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J Jekel

Publications and source records attributed to J Jekel.

5 recordsLinked to original sources
PubMed2001

Computed tomography of the head before lumbar puncture in adults with suspected meningitis.

BACKGROUND: In adults with suspected meningitis clinicians routinely order computed tomography (CT) of the head before performing a lumbar puncture. METHODS: We prospectively studied 301 adults with suspected meningitis to determine whether clinical characteristics that were present before CT of the head was performed could be used to identify patients who were unlikely to have abnormalities on CT. The Modified National Institutes of Health Stroke Scale was used to identify neurologic abnormalities. RESULTS: Of the 301 patients with suspected meningitis, 235 (78 percent) underwent CT of the head before undergoing lumbar puncture. In 56 of the 235 patients (24 percent), the results of CT were abnormal; 11 patients (5 percent) had evidence of a mass effect. The clinical features at base line that were associated with an abnormal finding on CT of the head were an age of at least 60 years, immunocompromise, a history of central nervous system disease, and a history of seizure within one week before presentation, as well as the following neurologic abnormalities: an abnormal level of consciousness, an inability to answer two consecutive questions correctly or to follow two consecutive commands, gaze palsy, abnormal visual fields, facial palsy, arm drift, leg drift, and abnormal language (e.g., aphasia). None of these features were present at base line in 96 of the 235 patients who underwent CT scanning of the head (41 percent). The CT scan was normal in 93 of these 96 patients, yielding a negative predictive value of 97 percent. Of the three misclassified patients, only one had a mild mass effect on CT, and all three subsequently underwent lumbar puncture, with no evidence of brain herniation one week later. CONCLUSIONS: In adults with suspected meningitis, clinical features can be used to identify those who are unlikely to have abnormal findings on CT of the head.

Adolescent↗
PubMed1995

PTSD symptoms in urban adolescent girls: compounded community trauma.

OBJECTIVE: To describe the assessments for exposure to violent events and posttraumatic stress disorder (PTSD) symptoms in a population of urban adolescent girls. METHOD: Seventy-nine urban adolescent girls attending an adolescent medicine clinic were assessed via clinician-assisted self-report measures called the Adolescent Self-Report Trauma Questionnaire. The questionnaire gathered information on demographics, exposure to community and domestic violent events, and PTSD symptoms. RESULTS: The adolescents experienced between 8 and 55 different types of community and domestic violent events, with the mean number of violent events being 28. Hyperarousal cluster symptoms were present in 90%, reexperiencing clusters symptoms in 89%, and avoidance cluster symptoms in 80%, while 67% met symptom criteria for PTSD. Increased number of types of violent events was positively correlated with meeting PTSD criteria (p = .01) and with increased PTSD severity scores (p = .001). CONCLUSIONS: These urban adolescent girls have experienced prolonged and repeated exposure to multiple types of community as well as domestic violent events, via multiple modalities of contact, over time. They reported a high percentage of PTSD symptoms across all three symptom clusters. The authors propose the concept of "compounded community trauma" and discuss its marked impact on female adolescent development.

Adolescent↗
PubMed1992

Influence of dietary fat, apolipoprotein E phenotype, and sex on plasma lipoprotein levels.

BACKGROUND: The "Western" diet, sex, and apolipoprotein (Apo) E polymorphism have been implicated as codeterminants of lipid levels. METHODS AND RESULTS: In a retrospective analysis, we evaluated the combined impact of dietary fat, sex, and Apo E phenotype on lipoprotein levels in 67 subjects fed two contrasting, metabolically controlled diets: one a "Western" diet, with a low polyunsaturated to saturated (P:S) fatty acid ratio and the other a "therapeutic" diet, with a high P:S ratio. The high P:S diet compared with P:S diet exerted a far stronger predictive influence on lipoprotein concentrations than Apo E phenotype, sex, or the latter two factors combined. Apo E phenotype alone was associated with a stepwise increase in low density lipoprotein cholesterol (LDL-C), such that 3/2 less than 3/3 less than 4/3 on either the low or the high P:S diets. On the low P:S diet only, sex was shown to be a significant predictor of high density lipoprotein cholesterol (HDL-C) levels, with women greater than men, and the associated LDL/HDL ratio with men greater than women. On the high P:S diet, women displayed a dramatic fall in HDL-C, effectively raising the LDL/HDL ratio to equivalency with men and obliterating the sex influence seen with the low P:S diet. Controlled for dietary fat, Apo E and sex exerted independent, additive effects on lipoprotein levels on the low P:S diet only. Only the Apo E phenotype remained predictive on the high P:S diet. CONCLUSIONS: Women of the Apo E 3/2 phenotype stand to benefit the least from a high P:S diet because of reduction in the more "protective" HDL-C, whereas men of the 4/3 phenotype showed the greatest improvement in the LDL/HDL ratio.

Adult↗
PubMed1986

Community perceptions of appropriate sources of emergency care.

Two hundred eighteen residents in a suburban community northwest of Chicago were interviewed using standard telephone survey techniques. Respondents lived in an area served by two hospitals and two freestanding emergency centers (FECs) that had been in operation for three years prior to the survey. Those surveyed were asked to react to three common medical emergencies of graded levels of severity, small laceration, injured ankle, and myocardial infarction, to identify self-referral patterns of this community. Respondents were questioned about their knowledge and perception of the FECs and their hours of operation. Approximately 66.5% of the sample population was aware of the existence of these two centers. Fifty-four percent to 85.5% of respondents did not view these facilities as appropriate centers for the treatment of major emergencies. Only 58.3% (at 6:00 PM) and 63.3% (at 3:00 AM) of those surveyed would activate the emergency medical services system for a suspected myocardial infarction. Respondents made choices that would have delayed definitive care, including going to an FEC. Of those who thought they knew the hours of operation of the FECs, 65% believed these facilities were open 24 hours a day when, in fact, they were not.

Adult↗