Trnavská univerzita V Trnave Fakulta zdravotníctva a sociálnej práce Sprachkompetenz in der Wissenschaft Language Competence in the Science

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Quality standards for communicable diseases surveillance- research design

DeNISA jakubcová, VIERA rusnáková

Slovakia, Trnava University in Trnava

Faculty of Health Sciences and Social Work

Public Health Department

E-Mail: [e-mail], [e-mail]


Abstract

Communicable diseases are possible threat to public health in spite of available effective prevention and therapy. Surveillance system provides data useful for early warning, outbreak detection, following trends of endemic diseases, evaluation of public health programs, including immunization programs, programs for elimination and eradication of diseases.In the whole process of surveillance and data flow play a crucial role primary care physician of first contact. Surveillance system relies on the detection of communicable disease in the patients and disease notification. For assessment of surveillance system, there were defined quality standards, which should by implemented regularly. Main aim of dissertation research is to assess surveillance system according to the quality standards and based on results, prepare lecture for primary care physicians in Slovakia, Trnava region.

Key words:

Communicable diseases. Surveillance. Quality standards.

Introduction
Communicable diseases pose a threat to public health despite available effective prevention and therapy. Increase the size and density of population, globalization of the food supply and the method of their production and distribution, acceleration of international transport, global climate change, wars, social changes and social upheavals increase the risk of infectious diseases and the spread in epidemic and pandemic proportions (Alirol et al., 2011). Economic costs of belated intervention are more extensive than those costs associated with the early warning and response to disease incidence. Over the last 20 years there were identified more than 30 previously unrecognized microorganisms capable of inducing an infectious disease with severe clinical course. The issue is acute because of the increasing phenomenon of antibiotic resistance (Bakoss et al., 2005 Bazovská et al., 2007 Sattar- Tetro-Springthorpe, 2009).

Surveillance is a system of long-term continuous observation and supervision of all aspects of the occurrence of the disease in the population, based on the regular collection, analysis and dissemination of data feedback (Weightman et al., 2005). Surveillance provides important data needed for effective prevention and control of infectious diseases in the population (CDC, 2008).

The main aim of surveillance is the elimination and eradication of diseases. Surveillance system allows you to monitor trends in the incidence of endemic diseases and provides data that can be used in the analysis of the impact of interventions and programs aimed at the prevention and control of infectious diseases (ECDC, 2006 a, b).

The function of early warning and response for the prevention and control of communicable diseases is necessary to ensure public health at regional, national and global levels. Recent cases of severe acute respiratory syndrome, avian influenza and the threat from the possibility of misuse of biological and chemical agents demonstrate the need for an effective system of surveillance and early warning at national level providing higher data structures (Weinberg, 2005).

Surveillance structure and organization

The structure of the surveillance system is designed to treasure the current legislation, existing strategies for the implementation of the system, identifying stakeholders and their mutual relations, networks and partnerships (Nsubuga et al., 2002).

Strategies and regulations, including the International Health Regulations of 2005 provides the legal framework for the implementation of the surveillance of communicable diseases and an early response. International Health Regulations are an important part of the legal regulations in the field of public health and are designed to provide relevant measures to protect public health on a global scale with minimal disruption of international trade and transport. To achieve this it is necessary that the individual states strengthen and develop capacities for surveillance, reporting, verification and response to the occurrence of communicable diseases (WHO, 2010).

Defining the strategy depends on surveillance of diseases subject to the reporting system, the targets set for the surveillance system, the performance of surveillance methods and the way in which output data will be used to inform the public and policy makers (WHO, 2006).

Communicable disease surveillance requires coordinated efforts and cooperation between stakeholders and partners at national and international level. Inter-sectoral cooperation and coordination among key partners is essential for the implementation of effective and comprehensive measures to ensure the functions of the monitoring system. Various monitoring networks and partnerships exist at the country level and at the transnational level.

Laboratory network is a good example of the network at the country level, while cooperation on surveillance and early response activities with neighboring countries is a transnational network and cooperation. Interdepartmental cooperation is a prerequisite for effective results early warning system (WHO, 1999).

Basic functions of surveillance are:

• 
  Case detection- process of identifying cases and outbreaks.
  
• 
  Case registration - process of recording existing cases of the disease, which can require the existence of a standardized form for registration minimum data elements specified for each disease.
  
• 
  Case confirmation- process of laboratory confirmation of a case with an epidemiological link.
  
• 
  Reporting- process of communicating information about the probable and confirmed cases and outbreaks.
  
• 
  Data analysis and interpretation- surveillance data should be analyzed routinely and the information interpreted for use in public health actions.
  
• 
  Epidemic preparedness- Epidemic preparedness refers to the existing level of preparedness for potential epidemics and includes availability of preparedness plans, stockpiling, designation of isolation facilities, setting aside of resources for outbreak response, etc.
  
• 
  Response and control- a process of providing information for an early warning system (Jamison et al., 2006).
  

The support functions are those that facilitate implementation of the core functions and included the following:

• Standards and guidelines (case definitions, laboratory guidelines, outbreak investigation guidelines, etc);

• Training for epidemiology and laboratory personnel and/or community health agents;

• Supervisory activities;

• Communication facilities;

• Resources (human, financial, logistical);

• Monitoring and evaluation

• Coordination.
Surveillance quality standards

To achieve the objectives and effectiveness of surveillance it is necessary to establish quality standards for surveillance, assess the quality attributes in practice and then set priorities for streamlining and enhancing the quality of surveillance (M'ikanatha et al., 2013).

The quality of surveillance is defined by attributes: completeness, timeliness of reporting, usefulness, simplicity, acceptability, flexibility, sensitivity, positive predictive value and representativeness (WHO, 1999).

Completeness of surveillance is multidimensional and includes aspects of completeness forms of surveillance, the completeness of reported cases and completeness of data. Completeness of reporting forms of surveillance represents the proportion of forms of surveillance carried out message. This attribute can be measured, provided that they are available to known numbers of parties claiming the territory covered by the institutions conducting surveillance, the number of reports expected for the time period and the sum of reported cases over time. The comprehensive surveillance system is expected situation when the number of parties claiming equal to the expected number of cases reported. Compared to the sentinel surveillance is considered that the expected number of reported cases exceeds the number of parties who claim. Completeness of the reported cases the difference between the number of reported cases and the actual incidence of cases. Completeness of the reported data represents the correlation between the extent of the expected minimum requirements for the reporting of the case and the extent of the reported data (Declich-Carter, 1994).

One of the most important attributes of quality surveillance punctuality and timeliness of data, thus provide relevant data in an adequate response time for the implementation of prevention and control measures. Timeliness standard specifications need to be defined for each individual country. Attribute timeliness of reports include: timeliness immediate notification (within 24 hours), timeliness of weekly reporting and timeliness of monthly reports (WHO, 2006).

Output surveillance data provide several uses. Attribute usefulness of surveillance should be evaluated in the context of two key tasks surveillance: an early warning system and a system of routine monitoring for the occurrence of communicable diseases. To evaluate the usefulness of early warning data are needed from the previous calendar year, confirmed and probable outbreaks of communicable diseases requiring reporting. Subsequently defines whether an outbreak was detected early warning system, evaluation of epidemiological investigations carried out at the site of an outbreak and adequate response time. To evaluate the effectiveness of routine monitoring should be used qualitative interviews and discussions with workers carrying out surveillance and end users of output data on the possibility of using surveillance data to define new priorities, strategies and so on. Through interviews with employees may have identified redundant data and factors affecting nevyužívanosť data (Doherty, 2000).

Ease surveillance refers to the structure CAD- the ease of implementation and ease the flow of information from their point of origin to the place end users. Evaluating the simplicity of the system makes it impossible to apply quantitative methods of research because of subjective perception. It is necessary to choose the qualitative interviews and discussions with staff focusing on the subjective perception of the complexity of surveillance and proposals for changes to the system that would contribute to increasing the simplicity of the structure of surveillance (Lemon et al., 2007).

Acceptability reflects the willingness of workers and end users to exercise surveillance activities related to surveillance and their willingness to accept and use the data collected by the system. In the context of evaluating the acceptability attribute is necessary to determine whether workers have needs and suggestions to improve surveillance and increase their acceptability (Jamison et al., 2006).

Flexibility refers to the ability of the system to adapt to changing needs, such as elimination or inclusion of other diseases in the report, change the frequency of reporting requirements to the extent of changes in data, etc.. Flexibility is particularly important for the early warning system (Declich-Carter, 1994).

The sensitivity of surveillance represents the proportion of actual cases in the population that are detected and confirmed through surveillance. There are three levels of sensitivity surveillance- sensitivity of the case definition (the ability of case definition, all cases in the population), the sensitivity of detection of events requiring intervention and public health notification system sensitivity (proportion of interceptions and surveillance of all cases in the population) (WHO, 2006).

Positive predictive value is the value of surveillance proportions of individuals suffering from the disease who actually suffer from a given disease. Positive predictive value attribute specifies the positive predictive value of the case definition, detection and detection of disease outbreaks (Declich-Carter, 1994).

Representativeness of surveillance refers to the degree in which reported cases reflect the presence and distribution of disease in populations that are subject to notification. Geographical representativeness is particularly important for an early warning system to ensure detection of disease outbreaks. In case if there are reported cases of the same disease representative of all cases occurring in the population can be implemented prevention and health promotion insufficient and inadequate in line with current needs. Since the actual frequency and the distribution of the disease are unknown, it is impossible to establish the exact representativeness surveillance. If available, population-based studies conducted with reliable estimates, it is possible to compare the outcomes of these studies with surveillance outputs on the frequency and distribution of disease in the population (WHO, 1999).

Aims of the research
The main objective of the research is to evaluate the quality standards of communicable diseases surveillance system for selected communicable diseases reported in the Trnava region, Slovak Republic according to the existing recommendations for the evaluation of surveillance.

1. 
   Evaluate the attribute of completenessfor following diseases: viral hepatitis B, viral hepatitis C, chlamydial infection, syphilis, Lyme disease and campylobacteriosis.
   
2. 
   Evaluate attribute of timeliness for following diseases: viral hepatitis B, viral hepatitis C, chlamydial infection, syphilis, Lyme disease and campylobacteriosis.
   
3. 
   Based on the of the evaluation results, there will be implemented interventions to improve the quality of reported data of selected diseases through the educational lecture for primary care physicians.
   

Methods
Evaluation of quality attributes will be implemented for reported cases of following communicable diseases diagnoses:

• 
  viral hepatitis B,
  
• 
  viral hepatitis C,
  
• 
  chlamydia infections,
  
• 
  syphilis,
  
• 
  Lyme disease,
  
• 
  campylobacteriosis
  

reported by primary care physicians from the district of Trnava. The reason for the evaluation of quality attributes for these diagnoses is the burden in rising incidence, clinical severity, initial asymptomatic stage, potential progression to chronic stage of and potential toepidemic spread. This is the reason why it is necessary to achieve the full potential of surveillance effectiveness.

Evaluation of completeness of the data reported by primary care physicians will be carried out in accordance with the reporting tool defined by law 355/2007 Coll. We evaluate proportions and the difference between the required data and actually reported data by primary care physicians. We will monitor following data:

• 
  Diagnosis (according to ICD)
  

• 
  Village of residence
  
• 
  Date of first symptoms
  
• 
  Date of reporting
  
• 
  Case classification
  
• 
  Vaccination data
  
• 
  Place and type of job
  
• 
  Epidemiological history in the family
  
• 
  Date of isolation
  

Timeliness will be evaluated as the time difference between two steps in process of reporting (between the date of patients’ first symptoms and the dateof case reporting). The source of data for the evaluation of quality attributes will be web platform of epidemiological information system- EPIS.SK

Design of the intervention
The target groups of intervention are primary care physicians working in the district of Trnava. The primary care physiciansplay crucial role in the whole process of data reporting due to their recognition of communicable disease and cases notifications to the relevant surveillance stakeholders.

The intervention will be taken in the form of educational lectures and discussion panels. There will be presented the standard case definitions of communicable diseases to physicians. Then, they will discuss the practical problems within the disease notification.

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ALIROL, E et al. 2011. Urbanisation and infectious diseases in a globalised world. In Lancet Infectious Diseases. 2011, ISSN 1474-4457, roč.12, č.2., s131-141.
Bazovská, S. et al. 2007. Špeciálna epidemiológia. 1. Vyd. Bratislava: Univerzita Komenského, 2007. 88s. ISBN 978-80-223-2354-3.
Bakoss, P. et al. 2005. Epidemiológia. 1. Vyd. Bratislava: Univerzita Komenského, 2007. 340s. ISBN 978-80-223-2301-7.
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GRAMMAR AND VOCABULARY INSTRUCTION IN ESP
SANDRA KOTLEBOVÁ

Slovak Republik, Trnava University in Trnava

E-Mail: [e-mail]


Abstract

The article underlines the importance of the interrelated inductive grammar and vocabularyinstruction for the student to meet the needs and peculiarities of ESP (English for Specific Purposes), which leads to academic English knowledge. It discusses the importance of the academic English language competence concerning certain lexical and grammatical minimum for higher education students, academics and researchers who are supposed to use English as a means of communication at conferences, meetings, in written papers, etc.

Key words:

Grammar. Vocabulary. Lexis. ESP. Academic English. Lexical minimum. Grammatical minimum.

ESP

ESP is defined to meet specific needs of the learners, making use of specific methodology and activities of the study field it serves and is centred on the language appropriate to these activities in terms of grammar, lexis, register, study skills, discourse and genre.ESP is mainly designed for adult learners athigher education institutions and professional work situations, as its competence is a must in any area of profession and the level to which one can master it,makes their overall skills much better and much more desirable in today labour market. In addition, ESP is what makes English the academic language needed for every academic and researcher who is supposed to read, speak, write, study, describe and explain their own ideas in a specific study or scientific field. This article discusses the relationship between grammar and vocabulary instruction in ESP as they are traditionally seen as separate areas in foreign language teaching. However, lexis binds to the grammar, which constitutes and shapes words in particular grammatical forms. The boundary between lexis and grammar is not sharp; there is a certain overlap (Repka, P. Gavora, P., 1987). They are integral components of the communication process and new trends and papers focused on academic English teaching show patterns of the use of vocabulary and grammar as an integral part of the proper use of academic English, and their teaching and learning definitely should be effectively combined. The ESPteacher shall focus on the patterns related to grammar and lexis in English in a way to easily support the students' language acquisition in four areas: comprehension, accuracy, fluency and flexibility.