Introduction
The economic situation of the Republic of Indonesia has been good with 6% economic growth in 2010. The health provision was affected by the decentralization after 2001, which has caused the prominent diversity in health condition. The health system and health situation in Indonesia are overviewed.
Health situation
The health indicators of Indonesia have been improving in general though maternal and child health (MCH) indicators are still not good enough compared to the surrounding ASEAN countries. The health budget has been increasing though up to 2% of GDP. The efforts by the Government have increased the number of health facilities as well as health workforce through it is yet to be improved. The Public Health Security Fund has extended its coverage with the target of universal health coverage. The health strategic plan 2010-2014 shows us the master plan of health development, whose vision is to encourage autonomous efforts by the community for health and the equity of health.
Conclusions
Indonesia is now on the epidemiological and populational transition with double burden of diseases. With the target of universal health coverage, it is urgent need to enhance the health service provision with development of health workforce in order to meet the demand along with enhancement of the health insurance coverage.

The purpose of this study was to clarify the relationship between the low back pain of college students and psychological factors by using a questionnaire for low back pains and five psychological tests. The tests consisted of the Hopkins Symptom Checklist (HSCL), State-Trait Anxiety Inventory (STAI), Purpose in Life (PIL) test, Hassles Scale for students and Type A test. The subjects were 337 college students (126 male, 211 female) ranging in age from 19 to 22 (mean ± SD: 20.2 ± 1.3) years. Seventy-four subjects whose lower back pain was thought to be caused by organic factors were excluded. The 263 subjects (102 males, 161 females, mean ± SD: 20.1 ± 1.1 years) were divided into three groups (NP: subjects with no pain, PND: subjects with pain but no difficulties in daily life, PD: subjects with pain and difficulties in daily life) by degrees of low back pain. The PD subjects showed a more negative attitude than those in the PND and/or NP groups for four tests, i.e., Hassles Scale and the psychosomatic component of the HSCL and State-Trait Anxiety Inventory tests. It was suggested that low back pain was related to psychological factors such as stress and anxiety.

This study was designed to investigate the relationships between the tendencies toward Type A behavior pattern (TABP) and sports injuries. A total of 2164 (1631 males and 533 females) athletes from several colleges in Japan, volunteered for this study. They were divided into two groups ; an injury group and a non-injury group. KG's Daily Life Questionnaire was used to investigate the tendency of TABP. Our hypothesis was that Type A individuals showed higher occurrences of sports injury than Type B individuals. Most of the results in this study supported our hypothesis. To put it concretely, the injury group showed higher TABP tendency than the non-injury group. And the higher TABP score group showed higher occurrence of injury experiences than those of low score group. Therefore, there was a possibility that TABP tendency of athletes might be one of the informations to prevent sports injuries.

A 76-year-old man with multivessel disease in the coronary artery and abdominal aortic aneurysm, including the bilateral common iliac artery aneurysms, underwent off-pump coronary artery bypass (OPCAB) combined with repair of the aneurysms. We were able to perform three coronary artery bypass graftings (left internal thoracic artery-left anterior descending artery, saphenous vein graft-diagonal branch, and saphenous vein graft-atrio-ventricular branch) using an Octopus 2 and a“Lima”suture technique without cardiopulmonary bypass. The postoperative course was uneventful. All grafts were patent on postoperative angiograms. OPCAB combined with repair of abdominal aortic aneurysm was useful for the high-risk patient.

BACKGROUND/AIMS: Colonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH. METHODS: Among patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort. RESULTS: Among the 273 patients with DH, use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164–6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154–7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554–9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310–6.535) showed an increased risk of severe DH even after controlling for other factors. CONCLUSIONS: Severe DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH.
Anti-Inflammatory Agents, Non-Steroidal ; Cohort Studies ; Colon* ; Colonoscopy ; Dizziness ; Hemorrhage* ; Humans ; Incidence ; Japan ; Rare Diseases ; Recurrence ; Retrospective Studies ; Risk Factors*

Anti-inflammatory therapy is generally considered to be prior to surgery for Takayasu disease to achieve better outcomes. We report two Takayasu arteritis patients with thoracic aneurysm. Case 1 was a 19-year-old woman who presented acute trachyphonia for one month. CT revealed aortic arch aneurysm of which maximal diameter was 64 mm with partial cystic protrusion. We performed urgent total arch replacement before anti-inflammation therapy was induced. Postoperative course was uneventful and the patient discharged on steroid therapy. Case 2 was a 35-year-old woman who complained chest pain for two weeks. CT revealed a Valsalva aneurysm with maximal diameter 54 mm and the aortic wall of the arch including its branches was surrounded by thick low density area. As the FDG-PET confirmed inflammatory arteritis, initial steroid therapy was planned. However, one day before admission, the patient presented acute aortic dissection and did not respond to any resuscitation. We conclude that the right time of surgery or the initial induction of anti-inflammatory therapy for anuerysmal dilation by Takayasu arteritis is to be determined based not only on the inflammation level but also on aneurysmal size and the patient's severity of complaints.

Today, syphilitic aortic aneurysm is rarely diagnosed due to widespread use of penicillin for early syphilis. Large aneurysms can be symptomatic by compressing on adjacent organs. We report a case of a huge syphilitic aneurysm of the thoracic aorta complicated with airway obstruction and superior vena cava syndrome. A 62-year-old man presented with acute severe dyspnea and distention of superficial veins. Contrast-enhanced computed tomography revealed an aneurysm of the ascending aorta extending to the transverse arch the diameter of which was 90 mm. The aneurysm compressed the bilateral main bronchi and superior vena cava. We performed an emergency operation because respiratory failure persisted despite the support of a ventilator. Since the aneurysm eroded the sternum, median sternotomy was performed under hypothermic circulatory arrest. Dissecting the aneurysm was complicated due to dense adhesion. Ascending aorta and partial arch replacement with reconstruction of the brachiocephalic trunk was successfully performed with antegrade cerebral perfusion. Postoperative computed tomography demonstrated that compression of the bilateral main bronchi was released. The result of preoperative syphilitic serologic test was strongly positive, and pathological findings of the aneurysm wall specimen was compatible with syphilitic aneurysm. Following treatment with benzyl penicillin for 14 days, the patient was discharged on the 19th postoperative day without specific complications.

Surgical stress is closely associated with the activity of the thyroid hormone. Although many patients undergoing cardiac surgery revealed markedly low triiodothyronine (T3), few patients showed symptomatic hypothyroidism. This condition is generally recognized as “non thyroidal illness (NTI) ” which is characterized by a low T3 level, despite the normal function of hypothalamus-pituitary-thyroid system. NTI is generally considered as one of the biological defense mechanisms rather than a pathological condition, eliminating the requirement of medical intervention. Even if low T3 is observed in blood biochemical examination after open heart surgery, a cautious interpretation is required. We report an elderly case presenting severe fatigue and mild disorientation accompanied by significantly low thyroid hormone after aortic valve replacement. The morbidity was remarkably improved with medical treatment, suggesting hypothyroidism after cardiac surgery.