On 21 November, Croatian Medical Association’s Cancer Epidemiology and Prevention Chapter held a meeting at the Primorsko‑Goranska County Public Health Institute.  Its chairperson is Professor Marija Strnad with Ariana Znaor, ScD as its secretary.  The subject was a presentation of the county programme of early prevention and detection of breast cancer in the Primorsko‑Goranska County.  Other attendees were Pr Zeljko Baklaic, MD, MSc, director of CNIPH; Professor Mirko Samija, Croatian Oncological Society chairman, Professor Boris Brkljacic, chairman of Croatian health ministry’s Mammographic Screening Board, and Dr Valerija Stamenic (representing the Ministry of Health and Social Welfare).  The debate ranged from individual aspects of the programme to their applicability on the national level.

INFECTIOUS DISEASE EPIDEMIOLOGY SERVICE

- Head, Prof. Dr Ira Gjenero‑Margan

Organised by Croatian Medical Association’s Croatian Epidemiological Society, and sponsored by the Ministry of Health and Social Welfare of Croatia, the second Croatian Epidemiologic Congress with International Participation took place on 26‑29 October.  (The first ended successfully in Split in 1999.).  About 200 conferees, mainly medical epidemiologists, attended; from the related fields there came microbiologists, vaccinologists, sanitary inspectors, biologists, veterinarians etc., delivering 130 technical and scientific reports, covering practically every aspect of epidemiology.  Roughly, these can be divided into the topics from the epidemiology of infectious diseases and from the epidemiology of non-infectious diseases.  The work unfolded through plenary sessions held in the parallel working groups of the congress.  A small scientific meeting with the highlight of a report by the head of that superb action celebrated the 50th anniversary of the eradication of malaria in Croatia.  It thanked symbolically all participants of the action.  The presentation at the Congress mainly of domestic experts, combined with worthy contributions of foreign guests, has uncovered the broad range and successes of the work in this field, as well as all the peculiarities of epidemiology as a branch of medicine and medical profession.  This epidemiology seeks to learn the patterns and regularities of the phenomenon and presence (or absence) of individual diseases and conditions in humans through a combination of the techniques that are proper to natural science and other exact scientific techniques.  It does so in order to exert a practical action (intervention) aimed at changing such state of affairs and suppressing, controlling or eradicating the diseases.  Our Service staff delivered to the Congress eight reports from their respective areas.  As to Congress reports, they are assembled in its representative Proceedings.  Later on, a collection of all works in full is planned to appear under the name Epidemiology 2005 (epidemiologija 2005.).  In the assessment of all attendees, the congress was a success.

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

Pr Vlasta Hrabak‑Zerjavic, MD, MSc took part on 7‑8 November in Venice in the forum “Governance of health promotion to address the wider determinants of population health” held at the WHO’s European Office for Health Investment and Development.  It was emphasised that there were health inequalities not only between, but also within, individual EU member states.  Research has shown that individuals with higher education and individuals of higher socioeconomic standing live 10 years of healthy life more on average than others.  Conversely, individuals with poorer health exhibit lower productivity, posing a heavier burden on health funds, more often take an early retirement, etc.  Investing in health thus amounts to investing simultaneously in development too.

November 14, this year’s World Diabetes Day was marked by a slogan “Diabetes and Foot Care”.  In view of diabetes still causing many amputations of the extremities worldwide, a decision was taken to make foot care the topic of that day.  This was in support of the measures to prevent the amputations for complications of diabetes from taking place. 

At the 13th European Conference on Public Health in Graz, Austria, on 10‑12 November, Pr V. Hrabak‑Zerjavic and Dr M. Silobrcic made two poster presentations: “Epidemiologic Review of Mental Disorders in Croatia” and “Epidemiologic Review of Suicides in Croatia”. 

Organised by WHO/EURO, The First Meeting of European National Commissioners for Prevention of Injuries and Violence took place on 17‑18 November in Netherlands.  Dr Ivana Brkic Bilos attended there in the capacity of a Ministry of Health and Social Welfare representative and as the national commissioner for the prevention of violence.  On organiser invitation, a synopsis and a poster titled “Violence, a major public health problem in Croatia” were prepared.  The meeting proceeded in the form of lectures and workshops with a debate of the vision of a network of national commissioners and their role, and of the activities and opportunities for establishing better collaboration with WHO experts.  

SOCIAL MEDICINE SERVICE

- Head, Pr Urelija Rodin, MD, MSc

The paper “An innovative primary health care reform: what it should be like?”  was presented by Pr Ranko Stevanovic, MD, ScD at “Croatian Primary Health Care Days – Labin 2005” at Rabac on 10‑12 November.  

SCHOOL HEALTH SERVICE

- Head, Pr Marina Kuzman, MD, ScD

The Fourth Workshop on Practice of Evaluation of the Health Promoting School Concepts, Indicators and Evidence took place at Sigriswil, Switzerland, on 17‑20 November.  It was attended by representatives of more than 40 European countries, with Dr Ivana Pavic Simetin present on behalf of the Croatian team.  In addition to the organisers (World Health Organization, European Network of Health Promoting Schools) running the workshop, a Task Force consisting of a group of professionals in the area of health promotion in schools did likewise.  An arrangement made by the conferees was for an intensive evaluation of the health promoting school concept until the next gathering scheduled for June 2006.  Further, they developed a preliminary working plan for each country.  For Croatia, it envisaged the making of a national‑level evaluation.  Concerning observation indicators, they were arranged for with the national coordinator Pr Marina Kuzman, MD, ScD on return from the workshop.  Preliminary activities also started including the working plan finalisation and the completion of an evaluative questionnaire designed for school doctors. 

ADDICTION PREVENTION SERVICE

- Head, Pr Marina Kuzman, MD, ScD

A conference on the prevention of addictions named “Prevention: Do it – Share it, Spreading Good Practice in Drug Prevention” took place on 30 November‑2 December in Strasbourg.  Representatives from 17 countries attended.  Dr Dragica Katalinic, member of the Pompidou Group for Drug Prevention from CNIPH’s Addiction Prevention Service, Darko Tot, BSc, from the Institute of Education, Bernardica Juretic, MSc, head of Government Office of Drug Prevention,  Mrs. Lidija Vugrinec from Government Office of Drug Prevention, and Dr Zvonimir Sostar, head of Zagreb Office for Health, Work, Social Welfare and War Veterans made up the Croatian delegation.  Apart from discussing theoretical characteristics of preventive methods, the conferees also became familiar with the illustrations of various preventive activities in different countries.  The next meeting of the Preventive Platform of the Pompidou Group for Drug Prevention is due to take place in Zagreb in March 2006.

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

A regular annual convention of Croatian microbiologists was held at CNIPH on 11 November.  Seventeenth so far nearly all TB diagnostic laboratories’ heads attended it.  Croatian microbiologic laboratory network currently consists of 15 laboratories.  It evaluated the results of each one separately from the received progress reports for 2004, also analysing the trend of positive microscopic and of positive culture findings over the six years past.  The results served as a kind of external quality assessment of the laboratory activity.  From ca 5.2% of positive samples, 4,170 mycobacterium strains were isolated in 2004.  M. tuberculosis with 94.9% of the strains still predominated.  Only 207 (5.2%) of the strains displayed resistance to one or more antituberculous drugs.  The low trend of resistant tuberculosis continued, placing Croatia among the countries with a low prevalence both of resistant and multiresistant tuberculosis.  The monitoring of prevalence, mortality and incidence indicators within the “World Health Assembly targets for tuberculosis control” in our laboratories gives TB diagnosis and management a key role. 

In the capacity of a member of the WHO expert team WHO‑EURO Laboratory Strengthening Task Force (LSTF) for TB control for the WHO European Region, Dr Vera Katalinic-Jankovic attended the 2nd Meeting, Tuberculosis Programme, held in Copenhagen, Denmark, on 21‑22 November.  The meeting schedule covered an evaluation and an account of the realisation of the conclusions of the first meeting.  It also included a report on the conclusions of the 2nd Technical Advisory Group Meeting for the European Region and of the extra large meeting held at the end of October in Paris during the conference of the International Union Against Tuberculosis and Lung Diseases (UNION),  a report on the quality assurance system in the countries with a high incidence of tuberculosis, an analysis of the needs plan for trained and highly trained staff essential in European TB diagnostic laboratories.  Finally, it covered a report on a joint project by the EU (Strengthening the laboratory network for improving tuberculosis control in Europe) and by the European Task Force in Infection Control.  The meeting also proposed subjects for a discussion with the European branch of the CDC (Center for Disease Control) scheduled for 6 December in Stockholm, Sweden.  During the meeting, considerable amount of time was devoted to considering the fund raising to strengthen the TB laboratory network in Europe.

ENVIRONMENTAL HEALTH SERVICE

- Head, Krunoslav Capak, MD, MSc

A visit by Croatian professionals to the Regional Office of Health and Social Welfare of the Seine‑Maritime Region was organised as part of the Croatian‑French co‑operation and of a joint project between the Andrija Stampar School of Public Health, Zagreb, Croatia, and the National School of Public Health, Rennes, France.  Its purpose was to obtain an insight into the organisation and operation of public health on the regional level in France.  Members of the Croatian delegation were: Dr Mladen Smoljanovic, director, Splitsko‑Dalmatinska County Public Health Institute; Professor Vladimir Micovic, director, Primorsko‑Goranska County Public Health Institute; Natalija Marinkovic, engineering graduate, A. Stampar School of Public Health; Dr Krunoslav Capak, head, Environmental Health Service, Croatian National Institute of Public Health.

On the regional and local levels in France, local offices of health and social welfare are responsible for implementing the health policies, health care and health promotion.  Because health and social status are generally considered to be interrelated, the desire to have an integrated social welfare and health care is also manifested in the form of joint offices.  In consequence, regional and local offices of health and social welfare are interministerial administrative and technical bodies in charge of implementation of health care and social welfare measures on the regional and local levels.  Although they are accountable to the prefect, they are under the technical competence of the Ministry of Health.  Nevertheless, in certain specific segments they also collaborate with the ministries of agriculture, environmental protection, industry etc.  Health Act provides the legal framework for their activity, and so do the centrally enacted national programmes (e.g., NEHAP – National Environment and Health Action Plan).  As regards supplemental local programmes, as well as prioritisation of health problems, they and pertinent plans and actions to address priority problems are enacted locally at periodic Regional Health Conferences in accordance with the observed situation and geographic specifics of the region.

From the data presented to them and from the talks, our professionals have gained an idea of the public health organisation and activities at the regional and local levels in a highly industrialised country with a long tradition of democracy.  Particularly useful was the French presentation of the contents and functionalities of the information system for drinking water surveillance.  The system encompasses all data on water supply facilities and drinking water safety findings for the whole of France, offering wide‑ranging search options and statistical analyses.  In keeping with Croatia’s new Drinking Water Safety Regulation, we should create such information system, something to enable us to implement the above experience in the course of its elaboration.