Climate change has substantial broad implications for individual and population health. This impact on health, as well as the considerable contribution of the healthcare sector to greenhouse gas emissions and waste production, implicates healthcare workers to understand their role within the climate crisis. Reproductive healthcare workers are at the center of this issue, as downstream effects of climate change impact nearly all areas of reproductive health including fertility, pregnancy and neonatal outcomes, and relevant infectious diseases and cancers. Obstetricians, gynecologists, and other reproductive clinicians are experienced advocates for our patients, and it is prudent that we continue utilizing our unique knowledge and skillsets to promote reproductive health as it relates to climate change and environmental impact. In this piece, we review the implications of climate change on reproductive health, emphasize why reproductive health professionals may be compelled to help mitigate these outcomes, as well as describe ongoing efforts and suggest opportunities for action from the level of an individual to organizational leader. Our aim is to present the existing evidence surrounding climate change and reproductive health, in an effort to educate and empower reproductive health professionals to improve the health of our patients for generations to come.

Climate change is killing people. Whether directly or indirectly through extreme weather events, excessive heat, rising sea levels, air pollution, changes in vector ecology, water scarcity, or reduced food production caused by climate change, the impact is an increase in human morbidity and mortality. The health care sector in general — and academic health systems in particular — are part of the problem, responsible for significant amounts of carbon pollution emissions. Various how-to guides and manuals aim to inform and instruct health system leaders on addressing climate change in their institutions. However, the authors note they are unaware of studies that have documented the enablers that propel and the barriers that impede academic health system leaders' engagement in climate change efforts from the experience of these executive leaders themselves. In this article, the authors report the findings of a multi-institutional qualitative descriptive study exploring to what extent academic health system executive leaders think about, plan for, and lead institutional efforts to address climate change and reduce institutional greenhouse gas emissions. The study found variability in how executive leaders are engaged in and lead sustainability and climate-change efforts in their institutions and communities. Academic health systems that are reducing their institutional greenhouse gas emissions and improving their sustainability and resilience demonstrated five key elements associated with organizational transformation: (1) responding to drivers of change; (2) demonstrating leadership commitment; (3) driving improvement initiatives; (4) aligning organizational strategies and goals; and (5) integrating across organizational boundaries. In turn, these elements suggest a road map for other academic health systems that are not yet assertively tackling their carbon pollution. This study lends evidence to why academic health systems should — and how they can — address climate change through leadership action. Academic health systems can and should be leaders in the sustainability space because of the primacy of their missions to improve the health of people and communities; to this end, they must exercise their leadership role to influence the health care delivery, research, and health professions education domains.

This Viewpoint makes the case for academic health systems to lead the way on climate change action in the US, including planning to reduce greenhouse gas emissions, educating current and future clinicians, and communicating with their patients and communities.

Among the many trends influencing health and health care delivery over the next decade, three are particularly important: the transition to value-based care and increased focus on population health; the shift of care from acute to community-based settings; and addressing the vulnerability of rural health care systems in North Carolina.

Roger Zemek, MD; Nick Barrowman, PhD; Stephen B. Freedman, MDCM, MSc; Jocelyn Gravel, MD; Isabelle Gagnon, PhD; Candice McGahern, BA; Mary Aglipay, MSc; Gurinder Sangha, MD; Kathy Boutis, MD; Darcy Beer, MD; William Craig, MDCM; Emma Burns, MD; Ken J. Farion, MD; Angelo Mikrogianakis, MD; Karen Barlow, MD; Alexander S. Dubrovsky, MDCM, MSc; Willem Meeuwisse, MD, PhD; Gerard Gioia, PhD; William P. Meehan III, MD; Miriam H. Beauchamp, PhD; Yael Kamil, BSc; Anne M. Grool, MD, PhD, MSc; Blaine Hoshizaki, PhD; Peter Anderson, PhD; Brian L. Brooks, PhD; Keith Owen Yeates, PhD; Michael Vassilyadi, MDCM, MSc; Terry Klassen, MD; Michelle Keightley, PhD; Lawrence Richer, MD; Carol DeMatteo, MSc; Martin H. Osmond, MDCM; for the Pediatric Emergency Research Canada (PERC) Concussion Team

reported data in the Table, which also affected the Figure and the text.In the Table, under the Mandate Language column, check marks needed to be added for Nevada and Oregon (Oregon only mandates language for women with extremely dense breasts);

This manuscript describes the development and implementation of community engagement as a mission at UCLA’s David Geffen School of Medicine (DGSOM) and UCLA Health System, and summarizes survey results documenting existing community-engaged projects and interest between 2010 to 2013.

This Viewpoint discusses opportunities and challenges facing academic health systems as they move beyond providing individual-patient care and population-specific management to providing health improvement at the population level.

In our leadership roles with Academic Health Systems, we are simultaneously excited by the stunning potential we see for health and health care and also sensitive to the strains that arise from the pace of changes underway in the organization, financing, and delivery of health care in America. It is critical that as the […]

In this Journal in 1972, 100 leaders in obstetrics and gynecology published a compelling statement that recognized the legalization of abortion in several states and anticipated the 1973 Supreme Court decision in Roe v Wade. They projected the numbers of legal abortions that likely would be required by women in the United States and described the role of the teaching hospital in meeting that responsibility. They wrote to express their concern for women's health in a new legal and medical era of reproductive control and to define the responsibilities of academic obstetrician-gynecologists. Forty years later, 100 professors examine the statement of their predecessors in light of medical advances and legal changes and suggest a further course of action for obstetrician gynecologists.

OBJECTIVE:To document the long-term effect of surgical interventions for noncancerous uterine conditions on health-related quality of life. METHODS:The Study of Pelvic Problems, Hysterectomy and Intervention Alternatives, conducted between 1998 and 2008, was a longitudinal study of 1,503 women with intact uteri experiencing abnormal uterine bleeding with or without leiomyomas, chronic pelvic pain, or pressure resulting from leiomyomas. Baseline and follow-up questionnaires included three condition-specific measures (Pelvic Problem Resolution, Pelvic Problem Impact Overall, and Pelvic Problem Impact on Sex) and five generic measures (Short Form-12 Mental and Physical Component Summaries, Current Health Utility, Feelings about Heath, and Satisfaction with Sex). We modeled changes over time in these patient-reported outcomes stratified by the most invasive treatment undergone (hysterectomy [13.7%], uterus-preserving surgery [9.0%], or nonsurgical therapy [77.3%]). RESULTS:Participants in all three groups reported significant improvement on all condition-specific measures and two of the five generic measures (Current Health Utility and Feelings about Health) from enrollment to final interview (all P values <.01). In general, greater improvements were experienced by women who had surgery. Trajectories modeled around the dates of surgery showed dramatic improvements after hysterectomy and, to a lesser degree, after uterus-preserving surgery. Although women who underwent uterus-preserving surgery tended to show immediate improvement, women who underwent hysterectomy experienced a 6-month delay in improvement in some outcomes with trajectories converging by 4 years postsurgery. CONCLUSION:Women seeking care for noncancerous uterine conditions can expect to experience improvement over time. Those who opt for surgery may experience most improvement. Understanding health-related quality-of-life trajectories may enhance counseling for women deciding between hysterectomy and alternative interventions. LEVEL OF EVIDENCE:II.

OBJECTIVE:This study evaluated how well women from diverse race/ethnic groups were able to take a quantitative cancer risk statistic verbally provided to them and report it in a visual format. METHODS:Cross-sectional survey was administered in English, Spanish or Chinese, to women aged 50-80 (n=1160), recruited from primary care practices. The survey contained breast, colorectal or cervical cancer questions regarding screening and prevention. Women were told cancer-specific lifetime risk then shown a visual display of risk and asked to indicate the specific lifetime risk. Correct indication of risk was the main outcome. RESULTS:Correct responses on icon arrays were 46% for breast, 55% for colon, and 44% for cervical; only 25% correctly responded to a magnifying glass graphic. Compared to Whites, African American and Latina women were significantly less likely to use the icon arrays correctly. Higher education and higher numeracy were associated with correct responses. Lower education was associated with lower numeracy. CONCLUSIONS:Race/ethnic differences were associated with women's ability to take a quantitative cancer risk statistic verbally provided to them and report it in a visual format. PRACTICE IMPLICATIONS:Systematically considering the complexity of intersecting factors such as race/ethnicity, educational level, poverty, and numeracy in most health communications is needed.

OBJECTIVE: To identify static and time-varying sociodemographic, clinical, health-related quality-of-life and attitudinal predictors of use and satisfaction with hysterectomy for noncancerous conditions.METHODS: The Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) was conducted from 1998 to 2008. English-, Spanish-, or Chinese-speaking premenopausal women (n=1,420) with intact uteri who had sought care for pelvic pressure, bleeding, or pain from an academic medical center, county hospital, closed-panel health maintenance organization, or one of several community-based practices in the San Francisco Bay area were interviewed annually for up to 8 years. Primary outcomes were use of and satisfaction with hysterectomy.RESULTS: A total of 207 women (14.6%) underwent hysterectomy. In addition to well-established clinical predictors (entering menopause, symptomatic leiomyomas, prior treatment with gonadotropin-releasing hormone agonist, and less symptom resolution), greater symptom impact on sex (P=.001), higher 12-Item Short Form Health Survey mental component summary scores (P=.010), and higher scores on an attitude measure describing "benefits of not having a uterus" and lower "hysterectomy concerns" scores (P<.001 for each) were predictive of hysterectomy use. Most participants who underwent hysterectomy were very (63.9%) or somewhat (21.4%) satisfied in the year after the procedure, and we observed significant variations in posthysterectomy satisfaction across the clinical sites (omnibus P=.036). Other determinants of postsurgical satisfaction included higher pelvic problem impact (P=.035) and "benefits of not having a uterus" scores (P=.008) before surgery and greater posthysterectomy symptom resolution (P=.001).CONCLUSION: Numerous factors beyond clinical symptoms predict hysterectomy use and satisfaction. Providers should discuss health-related quality of life, sexual function, and attitudes with patients to help identify those who are most likely to benefit from this procedure. (Obstet Gynecol 2010;115:543-51)

Wide disparities in obstetric outcomes exist between women of different race/ethnicities. The prevalence of preterm birth, fetal growth restriction, fetal demise, maternal mortality, and inadequate receipt of prenatal care all vary by maternal race/ethnicity. These disparities have their roots in maternal health behaviors, genetics, the physical and social environments, and access to and quality of health care. Elimination of the health inequities because of sociocultural differences or access to or quality of health care will require a multidisciplinary approach. We aim to describe these obstetric disparities, with an eye toward potential etiologies, thereby improving our ability to target appropriate solutions.

OBJECTIVE:The objective of the study was to examine the rates of gestational diabetes mellitus (GDM) associated with both maternal and paternal race/ethnicity.STUDY DESIGN:This was a retrospective cohort study of all women delivered within a managed care network. Rates of GDM were calculated for maternal, paternal, and combined race/ethnicity.RESULTS:Among the 139,848 women with identified race/ethnicity, Asians had the highest rate (P < .001) of GDM (6.8%) as compared with whites (3.4%), African Americans (3.2%), and Hispanics (4.9%). When examining race/ethnicity controlling for potential confounders, we found that the rates of GDM were higher among Asian (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.4-1.6) and Hispanic (aOR, 1.2; 95% CI, 1.1-1.4) women as well as Asian (aOR, 1.4; 95% CI, 1.3-1.5) and Hispanic (aOR, 1.3; 95% CI, 1.2-1.4) men as compared with their white counterparts.CONCLUSION:We found that rates of GDM are affected by both maternal and paternal race/ethnicity. In both Asians and Hispanics, maternal and paternal race are equally associated with an increase in GDM. These differences may inform further investigation of the pathophysiology of GDM.

Common gynecologic conditions and surgeries may vary significantly by race or ethnicity. Uterine fibroid tumors are more prevalent in black women, and black women may have larger, more numerous fibroid tumors that cause worse symptoms and greater myomectomy complications. Some, but not all, studies have found a higher prevalence of endometriosis among Asian women. Race and ethnicity are also associated with hysterectomy rate, route, and complications. Overall, the current literature has significant deficits in the identification of racial and ethnic disparities in the incidence of fibroid tumors, endometriosis, and hysterectomy. Further research is needed to better define racial and ethnic differences in these conditions and to examine the complex mechanisms that may result in associated health disparities.