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  1. Economic burden of stroke: a systematic review on post-stroke care
    Rajsic S, Gothe H, Borba HH, Sroczynski G, Vujicic J, Toell T, et al.
    Eur J Health Econ, 2019 Feb;20(1):107-134.
    PMID: 29909569 DOI: 10.1007/s10198-018-0984-0
    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.

  2. Fulltext Health effects from contaminant exposure in Baltic Sea birds and marine mammals: A review
    Sonne C, Siebert U, Gonnsen K, Desforges JP, Eulaers I, Persson S, et al.
    Environ Int, 2020 06;139:105725.
    PMID: 32311628 DOI: 10.1016/j.envint.2020.105725
    Here we review contaminant exposure and related health effects in six selected Baltic key species. Sentinel species included are common eider, white-tailed eagle, harbour porpoise, harbour seal, ringed seal and grey seal. The review represents the first attempt of summarizing available information and baseline data for these biomonitoring key species exposed to industrial hazardous substances focusing on anthropogenic persistent organic pollutants (POPs). There was only limited information available for white-tailed eagles and common eider while extensive information exist on POP exposure and health effects in the four marine mammal species. Here we report organ-tissue endpoints (pathologies) and multiple biomarkers used to evaluate health and exposure of key species to POPs, respectively, over the past several decades during which episodes of significant population declines have been reported. Our review shows that POP exposure affects the reproductive system and survival through immune suppression and endocrine disruption, which have led to population-level effects on seals and white-tailed eagles in the Baltic. It is notable that many legacy contaminants, which have been banned for decades, still appear to affect Baltic wildlife. With respect to common eiders, changes in food composition, quality and contaminant exposure seem to have population effects which need to be investigated further, especially during the incubation period where the birds fast. Since new industrial contaminants continuously leak into the environment, we recommend continued monitoring of them in sentinel species in the Baltic, identifying possible effects linked to climate change, and modelling of population level effects of contaminants and climate change.
  3. Fulltext Seroprevalence of avian influenza in Baltic common eiders (Somateria mollissima) and pink-footed geese (Anser brachyrhynchus)
    Lam SS, Tjørnløv RS, Therkildsen OR, Christensen TK, Madsen J, Daugaard-Petersen T, et al.
    Environ Int, 2020 09;142:105873.
    PMID: 32585505 DOI: 10.1016/j.envint.2020.105873
    Blood plasma was collected during 2016-2018 from healthy incubating eiders (Somateria molissima, n = 183) in three Danish colonies, and healthy migrating pink-footed geese (Anser brachyrhynchus, n = 427) at their spring roost in Central Norway (Svalbard breeding population) and their novel flyway through the Finnish Baltic Sea (Russian breeding population). These species and flyways altogether represent terrestrial, brackish and marine ecosystems spanning from the Western to the Eastern and Northern part of the Baltic Sea. Plasma of these species was analysed for seroprevalence of specific avian influenza A (AI) antibodies to obtain information on circulating AI serotypes and exposure. Overall, antibody prevalence was 55% for the eiders and 47% for the pink-footed geese. Of AI-antibody seropositive birds, 12% (22/183) of the eiders and 3% (12/427) of the pink-footed geese had been exposed to AI of the potentially zoonotic serotypes H5 and/or H7 virus. AI seropositive samples selected at random (n = 33) showed a low frequency of serotypes H1, H6 and H9. Future projects should aim at sampling and isolating AI virus to characterize dominant serotypes and virus strains (PCR). This will increase our understanding of how AI exposure may affect health, breeding and population viability of Baltic common eiders and pink-footed geese as well as the potential spill-over to humans (zoonotic potential).
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