Year three, no. 5 - May 2003 

Director’s introduction
Marijan Erceg, MD, MSc

A paper called “Health safety to promote tourism” was presented at a gathering devoted to medicine and tourism that was held May 26 at the Solaris Hotel, Šibenik. Though being a fundamental resource for sustainable development, health and health safety issues are not covered by development strategies for tourism and economy. A need for interdisciplinary approach and improved collaboration in these matters was highlighted. 

Talks on public health network took place at the Croatian Ministry of Health. Representatives of the Croatian Institute for Health Insurance and of Croatian Medical Chamber gave their backing to the proposal on Hygienic-Epidemiologic Service network. Talks on other public health networks continue.

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

· Infectious Disease Epidemiology Department

In the capacity of a WHO adviser, head of the Infectious Disease Epidemiology Department went on a trip to Bulgaria to take part in an assessment of the effectiveness of its infectious disease surveillance and control system. Surveillance of infectious disease also being a WHO and EU priority, this initiated a process of assessment and advancement of the epidemiological system and laboratory support (bacteriological, parasitological and virological) in the area of infectious disease surveillance on the European level.

In the past two months, the Department staff gave a number of lectures on the epidemiology of infectious diseases. At the Infectious Disease Clinic a lecture dealt with haemorrhagic fever; a lecture on bioterrorism at the Congress on Infectology in Dubrovnik dealt with anthrax. The lecture in Zagreb was about morbilli as a topic within a continuing education programme for physicians.

Within training lectures on SARS, the Department’s physicians jointly with physicians from the Microbiology Service, Social Medicine Service as well as from the Infectious Disease Clinic gave lectures in Zagreb, Rijeka and Osijek to their medical colleagues.

An Infectious Disease Annual Report, 2002, was prepared dealing with the diseases subject to monitoring within the epidemiological information system. The monitoring covers 74 infectious diseases and 69,000 individual infectious disease notifications (not counting influenza) were processed. As to data presentation, it illustrated morbidity, mortality and lethality by age, sex, hygiene-epidemiology outpost, month and county. 

It bears noting this time again that the prime reason for infectious disease monitoring is to make an intervention, which subsumes epidemiological investigation and survey and, at need, taking of epidemic control measures.

· Chronic Mass Disease Epidemiology Department

Organised by Croatian Medical Association and by Croatian Society for Atherosclerosis, the Fourth Croatian Congress on Atherosclerosis with international participation took place 14-17 May 2003 in Dubrovnik. The programme consisted of invited lectures and poster presentations. It dealt with current atherosclerosis-related topics, its epidemiology, pathogenesis, risk factors, and scope for prevention, diagnosis and treatment. As an invited lecturer, V. Hrabak﷓Zerjavic presented on the part of CNIPH a lecture “Epidemiology of cardiovascular diseases in Croatia”. Pr V. Hrabak-Zerjavic, MSc, Dr V. Kralj, Dr M. Silobrcic-Radic, Dr I. Brkic, and Dr Z. Petrovic authored seven poster presentations on cardiovascular diseases and their risk factors. 


Marking this year the World Nonsmoking Day (May 31), the World Health Organisation emphasized the role of the film and fashion-item industries in the prevention of smoking. For the purpose they created this year’s slogan “Tobacco free film, tobacco free fashion, Action!”. 

A joint symposium by Senologic Society and the Society for Reconstructive Surgery called “Breast cancer – diagnosis and treatment recommendations” was held on 9 May at the Dubrava Clinical Hospital. There, Ariana Znaor, MSc delivered a lecture “Incidence of breast cancer in Croatia”. 

SOCIAL MEDICINE SERVICE
Head, Pr Marina Kuzman, MD, MSc

According to the Croatian Institute for Health Insurance branch office and outpost monthly reports, Croatia had 21,184 industrial accidents in 2002. Most of these (83.4%) happened at workplace itself, 16.6% occurring in commuting to and from work. Industrial accident notifications showed 44 people to have died on the spot or on the way to hospital, 5 died in a hospital; as regards an extra 16 people the data were received from other sources (State Inspectorate and Confirmation of Death). This made the number of fatalities rise to 65. Traffic fatalities accounted for most deaths. While in 2002 we registered continued slight decline - 3.6% (a 1.5% decline in 2000/01) - in industrial accident total, we also noted a rising trend in injuries with fatal outcome of 4.8% (a 5%﷓increase in 2000/01). 

Owing to the logistical support of county public health institutes and of the media that have heralded WHO’s “World Health Survey”, our field interviewers have achieved a very good response rate in the households selected. About 10% of the surveys have been published so far. Thus, we hope to come close to a figure of 1,000 completed surveys by the end of June, this also being the survey target in Croatia. Further details about the survey can be found on our web page.

The First Adriatic Conference on Addictions: Treatment, Reduction of Damage and Rehabilitation took place in Poreč 21-22 May 2003. In Piran on May 23, the First Symposium on Addictions in Countries of Central and South East Europe was held, dealing with substitution therapy, and regional co-operation. The Conference and the Symposium were organised jointly by institutions from three neighbouring countries: Centres for Treatment of Addictions, Croatia; Coordination of Centres for Treatment of Addictions and the “Odsev se sliši” institution, Slovenia; Department of Psychiatry and Addictions, University of Trieste, Italy. Many professionals for addictions from all European countries and the USA attended the Conference. Attending on the part of CNIPH were Pr Marina Kuzman, MD, MSc and Dr Dragic Katalinic.

MICROBIOLOGY SERVICE
Head, Dr Vera Katalinic-Jankovic

Fifth in succession, the Symposium on Sexually Transmitted Diseases, held in Opatija 14﷓16 April 2003 attracted the largest audience and the greatest number of papers so far. Its chief topics were STD prevention among young people, new diagnostic and therapeutic guidelines for infections with chlamydial, human papilloma and herpes viruses, and the association between sexually transmitted infections and malignant diseases of the female urogenital system.

This Service was represented by conferees Drs Z. Persic and Ljubin-Sternak with the paper “Chlamydia thrachomatis and Ureaplasma urealyticum in patients with uterine cervical dysplasia”, as well as by Dr. V. Kruzicevic and B. Hunjak, MSc with the paper “Gardnerella vaginalis in cervical infections”. 

Great interest among our primary care colleagues has justified again the holding of such gathering, pointing to the importance of the problem of sexually transmitted diseases in our population. It was shown again that prevention of sexually transmitted diseases is made feasible only by collaboration among clinicians, diagnosticians, epidemiologists and primary care physicians. 

From 5-10 May 2003 there was a Course on Influenza Virus Diagnosis by Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA and World Health Organisation. Its participants were representatives of countries from our region, acting in influenza virus diagnosis as national centres. Dr. V. Drazenovic represented Croatia's National Centre. In part the Course took place at CDC, and partly at the Institute of Public Health, Georgia. The course provided education on the epidemiological and virological monitoring of the influenza virus, reaffirming the role of the National Centre and its laboratory in this regard. As to virological diagnosis, the emphasis was on different forms of influenza virus isolation and on antigenic virus typing by using polymerase chain reaction (PCR). It was concluded that whereas the present role of the National Centre is fully satisfactory, in prospect the Centre should accelerate the dispatch of isolated strains by using improved means of transport, and introduce new molecular diagnostic methods.

HEALTH ECOLOGY SERVICE
Head, Krunoslav Capak, MD, MSc

A Seminar on rapid methods for microbiological water analysis held 19-20 May 2003 in Opatija was organised by IDEXX (a US firm) and their Croatian representative Vendicija d.o.o. from Samobor. 

Methods for qualitative and quantitative determination that are based on the reaction of a specific enzyme and culture medium were presented. They have the advantages of dispensing with the need for complex training, permitting specific identification (that eliminates the interference from nonspecific bacteria), avoiding subjective interpretation that is present in classic tests, enabling the detection of the individual bacterium searched for. Besides, these methods have been confirmed as alternative methods in most EU countries. CNIPH will carry out comparative testing and, if the results are satisfactory, will adopt them as alternative methods for drinking water analysis. 

The Seventh Symposium of Croatian Society of Cosmetic Chemists (CSCC) took place in Hvar 7-10 May 2003. It was attended by some 120 conferees from several European countries, with Vjera Haberle, MSc, attending for CNIPH. A novelty was the participation of manufacturers of household and industrial cleansing agents, explainable by their using the same basic raw materials. In the technical section, presentations on rapid methods for microbiological analysis and new EU directives for vegetal preparations in cosmetic products, as well as dermatological topics of contact hypersensitivity to corticosteroids, contact allergy to a mixture of fragrances and contact dermatitis in hairdressers greatly interested the participants. Within the Symposium, presidents of AISA (International Association for Soaps, Detergents and Maintenance Products), CSCS, Croatian Chamber of Economy and CNIPH held a meeting devoted to the linking of the Croatian group with AISA.

As part of the “Stability Pact for South Eastern Europe (Social Cohesion Initiative) the Centre for Environment and Health, WHO, and EU organised the First Workshop on Food Policy and Legislation, on 12-16 May 2003 in Belgrade. Professionals from the EU institutions concerned with the health safety of foods gave detailed presentations of the EU legislation dealing with this area, and on its implemental elements. 
Participants were requested to use a questionnaire to describe relevant conditions in their respective countries and discuss a number of topics that were of special interest to each country. Croatian representatives Krunoslav Capak, MSc, and Marijan Katalenic, MSc, chose the topics of National Food Agency and implementation of ISO norm 17025 in laboratory accreditation. Most participants expressed their interest in elaborating national strategies for ensuring the health safety of foods. The above topics were proposed for the next workshop to be organised by WHO/EU Centre for Environment and Health. 
We were greatly honoured by health safety adviser to the European Region of WHO, Dr Cristina Tirado wishing to see the next workshop take place in Croatia.