OFFICE OF THE DIRECTOR

· Health Promoting Department

The first Meeting of South East European Countries within Bone and Joint Decade Project took place 6-7 October 2003 in Portoroz. The project was initiated by the World Health Organisation because of the ever-increasing number of people affected by musculoskeletal diseases and preventive needs. With Slovene colleagues reporting on everything done on the project so far, modalities of future collaboration in the SE Europe region were agreed. In view of certain activities in Croatia, such as traffic accident prevention programmes and prevention of osteoporotic complications, having preceded this project, we have a good base for joining it. Dr Branimir Bebek, a ministry of health representative, and Dr Tomislav Benjak, a CNIPH representative were members of the Croatian delegation.

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

· Infectious Disease Epidemiology Department

Infectious disease case/death notification (Official Journal of the Republic of Croatia 60/92) is an essential precondition for interventions. Therefore, we remind all physician colleagues of the professional and legal obligation to submit infectious disease notification by using the form. The main purpose of notifying about the occurrence of infectious diseases is to enable field interventions by epidemiologists. These interventions are frequently exigent; as to record keeping and analysis of the notifications received, they are secondary products of the infectious disease monitoring system. A notification must be sent within 24 hours of establishing a suspicion of notifiable infectious disease. In the case of noticing a grouping of infectious disease cases or an epidemic, notification of the event should be made by phone either to the local hygiene-epidemiology outpost or to the on-duty epidemiologist at Croatian National Institute of Public Health (098 22 77 53). 

We request that reports of other unusual events, such as sudden and unexpected death, unknown diseases and similar also be made by phone. 

Precisely because of their basic function, i.e. urgent outbreak control intervention, there is a 24-hour state of readiness on mobile phones in all county public health institutes. Phone numbers of the on-duty epidemiologists can be learnt from public health institutes of individual counties, and in Zagreb from the Zagreb Institute of Public Health. 

CNIPH’s ward epidemiologist took part in a 3-day introductory EPIET (European Programme for Intervention Epidemiology Training) course in France. The EPIET course is a 2-year programme of the European Union to train epidemiologists It was set up nine years ago with the objective of forming a network of equally well﷓trained epidemiologists, including the countries in which epidemiology is not a medical specialty. Comparing the EPIET curriculum with the specialisation in epidemiology in Croatia, we are pleased to note that the topics covered by the EPIET curriculum are fully covered by the Postgraduate Course in Epidemiology, which, in Croatia, is part of the specialisation curriculum. As regards the practical, it is organised very similarly to EPIET. In fact, the introductory course consists in studying the infectious disease monitoring system and epidemiologic methodics with a focus on analytic methods, being applied to both infectious and noncommunicable diseases. After the introductory course, programme trainees do two years of epidemiology work at some European public health institute, also attending statistical training, computer software user, infectious disease epidemiology, immunisation and other workshops. Despite the curriculum being envisaged for EU member and Scandinavian countries only, epidemiologists from third countries may enroll in the introductory course and in the training module in which they specialise. 

· Chronic Mass Disease Epidemiology Department

At the Second Croatian Symposium on Heart Failure with international participation, organised by Croatian Cardiologic Society on 10 October in Opatija, the head of Epidemiology Department delivered an invited lecture ‘Heart Failure Epidemiology in Croatia’. On 12 October in Cavtat, at the Sixth International Conference on Health, Insurance, Transition, which was organised by the Andrija Stampar School of Public Health, she presented ‘The Global Youth Tobacco Survey – Report for Croatia’. Croatian Academy of Arts and Sciences-organised scientific gathering took place in Zagreb on 17 October on the subject Association between Heart and Brain Diseases was held in Zagreb. There, she gave an invited lecture titled ‘Epidemiologic account of cerebrovascular disease risk factors’. 

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

Under the auspices of the Slovenian government, the Twelfth European Congress on School and University Health was held in Ljubljana 3-5 September 2003 with the motto, ‘We care for Europe’s young generation’. Pr Marina Kuzman, ScD, Dr Ivana Pavic Simetin and Dr Iva Pejnovic Franelic, Croatian participants at the Congress gave their lectures titled ‘Bullying, common health-problem symptoms, communication with the parents and friends of pupils in Croatia’ and ‘School health in Croatia, the type we need’. Stressing the importance of school health today when there are diverse trends in medicine, school health professionals had an extensive exchange of views, attitudes, concepts and knowledge, to enable the young generation of the future to benefit most from it. The EUSUHUM Presidency passed a decision to hold the next international congress on school and university students’ health in 2005 in Croatia. 

On 2-3 October 2003, member countries held a working session in Vilnius, Lithuania, on National Health Statistical Databases and Use of DPS (Data Presentation System) for data presentation at regional (local) levels. The meeting was attended by service head, Pr Marina Kuzman, ScD, who depicted the present state in health statistics, and exemplified the application of indicators in public health decision-making. 

On 6-10 October 2003, a Course on Health Promotion among Children and Youths: Violence-Free Society was held at the Inter-University Centre in Dubrovnik. Its concluding conference was organised in the framework of the Sixth International Conference on Biotechnology and Public Health at Cavtat. Pr Marina Kuzman, ScD, gave a lecture and held a workshop against child bullying in schools, and a speech on health promoting at institutes of public health in the “Learning for Change” module of the Cavtat Conference. 

MICROBIOLOGY SERVICE
Head, Dr Vera Katalinic-Jankovic

A “Molecular Tools and Epidemiology of Tuberculosis Course” was held 1-12 September 2003 in Paris. Organised by the National Reference Centre for Tuberculosis of the Pasteur Institute, it was attended by Mihaela Obrovac, ChE, from the Bacteriology Department. It consisted in lectures and a practical directed at the application of the molecular techniques required in the epidemiology of tuberculosis, and at analysis and application of the results obtained in various epidemiologic investigations of intrahospital outbreaks of tuberculosis, multiresistant tuberculosis, and of the results from national and European monitorings of tuberculosis. The lectures and practical covered different M. tuberculosis molecular typing techniques, e.g., IS6110-RFLP and polymerase chain reaction-based techniques (spoligotyping, LM-PCR and MIRU-VNTR). The Course ended with every participant being awarded a Pasteur Institute diploma.

HEALTH ECOLOGY SERVICE
Head, Krunoslav Capak, MD, MSc

Under the auspices of the minister of health Andre Vlahusic, MSc, the Seventh Scientific and Technical Conference on Water and Public Water Supply organised by CNIPH and by county public health institutes took place at Istarske Toplice 1-4 October 2003. In line with the UN Fresh Water Year, the Conference had ‘Croatia’s Fresh Waters’ for its main topic. 

Fifteen papers were delivered to a public of about 180 conferees. Through the Round Table venue, a discussion of legislation-, analytic procedure-, and result evaluation-related problems took place. The gathering closed with a run of the Butoniga Lake, Butoniga water supply system’s water treatment facility, table-water factory Vistra and Ziva voda, as well as Buzet Brewery (BUP).

The WHO-organised first Meeting of the Working Group on Environmental Health Information System (EHIS) was held at The Hague 1- 2 October 2003. It was to prepare a ministerial declaration for the Budapest conference on environment and health scheduled for 2004. Host to the meeting attended by representatives of 33 European countries and a number of international agencies and institutions was the Dutch ministry of health. Croatia was represented by Krunoslav Capak, MSc.

Within preparations for the Fourth Ministerial Conference on Environment and Health to be held in Budapest 23-25 June 2004 came the formation of an Ad Hoc Working Party for Drafting a Political Document on CEHAPE (Children’s Environment and Health Action Plan). It should be adopted and signed by health and environmental protection ministers. Our national representatives at the Conference were Dr Zrinka Petrovic and Mrs. Biserka Puc, a senior technical advisor from the Ministry of Environmental Protection and Physical Planning. The Ad Hoc Working Party for Drafting a Political Document on CEHAPE had its Second Session in Ljubljana, 25-26 September 2003. Its main topics were CEHAPE – the ministerial document, Conference programme for the Budapest meeting, and CEHAPE, framework chain of actions to protect child health from 14 environmental risk factors. Stated to belong among priority objectives were safe child enviroment, air purity, ensured access to wholesome water in combination with suitable sanitary conditions, protection of children from certain physical and chemical agents, and the creation of a national action plan for children’s environment and health until 2005. Following the objections voiced by representatives of the countries to certain European Action Plan elements, it was concluded that further improvements to the plan objectives and priorities should be made, and that the introductory part of CEHAPE needs restructuring.

The 9th Euopean Nutrition Conference was held in Rome 1-4 October 2003. The CNIPH staff participated actively: Katica Antonic Degac, MSc, and Dr Zrinka Petrovic with papers ‘Nutritional status and dietary habits of Croatian schoolchildren’ (authored by Petrovic Z, Antonic Degac K, Kaic-Rak A, Mesaros-Kanjski E, Capak K) and ‘Dietary Habits and Cardiovascular Disease Mortality in Croatia’ (authored by Antonic Degac K. Kralj V, Kaic-Rak A, Capak K, Petrovic Z). In addition, Lea Pollak, ChE, presented the paper ‘Gluten in Gluten-free Foods’ authored by herself and Balenovic J.