Using systems-mapping to address Adverse Childhood Experiences (ACEs) and trauma: A qualitative study of stakeholder experiences.

Adverse childhood experiences (ACEs) and trauma have been linked to decreased psychosocial and physiological health functioning. While various individual and community-level interventions to address ACEs have been reported, one novel approach that has not been explored in detail is a community-engaged causal loop diagramming project, or systems mapping project (SMP), in which diverse stakeholders work together to document the forces that are creating the outcomes and patterns within the community. To better document and understand the impact of participation in an SMP, we conducted in-depth, qualitative interviews with 16 stakeholders who were involved in a systems-mapping process facilitated by a local nonprofit in Eastern North Carolina. We used an iterative, content analysis coding process to generate and analyze themes from these interviews. Three major themes emerged: 1) Recognition and understanding of own trauma, 2) Trauma as both a community issue and an individual issue, and 3) Systems-mapping as a conceptual tool with practical benefits. All participants strongly recommended the systems-mapping approach to other communities and believed that it is a valuable tool for empowerment and provided several considerations for future organizers of similar systems-mapping projects. Our findings suggest that systems mapping is a feasible, transferable, and promising modality for understanding and addressing ACEs at the individual, interpersonal, and community-levels, as well as for putting community voices at the forefront of efforts to address ACEs.

Life-threatening hemorrhage during removal of a Nuss bar associated with sternal erosion.

We present a case of life-threatening hemorrhage occurring during Nuss bar removal without obvious cardiac or major vascular injury. A 19-year-old woman with marfanoid features had undergone a Nuss procedure 3 years earlier for a pectus index of 7.2. A lateral chest radiograph revealed erosion of the upper bar into the sternum. During surgery, a 3.5-L blood loss occurred after removal of the eroded bar. This case provided many opportunities to improve preparedness for bar removal.

Idiopathic gastric perforation in an asplenic infant.

INTRODUCTION: The cause of idiopathic gastric perforations in neonates remains unknown. Perforations of the abdominal oesophagus, stomach and duodenum in infants and children are the rarest type of intestinal perforations. There are 21 reported cases of an idiopathic gastric rupture in non-neonates. CASE REPORT: A 6-week-old boy presented with nausea, vomiting and decreased oral intake. Physical examination revealed a firm, distended abdomen tender. Abdominal lateral decubitus radiograph revealed massive free air. Patient was found to have an idiopathic gastric perforation of the greater curvature with incidental findings of asplenia. CONCLUSION: Paediatric abdominal foregut perforations have diverse aetiologies. The foregut is the least likely portion of the gastrointestinal tract to perforate in children. The aetiology is unknown but there are many postulated theories. We present a case of an idiopathic gastric rupture involving the greater curvature of 6-week-old boy with incidental findings of being asplenic.