The 56th Session of WHO/EURO took place on 11‑14 September in Copenhagen.  It was attended by Croatian delegation composed of Dr A. Z. Golem, permanent undersecretary of the Ministry of Health and Social Welfare (MHSW), Professor Marija Strnad of CNIPH and His Excellency Aleksandar Heina, Croatia’s ambassador to Denmark.  Presented were the usual reports on the progress of the Regional Director.  Items on the agenda covered:  European strategy for the prevention and control of noncommunicable diseases; strengthening of health safety; follow‑up on the execution of the previous resolutions about the implementation of the European Tobacco Control Strategy; annual report of the European Committee on Environment and Health; indicators for the implementation of the Framework Health for All Policy; a report on the implementation of the DOTS Strategy for Control of Tuberculosis.  There was also a report on the progress achieved in malaria control, and one on the progress in occupational health.  The gathering was also addressed by the acting director of the WHO’s from Geneva.

INFECTIOUS DISEASE EPIDEMIOLOGY SERVICE

- Head, Prof. Dr Ira Gjenero‑Margan

Between 14 and 21 September and on the eve of Tuberculosis Awareness Week, our Service staff addressed the public several times through the media on the subject of tuberculosis surveillance in Croatia.  It also drew up the annual report on tuberculosis trends in 2005 and sent it to WHO.

During September, we processed 4,325 individual notifications of infectious disease cases through the daily, weekly, and monthly reports on Croatia’s infectious disease trends.  This involved 11 notifications of disease outbreaks and an analysis of the received notifications of vaccination side‑effects.

The staffers have coordinated measures to control an outbreak of legionnaire’s disease at a hotel and have participated in collaboration with county public health institutes in an evaluation of the measures used to control enteric diseases.

Also drawn up in September was a proposal for Croatia’s Compulsory Vaccination Schedule 2007. With the assistance of the Microbiology Service, that of our epidemiologic colleagues from county public health institutes and with the consent of MHSW, we initiated a study on seroprevalence of hepatitis B in children.

To meet the needs of MHSW and WHO, a text was written on Croatia’s activities linked with international sanitary regulations.  There also appeared in Croatian and English a regular issue of the monthly Epidemiological Review; in the online version it is accessible on CNIPH’s web page.

As a member of the Working Group Preparing Croatia’s Negotiations on Accession to the EU, Pr Zerjavic attended on 10‑11 July a meeting in Brussels on assessment of readiness for EU – Acquis – Chapter 28: Health Care and Consumer Protection.  She reported on the areas of early detection of malignant diseases, on mental health, on tobacco control and on a portion of interventions in the health determinants area.

A central promotional campaign taking a slogan “How young is your heart?” to mark the World Heart Day took place on Trg Bana Jelacica on 24 September.  It was organised in collaboration with Croatian Cardiological Society, Zagreb Office of Health, Work and Social Welfare, Croatian Medical Association’s Croatian Society for Atherosclerosis, Croatian Cardiological Nurses’ Society, Zagreb Clinical Hospital Centre, and the “Srcana” Polyclinic.

The World Heart Day has traditionally been marked annually on the last Sunday in September.  It is intended to caution against the worrying consequences of cardiovascular disease morbidity and mortality and make the whole public aware of the need and importance of living a healthier life and of maintaining and promoting cardiac health.  By combating the most essential risk factors such as physical inactivity, unhealthy diet, and cigarette smoking, one can prevent 80% of heart strokes and cerebrovascular accidents and maintain the heart healthy.  It is a day celebrated under the auspices of the World Cardiological Federation and its members in over 100 countries.  In Croatia this year, it was marked under the auspices of Croatian Parliament and of the Ministry of Health and Social Welfare.  In Zagreb – besides consulting of physicians and handing out of educational materials about healthy lifestyles and risk factor prevention, blood pressure measuring and assessing of cardiovascular risk factors – there were displays of physical activity (as Nordic walk, traction exercises) and an entertainment programme.  CNIPH’s participation was in the form of educational materials (as on proper diet, regular physical activity, importance of nutrition for healthy heart), with our physicians calculating for citizens their body mass index and giving them advice.  Similar activities were organised in other Croatian towns too.

The Third Croatian Congress on Alzheimer’s Disease with international participation was held on Brijuni Islands on 7‑10 September. Dr Maja Silobrcic Radic gave an oral presentation titled “Hospital morbidity of Alzheimer’s disease in Croatia”.

SOCIAL MEDICINE SERVICE

- Head, Pr Urelija Rodin, MD, MSc

An analysis of findings by the “Survey of the Quality of Croatia’s Inpatient Care and Patient Satisfaction” and “Survey of the Quality of Care from Croatia’s General Practice/Family Medicine and Patient Satisfaction” has been completed and is due to be published.

Based on the joint collaboration of nine South‑East European countries in health, a new project titled “Maternal and Neonatal Care Promotion” has begun.  Like several previous ones, this project is conducted by WHO, with the financial support coming from a donor country (in this case Norway).  At a joint meeting in Skopje, Macedonia, on 25‑26 November 2005, health ministers of the nine countries agreed that Moldavia should be the project coordinator.  The first meeting on 28‑30 August 2006 in Moldavia set the basic directives for future work and presented the basic indicators and organisation of perinatal care for all states participating in the project.  Pr Urelija Rodin, MSc was chosen as the coordinator of all these activities in Croatia.

A point of interest to the Council of Europe, whose representatives made the trip to Croatia on 11‑12 September, was the Programmes of integration for certain social groups into the society of individual states, for Rommanies including.  They met with the representatives of the ministries addressing the implementation of the National Programme and of the Action Plan for Romannies, and with Rommany associations as well as with the National Appointed Commission for Rommanies.  Then the reports were submitted on the four key areas for Rommany integration, namely measures related to improving the education, housing, employment, and health.  Pr Urelija Rodin reviewed the health measures applied via health promotion, as well as a pilot project monitoring the morbidity and mortality of Rommany infants and children, and the linking with the local community to set health priorities and activity evaluation on county level.

SCHOOL HEALTH SERVICE

- Head, Pr Marina Kuzman, MD, ScD

On September 14‑17 in Leuven, Belgium, there was a working session and a workshop organised by the European Union of School and University Medicine, which was a part of a joint project by Flanders, Slovenia and Croatia named “Implementation of a methodology for developing professional guidelines on schoolchildren’s health care”.  The gathering was attended by Professor Vesna Juresa of Andrija Stampar School of Public Health, Pr Marina Kuzman, MD, ScD and Dr Ivana Simetin from CNIPH, and by Dr Nina Perkovic of the Zagreb Institute of Public Health.  All project associates discussed the basic draft guideline and prepared it for technical discussion on national levels.  Also considered by the Meeting was the health care for students in EUSUHM member states, with the preparations for the 14th Congress of EUSUHM, which is scheduled to take place at Tampere, Finland, on 6‑9 June 2007 being continued at the regular annual conference.

The 12th European Meeting of the International Association for Adolescent Health (IAAH) was held on 21‑23 September in Athens.  Pr Marina Kuzman, ScD and Dr Ivana Pavic Simetin attended on the part of CNIPH.  They presented two reports on the topical experience of Croatia’s School Health Service in the area of obesity prevention in the school population.  These were titled “Medical and Environmental Risk Factors in Obese/Overweight Schoolchildren Examined in Croatian School Health Service” (authored by M. Kuzman, N. Perkovic, and I. Pavic Simetin) and “Examination and Treatment of Overweight/Obese Schoolchildren – Case Study Croatia” (authored by I. Pavic Simetin, M. Kuzman, and N. Perkovic).  The reports were based on an investigation done as part of a guideline development on the prevention of obesity designed for school health.  The operation of school health and the organisation of healthcare for children and adolescents in Croatia were rated highly positive, particularly by the Greek colleagues.

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has organised on 25‑26 September in Lisbon a Meeting of the Working Group on Drug Addict Treatment Indicators, which was attended by representatives of 27 countries with in addition 10 guest experts. Croatia was represented by Dr Dragica Katalinic.

The agenda topics referred to the outstanding problems in standardising the data that are collected from different countries: methodological issues, analysis, future development, and projects on indicators of drug addict treatment.  The session unfolded via three workshops on the assessment and improvement of data coverage, drug addict treatment outcome, and potentials for improvement in data quality.  Whether countries have a quality control mechanism and how this mechanism operates in view of their each having a different data collection method was a point of debate.  Remaining for future debate there is a question of harmonising the method of notifying individual drugs and of registering the first and second subsidiary drug besides the main one.

The closing part of the Meeting tackled the problem of children and very young people (under 21 years) who present for treatment because of drug dependency.  It has been noticed that two thirds of them come from one‑parent families, with maltreatment being the most important factor for the onset of drug use in these children.

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

A workshop called “Development of National Guidelines for Prudent Use of Antimicrobials” took place in Zadar as part of the MATRA project (MAT05/HR/9/2) “Strengthening Surveillance of Antimicrobial Resistance in Croatia”.  Moderating the workshop were experts from Holland and Slovakia.  Its main aim was the use of the AGREE methodology in technical guideline writing and an evaluation by its means of the existing clinical guidelines in Croatia.  Dr V. Katalinic‑Jankovic of CNIPH attended the MATRA workshop as its working group member.

The second part of the meeting was taken up by a workshop “Development of Strategies for Reduction of MRSA Infections in Hospitals.” Experts from Holland, Great Britain and Croatia were the lecturers.

One of the basic precepts of the WHO document “Strategic approach for the strengthening of laboratory services for tuberculosis control, 2006‑2009” is that the network of national TB laboratories should be strengthened.  Accordingly, on 25‑26 September Drs Silva Tafaj and Fatbardha Sinani of the National Reference Centre for Mycobacteria from Tirana, Albania, stayed in our TB Diagnostics Department.  The purpose of the two‑day training was to gain familiarity with automated systems for the growth of mycobacteria by using the device MGIT 960.  Next, all standards that a modern TB laboratory in Europe should follow were evaluated.  Then they considered the possibilities to strengthen the network of mycobacteriologic laboratories in Albania.  Their stay also included a run of other departments within this Service.

A scientific gathering called “Respiratory Infections of Childhood”, which was organised by Croatian Academy of Medical Sciences and Children’s Disease Clinic, took place on 21 September at the Children’s Disease Clinic in Zagreb.  It was sponsored by Croatian Academy of Arts and Science.  Lecturers from CNIPH were Professor G. Mlinaric‑Galinovic, who reported on an 11‑year study of the respiratory infections in Croatia due to the respiratory syncytial virus (RSV), and Dr S. Ljubin Sternak with a lecture “Seroprevalence of Human Metapneumovirus in Croatia”.  Covered in other topics were human immunoreactions to RSV, as well as the clinical picture and treatment of RSV infections.  Dr Pearay L. Ogra, retired American professor of paediatrics, head of the Department of Pediatrics, University of Galveston, Texas, and professor of paediatrics, Children’s Hospital, State University of New York in Buffalo delivered two lectures: ’RSV – Current Understanding of the Disease’ and ‘Vaccines and the Development of Autoimmune Response’.

The 5th Croatian Congress on Infectious Diseases with international participation, organised by Croatian Medical Association, Croatian Society for Infectious Diseases and Croatian Academy of Medical Sciences took place on 23‑27 September in Zadar.  It reviewed the advances in diagnostic and therapeutic breakthroughs in infectology.  By holding a lecture “Specific diagnosis of Entamoeba histolytica infections using enzyme immunoassay” Drs D. Horvat‑Krejci and M. Sviben attended for CNIPH.  They stressed the importance of the diagnosis specific of this agent.  A poster presented by Drs S. Ljubin‑Sternak and T. Vilibic was named “Serologic evidence of the presence of human metapneumovirus in Croatia.”  The human respiratory metapneumovirus has been diagnosed recently and the results shown are the first review of the infection with this virus in Croatia.

A continuing education course “Does Avian Influenza lead to a New Influenza Pandemic?” organised by Croatian Medical Chamber, by Croatian Medical Association and run by Croatian Society for Infectious Diseases took place on 23 September and on 7 October in Zadar and Rijeka, respectively.  On behalf of the National Centre for Influenza and of CNIPH’s Virology Department, Dr V. Drazenovic depicted in a lecture the present situation, “bird flu” threat, neuraminidase inhibitors, immunisation, and all current topics.  Spurred by the live interest, Croatian Medical Association is organising an additional continuing education course of the same name and worth 11 credits to the takers; its attendance is free.  This cycle scheduled for 21 October in Pula and 28 October in Varaždin will be starting at 9 AM.

Within the National Centre for Influenza Dr V. Drazenovic has translated and adapted Kamps‑Hoffmann‑Preiser’s “Book on Influenza” to publicise the public‑health knowledge of influenza and of the alleviation of consequences in the case of pandemic.  The book, through its 10 chapters, is the first such extensive text in Croatian to introduce us to all the “secrets” of influenza.  These deal with the topics: influenza in 2006, avian influenza, structure of the influenza virus, pathogenesis and immunology, preparations for a pandemic, vaccines, laboratory diagnosis, clinical picture, treatment and preventive campaigns, new antivirals.