Trends in the of epidemiological perspectives on the causality of occupational diseases

The main role of industrial accident compensation insurance is to protect injured workers and their families by providing various benefits. If a certain disease occurs due to work, the worker must prove the causal relationship between the work and the disease, although it is not easy for injured workers to do so. The epidemiological approach to causality is based on a comparison of the incidence rate in exposed and non-exposed groups. Recently, some arguments have been made regarding the application of epidemiological causality in litigation related to tobacco and some environmental-related diseases. The 3 main points of dispute are as follows: 1) the distinction between specific and non-specific diseases and causal inference, 2) the relative risk and the attributable fraction of the causative factor for the related disease, and 3) the application of population-level epidemiological study results to individual causation. Until now, the main approach to the causality of occupational diseases has been proximate causal relationships because of the practical difficulties in applying epidemiological causality to all events. As coverage under the Industrial Accident Compensation Insurance Act expands, the application of epidemiological causality must be considered, as well as the expansion of applicable occupational diseases. Moreover, doing that could provide enough evidence for managers and workers to take steps to prevent occupational disease. The safety net provided by industrial accident compensation insurance for protecting injured workers needs to be implemented on the basis of scientific evidence.

Health care perspectives on community care

The Ministry of Health and Welfare announced a plan for community care in March 2018. Community care is a concept of social services that includes residential, welfare, and health care services, as well as direct care. It is a policy to actively prepare for an aged society. Various services must be developed for comprehensive community care. It is especially necessary to ensure that adequate resources are provided for home care and visiting care. To achieve this goal, the benefit policies of health insurance and long-term care insurance must be changed. Community service providers and infrastructure must be expanded, and a diverse professional workforce should be trained. Doctors need training and experience as team leaders, as they will be able to work with nurses, nutritionists, and social workers. It will be particularly important to operate clinics as group practices rather than as solo practices. Change is also needed in community hospitals, which must receive orientations regarding early patient discharge plans and community-centered collaboration. Hospitals should serve as health care safety nets, including short-term stays and same-day care. Regional governance is important for community care. Doctors must work with a variety of institutions, including community health centers, welfare centers, and elderly facilities. Medical professionals should prepare for and lead future social changes.

Requirements for Cerebrovascular Surgery in Comprehensive Stroke Centers in South Korea

OBJECTIVE: Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs).METHODS: This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent’s opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons.RESULTS: Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery.CONCLUSION: Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.

Latent Class Analysis of Gambling Activities among Korean Adolescents

PURPOSE: The aim of this study is to identify the types of gambling among adolescents and provide basic prevention information regarding adolescents' gambling problems. METHODS: Secondary data from representative national survey on 2015 Youth Gambling Problems of Korea Center on Gambling Problems were used. Using latent class analysis (LCA), 13 gambling types such as offline and online games of 14,011 adolescents were classified, and gambling experiences and characteristics were analyzed. RESULTS: The subgroups of adolescent gambling were identified as four latent classes: a rare group (84.5% of the sample), a risk group (1.0%), an offline group (11.9%), and an expanded group (2.6%). The types and characteristics of gambling among the latent classes differed. In the risk group, adolescents participated in online illegal sports betting and internet casino, and gambling time, gambling expenses, and the number of gambling types were higher than other groups. CONCLUSION: Gambling frequently occur among adolescent, and the subtypes of gambling did not reveal homogeneous characteristics. In order to prevent adolescent gambling problems, it is a necessary to develop tailored prevention intervention in the nursing field, which is appropriate to the characteristics of adolescent gambling group and can help with early identification.

Requirements for Cerebrovascular Surgery in Comprehensive Stroke Centers in South Korea

OBJECTIVE: Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs). METHODS: This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent’s opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons. RESULTS: Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery. CONCLUSION: Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.

Health care perspectives on community care

The Ministry of Health and Welfare announced a plan for community care in March 2018. Community care is a concept of social services that includes residential, welfare, and health care services, as well as direct care. It is a policy to actively prepare for an aged society. Various services must be developed for comprehensive community care. It is especially necessary to ensure that adequate resources are provided for home care and visiting care. To achieve this goal, the benefit policies of health insurance and long-term care insurance must be changed. Community service providers and infrastructure must be expanded, and a diverse professional workforce should be trained. Doctors need training and experience as team leaders, as they will be able to work with nurses, nutritionists, and social workers. It will be particularly important to operate clinics as group practices rather than as solo practices. Change is also needed in community hospitals, which must receive orientations regarding early patient discharge plans and community-centered collaboration. Hospitals should serve as health care safety nets, including short-term stays and same-day care. Regional governance is important for community care. Doctors must work with a variety of institutions, including community health centers, welfare centers, and elderly facilities. Medical professionals should prepare for and lead future social changes.

Trends in the of epidemiological perspectives on the causality of occupational diseases

The main role of industrial accident compensation insurance is to protect injured workers and their families by providing various benefits. If a certain disease occurs due to work, the worker must prove the causal relationship between the work and the disease, although it is not easy for injured workers to do so. The epidemiological approach to causality is based on a comparison of the incidence rate in exposed and non-exposed groups. Recently, some arguments have been made regarding the application of epidemiological causality in litigation related to tobacco and some environmental-related diseases. The 3 main points of dispute are as follows: 1) the distinction between specific and non-specific diseases and causal inference, 2) the relative risk and the attributable fraction of the causative factor for the related disease, and 3) the application of population-level epidemiological study results to individual causation. Until now, the main approach to the causality of occupational diseases has been proximate causal relationships because of the practical difficulties in applying epidemiological causality to all events. As coverage under the Industrial Accident Compensation Insurance Act expands, the application of epidemiological causality must be considered, as well as the expansion of applicable occupational diseases. Moreover, doing that could provide enough evidence for managers and workers to take steps to prevent occupational disease. The safety net provided by industrial accident compensation insurance for protecting injured workers needs to be implemented on the basis of scientific evidence.

Nationwide cervical cancer screening in Korea: data from the National Health Insurance Service Cancer Screening Program and National Cancer Screening Program, 2009–2014 / 부인종양

OBJECTIVE: The rates of participation in the Korean nationwide cervical cancer screening program and the rates of abnormal test results were determined. METHODS: The database of the National Health Insurance Service (NHIS) was used during the study period (2009–2014). RESULTS: The participation rate increased from 41.10% in 2009 to 51.52% in 2014 (annual percentage change, 4.126%; 95% confidence interval [CI]=2.253–6.034). During the study period, women ≥70 years of age had the lowest rate of participation (range, 21.7%–31.9%) and those 30–39 years of age the second-lowest (27.7%–44.9%). The participation rates of National Health Insurance beneficiaries (range, 48.6%–52.5%) were higher than those of Medical Aid Program (MAP) recipients (29.6%–33.2%). The rates of abnormal results were 0.65% in 2009 and 0.52% in 2014, with a decreasing tendency in all age groups except the youngest (30–39 years). Every year the abnormal result rates tended to decrease with age, from the age groups of 30–39 years to 60–69 years but increased in women ≥70 years of age. The ratio of patients with atypical squamous cells of undetermined significance compared with those with squamous intraepithelial lesions increased from 2.71 in 2009 to 4.91 in 2014. CONCLUSION: Differences related to age and occurring over time were found in the rates of participation and abnormal results. Further efforts are needed to encourage participation in cervical cancer screening, especially for MAP recipients, elderly women and women 30–39 years of age. Quality control measures for cervical cancer screening programs should be enforced consistently.

The Influence of Community Characteristics on Food Insecurity Korean Adults / 보건행정학회지

BACKGROUND: This study was conducted to analyze the influence of socioeconomic characteristics of community on the food insecurity under the control of personal socioeconomic factors which may be influence to the food security. METHODS: Food insecurity and individual socioeconomic characteristics were obtained from 2012 community health survey. Socioeconomic characteristics of communities were extracted from the data of Statistics Korea and local governments. Personal socioeconomic factors were sex, age, educational status, job, and monthly family income. Socioeconomic characteristics of communities were administrative district (urban vs. rural), senior population rate, degree of financial self reliance, degree of financial independence, portion of welfare budget, number of welfare facilities, and unemployment rate. We analysed the relationships between the food insecurity and socioeconomic characteristics of community using multi-level analysis under the control of personal characteristics. RESULTS: On personal level age, sex, education status, and monthly family income were related with food insecurity. On community level administrative district (urban vs. rural), degree of financial independence, unemployment rate, and proportion of welfare budget among local general government accounts were related to individual food insecurity. Rural area, district with low levels of financial independence, low portion of welfare budget, and greater unemployment rate showed a higher level of food insecurity. CONCLUSION: To reduce the level of food insecurity in a community it is necessary to decrease the unemployment rate, in addition to providing support from the central government by increasing the proportion of the welfare budget so that both factors contribute to raising the degree of financial independence.

Effects of Diabetic Case Management on Knowledge, Self-Management Abilities, Health Behaviors, and Health Service Utilization for Diabetes in Korea

PURPOSE: This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. MATERIALS AND METHODS: The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. RESULTS: The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. CONCLUSION: This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.

Variation in the Numbers of Red Blood Cell Units Transfused at Different Medical Institution Types from 2006 to 2010 in Korea

BACKGROUND: This study aimed at assessing the number of red blood cell (RBC) units transfused at different types of medical institution and examining the characteristics of transfusion recipients. METHODS: We calculated and compared the number of transfusion recipients, total RBC units transfused, and RBC units transfused per recipient. Study data were extracted from insurance benefits reimbursement claims for RBC units at the Health Insurance Review & Assessment Service from 2006 to 2010. RESULTS: Between 2006 and 2010, the number of recipients of RBC units increased from 298,049 to 376,445, the number of RBC units transfused increased from 1,460,799 to 1,841,695, and the number of RBC units transfused per recipient changed from 4.90 to 4.89. The number of recipients aged > or =65 yr increased from 133,833 (44.9%) in 2006 to 196,127 (52.1%) in 2010. The highest number of RBC units was transfused to patients with neoplastic diseases (31.9%) and diseases of the musculoskeletal system and connective tissue (14.4%). More than 80% of the total number of RBC units were transfused at tertiary and general hospitals. However, this composition rate was slightly decreasing, with the composition rate for hospitals increasing from 12.6% to 16.3%. CONCLUSIONS: This study revealed an increase in the number of RBC units transfused over a 5-yr period due to an increase in the number of transfused recipients, especially recipients aged > or =65 yr; moreover, the number of RBC units transfused differed based on medical institution type. These results provide fundamental data on RBC transfusions required for future research.

Factors Affecting Diabetic Screening Behavior of Korean Adults: A Multilevel Analysis

PURPOSE: We investigated the role of individual and community level factors on diabetes screening test behavior. METHODS: We used individual-level data from 170,193 adults aged 30 years or older who were not diagnosed with diabetes and participated in the 2009 community health survey. Community-level data includes 253 communities and were collected from various national statistics. Multilevel logistic regression analysis was conducted. RESULTS: The rate of diabetes screening within the year prior to this study was 53.2%. Community variance of Model I, Model II and Model III was 0.236, 0.252 and 0.238, respectively. The proportional change in variance of Model II and Model III was -6.8% and -1.2%. The odds ratio for participation of diabetic screening of areas with bottom financial independence compared to areas with top was 0.84 (95% confidence interval, 0.74-0.96); the odds ratio of areas with top internist compared to areas with bottom was 1.15 (95% confidence interval, 1.01-1.31). CONCLUSION: This study identified a contextual effect influencing the participation of Korean adults in diabetes screening. It is necessary to develop specific policies that consider not only individual factors, but also community factors relating to individual behaviors to increase the likelihood of diabetes screening.

Factors Affecting the Validity of Self-Reported Data on Health Services from the Community Health Survey in Korea

PURPOSE: As a follow-up for the validity study of Community Health Surveys (CHSs), the purpose of this study was to evaluate the factors affecting the accuracy of CHSs by investigating subjects' characteristics. MATERIALS AND METHODS: We used data from 11,217 participants (aged 19 years or older) who had participated in the CHS, conducted by a local government in 2008 and analyzed the variables affecting the sensitivity and specificity of hospitalization and outpatient visit. RESULTS: Multivariate logistic regression analysis showed that, factors related with the sensitivity of hospitalization and outpatient visit questions were gender, age, marital status, chronic diseases, medical checkup, the subjective health status and necessary medical services. Factors related with the specificity were gender, marital status, educational background, chronic diseases, medical checkup, alcohol consumption, necessary medical services and sadness. CONCLUSION: This study revealed the subject-related factors associated with the validity of the CHS. Efforts to improve the sensitivity and the specificity from self-report questionnaires should consider how the characteristics of subjects may affect their responses.

Time Trends of Allergic Rhinitis and Effects of Residence on Allergic Rhinitis in Korea From 1998 Through 2007-2009

PURPOSE: Longitudinal changes in the prevalence of self-reported physician-diagnosed allergic rhinitis (AR) in Korea and the association between the prevalence of AR and type of residence area among Korean males and females in 1998, 2001, 2005 and 2007-2009 were evaluated. METHODS: Age-standardized prevalence was calculated using the Korea National Health and Nutrition Examination Survey (KNHANES) I-IV. Stratified factors of sex, age, and socioeconomic status were adjusted to compare the prevalence of AR in relation to residential area by multiple logistic analysis. RESULTS: The prevalence of AR increased by tenfolds from 1.2 % in 1998 to 12.0 % in 2007-2009. The trends for prevalence of AR were also statistically significant (p < .05). The age-standardized prevalence of AR among urban females was higher (13.9%) than that in rural females (11.5%). After adjustment for survey years, age, socioeconomic levels and asthma, the odds of AR were higher in urban than rural residents, except for males in 1998. CONCLUSION: The prevalence of AR in Korea has increased over the past decade, and living in an urban area may be a susceptible factor. For prevention and management of AR, further evaluations of contributing factors and mechanisms underlying differences in AR are needed.

Factors Affecting Preparation Stage to Quit Smoking in Men

PURPOSE: This study was done to investigate factors affecting preparation stage to quit smoking in men. METHODS: Based on data from the Community Health Survey conducted in Chungbuk Province in 2008, we estimated rates and odds ratio (OR) of smoking cessation intention for 2,639 men who were current smokers. Multivariate logistic regression analyses were used to identify factors affecting preparation stage to quit smoking. RESULTS: Among current male smokers, the rate of smoking cessation intention was 17.1%. The OR of factors affecting smoking cessation was as follows: Compared to men with middle school education, the OR for rate of smoking cessation intention in men with high school education was 1.47 (p=.018), and for college or higher, 1.55 (p=.017). Compared to being single, the OR for cohabitation after marriage was 1.61 (p=.011) and living alone after marriage, 2.23 (p=.005). The OR for attempt to quit smoking, exposure to secondhand smoke and participation in smoking education were 6.80 (p<.001), 1.32 (p=.020) and 1.69 (p=.005), respectively. CONCLUSION: Results of this study show that it is necessary to decrease exposure to secondhand smoke and to increase participation in smoking cessation education targeting current smokers to move them from precontemplation or contemplation stage to preparation stage.

Pre- and Post-transfusion Testing for Hepatitis B Virus Surface Antigen and Antibody in Blood Recipients: A Single-Institution Experience in an Area of High Endemicity

BACKGROUND: Hepatitis B remains the most common transfusion-transmitted viral infection. We explored the current status of pre-transfusion screening and post-transfusion follow-up testing for hepatitis B virus (HBV) surface antigen (HBsAg) and antibodies (anti-HBs) in blood recipients from an area of high HBV endemicity. METHODS: A total of 7,780 blood recipients were transfused with at least 1 unit of blood component at a single university hospital in Korea between January 2006 and December 2009. Their medical records were reviewed, and their demographic and transfusion-related data were analyzed. RESULTS: Pre-transfusion HBsAg and anti-HBs levels were tested in 77.6% (6,037/7,780) of the recipients. The results varied widely according to recipient age. In all, 32.8% (1,982/6,037) of the recipients who were tested had dual negative pre-transfusion results for HBsAg and anti-HBs and, therefore, were at increased risk of HBV transmission. Post-transfusion follow-up testing for HBsAg and/or anti-HBs was performed in 22% (436/1,982) of the increased-risk group. CONCLUSIONS: Our data show that current transfusion-related laboratory testing practice is not sufficient to properly investigate possible post-transfusion infections. Routine laboratory tests, including HBsAg and anti-HBs, should be recommended in transfusion guidelines.

Validity of Self-reported Healthcare Utilization Data in the Community Health Survey in Korea

To evaluate the sensitivity and specificity of Community Health Survey (CHS), we analyzed data from 11,217 participants aged > or = 19 yr, in 13 cities and counties in 2008. Three healthcare utilization indices (admission, outpatient visits, dental visits) as comparative variables and the insurance benefit claim data of the Health Insurance Review & Assessment Service as the gold-standard were used. The sensitivities of admission, outpatient visits, and dental visits in CHS were 54.8%, 52.1%, and 61.0%, respectively. The specificities were 96.4%, 85.6%, and 82.7%, respectively. This is the first study to evaluate the validity of nationwide health statistics resulting from questionnaire surveys and shows that CHS needs a lot of efforts to reflect the true health status, health behavior, and healthcare utilization of the population.

Application of Magnetic Resonance Imaging and Magnetic Resonance Angiography as Diagnostic Measures for the First Attack of Suspected Cerebrovascular Diseases in Korea

PURPOSE: No precise data are available showing how magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) can be applied to diagnosis for the first attack of a suspected cerebrovascular disease in Korea. The purpose of this study was to evaluate the application level of MRI and MRA as diagnostic tools and the related factors to the use of these techniques. MATERIALS AND METHODS: This study used the health benefit claim data of 89,890 patients who were hospitalized for the first time due to suspected cerebrovascular disease in 2007 without having visited medical institutions as an outpatient or inpatient from 2003 to 2006. RESULTS: Of the 89,890 cases, 28.4% took both MRI and MRA, 10.7% took only MRI and 6.9% took only MRA. The related factors identified in the multivariate logistic regression analysis were gender, type of insurance, type of medical institution, type of department, duration of hospitalization, and type of disease. CONCLUSION: This study showed that the application level of MRI and MRA as diagnostic measures for the first attack of a suspected cerebrovascular diseases varied depending on several factors. It is necessary to study more accurate levels of computerized tomography (CT), computerized tomography angiography (CTA), MRI or MRA as measures to diagnose a first attack of suspected cerebrovascular disease.

Validity of Measles Immunization Certificates Submitted upon Enrollment in an Elementary School in Korea / 예방의학회지

OBJECTIVES: To increase the booster vaccination rate, the Korean government legislated a measles vaccination for elementary school students in 2001, requiring parents to submit a certificate of vaccination upon the admission of the students to elementary school. The purpose of this study was to evaluate the validity of measles vaccination certificates which were issued to parents. METHODS: Using questionnaire survey data of 890 general practitioners and 9,235 parents in 2005, we investigated the evidence for booster vaccination certificates of measles. RESULTS: In the survey of general practitioners, 59.5% of the certificates depended on the medical records of clinic, 13.5% was immunization booklets, 23.7% was re-immunizations, 1.9% was confirmation of record of other clinics, and 1.4% was parents' statements or requests without evidence. In the survey of parents, 36.2% of the certificates depended on the medical records of clinic, 43.4% was immunization booklets, 18.0% was reimmunizations, and 2.4% was parents statements or requests without evidence. CONCLUSIONS: Our findings show that a majority of the booster vaccination certificates of measles was issued on the basis of documented vaccinations and it means that the implementation of the law requiring the submission of elementary school students' vaccination certificates has been very successful in Korea.

Factors Affecting the Designation of Cerebrovascular Diseases as Work-Related in Administrative Litigation

The purpose of this study was to identify factors that could be used as standardized criteria for evaluating occupational diseases in initial assessments or requests for examination. Using 100 administrative litigation cases on the work-relatedness of cerebrovascular diseases (CVDs) by the Seoul Branch of the Korea Labor Welfare Corporation (KLWC) from 1997 to 2002, we estimated the relationship between the investigated variables and designation of the work-relatedness of the CVD. As for the age, the odds ratio of the acceptance rate of a case as work-related in subjects over 60 yr of age was 0.08 (95% CI, 0.01-0.75), which was compared to subjects under 30 yr of age. Regarding working hours, the odds ratio of the acceptance rate of a case as work-related in CVDs in those over 56 hr was 9.50 (95% CI, 1.92-47.10) when compared to those less than 56 hr. As for the benefit type, the odds ratio of the acceptance rate of a case as work-related in medical benefits was 5.74 (95% CI, 1.29-25.54), compared to survivor benefits. As for the criteria for defining situations as work overload, the odds ratio of the acceptance rate of a case as work-related in injured workers was 12.06 (95% CI, 3.12-46.62), compared to that in non-injured workers. Our findings show that the criteria for defining situations of work overload played an important role in assessing the work-relatedness of CVDs in administrative litigation, and it is necessary to make the scientific evidence on judgement of workrelatedness on overwork.