Year three, no. 7 - July 2003 

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

Appointed Committee on Early Detection and Prevention of Cancer, led by Prof. Dr M. Samija from the Tumours Clinic, had its second session at the ministry of health. It was agreed that national early cancer detection programmes should be developed for breast cancer, colorectal cancer, uterine cervical cancer and prostate cancer. Programme co﷓ordinators are Assistant Professor Dr Marija Strnad for breast cancer, Professor Dr. Z. Ebling for colorectal cancer, A. Znaor, MSc for uterine cervical cancer, and Professor Dr. L. Kovacic for prostate cancer.

A Course on Health and Health Policy: Challenges of Decentralisation took place within the 10th Motovun Summer School for Health Promotion held 10-13 July. M. Erceg, MSc, Assistant Professor M. Strnad, and Assistant Professor S. Lang attended it on the part of CNIPH. On 10 July, they also visited the Istrian County Institute of Public Health in Pula.

An Appointed Committee charged with preparing health-related replies to the European Commission’s questionnaire has been set up at the Ministry of Health, Croatia. It is headed by Prof. Dr A. Bilic. Its CNIPH members are M. Erceg, MSc, M. Kuzman, ScD, and Pr V. Hrabak-Zerjavic, MSc.

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

· Infectious Disease Epidemiology Department

Working Group for Development of Educational Courses on Interventive Epidemiology for European managers concerned with infectious disease surveillance met in Lyon, France, in June. Assistant Prof. Dr Ira Gjenero-Margan attended this session.
Organised by UNAIDS and WHO, and attended for CNIPH by Bernard Kaic, MSc a workshop for assessment of the prevalence of HIV and AIDS was held in Šibenik 7-9 July 2003. 

· Chronic Mass Disease Epidemiology Department

In parallel with CNIPH’s other staff, the Epidemiology Service staff participated in producing the “Health Status and Health Determinants in the Republic of Croatia”, a document that is one of the answers to the questionnaire from the European Commission, thus answering a major part of the questions received so far. 

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

On 3-6 July the 10th Summer School on Health Promotion took place at Motovun. A Course on Media and Health – Solutions for Crisis Situations was organised as part of it. Zagreb University, Medical School, Andrija Stampar School of Public Health, Croatian Network of Healthy Towns, Croatian Medical Chamber, and Croatian Newspapermen Society were the course organisers. 
The attendees were medical workers, reporters, and public relations professionals from specialised institutions. Dr Dragica Katalinic and Bernard Kaic, MSc attended on the part of CNIPH.

The Course was a continuation of similar ones from previous years with a common purpose of familiarising health professionals with communication skills and improving collaboration between the information and health sectors. The importance of this dialogue definitely lies in promoting health and the quality of life as well. 

In workshops, the Course ran three days. It concluded that a draft Agreement on Procedures in Crisis Situations is necessary, suggesting that Ministry of Health of the Republic of Croatia, Croatian Institute of Health Insurance, Croatian National Institute of Public Health, Croatian Medical Chamber, Croatian Medical Syndicate, and Croatian Parliament’s Committee on Work, Social Policy and Health should be its signatories. Every health facility should have a detailed algorithm of procedures to follow at the time of crisis. Indicative of the importance of this problem area was the announcement that it should be a subject of debate at a session of the Parliamentary Committee on Work, Social Policy and Health scheduled for September. Croatian Newspapermen Society, respectively the Association of Newsmen monitoring health would pledge to observe when reporting the Ethical Codex of the Croatian Newspapermen Society. 

Within the Croatian Health Project, in its segment related to advancing health promoting activities at public health institutes on the basis of a World Bank loan (Cro-Can project), a study trip to the Centre for Health Promotion of the University of Toronto and to the Health Promoting Summer School was organised by institutes of public health in collaboration with the Canadian Society for International Health. Lectures and interactive exercises have covered an introduction to the concept of health promotion, the process of planning the transfer of knowledge and of communicating health promoting messages, programme evaluation, and the health-oriented public policy, as well as interdepartmental collaboration. Attendees visited the Ministry of Health of the Province of Ontario and various organisations oriented to health activities in the community, general population or special population groups. Prepared and presented were the projects that could be implemented in individual institutes and counties in the forthcoming period. At the Course, our attendees will be included both as listeners and as lecturers in the education process that is continuing as part of the CroCan project. Eleven medical doctors (from the Zagreb City Institute of Public Health, Šibensko﷓Kninska County Institute of Public Health, Osječko-Baranjska County Institute of Public Health, Istrian County Institute of Public Health, Croatian National Inastitute of Public Health, Andrija Stampar School of Public Health, and a Croatian Ministry of Health representative) have attended the Summer School.

MICROBIOLOGY SERVICE
Head, Dr Vera Katalinic-Jankovic

In the university town of Tartu, Estonia, the 24th Annual Congress of the European Society of Mycobacteriology took place 29 June-2 July 2003. 

There, engineer Mihaela Obrovac and doctor Vera Katalinic-Jankovic from our Microbiology Service presented a report “Drug resistance analysis of M. tuberculosis by means of drug susceptibility test and reverse hybridization﷓based line probe assay”. In the previous term, Dr. V. Katalinic-Jankovic was the president of the European Society of Mycobacteriology. The Congress programme covered a range of topical issues from the mycobacterial area, such as molecular epidemiology of tuberculosis, multiresistant tuberculosis, drug sensitivity test and new diagnostic methods, ecology of mycobacteria, epidemiology of other mycobacterial diseases, and new vaccine development. During the Congress, two courses were held, one dealing with the "identification of mycobacteria: new diagnostic tools and how to use them”, the other with “molecular epidemiology tools". Attending there enabled us to establish many technical and professional contacts and make arrangements for Croatia’s inclusion in the EU project “New genetic markers and techniques for the epidemiology and control of tuberculosis” (EU project QLK2﷓CT﷓2000﷓00630). 

HEALTH ECOLOGY SERVICE
Head, Krunoslav Capak, MD, MSc

A Food Act (Official Journal of the Republic of Croatia 117/03) to form a base for harmonisation of our food legislation with the EU has finally come out. Although a portion of our horizontal legislation is already harmonised, most vertical legislation still has not been harmonised accordingly. In a few days, the third, amended, issue of the Allowed Food Additives Regulation (first appearing in 1998) is due to come out. It incorporates the remarks received from food manufacturers and food importers, as well as all additions made to the EU regulations on additives between 2000 and 2003. 

Indicated in this Regulation is the separation between aromas, enzymes and substances auxilliary to the manufacturing process, which, in compliance with the Codex Alimentarius classification, were part of this Regulation. The List of Toxicologically Evaluated Additives has also been fully harmonised with the EU list. Some tables relating to the use of additives in individual food groups are extended, Table 8 (biscuits and cakes) now are amalgamated with Table 1 where milling and bakery products belong. Unfortunately, unlike their EU classication, other soft drinks like fruit juice or nectar have not been added to the Soft Drinks Table (currently Table 9). Nevertheless, this problem too will be solved by changing vertical regulations whose harmonisation with the EU should be completed by the end of 2004. 

The most important change occurred in Table 3 (Milk and Dairy Produce) with the introduction of a term “ice cream with the aroma of … fruit”. This means the concept of ice cream will be expanded to include such ice creams in which adding of food colours and of aromas is allowed, provided this has been properly declared. Thus, “ice cream with the taste of strawberry” will be allowed to contain as additive a synthetic organic colour (e.g. E122) and the aroma of strawberry without having been added this fruit. Provisions regulating puddings with fruit aroma follow the same line of reasoning, which is the only logical way to describe the composition of the product mentioned. For “strawberry ice cream”, the past rules will obtain unchanged. Adding colours E140 and E141 as additives to the pistaccio and kiwi ice creams colours will be allowed. The basic intention of this change is to have the products properly labelled as well as EU notified about the intake of additives in 2001. The latter has shown the ADI (acceptable daily intake) for synthetic organic colours to average half the levels recommended.

Nonetheless, this change was based on a draft new general food labelling regulation, which will also prescribe labelling for unpacked products, thus also including the marketing of ice creams sold in scoops at ice cream parlours. The labels of such ice creams will have to show the composition of the ingredients used in their manufacture, additives included; besides, they should be posted at a point clearly visible to the consumer. In ice creams with the addition of fruit, showing the quantity of fruit used in manufacturing it will be compulsory. Given the clear trend of openness to consumers not only in the EU but also in Croatia, it will soon become apparent what is acceptable to consumers and what is not. So long as consumer health is not threatened by additive intake, the consumer himself, in the setting of proper product labelling will decide whether to buy an inferior product or the one deserving it on the grounds of its composition. Additive intake control will also change the allowability of acceptable daily allowance of individual additives when it has been established that their ADI is high or exceeded. 
As part of the European Regional Biotechnology and Food Safety project, Krunoslav Capak, MSc, stayed in the US from 7-29 June. This was organised by the Department of State USA – Bureau of Educational and Cultural Affairs. The project aims are to provide education in the US in agricultural biology with special reference to vegetable GMO products, improve the understanding of the US Food Safety Regulation, and debate current and potential effects of biotechnology on world foood supply and on international agricultural trade. Thirteen representatives from nine European countries took part in this study trip. During the trip, the group visited all institutions (administration, science, industry etc.) concerned with passing the programme, carrying out control and inspection, as well as manufacture and marketing of modern biotechnology products. The above institutions are in four federal states (Minnesota, Missouri, California, and Washington).