TED英语演讲：童年创伤如何影响一生的健康.docx

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1、TED英语演讲：童年创伤如何影响一生的健康TED英语演讲：童年创伤如何影响一生的健康童年创伤不是一件长大就能解决的事。儿科医生Nadine解释虐待、忽视、和父母精神健康不良或有药物或饮酒问题，都会影响儿童的大脑发展。童年经历影响终身，在高压环境下长大的儿童比别人得到心肺疾病的比例高三倍。下面是我为大家采集关于TED英语演讲：童年创伤如何影响一生的健康，欢迎借鉴参考。演讲题目：童年创伤如何影响一生的健康!演讲者：NadineBurkeHarrisInthemid-90s,theCDCandKaiserPermanentediscoveredanexposurethatdramaticallyin

2、creasedtheriskforsevenoutof10oftheleadingcausesofdeathintheUnitedStates.Inhighdoses,itaffectsbraindevelopment,theimmunesystem,hormonalsystems,andeventhewayourDNAisreadandtranscribed.Folkswhoareexposedinveryhighdoseshavetriplethelifetimeriskofheartdiseaseandlungcanceranda20-yeardifferenceinlifeexpect

3、ancy.Andyet,doctorstodayarenottrainedinroutinescreeningortreatment.Now,theexposureImtalkingaboutisnotapesticideorapackagingchemical.Itschildhoodtrauma.90年代中期,CDC和KaiserPermanente发现:暴露于某种事物中会极大增加死亡风险,七成美国民众的首要死因皆由此引起。暴露剂量较高时,会影响大脑发育,免疫系统,内分泌系统,甚至影响到基因的读取及转录方式。暴露在极高剂量下的人群,有3倍的风险患上心脏病和肺癌,预期寿命缩短20年。然而,目

4、前医生们还未被培训以常规筛查和治疗的手段来应对这种风险。我所讲的暴露危害并不针对某种农药或包装上的化学物质。而是儿童期创伤。Okay.WhatkindoftraumaamItalkingabouthere?Imnottalkingaboutfailingatestorlosingabasketballgame.Iamtalkingaboutthreatsthataresosevereorpervasivethattheyliterallygetunderourskinandchangeourphysiology:thingslikeabuseorneglect,orgrowingupwitha

5、parentwhostruggleswithmentalillnessorsubstancedependence.那么,我要讲的是哪种创伤呢?我要讲的可不是考试不及格或输掉篮球比赛。我要讲的是那种如此严重而又无处不在的威胁,以致于它让我们毛骨悚然,并从生理上改变了我们：比方,受虐待或被忽视,又或者,抚养我们的父母,本身就深受精神疾病之苦,或是深陷于物质依靠疾病。Now,foralongtime,IviewedthesethingsinthewayIwastrainedtoviewthem,eitherasasocialproblem-refertosocialservices-orasamen

6、talhealthproblem-refertomentalhealthservices.Andthensomethinghappenedtomakemerethinkmyentireapproach.WhenIfinishedmyresidency,IwantedtogosomeplacewhereIfeltreallyneeded,someplacewhereIcouldmakeadifference.So,IcametoworkforCaliforniaPacificMedicalCenter,oneofthebestprivatehospitalsinNorthernCaliforni

7、a,andtogether,weopenedaclinicinBayview-HuntersPoint,oneofthepoorest,mostunderservedneighborhoodsinSanFrancisco.Now,priortothatpoint,therehadbeenonlyonepediatricianinallofBayviewtoservemorethan10,000children,sowehungashingle,andwewereabletoprovidetop-qualitycareregardlessofabilitytopay.Itwassocool.We

8、targetedthetypicalhealthdisparities:accesstocare,immunizationrates,asthmahospitalizationrates,andwehitallofournumbers.Wefeltveryproudofourselves.一直以来,我都根据所教诲的方式来看待这些事情。要么把它当成一个社会问题-交给社会服务去处理,要么把它当成一个心理健康问题-交给心理健康咨询来解决。后来发生了一些事情,使我反思我的整个思维方式。在医院实习结束后,我想去个我觉得真正需要我的地方,去个我能够有所作为的地方。因而，我选择为加利利福尼亚太平洋医疗中心(

9、CPMC)工作,这是加利福尼亚北部最优秀的私立医院之一,我与该医院合作,在旧金山最穷、社区服务最差的居民区-湾景区猎人角(Bayview-HuntersPoint)开了一家诊所。在此之前,整个湾景区(Bayview)社区仅有一名儿科医生,为一万多名儿童服务,因而,我们开场挂牌营业,提供最优质的医疗服务,不管能否有能力支付医疗费用。这种感觉很棒。我们找出了在医疗服务上现状与标准的差距：普及医疗保健,免疫接种率、哮喘住院率等,我们都完成了达标。我们为本人感到骄傲。ButthenIstartednoticingadisturbingtrend.Alotofkidswerebeingreferredt

10、omeforADHD,orAttentionDeficitHyperactivityDisorder,butwhenIactuallydidathoroughhistoryandphysical,whatIfoundwasthatformostofmypatients,IcouldntmakeadiagnosisofADHD.MostofthekidsIwasseeinghadexperiencedsuchseveretraumathatitfeltlikesomethingelsewasgoingon.Somehow,Iwasmissingsomethingimportant.但就在那时,我

11、开场注意到一种令人忧心的趋势。很多孩子由于多动症(简称ADHD),被送到我这里进行医治,可是,当我对孩子们的病史和身体状况进行彻查时,却发现大多数患儿的情况,我无法下多动症(ADHD)的诊断。多数来就诊的孩子都经历过如此严重的创伤,让人觉得似乎事情并不简单。不知怎的,我漏查了某个重要的因素。Now,beforeIdidmyresidency,Ididamastersdegreeinpublichealth,andoneofthethingsthattheyteachyouinpublichealthschoolisthatifyoureadoctorandyousee100kidsthatal

12、ldrinkfromthesamewell,and98ofthemdevelopdiarrhea,youcangoaheadandwritethatprescriptionfordoseafterdoseafterdoseofantibiotics,oryoucanwalkoverandsay,Whatthehellisinthiswell?So,IbeganreadingeverythingthatIcouldgetmyhandsonabouthowexposuretoadversityaffectsthedevelopingbrainsandbodiesofchildren.在实习之前,我

13、曾攻读公共健康硕士学位,在公共健康学校里,我们曾学过这样的一课,假如你是一名医生,当你知道有100个孩子从同一口井中饮水,其中98人患了腹泻,你能够着手治疗,给每个病人都开抗生素,一剂,一剂,又一剂的开。可是你可以以走去井边，问声,井里到底有什么鬼东西?所以,我开场查阅手头所有的相关资料,了解暴露在不幸中,是怎样影响儿童的大脑和身体发育的。Andthenoneday,mycolleaguewalkedintomyoffice,andhesaid,Dr.Burke,haveyouseenthis?InhishandwasacopyofaresearchstudycalledtheAdverseC

14、hildhoodExperiencesStudy.Thatdaychangedmyclinicalpracticeandultimatelymycareer.然后有一天,一个同事走进我的办公室,他问我,伯克医生,你看过这个吗?在他手里的是一份调查研究的复印件,题目是童年不良经历(ACE)研究。那一天,改变了我的临床实践,也最终改变了我的职业生涯。TheAdverseChildhoodExperiencesStudyissomethingthateverybodyneedstoknowabout.ItwasdonebyDr.VinceFelitaatKaiserandDr.BobAndatthe

15、CDC,andtogether,theyasked17,500adultsabouttheirhistoryofexposuretowhattheycalledadversechildhoodexperiences,orACEs.Thoseincludephysical,emotional,orsexualabuse;physicaloremotionalneglect;parentalmentalillness,substancedependence,incarceration;parentalseparationordivorce;ordomesticviolence.Foreveryye

16、s,youwouldgetapointonyourACEscore.AndthenwhattheydidwastheycorrelatedtheseACEscoresagainsthealthoutcomes.Whattheyfoundwasstriking.Twothings:Numberone,ACEsareincrediblycommon.Sixty-sevenpercentofthepopulationhadatleastoneACE,and12.6percent,oneineight,hadfourormoreACEs.Thesecondthingthattheyfoundwasth

17、attherewasadose-responserelationshipbetweenACEsandhealthoutcomes:thehigheryourACEscore,theworseyourhealthoutcomes.ForapersonwithanACEscoreoffourormore,theirrelativeriskofchronicobstructivepulmonarydiseasewastwoandahalftimesthatofsomeonewithanACEscoreofzero.Forhepatitis,itwasalsotwoandahalftimes.Ford

18、epression,itwasfourandahalftimes.Forsuicidality,itwas12times.ApersonwithanACEscoreofsevenormorehadtriplethelifetimeriskoflungcancerandthreeandahalftimestheriskofischemicheartdisease,thenumberonekillerintheUnitedStatesofAmerica.童年不良经历(ACE)的研究是每一个人都应该要了解的。VinceFelitti博士和BobAnda博士分别在Kaiser和CDC进行了这项研究,他

19、们两人一起询问了17,500成年人,了解他们的童年不良经历,又称ACE。这包括生理上、情感上遭受的不幸或是性损害;生理或情感上遭受的忽视;父母患有精神疾病、物质依靠、遭到监禁;父母分居或离婚;或家庭暴力。每个问题只要回答是,ACE分数就增加一分。接下来,他们将ACE分数与健康状况关联起来,得出的结果是令人震惊的。结论有两点：第一点,ACE特别普遍,几乎令人不可思议。67%的人曾至少有一个ACE得分,有12.6%(八分之一)的人有四或四以上的ACE得分。研究发现的第二点,是ACE与健康状况之间存在着一种剂量反响关系：ACE得分越高,健康状况越糟糕。假如一个人的ACE分数大于等于4分,他患慢性阻塞

20、性肺病的相对风险是ACE分数为0时的2.5倍。患上肝炎的风险是2.5倍。而患上抑郁症的风险是4.5倍。自杀风险是12倍。ACE分数大于等于7的人终身都有3倍的风险患上肺癌,和3.5倍的风险患上冠心病-这种目前在美国当属头号杀手的疾病。Well,ofcoursethismakessense.Somepeoplelookedatthisdataandtheysaid,Comeon.Youhavearoughchildhood,youremorelikelytodrinkandsmokeanddoallthesethingsthataregoingtoruinyourhealth.Thisisnts

21、cience.Thisisjustbadbehavior.当然,这其实挺有道理。有些人看了这些数据之后会讲,好啦,你有个糟糕的童年,你更容易酗酒和吸烟,还去做一切会毁掉你健康的事情。这又不是科学,这只是坏的行为罢了.Itturnsoutthisisexactlywherethesciencecomesin.Wenowunderstandbetterthanweeverhavebeforehowexposuretoearlyadversityaffectsthedevelopingbrainsandbodiesofchildren.Itaffectsareaslikethenucleusaccu

22、mbent,thepleasureandrewardcenterofthebrainthatisimplicatedinsubstancedependence.Itinhibitstheprefrontalcortex,whichisnecessaryforimpulsecontrolandexecutivefunction,acriticalareaforlearning.AndonMRIscans,weseemeasurabledifferencesintheamygdala,thebrainsfearresponsecenter.So,therearerealneurologicreas

23、onswhyfolksexposedtohighdosesofadversityaremorelikelytoengageinhigh-riskbehavior,andthatsimportanttoknow.然而,事实证实我们恰恰要用科学来分析它。目前,我们史无前例的愈加理解早年遭受的不幸会如何影响儿童大脑和身体的发育。早年遭受的不幸会影响大脑的伏隔核(nucleusaccumbens)-人脑中与快乐和奖赏相关的处理中心,它与物质依靠疾病相关。早年遭受的不幸还会抑制大脑的前额叶皮质(Prefrontalcortex),而前额皮质对神经冲动控制与执行功能是必不可少的,这个区域对于学习能力非常关

24、键。在核磁共振成像扫描(MRI)上,我们观察到大脑的恐惧反响中枢-杏仁核(amygdala)中,存在能够测量的差异。因而,这便能够从神经学角度诠释：为什么人们一旦遭受大量不幸,则更容易出现高风险行为。了解了这点特别重要。Butitturnsoutthatevenifyoudontengageinanyhigh-riskbehavior,yourestillmorelikelytodevelopheartdiseaseorcancer.Thereasonforthishastodowiththehypothalamicpituitaryadrenalaxis,thebrainsandbodyss

25、tressresponsesystemthatgovernsourfight-or-flightresponse.Howdoesitwork?Well,imagineyourewalkingintheforestandyouseeabear.Immediately,yourhypothalamussendsasignaltoyourpituitary,whichsendsasignaltoyouradrenalglandthatsays,Releasestresshormones!Adrenaline!Cortisol!Andso,yourheartstartstopound,yourpupi

26、lsdilate,yourairwaysopenup,andyouarereadytoeitherfightthatbearorrunfromthebear.Andthatiswonderfulifyoureinaforestandtheresabear.(Laughter)Buttheproblemiswhathappenswhenthebearcomeshomeeverynight,andthissystemisactivatedoverandoverandoveragain,anditgoesfrombeingadaptive,orlife-saving,tomaladaptive,or

27、health-damaging.Childrenareespeciallysensitivetothisrepeatedstressactivation,becausetheirbrainsandbodiesarejustdeveloping.Highdosesofadversitynotonlyaffectbrainstructureandfunction,theyaffectthedevelopingimmunesystem,developinghormonalsystems,andeventhewayourDNAisreadandtranscribed.但事实证实,即便你不从事任何高风险

28、的行为,你仍然更容易患上心脏疾病或癌症。由于这与下丘脑-垂体-肾上腺轴有关-它是大脑和身体的应激反响系统,支配我们做出或战或逃反响。(fight-or-flightresponse)。这一系统是怎样运行的呢?想象你安步在森林里,忽然看到一头熊。你的下丘脑会立即向你的垂体发送信号,垂体再向你的肾上腺发送信号：释放应激激素!肾上腺素!皮质醇!你的心脏因此开场快速跳动,瞳孔扩张,呼吸道打开,这时你已准备好：要么就和熊战斗,要么就逃跑。这个反响很棒-假如你在森林里,那还有一只熊。(笑声)可问题是,假设每个晚上熊都回家来该怎么办,这套系统将一遍又一遍地被激活,它就会从适应到不适应,从救你的命到损害你的健

29、康。儿童对这种反复的应激激活尤其敏感,由于他们的大脑和身体正处在发育阶段。高剂量的不良经历不仅会影响大脑构造和功能,还会影响正在发育的免疫系统,以及正在发育的内分泌系统,甚至还会影响我们的DNA读取和转录方式。Soforme,thisinformationthrewmyoldtrainingoutthewindow,becausewhenweunderstandthemechanismofadisease,whenweknownotonlywhichpathwaysaredisrupted,buthow,thenasdoctors,itisourjobtousethisscienceforpr

30、eventionandtreatment.Thatswhatwedo.这些知识让我彻底抛弃了以前所受训的那一套,由于,当我们了解疾病机制时,当我们不仅知道哪些途径被干扰,而且知道它们是如何被干扰时,作为医生,我们的职责,就是使用这门科学去做疾病的防治工作。那就是我们要做的。SoinSanFrancisco,wecreatedtheCenterforYouthWellnesstoprevent,screenandhealtheimpactsofACEsandtoxicstress.Westartedsimplywithroutinescreeningofeveryoneofourkidsatth

31、eirregularphysical,becauseIknowthatifmypatienthasanACEscoreof4,shestwoandahalftimesaslikelytodevelophepatitisorCOPD,shesfourandhalftimesaslikelytobecomedepressed,andshes12timesaslikelytoattempttotakeherownlifeasmypatientwithzeroACEs.Iknowthatwhenshesinmyexamroom.Forourpatientswhodoscreenpositive,weh

32、aveamultidisciplinarytreatmentteamthatworkstoreducethedoseofadversityandtreatsymptomsusingbestpractices,includinghomevisits,carecoordination,mentalhealthcare,nutrition,holisticinterventions,andyes,medicationwhennecessary.ButwealsoeducateparentsabouttheimpactsofACEsandtoxicstressthesamewayyouwouldfor

33、coveringelectricaloutlets,orleadpoisoning,andwetailorthecareofourasthmaticsandourdiabeticsinawaythatrecognizesthattheymayneedmoreaggressivetreatment,giventhechangestotheirhormonalandimmunesystems.因而，我们在旧金山创办了青少年健康中心,目的是预防、筛查和治愈ACE和毒性应激的影响。我们开场在孩子们的定期体检中,对每个孩子进行例行检查,由于我知道,假如我的病人ACE得分为4分,她患上肝炎或慢性阻塞性肺病

34、(COPD)的概率是1.5倍,患上抑郁症的概率是4.5倍,她自杀的几率是ACE得分为0的病人的12倍。她在我的检查室里,我就已经知道这一切了。对于检查结果为阳性的病人,我们有一支多学科综合治疗团队,致力于减少不良经历造成的影响,并使用最佳疗法治疗病症,包括家庭访视、护理协调、心理保健、营养、综合干涉措施,以及必要时结合药物治疗。但我们也教家长们了解ACE和毒性应激造成的影响,这种影响与电源插座或铅中毒的危险性能够相提并论,我们调整了哮喘及糖尿病患儿的护理服务,意识到他们可能需要更积极主动的治疗,以作用于他们的内分泌和免疫系统。Sotheotherthingthathappenswhenyouu

35、nderstandthisscienceisthatyouwanttoshoutitfromtherooftops,becausethisisntjustanissueforkidsinBayview.Ifiguredtheminutethateverybodyelseheardaboutthis,itwouldberoutinescreening,multi-disciplinarytreatmentteams,anditwouldbearacetothemosteffectiveclinicaltreatmentprotocols.Yeah.Thatdidnothappen.Andthat

36、wasahugelearningforme.WhatIhadthoughtofassimplybestclinicalpracticeInowunderstandtobeamovement.InthewordsofDr.RobertBlock,theformerPresidentoftheAmericanAcademyofPediatrics,Adversechildhoodexperiencesarethesinglegreatestunaddressedpublichealththreatfacingournationtoday.Andforalotofpeople,thatsaterri

37、fyingprospect.Thescopeandscaleoftheproblemseemssolargethatitfeelsoverwhelmingtothinkabouthowwemightapproachit.Butforme,thatsactuallywherethehopeslie,becausewhenwehavetherightframework,whenwerecognizethistobeapublichealthcrisis,thenwecanbegintousetherighttoolkittocomeupwithsolutions.Fromtobaccotolead

38、poisoningtoHIV/AIDS,theUnitedStatesactuallyhasquiteastrongtrackrecordwithaddressingpublichealthproblems,butreplicatingthosesuccesseswithACEsandtoxicstressisgoingtotakedeterminationandcommitment,andwhenIlookatwhatournationsresponsehasbeensofar,Iwonder,whyhaventwetakenthismoreseriously?当你理解了这门科学时,你会想要

39、把它广而告之,由于这不仅仅是湾景区(Bayview)孩子的问题。我本来以为其别人一旦了解到这一点,就会着手例行检查、组建多学科治疗团队,甚至大家争先恐后想找到最有效的治疗方案。可这些都没有发生。这可是给了我一个很大的教训。我原以为简单的找到最好的临床手段来治疗就行了,如今我明白了,这是一场运动。正如RobertBlock博士,这位前美国儿科学会会长所言,童年不良经历(ACE)是今天我们国家所面临的,唯一,最大的,未能解决的公共健康威胁.对于很多人来讲,这个前景可不容乐观。这个问题的范围之广,规模之大使我们不得不考虑应对之策。但在我看来,危机即是转机，当我们确立正确框架时,当我们意识到这是公共健

40、康危机时,我们才能开场使用正确的方法来求得解决方案。从烟草到铅中毒,再到艾滋病,在解决公共健康问题方面,美国实际上保持着良好记录,但要,在ACE和毒性应激方面获得同样成功,则需要下定决心、履行承诺,当我看到,我们国家对这一问题至今的反响时,我想知道,为什么我们没有更认真的对待这个问题?Youknow,atfirstIthoughtthatwemarginalizedtheissuebecauseitdoesntapplytous.Thatsanissueforthosekidsinthoseneighborhoods.Whichisweird,becausethedatadoesntbeart

41、hatout.TheoriginalACEsstudywasdoneinapopulationthatwas70percentCaucasian,70percentcollege-educated.Butthen,themoreItalkedtofolks,ImbeginningtothinkthatmaybeIhaditcompletelybackwards.IfIweretoaskhowmanypeopleinthisroomgrewupwithafamilymemberwhosufferedfrommentalillness,Ibetafewhandswouldgoup.Andtheni

42、fIweretoaskhowmanyfolkshadaparentwhomaybedranktoomuch,orwhoreallybelievedthatifyousparetherod,youspoilthechild,Ibetafewmorehandswouldgoup.Eveninthisroom,thisisanissuethattouchesmanyofus,andIambeginningtobelievethatwemarginalizetheissuebecauseitdoesapplytous.Maybeitseasiertoseeinotherzipcodesbecausew

43、edontwanttolookatit.Wedratherbesick.要知道,一开场我还想,这是由于我们漠视了这个问题,以为它跟我们无关。以为只要别的小孩,邻居家的小孩才有这问题。但很奇怪,数据可不是这么讲的。初始ACE的研究样本群体为：白人占70%,大学毕业占70%。后来,我和大家谈得多了,我便开场想,也许我把这个问题完全本末倒置了。假如我问现场这个房间内有多少人在成长经过中有家庭成员患有精神疾病,我相信,会有几个人举手。假如我再问,有多少人父亲或母亲酗酒,或者是坚信：孩子要打,惯不得。我敢打赌会有更多的人举手。即便只是在我们的会场,这也是一个影响到了很多人的问题。我开场相信我们漠视这个问

44、题是由于,它与我们息息相关。也许把它讲成别的地区的事,我们才能更容易的看清楚,由于我们本人情愿生病,也不愿意正视这个问题。Fortunately,scientificadvancesand,frankly,economicrealitiesmakethatoptionlessviableeveryday.Thescienceisclear:Earlyadversitydramaticallyaffectshealthacrossalifetime.Today,wearebeginningtounderstandhowtointerrupttheprogressionfromearlyadver

45、sitytodiseaseandearlydeath,and30yearsfromnow,thechildwhohasahighACEscoreandwhosebehavioralsymptomsgounrecognized,whoseasthmamanagementisnotconnected,andwhogoesontodevelophighbloodpressureandearlyheartdiseaseorcancerwillbejustasanomalousasasix-monthmortalityfromHIV/AIDS.Peoplewilllookatthatsituationa

46、ndsay,Whattheheckhappenedthere?Thisistreatable.Thisisbeatable.Thesinglemostimportantthingthatweneedtodayisthecouragetolookthisprobleminthefaceandsay,thisisrealandthisisallofus.Ibelievethatwearethemovement.Thankyou.幸运的是,科学进步,坦率地讲,还有经济现实逐步使我们无法再继续漠视下去了。科学研究清楚显示：早期不良经历对人的一生的健康影响宏大。今天,我们开场了解怎样中断从早期不良经历发展至疾病和过早死亡这一进程,从如今算起,30年后,高ACE分数的儿童,假如其行为症状未被识别,哮喘诊疗未与ACE相关联,持续发展为高血压,并患上早期心脏病或癌症,那么这就象6个月的婴儿患艾滋病一样,都是异常的。人们看到这种情况都会讲：这究竟发生的是什么鬼事?这种病症是能够治疗的,也是能够战胜的。我们今天最需要的是直面这个问题的勇气,并且成认,这个问题确实存在,与我们息息相关。我相信我们将实现这一变革运动。谢谢大家。