Year three, no. 6 - June 2003 

Assistant Prof. Marija Strnad, MD, MPH, PhD, deputy general manager

The Second Congress of Croatian Senological Society took place 3-8 June 2003 in Dubrovnik. The topic “Epidemiology, primary health care and breast cancer” figured among others. Two publications had a promotion (i) “Breast cancer prevention and protocols for primary care physicians for diagnosis, treatment and follow-up of female breast cancer patients” (ii) “Guidelines for diagnosing, treating and following-up female breast cancer patients”. There was also a seminar named “Breast cancer epidemiology”, headed by M. Strnad and V. Stamenic. This widely attended seminar discussed methods for monitoring the epidemiological situation of breast cancer, epidemiological research and public health, collaboration between public health and other factors in health care, epidemiologists’ participation in the execution and evaluation of prevention programmes, and collaboration with nongovernmental organisations. In addition to group chairpersons, introductory presentations to the Seminar were given by J. Fajdic (Požega General Hospital), I. Tripkovic (Splitsko-Dalmatinska Public Health Institute), Lj. Kronja (Šibensko-Kninska County Public Health Institute), M. Leppee (Zagreb Public Health Institute), and D. Lazaric-Zec (Istrian County Public Health Institute). 

Minister of health-appointed Public Health Working Party had a session on 17 June with on the agendum “Plan and curriculum of specialisations and subspecialisations in epidemiology and public health”. Among those invited to the meeting were chairmen of the professional societies for epidemiology (B. Aleraj), public health (Z. Sosic), medical ecology (B. Cvoriscec was unable to attend), and M. Ljubicic. The activities considered will continue.

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

· Infectious Disease Epidemiology Department

Croatian Medical Association’s Croatian Epidemiological Society had its fifty-fourth meeting on June 13 at Crikvenica. Three epidemiologists from our department attended, presenting their papers. On this occasion, the applicability of epidemiologic working methods to different areas of medicine was reaffirmed by the accounts of participants’ activity. The epidemiologists illustrated their work from the areas of epidemiology of infectious diseases, vaccination, noncommunicable diseases, health promotion and health education. A total of 30 accounts were delivered. At the close of the meeting, reports were heard about the implementation of hygienic﷓epidemiological care during the Pope’s visit to Croatia. We are proud of those epidemiologists who provided the hygienic﷓epidemiological care, because it is their merit that the Holy Father’s entire visit, which was marked by mass gatherings of believers from various parts of the country, passed without human health hazards.
A debate on the topic “Epidemiology as a medical profession and fundamental medical specialisation in Croatia – the present state and future vision” ended the meeting. The conclusion of the debate, also the attitude of Croatian Medical Association’s Croatian Epidemiological Society, was that epidemiolgy should continue as the fundamental specialisation for the added reason that, according to the WHO attitude, epidemiology needs to be strengthened and introduced as a specialisation in those countries that lack it. 
We thank the hosts, Primorsko-Goranska County Institute of Public Health, for the hospitality and excellent support to and organisation of the meeting.

· Chronic Mass Disease Epidemiology Department

International Agency for Cancer Research of the WHO has published the eighth volume of “Cancer Incidence in Five Continents”. It contains cancer incidence data in over 200 populations around the world in the period 1993-97. Age-specific, standardised and cumulative incidence rates by sex and cancer site are given for each population. Publication of the “Cancer Incidence in Five Continents” series is considered a source of reference information on the world cancer incidence. This is the second successive publication to present Coatia’s cancer incidence as well. 

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

A Meeting with county appointees was held June 16 at CNIPH. It discussed the problems related to health statistical reporting by Primary Care Service, Medical Consulting Service and Hospital-type Service on the preceding reporting year, 2002. Other topics dealth with were data quality control and new instructions for completing individual health statistical case notifications. Given that data collection problems recur year after year, the suggestion came to impose fines on those failing to fulfill the legal obligation of submitting data and reporting properly. Pr Ranko Stevanovic has reported on computerization in Primary Care Service where, as a pilot project, information technology is introduced in 60 teams in eight health centres. Data submission by teams is via a closed internet system, accessed by smart card. The system generates daily reports, which improves the quality of data. As the norms required for the informatics equipment needed and the licensed and standardised software that the teams must possess will appear in the Official Journal of the Republic of Croatia, they will become a prerequisite to entering contracts in 2004 with the Croatian Institute for Health Insurance. 

A second (expanded) edition of “Instructions on completion of individual health statistical case cards” was printed with file formatting directions for health statistical reporting either on magnetic media or by e-mail. In the Annex titled “Directive”, examples are provided of properly filled forms, and of the properly completed electronic codes for these examples. Also appearing in the Annex are codebooks, the 5-digit ICD-10 included. Instructions can also be found on CNIPH’s web page.

The number of occupational diseases reported in 2002 was the lowest since 1990 when their monitoring and reporting became regular and compulsory. As few as 71 occupational diseases were reported, which is 22% less than in 2001 or 11.3% less than in 1999 (the lowest year until now with its 80 notifications). Most cases of occupational diseases came from the manufacturing industry, 28(39.4%), followed by agriculture, hunting and forestry, 18(25.4%), and from medical care and social welfare, 14(19.7%). In 2002, diseases due to the deleterious effect of vibration with 16 (22.5%) cases, infectious diseases with 13 (18.3%), hearing damage due to the deleterious effect of noise and chronic periartritic changes were diagnosed in 7 (9.9%) cases each. Further details on this can be found on the web page www.hzjz.hr/publikacije.htm. 

MICROBIOLOGY SERVICE
Head, Dr Vera Katalinic-Jankovic

Organised by the WHO and by the Polish National Institute of Public Health, a “WHO International Training Course on Salmonella and Campylobacter” took place 9-13 June 2003. D. Perkovic, MD, MSc, from our Bacteriology Division was a course participant. In addition to the salmonellosis problem - the principal topic of the last year’s Warsaw course – this year’s course also covered the isolation of Campylobacter sp. from human stool samples and from food equally. Countries with high civilisational and sanitary standards also encounter the problems of salmonellosis and campylobacteriosis, most frequently as food-mediated diseases. 
The course concluded that there was a need for permanent supervision of these diseases and causative organisms in the population, typing of these bacteria by use of more recent methods, as PFGE (pulse field gel electrophoresis), this to enable a better and more reliable data exchange.

HEALTH ECOLOGY SERVICE
Head, Krunoslav Capak, MD, MSc

A training course “Regulatory & Safety Infrastructure Development for Food Safety & Quality” for the Balkan states region was held 27 April-23 May 2003 in Sweden. It involved the following nutritional topics: international trade, integration of the SEE countries into European structures, WTO Agreement on Sanitary and Phitosanitary Measures, Food and Feed Act, legislation on veterinary medicine, zoonoses, GMOs, official control, follow-up, Codex Alimentarius, an HACCP course, fertilisers – plant protection, labelling, pesticide residues, drinking water, accreditation, laboratory testing, and the methodology and structure of reporting for the execution of the “follow-up” portion of a national study. Attending the course were three candidates from Croatia, i.e. from the ministry of health, ministry of agriculture and forestry, and CNIPH one each. 

At the May 31 Symposium on Prevention of Childhood Obesity in Skrad, Katica Antonic-Degac, MSc gave a lecture on the nutritional status and diet of Croatia’s children. 

In Vilnius, Lithouania, K. Capak, MSc, and Zrinka Petrovic, MD attended 27-30 May the UNEP﷓GEF-organised regional workshop. It is linked with the genetically modified product (GMO) area dealt with in Croatian Ministry of Environmental Protection and Physical Planning’s project “National Biosafety Framework Development in Croatia”. The main topics at the workshop were risk assessment, risk management, and the need for participation and other activity of the public.