Relation of urinary mercury level to chronic fatigue syndrome among workers of artisanal and small-scale gold mining: A study of 3 districts in West Nusa Tenggara Province and Lebak District of Banten Province, Indonesia

INTRODUCTION@#Chronic Fatigue Syndrome (CFS) is a collection of symptoms from a substantial reduction in the ability to engage in preillness levels of occupational, educational, social, or personal activities that persists for more than six months and is accompanied by fatigue, post-exertional malaise, and unrefreshing sleep. One of the effects of heavy metal exposure is the occurrence of CFS among workers. Artisanal and Small-scale Gold Mining (ASGM) workers used mercury in their work, and this leads to a higher risk of chronic mercury poisoning. One of the health problems dueto mercury exposure is the occurrence of CFS and this has not been studied among ASGM workers.@*OBJECTIVE@#This study intended to discover the prevalence of CFS among ASGM workers and the factors associated with it.@*METHOD@#This study used a cross-sectional design to find the relationship between independent variables such as age, sex, working period as a miner, type of work activities in ASGM, and cumulative urinary mercury levels with CFS in ASGM workers in West Nusa Tenggara and Banten province. CFS was measured using standardized questionnaire on effect on mercury released by WHO-UNEP, and creatinine-corrected urinary mercury levels.@*RESULTS@#The prevalence of CFS in ASGM workers in West Nusa Tenggara and Banten provinces was 17.9%. Based on the results, the factors of age, sex, work period, type of work, province of origin and cumulative urinary mercury levels did not have a statistically significant relationship with CFS (p> 0.05).@*CONCLUSION@#There was no significant relationship between age, sex, work period, type of work, urinary mercury level and cumulative urinary mercury levels with CFS in ASGM workers.

Renal function analysis of crane operators in a container terminal and its related factors

Objective@#The objective of this study was to assess factors related to renal function in crane operators at a port container terminal in Indonesia. @*Methods@#A cross-sectional study on crane operators in Medan Container Terminal, Indonesia, was conducted. Renal function was measured through Glomerular Filtration Rate (GFR). Individual characteristics such as age, nutritional status, fluid consumption, hydration status, and physical activity level were collected. Fluid consumption was obtained from a 24-h food recall questionnaire. Physical activity was measured based on the Bouchard questionnaire. Association was determined by calculating the odds ratio (OR) and its 95% confidence interval (CI). @*Results@#A total of 87 subjects were involved. All were male with the median age of 30.1 ± 2.4 years old. The prevalence of decreased renal function was 49.4%. Inadequate fluid consumption (OR = 6.1, 95% CI 2.1 -17.7; p<0.001) significantly increase the risk of renal function decreased, while being overweight/obese (OR 3.3, 95% CI 0.7 -11.7;p<0.125) and dehydration (OR 2.3, 95% CI 0.8-26.9; p=0.111) also increase the risk although not significantly. @*Conclusion@#Inadequate fluid consumption increases the risk of decline in the renal function of crane operators in the container terminal. A company should regularly monitor and evaluate the kidney function of this group of workers through annual medical checkups and provide easier access to drinking water and convenient toilets to improve fluid consumption of the workers.

The effect of COVID-19 pandemic on anxiety disorders among workers in a hospital in Balikpapan, East Kalimantan

INTRODUCTION@#During the global COVID-19 pandemic, health workers were found to have a higher prevalence of anxiety disorder compared to non-health workers. Anxiety disorder that occurs chronically have a 25% chance to become a major depression disorder.@*OBJECTIVE@#The aim of this study is to understand the anxiety condition and related risk factors among workers in a Balikpapan hospital during the COVID-19 pandemic.@*METHOD@#The design of this research used a cross sectional method that involved 279 respondents who are workers in a Balikpapan hospital. The study used SPSS version 20.0, using the chi square and Fisher’s Exact test for the bivariate analysis, and the logistic regression with enter method for the multivariate analysis.@*RESULTS@#The study shows that using the General Anxiety Disorder 7 (GAD-7) questionnaire from 279 hospital workers, there were 10.8% with mild-, 1.45% with moderate-, and 0.4% with severe anxiety disorder. A significant relation was found between anxiety disorder and risk factors such as being a health worker with p=0.001 and a 4.8 OR adj (95% CI: 1.9-12.3), working in areas with high risk of transmitting COVID-19 with p=0.04 and a 5.1 OR adj (95% CI: 1.0-24.2), and workers who are being quarantined with p=0.001 a 10.5 OR adj (2.6-42.3) after being adjusted by age and gender variables.@*CONCLUSION@#Significant relations were found between anxiety disorder among hospital workers with risk factors such as being health workers, working in areas with high risk of transmitting COVID-19, and workers who are being quarantined. Researchers strongly advise health providers to do regular monitoring and seek moral support especially for workers who have higher risk of anxiety disorder.

Effects of Indonesian marine sponges ethanol extracts on the lipid profile of hyperlipidemic rats

This study was aimed to investigate the effects of ethanol extracts of Indonesian marine sponges (Callyspongia sp.,Melophlus sarasinorum, and Xestospongia sp.) on the lipid profile of hyperlipidemic rats. The antihyperlipidemicstudy of these sponges is firstly reported in this study. Experimental hyperlipidemic rats were induced by daily intakeof propylthiouracil (1.8 mg/200 g b.wt and quail yolk (10 ml/kg) for the duration of 3 weeks. Hyperlipidemic ratgroups were administered orally with three doses (30, 60, and 120 mg/kg) of the ethanol extracts for 1-week onward.Blood sample was then collected via intracardiac puncture and serum was biochemically analyzed. Ethanol extractsof Callyspongia sp., M. sarasinorum, and Xestospongia sp. at doses of 60 and 120 mg/kg exhibited a significantreduction of cholesterols, triglycerides, and low-density lipoprotein. These doses also significantly increased the highdensity lipoprotein level. Levels of atherogenic indices (Atherogenic Index, Atherogenic Index Plasma, Castelli’s RiskIndex-I, and Castelli’s Risk Index-II) were also decreased by both doses with percentages protection ranging from70.6% to 81.6%. These results showed that ethanol extracts of Callyspongia sp., M. sarasinorum, and Xestospongiasp. exhibited a lipid-lowering activity in hyperlipidemic rats. Hence, these extracts could be used as sources of leadmolecules in the development of natural lipid-lowering agents from marine species

Availability of sugar-free medicine for children: Are we denying their needs?

@#This study aimed to review the availability of sugar-free medicine available in the market using the online Monthly Index of Medical Specialties (MIMS) Malaysia 2016. Data collection was obtained from product information (PI) for prescription medications contained in the MIMS Malaysia 2016. Concise information for each product was collected based on therapeutic class groupings. The therapeutic class obtained from PI was assigned to one of the 11 major therapeutic classes. PI that stated its use in paediatrics was further reviewed for the availability of sugar free ingredient. Each product was then allocated into the poison groups: Group B, Group C and Non-Scheduled Poison. A total of 282 PI items from 336 companies in MIMS Malaysia 2016 that satisfied our eligibility criteria were reviewed. Of the 282 PI items reviewed, most of the products, 169 (59.9%) were sugarbased product, while 87 (30.9%) of them belong to sugar free products. Our study found that most of the medicines reviewed in the MIMS Malaysia 2016 were under Group C (134 of total 282). There is still a high number of sugar-containing medicines despite the promotion of sugar-free medication. Therefore, consumers need to be educated on the use of sugar-free medicines in children to increase the demand and availability in the market.

Association of oral lichen planus with hepatitis-C and diabetes mellitus

The aim of the study is to determine the association of oral lichen planus with hepatitis C and diabetes mellitus

A retrospective cohort study was carried out at the Department of Oral and Maxillofacial Surgery, Sardar Begum Dental College, Peshawar from January 201 1 to July 2015. A total of 34 male and female patients having oral lichen planus were selected with age range 20-60 years and mean age 39.4 +/- 15.8 years. Only clinical features were included to diagnose oral lichen planus which was made through the clinical evaluation of patient's oral cavity by a specialist team at the Department as proposed by van der Meij et al in 2003 based on the WHO definition of oral lichen planus. The data were analyzed through SPSS 22 with significance level ofp-value <0.05 and chi-square statistics were applied for association

The results showed that the data was statistically not significant with p-value >0.05 for all diseases having lichen planus and chi-square statistics revealed that no association exist among lichen planus, diabetes mellitus and hepatitis C. This study fails to find any association between oral lichen planus, hepatitis C and diabetes mellitus

Ultrasonographic assessment of amniotic fluid index in post date pregnancies

To assess fetal outcome in postdate pregnancies [40 weeks and beyond] with women having amniotic fluid index [AFI] < 6 cm and between 6-15cm using greyscale ultrasound. Cross-sectional comparative study. CMH Rawalpindi from 26 October 2006 to 09 May 2007. A total of 60 patients were studied. The antenatal fetal surveillance in these patients was based on ultrasound assessment of AFI after 40 weeks. An abnormal AFI was defined as less than 6 cm, between 6-8 cm as equivocal and more than or equal to 8 as normal. Patients were equally divided into two groups of 30 each based on AFI as group I having AFI <6 cm and group II with AFI of 6-15 cms. Delivery mode, fetal distress and early neonatal complications were main assessment parameters for the fetus. Rate of caesarean section [50%] in the women with AFI< 6 cm was found significantly higher than 17% rate of caesarean section of the women having AFI > 6 cm .Proportion of early neonatal complications was also significantly higher in the women with AFI< 6 cm. AFI assessment by ultrasound is a reliable fetal surveillance test. It may allow the conservative approach till 42 weeks to reduce the caesarean section rate and neonatal complications

Dental caries among the patients visiting out patient department of liaquat medical uinversity Hospital, Hyderabad - Sindh

The objective of this study was to find out the prevalence of dental caries and DMFT score among the patients visiting out-patient department ofLiaquat Medical University Hospital. This was cross sectional study conducted at the Liaquat Medical University Hospital. The minimum sample size calculated was 278. Oral examination was carried out using mouth mirror and a blunt ball-ended probe on the dental chair using artificial light. The results showed that there were 57.2% male and 42.8% female. The prevalence of dental caries was 60.4%.The mean DMFT score was 2.10 with Standard Deviation 2.11. 59.5% caries was present in male and 40.5% caries was present in female, the male patients were more affected than female showed insignificant results. Male and female patients had mean DMFT score 1.26 with a Standard Deviation [SD] 0.449 and 1.39 with a Standard Deviation [SD] 0.493 respectively. It was concluded that the prevalence of dental caries and DMFT score is higher in the selected study population so for prevention and control of dental caries continuing dental health education programs should be emphasized for general population as a whole

Plaque score and gingival health status among 6-12 years old children in hyderabad division

The objective of this study was to evaluate the plaque score and gingival health status among 6-12 years old school children. This cross sectional study was done from 15th July to 10th August 2014 among the students of Matiari [Rural Area] and Hirabad Hyderabad [Urban Area]. Schools were selected on convenient basis. Age ranged from six to twelve years and only boys were included in the study. All clinical dental examinations were conducted in schools with mouth mirror and explorer in the day light. Plaque index and gingival index developed by Loe and Silness were used for each student to record the plaque score and gingival condition. The plaque disclosing tablet [Eviplac Pastilhas; Biodinamicas TM], was used to identify the plaque score. All the students were asked about routine oral hygiene procedures. Data were analyzed in statistical package for social sciences [SPSS] version 16. Quantitative variables are presented in percentages. Mean and standard deviations were computed for qualitative variables. Chi-square test and independent sample t-test were applied to see the significant association. Total one hundred seventy six school children were included in this study; ninety six were from rural area and eighty from urban area. The mean age was 15.85 +/- 7.773. The gingivitis was seen in 80.7% students. Gingivitis was more in the rural children than from urban areas which was statistically not significant. The mean plaque score was 39.63 +/- 19.15 in present study. The independent sample T-test analysis revealed no significant difference between rural and urban students. Gum bleeding was more common in rural school students which is statistically significant. It is concluded that there was a higher gingival inflammation in present study population. Urban students had good gingival condition and low mean plaque score than rural students. Mild type of gingivitis was more common in rural students

Demographic data on the characterization of oral clefts in Malaysia

The aim of this study was to investigate current epidemiology of several types of oral clefts among the patients receiving treatment at two tertiary care hospitals, namely University Malaya Medical Centre [UMMC] Kuala Lumpur, and Hospital Kota Bharu / Hospital Raja Perumpuan Zainab II [HKB/ HRPZII] Kelantan. This study evaluated the records of 526 cleft lip and palate [CLP] patients with or without additional malformations, who came for treatment during 2003 to 2007. Of the total 526 patients registered in the study hospital records during the study period, 338 were from HKB/ HRPZ II and 188 from UMMC. Majority 86.7% of these patients were in the age group

Causes of tooth extraction amongst diabetic patients seen in a dental hospital in Peshawar

The aim of the study was to evaluate the causes of common conditions leading to tooth extraction, male/female ratio in diabetic patients. This was a retrospective cohort study. Data were collected from previous records between January 2011 to July 2015 from the Department of Oral and Maxillofacial Surgery, Sardar Begum Dental College, Peshawar. Among 2,103 total diabetic patients presented to the department, 1,618 diabetic patients have their complete record for tooth extractions. The primary reasons for exodontia specified in the records were Caries, Periodontitis, others. Others include those patients who have extractions either due to preprosthetic purpose, trauma or fracture or any other reason other than caries and periodontitis. The data was analysed through SPSS 22. The mean age presentation was 47.50 +/- 19.82 years and the age range 25-70 years. There were 1,618 extractions carried out in 2,103 subjects [76.94%]. The female diabetic patients predominate n=983 [60.75%] the male patients n=635 [39.25%]. Caries was the dominant cause of tooth extraction in both subjects n= 1042 [64.40%] followed by periodontitis n= 416 [25.71%] and others n=160 [9.90%]. Caries is the dominant cause of extraction in diabetic patients and female diabetic patients predominate male diabetic patients in terms of tooth extraction

Etiology and epidemiology of patients presenting with liver disease during pregnancy

We conducted this study to elaborate the etiology and epidemiology of liver diseases presenting during pregnancy. It was a prospective, observational study. This study was conducted in the Department of Gastroenterology, Fatima Memorial Hospital in collaboration with the Department of Obstetrics and Gynaecology from June 2011 -May 2013. 73 patients were evaluated. Data was evaluated for quantitative and qualitative variables. Outcome of mother, pregnancy and neonates was also recorded were available. During the study period 73 pregnant patients were evaluated for the presence of liver disease giving an incidence of 3.6%. The mean age of the patients was 26.3 +/- 3.8 [median: 26, range: 16 - 45] years. The patients presented at a mean gestational age of 5.8 +/- 2.4 [median: 6, range: 1- 9] months. The mean STB and ALT levelswere 11.5 +/- 8.5 [median: 9.3, range: 1.4 - 48] mg/dL and 943.5 +/- 887.4 [median: 765, range: 13 - 4810] IU/Lrespectively. The mean duration of jaundice and mean hospital stay were 6.82 +/- 5.32 [median: 5, range: 2 - 30] days and 5.6 +/- 2.7 [median: 5, range: 1-18] days. Fulminant hepatic failure was seen in 6.8% of the patients. Acute Hepatitis E was the most frequent diagnosis in our population. Maternal deaths were seen in 8.2%, foetal deaths were seen in 12.3% and neonatal deaths in 6.5%. Liver diseases during pregnancy can have multiple causes and may predict poor outcomes for the patients and neonates

Impacted mandibular third molar surgery; the role of dexamethasone in postoperative swelling and trismus

The objective of this study was to evaluate the therapeutic effect of dexamethasone in post-operative edema and trismus after impacted third molar surgery. It was a prospective randomized control study carried in Department of Oral and Maxillofacial surgery, BADC, Larkana from March 2012 to Feb 2013. Patients age between 20-45 years of either gender; unilateral mandibular impacted third molars [right or left] were included. Patients divided in two groups by using random allocation number. Patients in Group-A were given intramuscular 8 mg dexamethasone 1 hour before surgery and four tablets [2mg] dexamethasone orally immediate postoperatively and 24 hours after surgery. The facial swelling was checked before surgery, after 24 hours [1st day], after 48 hours [2nd day], after 72 hours [3rd day] and on 7th postoperative day Inter-incisor distance was checked on every follow up. Data was analyzed by SPSS version 17. Mean and standard deviation was calculated for age and gender. Mean and SD of facial swelling and mouth opening was calculated before extraction, on 1st, 2nd, 3rd and on 7th post-operative day in both groups. The dexamethasone group showed significant reduction in swellingcompared with control group at all intervals. Dexamethasone resulted in significantly less trismus than controls on day 2 postoperatively, but there was no significant difference among the groups at 7thday. Dexamethasone is effective in minimizing swelling and trismus after removal of impacted lower third molar and improves the social life of individual

Effects of Toxic Dose of Lead Acetate on Testicular Morphology in Albino Rats

The objective of this study was to observe the morphometric changes in the testes of albino rats exposed to lead acetate. Experimental animal study. This study was conducted from January to April, 2009 at National Institute of Health Islamabad. Animals were obtained from the animal house of N.I.H and were divided into two groups A and B. The animals in group A were used as control, while those of groups B were treated with lead acetate that was given intraperitonially in the dose of 4mg/kg body weight, 5 days a week for 6 weeks. After 6 weeks the animals of group A [control] and group B [experimental] were sacrificed by an overdose of ether anesthesia. The testes were fixed in formalin and then processed for paraffin embedding. Five micrometer thick section were cut, stained with hematoxylin and eosin, and observed microscopically for germinal epithelium thickness and the basement membrane of seminiferous tubules. The histological comparison of testes of both groups of animals showed that after six weeks, the width of germinal epithelium and the number of spermatogenic cells had decreased in the test group as compared to the control group [p<0.05] and in majority of the seminiferous tubules, the basement membrane was disrupted

Evaluation of pain after administration of local anesthesia with and without medication [midazolam] in irreversible pulpitis in a sample of Sindh

The objective was to evaluate pain experience of the patient after administration of local anesthesia in symptomatic irreversible pulpitis with and without pre-medication Patients were diagnosed after taking medical and dental history, clinical examination, thermal tests and by taking radio-graphs. One hundred patients formed the study group. They were divided into two groups of fifty each, Group-A patients were given oral medication [Midazolan, Dormicum 7.5mg] and inferior dental nerve Block, while Group-B patients were given only Inferior Alveolar Nerve [IAN] Block [1.8 ml cartridge-1:100000 epinephrine] of Xylestesin-S [ESPE-Germany] without any pre-medication. Pre-operative pain of patients of both groups was recorded on Visual Analogue Scale [VAS] i.e: 0= no pain, 10 = most severe pain. [VAS 0>10] Group-A patients were given anesthesia 45 minutes after pre medication while Group-B, patients were treated routinely after administrating inferior dental nerve Block block. In group A [40% showed no pain, 44% mild pain, 12% moderate pain and 4% suffered severe pain n=50] while in group B [20% showed no pain, 50% mild pain, 20% moderate pain and 10% suffered from severe pain after the procedure was done. It was concluded that the patients who had received sedation, prior to anesthesia showed better results

Frequency and clinical presentations of hepatitis B and C virus co-infection in tertiary care hospital

To study the frequency and clinical presentations of hepatitis B and C virus co-infection in a tertiary care hospital. This descriptive study was conducted at Lady Reading Hospital Peshawar, Pakistan from January 2011 to January 2012. A total of 52 patients with positive HBsAg and anti HCV antibodies were included in the study. Clinical, demographic, laboratory data and results of the liver and abdominal ultrasound were recorded. Furthermore, both qualitative and quantitative PCR were performed. Data was analyzed using SPSS v 16. P

Burden of diabetes mellitus in the families of medical students of lower Sindh

The non communicable diseases are chronic and exist in human body for long period, diabetes is one of those. The origin word of diabetes means siphon or a pipe from which water or any liquid can pass to another container or bottle the word mellitus is Latin and it means sweet, thus diabetes mellitus means sweet urine excreted from the body of person. To ask history of Diabetes in the families of Medical Students. To alculate the burden of diabetes patients present in the family. cross sectional study. This study was carried out at faculty of community medicine and Public Health Sciences Liaquat University of Medical Health Sciences Jamshoro from 1[st] February 2013 to 31[st] May 2013. It is a cross sectional through a pre design and pre tested. Questionnaire having questions about personal bio data like age, sex, rural, urban, merit seats or self financed seats admission history of diabetes in the family and other relevant. The study shows male and female gender of students out of total 154 medical students there were male were 42 [27.27%] and there were 112 [72.72%] female students regarding the type of History of Diabetes in Families of medical students out of total medical students 154, there were 59 [38.31 %] who reported history of diabetes while 95 [61.68%] of no history of diabetes in their families. The Glucometer is a small machine, available in 53 [34.41%] families-and not available 101[65.58%] in the families of the students. The distribution of students according to seat of admission shows out of total 154 students who participated in the study 733 were on merit while 82 were on self finance which means having good income source. The study concludes that there is high burden of diabetes in medical students families in Sindh. Majority is managed on diet, more counseling is required

Frequency of hypertension in male and female medical students of public sector university of Jamshoro in hilly region

To evaluate the Frequency of Hypertension in male and female Medical students of Public Sector University of Jamshoro in hilly region. Cross sectional study. This study was conducted at Liaquat University of Medical and Health Sciences Jamshoro from October 2012 to November 2012. A total of 94 Medical students studying in 4[th] year MBBS were randomly selected and were administered questionnaire comprising sections on personal information, gender distribution, age distribution, current status of hypertension, hobbies, family history of hypertension, father's occupation, blood pressure readings by using a standardized calibrated mercury column type sphygmomanometer [Certeza CE model CR 2001] in Medical ward were recorded and careful clinical examination of CVS by Senior and trained Doctors. Among male students 26 of Normal [<130/<85 mmHg], 05 of Prehypertension [130-139/85-89 mmHg], Among females 53 of Normal, 08 of prehypertension and 02 of mild hypertension [140-159/90-99 mmHg] .Some subjects had reduced physical activity with preference of watching TV and reading books. Majority of the students were normotensives. The study concludes that the hypertension is a problem of medical students, detection of common habits that might be correlated with hypertension which needs regular counseling and lifestyle changes, awareness and prevention about hypertension

Indus water related mortality and morbidity due to water borne diseases outbreak in Hyderabad

Much of the ill health in developing countries is connected to unsafe drinking water. The number of sick people suffering from water borne diseases in a year is more than 2.5 billion out of this 2 million die. Diarrhea is top killer of children in Pakistan. River water is most polluted water and carries, chemical substances, pathogens, which cause water borne diseases. Indus river flows on the west of Hyderabad city. An outbreak of water borne diseases occurred in Hyderabad in 2004. To analyze epidemiological data of water borne outbreak in Hyderabad during 2004. To collect data from various hospitals and director general health record, admission of patients and their mortality. To calculate the case fatality rate of water borne diseases among the patients who were treated admitted in Hyderabad city hospitals. Epidemiological cross sectional study. This study based on the data pertaining to Indus water pollution which occurred in the summer month of 2004. The study is epidemiological based on the data of water borne diseases due to Indus water pollution in Hyderabad city. Five hospitals where patients were admitted and 8 sites from where water samples were collected and tested. A special proforma and survey of hospitals and director general health Sindh reports were used for the study. There were 4979 patients who were admitted in big hospitals of Hyderabad. The laboratory report of the samples shows total dissolved salts 1536, coliform bacteria and conductivities parameters were unfit and above the permissible level of World health organization standards. Case fatality rate was 7.43 per thousand. The major hospitals were the main facilities to treat the patients. Only the fresh water from Sukkur barrage and community awareness of using safe and alternative water in Hyderabad improve the water borne outbreak. The medical universities must create awareness for water borne diseases

Psychological effects among internally displaced persons [IDPS] residing in two districts of Sindh

To identify the psychological effects of IDPs and to assess the psychological illnesses. Descriptive Cross Sectional study. This study was conducted at shelters surrounding the campus of Liaquat University of Medical and Health Sciences, Jamshoro and New Sabzi Mandi, Hyderabad after 1 month of the flood. During study 300 affected Internally Displaced Persons [IDPs] were examined for physical, social and psychological effects after one month of flood through structured interviews. We focused on the behavior and activities according to Diagnostic Statistical Manual of Mental Disorders IV [DSM-IV] to identify psychological effects. Beside that the history of diet manual in children, male and female gender was addressed. Out of 300 respondents, the mean age was 40 years. According to DSM IV, 134 [44%] participants met the criteria of depression. 30 [10%] IDPs reported aggression. 26 [9%] IDPs met the criteria of post traumatic stress disorder [PTSD], 110 [37%] IDPs reported lack of sleep. Geographically Pakistan faces frequent natural calamities. In recent past Pakistan has suffered a lot due to floods. There is need to focus on mental health of internally displaced persons which is most neglected aspect during and after flood and disasters. The government and nongovernment organizations should make implementing policy to take care of post health issues of IDPs