Sondra S. Crosby

Acute Human Immunodeficiency Virus Infection in Patients Presenting to an Urban Urgent Care Center

Acute infection with human immunodeficiency virus (HIV) is often accompanied by a flu-like illness, and early identification and treatment may help control the infection and prevent transmission. We enrolled patients who presented to an urban urgent care center with any symptoms of a viral illness and any recent potential risk for HIV infection, and we tested them for acute HIV infection using enzyme-linked immunosorbent and RNA assays. Of 499 patients enrolled over a 1-year period, acute HIV infection was diagnosed in 5 (1.0%; 95% confidence interval [CI], 0.1%-1.9%), and chronic HIV infection was diagnosed in 6 (1.2%; 95% CI, 0.2%-2.2%). There were no false-positive results of the RNA assay. No signs or symptoms reliably distinguished patients with acute HIV infection from those who were HIV uninfected. Given the importance of this diagnosis, testing for acute HIV infection using RNA and antibody assays should be offered to all patients in similar settings with viral symptoms and any risk factors for HIV infection.

Prevalence of torture survivors among foreign-born patients presenting to an urban ambulatory care practice

AbstractBACKGROUND: The prevalence of torture among foreign-born patients presenting to urban medical clinics is not well documented. OBJECTIVE: To determine the prevalence of torture among foreign-born patients presenting to an urban primary care practice. DESIGN: A survey of foreign-born patients. PATIENTS: Foreign-born patients, age ≥ 18, presenting to the Primary Care Clinic at Boston Medical Center. MEASUREMENTS: Self-reported history of torture as defined by the UN, and history of prior disclosure of torture. RESULTS: Of the 308 eligible patients, 88 (29%) declined participation, and 78 (25%) were not included owing to lack of a translator. Par ticipants had a mean age of 47 years (range 19 to 76), were mostly female (82/142, 58%), had been in the United States for an average of 14 years (range 1 month to 53 years), and came from 35 countries. Fully, 11% (16/142, 95 percent confidence interval 7% to 18%) of participants reported a history of torture that was consistent with the UN definition of torture. Thirty-nine percent (9/23) of patients reported that their health care provider asked them about torture. While most patients (15/23, 67%) reported discussing their experience of torture with someone in the United States, 8 of 23 (33%) reported that this survey was their first disclosure to anyone in the United States. CONCLUSION: Among foreign-born patients presenting to an urban primary care center, approximately 1 in 9 met the definition established by the UN Convention Against Torture. As survivors of torture may have significant psychological and physical sequelae, these data underscore the necessity for primary care physicians to screen for a torture history among foreign-born patients.

Primary Care Management of Non–English-Speaking Refugees Who Have Experienced Trauma: A Clinical Review

IMPORTANCE Refugees are a vulnerable class of immigrants who have fled their countries, typically following war, violence, or natural disaster, and who have frequently experienced trauma. In primary care, engaging refugees to develop a positive therapeutic relationship is challenging. Relative to care of other primary care patients, there are important differences in symptom evaluation and developing treatment plans. OBJECTIVES To discuss the importance of and methods for obtaining refugee trauma histories, to recognize the psychological and physical manifestations of trauma characteristic of refugees, and to explore how cultural differences and limited English proficiency affect the refugee patient-clinician relationship and how to best use interpreters. EVIDENCE REVIEW MEDLINE and the Cochrane Library were searched from 1984 to 2012. Additional citations were obtained from lists of references from select research and review articles on this topic. FINDINGS Engagement with a refugee patient who has experienced trauma requires an understanding of the trauma history and the trauma-related symptoms. Mental health symptoms and chronic pain are commonly experienced by refugee patients. Successful treatment requires a multidisciplinary approach that is culturally acceptable to the refugee. CONCLUSIONS AND RELEVANCE Refugee patients frequently have experienced trauma requiring a directed history and physical examination, facilitated by an interpreter if necessary. Intervention should be sensitive to the refugees cultural mores.

Guantanamo Bay: A Medical Ethics–free Zone?

U.S. physicians have not widely criticized medical policies at Guantanamo. But force-feeding mentally competent hunger strikers violates medical ethics, and such actions taken by military physicians on behalf of the government devalue medical ethics for all physicians.

Post-9/11 torture at CIA "black sites"--physicians and lawyers working together

According to the U.S. Senate Intelligence Committee, medical professionals at secret CIA prisons cleared terrorist suspects for torture, monitored torture to prevent death and treat injuries, developed novel torture methods, and tortured prisoners.

Medical Evidence of Human Rights Violations against Non-Arabic-Speaking Civilians in Darfur: A Cross-Sectional Study

Alexander Tsai and colleagues review medical records from the Amel Centre, Sudan, to assess consistency between recorded medical evidence and patient reports of human rights violations by the Government of Sudan and Janjaweed forces.

Head and neck sequelae of torture

To increase awareness of torture among otolaryngologists, and to describe methods and complications of head and neck torture.

Torture and Public Health

Historically, the practice of torture focused on the dyad of the torturer and his or her victim in the quest to obtain information. In the past few decades it has become clear that the impact of torture is far beyond the individual and includes society as a whole. The practice of torture is an attempt to instill fear in the community, not merely to oppress a single individual, and as such, the public health impact of torture is far reaching. In response to increasing recognition of torture as a public health problem, a field of research is evolving which seeks how best to help survivors. International law has also provided mechanisms to hold perpetrators accountable. However, the ultimate human rights and public health goal is to prevent torture from occurring at all.

Force feeding at Guantanamo in first case brought to US federal court

Kalk reported how South African doctors complied with ethical requirements outlined in the World Medical Association’s Declaration of Malta while caring for patients on hunger strike.1 2 Their refusal to forcibly feed patients starkly contrasts with the practices of military doctors and other health professionals at Guantanamo Bay. Despite more than 10 years of controversy around hunger strikes at Guantanamo Bay, Abu Wa’el Dhiab was the first to bring …

Learning from UJAMBO: Perspectives on Gynecologic Care in African Immigrant and Refugee Women in Boston, Massachusetts

African-born immigrant women, and particularly refugees and asylum seekers, are at risk for reproductive health disparities but inadequately use relevant gynecologic services. We sought to elucidate perspectives on gynecologic care in a population of Congolese and Somali immigrants. We conducted a secondary qualitative analysis of focus group data using a grounded theory approach and the Integrated Behavioral Model as our theoretical framework. Thirty one women participated in six focus groups. Participant beliefs included the states of pregnancy and/or pain as triggers for care, preferences included having female providers and those with familiarity with female genital cutting. Barriers included stigma, lack of partner support, and lack of resources to access care. Experiential attitudes, normative beliefs, and environmental constraints significantly mediated care preferences for/barriers to gynecologic health service utilization in this population. Centering of patient perspectives to adapt delivery of gynecologic care to immigrants and refugees may improve utilization and reduce disparities.