cycle. A qualitative review of CAHV-25 and a psychometric study of the revised version in each of its original dimensions was carried out, obtaining the fit indicators of exploratory and confirmatory factor analysis. In addition, the scale was studied as a function of sex and educational stage se in school children (N = 600) of the Region of Murcia (Spain). The four dimensions show better psychometric properties in their revised version. Attitudes towards violence are more present in males and in secondary school. As conclusions, the proposed version optimizes the detection of attitudes towards violence in schoolchildren and suggests more specific school violence prevention programs

La convivencia/violencia escolar, a menudo, es objeto de alarma social. No parece existir consenso en la prevalencia de conductas violentas en las aulas, pero sí en sus diferencias según sexo, nivel socioeconómico o la importancia de las intervenciones preventivas para su disminución. Los modelos sitúan a las actitudes hacia la violencia como un indicador de riesgo para la manifestación de dichas conductas. Los objetivos del presente estudio son explorar las propiedades psicométricas de la versión ampliada del Cuestionario de Actitudes Hacia la Violencia (CAHV-25) en alumnos de Educación Primaria y Secundaria, proponiendo una versión dividida en cuatro escalas y 28 ítems en total, junto a la exploración de la significación según sexo y etapa académica. Se ha llevado a cabo una revisión cualitativa del cuestionario CAHV-25 y se realizó un estudio psicométrico de la misma para cada una de sus dimensiones originales obteniendo los indicadores de ajuste de Análisis Factorial Exploratorio y Confirmatorio en menores de Educación Primaria y Secundaria (N = 600) de la Región de Murcia (España). Los resultados indican que las cuatro dimensiones tienen mejores propiedades psicométricas en su versión revisada. Las actitudes hacia la violencia son mayores en varones y en Secundaria. Se concluye que la versión propuesta permite maximizar la detección de actitudes hacia la violencia en menores escolarizados, sirviendo de base para el planteamiento de posibles programas de prevención de violencia escolar más específicos

Influence of parental styles and other psychosocial variables on the development of externalizing behaviors in adolescents: a sytematic review / La influencia de los estilos parentales y otras variables psicosociales en el desarrollo de los comportamientos externalizantes en adolescentes: revisión sistemática

The main objective of this systematic review is to synthesize the available evidence on the influence of parental styles and dimensions on the development of adolescents' externalizing behaviors. As a novelty, this review offers an analysis of possible differences in paternal and maternal parenting practices and the role of gender in adolescents will be analyzed. The methodology used consisted of a systematic search of articles in databases (Medline, Cochrane, Academic Search Premier, PsycINFO, ERIC y PsycARTICLES) and their lists of bibliographic references published between 2010 and 2016. Initially, we located 31,169 studies, of which 31,019 were excluded because they were either duplicates or did not meet the inclusion and exclusion criteria. The remaining articles were again reviewed in full text and were subjected to the assessment of bias risk, of which 17 had an adequate level of methodological quality, and so were included in the systematic review. The results suggest that the parenting style most closely associated with externalizing problems is the authoritarian style. In contrast, the authoritative parental style and the dimensions of affection, communication, and autonomy promotion guarantee positive results. A larger number of studies are deemed necessary to establish firm conclusions about aspects such as differences between parents' parenting style or adolescents' gender

Las últimas investigaciones indican que los estilos parentales influyen en el proceso de socialización de los hijos. El principal objetivo de esta revisión sistemática es sintetizar la evidencia disponible sobre la influencia de los estilos y las dimensiones parentales en el desarrollo de conductas externalizantes en adolescentes. Como novedad, esta revisión ofrece un análisis sobre las posibles diferencias de las prácticas de crianza paterna y materna y el rol del género en los adolescentes. La metodología utilizada consistió en una búsqueda sistemática de artículos en bases de datos (Medline, Cochrane, Academic Search Premier, PsycINFO, ERIC y PsycARTICLES) y de sus listas de referencias publicadas entre 2010 y 2016 acorde con las últimas revisiones sobre este tema. Inicialmente fueron localizados 31,169 estudios, de los que se excluyeron 31,019 por encontrarse duplicados o no cumplir los criterios de inclusión y exclusión establecidos previamente. Los 150 artículos restantes se revisaron de nuevo a texto completo, excluyéndose 79 estudios por no responder a los objetivos del estudio. Finalmente, 71 estudios se sometieron a evaluación de riesgo de sesgo, de los cuales 17 presentaron un adecuado nivel de calidad metodológica, por lo que fueron incluidos en la revisión sistemática. Los resultados sugieren que el estilo parental que más se relaciona con problemas de conducta externalizante es el estilo autoritario, reforzado por la utilización de prácticas coercitivas, el castigo físico o la imposición. En contraposición, el estilo parental fidedigno y las dimensiones de afecto, comunicación y fomento de la autonomía garantizan resultados positivos. Otros aspectos como el control parental y las prácticas indulgentes o negligentes ofrecen resultados contradictorios que es necesario matizar. Se considera necesario un mayor número de investigaciones para establecer conclusiones firmes sobre aspectos como las diferencias entre las prácticas de crianza de madres/padres o el género de los adolescentes

User violence in mental health services: Adaptation of an instrument. Healthcare-workers' Aggressive Behavior Scale-Users-Mental Health Version (HABS-U-MH).

BACKGROUND/OBJETIVE: According to the World Health Organization, one out of every four violent workplace acts takes place in the health setting. The aims of the study are to adapt the Healthcare-workers' Aggressive Behavior Scale-Users (HABS-U) to mental health professionals, to establish the frequency of exposure to hostile indicators and to determine which professional group is most exposed. METHOD: Study through qualitative and quantitative methodology in MH professionals of the Region of Murcia (Spain). In the qualitative phase, 12 in-depth interviews were conducted, and during the quantitative phase, the instrument was applied to 359 professionals of Mental Health Services (MHS). RESULTS: Non-medical and nursing staff were found to be the professional group most exposed, as well as Brief Psychiatric Inpatient and Medium-Stay Inpatient Services. CONCLUSION: The resulting scale shows excellent psychometric properties. The distribution of user violence is not homogeneous among the different professional groups of MHS. The adaptation of the scale may be useful to detect user violence, as well as to evaluate the efficacy of intervention programs.

User violence towards nursing professionals in mental health services and emergency units / Violencia de los usuarios hacia los profesionales de salud mental y urgencias

Workplace violence is present in many work sectors, but in the area of mental health, nurses have a higher risk due to the close relationship they have with users. This study analyzed hostile user statements against nursing professionals of Mental Health Services and Emergency Units in Health Service (MHS) hospitals in Murcia, Spain, and determined the frequency of exposure to the different violent user behaviors. The study was carried out with a sample of 518 nursing professionals from four hospital services: Mental Health, Emergency Units, Medical Hospitalization, and Maternal-and-Child. The nursing staff of Mental Health and Emergency Units was the most exposed to violence. Non-physical violence was more frequent in Emergency Units, whereas physical violence was more frequent in Mental Health. Among the consequences of exposure to non-physical violence are workers’ emotional exhaustion and the presence of psychological distress (AU)

La violencia en el trabajo está presente en muchos sectores laborales, pero en el ámbito de la salud mental los profesionales tienen un mayor riesgo por la estrecha relación que mantienen con los usuarios. El presente estudio analizó las manifestaciones hostiles de los usuarios hacia los profesionales de enfermería de Salud Mental y Urgencias de los hospitales del Servicio Murciano de Salud (SMS) en España y determinó la frecuencia de exposición a las distintas conductas violentas. Se llevó a cabo con una muestra de 518 profesionales de enfermería de cuatro servicios hospitalarios: Salud Mental, Urgencias, Hospitalización Médica y Materno-Infantil. El personal de enfermería más expuesto a la violencia fue el de Salud Mental y Urgencias. La violencia no física fue más frecuente en Urgencias y la física en Salud Mental. Entre las consecuencias de la exposición a la violencia no física se hallan el agotamiento emocional de los trabajadores y la presencia de malestar psicológico (AU)

Evaluation of the users violence in primary health care: Adaptation of an instrument / Evaluación de la violencia de usuarios en Atención Primaria: adaptación de un instrumento

Background/Objetivo: According to the World Health Organization, one out of every four violent workplace acts takes place in the health setting. The aims of the study are to study the prevalence of workplace violence in primary healthcare (PHC) professionals by adapting the Healthcare-worker's Aggresive Behaviour Scale-Users (HABS-U), to establish the frequency of exposure to hostile indicators and to determine which professional group is most exposed. Method: Study through qualitative and quantitative methodology in PHC professionals of the Region of Murcia (Spain). In the qualitative phase in-depth interviews were conducted and during the quantitative phase the instrument was used to 574 professionals of 39 PHC centres.Results: The resulting scale shows excellent psychometric properties and correlates significantly with job satisfaction, burnout components, the factors of empathy and psychological well-being. There was a 90.2% prevalence of user violence, and non-medical personnel were found to be the professional group most exposed. Conclusion: The distribution of user violence is not homogeneous among the different professional groups of PHC. The adaptation of the scale may be useful for detection of user violence, as well as to evaluate the efficacy of intervention programs (AU)

Antecedentes/Objetivo: Según la Organización Mundial de la Salud, en el ámbito sanitario se producen uno de cada cuatro incidentes laborales violentos. Los objetivos del estudio son examinar la prevalencia de violencia laboral en profesionales de Atención Primaria (AP) mediante la adaptación de la Healthcare-worker's Aggresive Behaviour Scale-Users (HABS-U), conocer la frecuencia de exposición a los indicadores hostiles y determinar el grupo profesional más expuesto. Método: Estudio realizado mediante metodología cualitativa y cuantitativa en profesionales de AP de la Región de Murcia (España). En la fase cualitativa se realizaron entrevistas en profundidad y en la fase cuantitativa se aplicó el instrumento a 574 profesionales de 39 centros de AP. Resultados: La escala resultante muestra excelentes propiedades psicométricas y sus medidas correlacionan de manera significativa con satisfacción laboral, los componentes del burnout, los factores de empatía y con el bienestar psicológico. La prevalencia de violencia de usuarios fue del 90,2% y el personal no sanitario resultó ser el grupo profesional más expuesto. Conclusión: La distribución de la violencia de usuarios no es homogénea entre los diferentes grupos profesionales de AP. La adaptación de la escala puede ser útil para la detección de la violencia de usuarios, así como para evaluar la eficacia de programas de intervención (AU)

Profile of partner aggressors as a function of risk of recidivism / Perfil de agresores contra la pareja según el riesgo de reincidencia

Partner aggressors present psychopathological, criminal, and sociodemographic characteristics that have been used for classification in typologies. The goal of the present work was to identify profile of aggressors as a function of the risk of recidivism, and assess whether there correspondence with type of offenders proposed by Holtzworth---Munroe and Stuart. The sample was made up of 90 men condemned for partner violence, of whom 50 were serving a prison sentence, and 40 mandatory community intervention/programs. The risk of recidivism was assessed with the SARA - Spousal Assault Risk Assessment Guide, completed with information obtained from prison records, clinical interviews for the assessment of personality disorders, and self-reports. The results reveal three profile of aggressors according to their risk of recidivism, related to the above-mentioned classification: high-risk aggressors coincide with the Dysphoric/Borderline (DB) type, medium-risk aggressors with the low-level antisocial type (LLA), and the low-risk group with the type of aggressors family only (FO). The implications are discussed in the penitentiary intervention of these results (AU)

Los agresores contra la pareja presentan características psicopatológicas, delictivas y sociodemográficas que han sido utilizadas para su clasificación en tipologías. El objetivo del presente trabajo ha sido identificar el perfil de estos agresores según el riesgo de reincidencia, y valorar si existe coincidencia con la tipología de agresores propuesta por Holtzworth---Munroe y Stuart. La muestra fue de 90 hombres condenados por violencia contra la pareja, de los que 50 cumplían pena de prisión y 40 una medida alternativa: intervención/programa. El riesgo de reincidencia se evaluó con la guía SARA-Spousal Assault Risk Assessment Guide, cumplimentada con la información obtenida de los expedientes penitenciarios, entrevistas clínicas para la evaluación de trastornos de personalidad y autoinformes. Los resultados muestran tres perfiles de agresores según su riesgo de reincidencia que se relacionan con la mencionada clasificación, ya que los agresores de alto riesgo coinciden con el tipo disfóricos/borderline (DB), los agresores de riesgo medio con el tipo antisocial de bajo nivel (LLA) y el grupo de menor riesgo con el tipo de agresores limitados al ámbito familiar (FO). Se discuten las implicaciones en la intervención penitenciaria de estos resultados (AU)

User Violence and Nursing Staff Burnout: The Modulating Role of Job Satisfaction.

Exposure to patient violence in health staff can lead to the onset of burnout in these workers. The main goal of this investigation is to study how exposure to this kind of violence affects onset of burnout and to appraise the role of job satisfaction as a modulating variable. A descriptive, cross-sectional study was carried out using a self-administered anonymous questionnaire with the nursing staff of all the public hospitals of the Region of Murcia (Spain), obtaining a sample of 1,489 health professionals. From the results obtained, we underline the modulating role of extrinsic job satisfaction in the relationship between nonphysical violence and emotional exhaustion, and the protective effect of job satisfaction on the impact of nonphysical violence and the level of cynicism. No effects of job satisfaction in the relationship between physical violence and burnout were observed. We therefore conclude that experiencing nonphysical aggression has a lower impact on the psychological health of workers who are satisfied with their job, and interventions aimed at increasing these workers' extrinsic job satisfaction are highly recommended.

Influence of attitudes, impulsivity, and parental styles in adolescents' externalizing behavior.

Diverse works have associated externalizing problem behavior with impulsivity, parental styles, and attitudes toward violence. The aim of this study is to analyze the association between these variables and externalizing behavior. A cross-sectional correlational design was used with a sample of 252 adolescents, aged between 12 and 15 years, from the general population. The results obtained indicate a significant association of externalization with high impulsivity, ingrained attitudes toward violence, and inconsistent parental styles, as well as gender and age differences. These results are discussed in relation with the influence of gender stereotypes and their implications in the development of attitudes toward violence.

Profile of partner aggressors as a function of risk of recidivism.

Partner aggressors present psychopathological, criminal, and sociodemographic characteristics that have been used for classification in typologies. The goal of the present work was to identify profile of aggressors as a function of the risk of recidivism, and assess whether there correspondence with type of offenders proposed by Holtzworth-Munroe and Stuart. The sample was made up of 90 men condemned for partner violence, of whom 50 were serving a prison sentence, and 40 mandatory community intervention/programs. The risk of recidivism was assessed with the SARA - Spousal Assault Risk Assessment Guide, completed with information obtained from prison records, clinical interviews for the assessment of personality disorders, and self-reports. The results reveal three profile of aggressors according to their risk of recidivism, related to the above-mentioned classification: high-risk aggressors coincide with the Dysphoric/Borderline (DB) type, medium-risk aggressors with the low-level antisocial type (LLA), and the low-risk group with the type of aggressors family only (FO). The implications are discussed in the penitentiary intervention of these results.

Los agresores contra la pareja presentan características psicopatológicas, delictivas y sociodemográficas que han sido utilizadas para su clasificación en tipologías. El objetivo del presente trabajo ha sido identificar el perfil de estos agresores según el riesgo de reincidencia, y valorar si existe coincidencia con la tipología de agresores propuesta por Holtzworth­Munroe y Stuart. La muestra fue de 90 hombres condenados por violencia contra la pareja, de los que 50 cumplían pena de prisión y 40 una medida alternativa: intervención/programa. El riesgo de reincidencia se evaluó con la guía SARA-Spousal Assault Risk Assessment Guide, cumplimentada con la información obtenida de los expedientes penitenciarios, entrevistas clínicas para la evaluación de trastornos de personalidad y autoinformes. Los resultados muestran tres perfiles de agresores según su riesgo de reincidencia que se relacionan con la mencionada clasificación, ya que los agresores de alto riesgo coinciden con el tipo disfóricos/borderline (DB), los agresores de riesgo medio con el tipo antisocial de bajo nivel (LLA) y el grupo de menor riesgo con el tipo de agresores limitados al ámbito familiar (FO). Se discuten las implicaciones en la intervención penitenciaria de estos resultados.

Evaluation of the users violence in primary health care: Adaptation of an instrument.

Background/Objetivo: According to the World Health Organization, one out of every four violent workplace acts takes place in the health setting. The aims of the study are to study the prevalence of workplace violence in primary healthcare (PHC) professionals by adapting the Healthcare-worker's Aggresive Behaviour Scale-Users (HABS-U), to establish the frequency of exposure to hostile indicators and to determine which professional group is most exposed. Method: Study through qualitative and quantitative methodology in PHC professionals of the Region of Murcia (Spain). In the qualitative phase in-depth interviews were conducted and during the quantitative phase the instrument was used to 574 professionals of 39 PHC centres. Results: The resulting scale shows excellent psychometric properties and correlates significantly with job satisfaction, burnout components, the factors of empathy and psychological well-being. There was a 90.2% prevalence of user violence, and non-medical personnel were found to be the professional group most exposed. Conclusion: The distribution of user violence is not homogeneous among the different professional groups of PHC. The adaptation of the scale may be useful for detection of user violence, as well as to evaluate the efficacy of intervention programs.

Antecedentes/Objetivo: Según la Organización Mundial de la Salud, en el ámbito sanitario se producen uno de cada cuatro incidentes laborales violentos. Los objetivos del estudio son examinar la prevalencia de violencia laboral en profesionales de Atención Primaria (AP) mediante la adaptación de la Healthcare-worker's Aggresive Behaviour Scale-Users (HABS-U), conocer la frecuencia de exposición a los indicadores hostiles y determinar el grupo profesional más expuesto. Método: Estudio realizado mediante metodología cualitativa y cuantitativa en profesionales de AP de la Región de Murcia (España). En la fase cualitativa se realizaron entrevistas en profundidad y en la fase cuantitativa se aplicó el instrumento a 574 profesionales de 39 centros de AP. Resultados: La escala resultante muestra excelentes propiedades psicométricas y sus medidas correlacionan de manera significativa con satisfacción laboral, los componentes del burnout, los factores de empatía y con el bienestar psicológico. La prevalencia de violencia de usuarios fue del 90,2% y el personal no sanitario resultó ser el grupo profesional más expuesto. Conclusión: La distribución de la violencia de usuarios no es homogénea entre los diferentes grupos profesionales de AP. La adaptación de la escala puede ser útil para la detección de la violencia de usuarios, así como para evaluar la eficacia de programas de intervención.