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Applying Complexity Scienceto Womens Health Care

Eileen Hoffman, M.D.Clinical Associate Professor of Medicine,New York University School of Medicine

and

Kathryn Reed, M.D.Professor of Obstetrics/Gynecology

University of Arizona College of Medicine

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Where are we coming from?

Dr. Eileen Hoffman

Internist

Organ Systems

Dr. Kathryn Reed

Obstetrician/Gynecologist

Reproductive Medicine

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into into altered by determines

such as

into reflects due to have a

organizationalaspects of care

fragmentedservice

delivery

contentinadequate/

inaccurate

problems inprocess of

care

affectivecomponent

technicalcomponent

mentalhealth

services

physicalhealth

services

invisibility absence of

gender-basedmedical

evidence

generalmedical care

reproductivecare

genderbias quality

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The New Science of

Womens Health Mind is not separate from body

Sex differences exist in all organ systems Gender differences exist in how females &

males live in and experience their worlds Complex interactions exist between

reproductive & all other medical sciences Womens capacity for reproduction holds

important insights for global medicalapplications

Hoffman. Womens Health and Complexity Science. Academic Medicine. 2000.

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Optimal Health for

Women Balance and integration of physical, social,

emotional, & spiritual elements of life Harmony and stability within family and close

relationships Support, empathy, & connection with friends

& within communities Equality, power & respect Living within a society that values people,

relationships & diversity

Kasle, Wilhelm, Reed. Optimal Health and Well-Being for Women: Definitions and Strategies Derived from FocusGrou s of Women. Womens Health Issues. 2002

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Reductionism

Whole=sum of parts Linear

Closed system

Entropy Predictable

Objectivity

Complexity

Whole=interactive network Non-linear

Open system

Self-organizing Sensitive to initial conditions

Observer bias

Old Science New Science

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Womens Health Science & Systemfrom a Complexity Perspective

Mind is not separate from body Support, empathy & connectionwithin communities

Interactive Network

Sex differences in all organs Value people, relationships & diversity

VariabilityFractal v. Normal Distribution

Gender differences in how men & women experience their worlds

Equality, power & respect(equity )

Open systemDissipative Structure

Interactions betweenreproductive & all organ systems

Harmony & stability within family& friendships

Self-organizingDynamic Balance

Adaptations/maladaptations topregnant state have globalapplications

Balance & integration of physical,social, emotional & spiritualelements (resilience )

Non-linear

Scientific Domains(Physicians)

Optimal Health Meta-themes(women) Complexity Concepts

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Womens Health Science & Systemfrom a Complexity Perspective

Mind is not separate frombody

Support, empathy & connection withincommunities

Interactive Network

Sex differences in allorgans

Value people,relationships & diversity

VariabilityFractal v. NormalDistribution

Gender differences inhow men & womenexperience their worlds

Equality, power & respect(equity )

Open systemDissipative Structure

Interactions betweenreproductive & all organsystems

Harmony & stability within family & friendships

Self-organizingDynamic Balance

Adaptations/maladaptations to pregnant state haveglobal applications

Balance & integration of physical, social,emotional & spiritualelements (resilience )

Non-linear

Scientific Domains(Physicians)

Optimal Health Meta-themes(women) Complexity Concept Policy Implications

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Womens Health Science & Systemfrom a Complexity Perspective

Mind is not separate frombody

Support, empathy & connection withincommunities

Interactive Network Process informs outcomeProfessional modeling

Sex differences in allorgans

Value people,relationships & diversity

VariabilityFractal v. NormalDistribution

Diverse models of care

Gender differences inhow men & womenexperience their worlds

Equality, power & respect(equity )

Open systemDissipative Structure

Equal quality of careChoice & Voice

Informed decision-making

Interactions betweenreproductive & all organsystems

Harmony & stability within family & friendships

Self-organizingDynamic Balance

Relationality at all levels of care

Adaptations/maladaptatio

ns to pregnant state haveglobal applications

Balance & integration of

physical, social,emotional & spiritualelements resilience

Non-linear Access, interaction &

feedback financial,structural, medical & communit social services

Scientific Domains(Physicians)

Optimal Health Meta-themes(women) Complexity Concept Policy Implications

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NORMAL DISTRIBUTION

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FRACTAL DISTRIBUTION

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NORMAL DISTRIBUTION

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FRACTAL DISTRIBUTION

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RACE

SEX AGE

ETHNICITY RELIGION GENOME

70 KG

WHITE

NO. AMERICAN

MIDDLE CLASS

MALE

DISEASE TYPE