Abstract

In Taiwan, the prevalence of colorectal cancer has been increasing in recent decades. As a result, the fecal occult blood test (FOBT) has been advocated and widely used for colorectal cancer screening in areas with limited colonoscopy capacity. The goal of this study was to analyze the sensitivity of a single immunochemical FOBT (I-FOBT) and correlate it with the results of colonoscopy for detecting colorectal neoplasia in the asymptomatic Taiwanese population. Data were collected from the results of health examinations conducted on asymptomatic adults older than 40 years and who simultaneously underwent one-time I-FOBT and colonoscopy examinations between January 01, 2008 and June 30, 2009. The sensitivity and specificity of the I-FOBT were calculated in correlation to age, size, and pathologic result. A total of 6096 patients were analyzed, including 3418 men and 2678 women, aged 40–87 years. I-FOBT result was positive in 229 patients (3.8%), the sensitivity of detection of total colorectal neoplasia and advanced neoplasia were 6.98% and 22.1%, respectively. A total of 13 participants were found to have invasive cancer in this study, and the sensitivity and specificity of the I-FOBT in this group were 69.2% and 96.4%, respectively. Besides, the positive rate of I-FOBT increased with age, with 40–49 years (2.89%), 50–75 years (4.21%), and >75 years (5.68%). In addition, the sensitivity for detecting total neoplasia and advanced neoplasia was similar in patients ≥50 years and ≥40 years of age. The I-FOBT has better sensitivity for detecting invasive cancer and advanced neoplasia than for detecting nonadvanced neoplasia. Repeated I-FOBT examinations with good adherence to the screening program may improve the detection rate and sensitivity of the I-FOBT.

Abstract

Deaths due to coronary heart disease (CHD) remain high worldwide, despite recent achievements. An effective screening strategy may improve outcomes further if implemented in a high or ‘at risk’ cohort. Asymptomatic CHD in the young maybe underappreciated and applying an effective screening strategy to a young cohort may lead to improved outcomes due to significant socioeconomic impact from the consequences of CHD in this sub-group. A positive family history of CHD, which is known to be associated with an increased risk of future myocardial events, could aid in identifying the ‘at risk’ young cohort. Traditional cardiovascular risk scoring systems are in wide use but lack the sensitivity or specificity required to estimate risk in an individual. Rather their use is limited to predicting population attributable risk. Functional studies such as exercise stress tests are readily available and cost effective but do not have the required sensitivity required to suggest their use as part of a screening protocol. Coronary CT angiography has been demonstrated to have high sensitivity for the detection of CHD and therefore may be suitable for screening purposes but there are concerns regarding radiation exposure. Here we review the evidence for the use of potential screening strategies and the suitability of using such strategies to estimate risk of CHD in a young ‘at risk’ population.

Abstract

The short version of Depression, Anxiety and Stress Scales (DASS-21, Lovibond y Lovibond, 1995) has been shown to have appropriate psychometric properties among Chilean adolescents and undergraduates. The current study was aimed at determining the cut-off scores of the Depression, Anxiety and Stress Scales (DASS-21) for screening Chilean youngsters at risk of mental health problems and requiring mental health treatment. The sample comprised 393 non-patients youngsters aged 15-24 and 77 youngsters at early stage of psychotherapy. The presence of symptoms was used as gold standard for estimating the cut-off betWeen non-symptomatic youngsters and symptomatic patients. Receiving Operating Characteristic (ROC) analyses allowed examining accuracy of each scale and sensitivity and specificity analysis was performed for determining the cut-off points. The area under the receiver operating characteristics curve (AUC) was higher than 0.9 for each scale of the DASS-21. The optimal cut-off score for the Depression scale was 6 and above, which resulted in sensitivity=88, 46 and specificity=86, 77, and a cut-off of 5 and above was optimal for the anxiety scale, with a sensitivity of 87, 50 and specificity of 83, 38.The Stress Scale had sensitivity of 81, 48 and specificity of 71, 36 at the optimal cut-off score of 6 and above. These findings suggest that the DASS-21 performs adequately as a screening tool to identify Chilean young people at risk of mental health problems.

Abstract

Road transport contributes to approximately one quarter of all EU greenhouse gas emissions and is the leading cause of air pollution in cities. There are significant measures aimed at the reduction of use phase environmental impacts; in the EU, these strategies focus on the decarbonisation of road transport, such as through the prioritization of low- and zero-emission vehicles. Electric vehicles are seen as one of the primary measures for reducing road transport impacts. However, the introduction of new technology includes new challenges throughout the vehicle life cycle, such as the need for critical raw materials, high-energy manufacturing, charging electricity, and waste management; this, in turn, leads to a risk of impact shifts between life cycle phases and impact categories. Life Cycle Assessment (LCA) is one way to analyse environmental impacts. Applying LCA and life cycle thinking in research and industry allows for the detection of impact shifts and environmental sub-optimisation. A full LCA study is demanding in terms of both data collection efforts and user expertise requirements. The need to simplify the process and results of an assessment in order to support decision-making was identified in the early days of LCA development. There are numerous simplification approaches in LCA. Previously, the most prominent simplification terms were screening and streamlined LCA; now, a multitude of names and approaches have emerged. There is no consensus in the LCA community about LCA simplifications. In some cases, the line between what should be considered an LCA, simplified LCA or neither is fuzzy. The haphazard application of simplifications in LCA studies undermines the transparency and confidence in results. The aim of this thesis is to use the life cycle perspective guided by simplified LCA approaches to increase our understanding of the risk of impact shifts, resulting from measures to reduce vehicle environmental impacts. Four appended publications present five LCA studies of road vehicles. All appended studies are simplified using different approaches. The studies examine different impact reduction measures such as changing drivetrains, reducing particulate emissions from braking, and the scrapping of old vehicles. A fifth publication is a literature review that explores the common understanding of simplifications used in published LCA studies. The review identifies and investigates the types of simplifications used and discusses how these might be categorised. The appended LCA studies examine both impact shifts from one life cycle phase to another and between impact categories. It is difficult to determine whether a decrease in a life cycle phase or impact category could offset an increase in another and, therefore, to be able to determine if an impact shift is an acceptable compromise. New smart materials are expected to solve many environmental impact issues; however, there are risks associated with insufficient life cycle inventory data, limitations in knowledge about potential environmental impacts, and inefficient regulations covering new materials. The analysis of simplification approaches and case studies indicates that most simplifications are motivated by the lack of primary data. Additionally, study findings strengthen concerns about the significant inconsistency in LCA simplification terminology and how well approaches are described in individual studies. There is a need for a common simplification terminology and reporting standard. Due to the wide variety of purposes, scenarios, and products assessed, it is impossible to devise a one-size-fits-all approach for simplifications, especially if the aim is to identify potential impact shifts. Vägtransporter orsakar ungefär en fjärdedel av EUs totala utsläpp av växthusgaser och är den ledande orsaken till luftföroreningar i städer. Betydande åtgärder syftar till att minska användningsfasens miljöpåverkan. EUs strategier fokuserar på att minska vägtransporters koldioxidutsläpp, t.ex. genom att prioritera fordon med låga eller inga användning-utsläpp. Elektriska fordon ses som en av de främsta åtgärderna för att minska miljöpåverkan från vägtransport. Dock innebär introduktionen av ny teknik nya utmaningar längs fordonets livscykel, t.ex. behov av kritiska råmaterial, högenergiproduktion, ökad el-behov vid laddning och avfallshantering. Det finns en risk för förskjutning av miljöpåverkan mellan livscykelfaser och påverkanskategorier.   Livscykelanalys (LCA) är ett sätt att analysera miljöpåverkan. Möjligheten att upptäcka förskjutning av miljöpåverkan och ineffektiva åtgärder för miljön är en anledning till att tillämpa LCA och livscykeltänkande inom forskning och industri. En fullständig LCA-studie kräver både betydande datainsamlingsinsatser och krav på användarexpertis. Behovet av att förenkla processen och utvärderingsresultaten för att stödja beslut identifierades redan tidigt under utvecklingen av LCA.   Det finns en betydande mängd av LCA förenklingar. De mest framträdande förenklingstillvägagångssätten var tidigare ”screening” och ”streamlined” LCA, dessutom har en mängd andra namn och tillvägagångssätt dykt upp. Det finns ingen konsensus inom LCA-världen om hanteringen av LCA förenklingar. I vissa fall är gränsen luddig mellan vad som ska betraktas som en LCA, förenklad LCA och ingendera. Godtycklig tillämpning av förenklingar i LCA-studier undergräver transparensen och förtroendet för resultaten.   Syftet med denna avhandling är att öka förståelsen för risken för förskjutning av miljöpåverkan, vid åtgärder för att minska fordonens påverkan, genom att använda livscykelperspektivet stödd av förenklad LCA. De fyra publikationerna inkluderar fem LCA-studier av vägfordon och fordonskomponenter. Alla fem studierna är förenklade genom olika tillvägagångssätt. Studierna undersöker olika miljöåtgärder så som att byta drivlina, minska partikelutsläpp vid bromsning och skrotning av gamla fordon. En femte publikation undersöker också den gemensamma förståelsen för LCA förenklingar, genom en litteraturöversikt av publicerade LCA-studier. Litteraturöversikten identifierade och undersökte vilka förenklingar som används och hur dessa skulle kunna kategoriseras.   De inkluderade LCA-studierna exemplifierade både förskjutning av miljöpåverkan mellan livscykelfaser och påverkanskategorier. Det är svårt att avgöra om en minskning i en livscykelfas eller påverkanskategori kan kompensera för en ökning i en annan. Detta betyder att det är komplicerat att kunna avgöra om en förskjutning av miljöpåverkan är en acceptabel kompromiss. Nya smarta material förväntas vara lösningen för många miljöproblem. Det finns emellertid risker med otillräcklig LCI-data, kunskapsbegränsningar angående potentiella miljökonsekvenser och ineffektiva regler gällande nya material.   Analysen av förenklingstillvägagångssätt och fallstudier indikerade att de flesta förenklingar styrdes av brist på primärdata. Dessutom stärktes anledningen till oro gällande den betydande inkonsekvens i LCA-förenklingsterminologin och hur väl tillvägagångssätten beskrivs i enskilda studier. Det finns ett behov av en gemensam terminologi och rapporteringsstandard för LCA förenklingstillvägagångssätt. På grund av studiers varierande syften, scenarier och analyserade produkter är det omöjligt att utforma ett generellt tillvägagångssätt för alla LCA förenklingar, särskilt om syftet är att identifiera potentiella förskjutningar av miljöpåverkan.