This review presents a schematic attempt to classify the major pain pathways, based on the results of recent studies in our laboratory, with a special emphasis on the parabrachial system. Our view is based on results from experiments in the rat, using very small iontophoretic injections of anterograde tracers. As illustrated in this report, we have found a very dramatic difference between ascending projections originating from deep laminae compared with those arising from lamina I of the dorsal horn. We propose three main pain systems and discuss their functional-anatomical relationships. The first system is centred on the projection from deep laminae to three caudal reticular areas - the lateral reticular nucleus (LRN), the subnucleus reticularis dorsalis (SRD) and the gigantocellular lateral paragigantocellular reticular nuclei (NGc) - and the parabrachial internal lateral subnucleus (PBil). The second system is centred on the projection from lamina I to the ventral posterolateral nucleus (VPL), the ventral posteromedial (VPM), the posterior nuclear group (Po) and triangular posterior nucleus (PoT) of the thalamus. The third system is centred on the projection from lamina I to the lateral parabrachial area. We also present the four main projections from the latter area to the extended amygdala, the hypothalamus, the periaqueductal grey matter (PAG), and the ventrolateral medulla (VLM), and their involvement in emotional and autonomic (homeostatic) aspects of pain.
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http://dx.doi.org/10.1113/eph8702357 | DOI Listing |
BMC Complement Med Ther
January 2025
Public Health and Tropical Medicine, James Cook University, Townsville, QLD, 4811, Australia.
Background: The integration of herbal and orthodox medicines has gained momentum in global health, ensuring improved management of infectious diseases like malaria. This study explored the experiences of medical herbalists working in Ghana's diverse ecological zones to understand the contributions of integrated healthcare to malaria control.
Methods: A phenomenological design was employed to conduct in-depth interviews with 19 purposively sampled medical herbalists.
BMJ Glob Health
January 2025
Results for Development Institute, Washington, District of Columbia, USA.
Despite primary healthcare (PHC) being recognised in global declarations-Alma Ata in 1978 and Astana in 2018-and prioritised in national health strategies, chronic under-resourcing of PHC persists in most low-income and middle-income countries. More public spending is needed for PHC, but macrofiscal and political constraints often limit the ability of governments to allocate more public resources to PHC. Under-resourcing has been compounded by fragmented and rigid funding flows, which are inefficient and may erode equity, quality of care and public trust in PHC.
View Article and Find Full Text PDFBMJ Open
December 2024
EPH, LSHTM, London, UK.
Objectives: Hypertension is one of the most prevalent non-communicable diseases in West Africa, which responds to effective primary care. This scoping review explored factors influencing primary care access, utilisation and quality for patients with hypertension in West Africa.
Design: Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews.
BMJ Open
December 2024
Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.
Introduction: Early lung cancer screening (LCS) through low-dose CT (LDCT) is crucial but underused due to various barriers, including incomplete or inaccurate patient smoking data in the electronic health record and limited time for shared decision-making. The objective of this trial is to investigate a patient-centred intervention, MyLungHealth, delivered through the patient portal. The intervention is designed to improve LCS rates through increased identification of eligible patients and informed decision-making.
View Article and Find Full Text PDFBMC Health Serv Res
January 2025
Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK.
Background: Poor care experiences are reported for premenstrual disorders, which may result in negative outcomes such as distress, reduced healthcare engagement, and delays to diagnosis. This research aimed to explore healthcare experiences for premenstrual symptoms in the United Kingdom and identify areas for potential improvements based on participant responses.
Method: An online survey was delivered, with participants recruited via social media.
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