EUROPEAN CONFERENCE ON HARMONIZATION OF PhD PROGRAMS IN MEDICINE AND HEALTH SCIENCES

University of Zagreb –Medical SchoolZagreb, Croatia, April 24 and 25, 2004   PROGRAM 

http://bio.mef.hr/conference

 SCIENTIFIC & ORGANIZING COMMITTEE President: Professor Zdravko Lacković, MD, PhD, – PhD Program Director, Deputy Dean for Postgraduate Studies, University of Zagreb Medical School, Zagreb, CroatiaSecretaries:Professor Jadranka Božikov, PhD, – PhD Program Deputy Director, Andrija Štampar School of Public Health, University of Zagreb Medical School, Zagreb, CroatiaMr. Julien Goodman, – Program Manager, Association of Schools of Public Health in the European Region(ASPHER), Saint Maurice, FranceINTERNATIONALVincenzo Costigliola, MD, President, European Medical Association (EMEA), Bruxelles, BelgiumProfessor Petr Hach, President, Asociation of Medical Schools in Europe (AMSE), 3rd Faculty of Medicine Charles University, Prague, The Czeck Republic

Dr. Guy Haug, Expert on the European Higher Education Area (“Bologna process”), Brussels, Belgium

Dr. Cees C. Leibbrandt, MD., – a former (1999-2002) Secretary General of European Union of Medical Specialists (UEMS), Nijmegen, The NetherlandsProfessor Jadwiga Mirecka MD, PhD, – Member of the Executive Committee Association for Medical Education in Europe (AMEE), Department of Medical Education in Jagiellonian, University Medical College in Kraków, PolandProfessor Charles Normand, PhD, – President – Association of Schools of Public Health in the European Region (ASPHER), Trinity College, Dublin, IrelandProfessor Hans Joachim Seitz, MD, DAAD Deutscher Akademischer Austausch Dienst – German Academic Exchange Service), South-Eastern-European-Cooperation, Curriculum Reform in Medicine, Universitätsklinikum Hamburg-Eppendorf, Zentrum für Experimentelle Medizin Institut f. Biochemie u. Molekularbiologie Biochemische Endokrinologie Hamburg, GermanyProfessor László Vécsei, MD, PhD, DSc. – Director of the Experimental and Clinical Neuroscience PhD Program, Albert Szent-Gyorgyi Medical and Pharmaceutical Center, Faculty of General Medicine, Department of Neurology, University of Szeged, HungaryCROATIAN

Professor Nada Čikeš, MD, PhD, – ECTS coordinator, University of Zagreb Medical School, Zagreb, Croatia

Professor Marija Dominis, MD, PhD, Vice-Dean for postgraduate education, University of Zagreb Medical School, Zagreb, CroatiaProfessor Boris Labar, MD, PhD, – Dean of the University of Zagreb Medical School, Zagreb, CroatiaProfessor Jasna Helena Mencer, PhD, – Rector of the University of Zagreb, Zagreb, Croatia

Professor Stjepan Orešković, PhD, – Director, Andrija Štampar School of Public Health, University of Zagreb Medical School, Zagreb, Croatia

Professor Krešimir Pavelić, MD, PhD, – Director, Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia

CONFERENCE OBJECTIVES

The initiative to organise European conference on the harmonization of PhD programs has been prompted by:

1. The variety of organisational models of European PhD programs in biomedicine and health sciences. Some countries do not have PhD programs in medicine and health sciences at all. There are considerable differences between different universities in the same country, and even in the same country we can find two degrees: PhD and DSc. Most important information about PhD programs in medicine and public health in most European countries are not internationally available. Let us come together and exchange our experiences. Since the time available is limited, we should write information on our PhD programs in advance. Thus we are all to become active participants in the Conference, and the first booklet on PhD program, with our contribution, will be waiting for us in Zagreb.
2. On the other hand, in the attempt to comply with the «Bologna Process», many universities are now organizing new PhD programs. According to the Bologna Process, the PhD program is the last step in higher education, but in its best tradition, it is a research as well, and should therefore be completed with a PhD Thesis. What is the place of advanced learning in such programs and should there be some minimal criteria for scientific accomplishments in one’s PhD Thesis? Is the PhD title the beginning or a “crown” of one’s academic and scientific career, or is it only the last step in education wherein research is not obligatory. If internationally recognized research should be the basis, how is one to organize good PhD programs in countries with a “small scientific community” (and a small scientific output). Following formally Bologna requirements, is there a danger to create a very diversified output? Is there a proper solution to these problems? Is it possible to reach a consensus on what exactly a PhD program should be, or perhaps even to offer certain recommendations for basic organizational and scientific requirements?
3. The additional important questions are: the position of the existing Master programs in the light of the Bologna Process, introduction of ECTS in postgraduate education, and an open possibility to connect all forms of postgraduate and lifelong learning by means of ECTS. The problem of Master programs can be best observed in the field of public health where such programs are entered by scholars of different professional background (MDs which equals MSc according to the Bologna Process, MSc or even BSc degrees in social sciences, economics etc.). Is then a Master program in public health a postgraduate or additional graduate (MSc) program?

The solution to some of the above mentioned problems could be achieved by creating a regional i.e. international network(s) which would enable an increased fluctuation of students and academic staff, the exchange of new achievements and a wider range of subjects. Probably no country in Europe can meet the highest standards in all fields of current medical research on its own. Along with an improvement of quality, the aim of international co-operation is the broadening of contents, in order to be as close as possible to the dissertation topic of each individual attendant of the doctoral study. Therefore, this kind of network(s) represents an indispensable way of cooperation.

And finally, the major aim of the Conference is to gather in one place the representatives of European medical schools, schools of public health and research institutes participating in PhD programs in medicine and public health, who will give an insight into their experiences and the experiences of their countries, as well as try to propose the best way of mutual harmonization. Even if the only outcome would be the first publication of PhD programs in Europe, it would still be an important guideline for many universities in creating or reshaping their PhD programs. If, additionally, we propose certain recommendations and start initiatives for mutual cooperation, it will represent a significant achievement.

PRELIMINARY PROGRAM

In general we will work in sessions, chaired by several members of Scientific & Organizing Committee. Chairmen, together with the Scientific & Organizing Committee, will prepare written proposal of consensus statement (that is why we have usually one invited speaker but 4 chairmen). Discussion about invited lecturers and proposed consensus statement, exchange of experiences and ideas as cornerstone of the Conference.

 FRIDAY, April 23, 200420.00 – Welcoming reception cocktail party at the Dverce City Palace given by the Lady Major of Zagreb Ms. Vlasta Pavić.   

SATURDAY, April 24, 2004

09.30 – 10.30 Welcome and introduction

                        Chair: Helena Jasna Mencer, Boris Labar, Mara Dominis

10.30 – 11.00  Coffee break

11.00 – 13.30 Session 1. Overview of PhD programs in different universities and countries

Chair: Petr Hach, László Vécsei, Zdravko Lacković

Invited Lecturer:

Vincenzo Costigliola: EPOWEB project about medical postgraduate programs in Europe

Zdravko Lacković, Jadranka Božikov and Marija Dominis: A survey of PhD programs in European medicine and public health: A compilation of answers to a questionnaire

Tina Dušek, Alena Kavalirova (PhD students from Croatia and Czech Repubic): An overview of European PhD programs as available on the Internet 

Chairpersons will present proposal of consensus statement.

13.30 – 14.30  Lunch

14.30– 16.00   Session 2. PhD programs in the Bologna process

Chair: Vincenzo Costigliola, Charls Normand, Marija Dominis, Jardanka Bozikov

Invited Lecture: Guy Haug:“Trends in PhD programs in the context of the Bologna process”.

Chairpersons will present proposal of consensus statement.

15.30 – 16.00  Coffee break

16.00 – 16.30  Session 3. Master programs in Medicine and Public Health: are they still necessary: where to place them in the «Bologna process», interrelations among Master programs, PhD programs, programs of specialist CME.

Chair: Charles Normand, Cees C. Leibbrandt, Stjepan Orešković

Invited Lecturers:

Charles Normand: Is there a need for Master Programs in Public Health and Medicine?

Luke Kovačića i Jadranke Boľikov:  Master Programs in Public Health – Dilemmas and Challenges

Cees C. Leibbrandt: Problems and achievements in continuing medical education (CME) in Europe.

Chairpersons will present proposal of consensus statement.

20.00 Dean’s welcoming dinner reception party  (information will be available on Internet site of the Conference: http://bio.mef.hr)

SUNDAY, April 26, 2004

9.30 – 11.00    Session 4. Is there a need for regional, international cooperative network(s) in PhD Programs (what possible modalities)?

Chair: Joachim Seitz, Nada Čikeš, Boris Labar

Invited Lecturers:

Joachim Seitz: How to promote cooperation in South –East Europe? DAAD Experinece.

Nada Čikeš, Aleksa Bjeliš, Jasna Helena Mence; The role of University of Zagreb in developing joint doctoral programs.

Chairpersons will present proposal of consensus statement.

11.00 – 11.30  Coffee break

11.30 – 13.30  Session 5. Closing discussion, conclusions, recommendations etc.

Chair: Petr Hach, Vicenco Costigliola, Charles Normand, Zdravko Lacković, Jadwiga Mirecka

Chairpersons will present proposals of consensus statements and recommendations.

13.30                                          Lunch

INSTRUCTION FOR PREPARATION OF MANUSCRIPT TO BE PUBLISHED IN EXTENSIO IN MONOGRAPH WITH A WORKING TITLE:

EUROPEAN PhD PROGRAMS

IN MEDICINE & HEALTH SCIENCES

One of the primary goals of the Conference is to collect data on what PhD programs in medicine and health sciences currently look like in Europe. We think that a publication with some introductory articles by our invited speakers might contribute to harmonization and development of these programs. It is thus very important to collect such data from as many European universities as possible. We kindly ask even those universities which will not be able to attend the conference to send us manuscripts about their programs. In return all first authors and all institutions will receive one copy of a monograph free of charge.

Preparing the manuscript please follow rules outlined bellow.

All manuscripts should be sent as attachments to the e-mail address of Conference Secretary: Professor Jadranka Božikov: jbozikov@snz.hr.

To have a monograph printed for the Conference all manuscripts must be received until April 19^th.

Manuscripts should be written using most common fonts like Times New Roman. If you want to use figures and pictures please incorporate them in the text in.jpg or.gif format. They will be reproduced in black and white.

Try to organize the manuscript as follows.

Title:

Name, surname, titles and academic function of all authors.

Address.

Text

References (if you use them please use Vancouver rules, yr; vol: pp)

Writing the manuscript please tray to answer the questions outlined bellow:

1. Do you have a PhD program at your Medical School, School of Public Health or Research Institute?
2. If so, is it covering only a certain more or less narrow field (i.e. neuroscience, public health etc)? If you have more than one program please provide a list.
3. Are you planning to organize a new PhD program(s) in accordance with the Bologna Declaration?
4. If you don’t have a PhD program what is a substitute for it in scientific/academic career (for example habilitation /please give us a short description), published papers (is it a quantitative criterion), experience (is it quantitative)?
5. If you have a PhD program is it organized: (a) as research under the guidance of a supervisor of the PhD thesis only or (b) a combination of research for the thesis and organized courses (Course load)?
6. If your answer to the previous question was (b); is the study divided into fields (disciplines), are the students allowed to choose courses regardless of disciplines, duration of the PhD study in years.
7. Is there an intermediate degree (for example Master of Science, licentiate) before or during attaining the PhD and, if so, state the name of the degree.
8. Conditions for PhD enrolment: whether MD or some other degree is a prerogative (and which?). What is the required grade average and whether supervisors are required.
9. Conditions for approval of PhD dissertation: number of accumulated credits, number of published papers, other.
10. Are foreign experts involved in evaluation of PhD dissertation? How often?
11. Appearance of the PhD dissertation: whether or not it contains published papers.
12. Whether the attainment of the PhD degree a prerequisite for academic career (i.e attaining a status of associate professor or other).

Manuscript should not exceed 4 pages (single spacing, font 10, Times New Roman).

CONFERENCE VENUE:

Zagreb University Medical School, Miroslav Čačković Hall, Šalata 3, Zagreb (10-15 min walking distance from city center (Ban Jelačić square). Transfer from hotels to Zagreb’s Medical School and back will be organized by official accommodation agent.

REGISTRATION.

All representatives of European medical schools, research institutes and schools of public health should register filling up enclosed registration form and a questionnaire in written or electronic form, and sending it to Conference organizer

Dedline: April 20, 2004.

CONFERENCE FEE: For registered representatives of European medical schools, research institutes and schools of public health there is no conference fee. All registered participants will receive conference material and participate in social program free of charge.

TECHNICAL EQUIPEMENT.

Facilities for overhead projection, single and dual slide projection (size 5×5 cm), video projection (VHS format) and computer assisted presentation will be available. Computer assisted presentation in PowerPoint program can be performed by using 3.5’’ floppy disk, CD, ZIP disc or notebook. The slides numbered in the order of projection should be delivered to Registration and Slide Desk 15 min before the start of the session and collected afterwards by the authors.

SOCIAL PROGRAM:

During a conference at Medical School coffee, refreshment and light lunch will be served. Social program in late afternoon and evening hours is also organized.

For accompanying persons different social programs are available trough our travel and accommodation agent.

TRAVEL AND ACCOMODATION: Official travel and accommodation agent:

BTI O-Tours

Mrs. Smiljka Latković, Project Manager

Gajeva 6/ 1^st floor, HR-10 000 Zagreb, Croatia

Phone:+385 1 4831 444, Fax: +385 1 4813 013

e-mail: smiljka.latkovic@otours.hr, congresses@otours.hr, otours@otours.hr | WEB page: www.otours.hr, www.bti-worldwide.com

ORPHEUS Zagreb Proceedings Document 2004

The Declaration of European Conference on

Harmonisation of PhD Programmes in Biomedicine and Health Sciences

Convened in Zagreb on April 24 – 25, 2004

(hereafter referred to as the «Zagreb Declaration»)

After extensive discussion and exchange of ideas and experiences among participants coming from 25 universities and from 16 European countries having different schemes for obtaining PhD degree in medicine and health sciences regarding both form and the way of evaluation, ranging from monograph and evaluation within the same university to high standards of PhD thesis containing four or more papers published in internationally recognized peer reviewed journals, often with high impact factor and the inclusion of evaluators from abroad, the participants of the European Conference on Harmonisation of PhD Programmes in Biomedicine and Health Sciences (hereafter referred to as the «Zagreb Conference» or the «Conference») have agreed on the following:

Article 1

PhD programme is intended to enable individuals, after completing and defending their PhD thesis, to carry out independent, original and scientifically significant research and critically evaluate work done by others. To assure the above, the participants of the Conference reached consensus on the following:

Article 2

As in any kind of scientific peer review process, the reviewers of PhD thesis should be competent and independent from the PhD thesis, candidates and supervisor. In this sense, the participants of the Conference would like to encourage the inclusion of supervisors from other universities and countries.

Article 3

The Conference agreed that a suitable benchmark to describe the necessary achievement is a PhD thesis based on original in extenso publications in internationally recognized scientific-medical journals. The independent contribution of the candidate should be clearly demonstrated (for example the candidate being the first author). The Conference recommends that the minimal requirement for the PhD thesis in medicine and health sciences should be the equivalent of at least three in extenso papers published in internationally recognized journals. In addition to the papers presented the candidate should provide a full review of the literature relevant to the themes in the papers, and, where necessary, a fuller account of the research methods and results. Where the PhD research is presented in other formats, such as the single monograph, reviewers should demonstrate that the contribution is at least equivalent to this benchmark, and should encourage inclusion of publication from the research.

Article 4

While the main demonstration of the achievement should be the thesis and published papers, PhD programmes should include a theoretical basis as well as the development of technical research skills in taught courses where appropriate.

Article 5

The Conference recommends to all universities to make their PhD programmes publicly available to students, lecturers and tutors from other universities and countries. All medical schools are recommended to create their web pages and written material about PhD programmes in English and to make their programs open to candidates from other universities and countries.  The Conference encourages the development of joint PhD programmes in order to enhance the link between the European Higher Education Area and the European Research Area with a view to ensure higher quality and enable joint degree recognition.

Article 6

The development of well-designed and high-quality PhD programmes requires substantial support by medical faculties, universities, national governments, the European Commission or private sponsors and other institutions in order to engage the best medical students into scientific research so as not to lose our future in medicine and public health.

The Zagreb Declaration was adopted unanimously on April 25, 2004 at 2:00 P.M. by:

Conference participants

Representatives of international and Croatian professional / academic associations and governmental institutions (in alphabetical order)

Association of Medical Education in Europe (AMEE)

Prof. Jadwiga Mirecka, MD, PhD, Executive Committee member

Association of Medical Schools in Europe (AMSE)

Prof. Petr Hach, MD, PhD, President

Association of Schools of Public Health in the European Region (ASPHER)

Prof. Charles Normand, BA, DPhil, FFPHM, President

Croatian Medical Association

Prof. Ivan Bakran, MD, PhD, Vice-President

European Medical Association (EMA)

Vincenzo Costigliola, MD, President

German Academic Exchange Service (DAAD), South-Eastern European Cooperation, Curriculum Reform in Medicine

Prof. Hans Joachim Seitz, MD,

Ministry of Health and Social Welfare of the Republic of Croatia

Prof. Velimir Božikov, MD, PhD, State Secretary for Health

Ministry of Science, Education and Sports of the Republic of Croatia

Prof. Pavo Barišić, PhD, Assistant Minister

University of Zagreb, Croatia

Prof. Aleksa Bjeliš, PhD, Vice-Rector

Prof. Helena Jasna Mencer, PhD, Rector

Representatives of medical schools and schools of public health (in alphabetical order by country name)

University of Mostar, Medical School, Mostar, Bosnia and Herzegovina

Prof. Filip Čulo, MD, PhD, Dean

Prof. Mirna Saraga-Babić, MD, PhD, Vice-Dean for Science

University of Sarajevo, Medical School, Sarajevo, Bosnia and Herzegovina

Prof. Jadranka Dizdarević, MD, PhD, Vice-Dean for Undergraduate Studies

Prof. Benjamin Vojniković, MD, PhD, Secretary General of the Medical School

University of Tuzla, Medical School, Tuzla, Bosnia and Herzegovina

Prof. Lejla Begić, MD, PhD, Vice-Dean for Science

Prof. Osman Sinanović, MD, PhD, PhD ProgrammeDirector

Prof. Husref Tahirović, MD, PhD, Dean

Higher Medical Institute of Pleven, Pleven, Bulgaria

Prof. Maria Simeonova, MD, PhD, Head of Medical Genetics Department

1. J. Strossmayer University, Medical School, Osijek, Croatia

Asst. Prof. Gordan Lauc, MD, PhD, Vice-Dean for Education

Asst. Professor Ante Tvrdeić, MD, PhD, Vice-Dean for Postgraduate Studies

University of Rijeka, Medical School, Rijeka, Croatia

Prof. Anđelka Radojčić Badovinac, MD, PhD, Vice-Dean for Postgraduate Studies

Prof. Dragica Bobinac, MD, PhD, Vice-Dean for Graduated Studies

Asst. Prof. Zlatko Trobonjača, MD, PhD

Prof. Luka Zaputović, MD, PhD, Vice-Dean for Science

University of Split, Medical School, Split, Croatia

Prof. Mladen Boban, MD, PhD, Dean

Prof. Željko Dujić, MD, PhD, Coordinator of Postgraduate Studies

Prof. Stjepan Gamulin, MD, PhD, Head of Postgraduate Studies Committee

Prof. Marijan Saraga, MD, PhD, Vice-Dean for Science

University of Zagreb, Medical School, Zagreb, Croatia

Prof. Nada Čikeš, MD, PhD, ECTS Coordinator

Prof. Marija Dominis, MD, PhD, Vice-Dean for Postgraduate Studies

Prof. Boris Labar, MD, PhD, Dean

Prof. Zdravko Lacković, MD, PhD, PhD Programme Director, Deputy Dean for Postgraduate Studies

University of Zagreb, Medical School, Andrija Štampar School of Public Health, Zagreb, Croatia

Prof. Jadranka Božikov, PhD, PhD Programme Deputy Director

Prof. Luka Kovačić, MD, PhD Deputy Director

Prof. Stjepan Orešković, PhD, Director

Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic

Prof. MUDr. Stanislav Štípek, DrSc., Vice-Dean for Pedagogical Affairs

University of Helsinki, Faculty of Medicine, Finland

Prof. Seppo Meri, MD, PhD, Head, Committee for Postgraduate Scientific Studies in Medicine

University of Hamburg-Eppendorf, Germany

Prof. Dr. Hans Joachim Seitz, MD, Director of the Institute for Biochemistry and Molecular Biology III – Biochemical Endocrinology

University of Szeged, Albert Szent-Gyorgyi Medical and Pharmaceutical Centre, Faculty of General Medicine, Szeged, Hungary

Prof. László Vécsei, MD, PhD, DSc, Director of the Experimental and Clinical Neuroscience PhD Programme

University of Dublin, Trinity College, Dublin, Ireland

Prof. Charles Normand, BA, DPhil, FFPHM, Edward Kennedy Professor of Health Policy and Management

University of Pavia, Faculty of Medicine and Surgery, Pavia, Italy

Prof. Alberto Calligaro, Deputy Dean

University “St. Cyril and Methodius”, Medical School, Skopje, R. Macedonia

Prof. Magdalena Žanteva-Naumoska, MD, PhD, Vice-Dean for Postgraduate Studies

Prof. Ljubica Georgijevski-Ismail, MD, PhD, FESC, Member of the Postgraduate Studies Committee

Norwegian University of Science and Technology (NTNU), Faculty of Medicine, Trondheim, Norway

Anne Britt Storeng, Senior Executive Officer, Research Administration

Prof. Alf O. Brubakk, Professor of Environmental Physiology

University of Oslo, Faculty of Medicine, Oslo, Norway

Sigrid Bergseng, Senior Executive Officer and Head of PhD Programme University Administration

Medical Centre of Postgraduate Education, Warsaw, Poland

Zbigniew Wegrzyn, MD, Department of Education and Quality Assessment

Jagellonian University, University Medical College, Kraków, Poland

Prof. Jadwiga Mirecka, MD, PhD, Head of the Department of Medical Education

Poznan University of Medical Sciences, Poznan, Poland

Prof. Maciej Zabel, PhD, Head of PhD Program

Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

Prof. Petru Adrian Mircea, Vice-President of the University

University of Niš, School of Medicine, Niš, Serbia and Montenegro

Prof. Goran Nikolić, MD, Vice-Dean

University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia and Montenegro

Prof. Nevena Sečen, MD, PhD, Vice-Dean for Foreign Communication and Foreign Students

Comenius University, Jessenius Faculty of  Medicine, Slovak Republic

Prof. Kamil Javorka, MD, DSc, Vice-Dean for PhD Study

University of Navarra, Medical School, Navarra, Spain

Prof. Alfonso Sánchez Ibarrola, MD, PhD, member of University PhD Committee

List of other invited lecturers not listed above (in alphabetical order):

Tina Dušek, MD, PhD student, University of Zagreb Medical School, Croatia

Dr. Guy Haug, Expert on the European Higher Education Area (Bologna Process), Bruxelles

Alena Kavalírová, graduated pharmacist, PhD student, Faculty of Pharmacy in Hradec Králové, Charles University in Prague

Dr. Cees C. Leibbrandt, MD, Former Secretary General (1999–2002) of the European Union of Medical Specialists (UEMS)

List of observers (in alphabetical order)

Sandra Belko, BA (English), PhD Programme Secretary, Medical School, University of Zagreb; Kristina Fišter, MD, Research Fellow, Andrija Štampar School of Public Health, Medical School, University of Zagreb; Asst. Prof. Ileana Linčir, MD, PhD, Vice-Dean for Postgraduate Education, University of Zagreb School of Stomatology; Prof. Josip Madić, DVM, PhD, Vice-Dean of Science and International Cooperation, Faculty of Veterinary Medicine, University of Zagreb; Prof. Albert Marinculić, DVM, PhD, Vice-Dean of Education, Faculty of Veterinary Medicine, University of Zagreb; Anita Putrić, BA (Political Science), Senior Executive Officer of PhD Programme Administration, Medical School, University of Zagreb; Marita Mimica, BA (psychologist), Head of Postgraduate Studies Department, Medical School, University of Split, Miroslav Sabolek, BA (economy), Head of PhD Programme Administration, Medical School, University of Zagreb; Assoc. Prof. Velimir Sušić DVM, PhD, ECTS Coordinator, Faculty of Veterinary Medicine, University of Zagreb; Tea Vukušić Rukavina, MD, Research Fellow, Andrija Štampar School of Public Health, Medical School, University of Zagreb.