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楼主:中华卫生 时间:2020年02月23日 03:56:51 点击:0 回复:0
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If your dog looks pleased to see you – it is probably because it loves the particular way you smell.如果你的一见到你就显得很开心的话,有可能是因为它喜欢你散发出的独特气味。The odour of a familiar human apparently lingers like perfume in the animal’s brain – where it triggers an instinctive emotional response, research published yesterday reveals.根据近日公布的一份研究显示,熟悉的人所散发的气味会如同香水一般深深地存在于动物的脑海里。这些气味会触发大脑内部本能的情绪反应。Our scent acts on a part of the canine brain associated with reward and the strongest reactions are produced by humans that pets know best, say scientists in America.美国科学家声称,犬类的大脑中有一块负责“奖励”的区域,与宠物最亲密的人身上的气味能够激起该区最强烈的反应。Gregory Berns, of Emory University in Atlanta, said: ‘While we might expect that dogs should be highly tuned to the smell of other dogs, it seems that the “reward response” is reserved for their humans.埃默里大学的格里高利· 伯恩斯(Gregory Berns)说:“我们原以为这种反应是适用于之间的。目前看来这种‘奖励反应’只适用于的主人。”#39;When humans smell the perfume or cologne of someone they love, they may have an immediate, emotional reaction that#39;s not necessarily cognitive.“当人们嗅到爱人身上的香水或古龙水时,会立刻出现情绪上的反应,这种反应并不一定能被察觉到。”#39;Our experiment may be showing the same process in dogs. But since dogs are so much more olfactory than humans, their responses would likely be even more powerful than the ones we might have.“我们的实验或许可以表明,对气味的应激过程是相同的。不过鉴于的嗅觉比人类灵敏,因此它们对于气味的反应会比人类强烈得多。”#39;It#39;s one thing when you come home and your dog sees you and jumps on you and licks you and knows that good things are about to happen.“当你回到家时,你的一见到你就会扑到你怀里,不停地舔你,它知道有好事要降临了。”#39;In our experiment, however, the scent donors were not physically present.“但是在我们的实验中,气味样本的源体(主人)并不在场。”#39;That means the canine brain responses were being triggered by something distant in space and time. It shows that dogs#39; brains have these mental representations of us that persist when we#39;re not there.#39;“这意味着,犬类的大脑反应是由过去某处发生过的事所触发的。同时也表明,当我们不在身边的时候,我们的精神意识形态会留存在它们的大脑中。”The university’s experiment - the first of its type - involved 12 dogs of various breeds who underwent brain scans while five different scents were placed in front of them.埃默里大学这项开拓性的实验利用了十二只不同品种的作为实验对象,通过对这些的大脑进行扫描,来研究它们对五种气味的反应有何不同。The scent samples came from the subject itself, a dog the subject had never met, a dog that lived in the subject#39;s household, a human the dog had never met, and a human that lived in the subject#39;s household.气味样本有五个来源,分别是:被测自己、被测从未见过的另一只、居住在被测家中的另一只、被测从未见过的一个人,以及被测的家人。The familiar human scent samples were taken from someone else from the house other than the handlers during the experiment, so that none of the scent donors were physically present.在实验中,气味样本来自被测的家人,但他并不参与到实验中来。因此,所有气味样本的源体都没有出现在实验现场。The results showed that all five scents elicited a similar response in parts of the dogs#39; brains involved in detecting smells. Responses were significantly stronger for the scents of familiar humans, followed by that of familiar dogs.实验结果显示,脑内负责嗅觉的区域对这五种气味都产生了类似的反应。对于熟人的反应尤其强烈,对于熟悉的次之。The findings, which were published in the journal Behavioural Processes, showed that dogs reacted strongest to the scent of a familiar human even when they were not there.这项发现被刊登在《行为学过程》杂志上,文中写道,即使熟悉的人没在身边,他们的气味也会激发最强烈的反应。Pets trained as help or therapy dogs showed greater brain activity than the other dogs in the test.在实验中还发现,相比其他种类的而言,辅助犬和治疗犬的大脑对气味的反应更为明显。Researchers say the findings could improve the way animals who assist wounded veterans or disabled people are selected.研究者声称,这些发现对于如何为受伤老兵和残障人士选择合适的辅助犬大有裨益。 /201404/287797Like most women, my hair-washing ritual has always been hugely important to me. For as many years as I can remember, I have shampooed twice, then massaged conditioner from roots through to tips and waited two minutes before rinsing.像大部分女人一样,洗头发对我来说很重要。自有记忆的多年以来,我都是先抹两遍洗发水,然后把头发从上到下涂好护发素,等2分钟之后冲洗干净。A few woefully short, bouncy, glossy hours would follow before my hair would revert back to its default setting of lank and limp[. Now, it seems, that limpness was all my own fault.但令人悲伤的是,洗完头发后好看的发型只持续短短的几小时,然后头发就又变得又薄又茸、油腻腻地贴在头皮上很难看。现在看来,似乎是我洗头发的顺序错了。Reversing the order in which you wash your hair is meant to give you all the detangling and glossing benefits of conditioner - along with extra volume - but without any residual side-effects.调换一下涂洗发水和护发素的顺序,你不仅能让秀发柔顺飘逸,还能避免护发素残余造成的副作用。The method itself is simple: wet your hair then work in your favourite conditioner, concentrating almost solely on the ends of the hair, with just a tiny bit at the roots. Leave the conditioner in for five minutes, then rinse thoroughly. Only now should you shampoo, rinse, and repeat, making sure you don’t use more product than you need.方法本身很简单:把头发用清水淋湿,然后涂上你以往最喜欢的护发素,要注意把护发素主要涂在发梢、发根要少涂;然后让护发素在头发上停留5分钟,之后用清水把头发彻底冲洗一下;接下来才是涂洗发水、冲洗头发,并重复一遍,注意洗发水要适量不要放多。I towel-dried as gently as I could, worried that without the final smoothing of conditioner I#39;d be left with a mass of tangles which would explode into a haze of split ends the moment I tried to take a brush to it.我轻轻地用毛巾擦干头发,有点担心梳头的时候头发会不会打结。To my immense relief, however, my wide-toothed comb went through my hair as easily as it normally does - with not a tangle in sight.然而,当我用宽齿梳子梳头发的时候,头发像往常一样柔顺,一点都不打结。我终于如释重负了。I blow-dried it as normal and immediately noticed a difference. My hair definitely looked shinier than normal.我像以往一样吹干头发,马上就注意到了与以往不一样的地方:我的头发比平时要光泽得多嘛!Two days later I repeated the process - and the difference was just as pronounced. My hair was definitely looking thicker - as though I#39;d used a volumising mousse, but without the dulling effect that many styling products leave behind.两天后我重复了这个试验,效果就像照片里一样:我的头发看上去厚多了,就像用过增发剂一样,但却毫无增发剂的那种副作用!By the end of the seven-day challenge, I could see a marked difference in my hair. Not only did it leave hair shinier, it helped combat frizz caused when particles of dirt stick to the residual product. Best of all, it felt softer yet thicker. Not a sticking-out ear in sight.在7天测试结束的时候,我看到了自己头发和以前相比的显著差异。先用护发素再用洗发水,不仅让头发更光泽,还避免了护发素残余导致头发小卷曲;最好的一点是头发摸上去更柔软、看上去更蓬松,甚至把耳朵都遮住了呢。 /201404/288114May Liu earns about ,500 a month as an office worker in Hong Kong, but she spends about 10 to 15 times that on luxury goods, buying everything from Prada handbags to products from US cosmetic brand Fresh.May Liu是一名在香港工作的办公室文员,每月收入约2500美元,但她在奢侈品上的花费是这一金额的10至15倍,购买的产品从普拉达(Prada)的手袋到美国馥蕾诗(Fresh)的化妆品无所不包。While Ms Liu loves shopping, she buys mostly for others in her role as a “daigou” agent – a growing breed of people who specialise in helping mainland Chinese consumers secure products from overseas.虽然May Liu喜欢购物,但她主要是作为一名“代购”帮别人买东西——作为一个人数日渐增长的群体,代购专门帮助中国内地顾客从境外购买商品。She started her daigou business a year ago as a way to earn more money, but the young mainland Chinese was soon bringing in up to ,000 a month. Ms Liu now has about 2,600 clients, who use Weibo, China’s equivalent of Twitter, and WeChat, a messaging app, to order goods.她一年前开始从事代购业务,以增加收入,但不久之后,这位来自中国内地的年轻人每月最高就可进账一万美元。May Liu现在约有2600名客户,这些客户通过微(Weibo,相当于中国的推特(Twitter))以及聊天应用微信(WeChat)来下单订购商品。“I didn’t know how much money I would make. I didn’t have any expectation of profits,” says Ms Liu, who asked to use a pseudonym. “I only knew it would be profitable.”May Liu要求使用化名。她说:“我不知道自己能赚到多少钱。我对利润没有任何预期。我只知道这一行能赚钱。”She has not given up her day job, realising that being a daigou agent, while highly profitable, can also be illegal.她没有辞去正职工作,因为她明白,代购这一行虽然利润丰厚,但可能是违法违规的。Some agents focus on ferrying goods from Hong Kong to mainland China.一些代购专门从事将商品从香港代送到中国内地的业务。But the web-based phenomenon has sp to expatriate Chinese who are help compatriots back home buy brands from cities such as Paris, London, New York, Hong Kong, Tokyo and Seoul.但这一兴起于网络的现象现已扩散到了旅居海外的中国侨胞群体,他们帮助国内同胞从巴黎、伦敦、纽约、香港、东京以及首尔等城市购买名牌商品。The daigou boom is an example of how ecommerce is rapidly transforming the Chinese retail market.代购热潮是一个明,表明电子商务正在快速改变中国零售市场的面貌。According to Chinese media, there are hundreds of thousands of people working in the daigou business. A search for the term on Alibaba’s Taobao, China’s largest online marketplace, produces more than 240,000 virtual stores and nearly 15m items from child car seats through air purifiers to pocket printers.据中国媒体报道,目前有好几十万人在从事代购业务。在阿里巴巴(Alibaba)旗下网站淘宝(Taobao)上搜索“代购”一词,会显示出超过24万个网络店铺以及近1500万种商品,从儿童汽车座椅、空气净化器到便携式打印机无所不包。淘宝是中国最大的在线交易平台。The China e-Commerce Research Centre says the daigou market grew 19-fold between 2008 and 2012 when it reached Rmb48bn, and reckons that it rose again in 2013 to Rmb74bn (bn). According to a recent study by Bain, about 60 per cent of the Chinese consumers who buy luxury goods have used daigou at some point.中国电子商务研究中心(China e-Commerce Research Centre)表示,代购市场在2008至2012年间增长了19倍,规模达到了人民币480亿元,2013年代购市场继续增长,规模达到了人民币740亿元(合120亿美元)。贝恩公司(Bain amp; Company)近期进行的一项研究显示,约有60%的中国奢侈品消费者曾经使用过代购务。The business is thriving for several reasons. Many Chinese believe the same product is better made when bought overseas because of the mainland’s uneven reputation for quality.代购行业蓬勃发展主要是由于以下几个原因。很多中国人认为,同一种产品,购自海外的质量会好一点,因为中国大陆的产品有着质量不稳定的名声。The rising strength of the renminbi, the growing purchasing power of Chinese consumers, and high-profile food safety scandals in China, have also spurred demand for safe and high-quality foreign products.人民币汇率稳步走强,中国消费者的购买力不断提升,中国食品安全丑闻引起公众关注,也都刺激了市场对安全性高、质量又好的外国产品的需求。Mo Daiqing, an analyst at the e-commerce research centre, says the main reason Chinese are turning to daigou is because of hefty import tariffs on luxury goods. China levies a 50 per cent duty on cosmetics, one of the dominant daigou categories, and that is before the imposition of the standard 17 per cent value added tax that is added to imported luxury products.中国电子商务研究中心的分析师莫岱青表示,中国消费者转向代购的主要原因是,国内对奢侈品的进口关税太高。目前中国对化妆品征收50%的关税(这是代购商品中的一大主要门类),而在此之后还要再对进口奢侈品按标准征收17%的增值税。“The same brands of milk powder, cosmetics and handbags are much cheaper in Hong Kong, the US, Japan and South Korea than in mainland China,” said Ms Mo.莫岱青表示:“同样品牌的奶粉、化妆品以及手袋,在香港、美国以及韩国买的要比在中国大陆便宜很多。”But the industry is increasingly drawing attention from customs officials in mainland China and Hong Kong, particularly with the rising numbers of so-called parallel traders who take advantage of multi-entry visas to cross the border at the southern Chinese city of Shenzhen many times a day, carrying products for resale that they do not declare at customs.但代购行业正日益受到中国内地和香港海关官员的关注,特别是人数越来越多的“水客”(parallel traders)。这类人利用一签多行政策,在中国南方城市深圳每日穿越边境多次,将所携带的未报关商品在境内转手出售。Dong Yizhi, a lawyer who specialises in ecommerce, points out that the daigou business is not illegal if the agents pay import taxes, but says that if agents pay duties the premise of the business becomes moot.专长电商领域的律师董毅智指出,如果代购人员付进口关税,那么代购业务就不是违法的;但在这种情况下,代购将失去存在的意义。“If they pay customs duties, the price disparities will be much smaller and they won’t make money,” said Mr Dong.董毅智表示:“如果代购付关税,国内外商品的差价将显著缩窄,代购就赚不了什么钱。”Chinese citizens can legally import Rmb5,000 (3) of duty-free goods for personal use each time they return to the mainland. But Shenzhen customs officers are taking a tougher line on parallel traders who cross the border back into the mainland more than once a day with goods over the value of Rmb500.中国公民从境外返回中国大陆时,每次可以依法携带价值不超过人民币5000元(合823美元)的免税商品供个人使用。但深圳海关对每天往返境内超过一次的水客采取了更加严厉的标准:每次携带的免税货品价值不得超过人民币500元。Liu Lizhen, a Shenzhen customs official, said the move was aimed at clamping down on the abuse of the multiple re-entry system.深圳海关官员刘丽珍(音译)表示,此举旨在打击滥用多次往返签机制的情况。This has become a more serious issue in Hong Kong since 2009 when it started allowing Shenzhen permanent residents to enter the former British colony without restrictions.自2009年以来,水客在香港已经成了一个愈发严重的问题。香港自2009年开始允许深圳市永久居民不限次数前往这片曾经的英属殖民地。“We once found a person who had crossed the border 26 times a day,” said Ms Liu.刘丽珍称:“我们曾经发现过一个人,他在一天之内穿越边境26次。”According to the Shenzhen customs bureau, more than 20,000 parallel traders operate at the six land border checkpoints between Hong Kong and the southern Chinese city.来自深圳海关的信息显示,在香港与深圳之间的6个陆路口岸往返的水客数量超过了两万人。Hong Kong’s immigration department said just over a thousand parallel traders were arrested last year for breaching the terms of their stay in the territory.香港入境事务处表示,去年超过1000名水客因为违反在香港境内的逗留条款而被逮捕。Despite the crackdown, May Liu, the daigou agent, says she is not worried, and still travels to Shenzhen a few times a week.虽然面临政府打压,但作为一名代购的May Liu表示自己并不担心,仍然每周数次前往深圳。“Carrying so much stuff across the border every time provides me with a lot of exercise. I don’t even have to go to the gym,” jokes Ms Liu.她开玩笑称:“每次带这么多东西穿越边境对我来说是强度很大的锻炼。我甚至都不用去健身房了。”‘Brands are much cheaper in Hong Kong, the US, Japan and South Korea than China’“名牌商品在香港、美国、日本以及韩国的售价远比在中国内地便宜。” /201402/277279

BOSTON — David Baldwin wasn#39;t sure how he had come across the other day in group therapy at the hospital, near the co-op apartment where he lives with his rescue cat, Zoey. He struggles with bipolar disorder, severe anxiety and depression. Like so many patients, he secretly wondered what his therapist thought of him.波士顿——大卫·鲍德温(David Baldwin)和他救助的猫咪佐伊(Zoey)共同居住的合作公寓附近有家医院,不久前的一天,他在那里参加了一次团体治疗,但并不确定自己当时给人留下了怎样的印象。鲍德温一直在与会让人陷入极度焦虑和沮丧之中的躁郁症做斗争。和很多患者一样,他会暗自揣测治疗师对他的看法。But unlike those patients, Mr. Baldwin, 64, was able to find out, swiftly and privately. Pulling his black leather swivel chair to his desk, he logged onto a hospital website and eagerly perused his therapist#39;s session notes.但与其他患者不同, 64岁的鲍德温能迅速地、悄悄地找到。他把黑色皮转椅拖到自己的书桌前,随后登录到医院的网站,急切地看起了他的治疗师对那次会谈的记录。The clinical social worker, Stephen O#39;Neill, wrote that Mr. Baldwin#39;s self-consciousness about his disorder kept him isolated. Because he longed to connect with others, this was particularly self-defeating, Mr. O#39;Neill observed. But during the session, he had also discussed how he had helped out neighbors in his co-op.临床社工斯蒂芬·奥尼尔(Stephen O#39;Neill)写道,鲍德温对他的疾病感到尴尬,这让他处于孤立的状态。奥尼尔注意到,该状态给他带来了强烈的挫败感,因为他渴望与人交往。但在治疗期间,他也曾谈论过自己是如何给合作公寓里的邻居们帮忙的。;This seems greatly appreciated, and he noted his clear enjoyment in helping others,; Mr. O#39;Neill wrote. ;This greatly assists his self-esteem.;“人们似乎非常感谢他,他则明显感到帮助别人时他自己也乐在其中,”奥尼尔写道,“这可以非常有效地帮他建立自尊心。”A smile animated Mr. Baldwin#39;s broad, amiable features. ;I have a tough time recognizing that I#39;ve made progress,; he said. ;So it#39;s nice to this as a reminder.;鲍德温宽和的脸庞上掠过了一丝微笑。“我很难确认自己已经有所进步,”他说,“阅读这些内容让我得到了提示,真不错。”Mental health patients do not have the y access to office visit notes that, increasingly, other patients enjoy. But Mr. Baldwin is among about 700 patients at Beth Israel Deaconess Medical Center who are participating in a novel experiment.心理疾病患者是无法便捷地查询门诊病历的,尽管罹患其他疾病的患者已经逐渐可以这样做了。但包括鲍德温在内,以色列堂-女执事医疗中心(Beth Israel Deaconess Medical Center)的大约700名患者正在参与一场新奇的实验。Within days of a session, they can their therapists#39; notes on their computers or smartphones. The hope is that this transparency will improve therapeutic trust and communication.参加完会谈数日后,他们就可以在自己的电脑或者智能手机上阅读治疗师做的记录了。提高信息透明度的目的,是希望加深医患之间的信任和沟通。;We#39;re creating a revolution,; said Dr. Tom Delbanco, a professor of medicine at Harvard and a proponent of giving patients access to notes by therapists as well as by physicians. ;Some people are aghast.;“我们正掀起一场革命,”主张允许患者查看治疗师及医生所做记录的哈佛大学(Harvard)医学教授汤姆·德尔班科(Tom Delbanco)表示,“有些人被惊呆了。”The pilot project has raised questions in the mental health community. Which patients will benefit and which might be harmed? How will the notes alter a therapeutic relationship built on face-to-face exchanges? What will be the impact on confidentiality and privacy?这一试点项目已经在心理健康群体内引发了争议。哪些患者会从中受益,哪些又会受到伤害?病历将如何改变基于当面交流的医患关系?对保密性和隐私权又会有什么样的影响?And the project presents difficult choices for those who argue for parity between medical and mental health patients. Should patients with schizophrenia, for example, who may stop taking their medication after ing that they are doing well, have the same access to treatment notes as those with irritable bowel syndrome?该项目也让主张同等对待内科和心理疾病患者的人面临艰难的抉择。举例来说,精神分裂症患者如果读到关于自己的病情正在好转的内容,或许会停止用药,他们也该和肠易激综合征患者享有同等的查阅诊疗记录的机会吗?But the lingering underlying question is, do patients really want to know what their therapists think? Dr. Kenneth Duckworth, who is the medical director of the National Alliance on Mental Illness, an advocacy group, said: ;I#39;ve offered to share my notes with patients and they#39;ll say, #39;No, I#39;m good.#39; But it#39;s a good concept that should be researched.;在人们脑海中徘徊的根本问题则是,患者真的想知道他们的治疗师是怎么想的吗?倡导组织“全国心理疾病联盟”(National Alliance on Mental Illness)的医务主任肯尼思·达克沃斯(Kenneth Duckworth)士表示:“我已经表示愿意和病人分享我做的记录,而他们会说#39;不用了#39;。但它是一个值得研究的好想法。”The practice is so new that it is too early for a comprehensive evaluation. The Department of Veterans Affairs, which began making medical and mental health records available online last year, is only just beginning to study the effect on mental health patients.这种做法非常新颖,对其加以综合性评估还为时尚早。去年着手把内科和心理疾病病历放在网上以便查阅的退伍军人事务部(Department of Veterans Affairs),也不过刚刚开始研究该做法对心理疾病患者的影响。Older studies from psychiatric wards where patients charts with doctors found that the patients were confused or offended by the content. But as doctors helped interpret their notes, patients began participating more in their care and trusting their team.此前有人研究过心理病房的患者与医生共同阅读病历的情形,其结果表明:一些内容会让患者感到困惑和受了冒犯,但在医生帮忙加以解释后,患者开始更多地参与治疗,也更信任他们的治疗团队。Although Beth Israel therapists report that some patients have no interest in ing their notes, responses from a few have been positive and powerful.尽管以色列堂-女执事医疗中心的治疗师表示,某些患者没兴趣阅读病历,但还是有患者做出了积极的、强烈的响应。Stacey Whiteman, 52, a former executive secretary in Needham with multiple sclerosis, faces growing cognitive as well as physical difficulties. The disease has shaken her self-image and relationships; her psychological health affects her willingness to manage the disease. She finds that her medical and mental health notes complement each other.尼德汉姆(Needham)公司前行政秘书斯泰西·怀特曼(Stacey Whiteman)患有多发性动脉硬化症,面临着身体和认知上的双重问题。这种疾病损害了她的自我形象和人际关系;糟糕的心理健康状况影响了她控制病情的意愿。她发现,内科和心理疾病病历是互为补充的。;Yes, the therapy notes can be hard to , and sometimes I wonder, #39;Really, I said all of that?#39; ; she said. ;But there#39;s no question that ing this stuff just charges you back up to moving forward.;“不错,诊疗记录可能很难读,有时候我会怀疑,#39;我真的说过这些话吗?#39;”她说,“但毫无疑问,阅读这些东西可以督促你继续接受治疗。”While such a program may be feasible in larger systems like Beth Israel, a Harvard hospital, some solo practitioners fear it may require too much time and technological sophistication.以色列堂-女执事医疗中心是哈佛大学的一所附属医院。在此类规模较大的机构里,这样一个项目或许是可行的。但有些个体从业者担心它太耗费时间,在技术上太过复杂。But Peggy Kriss, a psychologist in Newton, is an early adopter. For over a year she has maintained a website with private pages for patients on which she posts session notes, as well as articles, s and meditations.不过,牛顿市的心理学家佩吉·克里斯(Peggy Kriss)是一位先行者。一年多来,她一直在维护一个由务于患者的私人网页构成的网站。除了会谈记录,她还会在上边发布文章、视频以及自己的一些思考。Toward the end of each session, she and the patient begin the note together defining the key points that have been raised.每次治疗结束前,她会和病人一起着手整理会谈记录的内容,厘清此前提到的重点问题。Dr. Kriss said that for most of her patients, online notes have become the new normal. One described them to her as a security blanket between appointments.克里斯医生称,对她的大多数患者而言,线上记录已经成了一种新的常态。一位病人将其形容为两次会谈间隙的慰藉。Some write replies. ;An O.C.D. patient told me I was spelling things wrong,; Dr. Kriss said. ;So I said, #39;I#39;m just modeling anti-perfectionism for you.#39; ;有些患者会回帖。“一位强迫症患者告诉我,我犯了些拼写错误,”克里斯医生说,“于是我回应道,#39;我只是在为你示范什么叫反完美主义。#39;”The Beth Israel project grew out of OpenNotes, a program by Dr. Delbanco and his colleagues that made physicians#39; notes accessible to 22,000 patients at three institutions. A 2011 study showed that patients responded positively and became more involved in their care.以色列堂-女执事医疗中心的项目脱胎于由德尔班科士及其同事发起的“公开病历”(OpenNotes)计划。该计划让三家医疗机构的2.2万名患者得以查阅医生做的记录。2011年的一份调查报告显示,患者们做出了积极的响应,开始对治疗更为投入。More systems are adopting the model. At least three million patients now have swift access to office visit notes, including observations and recommendations.更多的医疗机构正在采用这种模式。眼下,至少有300万名患者可以便捷地查阅包括医生意见和建议在内的门诊病历。But even those institutions have hesitated to share mental health notes. Critics have raised concerns about whether ing notes could prompt anxiety and even rejection of treatment. What will happen if the patient posts the notes on Facebook, inviting comment?但即便是这些机构,也不愿贸然与心理疾病患者分享病历。批评者担心的是,阅读病历是否有可能让患者感到焦虑,进而抗拒治疗。要是患者把病历放在Facebook上,请人发表看法,又会发生什么事呢?Proponents of access point out that such notes, which include extensive diagnostic reports, are aly available to other doctors and to insurers.主张允许心理疾病患者查询病历——包括大量诊断报告在内——的人士指出,这类病历已经对其他医生以及保险商开放了。Although patients have long had the right to their records, the process to obtain copies can be protracted. If a doctor thinks that ing notes would be harmful to the patient or others, they can be withheld.尽管长期以来患者一直有权获得病历的复印件,但相关程序可能拖拖拉拉。如果医生认为阅读病历会对患者或其他人造成伤害,则可能拒绝提供病历。Mindful of such pitfalls, the Beth Israel psychiatrists have offered notes initially to only 10 percent of patients. Clinical social workers are making notes more widely available, though some therapists have temporarily opted out. Nina Douglass, a social worker in the ob-gyn clinic, worries about patients with abusive partners. If the abuser insisted on ing the notes, the patient could be in danger.考虑到此类潜在的困难,以色列堂-女执事医疗中心的心理医生初步只向10%的患者提供了病历。临床社工们正把病历提供给更多患者,但一些治疗师暂时选择了退出。妇科门诊部的社工尼娜·道格拉斯(Nina Douglass)担心,有些患者的伴侣言语恶毒。如果这样的人坚持要阅读病历,可能会将患者置于险境。;I can imagine that our work can be deepened and enhanced through people ing their notes,; Ms. Douglass said. ;But one size doesn#39;t fit all.;“可以想见,通过让病人阅读他们的病历,我们的工作能得到深化和加强,”道格拉斯说,“但不能搞#39;一刀切#39;。”Mental health notes have very different ers: the therapist, who may use them as a memory prompt; other doctors treating the patient; insurers; and now the patient. Writing a note with necessary information for all can be daunting.心理疾病病历有各种各样的读者:把病历当成记事本来用的治疗师;治疗该病人的其他医生;保险商;现在又多出了患者本人。书写一份包含各方所需信息的病历可能是一项艰巨的任务。Mr. O#39;Neill, the social work manager, is pressing therapists to use straightforward descriptions. ;I used #39;affect dysregulation,#39; and a patient said, #39;What on earth is that? Are you saying I#39;m totally crazy?#39; ; he said. ;It just means they can get upset. So why not use the word #39;upset#39;?;身为社会工作管理者的奥尼尔一直在敦促治疗师们使用简单易懂的措辞。“有一次我用了#39;情绪失调#39;,一个病人问道:#39;这究竟是什么东西?你的意思是我完全疯掉了?#39;”他说,“其实它只不过意味着患者可能会感到沮丧。那么何不就用#39;沮丧#39;这个词呢?”Some psychiatrists disagree.一些心理医生对此各持己见。;Diagnostic language is used among doctors to describe features of a mental illness,; said Dr. Brian K. Clinton, an assistant professor at Columbia University Medical Center who has written about sharing records. ;I would be willing to discuss with a patient what I think. It#39;s a better way to communicate than a note I wrote for other doctors.;“诊断用语是医生群体用来描述心理疾病特征的工具。”以病历分享为题写过文章的哥伦比亚大学医学中心(Columbia University Medical Center)助理教授布莱恩·K·克林顿(Brian K. Clinton)士表示,“我愿意和患者讨论我的想法。比起让患者阅读我写给其他医生看的病历,这种交流方式更好一些。”But Dr. Michael W. Kahn, an assistant professor of psychiatry at Harvard Medical School who wrote about the project in JAMA, said that if the therapist explained the diagnosis, some patients might feel relieved, knowing their behavior fits a pattern that others also experience.但在美国医学会杂志(JAMA)上撰文探讨过该项目的哈佛大学医学院(Harvard Medical School )心理学助理教授迈克尔·W·卡恩(Michael W. Kahn)士说,如果治疗师对诊断加以解释,一些患者或许会感到如释重负,因为了解到其他一些人有着跟他们雷同的行为模式。Dr. Glen O. Gabbard, a psychiatrist and professor at Baylor College of Medicine, said that opening notes to patients might have a chilling effect on doctors.贝勒医学院(Baylor College of Medicine)的心理医生及教授格伦·O· 加巴德(Glen O. Gabbard)士称,向患者公开病历,可能会让医生不愿表达看法。;A psychiatrist would be less likely to put down anything he is musing about as diagnostic possibilities or write about what he feels the patient is leaving out,; he said.他说,“心理医生不太可能像从前那样,写下他所考虑到的一切诊断可能性,或者写下他觉得患者并未和盘托出的一些事情。”Mr. Baldwin#39;s longtime friends know about his harrowing battles with mental illness: The hospitalizations. The manic episodes. The depression. The anxiety so crippling that two years ago, at a Costco parking lot, he couldn#39;t get out of the car.鲍德温的老朋友们都知道他和心理疾病作战的惨痛经历:住院治疗;躁狂发作;抑郁;以及极具破坏力的焦虑——两年前,他甚至在好市多(Costco)的停车场里无法下车。As he withdrew into his apartment, pints of ice cream, Zoey, and the telephone became his constant companions. During the worst sieges of anxiety, he would call a few friends three, four times a day.他曾蜷缩在公寓里,成天与冰淇淋、佐伊和电话为伴。压力最大的那些日子,他每天要给少数几个朋友打三四个电话。That is the man they recall, he recounted in his freshly tidied apartment. Its décor is hopeful: a multicolored rug, violet curtains, a jaunty lime-green wall.这就是他们记忆中的那个男人——他在刚刚整理过的公寓里讲述着自己的经历。公寓内部的装潢给人以充满希望之感:地毯五缤纷,窗帘是紫色的,墙壁是生机勃勃的浅绿色。And so is Mr. Baldwin. He is trying to lose weight, maybe someday have a new man in his life.鲍德温本人也是如此。他正努力减肥,期盼着有一天或许会在生活中迎来一个崭新的自己。He clicked open another therapy note.他点开了另一份诊疗记录。Mr. Baldwin ;is continuing to try to push himself to get out more and to be more socially connected even while his emotions tell him to do the opposite,; Mr. O#39;Neill wrote, adding that his patient is ;clearly making good, and even courageous, efforts on a number of fronts.;“鲍德温仍在竭力敦促自己更多地走出去,更多地跟他人交往,尽管从情感上来说,他更愿意反其道而行之,”奥尼尔如此写道。他还说,他的病人“显然正虔诚地,甚至可以说是勇敢地做着多方面的努力。”Mr. Baldwin, who celebrated his birthday recently with a museum lecture, movie and dinner, flushed with pride.不久前刚以去物馆听讲座、看电影、吃大餐的方式庆祝了的生日鲍德温,因为自豪而涨红了脸颊。;I#39;m going to email this to my friends,; he said.“我要把这些话用邮件发给朋友们,”他说。 /201410/338016

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