Financial burden of survivors of medically-managed myocardial infarction and its association with selected social determinants and quality of life in a lower middle income country.

BACKGROUND: Burden from ischemic heart disease is rising in Sri Lanka due to the demographic and epidemiological transitions. Documented literature is scarce on quality of life, financial burden and its determinants in relation to myocardial infarction (MI). This study was done to describe the financial burden among the survivors of MI managed only with drugs (i.e. those who did not undergo Percutaneous Coronary Intervention or Coronary Artery Bypass Graft) and its association with selected social determinants (SDHs) and quality of life (QOL). METHODS: A cross sectional study was done among MI survivors in 13 hospitals in the premier province of Sri Lanka. Out of 336 participants recruited at hospital stay, 270 responded through a self-administered questionnaire at 1 month post discharge. Questionnaire included sections on financial burden, selected SDHs and on QOL measured by the EQ-5D-3 L QOL tool. Presence of financial burden was determined using an operational definition. Associations were tested with Mann-Whitney-U test, Chi square test and Spearman-correlation-coefficient at 5% significant level. RESULTS: Around 40% (n = 116) had to seek financial support for out-of-pocket expenditure. Nearly 5% (n = 6) of previously employed participants had lost their job. Of the employed respondents (n = 139, 51.5%), 29% (n = 85) had limited physical activity and 40% (n = 115) had limitations of employment time. Of the respondents, 15.4% had to apply for a loan, 7.8% had to sell a property, 19.1% had an income loss and 33.8% had to restrict usual expenses. Financial burden was not significantly associated with gender (p = 0.146), ethnicity (p = 0.068), highest education (p = 0.184) and area of residence (p = 0.369). Influence of income (p = 0.001), social support (p = 0.002) and the health infrastructure (p < 0.001) were significantly associated with the occurrence of a financial burden. In the group with a financial burden, the index score (p = 0.002) and VAS score (p < 0.001) of EQ-5D-3 L were significantly lower. CONCLUSIONS: Financial burden is common among survivors of medically-managed occurring irrespective of the gender, ethnicity, education and the area. It is influenced significantly by the income, level of social support and the level of health infrastructure. The financial burden is influencing the post-discharge-1-month QOL.

Trace-level determination of 1,4-dioxane in water by isotopic dilution GC and GC-MS.

The volatile and polar solvent 1,4-dioxane has recently been reported as a contaminant of ground and surface waters, establishing the need to determine this substance in drinking water. This investigation established that 1,4-dioxane can be determined in water by various techniques including direct aqueous injection (DAI) gas chromatography (GC) and purge and trap GC-mass spectrometry (MS). Purge and trap GC-MS is limited by 1,4-dioxane's poor purge efficiency, resulting in detection limits up to 100 times greater than the efficiently purged volatile organic compounds. To attain the sensitivity required for drinking water monitoring, a method based on continuous liquid-liquid extraction with dichloromethane was developed. Isotope dilution was more accurate and reproducible than quantification with external standards, and the improvement in precision led to a lower method detection limit, 0.2 microgram L-1, using a quadrupole ion trap instrument in the electron ionization mode. Isotope dilution accuracy approached 100% in ppb determinations. Isotopic dilution quantification was also possible using a non-selective GC detector owing to the high efficiency of capillary GC columns that resolve the deuterium-labeled solvent from the natural isotopes.

Multiresidue HPLC methods for phenyl urea herbicides in water.

High-performance liquid chromatography (HPLC) methods for the determination of phenyl urea herbicides in water are described. The target compounds include chlortoluron, diuron, fluometuron, isoproturon, linuron, metobromuron, metoxuron, monuron, neburon, and siduron. Water was subjected to solid phase extraction (SPE) using either automated SPE with 47 mm C(18) Empore disks or on-line precolumn concentration. Herbicides were separated on a C(18) reversed phase column with an acetonitile-water gradient and were detected with either a diode array detector (DAD) or a postcolumn photolysis and derivatization (PPD) detector system. Photolysis converted the phenyl ureas to monoalkylamines that were derivatized to fluorescent isoindoles by reaction with o-phthalaldehyde and 2-mercaptoethanol. The DAD monitoring at 245 nm was linear over three decades with instrument detection limits of approximately 0.01 mg/L. SPE efficiency was between 48 and 70% in laboratory reagent water, but use of the internal standard quantitation method improved accuracy. High total dissolved solids and total organic carbon values in surface water improved recoveries relative to laboratory reagent water for all of the phenyl ureas. In Colorado River water spiked at 1 or 50 microg/L, mean recoveries ranged from 74 to 104%. Method detection limits (MDLs) ranged from 4 to 40 ng/L (parts per trillion) with the DAD instrument. PPD detection was highly specific but resulted in a slight loss in chromatographic efficiency and average MDLs approximately 5 times higher using a single set of detection conditions. The study indicates that methods based on SPE followed by HPLC with diode array or PPD detection have practical utility for trace analysis of phenyl ureas in drinking water or surface waters.

Determination of rotenoids and piperonyl butoxide in water, sediments and piscicide formulations.

Rotenone is a naturally occurring insecticide and piscicide (fish poison) found in many leguminous plants. This paper describes high-performance liquid chromatography (HPLC) methods for the quantitative analysis of rotenone's principal biologically active components (rotenone, tephrosin, rotenolone, deguelin) and the synergist piperonyl butoxide (PBO) in various media. Compounds were separated on a C18 reversed phase column with an acetonitrile-0.025 M phosphoric acid mobile phase and detected by UV absorbance or fluorescence (PBO only). Solid phase extraction (SPE) was used in either coupled (on-line) mode with a C18 concentrator column or automated off-line mode using Empore C18 disks. The on-line extraction efficiency was improved significantly by adding small amounts of methanol to water. Method detection limits (MDLs) for rotenoids and PBO in reagent water were 0.3 and 2 micrograms L-1, respectively, with optimal recoveries ranging from 90% to 99%. Aquatic sediments were extracted with methanol and the extracts were diluted in water prior to analysis by coupled SPE-HPLC. In wet sediments, detection limits were approximately 20-100 micrograms kg-1 with recoveries of 71% to 87%. Sonication in dimethyl sulfoxide (DMSO) followed by dilution in acetonitrile and filtration allowed determination of the active ingredients in powdered rotenone formulations. Details of sample preparation, cartridge column cleanup and analyte confirmation are provided.