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.

Purpose: This study aimed to investigate the current status and related factors of End of Life discussions between heart failure patients and medical professionals. Method: We conducted a survey of medical records of patients who died between April 2015 and March 2020 in the Department of Cardiology, Kyoto University Hospital. We examined the presence or absence of discussions about prognosis and end-of-life care and their associated factors. Result: Of the 109 patients, prognosis was explained to 40 (36.7%) and discussion of end-of-life care was provided to 25 (22.9%). Age (younger), number of hospitalizations, palliative care team intervention, and end-of-life care discussions were associated with the prognostic explanations. Gender (male), number of hospitalizations, history of heart failure hospitalization, palliative care team intervention, and prognosis explanation were associated with the end-of-life care discussions. Conclusion: The study suggested that End of Life discussions in heart failure patients are currently focused on patients with severe and end-stage heart failure.