On 19 January 2006, the Sixth Congress on Health Management took place in Zagreb.  It was sponsored by the minister of health and social welfare Assist. Professor Neven Ljubicic, MD, ScD, and organised by Croatian Medical Association, Croatian Physicians’ Society for Health Organisation and Management, and Croatian Chamber of Economy.  It held sessions on three subjects: Republic of Croatia’s health system – its results and future vision; paramedical activities in state hospitals; gerontology and health management.  Participating in the Congress subject of Croatia’s health system, its results and future vision, were Professor Marija Strnad and Dr Tomislav Benjak with a joint paper “Croatia’s Disabilities Registry”.  Dr Benjak who brought the conferees’ attention to the possibility of progress in hospital activity based on this Registry presented the report. 

INFECTIOUS DISEASE EPIDEMIOLOGY SERVICE

- Head, Prof. Dr Ira Gjenero‑Margan

Most queries from citizens and news reporters in January related to ‘common’ influenza and to avian influenza.  On several occasions our staffers were hosted by radio and television programmes and making statements to the press.

Epidemiological service heads of county public health institutes held a coordinative session on the subject of execution of tasks under the National Preparedness Programme for Avian Influenza.  In this connection, a survey forwarded to all counties and concerning the completion of county level preparations for a possible influenza pandemic was analysed.  As January is the time when any question related to the proper completion of forms for annual reports on compulsory immunisations comes to the forefront, a member of our Service convened a special meeting with the Zagreb City and Zagreb County epidemiologists.  On Ministry of Health and Social Welfare demand, guidelines were drawn up for the Croatian Embassy staff in Turkey in connection with the present avian influenza situation in that country. 

To meet the needs of reporting to the World Health Organisation, our Service staffer has developed a computer application for antibiotic‑resistant tuberculosis case monitoring. 

As part of Croatia’s role in the Pact on Stability and Accession, a national action plan was made to upgrade the infectious disease monitoring in Croatia.

For the GFATM (Global Fund to Fight AIDS, Tuberculosis and Malaria) project “Advancement of HIV/AIDS Control in Croatia”, preparations to open three new free and anonymous HIV‑testing centres have intensified.

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

Dr Matt Muijen, a WHO/EURO regional adviser on mental health, visited this Institute on 26 January.  Substitute director Professor Marija Strnad gave the welcome and presented the Institute activity by each service.  Pr U. Rodin, MD, MSc described the Social Medicine Service activity with special reference to health indicators.  Pr V. Hrabak‑Zerjavic described the capacities of the mental health service and public health importance of mental diseases and disorders.  Next, Dr M. Silobrcic Radic, head of the Mental Disease Prevention Department, gave an account of committed suicides as an indicator of the threat to mental health. 

On 27 January, Pr Hrabak‑Zerjavic in her capacity of national focal point for South‑eastern Europe’s Health Network and Dr Silobrcic attended a professional gathering on mental health development in Croatia and the opening of the Community Mental Health Centre.

SOCIAL MEDICINE SERVICE

- Head, Pr Urelija Rodin, MD, MSc

Dr Branimir Tomic and Ana Ivicevic Uhernik, MSc, presented a report titled ‘Inpatient catchment areas in Croatia’ at the Sixth Health Management Congress in the subject group “Croatia’s health system, results and vision of the future”.  Achieving a balanced distribution of hospitalisations among clinical, general and special hospitals in order to attain an optimal utilisation of treatment, and of human and material resources as well as to minimise the costs is one of effective health management’s objectives.  An analysis of this distribution in 2004 – as an assumption for possible interventions – showed 49% of the hospitalisations to have taken place in clinical, 43% in general and 7% in special hospitals.  The clinical, general and special hospitals’ respective share of the hospitalisation total differs greatly from one county to another.  One cause is the uneven distribution of hospital‑type institutions.  Counties in which clinical hospitals are located, and their adjoining counties, also reported a greater share of hospitalisations in precisely these hospitals; these thus take over a major part of the general hospital’s functions.  Special hospitals also recorded considerably higher hospitalisation rates in the counties where they are located or in their neighbouring counties.  This implies that in the counties lacking such hospitals corresponding patients more often receive inpatient care at clinical and general hospitals.

SCHOOL HEALTH SERVICE

- Head, Pr Marina Kuzman, MD, ScD

During the past period this Service conducted a programme ’Pupil health promotion in Zagreb’s pupils’ hostels’.  The programme was supported by Zagreb Office for Health, Work, Social Welfare and War Veterans.  Following the preparations aimed at providing a comprehensive adaptation to pupils’ needs (through contacts and working meetings of the Project Working Group with the representatives of pupils’ hostels; situation and need analysis) targeted seminars were held in all pupils’ hostels in Zagreb.  The focus was on sex education‑ and proper diet‑related topics.  Educational packages for pupils were also developed and distributed during the seminar.  Besides that, some leaflets on alcohol abuse among youths and sexually transmitted diseases were written, graphically designed and printed.  Some evaluative interviews were made with the educators in pupils’ hostels aimed at defining future needs and activities.

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

A campaign named ‘Action versus Influenza’ is in progress.  Croatian Institute for Social Insurance is covering the material expenses of the tests done on clinical materials for patients with the influenza syndrome.  It was started on 12 December 2005 and is to last, depending on the epidemiologic situation, until the spring 2006.  In this framework, any health facility in Croatia can send the samples taken from influenza syndrome patients to CNIPH’s Virology Department.  There is no limitation placed on the age of the patient, and acceptable clinical samples for the diagnosis are nasopharyngeal smear in transport medium and nasopharyngeal secretion.  The samples taken from children will undergo additional testing for other respiratory viruses (respiratory syncytial virus, adenoviruses, parainfluenza viruses).  Diagnostic procedures for influenza virus demonstration include culture and direct immunofluorescence test.  In the typing and subtyping of isolated influenza type A viruses (H3N2, H1N1, H5N1, etc.) use will be made of haemagglutination inhibition test and molecular methods.  The end game of the Action versus Influenza campaign should reveal the epidemiologic circulation of the influenza virus in Croatia as well as the possible occurrence of emergent influenza virus subtypes.  A report on the outcome of this campaign will be sent to the WHO via the Flunet network. 

ENVIRONMENTAL HEALTH SERVICE

- Head, Krunoslav Capak, MD, MSc

Dr Andreja Barisin presented the results of a research by this Service on sanitary conditions in state hospitals at the Sixth Health Management Congress in the subject group paramedical activity in state hospitals.   The study conducted in 2005 involved 14 state hospitals.  Under the Ordinance on Conditions and Methods for Implementation of Measures to Prevent and Control Nosocomial Infections, each hospital must also have a Commission on Infection Control and Maintenance of Cleanness.  The Commission advises hospital managers on ways of controlling infections and keeping the cleanness and  there is also a draft long‑term infection control with a specification of procedures for cleaning the rooms inside the hospital and the pertaining environs.  It was discovered that 70% of hospital floors were made with furrows that are difficult to keep clean and often sustain damage.  Frequent and long sick leaves of cleaners were another problem noted.  These individuals need continuous education in addition to overseeing.  Where possible,   clear and brief working instructions should be posted conspicuously.  The person reporting to the hospital’s central storage should keep a record of the responsibility shown at work, as well as of the consumption of materials from the hospital ward’s storeroom.  National legislation also makes provisions for the Sanitary Inspectorate supervising the maintenance of cleanness.  A hospital that is committed to keeping a clean and safe environment creates trust in patients, its personnel and the public, something that ultimately leads to a higher standard of medical care delivery to patients.