The health reform program in 2006 was the biggest one for the last 30 years in Japan. According to the plan a nation-wide health promotion program for healthier population will be introduced. As a main program of health promotion, the specified health checkup and follow-up health guidance and intervention program will be introduced from 2008. This program is a Japanese disease management program. However, it is predicted that the new program will face to a number of operational difficulties, especially in the community setting, where not so much resources are available. In order to make the system more practical and operational, we have developed the clinic based health promotion program under the collaboration of local medical association, local government, and university. In this article the authors presents the general feature of this new program.

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It is pivotal how to advance health promotion activities into the health care system, in order to make the social insurance scheme sustainable in the coming aged society. In this article the author focuses the French health promotion program, Regional Public Health Plan (Plan Régional de la Santé Publique; PRSP). The PRSP project has been implemented under the principle of decentralization and new public health movement. Although there have been few evidences on effectiveness of PRSP, it seems that the French PRSP programs has been succeeding on the whole as a decentralization policy and new public health movement. One of the key success factors is its feature of decentralization. The French decentralization can be categorized into "deconcentaration". The central government always keeps its power of control over the territory thorough their local branches; DRASS and DDASS. The hypothesis of "steering at a distance" fits very well to the French decentralization process. The PRSP is implemented under the concept of new public health movement. The local health authorities are responsible for assessing the health needs of their population, deciding priorities for meeting those needs, placing contracts accordingly, evaluating the performance of those contracts and taking other action to promote health and prevent diseases. The French experiences will be suggestive for other developed countries with similar socio-political climates.

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In order to investigate the joint effect of history of diabetes and blood transfusion on ischemic heart disease mortality, we analyzed data for 7,759 subjects enrolled in a cohort study in Fukuoka Prefecture, Japan. All deaths due to ischemic heart disease were recorded. The Cox proportional hazards model was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) of ischemic heart disease with history of diabetes and blood transfusion. We also tested the null hypothesis of the multiplicative model to assess the potential joint effect of these two factors. During 102,800 person-years of follow-up, we observed 66 deaths due to ischemic heart disease. Adjusted HRs of diabetes only as well as transfusion only showed no statistical association, with HRs of 0.93 and 1.18, respectively. In contrast, an increased HR of 9.49 (95% CI: 2.82-32.00) was observed in subjects having both diabetes and blood transfusion, suggesting a positive interaction between them on the risk of death from ischemic heart disease (p=0.02). To conclude: We identified a multiplicative effect of history of diabetes and blood transfusion on the risk of death from ischemic heart disease.

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This paper discusses the issues that every researcher faces when he/she tries to model the medical cost using regression analysis and some possible measures for them. The main topics are the separation of frequency distribution and amount distribution, the systematical underestimation problem of log-transformation, variable transformation of U/V shaped variables, dummy variable, and the simulation for the distribution of predicted values.

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