Population Health Indicators Research Articles

Lifestyle Medicine and the Far Horizon: Before, Since, and Beyond.

The American College of Lifestyle Medicine was founded just over 20years ago. As the organization grew, it incubated an impressive array of structures and processes to foster professional standards, training, credentialing, networking, and scholarship. A compelling and accelerating drumbeat of peer-reviewed publications has demonstrated the advancing base of evidence in which lifestyle medicine practice is rooted. Despite all this good effort, however, the indicators of population health that matter most-longevity and vitality and healthspan, years in life and life in years-have largely trended away from, rather than toward, aspirations. The life course of ACLM has introduced an area of great allure and tremendous promise to health professionals seeking beyond reactive disease care. The processes, structures, and knowledge are in place to advance the goals of vitality and longevity at the population level. Needed, still, are the means of translating that accumulated knowledge into the power of routine, and effective action. Those of us committed to the full potential of lifestyle both in and as medicine have promises yet to keep and miles to go before we sleep. We can, however, see the light on the horizon from here.

An analysis of fetoinfantile losses in the Komi Republic

Background. The preservation of maternal and child health is an important component of health care. 2024 by Decree of the President of the Russian Federation dated 22.11.2023 No. 875 was declared the year of the family. The current negative dynamics of demographic processes in modern society raises the problem of ensuring a high level of survival and health of newborns. This issue carries importance both at the state level as a whole and at the strategic level to maintain the population size both at the federal level and in each of its regions, including the Komi Republic. In the conditions of the demographic crisis, not only in the Komi Republic, but also in the Russian Federation, the analysis of fetoinfantile losses plays an important role. The population living in the regions of the Far North and areas equated to them is subjected to a complex of extreme natural and climatic factors, which negatively affects the reproductive health of the population, causing fetoinfantile losses. The presented work describes the indicators of fetoinfantile losses in the Komi Republic in comparison with similar indicators in the Russian Federation as a whole. Objective. Conduct a comparative analysis of infant mortality rates, perinatal mortality dynamics, early neonatal and stillbirth rates from 2012 to 2022, thereby characterizing fetoinfantile losses in the Komi Republic. Design and methods. The analysis of fetoinfantile losses was carried out on the basis of data presented in the unified interdepartmental information and statistical system, the Federal State Statistics Service, statistical collections of GBUZ RK “RIAC” Basic Indicators of Population Health and Health Status of the Komi Republic for 2012–2022, State Report “On the State of Health of the Population of the Komi Republic in 2022”. A trend line was used to evaluate and illustrate trends. Results. Fetoinfantile losses in the Komi Republic tend to decrease, but exceed the average for the Russian Federation. Congenital abnormalities, deformities and chromosomal disorders continue to occupy a leading place in the structure of infant mortality in the Komi Republic. In the Komi Republic, the trend towards a decrease in the abortion rate remains, but 1.5 times higher than this figure in the Russian Federation. Conclusion. In the Komi Republic, there is a complex of behavioral, climatic and social factors that affect reproductive health, leading to fetoinfantile losses exceeding average indicators. There is a need to optimize the examination of women in the pre-gravidar and antenatal period, including medical genetic counseling, which will reduce stillbirth and the incidence of congenital malformations.

Growth modeling of the European grayling (Thymallus thymallus L.) in a large alpine river based on age-at-length, mark-recapture, and length-frequency data.

Animal growth is a fundamental component of population dynamics, which is closely tied to mortality, fecundity, and maturation. As a result, estimating growth often serves as the basis of population assessments. In fish, analysing growth typically involves fitting a growth model to age-at-length data derived from counting growth rings in calcified structures. Additionally, fish growth can be estimated using length-frequency data or data on changes in length derived from mark-recapture events. In our study of the European grayling (Thymallus thymallus L.) in the alpine region of Germany, we utilized all three types of datasets to develop the initial growth model. For the age-at-length data from scales, we applied the traditional von Bertalanffy growth function using both a Bayesian and a frequentist approach. Furthermore, we adopted the mark-recapture data along with the Fabens model for reparametrizing the von Bertalanffy growth model. The electronic length-frequency analysis (ELEFAN) was employed to examine the length-frequency data of the grayling, encompassing multiple sampling events from 2013 to 2022. Our findings indicated that the mark-recapture data, in conjunction with the Fabens model, yielded the most plausible values for both statistical approaches. When the von Bertalanffy growth function was used, the frequentist approach generated unreasonably high values, whereas the Bayesian version produced meaningful results when appropriate priors were applied, suggesting potential issues with the age-at-length data related to ageing. The ELEFAN approach produced the smallest yet reasonable growth parameters, contradicting other studies on the European grayling. The lower values may be attributed to the lack of larger fish in most of the sampling events, resulting in a relatively low asymptotic length and slow growth rate. As demonstrated in this case study on grayling from the River Inn, the use of growth characteristics may be a currently underestimated yet very useful indicator of target species assessment that can nicely complement other population health indicators.

Burden of leptospirosis in Brazil in the last decade.

OBJECTIVES: To correlate the incidence of leptospirosis with sociodemographic data in the Brazilian Unified Health System from 2011 to 2022.METHODS: This ecological study used national health and economic secondary data sources. Secondary analyses summarized the scenario of disease-related hospitalizations among federative units. In total, two analyses were conducted: variable description for relationship analysis and a secondary analysis with population health and sanitation indicators and economic indicators from the Instituto Brasileiro de Geografia e Estatística (IBGE - Brazilian Institute of Geography and Statistics). The statistical analysis following this framework summarized raw data by year-monthfederative unit. A time series regression was conducted, comparing the time variable with other national-level variables. Then, several simple linear regressions were performed.RESULTS: Linear regressions show the relationship between the reduction in cases and improved access to treated water and sewage collection, whereas an increase in per capita income seems to be inversely related to leptospirosis incidence. Geospatial distribution shows higher incidence in the Brazilian South and Southeast. Disease lethality varied over time but without significant change during the period. The average treatment cost remained constant over the years, despite its complexity. CONCLUSION: Leptospirosis incidence in Brazil from 2011 to 2021 decreased and wasassociated with improvements in socioeconomic conditions despite no changes in lethality.

Comprehensive assessment of the impact of blood pressure, body mass index, smoking, and diabetes on healthy life expectancy in Japan: NIPPON DATA90

Healthy life expectancy (HLE) is a population health indicator that is widely used in developed countries, but little is known about its relationships with combinations of non-communicable disease risk factors. This study was conducted to examine HLE at age 65 according to combinations of blood pressure levels, body mass index, smoking status, and diabetes mellitus (DM) in a Japanese population. In a nationwide cohort study (NIPPON DATA90), data on these risk factors were obtained from participants in 1990 through physical examinations, blood tests, interviews, and questionnaires. Subsequently, participants aged ≥65 years underwent surveys on activities of daily living in 1995 and 2000, and multistate life tables were used to calculate combination-specific HLEs and their 95% confidence intervals (CIs). The study population comprised 6,569 participants (men: 2,797; women: 3,772) who were followed-up until 2010. HLE at age 65 in men with grade II/III hypertension, obesity, current smoker status, and DM (HLE: 12.9 years, 95% CIs: 12.9-13.0 years) was 9.7 years shorter than men without these risk factors (HLE: 22.6 years, 95% CIs: 22.4-22.8 years). Similarly, HLE at age 65 in women with grade II/III hypertension, obesity, current smoker status, and DM (HLE: 16.2 years, 95% CIs: 15.9-16.5 years) was 10.1 years shorter than women without these risk factors (HLE: 26.3 years, 95% CIs: 26.3-26.3 years). The large discrepancies in HLEs underscore the impact of non-communicable disease risk factors, which should be considered when formulating health interventions to improve HLE in Japanese older adults.

Reasons for the increase and ways to reduce the frequency of cesarean sections in modern obstetrics

The progressive increase in the number of cesarean sections, which is not accompanied by a decrease in the perinatal mortality rate, is an urgent problem not only in obstetrics, but in the health care system in general. The frequency of operative delivery is influenced by both medical and non-medical factors. Moreover, the frequency varies across regions of the world and countries with different levels of economic development. At the present stage, the increase in the number of surgical deliveries in developed countries is due to changes in population health indicators (age, morbidity). The attention of WHO and associations of obstetricians and gynecologists is drawn to the development of measures to stabilize and reduce the frequency of cesarean sections. However, the proposed measures to reduce it through administration in obstetric hospitals and non-medical measures do not have an effect. There is evidence of an increase in the incidence of complications for the mother and fetus when indications for cesarean section are limited. A safe reduction in the frequency of caesarean sections is possible only with an integrated approach, including new solutions that improve the quality of medical care in general (social measures to support families, optimization of medical processes, introduction of decision support systems, improvement of medical technologies for pregnancy and childbirth).

The analysis of medical demographic indicators of rural population

The number of permanent average annual rural population in the Russian Federation is declining and over 2013-2022 decreased from 37.2 to 36.9 million people. The mortality rates for rural population x were higher than for urban population over past decades. The natality of rural population that had growing trend began to decline since 2013 and in 2022 indices made up to 8.8‰ in for the rural population and 8.9‰ in urban population. The general and newly registered morbidity of rural population was lower than of urban population. In 2022, general morbidity of rural population consisted 129761.8‰00, of urban population 187593.8‰00, primary morbidity consisted 64755.2 and 96963.8‰00 respectively. The analysis of total morbidity of rural population in dynamics from pre-COVID year (2019) and in subsequent years of pandemic demonstrated its abrupt decline in 2020. In 2021-2022, total morbidity increased slightly up to 124,808.5 and 129761.8‰00 respectively. The increase occurred mainly in classes of respiratory diseases by 11% and of circulatory disease class by 3.2%. The increasing of COVID-19 morbidity was noted and indicators consisted 2151.9 in 2020, 6050.4 in 2021 and 144.2‰00 in 2022. The ranking of indicators of newly detected morbidity in rural population by Subjects of the Russian Federation demonstrated in 2022 difference up to 13.6 times. The provision of rural population with physicians in medical organizations located in rural areas consisted 13.2‰0. In the Subjects of the Russian Federation difference in indicators is great i.e. 54 times. The results of the study testify necessity of monitoring and in-depth analysis of health indicators of rural population and determining factors. The modernization of rural health care has to begin with increasing of accessibility of primary health care of rural residents. The reforms require increasing of potentials of financial, material, technical and human resources at regional and municipal levels.

The Impact of the COVID-19 Pandemic on the Sex Ratio at Birth in Ireland.

The sex ratio at birth (SRB), calculated as male divided by total live births, is an important indicator of population health. Typically, male live births slightly outnumber female live births. Population events, including pandemics, can alter the SRB, with effects sometimes evident 9 months post-event, potentially due to changes in sexual behavior and/or stress levels. This study investigates the impact of the COVID-19 pandemic on the SRB in the Republic of Ireland. Publicly available monthly live birth data for Ireland were obtained from the Central Statistics Office for the period 2015 to 2021. Time series analysis predicted the SRB for 2020 using data from 2015 to 2019, with comparisons made between observed and predicted values. In December 2020, 9 months after the March 2020 COVID-19 declaration, the observed SRB sharply fell to 49.44% (97.80 males for every 100 females), below the 95% prediction interval of 50.31% to 52.15%, significantly deviating from the expected male predominance. December 2020 also recorded the lowest average daily number of births (n = 145) in the study period. The sharp decline in the SRB in December 2020, alongside the lowest birth count, suggests reduced sexual intercourse at the population level, particularly in March 2020, aligning with recommendations from Ireland's Health Service Executive (HSE). The HSE advocated precautionary measures such as limiting partnered sex in March 2020 to mitigate the spread of COVID-19. These findings highlight the pandemic's potential impact on population dynamics and stress the importance of SRB monitoring as a low-cost and readily available health indicator, especially during national crises.

Social policy system in the Republic of Korea: features of development and performance

The article studies the history of the formation and features of the functioning of social policy in the Republic of Korea in the 20th–21st centuries. It examines the emergence of rules for social insurance, social support, assistance to the needy, unemployment insurance and employment promotion, the role of state redistribution and regulation. The principles of the pension system organisation are analyzed. The development of the health care system is studied. Korea's experience in the field of demographic policy, the effectiveness of family benefit programs are analyzed, and the key problems causing the decline in the birth rate in the country below the replacement level are assessed. The organization of social policy in Korea and other developed countries is compared, as well as approaches to determine the place of the Korean social policy system in established typologies. The social policy system in Korea is noticeably behind European welfare states, especially in terms of pension provision. The health care system in Korea is not inferior to European ones in terms of technical equipment and quality of services. In terms of population health indicators, Korea is one of the world leaders with relatively low health care costs. But from a financial and administrative point of view, Korea is characterized by a greater burden on consumers than European countries. The consensus among researchers regarding the reasons for the decline in the birth rate is that raising children in Korea in the 21st century has become an unbearable financial burden. Significant resources are spent on demographic programs in Korea, but they do not bring noticeable benefits, since the decline in the birth rate does not stop. The education system in Korea is one of the best in the world.

Continuing Education Certificate in Trauma Skills Among Emergency Nurses: A National Sample Survey Analysis.

Trauma population health indicators are worsening in the United States. Nurses working in trauma care settings require specialized training for patient care. Little is known about national enumeration of nurses who hold skill-based trauma certificates. The purpose of this project was to estimate (1) skill-based certificate status among U.S. nurses who primarily work with emergency or trauma patients, (2) demographic and work characteristic differences between those who report skill-based trauma certificates and those who do not, and (3) continuing education learning needs among nurses who hold skill-based trauma certificates. This was an applied epidemiologic analysis of the 2022 National Sample Survey of Registered Nurses. The weighted analysis of 239,893 emergency nurses indicated 57% held skill-based trauma certificates with disparities by rural practice, racial identity, age, and marital status. Among those who held skill-based trauma certificates, the greatest need for continuing education was on topics of mental health, quality improvement, and substance use disorders. Approximately 87% of emergency nurses with trauma skill-based certificates only spoke English fluently. Population health management interventions are needed to enhance workforce equity and continuing education opportunities for trauma nurses. Professional nursing organizations, emergency nursing employers, and academic settings should offer continuing education in mental health and quality improvement. These findings also support the need for ongoing activities to enhance language accessibility for non-English speaking patients in the trauma care system.

Using outcome measures in sub-national level performance management: When and under what circumstances?

There is growing interest in using outcome-based measures in sub-national level health system performance management, particularly in high-income countries. Increasingly, population health indicators used for making international comparisons are being applied at a sub-national level. This study aims to understand whether and under what circumstances population health outcome-based measures can be used for performance measurement and management at the sub-national level health systems. We have integrated empirical population-based data with key health system expert perspectives to evaluate the appropriateness of two population health indicators – amenable mortality and ambulatory-sensitive hospitalization of young children. Our assessment focused on two key aspects: (i) the technical validity of these indicators, ensuring they accurately measure these outcomes, and (ii) the functionality and legitimacy of performance information, determining whether it meets stakeholders' program or policy needs and supports strategic decision-making. Overall, we found that the 'intermediate' outcome measure, childhood ambulatory sensitive hospitalization, was more useful for identifying district-level health system performance variation than the 'end' outcome measure, amenable mortality. Performance information based on childhood ambulatory-sensitive hospitalization is more appropriate for improving decision-making, and it is more likely to be accepted by a wide range of stakeholders involved in health system performance improvement.

Exposure to firearm injury and suicide in a rural Pennsylvania county: implications for mental and behavioral health.

To evaluate the association between self-reported gun violence exposures and mental health and behavioral health indicators in a rural population. Using cross-sectional survey responses from 630 residents of a rural county in Pennsylvania, logistic regression models estimate the likelihood of residents indicating moderate or severe levels of health outcomes as a function of gun violence exposure. We control for a series of variables related to gun ownership, behavior, history with firearms and demographic characteristics. Personal firearm victimization was associated with self-reported depressive symptoms and interrupted sleep. Secondary exposure to firearm violence, particularly exposure to friends attempting or completing a suicide, was associated with higher odds of reporting severe levels (14days or more in the past month) of depressive symptoms, anxiety, and poor sleep. For firearm suicide involving a friend or family member, the odds of reporting severe levels of all three outcomes are 3 times greater (OR 2.984, 95% CI 1.457-6.108). For each additional firearm exposure, the odds of experiencing severe levels of mental health and sleep difficulties are 1.4 times greater (OR 1.384, 95% CI 1.115-1.720). Cumulative exposures also increase the odds of reporting binge drinking and drug use. Firearm violence exposure was associated with adverse health indicators in this rural population. Approaches to counter the effects of cumulative firearm exposure and firearm suicide exposure, including reinvigorating community spaces and strengthening social supports, may help to reduce mental health burden in rural communities.

Clustering Portuguese municipalities based on population health indicators

Abstract Background The large number of publicly available health-related indicators poses challenges in health planning to policymakers. Identifying patterns among municipalities may assist these processes, by grouping similar contexts and pointing out relevant differences among neighbouring locations. The aim of this work was to define clusters of municipalities based on health-related indicators. Methods All health-related indicators available at municipality level for the year 2021 were obtained from the Portuguese National Statistics Office website. Missing values were imputed with the closest available year or excluded. Indicators were standardized and K-means clustering was applied. Elbow criterion was used to select the optimal number of clusters. Sensitivity analysis was performed with a priori exclusion of indicators less directly associated with health outcomes. Results The clustering analysis revealed five distinct clusters of municipalities. Clusters were associated with specific socio-demographic patterns, providing insights into common health challenges and strengths within each group. Interestingly, geographic profiles emerged (e.g. coastal vs inland), despite no geographic information being specifically provided. One outlier municipality was identified (Lisbon), highlighting a need for special consideration. Conclusions Clustering techniques provide a data-driven approach to inform public health planning. Our findings show previously unrecognized patterns and relationships between municipalities. Using these clusters, policymakers may implement interventions based on what has been proven to work in similar contexts, enhance collaboration opportunities and promote a tailored policy development, contributing to an overall improvement of public health outcomes. Key messages • Clustering machine learning techniques provide a data-driven approach to inform public health planning. • Identifying comparable municipalities based on health-related indicators allows targeted public health interventions.

Hygienic Aspects of the Quality of Life of Residents of Yaroslavl and the Yaroslavl Region

Introduction. The relevance of the study is due to the need to conduct a scientific analysis of the quality of the country’s population life, improve the standard of citizens living through the implementation of medical measures, including medical and preventive work.The purpose of the work is to conduct a comparative analysis of the quality of life of urban and rural residents of the Yaroslavl Region based on physical and psychological well-being, determine the level of general health indicators of the working-age population, and analyze the role of organizational and preventive measures in improving the quality of life.Materials and methods. The SF‑36 questionnaire was used in the study to assess the quality of life. 600 residents (age (25.1±0.8) years) of Yaroslavl and the Yaroslavl Region took part in the survey. The ratio of men and women was 50 % and 50 %, respectively.Results. It was revealed that the quality of life of rural residents has lower values compared to city residents. This difference is especially noticeable in indicators that are directly dependent on the emotional and physical state of a person.Discussion. The conducted comprehensive analysis shows that as a result, the assessment of the quality of life of the population of the respondents was based on their subjective understanding and perception of their own situation in life, which is also typical for studies in other regions of the country. The indicators of the general health of the rural population of working age indicated insufficient access to medical care and a low level of literacy of the population in matters of maintaining and strengthening their own health, as well as medical activity.Conclusion. Hygienic assessment of the quality of the population life in terms of physical and psychological well-being made it possible to identify a number of differences in the assessment of the quality of urban and rural areas residents life at Yaroslavl and the Yaroslavl Region. Most of the considered characteristics of the quality of rural residents life had reliably significant low values in comparison with city residents.

Hygienic Aspects of the Quality of Life of Residents of Yaroslavl and the Yaroslavl Region

Introduction. The relevance of the study is due to the need to conduct a scientific analysis of the quality of the country’s population life, improve the standard of citizens living through the implementation of medical measures, including medical and preventive work.The purpose of the work is to conduct a comparative analysis of the quality of life of urban and rural residents of the Yaroslavl Region based on physical and psychological well-being, determine the level of general health indicators of the working-age population, and analyze the role of organizational and preventive measures in improving the quality of life.Materials and methods. The SF‑36 questionnaire was used in the study to assess the quality of life. 600 residents (age (25.1±0.8) years) of Yaroslavl and the Yaroslavl Region took part in the survey. The ratio of men and women was 50 % and 50 %, respectively.Results. It was revealed that the quality of life of rural residents has lower values compared to city residents. This difference is especially noticeable in indicators that are directly dependent on the emotional and physical state of a person.Discussion. The conducted comprehensive analysis shows that as a result, the assessment of the quality of life of the population of the respondents was based on their subjective understanding and perception of their own situation in life, which is also typical for studies in other regions of the country. The indicators of the general health of the rural population of working age indicated insufficient access to medical care and a low level of literacy of the population in matters of maintaining and strengthening their own health, as well as medical activity.Conclusion. Hygienic assessment of the quality of the population life in terms of physical and psychological well-being made it possible to identify a number of differences in the assessment of the quality of urban and rural areas residents life at Yaroslavl and the Yaroslavl Region. Most of the considered characteristics of the quality of rural residents life had reliably significant low values in comparison with city residents.

Association of social isolation and depressive symptoms with workplace productivity loss in a multi-ethnic Asian study

The association of health-related productivity loss (HRPL) with social isolation and depressive symptoms is not well studied. We aimed to examine the association of social isolation and depressive symptoms with productivity loss. Data on employed adults aged 21 years and above were derived from the Population Health Index (PHI) study conducted by the National Healthcare Group (NHG) on community-dwelling adults, residing in the Central and Northern residential areas of Singapore. The severity of depressive symptoms and social isolation were assessed using the 9-item Patient Health Questionnaire (PHQ-9) and Lubben Social Network Scale-6 (LSNS-6) respectively. Productivity loss was assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI). We used Generalised Linear Models, with family gamma, log link for the analysis. Models were adjusted for socio-demographic variables (including age, gender, ethnicity, employment status, housing type) and self-reported chronic conditions (including the presence of diabetes, hypertension, and dyslipidemia). There were 2,605 working (2,143 full-time) adults in this study. The median reported percentage of unadjusted productivity loss was 0.0%, 10.0% and 20.0% for participants with social isolation, depressive symptoms, and both, respectively. In the regression analysis, mean productivity loss scores were 2.81 times (95% Confidence Interval: 2.12, 3.72) higher in participants with depressive symptoms than those without. On the other hand, social isolation was not found to be associated with productivity loss scores (1.17, 95% Confidence Interval: 0.96, 1.42). The interaction term of depressive symptoms with social isolation was statistically significant, with an effect size of 1.89 (95% Confidence Interval: 1.04, 3.44). It appeared that productivity loss was amplified when social isolation and depressive symptoms were concomitant. Our results suggested significant associations of social isolation and depressive symptoms with productivity loss. These findings highlighted the potential impact of social isolation and depressive symptoms on work performance and drew attention to the importance of having a holistic work support system that promotes social connectedness, mental wellbeing and work productivity.

Mapping fertility rates at national, sub-national, and local levels in Ethiopia between 2000 and 2019.

Fertility rates are key indicators of population health and demographic change, influencing economic development, healthcare planning, and social policies. Understanding subnational variation in fertility rate is important for effective geographical targeting and policy prioritization. This study aimed to identify geographic variation, trends, and determinants of fertility rates in Ethiopia over the past two decades. We estimated total fertility rates (TFRs) and age-specific fertility rates (ASFRs) using five nationally representative cross-sectional Demographic and Health Surveys collected in Ethiopia between 2000 and 2019. ASFRs represent the number of live births per 1,000 women aged 15 to 49 during the 3 years before each survey, while TFRs indicate the average number of children a woman would have by the end of her reproductive years, calculated as the sum of ASFRs over five-year intervals. We developed model-based geostatistics by incorporating demographic and healthcare access data with spatial random fields to produce high-resolution fertility rate maps. These results were then aggregated to produce fertility rate estimates at local, sub-national, and national levels in Ethiopia. The national TFR gradually declined from 4.8 live births in 2000 to 4.2 live births in 2019, but it is still above the replacement level of 2.1 children per woman. There were sub-national and local variations in TFR, ranging from 5.7 live births in Somalia and 5.3 Oromia regions to 2.7 live births in Addis Ababa and 3.6 live births Dire Dawa cities. Geographical areas with high TFR were mostly associated with a high proportion of Muslim women and low access to health facilities. Despite a decline in fertility rates among women of reproductive age over the past two decades, marked spatial variation persists at sub-national and local levels in Ethiopia, with demographic factors determining the spatial distribution and rate of decline, highlighting the need for tailored programs and strategies in high-fertility areas to increase access to family planning.

Identify Affecting Factors on Total Fertility Rate: A Systematic Review

Background: The total fertility rate (TFR) is a key indicator of population dynamics and health. It shows the average number of children a woman would have in her lifetime, based on the current fertility rates for different age groups. Various factors affect the TFR, such as social, economic, political, technological, environmental, and health factors. By analyzing these factors and how they influence the TFR, policymakers and planners can design and implement interventions to achieve optimal population and health outcomes. Methods: We searched PubMed, Scopus, ISI Web of Science, and ProQuest databases, as well as the Google Scholar search engine systematically. We searched for studies from 13 December 2021 - 20 May 2022, without time limits. We included studies that described at least one driver of TFR. We applied the STEEPH framework (social, technology, environmental, economic, political, and health) method to analyze the qualitative data. Results: We included 64 studies from 26 countries. We identified 410 drivers of TFR, and classified 181 drivers into six main categories: Social, technological, environmental, economic, political, and health. The main factors that lower the fertility rate are education, aging, poverty, postponing marriage (social), exposure of women to mass media (technology), type of residence and living in urban areas, road accidents (environmental), income and economic situation (recession and inflation), unemployment, debt, women’s employment (economic), government policies (political), use of anti-fertility drugs (health). The main drivers that raise the fertility rate are having first child girls, women’s proximity to their workplace (social), use of assisted reproductive technology (technology), living in rural areas and natural and unnatural disasters (environmental), improvement in men’s labor market conditions, employment opportunities (economic), increased parental leave (political), high infant mortality (health). Conclusions: We identified a comprehensive list of effective drivers that have increased or decreased TFR in different parts of the world. It is necessary to review these drivers considering the specific conditions and social, cultural, economic, and political coordinates of each country. This review should inform policymakers' actions in this area.

Maternal Health Disparities in Acute Care Rehabilitation.

Patients with a high-risk pregnancy or who immediately give birth are often not provided access to acute care occupational and physical therapy during their hospital admission. The greatest potential for health care crises, including maternal mortality, occurs during the first 6 weeks after birth. Maternal mortality and morbidity, which continue to rise in the United States, are considered indicators of the overall population health of a country. It is estimated that over 80% of pregnancy-related deaths are preventable. The leading causes of death within the first 6 days after birth are hemorrhage, hypertensive disorders, and infection. Implicit biases about childbearing individuals who are perceived to be relatively young, independent, active, and healthy may unintentionally contribute to areas of substandard care that adversely impact maternal health outcomes. It is a professional and ethical imperative that health providers, including occupational and physical therapists, establish themselves as allies to patient groups at high risk for disparate treatment. The Acute Care OB Rehab Implicit Bias Self-Reflection Tool is an instrument designed for health providers to identify stereotypes that may contribute to inequitable access to rehabilitation in the hospital after birth. Including rehabilitation services for the perinatal population in the hospital setting can play a pivotal role in early detection of adverse events with activity that may directly impact the increasing maternal mortality rate in the United States.

The hierarchy of needs for laboratory medicine requires a foundational care delivery model

Under the collective weight of growing test volume, staffing constraints, and Medicare reimbursements cuts, an enhancement-based, alternative payment structure focused on rewarding the laboratory's care delivery efforts via benchmarking is appealing. However, achieving a value-based payment model requires the development of an inclusive laboratory care delivery model (LCDM) framework. Today, a holistic, practical LCDM framework for laboratory medicine does not exist. However, such creation is essential for establishing unifying tenants of practice for value-tracing by which standardized key performance and population health indicators can be derived. LAB-CARES is the first step in formulating an LCDM with the primary objective of defining and streamlining the processes and strategies necessary to deliver and articulate the value of diagnostic excellence across the healthcare system. The goal of LAB-CARES is to maximize efficiencies, enhance quality, disseminate clinical expertise, increase patient safety, and promote integrative practice. LAB-CARES is designed to improve an individual patient's quality of life (longitudinal laboratory results – beyond one test) and their surrounding communities (e.g., through surveillance and prevention – beyond one patient). Further professional conversation and efforts are paramount to integrate LAB-CARES as a formalized structure within the healthcare landscape.