Sponsored by the Ministry of Health and Social Welfare of the Republic of Croatia and by the Academy of Medical Sciences, the Seventh Symposium of the Croatian Informatics Society took place in Rijeka on 21 October.  More than 30 works were presented to the attendees within the topics development, application and evaluation of health information systems, health information systems, web technology in health, medical systems, pictures and signals, and educational technologies and methodologies.  The participation of our Slovenian and Bosnian colleagues this year made the symposium international in character.  On behalf of CNIPH there were three speakers: Professor Marija Strnad chaired the topic “development, application and evaluation of health information systems”, Dr Tomislav Benjak presenting their joint report “Information System of the Croatian Disabilities Registry”, and Pr Ranko Stevanovic MD, ScD his report “Purchasing a Software Application for Health”

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

This year for 10 October, the World Mental Health Day, the motto chosen was “Mental and Physical Health through Life” to underscore the link between good mental and physical health at any age.

Deteriorated physical health in childhood, adolescence, adulthood and older age can affect the emotional health and the feeling of wellbeing.  Severe mental diseases and disorders, such as depression and anxiety often result in ignoring serious physical illnesses, as cancer, heart disease, diabetes, arthritis and respiratory diseases.  Stressing the fact that “there is no health without mental health”, the topic of this year’s mental health day rouses the growth of awareness and understanding that good physical and mental health are very significant for successful growth and development at any age in life.

On 7th October the international symposium ‘HPV infection and cervical cancer prevention – where we are now, what to do next?’ took place in Ljubljana.  It was attended by Ariana Znaor, ScD.  The second most common cancer site in women globally, uterine cervical cancer is also a major cause of female deaths in the developing countries.  Screening a population with the Papanicolaou’s test permits the detection of around 80% of uterine cervical cancer cases.  Since the demonstration in the past decade that human papillomavirus (HPV) is the necessary cause for the development of uterine cervical cancer, work has been in progress to develop a vaccine.  Vaccines against the most common oncogenic viral types HPV 16 and HPV 18 are in the final development stage and should become available on the market by year 2007.  In addition to providing an effective protection from HPV 16 and HPV 18, the vaccines also protect partially from other oncogenic HPV types.  Considering that HPV is a very common infection that is transmitted by intimate contact, ideally the female population should be immunized before the start of sexual life.  The introductions of HPV immunization in the future would not mean an abandonment of the traditional cytologic screening method for early diagnosis, but would probably modify with time the screening intervals and methods. Given that Croatia still reports about 350 new uterine cervical cancer cases annually, with about 100 female deaths from it every year, the focus for the present should be on improving the Papa test coverage of the population, respectively on implementing the malignant disease early detection programme.

SOCIAL MEDICINE SERVICE

- Head, Pr Urelija Rodin, MD, MSc

Ca HRK800,000 were donated by the government of the Kingdom of Norway to the Croatian project “Development of Telemedicine on Islands”.  As an element of the project, experts of the Norwegian Centre for Telemedicine visited CNIPH on 5 October 2005.  At the meeting, Pr Ranko Stevanovic, MD, ScD presented the visions and projects for the establishment and development of a national public health information system in Croatia, for a national public health information system, and for the utilisation of telemedicine as a diagnostic tool in primary health care.  

Pr R. Stevanovic, MD, ScD presented two reports “Development and Deployment of Health Information System in Transitional Countries (Croatian Experience)” and “Telemedical Segment of Croatian e‑Health System” at the international conference “Information and Telemedical Technologies in Health Care – ITTHC 2005” on 25‑28 October in Moscow.  The Conference was held on the occasion of the 50th anniversary of medical informatics in Russia, and Dr Stevanovic, also an invited lecturer, chaired one of the plenary sessions.

SCHOOL HEALTH SERVICE

- Head, Pr Marina Kuzman, MD, ScD

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

Organised by WHO/EURO for the southeast of Europe, the Fourth Meeting for Tuberculosis Control took place in Istanbul, 2‑4 October 2005.  It was attended by national focal points for tuberculosis and heads of national reference laboratories for TB diagnosis.  Due to our national co‑ordinator being prevented by illness, Croatia was represented by Dr Anamarija Jurcev Savicevic from the Split‑Dalmatia County Public Health Institute and, from CNIPH, by Dr Vera Katalinic‑Jankovic, head, National Reference Laboratory for Tuberculosis.  The Meeting was aimed at presenting the status of tuberculosis in individual countries in the light of the objectives set for 2005, and at defining priorities with regard to the monitoring of tuberculosis in line with the Millennium Declaration indicators.  There was a debate on whether these objectives are attainable and how.  Special attention was devoted to the quality of data collection for “TB Surveillance and Monitoring Indicators” and of “Building an Individual TB Notification Data Set”.  The Meeting ended with a joint proposal covering the improvement and strengthening of the laboratory network, human resources and the work on improving the political and financial support to the above activities.

For the first time, Parasitology Department, Microbiology Service, Croatian National Institute of Public Health organised on 18 October the annual meeting of county public health microbiologists on parasitologic subjects for the purpose of standardising and improving parasitologic diagnostics.  Sixteen microbiologists from county public health institutes participated.  The first topic of the Meeting was a detailed analysis of the data received from county public health institutes’ annual reports.  Advanced and specific diagnosis of the histolytic amoeba under the WHO recommendations of 1997, implemented until now only in CNIPH’s Parasitologic Laboratory was the next.  Head of CNIPH’s Parasitology Department, Dr Dubravka Horvat Krejci reported on this topic.  After a discussion, a resolve taken was that county microbiologic laboratories would seek to introduce new methods in the diagnosis of Entamoeba histolytica, except for the laboratories unable to do this (these would be sending their samples to CNIPH’s Parasitologic Laboratory for analysis).  Another speaker at the Meeting, Dr Borislav Aleraj explained the epidemiological significance and purpose of the periodic microbiologic testing of stools for certain categories of workers as required by law.  Finally, the attendees expressed themselves satisfied with the Meeting and voiced the need for the Meeting to grow either into a traditional one and/or into a continuing medical training course in parasitology. 

Organised by the Hungarian and Croatian microbiological societies, CEFORM (1st Central European Forum for Microbiology) was held in Keszthely, on the Balaton, Hungary on 26-28 October.  The work unfolded through lectures, poster sections and workshops covering new knowledge from all segments of microbiology.  Taking part in the Forum were five members of our Service staff: Dr Vilibic-Cavlek, Dr S. Ljubin‑Sternak and Prof. Dr. G. Mlinaric-Galinovic with a poster “Subacute sclerosing panencephalitis in Croatia (1994-2004)”, as well as engineer M. Obrovac and Dr V. Katalinic‑Jankovic with another titled “Implementing the multiplex PCR method in determining resistance to isoniazid in Mycobacterium tuberculosis strains in Croatia”.

Speaking on behalf of the National Centre for Influenza and of Virology Department, Dr. Vladimir Drazenovic presented a lecture “Do we know every detail of influenza?” in 10 county public health institutes between 10 and 21 October on the present situation with avian influenza.  His lecture equally covered the level of the “bird flu” threat, neuroaminidase inhibitors, immunisation and other topical issues.  Speaking for public at large at the Forum, the same lecturer gave a lecture “What you need to know about the bird flu” sponsored by Zagreb City and by Zagreb Office of Health, Work, Social Welfare and War Veterans.  At the Croatian Academy of Sciences and Arts, Dr Drazenovic presented a subject “Specifics of the Influenza Virus in Croatia”, a subject on which he is to give a lecture on 9 December at the Infectious Disease Clinic within the technical‑scientific symposium “Is avian influenza an introduction into a new pandemic?”

ENVIRONMENTAL HEALTH SERVICE

- Head, Krunoslav Capak, MD, MSc

Katica Antonic Degac, MSc took part in the Copenhagen “Member States Consultation for the Ministerial Conference on Counteracting Obesity” on 10‑12 October, in the capacity of a national commissioner on nutrition for co‑operation with WHO.  The public health problem of obesity, which in most countries has already taken alarming (epidemic) proportions, was the subject of the debate.  A framework plan of expert group meetings where materials would be prepared for a Ministerial Conference scheduled for 15‑17 November 2006 in Istanbul (which should also pass a European Declaration on Obesity)   was drawn up.  Other topics of the above Conference involved nutritional policy and the realisation of national action plans for food and nutrition, as well as on the preparation of a Second Action Plan for Food and Nutrition of WHO/EURO.

In Vilnius, Lithuania, a regional working seminar by Codex Alimentarius took place on 25‑27 October.  Its main subjects and topics were (i) understanding the role of Codex and its organisation  (Codex‑WTO relationship, the basic role of Codex, Codex Committees organisation and their structure, understanding Codex documentation), (ii) National Codex programmes (activity of the individuals charged with maintaining contact with  Codex – contact points, workings of the national Codex Committees, national Codex committees, the promoting of national interests according to Codex recommendations,  considering the election of national representatives); (iii)  scientific base for Codex activity (risk analysis in the framework of Codex; definitions of JECFA, JMPR, and JEMRA), (iv) plans of the European FAO/WHO coordinating commission CCEURO (membership, definitions and quotations, regional standards, food safety in Lithuania, legislation, organisation,  experience and the lessons learned from everything implemented, identification of priorities for CCEURO’s 25th meeting in September 2006, relationship between Codex and EU), (v) activity by working group, evaluation of lectures through an illustration of Codex action implementation by individual country participant of the working seminar (presentation by working group).

The working seminar attended by representatives of 15 countries (27 participants) and those of various organisations (FAO, WHO, EFSA, EC, Switzerland and Lithuania), had 43 participants in all.  It was a continuation of the Bratislava 2003 working meeting organised by NCCs of Switzerland and Lithuania.   At report presentation by different working groups, different approaches and needs of individual countries were noted.  Countries of the former USSR are working on horizontal and vertical regulations only now, searching for implementation models and being in two minds as to whether to apply Codex or EU standards.  Some countries, Croatia included, know when to use Codex and when EU standards.  However, organisationally they lack national Codex Committees, having instead only national contact points, respectively an individual communicating with Codex and distributing received materials that require an opinion.  Direct communication with the bodies of the EU commissions could be established (through a Codex representative), which during the current accession talks could be an additional means of exchange for the information essential in the talks.  On the proposal of the Croatian representative, it was thus suggested to organise a Workshop where representatives of the countries wishing to set up national Codex committees (NCCs) would learn how to organise the work of their NCC and familiarise themselves with options to communicate with other bodies of the Codex, WHO, FAO, EU, and similar.  This is very important because the commitments to be honoured by the institution in which NCC has its head office could only be assessed upon the professionals in charge of national Codexes receiving a clearly defined training.  In Macedonian experience, where NCC is part of the national public health institute, the benefits are multiple and commitments acceptable.  The Codex representatives accepted the proposal, and it was put forward that the working session as described be held in spring 2006 in Croatia with FAO/WHO funding and in CNIPH’s organisation.  As this also met with the support of CNIPH’s director, Pr Zeljko Baklaic, MD, MSc, preparations are now under way.  Croatia’s representatives at the Vilnius working seminar were Visnja Papac, MSc, senior advisor on meat and meat products at the Ministry of Agriculture, Forestry and Water Management, and Marijan Katalenic, MSc from CNIPH.