TEDMED 2014
Nadine Burke Harris: How childhood trauma affects health across a lifetime
Nadine Burke Harris: O efecto dos traumas infantís na saúde durante toda a vida
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Os traumas infantís non son algo que simplemente se supera ao medrar. A pediatra Nadine Burke Harris explícanos que o estrés reiterado provocado polas situacións de abuso ou abandono ou polo feito de que algún dos proxenitores padece unha enfermidade mental ou drogodependencia ten efectos reais e significativos sobre o desenvolvemento cerebral. Isto vaise manifestando ao longo de toda a vida, ata o punto de que o risco de padecer enfermidades cardíacas e cancro de pulmón é tres veces máis elevado nas persoas que experimentaron un nivel alto de trauma. Nadine Burke Harris fai un chamamento apaixoado para que a medicina pediátrica se enfronte con decisión á prevención e o tratamento do trauma.
Nadine Burke Harris - Pediatrician
Nadine Burke Harris’ healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma. Full bio
Nadine Burke Harris’ healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma. Full bio
Double-click the English transcript below to play the video.
A mediados da década de 1990,
00:12
In the mid-'90s,
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o CDC (centro oficial para o control de
enfermidades) e Kaiser Permanente
enfermidades) e Kaiser Permanente
00:14
the CDC and Kaiser Permanente
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00:17
discovered an exposure
that dramatically increased the risk
that dramatically increased the risk
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descubriron un tipo de exposición
que aumentaba gravemente o risco
que aumentaba gravemente o risco
00:21
for seven out of 10 of the leading
causes of death in the United States.
causes of death in the United States.
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de sete das dez causas principais
de morte nos Estados Unidos.
de morte nos Estados Unidos.
00:27
In high doses, it affects
brain development,
brain development,
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En doses altas, afecta ao
desenvolvemento cerebral,
desenvolvemento cerebral,
00:30
the immune system, hormonal systems,
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ao sistema inmunitario,
ao sistema endócrino,
ao sistema endócrino,
00:34
and even the way our DNA
is read and transcribed.
is read and transcribed.
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e ata ao xeito no que o noso ADN
é lido e replicado.
é lido e replicado.
00:38
Folks who are exposed in very high doses
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Os que están expostos a doses moi altas
teńen tres veces máis risco de ter
doenzas cardíacas e cáncer de pulmón
doenzas cardíacas e cáncer de pulmón
00:42
have triple the lifetime risk
of heart disease and lung cancer
of heart disease and lung cancer
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00:46
and a 20-year difference
in life expectancy.
in life expectancy.
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e a súa esperanza de vida
é 20 anos menor.
é 20 anos menor.
Malia así, os nosos médicos non están
preparados para detectala nin tratala.
preparados para detectala nin tratala.
00:52
And yet, doctors today are not trained
in routine screening or treatment.
in routine screening or treatment.
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A exposición da que estou a falar non é
a un praguicida, nin a un produto químico.
a un praguicida, nin a un produto químico.
00:58
Now, the exposure I'm talking about is
not a pesticide or a packaging chemical.
not a pesticide or a packaging chemical.
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01:03
It's childhood trauma.
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É ao trauma infantil.
Xa, de que trauma estou a falar?
01:07
Okay. What kind of trauma
am I talking about here?
am I talking about here?
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Non me refiro a suspender un exame
ou perder un partido de baloncesto.
ou perder un partido de baloncesto.
01:09
I'm not talking about failing a test
or losing a basketball game.
or losing a basketball game.
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01:14
I am talking about threats
that are so severe or pervasive
that are so severe or pervasive
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Refírome a ameazas
tan graves e penetrantes
tan graves e penetrantes
que literalmente se meten baixo a nosa pel
e cambian a nosa fisioloxía:
e cambian a nosa fisioloxía:
01:18
that they literally get under our skin
and change our physiology:
and change our physiology:
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cousas como o abuso ou o abandono,
01:23
things like abuse or neglect,
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ou crecer cun pai ou unha nai que
sofre unha enfermidade mental
sofre unha enfermidade mental
01:25
or growing up with a parent
who struggles with mental illness
who struggles with mental illness
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ou drogodependencia.
01:29
or substance dependence.
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Durante moito tempo,
01:32
Now, for a long time,
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eu vía estas cousas como
me ensinaron a velas:
me ensinaron a velas:
01:33
I viewed these things in the way
I was trained to view them,
I was trained to view them,
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ou ben como un problema social
--remitir aos servizos sociais--
--remitir aos servizos sociais--
01:36
either as a social problem --
refer to social services --
refer to social services --
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ou como un problema de saúde mental
--remitir aos servizos de saúde mental.
--remitir aos servizos de saúde mental.
01:40
or as a mental health problem --
refer to mental health services.
refer to mental health services.
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Pero logo aconteceu algo que me fixo
reformular todo o meu enfoque.
reformular todo o meu enfoque.
01:46
And then something happened
to make me rethink my entire approach.
to make me rethink my entire approach.
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Cando rematei a mińa residencia,
01:51
When I finished my residency,
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quería ir a un sitio onde
realmente me precisaran,
realmente me precisaran,
01:53
I wanted to go someplace
where I felt really needed,
where I felt really needed,
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un sitio no que marcar a diferenza.
01:57
someplace where I could make a difference.
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Así que fun a traballar para o
California Pacific Medical Center,
California Pacific Medical Center,
02:00
So I came to work for
California Pacific Medical Center,
California Pacific Medical Center,
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un dos mellores hospitais privados
do norte de California,
do norte de California,
02:03
one of the best private hospitals
in Northern California,
in Northern California,
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e xuntos abrimos unha clínica
en Bayview-Hunters Point,
en Bayview-Hunters Point,
02:07
and together, we opened a clinic
in Bayview-Hunters Point,
in Bayview-Hunters Point,
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un dos barrios máis pobres
e desfavorecidos de San Francisco.
e desfavorecidos de San Francisco.
02:12
one of the poorest, most underserved
neighborhoods in San Francisco.
neighborhoods in San Francisco.
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Ata aquel entón,
02:16
Now, prior to that point,
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había unha única pediatra
para todo Bayview
para todo Bayview
02:18
there had been only
one pediatrician in all of Bayview
one pediatrician in all of Bayview
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02:21
to serve more than 10,000 children,
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que atendía a máis de 10 000 nenos.
Así que abrimos a clínica e ofrecemos
atención sanitaria de alta calidade
atención sanitaria de alta calidade
02:24
so we hung a shingle, and we were able
to provide top-quality care
to provide top-quality care
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02:29
regardless of ability to pay.
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sen mirar a capacidade para pagar.
02:31
It was so cool. We targeted
the typical health disparities:
the typical health disparities:
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Era impresionante. Centrámonos
nas típicas desigualdades sanitarias:
nas típicas desigualdades sanitarias:
02:35
access to care, immunization rates,
asthma hospitalization rates,
asthma hospitalization rates,
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acceso á atención sanitaria,
taxas de inmunización,
taxas de inmunización,
taxas de hospitalización por asma,
e tivemos moi bos resultados.
e tivemos moi bos resultados.
02:40
and we hit all of our numbers.
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Sentiámonos moi orgullosos.
02:42
We felt very proud of ourselves.
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Mais comecei a notar unha tendencia
un tanto preocupante.
un tanto preocupante.
02:45
But then I started noticing
a disturbing trend.
a disturbing trend.
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Chegábanme moitos
nenos con TDAH,
nenos con TDAH,
02:48
A lot of kids were being
referred to me for ADHD,
referred to me for ADHD,
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trastorno por déficit
de atención con hiperactividade,
de atención con hiperactividade,
02:52
or Attention Deficit
Hyperactivity Disorder,
Hyperactivity Disorder,
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pero en canto lles
facía un exame clínico
facía un exame clínico
02:55
but when I actually did
a thorough history and physical,
a thorough history and physical,
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03:00
what I found was that
for most of my patients,
for most of my patients,
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descubría que, á maioría deles,
non os podía diagnosticar con TDAH.
non os podía diagnosticar con TDAH.
03:03
I couldn't make a diagnosis of ADHD.
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A maioría dos nenos que trataba
03:07
Most of the kids I was seeing
had experienced such severe trauma
had experienced such severe trauma
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sufriran un trauma tan grave
que sentía que había algo máis.
que sentía que había algo máis.
03:13
that it felt like something else
was going on.
was going on.
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Dalgún xeito estaba pasando
por alto algún detalle importante.
por alto algún detalle importante.
03:16
Somehow I was missing something important.
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Antes de facer a mińa residencia,
fixen un máster en saúde pública
fixen un máster en saúde pública
03:21
Now, before I did my residency,
I did a master's degree in public health,
I did a master's degree in public health,
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03:25
and one of the things that they teach you
in public health school
in public health school
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e unha das cousas que alí
che ensinan é que se es doutor
che ensinan é que se es doutor
03:28
is that if you're a doctor
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e ves 100 nenos beber do mesmo pozo
e 98 deles contraen diarrea
e 98 deles contraen diarrea
03:30
and you see 100 kids
that all drink from the same well,
that all drink from the same well,
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03:34
and 98 of them develop diarrhea,
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podes prescribir dose tras dose
tras dose de antibióticos
tras dose de antibióticos
03:37
you can go ahead
and write that prescription
and write that prescription
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03:39
for dose after dose
after dose of antibiotics,
after dose of antibiotics,
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ou podes ir alí e preguntarte:
Arre demo, pero que hai neste pozo?
Arre demo, pero que hai neste pozo?
03:44
or you can walk over and say,
"What the hell is in this well?"
"What the hell is in this well?"
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Así que lin todo o que atopei
sobre como a exposición á adversidade
sobre como a exposición á adversidade
03:50
So I began reading everything that
I could get my hands on
I could get my hands on
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03:53
about how exposure to adversity
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afecta os cerebros e os corpos
en desenvolvemento dos nenos.
en desenvolvemento dos nenos.
03:56
affects the developing brains
and bodies of children.
and bodies of children.
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03:59
And then one day,
my colleague walked into my office,
my colleague walked into my office,
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Entón, un día, un compańeiro
entrou no meu despacho
entrou no meu despacho
04:03
and he said, "Dr. Burke,
have you seen this?"
have you seen this?"
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e dixo: Dra. Burke, viches isto?
Na súa man había unha copia dun estudo
04:09
In his hand was a copy
of a research study
of a research study
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chamado "Estudo sobre experiencias
adversas na infancia"
adversas na infancia"
04:13
called the Adverse Childhood
Experiences Study.
Experiences Study.
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04:16
That day changed my clinical practice
and ultimately my career.
and ultimately my career.
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Aquel día cambiou a mińa práctica clínica
e, en última instancia, a mińa carreira.
e, en última instancia, a mińa carreira.
O Estudo sobre experiencias
adversas na infancia
adversas na infancia
04:24
The Adverse Childhood Experiences Study
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é algo que todos deberiamos cońecer.
04:26
is something that everybody
needs to know about.
needs to know about.
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Foi elaborado polo Dr. Vince Felitti
de Kaiser e o Dr. Bob Anda do CDC.
de Kaiser e o Dr. Bob Anda do CDC.
04:30
It was done by Dr. Vince Felitti at Kaiser
and Dr. Bob Anda at the CDC,
and Dr. Bob Anda at the CDC,
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Xuntos, preguntáronlles a 17 500 adultos
04:35
and together, they asked 17,500 adults
about their history of exposure
about their history of exposure
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sobre o seu historial de exposición a
"experiencias infantís adversas" ou EIA.
"experiencias infantís adversas" ou EIA.
04:43
to what they called "adverse
childhood experiences," or ACEs.
childhood experiences," or ACEs.
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Estas inclúen o maltrato físico
e psicolóxico e o abuso sexual,
e psicolóxico e o abuso sexual,
04:49
Those include physical, emotional,
or sexual abuse;
or sexual abuse;
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abandono físico ou emocional,
04:53
physical or emotional neglect;
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enfermidade mental dos pais,
drogodependencia ou encarceramento,
drogodependencia ou encarceramento,
04:56
parental mental illness,
substance dependence, incarceration;
substance dependence, incarceration;
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05:00
parental separation or divorce;
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separación ou divorcio dos pais
ou violencia doméstica.
ou violencia doméstica.
05:02
or domestic violence.
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Por cada "si", recibías un punto
na túa puntuación EIA.
na túa puntuación EIA.
05:05
For every yes, you would get
a point on your ACE score.
a point on your ACE score.
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Logo, correlacionaron estas puntuacións
cos problemas de saúde.
cos problemas de saúde.
05:09
And then what they did
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05:11
was they correlated these ACE scores
against health outcomes.
against health outcomes.
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O que atoparon foi sorprendente.
05:17
What they found was striking.
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05:19
Two things:
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Dúas cousas:
A primeira, as EIA
son incriblemente comúns.
son incriblemente comúns.
05:21
Number one, ACEs are incredibly common.
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05:25
Sixty-seven percent of the population
had at least one ACE,
had at least one ACE,
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O 67% da poboación tińa
polo menos unha EIA.
polo menos unha EIA.
05:32
and 12.6 percent, one in eight,
had four or more ACEs.
had four or more ACEs.
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E o 12.6%, 1 de cada 8,
tińa catro ou máis.
tińa catro ou máis.
A segunda cousa que descubriron
05:38
The second thing that they found
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foi que había unha relación
dose-resposta entre as EIA e a saúde.
dose-resposta entre as EIA e a saúde.
05:41
was that there was
a dose-response relationship
a dose-response relationship
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between ACEs and health outcomes:
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Canto máis alta a puntuación EIA,
peor a túa saúde.
peor a túa saúde.
05:49
the higher your ACE score,
the worse your health outcomes.
the worse your health outcomes.
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Para unha persoa cunha
puntuación de 4 ou máis,
puntuación de 4 ou máis,
05:53
For a person with an ACE score
of four or more,
of four or more,
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o risco relativo de ter unha
doenza pulmonar obstrutiva crónica
doenza pulmonar obstrutiva crónica
05:56
their relative risk of chronic
obstructive pulmonary disease
obstructive pulmonary disease
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era 2.5 veces maior que o de alguén
cunha puntuación EIA de cero.
cunha puntuación EIA de cero.
06:00
was two and a half times that
of someone with an ACE score of zero.
of someone with an ACE score of zero.
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Tamén era 2.5 veces maior para hepatite.
06:05
For hepatitis, it was also
two and a half times.
two and a half times.
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Para depresión era 4.5 veces maior.
06:08
For depression, it was
four and a half times.
four and a half times.
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Para suicidio xa era 12 veces maior.
06:11
For suicidality, it was 12 times.
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Unha persoa cunha puntuación de 7 ou máis
06:15
A person with an ACE score
of seven or more
of seven or more
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06:18
had triple the lifetime risk
of lung cancer
of lung cancer
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ten 3 veces máis probabilidades
de padecer cáncer de pulmón
de padecer cáncer de pulmón
e 3.5 veces máis risco
de cardiopatía isquémica,
de cardiopatía isquémica,
06:23
and three and a half times the risk
of ischemic heart disease,
of ischemic heart disease,
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a causa principal de morte
nos Estados Unidos.
nos Estados Unidos.
06:27
the number one killer
in the United States of America.
in the United States of America.
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Ben, por suposto que
isto ten sentido!
isto ten sentido!
06:31
Well, of course this makes sense.
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06:34
Some people looked at this data
and they said, "Come on.
and they said, "Come on.
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Algúns viron estes datos e dixeron
"Se tes unha infancia difícil,
es máis propenso a fumar, beber
es máis propenso a fumar, beber
06:38
You have a rough childhood,
you're more likely to drink and smoke
you're more likely to drink and smoke
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06:43
and do all these things
that are going to ruin your health.
that are going to ruin your health.
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e facer todas esas cousas
que arruinarán a túa saúde.
que arruinarán a túa saúde.
Isto non é ciencia.
Tan so é mal comportamento."
Tan so é mal comportamento."
06:46
This isn't science.
This is just bad behavior."
This is just bad behavior."
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06:50
It turns out this is exactly
where the science comes in.
where the science comes in.
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Pero resulta que é precisamente aí
onde intervén a ciencia.
onde intervén a ciencia.
Agora entendemos máis que nunca
como a exposición temperá á adversidade
como a exposición temperá á adversidade
06:55
We now understand
better than we ever have before
better than we ever have before
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07:00
how exposure to early adversity
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afecta o cerebro e o corpo
en desenvolvemento dos nenos.
en desenvolvemento dos nenos.
07:03
affects the developing brains
and bodies of children.
and bodies of children.
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Afecta a áreas como o núcleo accumbens,
centro de pracer e recompensa do cerebro,
centro de pracer e recompensa do cerebro,
07:06
It affects areas like
the nucleus accumbens,
the nucleus accumbens,
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07:09
the pleasure and reward
center of the brain
center of the brain
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involucrado na drogodependencia.
07:12
that is implicated
in substance dependence.
in substance dependence.
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07:14
It inhibits the prefrontal cortex,
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Inhibe o cortéx prefrontal
necesario para o control dos impulsos
necesario para o control dos impulsos
07:17
which is necessary for impulse control
and executive function,
and executive function,
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así como para a función executiva,
unha área crucial para a aprendizaxe.
unha área crucial para a aprendizaxe.
07:21
a critical area for learning.
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E, en resonancias magnéticas,
07:23
And on MRI scans,
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07:25
we see measurable differences
in the amygdala,
in the amygdala,
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vense cambios significativos na amígdala,
o centro de resposta ao medo do cerebro.
o centro de resposta ao medo do cerebro.
07:29
the brain's fear response center.
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Así que hai razóns neurolóxicas reais
07:32
So there are real neurologic reasons
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que explican por que a xente exposta
a altas doses de adversidade
a altas doses de adversidade
07:35
why folks exposed
to high doses of adversity
to high doses of adversity
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é máis propensa a adoptar
comportamentos de alto risco.
comportamentos de alto risco.
07:39
are more likely to engage
in high-risk behavior,
in high-risk behavior,
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E é importante sabelo.
07:42
and that's important to know.
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Pero resulta que incluso se non adoptas
ningún comportamento de alto risco,
ningún comportamento de alto risco,
07:44
But it turns out that even if you don't
engage in any high-risk behavior,
engage in any high-risk behavior,
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segues a ter máis probabilidades de
ter enfermidades cardíacas ou cáncer.
ter enfermidades cardíacas ou cáncer.
07:50
you're still more likely
to develop heart disease or cancer.
to develop heart disease or cancer.
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O motivo ten que ver co eixe
hipotalámico-hipofisario-adrenal,
hipotalámico-hipofisario-adrenal,
07:56
The reason for this has to do with
the hypothalamic–pituitary–adrenal axis,
the hypothalamic–pituitary–adrenal axis,
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o sistema corporal e cerebral
de resposta ao estrés
de resposta ao estrés
08:02
the brain's and body's
stress response system
stress response system
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08:05
that governs our fight-or-flight response.
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encargado de gobernar
a nosa resposta de loita ou fuxida.
a nosa resposta de loita ou fuxida.
Como funciona?
08:09
How does it work?
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Ben, imaxina que estás camińando
polo bosque e ves un oso.
polo bosque e ves un oso.
08:11
Well, imagine you're walking
in the forest and you see a bear.
in the forest and you see a bear.
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Inmediatamente, o hipotálamo
envía un sinal á glándula pituitaria
envía un sinal á glándula pituitaria
08:15
Immediately, your hypothalamus
sends a signal to your pituitary,
sends a signal to your pituitary,
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que envía outro sinal
á glándula suprarrenal que di:
á glándula suprarrenal que di:
08:19
which sends a signal
to your adrenal gland that says,
to your adrenal gland that says,
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08:22
"Release stress hormones!
Adrenaline! Cortisol!"
Adrenaline! Cortisol!"
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Liberade hormonas do estrés!
Adrenalina! Cortisol!
Adrenalina! Cortisol!
O teu corazón comeza a latexar con forza,
as túas pupilas dilátanse,
as túas pupilas dilátanse,
08:25
And so your heart starts to pound,
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08:28
Your pupils dilate, your airways open up,
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as túas vías respiratorias ábrense
08:30
and you are ready to either
fight that bear or run from the bear.
fight that bear or run from the bear.
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e ti estás listo para loitar
contra ese oso ou para escapar del.
contra ese oso ou para escapar del.
E iso é estupendo! Se estás
no bosque e hai un oso.
no bosque e hai un oso.
08:36
And that is wonderful
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08:38
if you're in a forest
and there's a bear.
and there's a bear.
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(Risas)
08:42
(Laughter)
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Pero o problema é qué ocorre cando
o oso vén á casa tódalas noites
o oso vén á casa tódalas noites
08:45
But the problem is what happens
when the bear comes home every night,
when the bear comes home every night,
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e este sistema se activa
unha vez tras doutra,
unha vez tras doutra,
08:50
and this system is activated
over and over and over again,
over and over and over again,
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deixando de ser adaptable
ou capaz de salvar unha vida,
ou capaz de salvar unha vida,
08:56
and it goes from being
adaptive, or life-saving,
adaptive, or life-saving,
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para ser pouco adaptable
ou prexudicial para a saúde.
ou prexudicial para a saúde.
09:00
to maladaptive, or health-damaging.
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Os nenos son especialmente sensibles
a esta activación repetitiva polo estrés,
a esta activación repetitiva polo estrés,
09:04
Children are especially sensitive
to this repeated stress activation,
to this repeated stress activation,
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porque os seus cerebros e corpos
aínda se están desenvolvendo.
aínda se están desenvolvendo.
09:10
because their brains and bodies
are just developing.
are just developing.
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As doses altas de adversidade non afectan
só á estrutura e ás funcións do cerebro,
só á estrutura e ás funcións do cerebro,
09:14
High doses of adversity not only affect
brain structure and function,
brain structure and function,
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senón tamén ao sistema inmunolóxico,
ao sistema endócrino,
ao sistema endócrino,
09:20
they affect the developing immune system,
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09:23
developing hormonal systems,
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e incluso ao xeito no que se le
e transcribe o noso ADN.
e transcribe o noso ADN.
09:26
and even the way our DNA
is read and transcribed.
is read and transcribed.
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A min, esta información fíxome
tirar pola borda todo o que aprendera
tirar pola borda todo o que aprendera
09:32
So for me, this information
threw my old training out the window,
threw my old training out the window,
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09:37
because when we understand
the mechanism of a disease,
the mechanism of a disease,
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porque cando entendemos
o mecanismo dunha enfermidade,
o mecanismo dunha enfermidade,
cando sabemos non só que vías
están danadas senón tamén como,
están danadas senón tamén como,
09:41
when we know not only
which pathways are disrupted, but how,
which pathways are disrupted, but how,
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o noso traballo como médicos
09:45
then as doctors, it is our job
to use this science
to use this science
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é empregar a ciencia para
previlo e tratalo.
previlo e tratalo.
09:50
for prevention and treatment.
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09:53
That's what we do.
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Iso é o que facemos.
09:54
So in San Francisco, we created
the Center for Youth Wellness
the Center for Youth Wellness
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Así que en San Francisco, creamos
o Centro para o Benestar da Mocidade
o Centro para o Benestar da Mocidade
para previr, diagnosticar e curar
o impacto das EIA e do estrés tóxico.
o impacto das EIA e do estrés tóxico.
09:58
to prevent, screen and heal the impacts
of ACEs and toxic stress.
of ACEs and toxic stress.
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10:04
We started simply with routine screening
of every one of our kids
of every one of our kids
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Comezamos só con revisións rutineiras
de tódolos nosos nenos
de tódolos nosos nenos
durante as súas visitas habituais,
10:09
at their regular physical,
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porque sei que se a mińa paciente
ten unha puntuación EIA de 4,
ten unha puntuación EIA de 4,
10:10
because I know that if my patient
has an ACE score of 4,
has an ACE score of 4,
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ten 2.5 veces máis probabilidades
de padecer hepatite ou DPOC,
de padecer hepatite ou DPOC,
10:15
she's two and a half times as likely
to develop hepatitis or COPD,
to develop hepatitis or COPD,
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10:19
she's four and half times as likely
to become depressed,
to become depressed,
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é 4.5 veces máis propensa a ter depresión
10:22
and she's 12 times as likely
to attempt to take her own life
to attempt to take her own life
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e ten 12 veces máis probabilidades
de intentar suicidarse
de intentar suicidarse
10:26
as my patient with zero ACEs.
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que o meu paciente con EIA cero.
Iso seino cando está no meu consultorio.
10:29
I know that when she's in my exam room.
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Para os pacientes que dan positivo,
contamos cun equipo multidisciplinario
contamos cun equipo multidisciplinario
10:32
For our patients who do screen positive,
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10:35
we have a multidisciplinary treatment team
that works to reduce the dose of adversity
that works to reduce the dose of adversity
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que traballa para reducir
as doses de adversidade
as doses de adversidade
e tratar os síntomas
coas mellores técnicas,
coas mellores técnicas,
10:40
and treat symptoms using best practices,
including home visits, care coordination,
including home visits, care coordination,
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incluíndo visitas a domicilio,
coordinación da atención,
coordinación da atención,
10:46
mental health care, nutrition,
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atención psiquiátrica, nutrición,
intervencións holísticas
e, se é necesario, medicación.
e, se é necesario, medicación.
10:50
holistic interventions, and yes,
medication when necessary.
medication when necessary.
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Pero tamén educamos aos pais sobre
o impacto das EIA e o estrés tóxico
o impacto das EIA e o estrés tóxico
10:54
But we also educate parents
about the impacts of ACEs and toxic stress
about the impacts of ACEs and toxic stress
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10:59
the same way you would for covering
electrical outlets, or lead poisoning,
electrical outlets, or lead poisoning,
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do mesmo xeito que o fariamos
para falar de tapar os enchufes
para falar de tapar os enchufes
ou sobre o envelenamento por chumbo,
e adaptamos o coidado
dos nosos asmáticos e diabéticos
dos nosos asmáticos e diabéticos
11:05
and we tailor the care
of our asthmatics and our diabetics
of our asthmatics and our diabetics
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para recońecer que quizais necesitan
un tratamento máis agresivo
un tratamento máis agresivo
11:09
in a way that recognizes that they may
need more aggressive treatment,
need more aggressive treatment,
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dados os cambios nos seus
sistemas endócrinos e inmunolóxicos.
sistemas endócrinos e inmunolóxicos.
11:13
given the changes to their hormonal
and immune systems.
and immune systems.
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11:17
So the other thing that happens
when you understand this science
when you understand this science
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Outra cousa que sucede cando
entendemos esta ciencia
entendemos esta ciencia
é que o queremos gritar aos catro ventos
11:22
is that you want to shout it
from the rooftops,
from the rooftops,
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porque isto non é un problema que
afecte tan só aos nenos de Bayview.
afecte tan só aos nenos de Bayview.
11:25
because this isn't just an issue
for kids in Bayview.
for kids in Bayview.
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Eu pensaba que no momento en que
todos souberan sobre isto
todos souberan sobre isto
11:29
I figured the minute
that everybody else heard about this,
that everybody else heard about this,
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habería rastrexos rutineiros,
equipos multidisplinarios de tratamento
equipos multidisplinarios de tratamento
11:33
it would be routine screening,
multi-disciplinary treatment teams,
multi-disciplinary treatment teams,
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11:36
and it would be a race to the most
effective clinical treatment protocols.
effective clinical treatment protocols.
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e habería unha carreira cara a protocolos
máis eficaces de tratamento clínico.
máis eficaces de tratamento clínico.
11:41
Yeah. That did not happen.
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Xa. Pois non pasou.
E foi unha gran lección para min.
11:45
And that was a huge learning for me.
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O que pensara que ía ser
a mellor práctica clínica
a mellor práctica clínica
11:48
What I had thought of as simply
best clinical practice
best clinical practice
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hoxe entendo que é un movemento.
11:53
I now understand to be a movement.
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11:57
In the words of Dr. Robert Block,
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En palabras do Dr. Robert Block,
ex presidente da Academia
de Pediatría de EEUU:
de Pediatría de EEUU:
11:59
the former President
of the American Academy of Pediatrics,
of the American Academy of Pediatrics,
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"As EIA son a maior e a principal
ameaza non resolta da saúde pública
ameaza non resolta da saúde pública
12:03
"Adverse childhood experiences
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12:06
are the single greatest
unaddressed public health threat
unaddressed public health threat
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á cal se enfronta hoxe
en día a nosa nación."
en día a nosa nación."
12:11
facing our nation today."
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12:13
And for a lot of people,
that's a terrifying prospect.
that's a terrifying prospect.
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E, para moita xente, esa é
unha perspectiva aterradora.
unha perspectiva aterradora.
A escala e o alcance do problema
parecen tan grandes
parecen tan grandes
12:18
The scope and scale of the problem
seems so large that it feels overwhelming
seems so large that it feels overwhelming
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que resulta desconsolador
pensar como podemos abordalo.
pensar como podemos abordalo.
12:24
to think about how we might approach it.
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Pero para min, en realidade,
é aí onde radica a esperanza,
é aí onde radica a esperanza,
12:26
But for me, that's actually
where the hopes lies,
where the hopes lies,
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porque, se temos o marco axeitado,
12:31
because when we have the right framework,
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se admitimos que isto
é unha crise da saúde pública,
é unha crise da saúde pública,
12:33
when we recognize this to be
a public health crisis,
a public health crisis,
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entón podemos empezar a usar
as ferramentas axeitadas
as ferramentas axeitadas
12:38
then we can begin to use the right
tool kit to come up with solutions.
tool kit to come up with solutions.
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para xerar solucións.
12:43
From tobacco to lead poisoning
to HIV/AIDS,
to HIV/AIDS,
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Dende o tabaco ata o envelenamento
por chumbo, pasando polo VIH,
por chumbo, pasando polo VIH,
12:47
the United States actually has
quite a strong track record
quite a strong track record
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os EEUU teńen, en realidade,
unha traxectoria bastante sólida
unha traxectoria bastante sólida
á hora de abordar os
problemas de saúde pública.
problemas de saúde pública.
12:52
with addressing public health problems,
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12:55
but replicating those successes
with ACEs and toxic stress
with ACEs and toxic stress
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Pero repetir eses éxitos
coas EIA e o estrés tóxico
coas EIA e o estrés tóxico
requirirá determinación e compromiso,
13:01
is going to take determination
and commitment,
and commitment,
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e cando miro a reacción da
nosa nación ata agora pregúntome:
nosa nación ata agora pregúntome:
13:05
and when I look at what
our nation's response has been so far,
our nation's response has been so far,
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13:09
I wonder,
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13:11
why haven't we taken this more seriously?
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Por que non tomamos
isto máis en serio?
isto máis en serio?
13:15
You know, at first I thought
that we marginalized the issue
that we marginalized the issue
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Ao comezo pensei que non lle damos
importancia porque non nos afecta a nós,
importancia porque non nos afecta a nós,
13:19
because it doesn't apply to us.
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13:21
That's an issue for those kids
in those neighborhoods.
in those neighborhoods.
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que era un problema
dos deses barrios.
dos deses barrios.
13:24
Which is weird, because the data
doesn't bear that out.
doesn't bear that out.
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O cal é estrańo
porque os datos non mostran iso.
porque os datos non mostran iso.
O estudo orixinal de EIA
realizouse cunha poboación
realizouse cunha poboación
13:28
The original ACEs study
was done in a population
was done in a population
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onde o 70% eran caucásicos
e o 70% tińa educación superior.
e o 70% tińa educación superior.
13:32
that was 70 percent Caucasian,
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13:35
70 percent college-educated.
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E canto máis falaba coa xente,
13:38
But then, the more I talked to folks,
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máis me daba conta de que,
talvez, entendera todo ao revés.
talvez, entendera todo ao revés.
13:42
I'm beginning to think that maybe
I had it completely backwards.
I had it completely backwards.
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Se eu preguntara cantas persoas
nesta sala foron criadas
nesta sala foron criadas
13:47
If I were to ask
how many people in this room
how many people in this room
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nunha familia onde alguén tińa
unha enfermidade mental,
unha enfermidade mental,
13:53
grew up with a family member
who suffered from mental illness,
who suffered from mental illness,
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aposto a que algún levantaría a man.
13:57
I bet a few hands would go up.
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E se preguntara cantos tiveron
un pai que bebía de máis
un pai que bebía de máis
14:00
And then if I were to ask how many folks
had a parent who maybe drank too much,
had a parent who maybe drank too much,
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14:05
or who really believed that
if you spare the rod, you spoil the child,
if you spare the rod, you spoil the child,
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ou que cría que debía castigarte
sempre que fixeras algo mal
sempre que fixeras algo mal
apostaría que uns cantos máis
levantarían a man.
levantarían a man.
14:11
I bet a few more hands would go up.
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14:14
Even in this room, this is an issue
that touches many of us,
that touches many of us,
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Incluso nesta sala, este problema
aféctanos a moitos de nós
aféctanos a moitos de nós
e comezo a crer que non lle damos
importancia porque si que nos afecta.
importancia porque si que nos afecta.
14:19
and I am beginning to believe
that we marginalize the issue
that we marginalize the issue
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14:22
because it does apply to us.
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14:25
Maybe it's easier to see
in other zip codes
in other zip codes
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Tal vez é máis fácil ver o
problema noutros sitios,
problema noutros sitios,
14:28
because we don't want to look at it.
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porque non queremos velo.
Antes preferiríamos estar enfermos.
14:31
We'd rather be sick.
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Afortunadamente, os avances científicos e,
francamente, a realidade económica
francamente, a realidade económica
14:34
Fortunately, scientific advances
and, frankly, economic realities
and, frankly, economic realities
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fan que esa opción sexa
menos viable cada día.
menos viable cada día.
14:40
make that option less viable every day.
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A ciencia é clara:
14:45
The science is clear:
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as adversidades da infancia afectan
drasticamente a saúde de toda a vida.
drasticamente a saúde de toda a vida.
14:48
Early adversity dramatically affects
health across a lifetime.
health across a lifetime.
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14:54
Today, we are beginning to understand
how to interrupt the progression
how to interrupt the progression
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Hoxe en día, estamos comezando
a entender como deter a progresión
a entender como deter a progresión
de adversidade temperá
a enfermidade e morte prematura,
a enfermidade e morte prematura,
14:58
from early adversity
to disease and early death,
to disease and early death,
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e, en 30 anos, o neno cunha
alta puntuación de EIA
alta puntuación de EIA
15:03
and 30 years from now,
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15:05
the child who has a high ACE score
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cuxos síntomas no comportamento
pasan desapercibidos,
pasan desapercibidos,
15:08
and whose behavioral symptoms
go unrecognized,
go unrecognized,
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cuxo control da asma
non está correlacionado
non está correlacionado
15:11
whose asthma management
is not connected,
is not connected,
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15:13
and who goes on to develop
high blood pressure
high blood pressure
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e que acaba desenvolvendo hipertensión,
algunha enfermidade cardíaca
ou cáncer a unha idade temperá
ou cáncer a unha idade temperá
15:17
and early heart disease or cancer
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será tan pouco usual como alguén cunha
taxa de mortalidade para o VIH de 6 meses.
taxa de mortalidade para o VIH de 6 meses.
15:20
will be just as anomalous
as a six-month mortality from HIV/AIDS.
as a six-month mortality from HIV/AIDS.
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15:25
People will look at that situation
and say, "What the heck happened there?"
and say, "What the heck happened there?"
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A xente ao ver estes casos dirá:
Arre demo, pero que pasou?
Arre demo, pero que pasou?
Isto é tratable. Pódese superar.
15:30
This is treatable.
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15:32
This is beatable.
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O máis importante que necesitamos hoxe
15:35
The single most important thing
that we need today
that we need today
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é o valor para enfrontar este problema
e admitir que existe e nos afecta a todos.
e admitir que existe e nos afecta a todos.
15:39
is the courage to look
this problem in the face
this problem in the face
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15:43
and say, this is real
and this is all of us.
and this is all of us.
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Creo que nós mesmos somos o movemento.
15:48
I believe that we are the movement.
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15:53
Thank you.
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Grazas.
(Aplausos)
15:54
(Applause)
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ABOUT THE SPEAKER
Nadine Burke Harris - PediatricianNadine Burke Harris’ healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma.
Why you should listen
Pediatrician Nadine Burke Harris noticed a disturbing trend as she treated children in an underserved neighborhood in San Francisco: that many of the kids who came to see her had experienced childhood trauma. She began studying how childhood exposure to adverse events affects brain development, as well as a person’s health as an adult.
Understanding this powerful correlation, Burke Harris became the founder and CEO of the Center for Youth Wellness, an initiative at the California Pacific Medical Center Bayview Child Health Center that seeks to create a clinical model that recognizes and effectively treats toxic stress in children. Her work pushes the health establishment to reexamine its relationship to social risk factors, and advocates for medical interventions to counteract the damaging impact of stress. Her goal: to change the standard of pediatric practice, across demographics.
Nadine Burke Harris | Speaker | TED.com