Using Facemasks or Respirators

• Avoid close contact (less than about 6 feet away) with the sick person as much as possible.
• If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a facemask (for example, surgical mask) or N95 disposable respirator.
• An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through an N95 mask for long periods of time. More information on facemasks and respirators can be found at H1N1 Flu (Swine Flu) website.
• Facemasks and respirators may be purchased at a pharmacy, building supply or hardware store.
• Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor. Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible.
• Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they don’t touch anything else.
• Avoid re-using disposable facemasks and N95 respirators, if possible. If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.
• After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.
• For more information, see the Interim Recommendations for Facemask and Respirator Use

If you are the caregiver

• Avoid being face-to-face with the sick person.
• When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.
• Clean your hands with soap and water or use an alcohol-based hand rub* after you touch the sick person or handle used tissues, or laundry.
• Talk to your health care provider about taking antiviral medication to prevent the caregiver from getting the flu.
• If you are at high risk of influenza associated complications, you should not be the designated caretaker, if possible.
• If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. Designate a person who is not at high risk of flu associated complications as the primary caretaker of household members who are sick with influenza, if at all possible. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Facemask and Respirator Use
• Monitor yourself and household members for flu symptoms and contact a telephone hotline or health care provider if symptoms occur.

Protect other persons in the home

• The sick person should not have visitors other than caregivers. A phone call is safer than a visit.
• If possible, have only one adult in the home take care of the sick person. People at increased risk of severe illness from flu should not be the designated caretaker, if possible.
• If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Facemask and Respirator Use.
• Avoid having pregnant women care for the sick person. (Pregnant women are at increased risk of influenza-related complications and immunity can be suppressed during pregnancy).
• Avoid having sick family members care for infants and other groups at high risk for complications of influenza.
• All persons in the household should clean their hands with soap and water or an alcohol-based hand rub* frequently, including after every contact with the sick person or the person’s room or bathroom.
• Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person.
• If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).
• Antiviral medications can be used to prevent the flu, so check with your health care provider to see if some persons in the home should use antiviral medications.

Placement of the sick person

• Keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that’s possible.) Keep the sickroom door closed.
• Unless necessary for medical care or other necessities, people who are sick with an influenza-like-illness should stay home and keep away from others as much as possible, including avoiding travel, for at least 24 hours after fever is gone except to get medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine). This is to keep from making others sick. Children, especially younger children, might potentially be contagious for longer periods.
• If persons with the flu need to leave the home (for example, for medical care), they should wear a facemask, if available and tolerable, and cover their nose and mouth when coughing or sneezing
• Have the sick person wear a facemask – if available and tolerable – if they need to be in a common area of the house near other persons.
• If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant (see below).

Steps to Lessen the Spread of Flu in the Home

When providing care to a household member who is sick with influenza, the most important ways to protect yourself and others who are not sick are to:

• keep the sick person away from other people as much as possible (see “placement of the sick person”) especially others who are at high risk for complications from influenza
• remind the sick person to cover their coughs, and clean their hands with soap and water or an alcohol-based hand rub often, especially after coughing and/or sneezing
• have everyone in the household clean their hands often, using soap and water or an alcohol-based hand rub. Children may need reminders or help keeping their hands clean
• ask your health care provider if household contacts of the sick person—particularly those contacts who may be pregnant or have chronic health conditions—should take antiviral medications such as oseltamivir (Tamiflu®) or zanamivir (Relenza®) to prevent the flu
• If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. Infants should not be cared for by sick family members. For more information, see the Interim Recommendations for Facemask and Respirator Use

How Flu Spreads

The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.

People with novel H1N1 flu who are cared for at home should:

• check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema
• check with their health care provider about whether they should take antiviral medications
• keep away from others as much as possible. This is to keep from making others sick. Do not go to work or school while ill
• stay home for at least 24 hours after fever is gone, except to seek medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine.)
• get plenty of rest
• drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
• cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands
• wear a facemask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza. For more information, see the Interim Recommendations for Facemask and Respirator Use
• be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention.

Interim Guidance for Novel H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home

Novel H1N1 flu virus infection (formerly known as swine flu) can cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with novel H1N1 flu. Like seasonal flu, novel H1N1 flu in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death is possible with novel H1N1 flu infection. Certain groups might be more likely to develop a severe illness from novel H1N1 flu infection, such as pregnant women and persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.

The following information can help you provide safer care at home for sick persons during a flu outbreak or flu pandemic.

2009 H1N1 Flu (Swine Flu)

Situation Update

Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of September 6-12, 2009, a review of the key indictors found that influenza activity continued to increase in the United States compared to the prior weeks.

PM10 (particulate matter) exposure

Data are provided by Eurostat. Fine particulates (PM10), i.e. particulates whose diameter is less than 10 micrometers, can be carried deep into the lungs where they can cause inflammation and a worsening of the condition of people with heart and lung diseases. The data in the indicator relate to target and limit values as set in EC legislation. The limit value for PM10 is 50 µg/m³ (24 h average) not to be exceeded for more than 35 days per calendar year, from 2005.

Consumption/availability of vegetables, excluding potatoes and juice

The DAFNE databank includes data from 44 Household Budget Surveys of some EU Member States and Norway. The information included in the table summarises the results of an inventory disseminated to all data providers, with the objective to understand the methodological attributes of each dataset and to evaluate the feasibility of comparisons between the participating countries. The tasks undertaken in the context of the DAFNE III project can be summarized in the following:

• Incorporation of the raw HBS data of each participating country in the central database, operating at the coordinating centre.
• Harmonisation of the food, demographic and socio-economic information collected in the HBS of the participating countries.
• Estimation of the average daily food availability for the overall population and socio-demographic groups.

Consumption/availability of fruit, excluding juice

The DAFNE databank includes data from 44 Household Budget Surveys of some EU Member States and Norway. The information included in the table summarises the results of an inventory disseminated to all data providers, with the objective to understand the methodological attributes of each dataset and to evaluate the feasibility of comparisons between the participating countries. The tasks undertaken in the context of the DAFNE III project can be summarized in the following:

• Incorporation of the raw HBS data of each participating country in the central database, operating at the coordinating centre.
• Harmonisation of the food, demographic and socio-economic information collected in the HBS of the participating countries.
• Estimation of the average daily food availability for the overall population and socio-demographic groups.

Total alcohol consumption

Data provided by WHO for alcohol consumption in litres per capita. The methodology to convert alcoholic drinks to pure alcohol may differ across countries. Typically beer is weighted as 4-5%, wine as 11-16% and spirits as 40% of pure alcohol equivalent.

Regular smokers

Data are provided in a comparable basis by Eurostat. Tobacco use remains the leading preventable cause of death and disease in our society. It is a major risk factor for diseases of the heart and blood vessels, chronic bronchitis and emphysema, cancers of the lung and other diseases. The indicator is defined as the number of current tobacco smokers among the population, expressed as a percentage of population. A person is a present smoker if he/she declares that smoke tobacco daily or occasionally. The data come from non-harmonised national Health Interview Surveys (HIS) and the countries were asked to post-harmonise the data according to the guidelines which are described in HIS_guidelines 2004 . The HIS data are collected in different years depending on the country, going from 1996 to 2003. There is no fixed periodicity in these kinds of health surveys. Very few countries have a yearly survey on these topics. The national surveys are not all performed in the same period and results are not all at the same time available. From 2004 onwards in EU15 Member States and 2005. From 2004 onwards in EU15 Member States and 2005 in the new Member States, the new EU Statistics on Income and Living Condition survey (SILC) will be used.

Healthy Life Years (HLY)

Eurostat data. The Healthy Life Years indicator (also called disability-free life expectancy) measures the number of remaining years that a person of a certain age can be expected to live without disability. Healthy Life Years is a solid indicator to monitor health as a productivity/economic factor. Healthy Life Years introduces the concept of quality of life. It is used to distinguish between years of life free of any activity limitation and years experienced with at least one activity limitation. The emphasis is not exclusively on the length of life, as is the case for life expectancy, but also on the quality of life.

Healthy Life Years (HLY) is a functional health status indicator that is increasingly used to complement conventional life expectancy indices. The HLY index was developed to reflect the fact that not all years of a person's life are typically lived in perfect health. Chronic disease, frailty and disability tend to become more prevalent at an older age, so a population with a higher life expectancy may not be healthier. Indeed, a major question with an aging population is whether increases in life expectancy will be associated with a greater or lesser proportion of the future population spending their years living with disability. If HLY is increase more rapidly than life expectancy in a population, then not only are people living longer, they are also living a greater portion of their lives free of disability.

Any loss of health will, nonetheless, have important secondary effects. These will include an altered pattern of resource allocation within the health-care system, as well as wider-ranging effects on consumption and production throughout the economy. It is important for policy-makers to be aware of the cost (i.e. the benefits foregone) of doing too little to prevent ill-health, resulting in the use of limited health-care resources for the diagnosis, treatment, and management of preventable illness and injuries

Prevalence of any chronic illness

Eurostat data. One of the ways used by governments to assess the positive aspects of health is surveying the population's self-perceived health status. The data come from non-harmonised national Health Interview Surveys (HIS) and the countries were asked to post-harmonise the data according to the guidelines described in HIS_guidelines 2004. The HIS data were collected in different years (between 1996 and 2003) depending on the country. There is no fixed periodicity for this kind of health survey. Very few countries have a yearly survey on these topics. The national surveys were not all performed in the same period and the results were not all available at the same time. From 2004 in EU15 Member States and 2005 in the new Member States, the new EU Statistics on Income and Living Condition survey (SILC) will be used.

Self-reported chronic morbidity

The European Statistics of Income and Living Condition (EU-SILC) survey from Eurostat contains a small module on health, including a question on chronic (long-standing) illnesses or conditions. Data refer to the self-declaration by the respondents of whether they have or do not have a chronic (longstanding) illness or condition. From 2005 onwards the data are available for all EU25 Member States, Iceland and Norway. Bulgaria, Romania, Turkey and Switzerland launched SILC in 2006. Data are broken down by sex, age group, activity status, educational level and income

Perceived general health, prevalence

Eurostat data. One of the ways used by governments to assess the positive aspects of health is surveying the population's self-perceived health status. Subjective or self-reported health status is not a substitute for more objective indicators but rather complements them: reports of self-perceived health introduce a consumer perspective into population health monitoring and reveal aspects of health that may not become apparent with more traditional measures. The data come from non-harmonised national Health Interview Surveys (HIS) and the countries were asked to post-harmonise the data according to the guidelines described in HIS_guidelines 2004. The HIS data were collected in different years (between 1996 and 2003) depending on the country. There is no fixed periodicity for this kind of health survey. Very few countries have a yearly survey on this subject. The national surveys were not all performed in the same period and the results were not all available at the same time. From 2004 in EU15 Member States and 2005 in the new Member States, the new EU Statistics on Income and Living Condition survey (SILC) will be used.

Injuries: workplace

Eurostat data on the evolution of the incidence rate of serious accidents at work in comparison to 1998 (= 100). The incidence rate = (number of accidents at work with more than 3 days' absence that occurred during the year/number of persons in employment in the reference population) x 100 000. An accident at work is a discrete event which occurs at work and leads to physical or mental harm. This includes accidents at work but outside the work premises, even if caused by a third party, and cases of acute poisoning. It excludes accidents on the way to or from work, incidents solely of medical origin, and occupational diseases.

Injuries: road traffic

Data are provided by Eurostat. The number of persons killed per year is the number of all those killed outright or within 30 days as a result of the accident. Fatality rate is the number of deaths per million inhabitants

(Low) birth weight

WHO provides data on the number of births within each 500g weight interval expressed as a proportion of all registered live and stillbirths. When analysed by gestational age, birth weight distributions provide an indication of growth restriction. Growth restriction is a major complication of pregnancy and is closely related to stillbirth, poor neonatal outcome and future health status. Although birth weight data are of value in their own right, they are especially useful where data on gestational age are lacking, and are associated with health in later life.

Dementia / Alzheimer

Thanks to the work of the European Community Concerted Action on the Epidemiology and Prevention of Dementia group (EURODEM), estimations now exist on how many people in a given country are likely to have dementia. Although dementia does not only affect older people, the likelihood of developing dementia nevertheless increases with age. EURODEM pooled data on the prevalence of moderate to severe dementia in several European countries and came up with a set of prevalence rates for men and women in 9 different age groups (30-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85-89, 90-94 and 95-99). The study included people with dementia who were living at home as well as those in institutions, nursing homes and residential care.

The Alzheimer Europe project European Collaboration on Dementia (EuroCoDe) reviewed epidemiological studies in the field of dementia and refined prevalence rates for dementia. EuroCoDe calculated the likelihood of developing dementia using the EURODEM (1991) and the EuroCoDe (2009) prevalence rates on the basis of United Nations population figures.

EuroCoDe confirmed existing prevalence rates of dementia for both men and women up to the age of 85. The review also showed that prevalence of dementia in women over the age of 85 had been under-reported. Therefore Alzheimer Europe has reassessed its estimation of the number of Europeans living with a form of dementia.

The results should also be treated with caution for the following reasons:

• The data for EuroCoDe were obtained from Germany, Finland, France, Italy, the Netherlands, Norway, Portugal, Spain, Sweden and the United Kingdom and might not therefore be accurate when used in connection with other countries not included in the study.
• The study was based solely on diagnosed cases. This poses a problem in accurately estimating the number of people with dementia, as many people with dementia never receive a diagnosis and it excludes those in the early stages of dementia who have not yet been diagnosed.
• The review of epidemiological studies highlighted that the prevalence of dementia in younger people (under the age of 60) requires further investigation.

Incidence of cancers related to the sex

Data are collected by the International Agency on Research on Cancer (IARC) and supply the GLOBOCAN 2002 database with the support of past and present EU action programmes on cancer and public health (DG SANCO). Incidence data are available from cancer registries. They cover entire national populations, or samples of such populations from selected regions. The prevalence of cancer (persons who are alive with cancer diagnosed within a given number of years of diagnoses) is estimated. Cancer data are always collected and compiled sometime after the events to which they relate, so that the most recent statistics available are always "late". The degree of lateness varies, but in order to make comprehensive (worldwide) estimates of burden, it is necessary to use data that are several years old. GLOBOCAN 2002 presents estimates for the year 2002. However, although the populations of the different countries are those estimated for the middle of 2002, the disease rates are not those for the year 2002, but from the most recent data available, generally 2-5 years earlier. It should be emphasized that:

• These estimates are based on the most recent data available at IARC, but more recent figures may be available directly from local sources.
• Because the sources of data are continuously improving in quality and extent, estimates may not be truly comparable overtime and care should be taken when comparing these estimates with those published earlier. The observed differences may be the result of a change in the methodology and should not be interpreted as a time trend effect.
• The Age-Standardized Rate (ASR, world standard) is calculated using the 5 age-groups 0-14, 15-44, 45-54, 55-64, 65+. The result may be slightly different from that computed using the same data categorised using the traditional 5 year age bands.

Cancer incidence

Data are collected by the International Agency on Research on Cancer (IARC) and supply the GLOBOCAN 2002 database with the support of past and present EU action programmes on cancer and public health (DG SANCO). Incidence data are available from cancer registries. They cover entire national populations, or samples of such populations from selected regions. The prevalence of cancer (persons who are alive with cancer diagnosed within a given number of years of diagnoses) is estimated. Cancer data are always collected and compiled sometime after the events to which they relate, so that the most recent statistics available are always "late". The degree of lateness varies, but in order to make comprehensive (worldwide) estimates of burden, it is necessary to use data that are several years old. GLOBOCAN 2002 presents estimates for the year 2002. However, although the populations of the different countries are those estimated for the middle of 2002, the disease rates are not those for the year 2002, but from the most recent data available, generally 2-5 years earlier. It should be emphasized that:

• These estimates are based on the most recent data available at IARC, but more recent figures may be available directly from local sources.
• Because the sources of data are continuously improving in quality and extent, estimates may not be truly comparable overtime and care should be taken when comparing these estimates with those published earlier. The observed differences may be the result of a change in the methodology and should not be interpreted as a time trend effect.
• The Age-Standardized Rate (ASR, world standard) is calculated using the 5 age-groups 0-14, 15-44, 45-54, 55-64, 65+. The result may be slightly different from that computed using the same data categorised using the traditional 5 year age bands.

Communicable Diseases

Data was obtained from the Joint DG SANCO / Eurostat Questionnaire (1981-2005) for The First European Communicable Disease Epidemiological Report, produced by the European Centre for Disease Prevention and Control (ECDC), except for data on tuberculosis, which was provided by the EuroTB Centre (supported by the European Commission) until 2007. From 2006 onwards, the ECDC started to collect data on communicable diseases. Since 1 January 2008, the ECDC and the World Health Organization Regional Office for Europe (WHO/Europe) have been jointly coordinating the tuberculosis surveillance activities in Europe. In calculating the incidence of disease per year, the numerator is the total number of reported cases in a specific year, whilst the denominator is the sum of the population of the countries that were reported in that year per 100 000.

Under Commission Decision 2000/96/EC of 22 December 1999, the EU agreed to set up a network at Community level to monitor the incidence of a certain number of specific communicable diseases. In selecting diseases to be covered by epidemiological surveillance within an EU network, the criteria included: (1) diseases that cause, or have the potential to cause, significant morbidity and/or mortality across the Community; (2) diseases where the exchange of information may provide early warning of threats to public health; (3) rare and serious diseases which would not be recognised at national level and where the pooling of data would allow hypothesis generation from a wider knowledge base; and (4) diseases for which effective preventive measures are available with a protective health gain.

The Commission Decision 2002/253/EC of 19 March 2002 (and subsequent modifications) lays down the compulsory case definitions for reporting these communicable diseases to the Community network.

HIV/AIDS

Data provided by the EuroHIV Centre (supported by the European Commission) on AIDS cases reported by EU Member States. Cases are recorded according to the AIDS-case definition of 1993 and subsequent revisions. Because of reporting delays (time between the diagnosis of an AIDS case and it being reported at national level), trends are best assessed by examining data by year of diagnosis and adjusting for reporting delay, rather than by year of report.

Drug-related deaths

The EMCDDA definition of drug-related death refers specifically to deaths caused directly by drug abuse. The EMCDDA has published guidelines on how to extract, select and report cases of drug-related death according to the EMCDDA definition, from general death registers founded on the EMCDDA report containing the results of field tests.

Standardised death rates Eurostat 65 causes

Death rate of a population adjusted to a standard age distribution. As most causes of death vary significantly with people's age and sex, the use of standardised death rates improves comparability over time and between countries, as they aim at measuring death rates independently of different age structures of populations. The standardised death rates used here are calculated on the basis of a standard European population (defined by the World Health Organization).

Perinatal mortality (foetal deaths plus early neonatal mortality)

Eurostat data on foetal deaths (over 1000g) plus early neonatal deaths (0-6 days) per 1 000 live births

Infant mortality

Data are provided by Eurostat as the ratio of the number of deaths of children under one year of age during the year to the number of live births in that year. The value is expressed per 1 000 live births.

Life expectancy

Life expectancy at birth is a summary measure of the age-specific all cause mortality rates in an area in a given period. It is the average number of years a new-born baby would survive, were he or she to experience the particular area's age-specific mortality rates for that time period throughout his or her life. Life expectancy can be calculated starting at different ages. Here we have life expectancy at birth, life expectancy at age 60 and life expectancy at age 65. Data are provided by Eurostat.

Population below poverty line

Data are provided by Eurostat as the share of persons with an equivalised disposable income below the risk-of-poverty threshold in the current year and in at least two of the preceding three years. The threshold is set at 60 % of the national median equivalised disposable income.

Total unemployment

Data are provided by Eurostat as the unemployed persons comprise persons aged 15 to 74 who were: without work during the reference week; currently available for work, i.e. were available for paid employment or self-employment before the end of the two weeks following the reference week; actively seeking work, i.e. had taken specific steps in the four weeks period ending with the reference week to seek paid employment or self-employment or who found a job to start later, i.e. within a period of at most three

Population projections

Data are provided by Eurostat. Population is divided into age groups covering intervals of 1 year and a group of all ages. Forecasts beginning with 1995 2005 and then every fivefth years. Forecasts are based on assumptions on total fertility rate, life expectancy and migration

Fertility rate

Data are provided by Eurostat as the mean number of children that would be born alive to a woman during her lifetime if she were to pass through her childbearing years conforming to the fertility rates by age of a given year. It is therefore the completed fertility of a hypothetical generation, computed by adding the fertility rates by age for women in a given year (the number of women at each age is assumed to be the same). The total fertility rate is also used to indicate the replacement level fertility; in more developed countries, a rate of 2.1 is considered to be replacement level.

Mother's age distribution (teenage pregnancies, aged mothers)

Data are provided by Eurostat. Life birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live born. The age of the mother is defined as the age reached in the year the event took place.

Crude Birth rate

The crude birth rate relates the number of births during the year to the average population in that year. The value is expressed per 1000 inhabitants. Data are provided by Eurostat.

Age dependency ratio

Data are provided by Eurostat and defined as the ratio of the population defined as dependent (the population age 0-14 and 65 and over) divided by the population 15-64, multiplied by 100.

Population by gender/age

Data are provided by Eurostat and the US Bureau of the Census and are calculated as the number of inhabitants of a given area on 1 January of the year in question (or, in some cases, on 31 December of the previous year). The population is based on data from the most recent census adjusted by the components of population change produced since the last census, or based on population registers.

ECHI

The ECHI (European Community Health Indicators) project was carried out in the framework of the Health Monitoring Programme and the Community Public Health Programme 2003-2008. The result is a list of 'indicators' for the public health field arranged according to a conceptual view on health and health determinants.

In general, the following criteria were applied in the selection of the indicators:

• Comprehensiveness: all aspects of the public health field should be covered.
• Meeting user needs: the set should cover the main priorities in public health policies of the Commission and the Member States.
• Being innovative: the set should not just be data-driven, but also indicate development needs.
• Using earlier work: the efforts of international institutions with Eurostat and other Commission Services as main providers, but also OECD and the WHO-Europe, in defining indicators and standard variables have been taken on board as much as possible.
• Using Health Monitoring Programme and Public Health Programme results: the results of projects should be included in the data where appropriate.
  

Indicators are at the crossroads of policy questions and data sets. Indicators reflect a policy interest as well as a selected set of possibilities in terms of what can be calculated. Therefore they will on one hand be justified from the policy side and on the other hand a short characterisation of the data source it's added.

The strategy on European Community Health Indicators (ECHI) (136 KB) has been summarised in a key document.

ICHI (International Compendium of Health Indicators) is a web-based application containing the health indicators used by WHO-Europe, OECD and Eurostat in their international databases. ICHI provides a selection of the most relevant indicator names and definitions as listed by these organisations. It also includes the complete list of health indicators developed by the ECHI project. All indicators are arranged following the ECHI taxonomy. The ECHI list and the ICHI website have been developed by the ECHI project (European Community Health Indicators, in two phases, 1998-2004) project, run under the EU Health Monitoring Programme. ICHI offers an easy entry to the indicator definitions used by the international organisations in their databases. This allows for a quick comparison between indicators and their definitions, in one coherent and structured system.

You can see the data of the First Set of ECHI indicators including 40 items. These data are readily available and are reasonably comparable (mostly based on assessment by Eurostat). For all indicators where this is considered useful or appropriate, stratification by gender and age is applied.

Treatment of Cancer

Surgery, chemotherapy or radiation, biological therapy, hormone therapy, and the target therapy treat cancer.

The treatment provides you options. You have to decide that if you want to cure and control your disease or only get comfort. In early diagnosis cure is possible in middle stage control is achieved and at the last stage the person just wants to live comfortably. Your health in general, financial costs of treatment, reactions of the treatment, effect of treatment can be checked and then after consulting with your surgeon treatment is decided.

Prevention of Cancer

If cancer causes by heavy alcohol intake, or cigarette smoking then it can be prevented. The cancers related to physical inactivity, obesity, nutrition could be prevented. The cancers associated to infectious agents as human papillomavirous (HPV), hepatitis B virus (HBV), human immunodeficiency virus (HIV), and others can be prevented through vaccines, behavioral changes, or antibodies. The sun ray protection can prevent various skin cancers.

Microscopic subtypes and smoking habits

Cancers that originate from lung cells can be divided into two groups, small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC), according to their microscopic characteristics. NSCLC's include squamous cell carcinoma (SQC), large-cell carcinoma (LCC) and adenocarcinoma (AD). Tobacco smoking causes all types of lung cancer, but predominantly increases the incidence of SQC. The incidence of this subtype is therefore more sensitive to the history of smoking in any given population.
The AD subtype dominates among non-smokers. It therefore appears to be more common among European women who took up the smoking habit considerably later than men.
The relative frequency of the different subtypes is therefore strongly influenced by the prevalence, duration and intensity of tobacco smoking in the population. For men, the typical distribution by subtype is 15% SCLC, 23% AD and 41% SQC. For women, it is 13% SCLC, 40 % AD and 23 SQC.

Basic facts and ICD classification

Lung cancer is the uncontrolled growth of abnormal cells in one or both of the lungs, causing lump (tumour) growth and disrThe ICD-10 classifies these cancers under rubric C34 as malignant neoplasms of the bronchus and lung. For the purpose of reporting, routine statistics for the lung and bronchus are often pooled with those of the trachea (C33). upting the normal functioning of the organ.This EUphact only covers tumours that originate in the lung. Malignant neoplasms that affect the lungs, but do not originate in the cells of the bronchus or lung are not covered within the scope of this EUphact.

Lung cancer is largely avoidable

Active or passive smoking causes approximately 90% of all lung cancers. This makes lung cancer the single largest avoidable cause of death in the EU. Apart from avoiding passive or active inhalation of tobacco smoke, there is currently little or no evidence for other effective preventive strategies, including screening and nutrition.

Differences between sexes and among regions

In most countries the lung cancer incidence and mortality rates for men are higher than for women. This observation is linked to the smoking habit that has become popular among women decades later compared to men. The rates for men are now slowly declining, while female lung cancer incidence and mortality are increasing in many countries. Estimates based on current smoking prevalence predict that these trends will continue for some decades in spite of improved prevention efforts. Differences in income and education among EU member states and regions are consistent with differences in lung cancer incidence and mortality, highlighting the health inequalities within the EU.

Lung cancer incidence and mortality vary considerably across the EU

Patterns of lung cancer incidence and mortality follow the patterns of smoking prevalence in the population with a delay of about 20 years. Both incidence and mortality differ by gender and vary considerably among EU member states. Differences in lung cancer incidence and mortality among countries reflect the distinctive patterns of the WHO tobacco pandemic model. In Sweden, both are relatively low and stable. They are slowly declining in some North Western EU countries, such as the UK, Finland and the Netherlands. In several of the new EU member states the incidence and mortality rates for lung cancer are among the highest in Europe and, in some cases, still rising.

Lung cancer

Lung cancer is one of the most fatal cancers
Lung cancer is the most common cancer in men, both worldwide and in the EU. It kills about 240,000 EU citizens yearly. Therapy options include surgery, chemotherapy and radiation. Survival rates, although generally very low, differ significantly among EU member states, suggesting differences in stage at presentation and access to optimal treatment.

Risk Factors of Cancer

External factors causing cancer are:
Tobacco
Infectious organisms
Radiation
Chemicals

Internal factors causing cancer are:
Hormone
Inherited mutations
Immune conditions
Mutations that occur from metabolism If you are exposed to external factor and you are caught by the disease then ten or more years pass till cancer is detected.

Cancer is a kind of disease in which cells divide abnormally without control and may overrun other tissues. Through blood and other lymph system these cells spread in all over body. Cancer results in death if spread of cells is not controlled.

Cancer

Every year 3.2 million Europeans are diagnosed with cancer, mostly breast, colorectal or lung cancers. Although great advances continue to be made in research and treatment, cancer remains a key health concern. The EU has taken action on various fronts to save life and improve cancer survivors' quality of life.
General health can be improved, and certain cancers avoided, by adopting a healthier lifestyle (see the European Code Against Cancer). Effective screening programmes are crucial too, for early detection and treatment of the disease.
There are currently worrying inequalities between EU countries in levels of cancer control and care, including screening and follow-up for breast, cervical and colorectal cancer. Several EU projects are gathering comparable data on cancer occurrence and outcomes to identify and promote good practice in prevention, diagnosis, treatment and care across the EU. EU countries have a lot to gain from working together. Cancer is not just a national but also a European health challenge. By sharing knowledge, capacity and expertise in cancer prevention and control, we can address the problem more effectively across the