bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation: Process, priorities, techniques
Authors: Cumper George E 
Published: November 2023

Abstract
The comparison of standards with performance provides the formal logical structure of health, as of other kinds of evaluation. It is therefore analogous with the comparison of experience with hypothesis which gives the structure of an experiment in the natural science –at least in its published form. But it has now become a commonplace that the testing of hypotheses against experience through experiment is only a small part of the process of science, telling us little about the choice of field for investigation, the emergence of hypotheses or the way experiments grow from rough conceptions to their final form. Similarly the process of evaluation is more complex and approximate than the formal structure would suggest. If it were not so, the task of evaluating a national health care system would be a daunting one, involving the comparison of performance and standards item by innumerable item, and we should have no useful answer to the first-time investigator who says ‘But how do I set about this?’
The future of national health system evaluation
Authors: Cumper George E 
Published: November 2023

Abstract
A former member of Who’s staff liked to tell how his little son, entertaining an early visitor, had been asked what was his father’s job. ‘A doctor, eh? If I am sick he will make me better?’ ‘Oh no, he is a talking doctor.’ Suppose the young surgeon who was left in Chapter 2 in transition to international consultancy has arrived, a few years later, at the status of the talking doctor, and even conducted a number of evaluations of the national health systems of developing countries. Picture him resting between assignments, perhaps in the Hotel Cornavin (‘pas de bruit, jour et nuit’). Outside his windows, if he could only hear it, is the decorous nightlife of Geneva. But he has decided to eat quietly and well in the Buffet Premiere Classe and retire to his room. Tomorrow he may have to set out again on his missionary rounds, praising rice to the Sikhs, yam to the Bengalis, and vegetarianism to the Masai. But tonight he is among the people of one of the richest and healthiest nations in the world, indistinguishable from them so long as he does not open his mouth to speak.
Introduction
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel 
Published: November 2023

Abstract
Several definitions of epidemiology have been suggested. The simplest is that epidemiology is the study of the occurrence o( disease or other health-related characteristics in human populations. Quite often epidemiologists study not only the frequency of disease but why the frequency differs in different groups of people. Diseases do not occur at random; they have causes, quite often man-made causes, which are avoidable. Thus, many diseases may be prevented if the causes are known. Many people are affected by the occurrence of diseases and their causes. Epidemiology is, therefore, not a discipline used only by professional researchers. The principles of epidemiological research are used by many people who do not even consider themselves epidemiologists. Modern epidemiology is a broad discipline which deals with determinants or risk indicators of a variety of health-related events in human populations. Much of our present knowledge in occupational medicine is drawn from epidemiological studies.
Problems and Possible Solutions
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel 
Published: November 2023

Abstract
An epidemiological study is often begun because a health problem exists and a solution is needed. The best solution would be to prevent diseases from occurring at the work place and sometimes that is possible. New chemicals or processes should ideally be tested before being used. However, no test based upon cells, bacteria, or animals will guarantee that the actual exposure is harmless for man. Chemical compounds can lead to very complex exposures and the damaging effect of this on health is difficult to predict or even document. The second best solution to work site health problems is to try to detect them as soon as they appear; but to implement a monitoring system, good company records are needed. Even if the concern is not about a current problem, proper record systems should be maintained. These data may turn out to be the essential clues if something goes wrong.
Important considerations
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel 
Published: November 2023

Abstract
Comparing the occurrence of disease among exposed and nonexposed might be a reasonable starting point, but often the study design can be strengthened by comparing groups with different degrees of exposure. If the risk of getting the disease does increase with an increasing degree of exposure, it speaks in favour of a causal relationship between exposure and disease, Table 3. When epidemiologists speak about risk or risk indicators, they are not necessarily speaking about causal relationship. Red haired people are at risk from skin cancer in sunny Australia, for example, not because of their red hair, but because they often lack skin protection against sunlight. The fact that people with yellow fingers run a much higher risk of lung cancer than others does not indicate that yellow fingers cause lung cancer. It is a statistical association of no causal importance. However, tobacco stained fingers are risk indicators. Risk indicators are not necessarily causes. Why do we say then that smoking is one of the causes of lung cancer as well as the cause of yellow fingers?
Case study in a power plant
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel 
Published: November 2023

Abstract
In March 1979 the factory inspectorate received a letter from a group of unions who had received by mail a number of reports from several power plants. These reports gave details of premature deaths from cardiovascular disease among union workers. In two plants, employing about 250 union members, there had been 20 deaths in a 12 year period. The average age of the deceased was 60 years and the average length of employment was 14-16 years. In another plant there had been 28 deaths in the period 1968-78 and 70 per cent of the deceased were union members. Union members, however, only accounted for one-third of the total employed at the power plant.
Ascertainment, registration, and assessment of exposure
Authors: Little Julian 
Published: November 2023

Abstract
The descriptive epidemiology of congenital anomalies is influenced not only by true variations in the occurrence of anomalies by time, place, and person but also by variations in the completeness of case finding and recording. In theory, it should be sufficient that there is no bias in ascertainment; in practice, this requires demonstration that ascertainment is as complete as possible. In analytical studies, the problems of interpretation posed by incomplete ascertainment differ between case-control and cohort studies. In case-control studies, the opportunity for bias of ascertainment is minimized as presence or absence of the anomaly under consideration is the characteristic defining the study groups, and incomplete ascertainment poses questions mainly about the external validity of the study. By contrast, in cohort studies ascertainment may be influenced by knowledge of the exposure status of the mother of the infant being examined. This is more likely to be a problem for minor malformations than for serious malformations such as neural tube defects, but even for these the issue is relevant for data on fetuses from pregnancies terminated after pre-natal diagnosis of a malformation, records of which are more difficult to obtain than for births.
Secular trends
Authors: Elwood Mark , Little Julian 
Published: November 2023

Abstract
Changes in the prevalence rate at birth of neural tube defects with time have been reported in almost all well-studied areas. These include long-term trends over 10 or more years and short-term changes over a few years. Seasonal variations are considered separately, in Chapter 7. Secular trends have been greatly affected by antenatal diagnosis and therapeutic abortion, making the trends since the late 1970s more difficult to interpret. It is therefore useful to consider separately trends in the period up to the mid-1970s, and trends in more recent years, although some repetition is unavoidable.
Seasonal variation
Authors: Little Julian , Elwood Mark 
Published: November 2023

Abstract
Seasonal variation in the frequencies of congenital malformations is of interest as it may indicate the potential action of environmental agents such as climate, dietary factors, or infections. Historically, the evident seasonality of congenital cataract (Gregg 1941) led to the demonstration of an infectious aetiology associating this defect with maternal rubella infection in early pregnancy. Seasonality in the prevalence at birth of anencephalus and spina bifida has been long recognized (McKeown and Record 1951), but much inconsistency and marked secular changes and geographical variation in seasonality of these malformations has been observed. Observations of seasonal variation in the occurrence of neural tube defects have led to a number of hypotheses. One suggested explanation is that the seasonal variation in births is secondary to seasonal variation in the spontaneous abortion rate of fetuses with anomalies (Leck and Record 1966). If an association between neural tube defects and season were due to seasonal factors acting in the periconceptional period rather than influencing the length of gestation, these effects might be postulated as acting at two levels—direct and indirect.
Smoking and Hormone-related disorders in the Nurses’ Health Study
Authors: Stampfer Meir J , Colditz Graham A , London Stephanie J , Chute Christopher G , Rosner Bernard , Willett Walter C , Hennekens Charles H , Speizer Frank E 
Published: November 2023

Abstract
Cigarette smoking alters levels of oestrogens and other hormones, and could therefore affect the incidence of disorders thought to be hormonally related. This issue is addressed in the Nurses ‘ Health Study. A cohort of 121 700 nurses was established in 1976, and followed through biennial questionnaires. In 1976, 34.4 per cent of the cohort were current smokers, a proportion very similar to the general US population of women. Smokers had a dose-related earlier menopause than non-smokers, independent of leanness. Cigarette smoking was an important risk factor for both stroke and coronary heart disease, with a pronounced dose effect. Even one to four cigarettes per day led to a relative risk of coronary heart disease of 2.4 (95 per cent confidence interval 1.1-1.5). Approximately half the cases of fatal coronary disease and nonfatal myocardial infarctions were attributable to cigarette smoking. These effects were not materially altered by menopausal status or use of postmenopausal hormones. Smokers who currently used oral contraceptives had a relative risk of coronary heart disease of 5.0 (confidence intervals 2. 7-9.0) compared to non-smoking women who never used them. No effect of past use of oral contraception was observed on risk of cardiovascular diseases in both pre- and post-menopausal women. There was a strong protective effect of post-menopausal oestrogen use for coronary disease that was similar in both smokers and non-smokers. No material association was found between smoking and colorectal cancer, breast cancer, endometrial cancer, or fractures.
Smoking and prostatic hypertrophy
Authors: Morrison Alan S 
Published: November 2023

Abstract
Hospitalization and surgery for urinary obstruction from prostatic hypertrophy (PH) is a major public health problem. PH ranks among the most common discharge diagnoses for men 65 years of age and older who are admitted to short-stay hospitals. The probability that a 40-year-old man will have an operation for PH, if he lives to age 80, has been estimated as 10 per cent to 30 per cent (Lytton et al. 1968; Glynn et al. 1985). Furthermore, PH may be a risk factor for prostatic cancer (Hutchison 1976).
Cigarette smoking and cancer of the breast
Authors: MacMahon Brian 
Published: November 2023

Abstract
All known published data on the possibility of an association between cigarette smoking and risk of breast cancer have been reviewed. Summary odds ratios and confidence intervals have been calculated for various types of study. The summary odds ratio was significantly below 1.0 only for the category of case-control studies in which controls were hospital patients including patients with diseases related to smoking. This finding is predictable on a priori grounds. Excluding this category other case-control studies gave an odds ratio of 1.12 with confidence limits 1.06 to 1.19. Cohort studies also gave an odds ratio slightly, though significantly, higher than 1.0-1.14 with confidence interval 1.02-1.2 7. There was no indication of effect modification by menopausal status. It is concluded that breast cancer risk is not reduced among cigarette smokers. The very small, though significant, elevation of risk in smokers is unexplained.
The effect of smoking on hormone levels in vivo and steroid hormone biosynthesis in vitro
Authors: Canick Jacob A , Barbieri Robert L 
Published: November 2023

Abstract
Cigarette smoking appears to be associated with alterations in oestrogen-related metabolic and disease processes, perhaps through a decrease in the levels of active hormones (Baron 1984). Such a decrease could be accomplished through mechanisms involving diminished rates of oestrogen biosynthesis or increased rates of metabolism, or both.
Oestrogen 2-hydroxylation in rat and human liver
Authors: Back David , Ball Simon , Forrester Lesley , Wolf Roland 
Published: November 2023

Abstract
Hydroxylation at C-2 effectively terminates the peripheral activity of oestradiol. There is evidence that cigarette smoking increases the rate of 2-hydroxylation of oestradiol by induction of cytochrome P450. However in recent years it has become evident that there are multiple forms (isozymes) of the P450 haemoprotein. This reviews attempts to define more closely the enzymatic catalysts of oestradiol 2-hydroxylation. Data from studies using purified rat liver isozymes show that oestradiol is metabolized by both forms of cytochrome P450 that are phenobarbitone and 3-methylcholanthrene inducible; in contrast the related contraceptive steroid ethinyloestradiol is metabolized only by phenobarbitone inducible isozymes. In human liver there is a weak correlation between oestradiol and ethinyloestradiol 2-hydroxylase activity and differential immunoinhibition is seen with antibodies raised against specific isozymes. Oestradiol appears to be metabolized by a protein within the P450/A family. As proteins within the family are induced by cigarette smoke this may explain changes in 2-hydroxylation rates in smokers.
Determination of the rules—definitions and concepts
Authors: Ellencweig Avi Yacar 
Published: November 2023

Abstract
Though it is complicated to investigate a health system, it is even more complicated to investigate and compare among health systems. In the preface, we discussed the importance of comparing health systems. As Victor Sidel (1981) put it, the comparative analysis of health systems is done to improve one’s understanding of one’s own systems and to learn from experience gained abroad. Such comparisons give us a broad perspective and enable us to pose questions that could not be answered by data from a single region or from a single country. For example, if only one country is examined, there is no way of evaluating the pros and cons of different methods for reimbursing physicians. The methods of several countries should be studied to discern the effects of various economic conditions or the influence of different perceptions of the physician’s role. In addition, comparative evaluation allows us to understand the characteristics of the organization of health services, as some variables and their effects can be studied only by comparing different countries or regions. For instance, the so-called benefits of universal health coverage should be carefully evaluated in more than one health system. This is because these benefits probably depend on the particular organizational structures prevailing in each country, as well as on the culture and the economy. What may be considered advantageous in one health system can easily be disadvantageous in another.
The process of health care delivery—direct and indirect determinants
Authors: Ellencweig Avi Yacar 
Published: November 2023

Abstract
Though the goal of health systems is to improve the health status of the population, outcomes are frequently forgotten due to the complex and turbulent process of care. Only a few sceptics, like Illich (1977), have dared to question the role of hospitals, for example, in shaping health status. As Illich put it, it is possible that instead of improving health, hospitals may rather sustain ‘iatrogenesis’. By ‘iatrogenesis’ Illich means the production of disease and sickness by the hospital system itself. Yet, for most people in modern societies, Illich’s view is unacceptable. Though hospitals and other health services are only means to improve the ends—which are the health of the population - the use of health services is so generally acceptable in modern societies that justifying the ends is no longer required.
Demand and consumption
Authors: Cohen David R , Henderson John B 
Published: November 2023

Abstract
Section 3.2.1 explained that a demand curve normally slopes downward from left to right, reflecting the fact that when price is high a smaller quantity of the good is demanded than when price is low. Economists are also concerned with how responsive demand is to price changes and use the concept of elasticity to measure this. The demand for a good is said to be ‘price elastic’ if proportionately small changes in price cause proportionately large changes in demand and ‘price inelastic’ if the opposite is true. For example, if a 20 per cent rise in price causes a 10 per cent fall in the quantity demanded (price elasticity of - 0.5), then demand is said to be inelastic. If a 10 per cent rise in price causes a 20 per cent fall in the quantity demanded (price elasticity of - 2.0), then demand is said to be elastic. In these examples the negative signs indicate that price and demand move in opposite directions.
Overview
Authors: Frankel Stephen 
Published: November 2023

Abstract
Community health workers (CHWs) have achieved much in many countries at different times, but the frequent disappointment with the outcome of CHW programmes is often attributed to inadequacies in the CHW concept, or even laid at the door of the CHWs themselves. This debate is a sterile one. There is no longer any place for discussion of whether CHW s can be key actors in achieving adequate health care. The question is how to achieve their potential. With this in mind, the contributors to this book have sought to provide an overview of the situation in their countries, by documenting experiences and offering informed observations on the way forward as they see it. The chapters represent a wide-ranging analysis of the achievements and difficulties of CHWs in Africa, South America, Asia, and Indonesia, and it is hoped that such a broad approach will contribute significantly to an understanding of the present position and an appreciation of future requirements. This introductory chapter seeks to synthesize some of the conclusions to be drawn from the vast literature which has accumulated on the implementation of CHW programmes throughout the world. The CHW provides an ideal bridge between the community and the health sector. However, experience in numerous countries has demonstrated that top priority must be given to understanding and tackling the problems raised by attempting to achieve this bridging function in practice. CHWs are variously regarded as extenders of health services and agents for educational and developmental change (Walt 1990). If they are to be more than an ‘extra pair of hands’ or an ‘additional element’, however welcome, then countries must show themselves more committed to structural change than has hitherto been apparent (Ramprasad 1988).
Community health workers in Nepal
Authors: Mcconnell Claudia , Taylor Mary 
Published: November 2023

Abstract
Community health worker (CHW) programmes have been implemented in a variety of ways, both prior to and following the 1978 Alma-Ata Declaration. In Nepal, the first training programme was initiated in 1979. Community Health Leaders were selected to improve the coverage of government health services, particularly in rural areas. Following a series of reviews in the 1980s a new programme for training Community Health Volunteers was implemented in 1988. In contrast to past efforts, this programme focuses on the training 0f rural village women with the aim of addressing maternal and child health (MCH) problems. It is similar in design and content to many other programmes around the world.
Italy
Authors: Paci Pierella , Wagstaff Adam 
Published: November 2023

Abstract
Prior to the reforms in the late 1970s public health care in Italy was financed largely through employment-based sickness funds and provided mainly by non-profit organizations.1 In 1975 coverage against inpatient care costs was increased from 95 per cent to 100 per cent when responsibility for public hospital services was transferred to the state. In 1978 the government created a national health service—the Servizio Sanitario Nazionale (SSN)— and cover for ambulatory care and medical goods was increased to 100 per cent. The SSN was to be financed eventually out of general taxation, although it was accepted that in the short term there would be some reliance on earnings-related health-specific social insurance contributions as under the old sickness fund system. In contrast to the British National Health Service (NHS), it was accepted that the private sector would play a part in the provision of SSN-financed health care.
The Netherlands
Authors: Doorslaer Eddy Van , Wagstaff Adam , Janssen Richard 
Published: November 2023

Abstract
In the Netherlands—as in many other European countries—equity concerns have always been an important motivation for government intervention in the way health care services are financed and delivered.1 Despite a long tradition of government intervention in health care, the uneasy coexistence of a public and private insurance sector has continued to foster political debate concerning radical reforms. In particular, the persistent and pronounced medical consumption differentials (see van Vliet and van de Ven 1985) and the alleged lack of financial solidarity between the publicly and the privately insured have often been cited as sufficient reasons for concern about the equity characteristics of the system.