Allen S Keller, M.D.

Bad Science Used to Support Torture and Human Experimentation
Iacopino, Vincent; Allen, Scott A.; Keller, Allen S.
2011 JAN 7 ;331(6013):-, Science
— id: 121338, year: 2011, vol: 331, page: , stat: Journal Article,

Screening for torture: A narrative checklist comparing legal definitions in a torture treatment clinic
Rasmussen, Andrew; Crager, Mia; Keatley, Eva; Keller, Allen S; Rosenfeld, Barry
2011 ;219(3):143-149, Zeitschrift fur Psychologie = Journal of psychology
Torture has been defined most precisely in legal contexts. Practitioners who work with torture survivors and researchers who study torture have frequently cited legal definitions, particularly those in the United States' Torture Victims Relief Act, the United Nations Convention against Torture, or the World Medical Association's Declaration of Tokyo. Few practitioners have operationalized these definitions and applied them in their practice. We describe how a New York City torture treatment clinic used a coding checklist that operationalizes the definitions, and present results. We found that in practice these definitions were nested; that using guidelines for applying the definitions in practice altered the number of cases meeting criteria for these definitions; and that the severity of psychological symptoms did not differ between those who were tortured and those who were not under any definition. We propose theoretical and practical implications of these findings.
— id: 139069, year: 2011, vol: 219, page: 143, stat: Journal Article,

Posttraumatic idioms of distress among Darfur refugees: Hozun and Majnun
Rasmussen, Andrew; Katoni, Basila; Keller, Allen S; Wilkinson, John
2011 Sep;48(4):392-415, Transcultural Psychiatry
Although psychosocial programming is seen as essential to the humanitarian response to the Darfur conflict, aid groups lack culturally-appropriate assessment instruments for monitoring and evaluation. The current study used an emic-etic integrated approach to: (i) create a culturally-appropriate measure of distress (Study 1), and (ii) test the measure in structured interviews of 848 Darfuris living in two refugee camps in Chad (Study 2). Traditional healers identified two trauma-related idioms, hozun and majnun, which shared features with but were not identical to posttraumatic stress disorder and depression. Measures of these constructs were reliable and correlated with trauma, loss, and functional impairment. Exploratory factor analysis resulted in empirical symptom clusters conceptually parallel to general Western psychiatric constructs. Findings are discussed in terms of their implications for psychosocial programming
— id: 137454, year: 2011, vol: 48, page: 392, stat: Journal Article,

Medical advocacy on behalf of detained immigrants
Venters, Homer D; Foote, Mary; Keller, Allen S
2011 ;13(3):625- 628, Journal of Immigrant Health
Detention of immigrants by Immigration and Customs Enforcement (ICE) is a rapidly growing form of incarceration in the U.S. with almost 400,000 people detained in 2008 (Schriro in Immigration and Customs Enforcement, 2009, http://www.ice.gov/doclib/091005_ice_detention_report-final.pdf ). ICE detainees are predominantly from Mexico and Latin America and only a small minority of detainees are asylum seekers. Immigrant detainees lack a legal guarantee of medical care (unlike criminal arrestees and prisoners) and face challenges in receiving medical care, particularly those with chronic medical conditions (Venters and Keller in J Health Care Poor Underserved 20:951-957, 2009). Although we and others have long been involved in advocating for detained asylum seekers, few resources are dedicated to medical advocacy for the broader population of ICE detainees. At the NYU Center for Health and Human Rights (CHHR), a program of medical advocacy was initiated in 2007 on behalf of ICE detainees focused on improvement of care in detention and medical parole. Our preliminary efforts reveal a pressing need for more involvement by physicians and other health advocates in this area.
— id: 140418, year: 2011, vol: 13, page: 625, stat: Journal Article,

Medical advocacy on behalf of detained immigrants
Venters, Homer D; Foote, Mary; Keller, Allen S
2011 Jun;13(3):625-628, Journal of Immigrant & Minority Health
Detention of immigrants by Immigration and Customs Enforcement (ICE) is a rapidly growing form of incarceration in the U.S. with almost 400,000 people detained in 2008 (Schriro in Immigration and Customs Enforcement, 2009, http://www.ice.gov/doclib/091005_ice_detention_report-final.pdf ). ICE detainees are predominantly from Mexico and Latin America and only a small minority of detainees are asylum seekers. Immigrant detainees lack a legal guarantee of medical care (unlike criminal arrestees and prisoners) and face challenges in receiving medical care, particularly those with chronic medical conditions (Venters and Keller in J Health Care Poor Underserved 20:951-957, 2009). Although we and others have long been involved in advocating for detained asylum seekers, few resources are dedicated to medical advocacy for the broader population of ICE detainees. At the NYU Center for Health and Human Rights (CHHR), a program of medical advocacy was initiated in 2007 on behalf of ICE detainees focused on improvement of care in detention and medical parole. Our preliminary efforts reveal a pressing need for more involvement by physicians and other health advocates in this area
— id: 132305, year: 2011, vol: 13, page: 625, stat: Journal Article,

Resilience in trauma-exposed refugees: the moderating effect of coping style on resilience variables
Hooberman, Joshua; Rosenfeld, Barry; Rasmussen, Andrew; Keller, Allen
2010 Oct;80(4):557-63, American journal of orthopsychiatry
Research with survivors of torture has generated considerable variability in prevalence rates of posttraumatic stress disorder (PTSD). Multiple risk and resilience factors may affect this variability, increasing or decreasing the likelihood of experiencing psychological distress. This study sought to investigate the effect of several such resilience factors, coping style, social support, cognitive appraisals, and social comparisons on PTSD symptom severity. Furthermore, this study examined whether coping style moderated the relationship between resilience variables and PTSD symptoms. Seventy-five torture survivors completed an intake interview and several self-report measures upon entry into a treatment program for survivors of torture. Results indicated that emotion-focused coping styles significantly moderated the relationship between cognitive appraisal and social comparison variables and PTSD, and usually increased the likelihood of developing severe symptoms. These results indicate that the salience of resilience variables may differ depending on the individual's coping style, which present implications for clinical practice with torture survivors
— id: 113950, year: 2010, vol: 80, page: 557, stat: Journal Article,

Rates and impact of trauma and current stressors among Darfuri refugees in Eastern Chad
Rasmussen, Andrew; Nguyen, Leanh; Wilkinson, John; Vundla, Sikhumbuzo; Raghavan, Sumithra; Miller, Kenneth E; Keller, Allen S
2010 Apr;80(2):227-236, American journal of orthopsychiatry
Darfur refugees face hardships associated with chronic displacement, including lack of basic needs and safety concerns. Psychiatric research on refugees has focused on trauma, but daily stressors may contribute more to variance in distress. This article reports rates of past trauma and current stressors among Darfur refugees and gauges the contribution of each to psychological distress and functional impairment. A representative sample of 848 Darfuris in 2 refugee camps were interviewed about traumatic events, stressors faced in the camps, psychological distress, and functional impairment. Basic needs and safety concerns were more strongly correlated with measures of distress (rs = .19-.31) than were war-related traumatic events (rs = .09-.20). Hierarchical regression supported models in which effects of trauma on distress were mediated by current stressors. Although war-related traumatic events are the initial causes of refugees' hardship, findings suggest that the day-to-day challenges and concerns in camps mediate psychological distress associated with these events
— id: 110083, year: 2010, vol: 80, page: 227, stat: Journal Article,

The immigration detention health plan: an acute care model for a chronic care population
Venters, Homer D; Keller, Allen S
2009 ;20(4):951-957, Journal of health care for the poor & underserved
Immigration detention is the fastest-growing form of incarceration in the U.S. Numerous reports by advocacy groups and detainees themselves have alleged substandard medical care for detainees. We have undertaken an analysis of the health plan that regulates reimbursement of much of detainee health care. We conclude that this plan may place detainees at risk of receiving inadequate care, particularly if they have chronic medical problems or would benefit from routine health screening exams. We present several concrete measures that could immediately improve the level of medical care afforded to this vulnerable population
— id: 111659, year: 2009, vol: 20, page: 951, stat: Journal Article,

HIV screening and care for immigration detainees
Venters, Homer D; McNeely, Jennifer; Keller, Allen S
2009 ;11(2):89-100, Health & human rights
The detention of immigrants in the United States is a rapidly expanding endeavor with serious health consequences for the detainees. This detainee population represents non-criminal immigrants who are detained because of a visa violation or other immigration issue but who are not charged with any crime and do not enter the criminal justice system. HIV-positive detainees are especially vulnerable to lapses in proper medical care, and press reports have highlighted deaths and adverse medical outcomes among HIV-positive detainees. We have examined reports on detainee health issues published by numerous groups and conducted our own analysis of the health plan used to govern much of the specialty care for detainees who are HIV positive. We conclude that the system of immigration detention in the US fails to adequately screen detainees for HIV and delivers a substandard level of medical care to those with HIV. We provide several specific recommendations for improving screening and medical care among this highly vulnerable population
— id: 112554, year: 2009, vol: 11, page: 89, stat: Journal Article,

Health and human rights under assault in Zimbabwe
Keller, Allen S; Stewart, Samantha A; Eppel, Shari
2008 Mar 29;371(9618):1057-1058, Lancet
— id: 78694, year: 2008, vol: 371, page: 1057, stat: Journal Article,

Entering exile: trauma, mental health, and coping among Tibetan refugees arriving in Dharamsala, India
Sachs, Emily; Rosenfeld, Barry; Lhewa, Dechen; Rasmussen, Andrew; Keller, Allen
2008 Apr;21(2):199-208, Journal of traumatic stress
Each year thousands of Tibetans escape Chinese-controlled Tibet. The authors present findings on the experiences, coping strategies, and psychological distress (depression, anxiety, somatization, and posttraumatic stress disorder) of 769 Tibetan refugees arriving in Dharamsala, India (2003-2004). Distress increased significantly with greater trauma exposure. However, despite a high prevalence of potentially traumatizing events, levels of psychological distress were extremely low. Coping activity (primarily religious) and subjective appraisals of trauma severity appeared to mediate the psychological effects of trauma exposure. The potential impact of other variables, including culturally determined attitudes about trauma and timing of assessment, are discussed
— id: 145552, year: 2008, vol: 21, page: 199, stat: Journal Article,

Classifying the torture experiences of refugees living in the United States
Hooberman, Joshua B; Rosenfeld, Barry; Lhewa, Dechen; Rasmussen, Andrew; Keller, Allen
2007 Jan;22(1):108-123, Journal of Interpersonal Violence
Few research studies have systematically categorized the types of torture experienced around the world. The purpose of this study is to categorize the diverse traumatic events that are defined as torture, and determine how these torture types relate to demographics and symptom presentation. Data for 325 individuals were obtained through a retrospective review of records from the Bellevue/NYU for Survivors of Torture. A factor analysis generated a model with five factors corresponding to witnessing torture of others, torture of family members, physical beating, rape/sexual assault, and deprivation/passive torture. These factors were significantly correlated with a number of demographic variables (sex, education, and region of origin). Post Traumatic Stress Disorder, anxiety, and depression symptoms were significantly correlated with the rape factor but no other factors were uniquely associated with psychological distress. The results offer insight into the nature of torture and differences in responses
— id: 114893, year: 2007, vol: 22, page: 108, stat: Journal Article,

Promoting professionalism through an online professional development portfolio: successes, joys, and frustrations
Kalet, Adina L; Sanger, Joseph; Chase, Julie; Keller, Allen; Schwartz, Mark D; Fishman, Miriam L; Garfall, Alfred L; Kitay, Alison
2007 Nov;82(11):1065-1072, Academic medicine
Medical educators strive to promote the development of a sound professional identity in learners, yet it is challenging to design, implement, and sustain fair and meaningful assessments of professionalism to accomplish this goal. The authors developed and implemented a program built around a Web-based Professional Development Portfolio (PDP) to assess and document professional development in medical students at New York University School of Medicine. This program requires students to regularly document their professional development through written reflections on curricular activities spanning preclinical and clinical years. Students post reflections, along with other documents that chronicle their professional growth, to their online PDP. Students meet annually with a faculty mentor to review their portfolios, assess their professional development based on predetermined criteria, and establish goals for the coming year. In this article, the authors describe the development of the PDP and share four years of experience with its implementation. We describe the experiences and attitudes of the first students to participate in this program as reported in an annual student survey. Students' experiences of and satisfaction with the PDP was varied. The PDP has been a catalyst for honest and lively debate concerning the meaning and behavioral manifestations of professionalism. A Web-based PDP promoted self-regulation on an individual level because it facilitated narrative reflection, self-assessment, and goal setting, and it structured mentorship. Therefore, the PDP may prepare students for the self-regulation of the medical profession--a privilege and obligation under the physician's social contract with society
— id: 75401, year: 2007, vol: 82, page: 1065, stat: Journal Article,

Validation of a Tibetan translation of the Hopkins Symptom Checklist 25 and the Harvard Trauma Questionnaire
Lhewa, Dechen; Banu, Sophia; Rosenfeld, Barry; Keller, Allen
2007 Sep;14(3):223-230, Assessment
This study sought to translate and validate the Hopkins Symptom Checklist-25 (HSCL) and the Harvard Trauma Questionnaire (HTQ) in a Tibetan population. Translated questionnaires were administered to 57 Tibetan survivors of torture/human rights abuses living in the United States and receiving services in a torture treatment program. Participants were evaluated to determine if they met criteria for major depressive episode, generalized anxiety disorder, or posttraumatic stress disorder (PTSD). Coefficient alpha for the HSCL Anxiety subscale (.89), Depression subscale (.92), and the HTQ (.89) were high. Diagnostic accuracy using receiver operating characteristic curve analysis generated good classification accuracy for anxiety (.89), depression (.92), and PTSD (.83). However, although sensitivity and specificity for HSCL subscales were quite high, the HTQ generated low sensitivity (.33), partly because of a low rate of PTSD. Results support the reliability and validity of the HSCL but suggest further study of the HTQ with this population is required
— id: 140336, year: 2007, vol: 14, page: 223, stat: Journal Article,

The effects of torture-related injuries on long-term psychological distress in a Punjabi Sikh sample
Rasmussen, Andrew; Rosenfeld, Barry; Reeves, Kim; Keller, Allen S
2007 Nov;116(4):734-740, Journal of abnormal psychology
Torture survivors often report chronic debilitating physical and psychological distress. Prior research on the relationship between physical and psychological trauma suggests that the 2 are not independent. Injury sustained during torture may increase the likelihood of subsequent distress as either a moderator or mediator. For long-term psychopathology in a sample of Punjabi Sikh survivors of human rights violations (N = 116), chronic injuries mediated the path between torture and posttraumatic stress disorder, specifically the severity of numbing symptoms. Although injuries were associated with major depression, torture was not, and injuries did not moderate the relationship between major depression and torture. Chronic injuries may represent trauma severity or persistent traumatic cues. These findings emphasize connections between physical and psychological trauma and the importance of an interdisciplinary approach to torture treatment
— id: 75460, year: 2007, vol: 116, page: 734, stat: Journal Article,

The subjective experience of trauma and subsequent PTSD in a sample of undocumented immigrants
Rasmussen, Andrew; Rosenfeld, Barry; Reeves, Kim; Keller, Allen S
2007 Feb;195(2):137-143, Journal of nervous & mental disease
Although a subjective component of trauma is commonly recognized in diagnosing posttraumatic stress disorder (PTSD), there are few studies that specifically address Criterion A2, and none addressing this issue among undocumented immigrants. We assessed 212 arriving undocumented immigrants with diverse trauma histories to investigate concordance between objective and subjective factors of trauma (Criteria A1 and A2) and across different types of trauma and PTSD. Concordance between Criteria A1 and A2 varied, with highest rates found for political violence. Interpersonal violence in general was associated with higher rates of PTSD. We identified a dose-response effect for PTSD, but this was not dependent on other events (i.e., other doses) meeting Criterion A2. Discussion focuses on Criterion A within the phenomenology of PTSD and the need to gauge subjective interpretations of trauma events among this population
— id: 72074, year: 2007, vol: 195, page: 137, stat: Journal Article,

Factor structure of PTSD symptoms among west and central African refugees
Rasmussen, Andrew; Smith, Hawthorne; Keller, Allen S
2007 Jun 27;20(3):271-280, Journal of traumatic stress
Although trauma is widespread in Africa, Africans are unrepresented in the literature on posttraumatic stress disorder (PTSD). The authors used confirmatory factor analysis of responses to the Harvard Trauma Questionnaire to model PTSD symptom structure in a sample of African refugees presenting at a U.S. torture treatment clinic. They tested four models that are proposed in the literature and one based on their clinical experience in which some symptoms of hyperarousal were integrated into intrusion. Their findings support a preference for a 4-factor aroused intrusion model. Discussion focuses on interpretation of models, the role of numbing and avoidance, and the limitations of Euro American symptoms in non-Euro American populations.
— id: 72982, year: 2007, vol: 20, page: 271, stat: Journal Article,

The ISTSS/Rand guidelines on mental health training of primary healthcare providers for trauma-exposed populations in conflict-affected countries
Eisenman, David; Weine, Stevan; Green, Bonnie; de Jong, Joop; Rayburn, Nadine; Ventevogel, Peter; Keller, Allen; Agani, Ferid
2006 Feb;19(1):5-17, Journal of traumatic stress
Mental health care for trauma-exposed populations in conflict-affected developing countries often is provided by primary healthcare providers (PHPs), including doctors, nurses, and lay health workers. The Task Force on International Trauma Training, through an initiative sponsored by the International Society for Traumatic Stress Studies and the RAND Corporation, has developed evidence- and consensus-based guidelines for the mental health training of PHPs in conflict-affected developing countries. This article presents the Guidelines, which provide a conceptual framework and specific principles for improving the quality of mental health training for PHPs working with trauma-exposed populations
— id: 68535, year: 2006, vol: 19, page: 5, stat: Journal Article,

Torture in Abu Ghraib
Keller, Allen S
2006 Autumn;49(4):553-569, Perspectives in biology & medicine
Iraqi detainees subjected to torture and mistreatment at Abu Ghraib prison may continue to suffer from significant physical and psychological consequences of their abuse. This article reports two cases of Iraqi individuals allegedly tortured at Abu Ghraib. Detailed forensic evaluations were conducted approximately one year after their abuse in accordance with international guidelines. The findings of these evaluations substantiate their allegations of torture and confirm the profound health consequences of torture. Furthermore, these cases support assertions that abuse of prisoners was not limited to being perpetrated by guards, but also occurred systematically in the context of interrogations. These cases also raise concerns about inadequate medical care for Iraqi detainees
— id: 70536, year: 2006, vol: 49, page: 553, stat: Journal Article,

Traumatic experiences and psychological distress in an urban refugee population seeking treatment services
Keller, Allen; Lhewa, Dechen; Rosenfeld, Barry; Sachs, Emily; Aladjem, Asher; Cohen, Ilene; Smith, Hawthorne; Porterfield, Katherine
2006 Mar;194(3):188-194, Journal of nervous & mental disease
While a growing literature has addressed the psychological consequences of torture and refugee trauma, most studies have focused on homogeneous samples drawn from a single region. Thus, relatively little research has attempted to identify demographic or experiential factors that might help explain different levels of distress in these individuals. We measured depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in a convenience sample of refugees and survivors of torture seeking treatment in a torture treatment program (N = 325). We found 81.1% of patients had clinically significant anxiety, 84.5% had clinically significant depressive symptoms, and 45.7% had significant PTSD symptoms. Regression analyses revealed that anxiety and depressive symptom were significant higher among women (beta = .08, p = 0.02 and beta = .22, p = 0.0001 for anxiety and depression respectively) and those who reported death threats as part of their traumatic experiences (beta = .10, p = 0.033 and beta = .12, p = 0.036 respectively). Symptoms of PTSD were also predicted by death threats (beta = .22, p = 0.03), but were also influenced by the experience of rape (beta = .33, p < 0.001), family torture experiences (beta = .23, p = 0.022), religion (beta = .21, p = 0.03), and age (beta = -.18, p = 0.004). The clinical implications of these results are discussed
— id: 63806, year: 2006, vol: 194, page: 188, stat: Journal Article,

STUDENTJAMA. Medical student care of indigent populations
Dodson, John A; Keller, Allen S
2004 Jan 7;291(1):121-121, JAMA
— id: 42624, year: 2004, vol: 291, page: 121, stat: Journal Article,

Assessment of torture and ill treatment of detainees in Mexico: attitudes and experiences of forensic physicians
Heisler, Michele; Moreno, Alejandro; DeMonner, Sonya; Keller, Allen; Iacopino, Vincent
2003 Apr 23-30;289(16):2135-2143, JAMA
CONTEXT: International and Mexican human rights organizations have documented torture of detainees (ie, those held and indicted but not sentenced) in all 31 states and the Federal District of Mexico, but little is known about the attitudes and experiences of forensic physicians examining detainees. OBJECTIVE: To assess forensic physicians' experiences with and attitudes toward the nature and extent of torture and ill treatment among detainees examined in the previous year. DESIGN, SETTING, AND PARTICIPANTS: With the support of the Mexican Office of the Federal Attorney General, as part of a larger initiative to implement governmental reforms to eradicate torture in Mexico, an anonymous, self-administered, written, 80-item survey designed to assess correspondence of physician practices and attitudes with international standards on forensic investigation and documentation of torture was distributed to all federal forensic physicians (n = 115) and a convenience sample of state forensic physicians (n = 99) in Mexico in 2002. MAIN OUTCOME MEASURES: Estimates of the numbers of federal detainees medically evaluated and numbers of cases of suspected, alleged, and documented torture or ill treatment among federal detainees; factors interfering with documentation of forensic evidence; physicians' attitudes toward torture; measures that would help them document torture; and recommendations for reform. RESULTS: Survey responses were received from 93 (81%) federal and 91 (92%) state forensic physicians. Forty-nine percent of federal physicians and 58% of state physicians reported that torture is a severe problem for detainees in Mexico. Federal physicians estimated that they had conducted 26 445 to 30 650 or more medical evaluations of the 13 000 federal detainees in the past year and that between 1658 and 4850 of these detainees had alleged torture; these physicians also estimated that they had documented evidence of torture in a range of 285 to 1090 cases. Forty percent of respondents had suspected torture and/or ill treatment of detainees examined during the previous year, 64% had examined detainees who alleged these practices had occurred, and 49% had documented forensic evidence of torture among these detainees. Respondents reported that lack of photographic equipment and services (58%), inadequate monitoring and accuracy of medical examinations (36%), inadequate documentation of torture (29%), limitations in their training (28%), fear of reprisals for documenting torture (23%), and fear of coercion by police officials (18%) are factors that interfere with documentation of torture and ill treatment of detainees. Respondents further reported the need for additional training (98%), standardized protocols and documentation procedures for use in cases of alleged or suspected torture and/or ill treatment (81%), and monitoring to ensure the quality and accuracy of medical evaluations (95%). CONCLUSIONS: Torture and ill treatment of detainees is a major problem in Mexico facilitated by multiple medical and legal factors. Mexican forensic physicians support measures to improve forensic documentation of torture and ill treatment of detainees
— id: 68536, year: 2003, vol: 289, page: 2135, stat: Journal Article,

The impact of detention on the health of asylum seekers
Keller, Allen S; Ford, Douglas; Sachs, Emily; Rosenfeld, Barry; Trinh-Shevrin, Chau; Meserve, Chris; Leviss, Jonathan A; Singer, Elizabeth; Smith, Hawthorne; Wilkinson, John; Kim, Glen; Allden, Kathleen; Rockline, Paul
2003 Oct-Dec;26(4):383-385, Journal of ambulatory care management
Asylum seekers arriving in the United States are often imprisoned for months or years while their asylum claims are processed. Recently, Physicians for Human Rights and the Bellevue/New York University Program for Survivors of Torture released the findings of the first systematic study examining the health of detained asylum seekers. The study found that the mental health of asylum seekers interviewed was extremely poor, including high levels of symptoms for anxiety, depression, and posttraumatic stress disorder, which worsened the longer individuals were in detention. The study also raises concerns about the manner in which asylum seekers are treated upon arrival in the United States and then while in detention. These findings support assertions that detention has a harmful effect on the health and well-being of asylum seekers. Policies regarding the long-term detention of asylum seekers should be reconsidered
— id: 46071, year: 2003, vol: 26, page: 383, stat: Journal Article,

Mental health of detained asylum seekers
Keller, Allen S; Rosenfeld, Barry; Trinh-Shevrin, Chau; Meserve, Chris; Sachs, Emily; Leviss, Jonathan A; Singer, Elizabeth; Smith, Hawthorne; Wilkinson, John; Kim, Glen; Allden, Kathleen; Ford, Douglas
2003 Dec 22;362(9397):1721-1723, Lancet
Asylum seekers arriving in the USA are likely to be held in detention for months or years pending adjudication of their asylum claims. We interviewed 70 asylum seekers detained in New York, New Jersey, and Pennsylvania. We used self-report questionnaires to assess symptoms of anxiety, depression, and post-traumatic stress disorder. At baseline, 54 (77%) participants had clinically significant symptoms of anxiety, 60 (86%) of depression, and 35 (50%) of post-traumatic stress disorder; all symptoms were significantly correlated with length of detention (p=0.004, 0.017, and 0.019, respectively). At follow-up, participants who had been released had marked reductions in all psychological symptoms, but those still detained were more distressed than at baseline. Our findings suggest detention of asylum seekers exacerbates psychological symptoms
— id: 46289, year: 2003, vol: 362, page: 1721, stat: Journal Article,

Documentation of torture and ill treatment in Mexico: A review of medical forensic investigations, 2000 and 2002
Moreno, A; Heisler, M; Keller, A; Iacopino, V
2003 APR ;18(3):233-233, Journal of general internal medicine
— id: 38491, year: 2003, vol: 18, page: 233, stat: Journal Article,

Why torture must not be sanctioned by the United States
Iacopino, Vincent; Keller, Allen; Oksenberg, Deborah
2002 May;176(3):148-149, Western journal of medicine
— id: 68537, year: 2002, vol: 176, page: 148, stat: Journal Article,

Psychological morbidity and perceived access to health care among detained asylum seekers
Keller, A; Meserve, C; Trinh, C; Ford, D; Leviss, J; Kim, G; Rosenfeld, B
2002 Apr;17(5):162-162, Journal of general internal medicine
— id: 27450, year: 2002, vol: 17, page: 162, stat: Journal Article,

Caring and advocating for victims of torture
Keller, Allen S
2002 Dec;360 Suppl(1):s55-s56, Lancet
— id: 36946, year: 2002, vol: 360 Suppl, page: s55, stat: Journal Article,

A population-based assessment of human rights abuses committed against ethnic Albanian refugees from Kosovo
Iacopino V; Frank MW; Bauer HM; Keller AS; Fink SL; Ford D; Pallin DJ; Waldman R
2001 Dec;91(12):2013-2018, American journal of public health. AJPH
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
— id: 36947, year: 2001, vol: 91, page: 2013, stat: Journal Article,

Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed?
Eisenman DP; Keller AS; Kim G
2000 May;172(5):301-304, Western journal of medicine
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
— id: 36948, year: 2000, vol: 172, page: 301, stat: Journal Article,

Caring for survivors of torture in an urban, municipal hospital
Keller AS; Saul JM; Eisenman DP
1998 Apr;21(2):20-29, Journal of ambulatory care management
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
— id: 12158, year: 1998, vol: 21, page: 20, stat: Journal Article,

Long-term evaluation of patients undergoing immediate mandibular reconstruction
Heller, K S; Dubner, S; Keller, A
1995 Nov;170(5):517-520, American journal of surgery
BACKGROUND: Immediate reconstruction following segmental mandibulectomy is an accepted surgical technique. The benefits and patient selection criteria need to be established. PATIENTS AND METHODS: Forty-seven patients who underwent immediate reconstruction of the mandible were followed for up to 14 years. Survival, complication rates, and functional results were analyzed. RESULTS: Median survival was 39 months and actuarial 5-year survival was 40%. Two patients died in the postoperative period, and 9 suffered major reconstruction-related complications. The majority of these complications were related to the use of reconstruction plates, and occurred when the mandibular defect included the arch or when the plates were covered by pectoralis flaps. Half of the patients interviewed were able to eat a regular diet. CONCLUSIONS: Mandibular reconstruction can be performed safely and expeditiously in nearly all patients undergoing segmental mandibulectomy. Functional results and long-term survival will be acceptable in many cases
— id: 71356, year: 1995, vol: 170, page: 517, stat: Journal Article,

Human Rights Education for Cambodian Health Professionals
Keller AS; Horn SK; Sopheap S; Otterman G
1995 ;1(3):256-271, Health & human rights
Health professionals have an essential role to play in protecting human rights. Beginning in April 1993, a team of Cambodians and international staff with health and human rights backgrounds developed a program to teach human rights to health professionals in Cambodia, a country with a long history of human rights abuses. In implementing this program, the team developed a 20-hour curriculum and an accompanying syllabus both in Khmer, the Cambodian language, and in English, providing an overview of human rights and a focus on the special role of health professionals in protecting human rights. Over 3,000 Cambodian health professionals received human rights training during the project's first year. This broadly based human rights education program for health professionals can serve as a model to be used in other countries
— id: 11995, year: 1995, vol: 1, page: 256, stat: Journal Article,

The medical and social consequences of land mines in Cambodia
Stover E; Keller AS; Cobey J; Sopheap S
1994 Aug 3;272(5):331-336, JAMA
— id: 36949, year: 1994, vol: 272, page: 331, stat: Journal Article,

Diabetic ketoacidosis in prisoners without access to insulin [see comments]
Keller AS; Link RN; Bickell NA; Charap MH; Kalet AL; Schwartz MD
1993 Feb 3;269(5):619-621, JAMA
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
— id: 13252, year: 1993, vol: 269, page: 619, stat: Journal Article,

PRISONERS ACCESS TO MEDICATIONS - REPLY
KELLER, AS; LINK, RN; BICKELL, NA; CHARAP, MH; KALET, AL; SCHWARTZ, MD
1993 MAY 19 ;269(19):2507-2508, JAMA
— id: 54182, year: 1993, vol: 269, page: 2507, stat: Journal Article,