Caring for survivors of torture in an urban, municipal hospital.

Survivors of torture can present with multiple health consequences, both physical and psychological, which can persist even years after the abuse. The authors developed a multidisciplinary program in the primary care medical clinic of an urban municipal hospital in New York City serving an ethnically diverse population to provide multidisciplinary care to survivors of torture and their families.

Hook method of retrieving wire for fixation of osteotomies.

A device for easing retrieval of wire from acute angles of holes drilled in base wedge osteotomies, or any other osteotomy requiring wire fixation, is a Folio Ianiro Retriever. The Folio Ianiro Retriever modifies the way the wire is guided while reducing microtrauma to the bone and expediting the procedure. The use of the device is described with a discussion of the surgical procedure.

Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed?

OBJECTIVES: To measure the frequency of people reporting torture among patients in a medical outpatient clinic and to determine primary care physicians' awareness of their patients' exposure to torture. DESIGN: Cross-sectional survey followed by selected in-depth interviews of participants reporting a history of torture. Medical record review and interview of torture survivors' primary care physicians. SETTING: The internal medicine clinic of a large, urban medical center. PARTICIPANTS: A convenience sample of 121 adult patients who were not born in the United States and who were attending the adult ambulatory care clinic. INTERVENTIONS: All participants were interviewed using the Detection of Torture Survivors Survey, a validated instrument that asks about exposure to torture according to the World Medical Association definition of torture. Participants who reported a history of torture were interviewed in depth to confirm that they had been tortured. We reviewed the medical records of participants who reported a history of torture and interviewed their primary care physicians. MAIN OUTCOME MEASURES: Self-reported history of torture. The awareness of primary care physicians of this history. RESULTS: Eight of 121 participants (6.6% [95% confidence interval: 3.1%-13.1%]) reported a history of torture. None of the survivors of torture had been identified as such by their primary care physician. CONCLUSIONS: Physicians of patients who have not been born in the United States and who attend urban general medical clinics frequently are unaware that their patients are survivors of torture. Primary care physicians can be the locus of intervention in the care of torture survivors. The first step is for physicians to recognize the possibility of torture survivors among their patients.

Diabetic ketoacidosis in prisoners without access to insulin.

OBJECTIVE: To assess the cause and clinical severity of diabetic ketoacidosis in male prisoners hospitalized in New York City. DESIGN: Retrospective chart review. SETTING: A municipal hospital in New York City. PATIENTS: Forty-nine adult male prisoners with a total of 54 hospital admissions for diabetic ketoacidosis between January 1, 1989, and June 30, 1991. MAIN OUTCOME MEASURES: Charts were reviewed for diabetic and medical history, time from arrest until hospitalization, cause of diabetic ketoacidosis, admission laboratory data, and hospital course. RESULTS: Thirty-eight (70%) of the 54 admissions for diabetic ketoacidosis among prisoners occurred because prisoners had not received insulin during the period immediately following arrest (mean number of days from arrest until hospitalization was 2.5). All of these individuals had a history of insulin-dependent diabetes and were reportedly compliant with their insulin regimen at the time of arrest. Admission laboratory data for this group of prisoners included a mean serum glucose level of 27.4 mmol/L (495 mg/dL) and a mean serum bicarbonate level of 14.4 mmol/L. Mean number of days in the hospital was 3.4 including a mean of 1 day in an intensive care unit. CONCLUSIONS: Inadequate access to medication results in serious sequelae for recently arrested prisoners in New York City with insulin-dependent diabetes. Access to health care for recently arrested prisoners needs to be improved.

A population-based assessment of human rights abuses committed against ethnic Albanian refugees from Kosovo.

OBJECTIVES: This study assessed patterns of displacement and human rights abuses among Kosovar refugees in Macedonia and Albania. METHODS: Between April 19 and May 3, 1999, 1180 ethnic Albanian refugees living in 31 refugee camps and collective centers in Macedonia and Albania were interviewed. RESULTS: The majority (68%) of participants reported that their families were directly expelled from their homes by Serb forces. Overall, 50% of participants saw Serb police or soldiers burning the houses of others, 16% saw Serb police or soldiers burn their own home, and 14% witnessed Serb police or soldiers killing someone. Large percentages of participants saw destroyed mosques, schools, or medical facilities. Thirty-one percent of respondents reported human rights abuses committed against their household members, including beatings, killings, torture, forced separation and disappearances, gunshot wounds, and sexual assault. CONCLUSIONS: The present findings confirm that Serb forces engaged in a systematic and brutal campaign to forcibly expel the ethnic Albanian population of Kosovo. In the course of these mass deportations, Serb forces committed widespread abuses of human rights against ethnic Albanians.