Introduction

  In Sri Lanka, there was ethnic violence in the form of armed conflict that lasted 26 years from 1983 through 2009. The conflict between two ethnic groups were bogged down by terrorism or by foreign military intervention. It destroyed the life of inhabitants and it is thought to have inhibited the health and growth of children.

  A case study was conducted in Sri Lanka to establish the effects of the armed conflict on children’s health, soon after the conflict ended. The case study was aimed at using the result for planning health administration.

Methods

  400 participants aged 12 and above were selected from 10 schools of two out of 11 Divisional Secretariat Divisions in Trincomalee District in Sri Lanka. 10 schools were classified into two DS Divisions, severely devastated and less devastated. Each participant was assessed, using anthropometric techniques and questionnaires including GHQ-12.　Reliability of the questions was confirmed through back translation and the use of an English-Tamil questionnaire. The mean values of the anthropometric measurements, the mean values of score by factor analysis of GHQ-12 response, and various items of social environment were compared between the two regions. These different significances were tested using F-test, t-test and Chi-square test.

Results

  　In comparisons between two regions, body weight, height and BMI among participants in severely affected region were significantly lower. Additionally, susceptibility to infectious and endemic diseases in severely affected were significantly increased.

  Four characteristics of mental health were identified, but there was no significant difference about the state of depression between the two regions.

Conclusion

  Children in conflict zones are susceptible not only to malnutrition, but also infectious diseases caused by unhygienic living conditions. The application of simple anthropometric techniques and relevant knowledge and food distribution are important in evaluating and responding to these children’s health problems.

[Objectives] This study aims to analyze women's health issues in post-conflict Cambodia and to discuss the impacts of conflicts on women's health.
[Methods] We collected a wide range of literatures and analyzed the historical background and the situation of health and health services in Cambodia. We visited the Ministry of Health, international agencies and health facilities in urban and rural areas for collecting information. We conducted semi-structured interviews to community women, health staff and married men, as well as focus group discussions (FGD) among women.
[Results and Discussions] During Pol Pot regime in the late 1970s, most people were subjected to forced migration and hard labor, and many of them, particularly intellectuals, were killed. As a result, most people are still suffering from physical and mental problems, and the reconstruction of the health services delayed due to shortage of skilled personnel including physicians. Health services have been improved dramatically since 1990s by receiving various international aids. However, gaps between the rich and the poor have been widened.
Although most women told that they had some health problems, those who were very poor or separated from their husbands seemed to suffer more seriously than those who had no family problems, and to be unable to control their emotions while talking about experiences during the conflict. This might be caused by unhealed psychological trauma, which, in turn, disturbed the reconstruction of their lives. Most women recognized that conflicts affected their health status and they also admitted that poverty and ill-health formed a vicious cycle. Possible interventions should empower women so that they can develop their latent capacities and rebuild community networks.
[Conclusion] It is important to focus on the access to the basic health services for the rural and urban poors. It is also important to improve mental health support, so that the poor women can get over the past experience.

Fees for comprehensive community-based care (CCC) wards were established as “CCC ward hospitalization fee and CCC hospitalization medical care fees: CCC wards” in the medical service fee revision of 2014. Since then, the number of hospitals submitting claims in this category has rapidly increased, from 114 in May 2014 to 2191 in June 2018. Although establishment of the CCC ward system and operational situation were previously described in featured articles and reports, the specific benefits of medical care provided in these wards remain unclear. In this study, we extracted descriptions from the Japanese literature of the benefits of medical care provided in CCC wards, organized this content using a qualitative approach, and examined the nursing roles revealed. In total, 25 papers were identified with information about the benefits of medical care in CCC wards. This content was abstracted into 50 codes and then grouped into 20 subcategories and 9 categories. These 9 categories were further classified into structure, process, and outcomes of medical care provided in CCC wards according to linguistic criteria developed based on the Donabedian model of health care quality, and the results were used to identify the nursing roles in CCC wards. Nurses appear to have diverse roles in the medical care provided in CCC wards, providing counseling on how to maintain basic service infrastructure (structure), supporting patients and families during their time in the wards (process), strengthening interdisciplinary collaboration (process), and improving nurses’ own professional competence (process). Through their roles in these structural and procedural dimensions, nurses support the intelligent operation of CCC wards and the expansion of community care support systems. Our results suggest that these activities may lead to outcomes in the form of enhanced community health.

The importance of medical education and technical cooperation with developing countries is emphasized. As an example, we looked at the residency program of the Department of Surgery, Santa Cruz General Hospital. Provision for postgraduate medical education is quite important in developing countries in order to prevent promising young doctors from leaving the country. Moreover, the curriculum for postgraduate education should be developed in accordance with the health situation of the respective countries. Technical cooperation should be carried out with a long-term perspective, focusing on human resource development, in this case the young doctors. From now on, it will not only be technical experts, but also medical education experts that will be needed in developing countries.

This study aimed to clarify factors that promote team care among nurses in comprehensive community-based care (CCC) wards. After the establishment of “CCC Ward Hospitalization Fees 1 and 2”, we conducted an anonymous, self-report survey at medical facilities affiliated with the Japanese Association of Hospitals for Community-based Care. The survey covered items related to the distinctive features of CCC wards including organization, types of conferences, and basic attributes of nurses. Other items examined were team care in CCC wards, including awareness of cooperation, goal and information sharing, and competency of interprofessional collaborative practice Data analysis included the t-test for comparison between variables, oneway analysis of variance, and the post hoc Tukey’s test for multiple comparisons. In the stepwise multiple regression model, scores for four “awareness of cooperation” factors and three “goal and information sharing” factors were used as independent variables and the total score for “competency of interprofessional collaborative practice” was used as the dependent variable. In total, 452 nurses returned the survey (response rate: 35.7%) and 309 provided valid responses (valid response rate: 68.3%). Results suggest that factors promoting team care for nurses in CCC wards predicted decision-making based on the following: patient conditions and lifestyles; clarification of team goals; proposal, consideration, and agreement regarding care methods and focus of care; and cooperation in team development. We believe that team care in CCC wards will be promoted by implementing the factors revealed in this study.