The Government of Indonesia (GOI) implemented a social security program, however, not all the population are covered as the Constitute of the Republic of Indonesia guarantee at its article 28th and obligate the GOI provide social security to all population.
  In 2004, the GOI introduced a new social security system targeting all population in order to achieve an improved coverage and integrated it into a unified system. The GOI has introduced a National Health Insurance System ahead of other social security systems on the 1st January 2014.
  It is also obligated foreigners who have lived in Indonesia for more than 6 months to participate. However, dissemination of the new system to the public was not enough at the timing of the introduction. Especially for foreigners as there is not enough information in any foreign language.
  The new system follows some parts of the previous program which was introduced for lower income population in 2005, the focuses are prioritizing on primary care and introducing a payment system for health care services. For accessing the health care services under the insurance system, all insurance holders have to attend the primary care institution at the beginning. Improving the quality and quantity of primary care service institutions requires important key factors to enhance the system and to increase the coverage.
  This article reviews the previous social security system and studies the laws and regulations relating to it, especially the new national health insurance system which was introduced in January 2014. It also discusses the challenges in enhancing the health insurance system and achieving Universal Health Coverage.

  Improvements in the performance of health personnel are being sought in an effort to achieve universal health coverage (UHC). Emphasis has thus been placed on the development of health personnel as part of a national UHC strategy throughout the world. In light of this, we planned the present symposium as a means of reviewing the current nursing trends in Southeast Asia and to investigate the issues facing the practical development of nursing personnel, as well as the future directions of nursing support, with a deliberate focus on UHC.
  At the symposium, changes in health issues in Japan, the contributions of nursing professionals in achieving UHC, and the educational programs required by Japanese nursing personnel for international cooperation were first presented. Next, the status of health personnel in Southeast Asia was reviewed. In particular, the status of the regulatory frameworks regarding nursing personnel and the measures for enhancing the practical ability of nurses through legal means were introduced separately for Laos, Cambodia, Vietnam, and Myanmar. Subsequently, as case examples of emerging countries in Southeast Asia, the nursing policies of Thailand and Indonesia were reviewed, measures for improving the practical ability of nurses through legal means in Indonesia were introduced, and support for enhancing networks within autonomous regions was proposed.
  International cooperation in the field of nursing requires strategic and comprehensive support for the development of nursing personnel in healthcare systems variable to economic growth and the means by which to achieve this are diversifying. Indeed, the symposium indicated the importance of responding to the diversity of support by enhancing networks of Japanese individuals involved in international cooperation and providing support for the enhancement of independent networks in Southeast Asia.

BACKGROUND/AIMS: Diffuse or segmental irregular narrowing of the main pancreatic duct (MPD), as observed by endoscopic retrograde cholangiopancreatography (ERCP), is a characteristic feature of autoimmune pancreatitis (AIP). METHODS: ERCP findings were retrospectively examined in 40 patients with AIP in whom irregular narrowing of the MPD was detected near the orifice. The MPD opening sign was defined as the MPD within 1.5 cm from the orifice being maintained. The distal common bile duct (CBD) sign was defined as the distal CBD within 1.5 cm from the orifice being maintained. Endoscopic findings of a swollen major papilla and histological findings of specimens obtained from the major papilla were examined in 26 and 21 patients, respectively. RESULTS: The MPD opening sign was detected in 26 of the 40 patients (65%). The distal CBD sign was detected in 25 of the 32 patients (78%), which showed stenosis of the lower bile duct. The patients who showed the MPD opening sign frequently showed the distal CBD sign (p=0.018). Lymphoplasmacytic infiltration, but not dense fibrosis, was histologically detected in biopsy specimens obtained from the major papilla. CONCLUSIONS: On ERCP, the MPD and CBD adjacent to the major papilla are frequently maintained in patients with AIP involving the pancreatic head. These signs are useful for diagnosing AIP on ERCP.
Autoimmune Diseases/*diagnosis/pathology ; *Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct/pathology ; Female ; Humans ; Male ; Middle Aged ; Pancreas/pathology ; Pancreatic Ducts/pathology ; Pancreatitis/*diagnosis/pathology ; Retrospective Studies

The purpose of this study was to clarify the changes in the sense of difficulty hospital staff felt toward palliative care before and after a palliative care team of the pediatric hospital started in-hospital consultation. A self-administered questionnaire about the difficulty, consisting of 21 items in five areas, was used to conduct a survey in 2015 for the pre-consultation period, and in 2018 for the post-consultation period. Responses were obtained from 222 people in the pre-consultation period (response rate of 70.9%) and from 384 people in the post-consultation period (response rate of 87.3%). Over 70% of the respondents were nurses and midwives. A lower sense of difficulty was observed in three of the items including “relief of painful symptoms”, “family care during caregiving”, and “support when oneself and surrounding staff feeling inadequate and lost”. Further, a significant decrease was observed in the sense of difficulty in six items reported by nurses and midwives in departments receiving the interventions. Eleven of the 16 cases in which the palliative care team intervened involved multiple requests for intervention for 2 patients with pain control difficulties, suggesting that the consultation activities contributed to the decrease in the sense of difficulty experienced by nurses and midwives.