A community health promotion partnership model: the South Carolina health connection.

Over a five year period, the South Carolina Health Connection Project has evolved to multi-site, multi-organization community-base collaborative initiative. From this project over $60,000.00 in funds have been secured. However, when costing the human resources and many other in-kind contributions involved in the SCHC Projects activities, the Project can modestly be valued at nearly $200,000.00. The efforts of a few have been shared with others, who also shared the resources with others, and the health promotion empowerment cycle continues. We believe the South Carolina Health Connection is an exemplary of a Community Health Promotion Partnership Model. We hope you will agree!

Self-esteem matters: racial & gender differences among rural southern adolescents.

Self-esteem does matter! It matters so much that Oprah dedicated an entire issue of "O" magazine to address the subject. "It's a woman's most treasured possession" (Winfrey, 2000a). Self-esteem has a profound influence on adolescent health promotion behaviors. This study contributes to understanding the role self-esteem plays in the behavior of adolescents. Utilizing a secondary data analysis, race and gender self-esteem differences among adolescents were investigated. The sample of 1,237 students (46% African-American and 52% White) from rural southern areas consisted of 744 females and 493 males. Self-esteem was assessed using the Miller Self-esteem Questionnaire (SEQ). The Hendricks Perceptual Health Promoting Determinants Model (HPHD) provided the theoretical framework for the study. The results of the study revealed a statistically significant difference in various aspects of self-esteem according to race and gender. African-Americans and males had a higher self-esteem which is consistent with many prior studies.

Health promoting behaviors among rural southern early adolescents.

A central element in attaining the goals and objectives of Healthy People 2010 is promoting healthy behavior lifestyles. Health promotion continues to be sanctioned as the long term most cost effective approach to a reduction in preventable health problems. Adolescents are presently an age group in jeopardy of making the transition into adulthood with healthy lifestyles. This paper describes the use of the Health Promoting Lifestyle Profile (HPLP) (Walker, Sechrist, and Pender, 1987) as a measure of health promoting behaviors in a group of rural southern early adolescents (1036 seventh and eight graders; 81% were African American). The findings suggest that rural southern adolescents perceive themselves to be enganging in health promoting lifestyle behaviors. However, some HPLP subscales seemed to be especially difficult for adolescents.

Nasolabial fasciocutaneous free flap for cheek defects.

The nasolabial fasciocutaneous free flap provides another option for the reconstruction of cheek defects. The flap can offer excellent skin texture and color match, precise donor and recipient vessel size match, and the potential for a superior donor-site scar.

Sensory reinnervation of autologous tissue TRAM flaps after breast reconstruction.

The use of the transverse rectus abdominis musculocutaneous (TRAM) flap has come to the forefront for breast reconstruction following mastectomy. Despite our ability to create surgically a supple breast mound, simulate the nipple with local skin flaps, and pigment the skin to create an areola, one of the last drawbacks has been the reestablishment of normal sensation. Some patients have anecdotally reported some sensory return in the reconstructed breast mound. We sought to quantitate the pattern of sensory return in TRAM flaps in 24 patients to identify factors that favor sensory reinnervation of the flap. Patients were recalled for sensory testing after unilateral or bilateral breast reconstruction following mastectomy for cancer or premalignant mastopathy. The interval from surgery varied from 3 to 41 months. Sensation was evaluated using the Semmes-Weinstein monofilament test, hot/cold recognition, and vibratory sensation measured in 16 segments of the reconstructed breast mound and compared to the opposite, unoperated breast or to volunteer controls. Thirty-four flaps were evaluated. The Semmes-Weinstein measurements demonstrated measurable sensation in 32 of 34 flaps with 2 flaps developing sensation equal to the control unoperated breast. The return of hot recognition occurred in 21 of 34 flaps, cold recognition in 22 of 34 flaps, and vibratory sensation in 26 of 34 flaps. Our findings suggest that excellent sensory return occurs in the majority of patients via nerve ingrowth into the flap from the mastectomy bed. It would appear that a natural breast reconstruction with some sensation can be a reality for the majority of patients in the absence of additional complex surgical maneuvers such as nerve preservation or nerve-nerve coaptation.

Use of a subcutaneous tunnel following replantation of an amputated penis.

We describe a new technique for immobilization and protection of the penis following microsurgical replantation, using a subcutaneous tunnel created in the suprapubic area. This tunnel protects the phallus from reinjury while maintaining an anatomic position and a normothermic environment in the immediate postoperative period.

Blood-flow contributions by the superior and inferior epigastric arterial systems in TRAM flaps, based on laser Doppler flowmetry.

This study was designed to quantify the relative contribution of the inferior and superior epigastric systems to infraumbilical TRAM flap skin blood flow, using laser Doppler flowmetry. In twelve flaps (11 patients), blood-flow measurements were obtained during routine elevation of the TRAM flap for breast reconstruction. Baseline readings were obtained and recorded after stabilization of blood flow. The deep inferior epigastric artery and vein (IEA) were clamped and measurements were obtained. An atraumatic aortic clamp was then placed across the superior strip of rectus abdominis muscle, occluding the superior epigastric system (SEA) and all collateral branches from the superior circulation, and readings obtained. IEA occlusion produced a reduction in skin flap blood flow which averaged 23 +/- 21 percent of baseline. When the SEA system was occluded, no significant decrease was noted. In fact, skin blood flow increased to 136 +/- 69 percent of baseline. When both the SEA system and IEA were clamped, skin blood flow averaged 10 +/- 9 percent of baseline, representing random movement of erythrocytes. The present study quantitatively documents the overwhelming dominance of the IEA system to supply the skin of the infraumbilical TRAM flap.

A case of multiple pilar tumors and pilar cysts involving the scalp and back.

The case of a patient with multiple proliferating trichilemmal tumors and trichilemmal cysts of the scalp and back is discussed. The multicentric presentation of this tumor is unusual and, to our knowledge, has not been described previously. The appearance of trichilemmal cysts in association with multiple proliferating trichilemmal tumors suggests a common histogenesis of these two neoplasms. The typical presenting features, histologic description, and recommended treatment for these tumors are reviewed.

A model of persistent partial hindlimb ischemia in the rabbit.

An animal model of resting limb ischemia in the rabbit was developed and studied. Anesthetized rabbits underwent unilateral common iliac artery (CIA) division, allowing comparisons between an experimental (ischemic) and the contralateral control limb in the same animal. The time course and severity of the ischemic insult were measured by quantitating muscle blood flow in seven muscle groups using 57Co-radiolabeled microspheres, limb femoral arteriovenous oxygen differences (AVDO2), and limb arterial pressure. Nine of 20 animals had objective evidence of functional limb impairment judged by abnormal resting posture and/or abnormal gait. Muscle blood flow in the experimental limbs became significantly less than blood flows of corresponding contralateral muscle groups (P less than 0.05) when measured at 1 week after CIA division. By 17 days, mean muscle blood flow had returned to within 82.5% of that of the control limb. AVDO2 increased from 4.8 +/- 0.99 to 8.13 +/- 2.26 ml O2/dl blood following CIA division and remained persistently greater than the control limb value until Day 31. Limb arterial pressure decreased markedly after CIA division and remained significantly depressed beyond 6 weeks when the study was terminated. The reasons for the differential time courses of these parameters of blood flow are discussed. Common iliac artery division in the rabbit appears to produce persistent, partial ischemia at least 17 days in duration, allowing in-depth study of the effects of persistent limb ischemia on muscle cell function in the laboratory setting, as well as permitting the assessment of various therapeutic manipulations for the treatment of prolonged muscle ischemia.

Indirect revascularization of the lower extremity by means of microvascular free-muscle flap--a preliminary report.

We describe the treatment of a patient with end-stage peripheral vascular disease and ischemic ulceration of the lower extremity in whom an obliteration of the distal arterial bed precluded conventional arterial reconstruction. A nonhealing dorsal foot ulcer was debrided, and soft tissue reconstruction was accomplished by the free microsurgical transfer of a muscle flap to the distal lower extremity. Arterial inflow to this free flap was provided by a contralateral reversed saphenous vein graft from the proximal arterial tree of the leg. This procedure resulted in a healed wound, stable coverage, and limb salvage. The patient also noted complete relief of rest pain and improvement in his claudication symptoms. A follow-up arteriogram was done 2 months after surgery. Contrast injection directly into the artery of this flap showed new blood vessel growth from the muscle flap into the foot with anastomoses of these "new vessels" to the patient's native circulation. This experience suggests that limb salvage may be possible by the free microvascular transplantation of a muscle flap onto the limb in selected patients whose limbs are deemed "nonreconstructible."

Effects of ingesting mercury-containing bacteria on mercury tolerance and growth rates of ciliates.

The ciliateUronema nigricans was found to acquire tolerance to mercury after being fed mercury-laden bacteria followed by exposure of washed suspensions of these ciliates to various concentrations of mercury in solution. Significant differences in percent mortality were observed for ciliates fed mercury-laden bacteria compared with control suspensions fed mercury-free bacteria. The phenomenon of acquired mercury tolerance was demonstrated within a single generation time. Ciliates fed mercury-free bacteria and subsequently exposed to increasing levels of mercury in solution showed an elevated tolerance to concentrations which, on initial testing, resulted in mortality of 83% of the ciliate population. The effect of ingesting mercury-laden bacteria on growth rate ofUronema was examined, and results showed no significant differences in growth rates of both 3- and 14-day-old cultures of protozoa that had been fed mercury-laden and mercury-free bacteria under controlled conditions.