Economic burden of stroke: a systematic review on post-stroke care.

OBJECTIVES: Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps. METHODS: A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated. RESULTS: We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors. CONCLUSION: The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.

Characterization of VOC sources in an urban area based on PTR-MS measurements and receptor modelling.

In this study, the concentrations of volatile organic compounds were measured by the use of proton transfer reaction mass spectrometry, together with NO x , NO, NO2, SO2, CO and PM10 and meteorological parameters in an urban area of Belgrade during winter 2014. The multivariate receptor model US EPA Unmix was applied to the obtained dataset resolving six source profiles, which can be attributed to traffic-related emissions, gasoline evaporation/oil refineries, petrochemical industry/biogenic emissions, aged plumes, solid-fuel burning and local laboratories. Besides the vehicle exhaust, accounting for 27.6 % of the total mixing ratios, industrial emissions, which are present in three out of six resolved profiles, exert a significant impact on air quality in the urban area. The major contribution of regional and long-range transport was determined for source profiles associated with petrochemical industry/biogenic emissions (40 %) and gasoline evaporation/oil refineries (29 %) using trajectory sector analysis. The concentration-weighted trajectory model was applied with the aim of resolving the spatial distribution of potential distant sources, and the results indicated that emission sources from neighbouring countries, as well as from Slovakia, Greece, Poland and Scandinavian countries, significantly contribute to the observed concentrations.

Monitoring of trace element atmospheric deposition using dry and wet moss bags: accumulation capacity versus exposure time.

To clarify the peculiarities of trace element accumulation in moss bags technique (active biomonitoring), samples of the moss Sphagnum girgensohnii Rusow were exposed in bags with and without irrigation for 15 days up to 5 months consequently in the semi-urban area of Belgrade (Serbia) starting from July 2007. The accumulation capacity for 49 elements determined by ICP-MS in wet and dry moss bags was compared. The concentration of some elements, i.e. Al, V, Cr, Fe, Zn, As, Se, Sr, Pb, and Sm increased continuously with exposure time in both dry and wet moss bags, whereas concentration of Na, Cl, K, Mn, Rb, Cs, and Ta decreased. Irrigation of moss resulted in a higher accumulation capacity for most of the elements, especially for Cr, Zn, As, Se, Br, and Sr. Principal component analysis was performed on the datasets of element concentrations in wet and dry moss bags for source identification. Results of the factor analysis were similar but not identical in the two cases due to possible differences in element accumulation mechanisms.

Active moss biomonitoring of trace elements with Sphagnum girgensohnii moss bags in relation to atmospheric bulk deposition in Belgrade, Serbia.

Active biomonitoring with wet and dry moss bags was used to examine trace element atmospheric deposition in the urban area of Belgrade. The element accumulation capability of Sphagnum girgensohnii Russow was tested in relation to atmospheric bulk deposition. Moss bags were mounted for five 3-month periods (July 2005-October 2006) at three representative urban sites. For the same period monthly bulk atmospheric deposition samples were collected. The concentrations of Al, V, Cr, Mn, Fe, Ni, Cu, Zn, As, Cd, and Pb were determined by instrumental neutron activation analyses and atomic absorption spectrometry. Significant accumulation of most elements occurred in the exposed moss bags compared with the initial moss content. High correlations between the elements in moss and bulk deposits were found for V, Cu, As, and Ni. The enrichment factors of the elements for both types of monitor followed the same pattern at the corresponding sites.

Contribution to biomonitoring of some trace metals by deciduous tree leaves in urban areas.

Leaves of the deciduous tree species, horse chestnut (Aesculus hippocastanum L.) and Turkish hazel (Corylus colurna L.) were used as accumulative biomonitors of trace metal pollution in the urban area of Belgrade. Using differential pulse anodic stripping voltametry, trace metal concentrations (Pb, Cu, Zn, Cd) were determined at the single leaf level (ten leaves per species, per month), during two successive years with markedly different atmospheric level of trace metals. Increased trace metal concentrations in the leaves of A. hippocastanum reflected elevated atmospheric trace metal pollution, whereas C. colurna L. did not respond accordingly. The contents of Pb and Zn in soil over the same period also followed this trend. Anatomical analyses, in young as well as in old leaves of both species, indicated typical foliar injuries of plants exposed to stressful air conditions. Water relations that correspond to leaf age may have contributed to the considerable trace metal accumulation in leaves.

Characterization of trace metal particles deposited on some deciduous tree leaves in an urban area.

In 1996 and 1997 horse chestnut (Aesculus hippocastanum L.) and Turkish hazel (Corulys colurna L.) leaves were sampled at 2 m height in the Belgrade Botanic Garden, located in an urban area with heavy traffic. Using a scanning electron microscope with an energy dispersive X-ray spectroscopy (SEM-EDAX), the size, size distribution, morphology and chemical composition of individual particles were examined on the adaxial and abaxial surfaces of leaf discs of both species. The majority of particles observed on leaves belonged to a class of fine particles (D < 2 microm). Morphological and chemical composition indicated that the most abundant particles were soot and dust with minor constituents such as Pb, Zn, Ni, V, Cd, Ti, As and Cu. Using an electrochemical technique (DPASV), it was possible to measure trace metal concentrations (Pb, Cu, Zn) in a water-soluble fraction of deposits on each single leaf. Trace metal contents in the leaf deposits, increased during the vegetation period for both species and were considerably higher in A. hippocastanum due to different epidermal characteristics. The higher trace metal concentrations in deposits in 1997 reflected greater atmospheric pollution in the Belgrade urban area.