Projections from the paratrigeminal nucleus and the medullary and spinal dorsal horns to the peribrachial area in the cat

The projections from the medullary and spinal dorsal horns to the dorsolateral pons were investigated in the cat utilizing both the retrograde and anterograde transport of a wheat germ agglutinin-horseradish peroxidase complex and the retrograde transport of the fluorescent dyes Fast Blue and Nuclear Yellow. After injections of wheat germ agglutinin-horseradish peroxidase into the area surrounding the brachium conjunctivum, numerous neurons were labeled ipsilaterally near levels of the obex in the paratrigeminal nucleus. Such neurons were located in connected pockets of neuropil located within the spinal trigeminal tract and along its medial edge. Most of the neurons labeled in the dorsal horns after such injections were found in lamina I. Those found in the medullary dorsal horn were mostly ipsilateral to the injection while those in the spinal dorsal horn were found bilaterally. Some labeled neurons were also found in lamina V of both the medullary and spinal dorsal horns bilaterally. When the injection was centered in either the medial parabrachial nucleus or the Kolliker-Fuse nucleus, a greater number of neurons were labeled ipsilaterally in lamina V of the medullary dorsal horn. Since neurons in lamina I of the medullary dorsal horn also project to the medial thalamus, fluorescent dyes were used to determine if the same neuron might project to both targets. Fast Blue was first injected into either the peribrachial area or the medial thalamus. After an appropriate period, Nuclear Yellow was injected into that target not injected first with Fast Blue. The injection of Nuclear Yellow was always placed on the side of the brain opposite to the first injection. Both dyes were transported retrogradely and were found in neurons located in lamina I of the medullary dorsal horn. However, no double-labeled neurons were seen. In general those labeled after injections of the medial thalamus were more superficial than those labeled after injections of the dorsolateral pons. The anterograde transport of wheat germ agglutinin-horseradish peroxidase was used to determine the termination of the projections from neurons in the medulary dorsal horn and the cervical spinal cord to the peribrachial area. After injections into these areas a moderate to sparse labeling of the lateral parabrachial nucleus and the Kolliker-Fuse nucleus was seen. It was mostly ipsilateral in cases with injections of the medullary dorsal horn but was bilateral following injections into the cervical enlargement.(ABSTRACT TRUNCATED AT 400 WORDS)     

The Development of a Multilevel Intervention to Optimise Participant Engagement with an Obesity Prevention Programme Delivered in UK children’s Centres

Prevention Science - Poor participant engagement threatens the potential impact and cost-effectiveness of public health programmes preventing meaningful evaluation and wider application. Although...     

Why adolescents delay with presentation to hospital with acute testicular pain: A qualitative study

Background/purposeAdolescents have poor outcomes following testicular torsion directly attributable to delay from onset of symptoms to presentation to hospital. The aim of this study was to investigate the barriers to urgent presentation in young men.MethodsSemistructured interviews were undertaken with young men (11–19 years), using a topic guide exploring issues surrounding testicular pain and health. Thematic analysis was undertaken using a framework approach.ResultsTwenty-seven adolescents were recruited, data saturation was reached at sixteen participants, and median age was 13.5 years (range 11–18). The process by which an adolescent gets to hospital with testicular pain is slow. They must recognize the problem and alert their parents, who then use a ‘watch and wait’ policy to assess need for medical review, often leaving it ‘a day’ or overnight. Adolescent males do not engage with healthcare services independently of their parents. Additional factors preventing early presentation include: absence of knowledge about testicular pathology from adolescents and their parents; concern from the young people about raising a false alarm and family concerns about burdening healthcare services.ConclusionsRecommendations include designing a testicular health education campaign for young men and educating parents regarding the medical conditions where a ‘watch and wait’ policy may be harmful to their child.Level of evidenceVI     

A model of nonparticipation in alcohol treatment programs

Why do the vast majority of those who suffer harm from drinking fail to obtain treatment? Based on a review of research literature and educational and treatment program materials, a model of nonparticipation in treatment is proposed whereby particular population groups are separated out according to whether or not they exhibit specified characteristics related to both harm from drinking and attitudes towards treatment. Eleven groups have been identified in the model, each of which has different reasons for failing to seek and/or obtain treatment. It is suggested that differing educational program messages should be sent to each group. While the model does not purport to be wholly inclusive of all nonparticipation, it offers a basis for addressing the variety of disparate groups that suffer harm from drinking but do not obtain treatment.     

Partnering. A cooperative approach to dietary procurement

The Toledo Hospital has initiated many innovative quality programs. One initiated with the dietary department involved turning its wholesaler into a partner to provide better-quality products, lower costs and better service. Specific requirements were established in each of these areas including guaranteed mark-ups, price caps and performance reports. The hospital and the wholesaler also do joint negotiating with product manufacturers. Through these and other strategies, the hospital has reduced purchase prices for food items by over 4%, drastically reduced administrative costs of procurement and lead time, increased inventory turns to over 80 and given the dietary department a single resource for "one stop shopping."     

Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care

STUDY DESIGN: A double-blind, randomized controlled trial of a novel educational booklet compared with a traditional booklet for patients seeking treatment in primary care for acute or recurrent low back pain. OBJECTIVE: To test the impact of a novel educational booklet on patients' beliefs about back pain and functional outcome. SUMMARY OF BACKGROUND DATA: The information and advice that health professionals give to patients may be important in health care intervention, but there is little scientific evidence of their effectiveness. A novel patient educational booklet, The Back Book, has been developed to provide evidence-based information and advice consistent with current clinical guidelines. METHODS: One hundred sixty-two patients were given either the experimental booklet or a traditional booklet. The main outcomes studied were fear-avoidance beliefs about physical activity, beliefs about the inevitable consequences of back trouble, the Roland Disability Questionnaire, and visual analogue pain scales. Postal follow-up response at 1 year after initial treatment was 78%. RESULTS: Patients receiving the experimental booklet showed a statistically significant greater early improvement in beliefs which was maintained at 1 year. A greater proportion of patients with an initially high fear-avoidance beliefs score who received the experimental booklet had clinically important improvement in fear-avoidance beliefs about physical activity at 2 weeks, followed by a clinically important improvement in the Roland Disability Questionnaire score at 3 months. There was no effect on pain. CONCLUSION: This trial shows that carefully selected and presented information and advice about back pain can have a positive effect on patients' beliefs and clinical outcomes, and suggests that a study of clinically important effects in individual patients may provide further insights into the management of low back pain.