During March, within the Forum on Preventive Medicine four lectures were held at the amphitheatre lecture hall in Rockefellerova 2. Brigadeer general Michael Rath, MD, commander of Minnesota’s National Guard gave a lecture on disease prevention, health promotion and public health indicators in the USA.  Mrs. Mira Katalenic, chair of the Croatian Society for Seeing Eye Dogs and Mobility, described the specifics of the treatment of and communication with the blind.  Professor Doris Bardahle from the North Rhein-Westphalia Institute of Public Health dealt with the topic “Indicators for health status assessment”. The final lecture in March was an evaluation by Assistant Professor Slobodan Lang, deputy director for medical issues, and by Dr Slavko Sobot, head, Research Unit, CNIPH of the preventive medicine forum held so far.

INFECTIOUS DISEASE EPIDEMIOLOGY SERVICE
(Croatian Ministry of Health Reference Centre for Epidemiology)
- Head, Prof. Ira Gjenero-Margan, MD, DSc

The 2003/2004 season saw 65,180 influenza cases reported, around 20,000 fewer than in the previous season.

Despite the predictions at the beginning of the season that were based on morbidity in North America and West Europe, envisaging substantially more cases in this season than the last, neither were the numbers larger, nor did the more severe clinical pictures than usual predominate.   The age distribution roughly approximated those from previous years, with the highest incidence being recorded in preschool and schoolchildren.  Basing itself on the monitoring of viral strains in circulation, WHO has published the following recommendation regarding the vaccine composition for the next season: A/New Caledonia/20/99(H1N1)-like virus, A/Fujian/411/2002(H3N2)-like virus, and B/Shanghai/361/2002-like virus.

CHRONIC MASS DISEASE EPIDEMIOLOGY DEPARTMENT
- Head, Pr Vlasta Hrabak-Zerjavic, MD, MSc

Invited by Dr J. Haafkens, WHO/EURO programme co-ordinator for Gender Mainstreaming and Women’s Health, Professor Marija Strnad and Pr V. Hrabak-Zerjavic attended on 26-27 February in Copenhagen a case study planning meeting Integration of Gender Perspective in Health Policy.   The invitation to this preparatory meeting was a result of Dr Haafken’s earlier trip to Zagreb and of the choice of CNIPH staff members to take part in a case study on cardiovascular diseases conjointly with professionals from the Netherlands, Great Britain and Ireland.  To analyse female reproductive health Turkey, Kirghistan and Tajikistan enter into the same tudy. 

CNIPH has joined the European Cervical Cancer Association (ECCA) membership. ECCA is a European Commission-financed international association aiming to disseminate information on uterine cervical cancer and prevention possibilities in Europe.  Translating the ECCA leaflet into Croatian and preparing an ECCA web page in Croatian are our current international activities.  Ariana Znaor, MD, MSc is CNIPH’s representative at the ECCA.

ADDICTION PREVENTION SERVICE
- Head, Pr Marina Kuzman, MD, ScD

MICROBIOLOGY SERVICE
- Head, Dr Vera Katalinic-Jankovic

TB Day, world day of the fight against tuberculosis, was marked in Zagreb on 24 March at Croatian Medical Association.  Organised by CNIPH and by Croatian Pulmonological Society, the gathering covered the subjects intended for pulmonologists, epidemiologists and microbiologists. Dr Vera Katalinic-Jankovic from the Department of Bacteriological Diagnosis of Tuberculosis, CNIPH spoke on the subject “Gene typing of M. tuberculosis and its role in molecular epidemiology”.  In spite of M. tuberculosis having a highly preserved genome, the polymorphism of repetitive, non-coding elements constitutes the basis of modern gene typing of M. tuberculosis. The M. tuberculosis gene typing methods for epidemiological purposes are used to acquire new knowledge on the transmission of tuberculosis and on the development of effective strategies for its prevention. Other purposes are discovering of transmission routes of drug-sensitive and drug-resistant strains of M. tuberculosis, distinguishing a relapse from a newly acquired infection, identifying clusters during an epidemic, ensuring rational use of medical resources for an adequate monitoring and control of tuberculosis. These gene typing methods are also used to detect contamination in sampling (intrahospital infections), and to detect laboratory contamination.   

One of the many gene typing methods having become the golden standard in the molecular epidemiology of tuberculosis is IS6110 RFLP (restriction fragment length polymorphism).  It is based on differences in the number and position in M. tuberculosis of the insertion sequence IS6110.  The objective of the Croatian National Institute of Public Health Reference Laboratory on Mycobacteria is to gene type with this method all strains in new cases of tuberculosis, establish the presence and trends of the drug-resistant tuberculosis nationally. It strives in this way to get included in the international studies encouraged by the World Health Organization and by the International Union for Control and Prevention of Tuberculosis.

HEALTH ECOLOGY SERVICE
Head, Krunoslav Capak, MD, MSc

The 16^th Seminar on Disinfection, Desinsection, Deratisation (DDD) and Protection of Stored Agricultural Products with International Participation took place in Porec on 17-19 March. Lectures titled “Do GMOs pose a human health hazard?” and “Importance of proper disinfectant selection and of their widespread use” presented by Krunoslav Capak, MD, MSc, respectively Andreja Barisin were contributions to promoting the interdisciplinary activity of DDD and protecting stored agricultural products.

To mark the World Water Day, 22 March, a news conference was convened at which Dr Slavko Sobot, Dr Zeljko Dadic and Mr. Edo Lovric, staff members of the Water and Mineral Water Chemistry Department, respectively Water and Water-Supply Safety Department informed the public about a number of important and interesting points concerning water.  

Croatia disposes with larger drinking water resources than many other European countries, owing to its specific geographic position, characteristics of its relief and geology, and peculiarities of its climate.

Over the past 20 years, our public water supply grew at an annual rate of 1%.  At the last population census and according to the monitoring of public water supply development, almost 77% of Croatia’s population has a link to a major or minor water supply system.

The remaining 23% of the population are supplied with drinking water from other public water supply installations. These must be distinguished from public water mains. Alternatively, they may have water supply facilities of various designs (drilled or dug wells, plunged pumps etc.) of their own.

There is a direct link between the modes of water supply for the population and water safety, and hence human health.  The portion of the population with attachments to a public water supply (especially to such major systems) has the safest water to drink. This is due to public utility laboratories as well as special and accredited public health institutions’ laboratories applying stricter water quality control regimens.  The safety of drinking water from public water mains in this country has been monitored on the national and county levels for many years.  As coverage with public water supply differs from one county to another, its health safety does similarly.   Overall, in the past 10 years in Croatia as a whole, fewer than 10% of the 23,000 water samples tested at public health laboratories annually were unsafe.  

For drinking water, health safety and monitoring are governed by the Drinking Water Safety Regulation (Official Journal of the Republic of Croatia 46/94 and 49/97).  The Sanitary Inspectorate in collaboration with accredited laboratories does this job.  Mostly they belong to county institutes of public health, CNIPH and other institutions accredited by the Ministry of Health.

The water for water bottling may potentially come from underground waters.  These make up about 12% of Croatian water total.   Even so, this quantity is considerably greater than the world average. Today, the quality of underground water in Croatia is considerably superior to the quality of underground waters in highly developed countries.  The main reasons for its satisfactory quality are the limited development of the country and its sparse inhabitation, with rational water resource management only partly contributing to the picture. 

There are regions in Croatia with potentially acceptable locations of high-quality water sources.  Ultimately, such water can be bottled in glass or PET packaging either as natural mineral water or as source water.  The above regions are Hrvatsko Zagorje, Prigorje, Banovina, Lika, and Dalmatia.   Across the area, there are a great number of sources with this potential.   In order to bottle this water in acceptable packaging, its quality has to be tested through one hydrologic year at different water tables (low, average, high).  A hydrogeologic survey of the area to explore the capacity of sources, establish water protection areas and look at all other conditions laid down by the Basic Safety Requirements for Natural Mineral, Source and Table Waters (Official Journal of the Republic of Croatia 58/98) is to be taken. 

In March, five seminars for school health team nurses were organised and held according to the “Obesity Prevention Programme in School Population” by the Nutrition Physiology, Monitoring and Promotion Department in collaboration with the School Health Service. The venues were Zagreb, Rijeka, Split and Osijek.  About 150 nurses from all over Croatia attended them.  The training seminar consisted of five lectures and three workshops.  The lecture by Pr Marina Kuzman, MD, ScD was titled “The role and potential of nurses in health education”.  Dr Zrinka Petrovic gave a lecture titled “Proper diet and disease prevention”. Katica Antonic Degac lectured on “Nutritional status and the obesity problem in Croatia’s child population”.  “HBSC survey findings” were presented by Dr Iva Pejnovic Franelic and Dr Ivana Pavic Simetin.  Prepared for the seminars and handed out to the nurses were the teaching materials named “Nutritional guidelines on children”. They were designed for the nurses teaching primary school classes’ 1-4 proper diet.