Grigoropoulou Maria, Attilakos Achilleas, Charalampopoulos Anestis, Fessatou Smaragdi, Vamvakas Efstratios, Dimopoulou Anastasia, Zavras Nikolaos
Second Health Centre,12132 Peristeri, Greece.
Department of Pediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece.
Children (Basel). 2023 May 10;10(5):853. doi: 10.3390/children10050853.
(1) Background: Children who undergo surgical or endoscopic procedures display high levels of stress, and various means are applied to reduce their anxiety. Salivary cortisol (S Cortisol) and salivary alpha-amylase (SAA) are often used as a valid biomarker of stress. The primary purpose of the study was the investigation of stress levels through S Cortisol and S amylase after intervention in surgical or endoscopic procedures (gastroscopy-colonoscopy). The secondary outcomes were the investigation of the intention to adopt new methods of saliva sampling. We collected saliva samples from children subjected to invasive medical procedures, with the aim of applying the Theory of Planned Behavior (TPB) as an intervention means to provide information and education to both parents and children undergoing stressful situations, and assess its efficacy in reducing stress levels. We also aimed at acquiring a better understanding of the acceptability of noninvasive biomarker collection in community settings. (2) Methods: The sample of this prospective study comprised 81 children who underwent surgical or endoscopic procedures at the Attikon General University Hospital, Athens, Greece and 90 parents. The sample was divided into two groups. The first, 'Group Unexplained', was not provided any information or education about the procedures, while the second, 'Group Explained', was informed and educated based on TPB. Thereafter, 8-10 weeks after intervention, the Theory of Planned Behavior questions were re-completed by the 'Group Explained'. (3) Results: Significant differences were detected in cortisol and amylase values between the two groups postoperatively after applying the TPB intervention. Saliva cortisol was reduced by 8.09 ng/mL in the 'Group Explained' while in the 'Group Unexplained' it was reduced by 4.45 ng/mL ( < 0.001). Salivary amylase values decreased by 9.69 ng/mL in the 'Group Explained' after the intervention phase of the study, while in the 'Group Unexplained' they increased by 35.04 ng/mL ( < 0.001). The regression explains 40.3% (baseline) and 28.5% (follow-up) of parental intention. The predictive factor of parental intention (baseline) is attitude ( < 0.001) and follow-up is behavioral control ( < 0.028) and attitude ( < 0.001). (4) Conclusions: Providing proper education and information for parents has a positive effect on reducing children's stress levels. Changing parental attitudes towards saliva collection plays the most important role, since a positive attitude can influence intention and ultimately participation in these procedures.
（1）背景：接受外科手术或内镜检查的儿童表现出高度的压力，人们采用了各种方法来减轻他们的焦虑。唾液皮质醇（S皮质醇）和唾液α淀粉酶（SAA）常被用作压力的有效生物标志物。本研究的主要目的是通过S皮质醇和S淀粉酶来调查外科手术或内镜检查（胃镜 - 结肠镜检查）干预后的压力水平。次要结果是调查采用新唾液采样方法的意愿。我们从接受侵入性医疗程序的儿童中收集唾液样本，目的是应用计划行为理论（TPB）作为干预手段，为经历压力情况的父母和儿童提供信息和教育，并评估其在降低压力水平方面的效果。我们还旨在更好地了解社区环境中无创生物标志物采集的可接受性。（2）方法：这项前瞻性研究的样本包括81名在希腊雅典阿提卡综合大学医院接受外科手术或内镜检查的儿童和90名家长。样本分为两组。第一组，“未解释组”，未获得任何有关手术的信息或教育，而第二组，“解释组”，基于计划行为理论接受了信息和教育。此后，在干预8 - 10周后，“解释组”重新完成了计划行为理论相关问题。（3）结果：应用计划行为理论干预后，两组术后皮质醇和淀粉酶值存在显著差异。“解释组”的唾液皮质醇降低了8.09 ng/mL，而“未解释组”降低了4.45 ng/mL（<0.001）。在研究的干预阶段后，“解释组”的唾液淀粉酶值降低了9.69 ng/mL，而“未解释组”则增加了35.04 ng/mL（<0.001）。回归分析解释了父母意愿的40.3%（基线）和28.5%（随访）。父母意愿（基线）的预测因素是态度（<0.001），随访时是行为控制（<0.028）和态度（<0.001）。（4）结论：为父母提供适当的教育和信息对降低儿童压力水平有积极影响。改变父母对唾液采集的态度起着最重要的作用，因为积极的态度可以影响意愿并最终影响对这些程序的参与。
