Facilitating post traumatic growth

Background: Whilst negative responses to traumatic injury have been well documented in the literature, there is a small but growing body of work that identifies posttraumatic growth as a salient feature of this experience. We contribute to this discourse by reporting on the experiences of 13 individuals who were traumatically injured, had undergone extensive rehabilitation and were discharged from formal care. All participants were injured through involvement in a motor vehicle accident, with the exception of one, who was injured through falling off the roof of a house.
Methods: In this qualitative study, we used an audio-taped in-depth interview with each participant as the means of data collection. Interviews were transcribed verbatim and analysed thematically to determine the participants' unique perspectives on the experience of recovery from traumatic injury. In reporting the findings, all participants' were given a pseudonym to assure their anonymity.
Results: Most participants indicated that their involvement in a traumatic occurrence was a springboard for growth that enabled them to develop new perspectives on life and living.
Conclusion: There are a number of contributions that health providers may make to the recovery of individuals who have been traumatically injured to assist them to develop new views of vulnerability and strength, make changes in relationships, and facilitate philosophical, physical and
spiritual growth.

The contributions of first nations ethnicity, income, and delays in surgery on mortality post-fracture : a population-based analysis

Summary We examined the independent contributions of First Nations ethnicity and lower income to post-fracture mortality. A similar relative increase in mortality associated with fracture appears to translate into a larger absolute increase in post-fracture mortality for First Nations compared to non-First Nations peoples. Lower income also predicted increased mortality post-fracture.

Introduction First Nations peoples have a greater risk of mortality than non-First Nations peoples. We examined the independent contributions of First Nations ethnicity and income to mortality post-fracture, and associations with time to surgery post-hip fracture.

Methods Non-traumatic fracture cases and fracture-free controls were identified from population-based administrative data repositories for Manitoba, Canada (aged ≥50 years). Populations were retrospectively matched for sex, age (within 5 years), First Nations ethnicity, and number of comorbidities. Differences in mortality post-fracture of hip, wrist, or spine, 1996–2004 (population 1, n = 63,081), and the hip, 1987–2002(Population 2, n = 41,211) were examined using Cox proportional hazards regression to model time to death. For hip fracture, logistic regression analyses were used to model the probability of death within 30 days and 1 year.

Results Population 1: First Nations ethnicity was associated with an increased mortality risk of 30–53 % for each fracture type. Lower income was associated with an increased mortality risk of 18–26 %. Population 2: lower income predicted mortality overall (odds ratio (OR) 1.15, 95 % confidence interval (CI) 1.07–1.23) and for hip fracture cases (OR 1.18, 95%CI 1.05–1.32), as did older age, male sex, diabetes, and >5 comorbidities (all p ≤ 0.01). Higher mortality was associated with pertrochanteric fracture (OR 1.14, 95 % CI 1.03–1.27), or surgery delay of 2–3 days (OR 1.34, 95 % CI 1.18–1.52) or ≥4 days (OR 2.35, 95 % CI 2.07–2.67).

Conclusion A larger absolute increase in mortality post-fracture was observed for First Nations compared to non-First Nations peoples. Lower income and surgery delay >2 days predicted mortality post-fracture. These data have implications regarding prioritization of healthcare to ensure targeted, timely care for First Nations peoples and/or individuals with lower income.

Capacity building for post disaster construction and demolition waste management: a case of Sri Lanka

Purpose – The purpose of this paper is to present a theoretical framework for capacity building in post disaster construction and demolition (C&D) waste management at a national level to address the identified capacity gaps in managing disaster waste resulting from natural hazards.

Design/methodology/approach – Data were gathered through pilot interviews, case studies and expert opinion surveys representing government, non-government and other sector organisations involved in post disaster waste management.

Findings – The study revealed unavailability of a single point of responsibility and provision for disaster waste in existing policies and capacity constraints in prevailing peace time solid waste management practices which were identified as major capacity gaps. Establishment of a regulatory body and enforceable rules and regulations with necessary levels of capacities was identified and presented in a theoretical framework comprising of seven identified areas for capacity building in post disaster waste management.

Research limitations/implications – This study is limited to disaster C&D waste as debris generated from totally or partially damaged buildings and infrastructure as a direct impact of natural hazards or from demolished buildings and infrastructure at rehabilitation or early recovery stages. Waste generated during reconstruction phase of post disaster management cycle is not considered as disaster C&D waste for purposes of this study.

Originality/value – The research enabled analysis of existing capacities and presents approaches for capacity building for identified gaps in post disaster C&D waste management to attain sustainable post disaster waste management for future resilience.