A round table conference “Integration of Adults and Children with Autism Spectrum Diagnosis into Health System and Community” took place in Zagreb on 19 April.  It was attended by parents of autistic children, as well as Mrs. Skulic, MP, representatives of Faculty of Education and Rehabilitation, many renowned health experts (Professor J. Mustajbegovic, Professor I. Grguric) and the media.  Dr Tomislav Benjak took part on behalf of the Disability Prevention Department.  The gathering concluded to inform in writing the Parliamentary Committee on Human Rights of the effectiveness of integration into health system and into community of adults and children diagnosed with autistic spectrum diseases.

He also participated in the final meeting of the project “Facilitating Employment of Disabled”, held on 28 April at the Croatian Association of Physically Disabled, the project carrier.  The project will include preparing leaflets for employers and the disabled on employment opportunities for disabled; staffers of the Disability Prevention Department are to participate in creating the leaflet contents.   

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

Sponsored by the Ministry of Health and Social Welfare and organised by CNIPH, the international competition Quit & Win was held this year too.  On WHO initiative, this event was taking place in the world for the seventh time (sixth in Croatia).  Its aim is to help smokers decide to quit smoking and give up a habit that is hazardous for health.  Equally, it aims at promoting their own health and creating a smoke‑free environment.  For this purpose, particulars of the competition and a competition application form in electronic form were published on this Institute’s web page.  We created a promotional poster with health messages and invitation to compete, which was distributed to general medical practices and public health institutes.  In addition, we created a promotional poster with health messages, competition rules and registration form of the competition, which was distributed to the majority of pharmacies and to all public health institutes. The competition and public health importance of smoking as a health risk factor were presented to the media at a press conference organised at CNIPH; detailed instructions were provided about the rules of competition, later appearing in the press.

A category 1 continuing education course named “Diagnosis, treatment and prognosis of preinvasive lesions and uterine cervical carcinoma” took place in Zagreb on 7‑8 April at the Women’s Disease and Obstetrics Clinic.  There, Ariana Znaor, ScD gave lectures on uterine cervical cancer epidemiology. 

The Ist World Meeting of National Commissioners for Prevention of Injury and Violence, organised by WHO was held in Durban on 31March-1 April.  Dr Ivana Brkic Bilos from CNIPH attended as our national commissioner.  The aim of the Meeting was to promote and intensify work in the area of injury and violence prevention by establishing and strengthening the collaboration between national commissioners and WHO experts.  Injuries and violence are a serious world public health problem and one that is largely preventable.  Every country should therefore strive strenuously to make their prevention a reality.  This is consistent with the Resolution of the WHO’s Regional Committee for Europe EUR/RC55/R9, according to which the problem of unintentional injuries and violence should be a public health priority.  Arising from this is the need to draw up and implement national strategies directed at the prevention of injuries.  Differences between the states and regions in the burden posed by this problem being big, it was resolved that is important to maintain and promote the active operation of the national commissioners’ network on the regional level.  Since a network made up of experts from all parts of the world would be less formal in character, a meeting on the global level could take place every second year ahead of the world conference on prevention of injuries and promotion of safety. 

On 6‑7 April Pr Vlasta Hrabak‑Zerjavic, MSc attended in Copenhagen the Conference of National Coordinators for European Strategy against Chronic Noncommunicable Diseases.  There she led there one of the three working groups as well as taking part in the final round table conference.  The chief topic of the gathering was a discussion of the second version of the Strategy and making recommendations for its improvement.  As a member of the working group of eight, she also attended a meeting on the same subject for the creation of the Strategy.  In the capacity of national focal point for the European strategy on tobacco control, she attended a meeting in Dublin on 10‑11 April where particulars of the draft Second European Report on Anti‑Tobacco Policy were debated and suggestions made concerning suitable amendments.     

SOCIAL MEDICINE SERVICE

- Head, Pr Urelija Rodin, MD, MSc

This Service has produced a 2005 report on preventive medical examinations of the ensured aged 50+ years.  It contains the information on the results of 10,275 preventive medical examinations of the insured above 50 years old (5,179 females and 5,061 males).  As part of the examination, the data collected included personal identity information, family medical history, anthropometric measurements (height, weight and arterial blood pressure), physical examination with focus on breast palpation and digitorectal examination, special targeted interview to elicit a response about nonspecific signs of malignant diseases, laboratory blood studies (SE, Hb, GUK and occult bleeding in stool), and final medical opinion on possibly new cases of disease as well as on the interventions made.   Severe and very severe obesity were found in 32% of the female and 25% of the male subjects.  Sixty‑two percent of females and 59% of males were found to have systolic blood pressure greater than 140 mmHg; diastolic blood pressure values above 90 mmHg were found in 44% of the females and 45% of males.  Glycaemia levels higher than 7 mmol/L were detected in 13% of the females and 16% of the males.  Overall, there were 5,316 new cases of disease (2,804 in females and 2,512 in males).  Of this, suspicion of malignancy was established in 116 examined females and 86 examined males.  They were promptly referred for further diagnosis and curative treatment.

The First Conference on European Countries on ANAMORT project, which is coordinated by InVS – Institute de Veille (France) and financed by the Health and Consumer Direction of the European Union (DG Santo), took place on 21 April in Paris.  There were presentations of the preliminary findings from an extensive questionnaire completed by all European countries, Croatia included.  The purpose of this portion of the project is to enhance the quality of modern statistics with a focus on coding the external cause of violent deaths.  Debated during the small‑group work were the dilemmas linked with some items of the questionnaire.  Thus, additional rules for coding the external cause of violent deaths came to be defined that should be applied by all countries to improve international comparisons. 

Coding of the underlying cause of death on DEM-2 forms for the year 2005 was completed in the Medical Demography Department on 30 April, CNIPH’s contractual obligation toward the Central Institute of Statistics.  In progress is the completing of the data obtained through collaboration developed with prefectural commissioners for statistics, who add the required data to the Death Certificates the completion of which they find to be below standard.  This step is intended to improve the quality of mortality statistics.        

SCHOOL HEALTH SERVICE

- Head, Pr Marina Kuzman, MD, ScD

In Florence, Italy, ”The Socioeconomic Determinants of Healthy Eating Habits and Physical Activity among Adolescents”, a forum organized by the WHO and HBSC researcher team, was held in March.  It considered issues related to the promotion of healthy nutrition and physical activity taking into account influential social, economic and cultural factors in young people.  For starting position, it took the results of the HBSC survey of pupil health behaviour.  The role of sectors other than health (education, agriculture, transportation, urban planning) in creating conditions for youth health promotion was emphasised.  Proceedings of the forum are to appear in a report intended for the Ministerial Conference on Obesity to be held in November 2006.  It will describe member state activities, Croatia’s including, in the area of healthy nutrition and physical activities of young people prepared by countries participating in the Forum.  Attending the Forum on behalf of CNIPH were Pr Marina Kuzman, ScD, Dr Ivana Pavic Simetin and Katica Antonic Degac, MSc.

In the last period this Service joined in the implementation of promotion of general medical examinations of secondary school pupils in class one.  School and University Medicine Service of the Sisačko‑Moslavačka County Public Health Institute had already started last year a pilot project as a reflection of the need expressed by the profession.  Given that the start of secondary education along with adolescence, which is in full swing, is connected with great changes in pupils’ lives (new school setting, new learning commitments/working duties, and distancing from their families), school doctors have clearly recognised the need for general medical examination in this period to attach more importance to pupils’ mental health.  Moreover, since in class eight of the primary school an extensive general medical examination is performed for the purposes of vocational guidance and continuation of education, all relevant characteristics are recorded with no substantial changes in pupil’s heath status expected shortly.  Jointly with her collaborators Dr Suzana Fabijanic, head, School Health Service, Sisačko‑Moslavačka County, organised theoretically a project aimed at screening out the pupils at risk of developing risk behaviour and mental health problems.  This procedure offers several advantages.  The pupils scheduled to undergo general medical examination first complete in class a questionnaire form structured to single out by evaluation on points the at‑risk pupils.  It encompasses four areas: schooling, family, behaviour and personal characteristics.  Additionally, an individual structured interview immediately precedes the general medical examination.  On repeated visits to Sisak between March and May 2006, Drs Ivana Pavic Simetin and Iva Pejnovic Franelic did a general medical examination of class one pupils of the Trade‑industrial School by using and testing the afore‑mentioned questionnaire.  The thus gained impression of the experience with the whole initiative was highly promising.

Sponsored by the Ministry of Health and Social Welfare and by Zagreb City government and organised by Croatian Chamber of Psychology, the First Croatian Congress on Applied Psychology “Psychologists in Health Promotion and Health Care: Interdisciplinary Approach” took place on 27‑29 April in Zagreb.  Psychologists, therapists, physicians and social workers presented their reports there.

A round‑table conference “Public Health Aspects of Disease Prevention and Health Maintenance” was attended by Drs Dragica Katalinic and Iva Pejnovic Franelic, the latter presenting the findings of ESPAD and HBSC surveys on the risk behaviour of young in Croatia.  The gathering drew a large attendance.  Professors Sakoman and Zarevski, Dr Dzepina, Professor Belak‑Kovacevic and the coordinator Dr Orban contributed to a stimulating debate.         

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

On 20-21 April, third postgraduate category 1 course named “Respiratory Infections: epidemiologic and clinical picture, diagnosis, therapy and prevention of tuberculosis and mycobacterioses” was held at the Croatian Medical Association.  Faculty of Medicine, CNIPH and Croatian Society of Medical Microbiology were its organisers.  As in previous years, the course leaders were Professor G. Mlinaric‑Galinovic, Dr V. Katalinic‑Jankovic, Professor I. Gjenero‑Margan,  and T. Vilibic‑Cavlek, MD, MSc.  The number of lecturers was large.  They came from CNIPH and county public health institutes, Pulmonary Disease and Tuberculosis Clinic, Dubrava Clinical Hospital, Zagreb Clinical Hospital, Jordanovac Clinical Hospital and from the Polyclinic for Respiratory System Diseases.  Guest lecturers were Mance Zolnir‑Dovc, ScD (“The Rapidity of TB Laboratory Diagnostics in Different Laboratories in Slovenia”) and Dr Damjan Erzen (“Detection and Importance of Latent M. tuberculosis Infections”) from Respiratory and Allergic Disease Clinic at Golnik, Slovenia.  Despite being narrowly specific, because of their continuous topicality these topics attracted many comers, contributing to the good attendance rate.  

Representing the National Centre for Influenza (Virology Department), Dr V. Drazenovic delivered a lecture on 8 April on the present “bird flu” situation and its threat, neuraminidase inhibitors, immunisation and all current topics at the continuing education course “Does Avian Influenza Lead to a New Influenza Pandemic?”.  It was organised by Croatian Medical Chamber and by Croatian Medical Association and run by Croatian Society for Infectious Diseases.  Taking note of the great interest aroused, Croatian Medical Chamber is preparing a new continuing education course under the same name; attendance, bringing 11 credits from the Chamber, is free.  The date set for the course is 20 May 2006 at the Infectious Disease Clinic.  Because of the drafting of written materials and attestation of attendance, registration for the course at the e‑mail address apavelic@bfm.hr is obligatory.

This year influenza has surprised us by exceptionally late appearance.  We recorded its first cases on 13 March and it affected exceptionally few people.  According to our virological indicators, we are in the eighth week since the start of the outbreak and the number of positive samples is decreasing.  Subtyping has proved the involvement of A/H3N2/ and A/H1N1/ influenza virus subtypes.