The protection and promotion of tourist health is a new branch of public health and preventive medicine.  Tourism, respectively any travel, is connected with certain health risks as well.  Nevertheless, most of these are avoidable or substantially reducible by suitable education, health promotion, disease prevention and protection of the environment.  These activities require anyone engaged in tourism to show equal responsibility: visitors as much as the local population on the one hand, and tourist workforce, health professionals and local authorities on the other.

In taking care of tourist health one should take account of the interaction between tourist population (characterised by massive numbers, mobility, seasonality, regional expansion, brief grouping in a limited area, and vulnerability) and tourist setting, respectively environment at a new destination during the rest.

Health, rest and recreation are the prime motivations for tourism.  Having tourist trade without providing health care to the tourists, and to the local population and environment of the travel destination country is therefore inconceivable.  Medicine and tourism are narrowly intertwined and mutually conditioned.

Publishing public health topics on the Internet is our way of contributing to a better information and education of the public; the present writing should contribute to healthier, safer and more agreeable resting in particular.

INFECTIOUS DISEASE EPIDEMIOLOGY SERVICE
(Ministry of Health’s Reference Centre for Epidemiology)
- Head, Prof. Dr Ira Gjenero-Margan

In July 2005, an agreement was reached on the signing of a co‑operation contract with the Dubrovačko-Neretvanska County on voluntary, free and anonymous HIV consultation and testing in Dubrovnik and Korčula.  This guidance centre, due to start operation on September 1, is the seventh opened as part of the “Greater Accessibility of Voluntary Testing and Consultation” project run by the Infectious Disease Epidemiology Service.

In July and August, the Service staff provided consulting assistance to county public health institutes and other health institutions on several occasions on the matters of epidemic investigation and control.   

To forestall its shortage, the Service also co‑ordinated the purchase of extra supplies of the anti‑rabies vaccine.  As certain amounts remain accessible, the antirabic stations whose vaccine stocks could be nearing depletion can contact the Infectious Disease Epidemiology Service for a supply in the quantities for use until regular delivery, which will take place as usual through a central distributor. 

As owing to the high vaccination coverage maintained by us for years, we are on the verge of measles and rubeola eradication in Croatia, it is necessary to improve the monitoring of these diseases.  For this purpose, we have sent all epidemiology services instructions on extra activities to take when notifying measles and rubeola cases.  It is also necessary to remind primary care physicians and clinicians of the need to report immediately any suspects of these childhood diseases.

The Preparatory Plan for an Influenza Pandemic drawn up by this Service is under revision in the light of new WHO documents. 

According to the Medicament Act and an instruction from the Ministry of Health and Social Welfare, an information exchange mechanism with the Drug and Medical Product Agency has been established for the matters of side effects upon the administration of a vaccine.

International collaboration is also running normally.  For example, in July, we contacted the Austrian National Institute of Public Health to throw more light on a food epidemic, and in August, we asked the Italian National Institute of Public Health to explain the problem of a grouping of food poisoning cases.

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

The Service has drawn up a bill of the Croatian Anti‑Smoking Action Plan as part of its collaboration with the WHO/EURO.  The plan was developed in keeping with the WHO Framework Convention on Tobacco Surveillance, whose signatories we are, Council of Europe directives and the European Strategy against Smoking.  The first draft of the bill was debated at a meeting attended not only by health sector representatives, but also by those of other ministries.

At the International Association of Cancer Registries (IACR) in Lyon Ariana Znaor, MSc attended an analytical course on time trends in cancer incidence and mortality.

SOCIAL MEDICINE SERVICE

- Head, Pr Urelija Rodin, MD, MSc

As in invited lecturer, Pr Ranko Stevanovic, ScD presented two papers “Telemedicine Segment of the Croatian e‑Health System” and “Development and Deployment of an Information System” at Desio, Milan, Italy on 8‑10 July 2005 at the e‑Government & e‑Health 2nd International Conference and Exhibition.

At the 11th Motovun Health Promotion School, held on 13-14 July, Pr Ranko Stevanovic, ScD led the Information System a Precondition for Quality Management Workshop where he presented his work “Establishment and Development of a Health Information System a Precondition for Quality in Health”.  

SCHOOL HEALTH SERVICE

- Head, Pr Marina Kuzman, MD, ScD

Organised by the University Medical Centre in Lausanne, a Summer School on European Training in Effective Adolescent Care and Health (EuTEACH) took place on 11-15 July in Switzerland.  Professor P.A. Michaud was the project co‑ordinator.  There were some 50 attendees, mainly from Europe, but with some also coming from Australia, Hong Kong and Mexico.  From CNIPH Dr Ivana Pavic Simetin attended the School.  The programme was carried out in two groups: public health and clinical, both tackling in parallel the same areas, namely adolescent health epidemiology, reproductive health, mental health, chronic diseases, addictions, ethical issues and dilemmas.  They met twice a day and reached conclusions jointly.  Active involvement of the participants with personal working experience and national specifics made the already rich contents even richer.  They also presented accounts of their own programmes, experience, and interventions.  Among the six papers selected for oral presentation at the WHO Office in Geneva was one by CNIPH’s School Health Service.  It describes an interdisciplinary approach to the health education of schoolchildren in Croatia, with Dr Pavic Simetin being its presenter.  It met with good reception and was rated an example of excellent collaboration between education and health. 

Organised by the WHO and the Thai Ministry of Health the 6th Global Conference on Health Promotion took place on 7‑11 August in Bangkok, Thailand.  From Croatia Pr Vlasta Hrabak‑Zerjavic, MD, MSc and Dr Ivana Pavic Simetin attended at organiser’s invitation.  There were around 700 conferees from more than 100 countries, including the leading professionals on health promotion and on other areas of public health, representatives of the governments, NGOs, private sector and international organisations.  The active and public support of all participants was followed by the adoption of The Bangkok Charter for Health Promotion in a Globalised World.  It relies on the values and principles of the Ottawa Charter for Health Promotion adopted in 1987 at the 1st Conference on Health Promotion, as well as on the resolutions of the conferences in Adelaide, Sundsvall, Jakarta and Mexico City.  The present Charter also takes account of the changes evolving in the world over the interval.  It clearly singles out both the positive and harmful health consequences as well as the whole context of health promotion brought by the globalisation process.  The Charter stressed that there was an increasing inequality between and within individual countries, new modes of communication and consumption, commercialisation, harms to the environment, urbanisation, rapid and often negative social and demographic changes.  Management of globalisation challenges must also be uniform and global.  For this reason, the Charter calls on all people, groups and organisations that could and should contribute to health to do so.  It specifically worded and underscored the responsibilities of governments and politicians at any level, duties of the civil society, private sector and international organisations.  Finally, it urged the WHO and all member states to transform the existing political frameworks into actions and to provide funds for and enable new activities in the health promotion area. 

The original text of the Charter is accessible at CNIPH’s web page www.hzjz.hr/bangkok.htm.

MICROBIOLOGY SERVICE
- Head, Prof. Dr Gordana Mlinaric-Galinovic

The 26th Annual Congress of the European Society of Mycobacteriology took place in Istanbul, Turkey on 16-29 June.  It holds its regular annual congresses each year in a different country.  The workings of the gathering unfolded in several key sections, i.e.,  the epidemiology of multiple resistance Mycobacterium tuberculosis (MDR‑TB), mycobacterial resistance,  testing methods for agent sensitivity and new diagnostic techniques, identification of mycobacteria, veterinary mycobacteriology, immunology and new vaccines. 

CNIPH’s conferees were Dr Vera Katalinic‑Jankovic and engineer Mihaela Obrovac who presented two papers: Obrovac M, Katalinic‑Jankovic V,  Mlinaric‑Galinovic G, Baklaic Z. “Discrimination between clustered MDR strains using rpoB and katG mutation analysis”, and Casal M, Vaquero M, Karcheeva A, Katalinic‑Jankovic V, Havelkova M, Maguein J, Tortoli E, Buono L, Mattei R, Rossetti R, Brum L, Ryser C, Uzun M. “Preliminary study of the biological risk in European bacteriology laboratories”.

Particular emphasis was placed on the importance of gene typing methods for M. tuberculosis, also a topic of the round table conference that took a common stand and set a standard for the currently used methods.  The consensus reached was that technically it was most acceptable to use a combination of genetic methods – MIRU‑VNTR (mycobacterial interspersed repetitive units – variable numbers of tandem repeats) and spoligotyping.   

ENVIRONMENTAL HEALTH SERVICE

- Head, Krunoslav Capak, MD, MSc

Member states of the CEECFOODS/FAO/EuroFIR (Central and Eastern European Countries Food Data Systems) held an international seminar named “Food Composition Database Workshop” on 26‑27 July in Sofia, Bulgaria.  It was organised by EuroFIR (European Food Information Resource Network) in collaboration with the CEECFOODS/FAO network’s managers in Bulgaria.  Attending as a substitute for our representative Katica Antonic Degac, MSc, was Dr Andreja Barisin who presented Croatia’s past record in the areas of nutrition promotion and of its food composition database.  The FAO/INFOODS representative Assist. Prof. B. Burlingame stressed the importance of accessibility of food composition databases, which are a base for analyses of and studies on nutrition promotion in public health.  Professor Paul Fingals, leader of the EuroFIR project EU FP6 explicated the need for an integral, reliable and readily accessible source of the above data, which are primarily useful to the health, agriculture and ecology sectors.