Gang formation and gang structure in Aruba: why they persist?

OBJECTIVE: The study of gangs is important to Aruba and some other Caribbean islands because gang existence is an issue at the moment and, to date, no research has been conducted on this disturbing social problem in the small Caribbean islands. DESIGN: This research is based on a qualitative research approach utilizing a single case study and is exploratory of nature. An ethnographic approach was applied. RESULTS: The study found that there are very dangerous gangs on the island, with similar structure, recruitments techniques and quitting difficulties as reflected as in the literature for other developed and developing countries. Specific findings are that some parents and trustful adults do nurture, encourage and inculcate gang attributes in their children and that members of the studied gang dropped out of school after they got involved in gang activities due to frequent gang violence at school. CONCLUSIONS: The study concludes that the one gang studied in Aruba is like a web of entrapment. This is because once you are a member of the gang, it is highly probable that you will become trapped with reduced opportunities to get out. Given the findings of the study therefore, there is a pressing need for immediate intervention to protect the island of Aruba from the detrimental effects which have the potential to ruin the image of Aruba as a tourist destination as well as to threaten the security and safety needs of its citizens.

Surfactant treatment in premature infants with respiratory distress syndrome in Curacao

Surfactant replacement therapy for Respiratory Distress Syndrome (RDS) in premature neonates has been established as an effective treatment, although significant mortality and morbidity remain. In Curacao, surfactant became available as a therapeutic option in 1994. A retrospective cohort study was performed to describe the results of surfactant treatment in premature newborns with RDS in Curacao between 1994 and 1998. Of 429 infants admitted to the study hospital in this period, 7.5 percent (n=32) developed RDS and were treated with surfactant. Twenty-five per cent (n=8) of these infants died, most of them in the first year of surfactant treatment. Twenty-eight per cent (n=9) developed bronchopulmonary dysplasia (BPD), the most frequently observed complication. The highest incidence of BPD (44 percent) was found in the very low birth weight infants (750-1500 g); all infants with BPD were 27-30 weeks of gestational age. The duration of ventilator dependence was significantly associated with the development of BPD (p < 0.05). No other risk factors for complications during the treatment course could be identified. The mean time between birth and the first surfactant treatment was more than nine hours. In this study, we found low incidence rates of RDS and BPD, and a considerable mortality in surfactant treated surfactant treatment newborns. This pilot study shows that surfactant treatment of premature infants is feasible in Curacao. Earlier administration of surfactant, preferably within 2-3 hrs after birth, is expected to lower the risk of death and oxygen dependence.(Au)

The Saba health study: methodology and main results

'The Saba Health Study' is the first large scale health interview survey of the island. This book presents the main results of the study. It discusses the population's health status, use of health services, and satisfaction with health care. Known health risks, such as smoking, alcohol consumption, and overweight are evaluated and compared with situations on the sister island of Curacao and in western countries. Attention is focused on the identification of risk groups in need of specific policy interventions and health promotion programs (AU)

Our experience with Retinophaty of prematurity screening in Curacao

At the beginning of 1996, we started with a structural periodical screening of babies that were prematurely born. This was done utilizing a protocol that was developed in cooperation with both the author and the Neonatology Department of our hospital in Curacao. After more than 200 screenings only one case of retinopathy of prematurity, stage 3, was detected. (AU)

New protocol of early preventative screening of children in coorporation with the island health services [abstract]

The protocol "Early Preventive Visual Screening of Children" has been developed in mutual Cooperation with both the Islands Ophthalmologic Society and the Department of Youth Preventitive Medicine of the Island Health Service. The aim is to periodically screen for function of the visual system in children starting at a very young age and going up to age 15 years. This means that at an early stage, dysfunctional problems can be detected and appropriately dealth with. This protocol has two parts. The first one is about the visual examination and the second part has to do with the visual acuity measurement in children. (AU)

Antimicrobial resistance in the Caribbean - Poster abstract

OBJECTIVE: To determine the resistance patterns of organisms causing hospital and community acquired infections in the English-and Dutch-speaking Caribbean. METHOD: The data on antimicrobial resistance of gram negative bacteria isolated in six laboratories during the first 6 month period in 1998 and pathogens isolated from community infections in selectedcountries during 1994-1997 were reviewed. RESULTS: The overall resistance of gram negative aerobic bacilli (excluding salmonella spp and shigella spp)to ampicillin (range 51-85 percent), gentamicin (range 3-11 percent and trimethoprim-sulphamethoxazole (range 27 to 47 percent) did not significantly differ between the laboratories and countries. The resistance to third generation cephalosporins was 9 percent and 16 percent in two laboratories in Trinidad. Multiple antibiotic resistant S typhimurium PT 104b, S heidelberg, Sh flexnerii type 2/2a and low levels of ampicillin and gentamycin resistant S enteritidis strains causing community acquired enteric infections were observed in the Caribbean. The rates of penicillin resistant pneumococci (1 percent) and chloramphenicol resistant H. influenzae ( 3 percent) were low in the Caribbean. CONCLUSIONS: The potential for introduction and spread pf resistance genes in the Caribbean is very high. Hence, continuing surveillance of antimicrobial resistant pathogens in nosocomial and community is essential in the Caribbean. (AU)

Chlamydial and gonococcal infections in Curacao: prevalence and determinants

OBJECTIVE: To determine prevalence and determinants of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among asymptomatic women and men in Curacao. DESIGN AND METHODS: This was a cross-sectional population-based study. Urine samples (n=579) were collected from Antillean people, > 18 years, randomly selected from participants of a 1994 population survey (the Curacao Health Study, n=2,248). For the detection of CT and Erasmus Medical Center, Rotterdam. RESULTS: CT and NG infections were found in 6.1 percent and 1.0 percent of samples, respectively. Concomitant CT and NG infection did not occur. Most CT infections were found in persons <44 years of age, the highest prevalence was found in the 18-24 year age group, 17.4 percent (13/75). In contrast, most NG infections were found in persons >44 years. CT infection, but not NG infection, was correlated with indices of low socio-economic status. Multiple regression confirmed the association of CT infection with age and socio-economic class. CONCLUSION: In Curacao, CT and NG infections are not epidemiologically linked. CT infection is highly prevalent and calls for a screening-intervention model based on prevalence and risk factors. (Au)

Increasing the incidence of the Guillain-Barre syndrome in Curacao

OBJECTIVE: To confirm an observed increase in the occurrence of Guillain-Barre syndrome (GBS) in patients in Curacao. DESIGN AND METHODS: Between 1987 and 1999, medical records of all patients who fulfilled the National Institute of Neurological Communicative Disorders and Stroke (NINCDS) criteria for GBS were reviewed. RESULTS: Forty-nine patients were diagnosed as GBS resulting in an incidence rate (IR) of 2.53/100,000 inhabitants (95 percent CI 1.87-3.35). From 1987 to 1991, the IR remained stable, whereas from 1992 to 1999, there was a linear increase in the IR. There was a high IR in the colder months and a low IR in the warmer months. Patients showed a low percentage of sensory involvement (17 percent, generally 65 percent), rapid progression of the disease (83 percent, generally 30 percent), high percentage of artificial respiration (31 percent, generally 17 percent) and high mortality rate (23 percent, generally 3-5 percent). Fifty-five percent of the patients reported a preceding gastroenteritis (GE); 9/10 serum samples showed evidence of a recent Campylobacter jejuni infection. CONCLUSIONS: This is the first report of an increase in IR of GBS over a longer period, associated with low percentage of sensory involvement, a more severe course and a high mortality rate. The characteristics suggest a role for C jejuni. Prospective research is needed to show whether the increase in GBS is due to an overall increase in IR of C. jejuni infections on the island.(Au)

Respiratory syncytial virus infections in Curacao

OBJECTIVE: To collect epidemiological data on the prevalence of respiratory syncytial virus (RSV) in Curacao and to assess a possible relation to seasons. DESIGN AND METHODS: All children aged 0 to 24 months admitted to the paediatric ward of St. Elisabeth Hospital in Curacao with acute lower respiratory tract illness (tachypnoea, dyspnoea with wheezing, crepitations or cough), from October 1998, to October 1999, were enrolled. Excluded from the study were patients whose respiratory symptoms were caused by a foreign body, congenital malformation of heart, lung or thorax. RESULTS: Forty-four children fulfilled the study criteria; 20 (47 percent) were RSV positive for parainfluenza virus. Almost half (48 percent) of the total population was ex-premature. The majority of the RSV infections occurred during the two rainy periods and >50 percent (n=34) of all children had acute otitis media. The frequency of otitis media, positive RSV test and length of hospital stay was higher for the ex-prematures. Cyanosis was present in 2/10 (20 percent) of RSV positive and 2/23 (9 percent) of RSV negative cases. None of the patients required artificial ventilation and none died. CONCLUSION: RSV infection does occur in Curacao mostly during the rainy season. Ex-prematures seem to be especially at risk and otitis media is found in the majority of cases. In the light of the growing number surviving extreme prematurity, RSV prophylaxis needs to be considered.(Au)

HIV registration in the Netherlands Antilles 1985-1996 - abstract

The objectives of this paper are to describe the HIV/AIDS epidemiology in the Netherlands Antilles over the last decade and the problems attached to the registration of these cases in a country that is spread over five islands. Some of the problems are that the total number of persons tested for HIV are not recorded, there is a lack of concensus on what case-definition to use in AIDS cases and when to start with administration of drugs. These problems in registration and the ensuing deficiences in the current data give further rise to underestimating the HIV/AIDS epidemic. Since HIV/AIDS has profound impication on demographic, economic and social aspects of a society; and considering the fact that there is still no cure for the disease, it is important to understand and to have a clear picture of the epidemilogy and the consequences of HIV infection and AIDS for the population. From 1985 until the third quarter of 1996 the cumulative total of known HIV -infected persons in the Netherlands Antilles was 793. Most of them are between the ages of 25 and 44 years. From 1991 and 1993 the leading cause of death of in Curacao for people between 25 to 44 years was AIDS. HIV/AIDS accounted for 14 percent of all deaths in this age group in 1991-1993. Curacao and Saint Maarten account for 97.5 percent of the known HIV-infected for the Netherlands Antilles. Recommendations are made for improving the HIV/AIDS registration in the Netherlands Antilles. (AU)

Serum calcium and vitamin D status of patients with sickle cell disease in Curacao: comparison with Saudi Arabia

Data from Saudi Arabia suggest that low vitamin D status is involved in skeletal abnormalities of patients with homozygous sickle-cell disease (HbSS). We measured parameters of calcium homeostasis and vitamin D status in HbSS patients (median age: 8 years, range: 3-19; 8 females, 10 males) and matched HbAA controls living in the tropical island of Curacao. Serum calcium of HbSS patients (2.32 ñ 0.07 mmol/l) was lower (ANCOVA, p = 0.002) than that of HbAA controls (2.44 ñ 0.14). None of the subjects had hypocalcaemia. There were no differences in phosphate, total protein, albumin, intact parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D; HbSS 87 ñ 27, HbAA 86 ñ 15 nmol/l] and 1,25-dihydroxyvitamin D. There were no significant relationships between serum calcium and albumin, calcium and total protein, and PTH and 25 (OH)D. Our data suggest that hypocalcaemia and hyperparathyroidic tendencies in Saudi Arabian HbSS patients are likely to be caused by the locally poor vitamin D status, attributable to insufficient exposure to direct sunlight (AU)

One year of perinatal registration in Curacao - abstract

Perinatal care in Curacao has been a cause for concern because of parameters that show poor outcome and the lack of an adequate, uniform and flexible registration system. In addressing this problem, the government chose a system that could deliver up-to-date information, make continuous evaluation possible and be an instrument in ensuring delivery of a minimum of antenatal care. After a try-out period, the Sistema Informatico Perinatal (SIP) of the Centro Latino Americano de Perinatologia y Desarollo Humano (CLAP) was introduced on October 1, 1993, among all practising midwives. This study analyses data compiled during the first year. Most striking results: low rate of missing information; high rate of teenage pregnancy; high rate of expecting mothers who made their first antenatal visit in their third trimester of pregnancy. Most frequent maternal pathologies: threat of premature labour, urinary tract infections, puerperal bleeding, premature rupture of membranes and pre-eclampsia. Most frequent new-born pathologies: hyper-bilirubinaemia, infections and RDS. We conclude that the CLAP system has the potential to provide timely information on antenatal and maternal data important for proving optimal care during pregnancy (AU)

Lipids, apolipoprotein-E genotypes and other risk factors of patients with coronary artery disease in Curacao, the Netherlands Antilles - abstract

We studied lipids, apolipoprotein-E genotypes (apoe) and other coronary artery disease (CAD) risk factors of 67 CAD patients (male/female ratio 6) in Curacao. Compared with 57 controls, male CAD patients had higher cholesterol, triglycerides, LDL-cholesterol, apo-apo-B, apo-B/apo-Al, and decreased HDL-cholesterol and HDL-cholesterol/cholesterol. Other CAD risk factors were increased fasting glucose, HbA1c and prevalences of renal disease, diabetes mellitus type II (DM-II), positive CAD family history and cigarette smoking. Male CAD patients had higher plasma O-tocopherol eq but normal plasma O-tocopherol eq/ total lipid and á-carotene/total lipid; 38.5 percent of male CAD patients and 37.8 percent of male controls had Lp(a) above 300 mg/l. Compared with 29 female controls, female CAD patients had higher fasting plasma glucose, HbA 1c and prevalences of renal disease and DM-II. Predicting factors for CAD development in the whole CAD group were DM-II, cigarette smoking, apo-i3/i4 and apoi4. Apo-i was associated with lower DLH-and higher LDL-cholesterol. We conclude that classical atherogenic lipid profiles are associated with CAD in Curacao. It is questionable whether Lp(a) contributes to CAD in a predominantly negroid population. DM-II may considerably contribute to CAD development, notably in women. Apoi4, possibly because of induction of atherogenic lipid profile, is likely to be a risk factor (AU)

Analysis of investment process in health and the environment in Netherland Antilles

Analyses the investment process in the environment and health in the Netherlands Antilles. Provides a macroeconomic and sectoral overview then proceeds to consider investment policies; public investments in health and environment; the principal constituents in the investment process and their interrelationships and investment allocation and project preparation. Suggests that intiatives be undertaken to get more involvement in the process of environment and health investments and that multi-year planning be instituted. (AU)

How healthy is Curacao?

The Curacao Health Study describes the health status and medical consumption of the population; assesses the prevalence of determinants of health especially lifestyle aspects which have health risks; analyzes and evaluates the relationships between health status, mediating variables and medical consumption; and recommends among others, a task force on health research being charged to undertake a long-term research strategy, extend the Curacao Health Study to other islands of the Netherlands Antilles, and sollicit technical support for this research development strategy. Proposes to not only describe the relations between lifestyle, health status and medical consumption, but to explain why the relations exist in a bid to inform health policy.(AU)

Cancer in the Caribbean and environs: a comparison of age-standardized rates for 9 population groups

Age-standardized rates for cancer in Kingston and St. Andrew, Jamaica are presented by site and sex, and compared with data from registries in the Caribbean and adjacent regions. These comprise Costa Rica, Cuba, Cali (Colombia), Martinique, the Netherlands Antilles (excluding Aruba), New Orleans (Whites and Blacks) and Puerto Rico. There are significant differences which demand explanation. Overall, the reported rates are highest in New Orleans, which leads in breast cancer, tumours of bronchus, larynx, colon, rectum, pancreas, prostate and bladder. Lymphomas occur most frequently in Whites in New Orleans while Blacks in that city show similiar rates to other registries in the area. Cali (Colombia) and Costa Rica lead in cervical cancer, with Jamaica third. The lowest figure is for Whites in New Orleans. Cali (Colombia) and Costa Rica also have very high rates for gastric cancer, and low rates for colonic. Oesophageal cancer is highest in Blacks in New Orleans, followed by Martinique and the Netherlands Antilles. Jamaica has shown a steady decline for this site over 30 years. The rate in Whites in New Orleans is only one-fourth of that in Blacks. (AU)