Introduction
Republic of Indonesia was badly affected by the economic crisis that began in Thailand in mid 1997. The crisis increased the incidence of poverty in Indonesia, and now it is time to grapple with this chronic poverty from various angles. The objective of this paper was to assess the impacts of the Social Safety Net (SSN) program on the health sector, which aimed to mitigate the effects of economic crisis. We focused on one of the SSN's health sector programs, the health card program, which provided free medical service for poor families.
We examined the usefulness and limitations of this program from an administration perspective.
Methods
Based on the ‘wealth ranking’ which is used in the field of development assistance, we chose 26 and 34 households that were classed as ‘relatively poor families’ from two villages in a rural area of Central Java, and interviewed households to understand how the health card program was delivered to them.
Results
The results indicated that 30 % (8/26) and 56 % (19/34) of the ‘relatively poor families’ have a health card, although half of these households had never used their cards, and half of them couldn't find their cards. Lack of awareness and indifference of medical staffs to the health card are considered to be possible reasons hindering people from using the card. Another reason was that some households felt ashamed to use the health card.
Conclusions
We suggest two methods to promote the increased usage of the SSN's health card as follows; first, choose the target household objectively, and secondly, enhance the management of the health sector program by taking advantage of midwives and teachers, as they have experience and can view the situation from a broader perspective. In addition, like any kind of public service, accessibility is an important factor to promote the usage of this health card.

It had been proposed by Kurata that relative threshold value F_th of single motor units depends on the gradient G (kg/sec) of the tension increase of muscle in such a manner as
F_th (≡T.G) =ρG^λ
Here T₁ is the time interval from the onset of EMG to the moment of recruitment of a motor unit and ρ is a proportional constant. The motor unit with a positive/negative value of λ is characterized to be static/phasic.
Morimoto and Hasegawa reported that the above relation also holds for the relaxation period, provided that Ftn and G are replaced by the tension at the moment of silence and the absolute value of G, respectively. In this case, the motor unit with a positive/ negative value of λ is characterized to be phasic/static.
In order to investigate the characteristics of motor units during relaxation period under the influence of pre-relaxation states, such as the increase of tension up to 4kg at the gradient of 0.5kg/sec and the state sustained at 4.0kg for 30sec. Single motor units of m, vastus medialis were studied by the same method as that of Morimoto and Hasegawa.
The following results were obtained;
1) Both at contraction and relaxation periods, the above relation was confirmed.
2) The motor unit with characteristics of recruitment modes was influenced by the pre-relaxation state, but its tendency was not definite. These results suggest that phasic/static characteristics of motor units are not stationary but fluctuate depending on the pre-relaxation states.

In this study, the relationships between the contractile properties of human motor units and their discharge patterns, characteristics of recruitment and others were examined. Action potentials of single human motor units in m, extensor digiterumwere detected by use of an inserted electrode. Tension curves of single motor units were recorded under the conditions that tension in finger extension was gradually increased, and that the subject relaxed his muscle as soon as he observed a sweep on a Braun tube triggered by the action potential of a single motor unit. About 100 twitch tension curves were summed up to obtain the average tension curve of a single motor unit. The τ-S diagrams were obtained from the mean discharge intervals (τ) of motor units at various sustained tensions and their standard deviations (S) . The λ values were also obtained from the relation F_th (-T₁G) =ρG^λ.
It was observed that the contraction time of the twitch tension curve of single human motor unit in a muscle was nearly proportional to τs (the τ values at a constant S value) . We presume that the regularity of discharging of motor unit affects the contraction speed in human muscle, because the motor unit with more regular discharging has longer contraction time of twitch.

A study was conducted to clarify the effects of running intensity and duration of endurance training on myoglobin concentration ( [Mb] ) in rat skeletal muscles, and to clarify its temporal changes during the training. One hundred five male Wistar rats were divided into a training group and an untrained group. The training was carried out at 5 times a week for 12 weeks when the animals were 4 to 16 weeks of age. The training intensities were set at 20, 30 and 40 m/min with a duration of 60 min. The training duration was varied to 30, 60, 90 and 120 min when the rats were trained at 30 m/min. The temporal changes in the [Mb] were examined after the first, third and ninth week of training, during which the rats were trained at 40 m/min for 60 min per session. Three muscles (soleus: Sol, plantaris: P1, gastrocnemius-surface/deep: Gas-S, Gas-D) were analyzed for the [Mb] and citrate synthase activity (CS activity) . With regard to the intensity of training, the [Mb] increased with exercise intensity in Sol, Gas-D and P1, but not in Gas-S. P1 showed a greater increase of the [Mb] than Sol or Gas-D. On the other hand, CS activity in red muscle (Sol and Gas-D) increased even at low intensity, whereas white muscle (fast-twitch muscle: Pl and Gas-S) showed a significant increase in CS activity at an intensity of 40m/min. As to the duration of training, the [Mb] increased with the duration of running at 30 m/min of intensity, and showed the maximal adaptation with 90-min duration in all muscles except for Gas-S. Changes in CS activity according to the duration of running were similar to those for the [Mb] in all muscles. Finally, the [Mb] increased significantly with prolongation of the training period (after the 1 st, 3 rd and 9 th weeks training) in all muscles except Gas-S. However, the adaptive response of Mb tended to be delayed as compared with CS activity. These results suggest that 1) the response of Mb to training stimuli can depend on the muscle specificity (fiber type composition or the initial [Mb] ), and level of motor unit recruitment in usual, 2) Mb synthesis can be enhanced by an increase of training intensity, 3) a training duration of 90 min can bring out the Mb adaptation maximally and 4) the adaptive response of Mb would need more time as compared with CS activity.

The purpose of this study is to examine the validity of muscle fatigue evaluation using maximum voluntary torque (MVT), and to identify the dependence of individual's tolerance for fatigue on the capacity to exert MVT. In 14 young male subjects (10 regular exercisers and 4 sedentary), MVT was measured during isometric knee extension, and voluntary activation (VA), which reflects motor unit activation, was evaluated using the twitch interpolation technique. In addition, the maximum endurance time (ET) was measured, and behavior of the mean power frequency (MPF) and the average rectified value (ARV) of surface EMGs from the vastus lateralis muscle were analyzed during constant force isometric contractions of 60% MVT (short-duration fatigue task; SDF task) and 20% MVT (long-duration fatigue task; LDF task) . Correlations were examined among these five variables.
The results were as follows:
1) Subjects were divided into a high voluntary activation group (HVA group) and a low voluntary activation group (LVA group) . Four sedentary subjects were included in the latter group.
2) MVT was significantly larger in the HVA group than in the LVA group (p<0.01) . A significant positive correlation (r=0.72) was found between MVT and VA (p<0.01) .
3) A significant negative correlation (r=-0.71) was found between MVT and endurance time (ET) for the LDF task (p<0.01) . The ET was significantly longer in the LVA group than in the HVA group (p<0.01) .
4) The MPF of voluntary EMG decreased consistently, as ARV increased during isometric contraction in both tasks (p<0.01), indicating the development of fatigue in the muscle. The final change of MPF relative to the initial value was significantly greater in the SDF task than in the LDF task (p<0.05) .
5) A significant correlation (r=-0.83) was seen between the relative change in MPF and ARV in the SDF task (p<0.01) .
6) For the SDF task, the final change of MPF and ARV relative to the initial value was significantly greater in the LVA group than in the HVA group (p<0.05) .
These results indicate that tolerance for local muscle fatigue usually evaluated as maximum endurance time, may depend on individual differences in VA, the VA, in turn, depending on adapta-tion to exercise, and that there appears to exist a corresponding adaptative strategy of the neuromuscular system during fatiguing contractions. Usefulness of our procedure using the twitch interpolation technique in evaluating muscle fatigue was also suggested.

We describe an unusual case of a chronic pulmonary thromboembolism with right atrial thrombus. A 56-year-old man suffering from chronic pulmonary thromboembolism for 5 years complained of increasing dyspnea. Computed tomography revealed massive emboli in bilateral pulmonary arteries and a thrombus in the right atrium. Massive tricuspid regurgitation and atrial fibrillation were also recognized. We performed pulmonary thromboendarterectomy using a Jamieson rigid long miniature sucker with a rounded tip and our original flexible sucker under deep hypothermic circulatory arrest. Right atrial thrombectomy, tricuspid annuloplasty and a Maze procedure were also performed during the cooling, recirculating, and warming period. His postoperative cause was uneventful, and he was able to return to an ordinary lifestyle without acquiring oxygen inhalation. Tricuspid annuloplasty and Maze operation during pulmonary thromboendarterectomy contributed to the maintenance of stable homodynamics during and after surgery.

To examine the personal space perception, measurements were conducted on both arms in 227 young men and women. Each subject, with his eyes closed, was instructed to stop the horizontal swing motion of his arm at the point he considered to be the middle of the range of possible motion on the horizontal plane, and this was repeated ten times.
Mean values of bisected angles were deviated from the middle points in the direction of the horizontal adduction, although there were large differences between the individuals. The deviation was larger in the right arms than that in the left, and it increased with the increasing range of motion of the horizontal abduction.
It was suggested that the gain of the personal space perception is higher in front of the body than in the side on the horizontal plane of the human shoulder.

To examine the variation in the knee extension force and the integrated electromyogram from rectus femoris, medial vastus and lateral vastus muscles with the knee joint angle in growing children, measurements were conducted in 61 school boys aged from 7 to 12 years old. Anthropometric measurements were also done on the body height, the lower limb length, and so on. Results obtained were as follows.
1) Ratio of the lower limb length comparing with the body height increased with the grade.
2) Maximal force at each joint angle in each grade was shifted peak from 70°to 90°with the grade.
3) The pattern of the integrated surface electromyogram from rectus femoris, medial vastus or lateral vastus muscle at each joint angle was the same in all of the grade. The integrated electromyogram at the maximal voluntary contraction was maximal at 45°of the knee joint angle in the rectus femoris muscle, at 110°in the medial vastus and at 90°in the lateral vastus muscle.

We studied the mechanism for slowing surface electromyography (EMG) during fatiguing contraction using superimposed M-wave analysis. Seven healthy male subjects exerted 60% maximum voluntary contraction of isometric abductions in the left first dorsal interosseous muscle (FDI) until exhaustion. Simultaneously with voluntary contractions, the ulnar nerve was electrically stimulated at supramaximal intensity, and volitional EMG and superimposed M-waves were obtained. We examined the behavior of muscle fiber conduction velocity (MFCV) and median frequency (MDF) for both EMG, with the following results:
1) MFCV calculated from volitional EMG of FDI was about 6 m/s during 60% MVC.
2) The waveform of voluntary EMG detected from FDI slowed in all subjects during fatiguing contraction at 60% MVC, indicating fatigue had developed in the muscle.
3) As fatigue progressed, the waveform of the superimposed M-wave tended to decrease in amplitude and increase in duration.
4) As fatigue progressed, MDF and MFCV in volitional EMG decreased significantly (p<0.04) . The rate of change was larger in MDF than in MFCV (p<0.01) .
5) As fatigue progressed, MDF and MFCV in the superimposed M-wave decreased significantly (p<0.01) . The rate of change was larger in NIDF than in MFCV (p<0.05) .
These results suggested that MFCV and other peripheral factors affected the slowing of volitional EMG. Elongation of the depolarization zone in muscle fiber is proposed as a peripheral factor.

The purpose of this study was to examine the effects of short-term immobilization on the maximum voluntary contraction (MVC) force. The first dorsal interosseus (FDI) of 10 healthy male adults was immobilized for 1 week using casting tape. Atrophy of the muscle was estimated from a cross sectional view of magnetic resonance images (MRI) . To clarify the factors of a peripheral neuromuscular system contributing to the change in the MVC force, twitch force at rest was measured. The contribution of central factors was estimated from a voluntary activation (VA) index, which was obtained by the twitch interpolation method.
The MRI showed no significant changes in the cross sectional area. The MVC force declined after immobilization (p<0.01), and recovered after 1 week from the termination of immobilization (p<0.01) . Both the twitch force at rest and the VA at MVC declined after immobilization (p<0.01), and recovered after 1 week (p<0.05) .
The results indicate that the temporary decline of the MVC force was not accompanied by atrophy of the muscle. Furthermore the decline of the MVC was caused both by the deterioration of peripheral and central functions in the neuromuscular system. Possible factors in the peripheral and central neuromuscular systems affected by the immobilization were discussed.