The history of pharmacoepidemiology in Japan is short, and despite its importance for physicians in prescribing medicine in daily clinical work, their interest in this evidence-based science has been far from social acceptance. Pharmacoepidemiology itself especially in Japan must be firmly established with systematically constructed harmonious features defined by pharmaceutical health promotion consisting of four independent facets ; health professionals, consumer, industry and regulatory faces. Also, pharmacoepidemiology has to be developed on a scientific basis for outcome research focusing on the clinical and economic consequences of drug therapy decisions. Persuing this aim, pharmacoepidemiology will need to simultaneously invoke principles in other scientific fields such as molecular biology, biostatistics and genetic epidemiology. Ultimately, these interdisciplinary synergies can contribute to intelligent and hopefully more efficient drug development, and a better understanding of what will happen when the drug goes to market. In the clinical field of cardiology, on the other hand, numerous facets are involved in pharmacoepidemiology ; PMDS, polypharmacy and genetic aspects in gene polymorphism with special regard to LQT syndrome and anticoagulation with warfarin. These clinical factors associated with pharmacoepidemiology are summarized and discussed in detail.

Exercise intensity is one of the major determinats in the exercise prescription, where THR plays an important role. This study was designed to reemphasize the usefulness of the Karvonen's formula with special regard to the anaerobic threshold (AT) in the exercise prescription to middle-aged healthy men. Fifty normal adult subjects between 30 and 59 years who were refered to the Life Planning Center for the evaluation of physical fitness were selected for the study. Symptom limited maximal treadmill stress testing after Bruce's protocol was performed for all subjects and AT was determined as the level, where the minute ventilatory volume curve during exercise revealed the first breaking point. The heart rate at AT (HR_AT) was compared to those obtained by the Karvonen's formula (k=0.6) and the other conventional method, in which the 70% and 85% of the maximal heart rate (HRmax) were determined as an optimal range for the exercise intensity. The following results were obtained: the average value of HRAT just coincided with the THR obtained with Karvonen's formula and its±1 S.D. values just fitted into the range of 70% and 85% of HRmax, respectively. THR by the Karvonen's formula varies with k values and is mostly affected by the resting heart rate (HRr) . If the k is fixed to 0.6, THR thus obtained can keep its range between 70% and 85% of HRmax under the normal range of HRr (mean±2 S. D. ; 37-116 bpm) . Moreover, THRs obtained from the Karvonen's formula (k=0.6) using the age predicted HRmax were best fitted into the ones derived from the HRmax obtained by the maximal exercise testings. Thus, THR detemined by the Karvonen's flrmula (k=0.6) can be the most suitable with regard to the anaerobic threshold and the most reliable within the wide range of normal resting heart rate.

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.
The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.
Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.