A psychometric appraisal of the dundee ready education environment measure in a medical school in Chile.

Background: The Dundee Ready Education Environment Measure (DREEM) is used in the curricular development of future health professionals worldwide, but often without first locally testing its psychometric qualities, for example, construct validity and internal consistency. These characteristics are modified by different environments, but must be locally appropriate to obtain unequivocal and reliable conclusions about the strong and weak areas of a curriculum. Here, we report the results of the psychometric testing of DREEM results in our institution in Chile. Methods: All 1st-5th-year undergraduate medical students were asked to respond the DREEM questionnaire. The construct validity of the results was assessed by an exploratory factor analysis (EFA), and their internal consistency was assessed by Cronbach's α. The Institutional Review Board approved the study, and each student signed an informed consent. Results: A total of 304 (88%) eligible students, aged 22 ± 2 years, 46% of females, answered the questionnaire. The EFA determined four instead of the original DREEM's five subareas with clearly different item contents. The inner consistencies of the locally defined subareas of teaching, learning, teachers and organizational aspects, and self-perception surpassed the originals with Cronbach's α values of 0.79, 0.78, 0.77, and 0.82, respectively. Discussion: The optimal psychometric structure to accurately interpret our DREEM results differed from both the original and previous similar studies, including one from Chile. There are several potential explanations for these differences, but most importantly, they underline the need to first define the psychometric characteristics of the test results, to obtain accurate conclusions about the strengths and the weaknesses of a curriculum.

Percepción del ambiente educacional preclínico en estudiantes de 1º a 4º año de enfermería de la Universidad Diego Portales, Santiago (Chile) / Perception on preclinical educational environment by 1st to 4th year nursing students at University Diego Portales, Santiago, Chile

Resumen:

Objetivo: el contexto donde se desarrolla el fenómeno educativo tiene gran importancia al decidir la permanencia y satisfacción de los estudiantes con la institución.

El objetivo, por tanto, es determinar la percepción del ambiente educacional (AE) de estudiantes de enfermería de la Universidad Diego Portales (UDP) en Santiago de Chile.

Metodología: diseño descriptivo transversal con una muestra intencionada de 446 estudiantes utilizando el Dundee Ready Education Environment Measure (DREEM) en español. Se analizó diferencias entre los dominios del AE y los cursos utilizando ANOVA y prueba de Spearman, con un nivel de significación del 95% (p< 0,05).

Resultados: el promedio del puntaje global de AE en los cursos fue 130 de 200 (DS 22), un 65% del puntaje máximo, definiéndose como percepción más bien positiva. Los estudiantes de primer año presentan los promedios más altos globales y por dominio de AE (P< 0,0001), disminuyendo significativamente en los cursos más avanzados.

El análisis de correlación entre los dominios de AE demostró que la percepción del dominio enseñanza, influencia significativamente la percepción del resto de los dominios (P< 0,0001). Discusión: la percepción del AE es similar a otros estudios, habiendo una clara disminución después del primer año y existiendo concordancia entre el dominio percepción de la enseñanza con el resto de los dominios. Conclusión: si bien se obtuvo un resultado más bien positivo es posible identificar claramente áreas que requieren diseñar estrategias de mejoras.

Abstract:

Purpose: the environment where education is carried out is very important when deciding permanence and assessing satisfaction by students in the institution.

To assess the perception on education environment (EE) by nursing students at University Diego Portales (UDP), Santiago de Chile, Chile. Methods: a descriptive, cross-sectional design with intentional sampling was used, with 446 students being included, using the Dundee Ready Education Environment Measure (DREEM) in Spanish. Differences between EE domains and years were analyzed by means of ANOVA and Spearman test, with a 95% level of significance (p < 0.05).

Results: average overall score for EE in all years was 130 over 200 (SD 22), corresponding to 65% of maximum score, which is a rather positive perception. First-year students show highest means both overall and in specific EE domains (p < 0.0001), with scores being gradually lower for later years. Correlation analysis of EE domains showed that perception on teaching domain has a significant impact on perception on other domains (p < 0.0001). Discussion: perception on EE is similar to other university studies, with a clear-cut reduction being observed after the first year and a correlation being present between perception on teaching and perception on other domains. Conclusion: although results were rather positive, some areas can be clearly identified where strategies for improvement should be designed.

Objetivo: o contexto em que se desenvolve o fenómeno educativo e de grande importância ao decidir a permanência e a satisfação dos estudantes com a instituição.

Determinar a percepção do Ambiente Educacional (AE) dos estudantes do 1º ao 4º ano do curso de enfermagem da Universidade de Diego Portales. Métodos: estudo transversal descritivo, amostra intencional de 446 estudantes foi utilizado o questionário Dundee Ready Education Environment Measure (DREEM) em espanhol. Analisando diferencias entre os domínios e os cursos foram utilizados ANOVA e a prova de Spearman, com um nível de significância de 95% (p < 0,05). Resultados: o promédio da pontuação global dos cursos foi 130 de 200 (DS 22) alcançando um 65% da pontuação máxima e definindo-o como uma percepção mais positiva. Os estudantes do primeiro ano apresentam promédios mais altos globais por domínio em relação ao resto (P< 0,0001) diminuendo significativamente nos cursos mais avançados. A análise de correlação entre domínios demostrou que a percepção do estudante de domínio ensino, influencia significativamente a percepção do resto dos domínios (P< 0,0001). Discussão: a percepção do AE e com estudos similares. É evidente a diminuição na percepção do AE depois do primeiro ano existindo uma concordância entre a percepção do domínio do ensino com o restante dos domínios. Conclusão: obteve-se um resultado meramente positivo e é possível identificar claramente áreas que requerem estratégias de melhorias com objetivo de potencializar.

Breastfeeding reduces immune activation in primary respiratory syncytial virus infection.

In epidemiological studies of respiratory syncytial virus (RSV) disease, breast milk has proven to be beneficial. However, a host mechanism that is associated with both disease severity and that is capable of being modulated by breast milk, has not yet been identified. Both the predominance of interleukin-10 (IL-10) over interferon-gamma (IFN-gamma), and high soluble interleukin-2 receptor antagonist (sCD25) concentrations have been associated with RSV severity. We explored if they were modulated by breastfeeding. Previously healthy Chilean infants from Santiago with RSV infection (n = 349) were consecutively enrolled in the study if they were term births, without underlying pathology. Breastfeeding was described as absent or present, and if partial or exclusive. Immune response was expressed through plasma concentrations of IFN-gamma, IL-10 and sCD25, obtained both in the acute and the recovery phase. The acute phase sCD25 concentrations were lower in the breastfed (13.8 ng/mL, n =133), compared with the non-breastfed infants (15.9 ng/mL, n 27, p = 0.015). The difference increased in infants below 3 months of age (p = 0.006) and with exclusive (p = 0.004), compared to partial breastfeeding (p = 0.025). When analyzed together with age, sex, severity and environment, breastfeeding was the only independent predictor of high sCD25 concentrations (above mean + 1SD, OR 4.6, 95% CI 1.8-11.9, p = 0.0015). The recovery phase IFN-gamma/IL-10 ratio was higher in the breastfed infants, but when analyzed with potential confounding factors, only female sex was associated with an increased ratio (OR 2.32, 95% CI 1.02-5.29, p = 0.045). High sCD25 concentrations during the acute phase of infection, previously associated with severe RSV disease, were significantly and independently reduced in association with breastfeeding, whereas the Th1/Th3 balance was only modified in the recovery phase.

Soluble interleukin-2 receptor (sCD25) and interleukin-10 plasma concentrations are associated with severity of primary respiratory syncytial virus (RSV) infection.

The role of the immune response in the severity of RSV infection was examined by determining plasma concentrations of interferon-gamma (IFN-gamma), interleukin-10 (IL-10), interleukin-2 receptor (sCD25) and soluble tumor necrosis factor receptor II (sTNFR-II) in 196, previously healthy infants, during acute and convalescence phases of primary RSV infection. The results were analyzed separately for days 1-4 (early) and days 5-7 (late) of symptoms before sample collection and according to disease severity (105 hypoxic, 91 non-hypoxic). Significant associations between plasma levels and severity were found in early samples only. IL-10 and sCD25 concentrations were higher (p=0.01, each) in hypoxic compared with non-hypoxic infants, whereas no differences were observed in IFN-gamma and sTNFR-II levels between the groups. Early sCD25 levels correlated positively with IL-10 concentrations (p= 0.0003; r= 0,401). Amongst the hypoxic infants, the number of days of oxygen supplementation correlated positively with early IL-10 levels (p=0.009; r=0.495) and negatively with the IFN-gamma/IL-10 ratio (p=0.007; r=0.495). IFN-gamma levels were significantly higher in the acute phase than during convalescence for hypoxic and non-hypoxic infants, while IL-10 levels were significantly higher in the acute phase only in hypoxic infants for days 1-4 (early; p=0.0007). sCD25 concentrations were elevated only in hypoxic infants at days 1-4 of the acute phase (p=0.002), whereas sTNFR-II levels did not vary between acute and convalescence phases, independent of severity and time point of sampling. We found no association between plasma levels during the convalescence phase and the severity of the RSV infection.