Year three, no. 1 - January 2003 

Director’s introduction
Marijan Erceg, MD, MSc
Health Care Bill was debated at a CNIPH (Croatian National Institute of Public Health) Technical Council meeting. There was another debate of the law in Zagreb on 16 January 2003 at a public health institute directors’ meeting. An appraisal of the bill (with minutes of the two meetings attached) was forwarded to the Ministry of Health. Directors of the institutes were informed about the idea to organize the First Croatian Congress on Preventive Medicine and Health Promotion with an invitation to all of them to collaborate in its organization.
CNIPH has initiated the setting up of a Working Group for Promotion of Proper Nutrition and Physical Activity with the aim of developing the guidelines and a working programme for this area. The Working Group then elected Zrinka Petrovic, MD, as its chairperson.

Assistant Prof. Marija Strnad, MD, MPH, PhD, deputy general manager
A starter meeting related to the project “Atlas of Cancer Mortality in Central Europe” took place 20-22 January 2003 in Warsaw. Examined by the project is the mortality trend for cancer total and for individual cancer sites in the period 1993-97. The meeting was convened by Professor W. Zatonski from The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, which is a WHO collaborating centre in Warsaw. It was a joint convening with P. Boyl from the European Institute for Oncology, Milan, Italy. Assistant Professor M. Strnad, MD, MPH, PhD, A Znaor, MSc, U. Rodin, MSc, B. Tomic, MD and T. Benjak, MD will be participating on the part of CNIPH.

EPIDEMIOLOGY SERVICE (Ministry of Health Reference Centre for Epidemiology)
Head, Pr Vlasta Hrabak-Zerjavic, MD, MSc
· Infectious Disease Epidemiology Department

Given the increasing number of enquiries about the beginning of the influenza season, we take this opportunity to let you know that infection with influenza virus has not been confirmed in Croatia yet. Two days before this section was written, the first oral report came in of a larger number of people seeking medical assistance because of the influenza syndrome. Therefore, as in previous years at the beginning of the season we will organise the gathering of samples for virological analysis aimed at finding the evidence of infection with influenza virus.

This winter the occurrence of influenza in Europe was merely sporadic (Spain, Portugal, Poland, Finland, Latvia) with some local clusters. In other words, no major outbreak has been recorded anywhere yet. Type B which, as a rule, causes a milder clinical picture than type A, dominates among the influenza virus isolates in reference laboratories of these countries.

The International Sanitary Regulation is undergoing revision by the World Health Organisation (WHO). On the occasion of this, one meeting attended by representatives of the Mediterranean countries was held in Rome on 20-21 January. There Croatia was represented by a member of this Department in the capacity of a national focal point (person nominated by the Ministry of Health for Regulation revision work and co-operation with WHO on this issue) and by the head of the Ministry of Health’s Sanitary Border Inspectorate.

The World Leprosy Day, i.e. day of the fight against the Hansen disease (named for the Norwegian physician who identified its causative agent in 1873) is marked on 26 January. From 10-12 million cases in 1985 the figure dropped to 750,000 in 2002. The disease still occurs in Asia, Africa, South America and, very rarely, North America. The last leprosy case in Croatia was reported in 1993 in a foreign national, i.e. an imported case. As there still are some endemic leprosy foci in the world, CNIPH’s Microbiology Service has kept the microbiological diagnosis of leprosy, applying it when necessary.

With the aim of abolishing the last leprosaria still existing in some developing countries, this year’s World Leprosy Day is marked by the slogan “homeless no more”. This will lead to the administering of therapy at patient’s home, decisive step in the fight against his stigmatisation.

· Chronic Mass Disease Epidemiology Department
The 4th Croatian Congress on Atherosclerosis is scheduled to take place 14-17 May 2003 in Dubrovnik. With cardiovascular diseases a public health priority, topics of public health importance (as epidemiology of cardiovascular diseases, life style and cardiovascular diseases, primary prevention of cardiovascular disease etc.) are among the leading ones at the Congress.

In connection with cardiovascular diseases, World Cardiological Association emphasizes the importance of psychic stress as a predictor of fatal ischaemic insult (Stroke 2002, Jan; 33(1):7-12).

SOCIAL MEDICINE SERVICE
Head, Pr Marina Kuzman, MD, MSc
The 27th International Congress on Occupational Health is to take place 23-28 March 2003 in Iguasso Falls, Brazil. Held triennially, it will be attended by Vlasta Deckovic-Vukres, MD, DSc, who will participate in this event with a paper “History of Occupational Health in Croatia” whose other authors are Professors J. Mustajbegovic and E. Zuskin, and academician M. Saric.

Global Youth Tobacco Survey (GYTS) was conducted in all sampled schools. School doctors from all counties and the City of Zagreb interviewed the primary school sixth, seventh and eighth formers, as well as secondary school first formers. Before doing the survey, the doctors had completed a training course which, under the given survey methodology, was organised at CNIPH in December 2002. The scanning of completed questionnaires and processing in Epi Info program will take place at CDC (Center for Disease Control) in Atlanta. For Croatia and other countries on GYTS, the results will be published upon completion by all national co-ordinators of a WHO training course planned for spring 2003.

Since 1995, the European School Survey Project on Alcohol and Other Drugs (ESPAD) has been undertaken at 4-year intervals under Council of Europe auspices. This year will see Croatia’s participation for the third time. As on two previous occasions, CNIPH is project carrier and co-ordinator. ESPAD is the source of a range of epidemiological data on the use of alcohol, tobacco and drugs in schools, full comparability of this data being assured through a harmonised and standardised execution method. The validity of comparative data permits any country to realise the extent of its problem nationally and regionally, and rate its position in the European setting accordingly. Performing the study for the third time allows trends in certain habits to be monitored.

MICROBIOLOGY SERVICE
Head, Dr Vera Katalinic-Jankovic

There are a growing number of references in the literature on TB diagnostics to QUANTIFERON- TB (QFT) as an additional aid in diagnosing a latent Mycobacterium tuberculosis-caused infection. Approved in 2001 by FDA (Food and Drug Administration, USA), the test is employed as a confirmatory test for skin tuberculin test results. If both tests are positive, the probability of the presence of pulmonary tuberculosis due to M. tuberculosis is greater. Similarly as skin tuberculin test QFT is based on cell immunity reaction measurements. In addition, QFT measures the concentration of excreted gamma-interferon (IFN-g) from the lymphocytes excited in patient bloods.

The test requires collecting blood samples from a potential patient. Together with purified protein derivative from M. tuberculosis (PPD, i.e. tuberculin) and control antigens, heparinised blood is incubated for 16-24 h, after which the concentration of the IFN-g secreted from plasma is measured using the ELISA (enzyme-linked immunosorbent assay) method. This new test has an advantage over the classic skin tuberculin test: it eliminates subjective errors at the reading of results.

QFT is designed to diagnose pulmonary tuberculosis in individuals at greater risk of developing this tuberculosis (migrants from high-prevalence countries, i.v. drug addicts, prisoners and jail staff, health workers with increased exposure to tuberculosis), and for the needs of epidemiological surveillance, or for conditions of a potentially large outbreak in a sensitive population group (army, hospital staff with low risk of exposure) with M. tuberculosis.


HEALTH ECOLOGY SERVICE
Head, Krunoslav Capak, MD, MSc
International Fresh Water Year 2003
Of all water on Earth only 2.5% is accounted for by fresh water, the rest being saline water. As to this fresh water, most of it is either frozen in glaciers, present as soil humidity, or inaccessible in deep underground water-bearing layers. This leaves less than 1% of all fresh water accessible for use.

The sustainable development of mankind depends on the availability of fresh water. More than a third of the world food production is estimated to be based on irrigation. Despite the progress made in the past two decades, around 1.1 thousand million people have no access to safe drinking water, with 2.4 thousand million living without basic sanitation. Water-deficient areas are getting larger, especially in North Africa and West Asia. In 20 years from now total water demand is expected to increase by 40%. In 2025, two thirds of the world population will live in a country affected by medium or acute water shortage.

Croatia has more drinking water available than many other European countries. Owing to its specific geographic position, features of relief and geology and climatic specifics, this country disposes with over 8700 m3 water/inhabitant/year. However, the uneven distribution of water, unresearched and unestimated water reserves and water quality combined with accelerated pollution of water sources are the causes of poorer drinking water supply in some parts of Croatia.

In order to “increase the awareness and encourage action for better management and protection of this crucial resource” the UN have proclaimed 2003 the International Fresh Water Year. During this year there will be an opportunity for us to amend our behaviour toward water. By protecting our fresh water resources we help ensure our future and secure a long-term prosperity for our planet. CNIPH will be marking the International Fresh Water Year with a number of activities and keep the readers of this News informed about their progress.