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.

Objective: This study evaluated the feasibility and outcomes of pneumovaginoscopy-assisted radical hysterectomy (PVRH) for cervical cancer up to stage IIA using a bidirectional fascia-oriented and nerve-sparing surgical approach. Methods: This retrospective observational cohort study examined the operative outcomes and prognoses of patients who underwent PVRH (n=59) for up to stage IIA cervical cancer. The basic procedure was Kyoto B2 (Viper Type II nerve-sparing) radical hysterectomy and pelvic lymphadenectomy through simultaneous vaginal and abdominal (open or laparoscopic) approaches. In all cases, pneumovaginoscopy (PV) was used to create a vaginal cuff and dissect the paracolpium and paracervical endopelvic fascia to minimize nerve damage. Results: Thirty-eight (64.4%) patients had stage IB1 cancer. Seven (11.9%) had vaginal invasion (stage IIA1, n=4; IIA2, n=3). The abdominal approach was open in 38 cases and laparoscopic in 21. Adjuvant therapy was administered to 24 patients (41%); one patient received concurrent chemoradiotherapy for gastric-type adenocarcinoma. There were three (6.1%) intraoperative complications (CO2 gas embolism [n=1], sigmoid colon musculosa injury [n=1], and ureteral injury [n=1]) and 8 (14%) postoperative complications (lymphedema with cellulitis [n=4], vaginal cuff dehiscence [n=1], sub-ileus [n=1], symptomatic lymphocyst [n=l], and ureterovaginal fistula [n=1]). The median urination recovery period was 3 days. Microscopic R0 was achieved in all cases. The median follow-up was 44.5 (2–122) months, and no recurrence occurred. Conclusion PVRH is a new fascia-oriented and nerve-sparing surgery for early-stage cervical cancer. Further, it has favorable operative outcomes and good prognoses, similar to those of adjacent pelvic surgery such as trans-anal total mesorectal excision and radical prostatectomy.