Traditional healing practices originating in Aruba, Bonaire, and Curaçao: A review of the literature on psychiatry and Brua.

Brua is an Afro-Caribbean religion and healing tradition from the southern part of the former Netherlands Antilles. Like other Caribbean healing traditions, it plays a significant role in shaping how individuals experience and express disorders which Western health professionals consider to require psychiatric care. Because little has been published on Brua, and because patients from Aruba, Bonaire, and Curaçao are often reluctant to discuss their commitment to this tradition, they are often misdiagnosed and either over- or undertreated by biomedically trained health professionals. The present paper provides a review of the literature on Brua and its relation to psychiatry. A systematic search was carried out in PubMed, the Ovid database, Google Scholar, and the historical literature. Our search yielded 35 texts on Brua, including three peer-reviewed scientific papers and eight academic theses. From those texts Brua emerges as a holistic patchwork of creolized beliefs and practices which are considered to be both cause and remedy for a wide variety of ailments. Despite the fact that tension between the Brua discourse and Western-oriented psychiatric practice is significant, adherence to Brua does not seem to cause much patient delay in help-seeking. However, belief in Brua as a possible source of mental and physical complaints, as well as patients' frequent recourse to Brua practices, including the use of hallucinogens, may affect the diagnosis and treatment of mental disorders.

Induced abortion is not associated with a higher likelihood of depression in Curaçao women.

OBJECTIVE: To investigate the risk of developing a depression after induced abortion. METHODS: A prospective cohort study conducted in Curaçao which involved 92 women having an induced abortion and 37 women delivering after an unplanned or unwanted pregnancy, who served as controls. All participants completed the Center of Epidemiological Studies Depression (CES-D) scale before and two to three weeks after the abortion or delivery. RESULTS: Following the abortion, significantly fewer women were at risk of depression (30%) as compared to when still pregnant (60%). Mean depression scores were significantly lower after- than before the procedure. The likelihood of depression post-abortum (30%) was similar to that after delivery of an unplanned/unwanted child (22%). Even though women in the abortion group more often reported having suffered from depression in the past than controls, they were not at greater risk of depression after their pregnancy had ended. CONCLUSION: Curaçao women's risk of developing a depression following an (early) induced abortion is not greater than that after carrying to term an unplanned/unwanted pregnancy. We recommend that the results of this study be taken into account in case the Curaçao government should consider legalisation of induced abortion in the near future.

Vitamin D deficiency in risk groups living in tropical curaçao / Deficiencia de vitamina D en los grupos de riesgo de curazao tropical

OBJECTIVE: Curaçao (12 degrees 10N, 69 degrees 0W) is characterized by whole year abundant sunshine (8-10 hours/day). We challenged the automatic assumption that people living in tropical countries do not have a high risk of vitamin D deficiency, and investigated the vitamin D status in a tropical environment. METHODS: For this, we selected fiftytwo elderly people with little or no exposure to direct sunlight [median 84 (60-96) years; 34 females, 18 males] and who were cared for by community nurses or lived in retirement or nursing homes. Furthermore, six rehabilitating orthopaedic patients [median 72 (38-90) years; one female, five males] were included. Serum 25(OH)D, calcium, phosphate, parathyroid hormone (PTH) and creatinine were measured. Those exhibiting elevated creatinine, PTH or both had their 1,25dihydroxyvitamin D [1,25(OH)2D] examined. RESULTS: Serum levels of 25(OH)D below 25, 50 and 75 nmol/L were detected in, respectively, seven (12%), 22 (38%) and 48 (83%) of the fiftyeight persons. Four persons had combined high creatinine and PTH, and low 1,25(OH)2D, which was not known by their caregivers. CONCLUSION: Abundant sunshine outdoors is no guarantee for vitamin D sufficiency. More attention is needed for vitamin D deficiency in risk groups living in tropical areas and elderly persons with poor kidney function.

OBJETIVO: Curazao (12 grados 10N, 69 grados 0W) se caracteriza por su abundante luz solar durante todo el año (8-10 horas/día). Ponemos en duda la suposición automática de que los habitantes de países tropicales no poseen un alto riesgo de deficiencia de vitamina D, e investigamos los niveles de vitamina D en un ambiente tropical. MÉTODOS: Para ello, seleccionamos a cincuenta y dos personas de avanzada edad [mediana 84 (60-96) años; 34 mujeres, 18 hombres] con poca o ninguna exposición directa a la luz solar, cuidados por enfermeras comunitarias o que vivían en hogares de ancianos o casas de retiro. Además, se incluyeron seis pacientes bajo rehabilitación ortopédica [mediana 72 (38-90) años; una mujer, cinco hombres]. Se les realizaron las siguientes mediciones: 25(OH)D en suero, calcio, fosfato, hormona paratiroidea (HPT), y creatinina. A todos aquellos que mostraron niveles elevados de creatinina, de HPT, o de ambas, se les realizó un examen de 1,25dihidroxivitamina D [1,25(OH)2D]. RESULTADOS: Se detectaron niveles séricos de 25(OH)D por debajo de 25, 50 y 75 nmol/L en siete (12%), 22 (38%) y 48 (83%) de las cincuenta y ocho personas, respectivamente. Cuatro personas presentaron una combinación de elevada creatinina y HPT, y bajo 1,25(OH)2D, datos desconocidos para sus cuidadores. CONCLUSIÓN: La abundancia de luz solar exterior no es garantía de suficiencia de vitamina D. Se necesita prestar mayor atención a la deficiencia de vitamina D en los grupos de riesgo que viven en áreas tropicales, así como a las personas de edad avanzada con pobre función renal.

Child abuse: a common problem in Curaçao? / Abuso infantil: ¿Un problema común en Curazao?

OBJECTIVE: To assess the prevalence of child abuse among high school students in Curaçao. METHODS: A questionnaire survey among high school students up to 17 years of age was conducted. The questionnaire was based on existing literature and validated questionnaires. The questionnaire used was analysed and adapted to the situation in Curaçao by a panel of experts on child abuse. The primary objective was to gain insight into the incidence, prevalence and various forms of child abuse among students in Curaçao. Five forms of child abuse are distinguished in the literature: physical abuse, emotional abuse, sexual abuse, neglect and exploitation. Furthermore, the degree of confidence of the students in general practitioners (GPs) as care providers in the field of child abuse was explored. RESULTS: Questionnaires from 545 of the 628 respondents were included. In total, 43% of the respondents had ever-experienced an event which could be defined as (a form of) child abuse. More than one-third of the respondents reporting child abuse ever had an experience that could be interpreted as physical abuse. More than 15% of the respondents reporting child abuse had experienced sexual abuse. Girls experienced significantly more sexual abuse than boys. Emotional abuse in the last year was experienced by 3% of the respondents. One per cent of the respondents ever-experienced neglect. according to most respondents, GPs were not seen as care providers in cases of child abuse; they believed that GPs were mainly to be consulted for illnesses or physical symptoms and not for forms of child abuse. CONCLUSION: The prevalence of ever-having-experienced a form of child abuse is estimated at 431 per 1000 students. Child abuse, particularly physical abuse, is common in Curaçao, and is probably comparable to other surrounding countries. General practitioners were not seen as care providers in identifying and reporting cases of child abuse according to most respondents.

OBJETIVO: Evaluar la prevalencia del abuso infantil entre estudiantes de secundaria en Curazao. MÉTODOS: Se aplicó un cuestionario entre estudiantes de secundaria de hasta 17 años de edad. El cuestionario se basó en la literatura existente y cuestionarios validados. El cuestionario usado fue analizado y adaptado a la situación de Curazao por un panel de expertos en abuso infantil. El objetivo principal fue profundizar los conocimientos acerca de la incidencia, prevalencia y diversas formas de abuso infantil entre estudiantes en Curazao. La literatura distingue cinco formas de abuso infantil: abuso físico, abuso emocional, abuso sexual, negligencia y explotación. Además, se exploró el grado de confianza de los estudiantes en los médicos generales (MGs) como proveedores de cuidado en el área del abuso infantil. RESULTADOS: Se incluyeron los cuestionarios de 545 de los 628 encuestados. En total, 43% de los encuestados nunca habían pasado por una experiencia que pudiera interpretarse como (forma de) abuso infantil. Más de un tercio de los encuestados a los que se les pidió reportar abuso infantil, jamás había tenido una experiencia que pudira interpretarse como abuso físico. Más del 15% de los encuestados sobre abuso infantil habían experimentado abuso sexual. Las niñas experimentaron significativamente más abuso sexual que los niños. El abuso emocional en el último año fue experimentado por 3% de los encuestados. El uno por ciento de los encuestados jamás experimentó negligencia. Los médicos generales no eran vistos como proveedores de cuidado en los casos de abuso infantil, de acuerdo con la mayoría de los encuestados. Según ellos, los MGs deben ser consultados principalmente en el caso de enfermedades o síntomas físicos, y no en casos de formas de abuso infantil. CONCLUSIÓN: La prevalencia de nunca haber experimentado una forma de maltrato infantil se estima en 431 por 1000 estudiantes. El abuso infantil, en particular el abuso físico, es común en Curazao, y es probablemente comparable a otros países circundantes. Los médicos generales no eran vistos como proveedores de cuidado en cuanto a identificar y reportar casos de abuso infantil, según la mayor parte de los encuestados.

Vitamin D deficiency in risk groups living in tropical Curaçao.

OBJECTIVE: Curaçao (12 degrees 10ON, 69 degrees OW) is characterized by whole year abundant sunshine (8-10 hours/day). We challenged the automatic assumption that people living in tropical countries do not have a high risk of vitamin D deficiency, and investigated the vitamin D status in a tropical environment. METHODS: For this, we selected fifty-two elderly people with little or no exposure to direct sunlight [median 84 (60-96) years; 34females, 18 males] and who were cared for by community nurses or lived in retirement or nursing homes. Furthermore, six rehabilitating orthopaedic patients [median 72 (38-90) years; one female, five males] were included. Serum 25(OH)D, calcium, phosphate, parathyroid hormone (PTH) and creatinine were measured. Those exhibiting elevated creatinine, PTH or both had their 1,25-dihydroxyvitamin D [1,25(OH)2D] examined. RESULTS: Serum levels of 25(OH)D below 25, 50 and 75 nmol/L were detected in, respectively, seven (12%), 22 (38%) and 48 (83%) ofthe fifty-eight persons. Four persons had combined high creatinine and PTH, and low 1,25(OH)2D, which was not known by their caregivers. CONCLUSION: Abundant sunshine outdoors is no guarantee for vitamin D sufficiency. More attention is needed for vitamin D deficiency in risk groups living in tropical areas and elderly persons with poor kidney function.

Child abuse: a common problem in Curaçao?

OBJECTIVE: To assess the prevalence of child abuse among high school students in Curacao. METHODS: A questionnaire survey among high school students up to 17 years of age was conducted. The questionnaire was based on existing literature and validated questionnaires. The questionnaire used was analysed and adapted to the situation in Curaçao by a panel of experts on child abuse. The primary objective was to gain insight into the incidence, prevalence and various forms of child abuse among students in Curaçao. Five forms of child abuse are distinguished in the literature: physical abuse, emotional abuse, sexual abuse, neglect and exploitation. Furthermore, the degree of confidence of the students in general practitioners (GPs) as care providers in the field of child abuse was explored. RESULTS: Questionnaires from 545 of the 628 respondents were included. In total, 43% of the respondents had ever-experienced an event which could be defined as (a form of) child abuse. More than one-third of the respondents reporting child abuse ever had an experience that could be interpreted as physical abuse. More than 15% of the respondents reporting child abuse had experienced sexual abuse. Girls experienced significantly more sexual abuse than boys. Emotional abuse in the last year was experienced by 3% of the respondents. One per cent of the respondents ever-experienced neglect. According to most respondents, GPs were not seen as care providers in cases of child abuse; they believed that GPs were mainly to be consulted for illnesses or physical symptoms and not for forms of child abuse. CONCLUSION: The prevalence of ever-having-experienced a form of child abuse is estimated at 431 per 1000 students. Child abuse, particularly physical abuse, is common in Curaçao, and is probably comparable to other surrounding countries. General practitioners were not seen as care providers in identifying and reporting cases of child abuse according to most respondents.

Epidemiology of febrile diseases in the emergency department of a Caribbean island: the Curaçao experience.

OBJECTIVE: The aetiology of febrile diseases in tropical countries often remains poorly characterized. We aim to describe the aetiology and outcome of febrile illnesses at the Emergency Department (ED) in Curaçao. METHODS: From April 2008 - April 2009, all adult febrile patients (T> 38.5 degrees C) at the ED of the St Elisabeth Hospital, Curaçao, Netherlands Antilles, were included. Clinical data were recorded, routine laboratory measurements and blood cultures were taken. Final diagnoses were made at discharge by an independent physician and in retrospect by the main investigator RESULTS: Four hundred and three patients were included: 223 patients (55.6%) were hospitalized, 32 patients (7.9%) died and 18 patients (4.5%) were admitted to the Intensive Care Unit. In 129 febrile patients (32.0%), infection was proven; 84.4% of patients had bacterial (29.0% urinary tract infection, 23.2% pneumonia infection), 5.6% viral and 10.0% parasitic or fungal infections. Twenty-one patients (5.2%) were discharged with a non-infectious diagnosis and 172 patients (42.7%) without a clear diagnosis. CONCLUSION: A high mortality rate of 7.9% was observed. We found a high prevalence of bacterial infections, with pneumonia and urinary tract infections as the most common causes of fever. One in 20 patients did not have an infectious disease.

Registration of work-related diseases, injuries, and complaints in Aruba, Bonaire, and Curaçao.

OBJECTIVE: To estimate the incidence of work-related diseases, injuries, and complaints in Aruba, Bonaire, and Curaçao and to identify some next steps in the prevention process. METHODS: All of the three countries' 18 occupational health specialists were asked to participate; 100% agreed to report all work-related diseases, injuries, and complaints in 2004-2008. A standard online notification form was used to register cases in a database maintained by the Netherlands Center for Occupational Diseases (NCOD). The public health service of Curaçao analyzed the data and presented the results to the participating physicians during educational and feedback meetings. RESULTS: During the study period, 1 519 cases were reported: 720 (47.0%) work-related diseases; 515 (34.0%) injuries; and 284 (19.0%) complaints. The mean patient age was 42.4 years (range 16-70 years); 924 (60.8%) were males and 571 (37.6%), females. Most frequently reported were musculoskeletal diseases, injuries, and complaints; mental health disorders; and skin injuries. Analysis showed incidence rates of work-related diseases, injuries, and complaints in Aruba to be 157 new cases per 100 000 employee years; in Bonaire, 53/100 000; and in Curaçao, 437/100 000. CONCLUSIONS: These results suggest that labor protection laws need improvement and that preventive action should be fostered. Further study is needed on working conditions, preventive policy, and the quality of occupational health and safety practices in Aruba, Bonaire, and Curaçao. Funding is imperative for collecting and publishing accurate data, which will keep this problem on the social-political agenda.

Registration of work-related diseases, injuries, and complaints in Aruba, Bonaire, and Curaçao / Registro de enfermedades, lesiones y síntomas relacionados con el trabajo en Aruba, Bonaire y Curazao

OBJECTIVE: To estimate the incidence of work-related diseases, injuries, and complaints in Aruba, Bonaire, and Curaçao and to identify some next steps in the prevention process. METHODS: All of the three countries' 18 occupational health specialists were asked to participate; 100 percent agreed to report all work-related diseases, injuries, and complaints in 2004-2008. A standard online notification form was used to register cases in a database maintained by the Netherlands Center for Occupational Diseases (NCOD). The public health service of Curaçao analyzed the data and presented the results to the participating physicians during educational and feedback meetings. RESULTS: During the study period, 1 519 cases were reported: 720 (47.0 percent) work-related diseases; 515 (34.0 percent) injuries; and 284 (19.0 percent) complaints. The mean patient age was 42.4 years (range 16-70 years); 924 (60.8 percent) were males and 571 (37.6 percent), females. Most frequently reported were musculoskeletal diseases, injuries, and complaints; mental health disorders; and skin injuries. Analysis showed incidence rates of work-related diseases, injuries, and complaints in Aruba to be 157 new cases per 100 000 employee years; in Bonaire, 53/100 000; and in Curaçao, 437/100 000. CONCLUSIONS: These results suggest that labor protection laws need improvement and that preventive action should be fostered. Further study is needed on working conditions, preventive policy, and the quality of occupational health and safety practices in Aruba, Bonaire, and Curaçao. Funding is imperative for collecting and publishing accurate data, which will keep this problem on the social-political agenda.

OBJETIVO: Calcular la incidencia de enfermedades, lesiones y síntomas relacionados con el trabajo en Aruba, Bonaire y Curazao e identificar los pasos siguientes en el proceso de prevención. MÉTODOS: Se invitó a participar a los 18 especialistas en salud ocupacional de los tres países; todos aceptaron notificar todas las enfermedades, lesiones y síntomas relacionados con el trabajo entre el 2004 y el 2008. Se usó un formulario estándar de notificación en línea para registrar los casos en una base de datos mantenida por el Centro para las Enfermedades Ocupacionales de los Países Bajos. El servicio de salud pública de Curazao analizó los datos y presentó los resultados a los médicos participantes durante las reuniones educativas y de retroalimentación. RESULTADOS: Durante el período del estudio se notificaron 1 519 casos relacionados con el trabajo: 720 (47,0 por ciento) enfermedades, 515 (34,0 por ciento) lesiones y 284 (19,0 por ciento) síntomas. La edad promedio de los pacientes fue 42,4 años (recorrido, 16-70 años); 924 (60,8 por ciento) eran varones y 571 (37,6 por ciento), mujeres. Se notificaron con mayor frecuencia las enfermedades, lesiones y síntomas musculoesqueléticos; los trastornos mentales; y las lesiones cutáneas. El análisis mostró tasas de incidencia de enfermedades, lesiones y síntomas relacionados con el trabajo de 157 nuevos casos por 100 000 empleados por año en Aruba, 53/100 000 en Bonaire y 437/100 000 en Curazao. CONCLUSIONES: Estos resultados indican que las leyes de protección laboral deben mejorarse y que deben promoverse las medidas preventivas. Es necesario llevar a cabo otros estudios sobre las condiciones de trabajo, los planes de prevención y la calidad de la salud ocupacional y las prácticas de seguridad en Aruba, Bonaire y Curazao. Se requiere financiamiento para recopilar y publicar datos exactos, a fin de mantener este problema en la agenda política y social.

Epidemiology of febrile diseases in the emergency department of a Caribbean Island: the Curaçao experience / Epidemiología de las enfermedades febriles en el departamento de emergencias de una Isla Caribeña: la experiencia de Curazao

OBJECTIVE: The aetiology of febrile diseases in tropical countries often remains poorly characterized. We aim to describe the aetiology and outcome of febrile illnesses at the Emergency Department (ED) in Curaçao. METHODS: From April 2008 - April 2009, all adult febrile patients (T > 38.5°C) at the ED of the St Elisabeth Hospital, Curaçao, Netherlands Antilles, were included. Clinical data were recorded, routine laboratory measurements and blood cultures were taken. Final diagnoses were made at discharge by an independent physician and in retrospect by the main investigator. RESULTS: Four hundred and three patients were included: 223 patients (55.6%) were hospitalized, 32 patients (7.9%) died and 18 patients (4.5%) were admitted to the Intensive Care Unit. In 129 febrile patients (32.0%), infection was proven; 84.4% of patients had bacterial (29.0% urinary tract infection, 23.2% pneumonia infection), 5.6% viral and 10.0% parasitic or fungal infections. Twenty-one patients (5.2%) were discharged with a non-infectious diagnosis and 172 patients (42.7%) without a clear diagnosis. CONCLUSION: A high mortality rate of 7.9% was observed. We found a high prevalence of bacterial infections, with pneumonia and urinary tract infections as the most common causes of fever. One in 20 patients did not have an infectious disease.

OBJETIVO: La etiología de las enfermedades febriles en los países tropicales posee aún una pobre caracterización. El presente trabajo se propone describir la etiología y la evolución clínica de las enfermedades febriles en el Departamento de Emergencias (DE) de Curazao. MÉTODOS: De abril 2008 - abril 2009, todos los pacientes febriles adultos (T > 38.5°C) en el DE del Hospital Saint Elisabeth, de Curazao, Antillas Holandesas, fueron incluidos. Se registraron los datos clínicos, se tomaron las medidas de rutina de laboratorio y los cultivos de sangre. Los diagnósticos finales se hicieron a la hora del alta por un médico independiente y en retrospectiva por el investigador principal. RESULTADOS: Se incluyeron cuatrocientos tres pacientes: 223 pacientes (55.6%) fueron hospitalizados, 32 pacientes (7.9%) murieron, y 18 pacientes (4.5%) fueron ingresados en la Unidad de Cuidados Intensivos. En 129 pacientes febriles (32.0%) se comprobó la infección; 84.4% de los pacientes tenían infección bacteriana (29.0% infección de las vías urinarias, 23.2% infección por pneumonia), 5.6% viral y 10.0% infección parasitaria o fúngica. Veintiún pacientes (5.2%) fueron dados de alta con un diagnóstico no infeccioso, y 172 pacientes (42.7%) sin un diagnóstico claro. CONCLUSIÓN: Se observó una alta tasa de mortalidad de 7.9%. Se halló una alta prevalencia de infecciones bacterianas, siendo la pneumonía y las infecciones de las vías urinarias las causas más comunes de fiebre. Uno de cada 20 pacientes no tenía una enfermedad infecciosa.

[Borderline intellectual functioning in Antillean suspected offenders]. / Zwakbegaafdheid bij Antilliaanse verdachten.

BACKGROUND: There is a high prevalence of borderline intellectual functioning in the pretrial reports on Antillean suspected offenders. AIM: To describe the prevalence of borderline intellectual functioning and mental retardation in Antillean suspected offenders on the basis of IQ-tests applied and reports on limitations in adaptive functioning of these 'offenders'. METHOD: A study was made of 249 psychological pre-trial reports of Antillean suspected offenders between 2003 and 2008 in one Dutch judicial district. RESULTS: Borderline intellectual functioning was ascertained in 91 reports (36.6%) and mental retardation in 26 reports (10.4%). The prevalence of borderline intellectual functioning was lowest when the GIT-2 was used (19.7%) and highest when the WISC-III was used (47.8%). Limitations in adaptive functioning were not mentioned in any reports or questionnaires, although both these criteria are required to be met for a diagnosis of borderline intellectual functioning. CONCLUSION: Pre-trial reports on Antillean suspected offenders need to state clearly whether these 'offenders' have exhibited limited adaptive functioning.

HIV transmission patterns among The Netherlands, Suriname, and The Netherlands Antilles: a molecular epidemiological study.

We aimed to study patterns of HIV transmission among Suriname, The Netherlands Antilles, and The Netherlands. Fragments of env, gag, and pol genes of 55 HIV-infected Surinamese, Antillean, and Dutch heterosexuals living in The Netherlands and 72 HIV-infected heterosexuals living in Suriname and the Antilles were amplified and sequenced. We included 145 pol sequences of HIV-infected Surinamese, Antillean, and Dutch heterosexuals living in The Netherlands from an observational cohort. All sequences were phylogenetically analyzed by neighbor-joining. Additionally, HIV-1 mobility among ethnic groups was estimated. A phylogenetic tree of all pol sequences showed two Surinamese and three Antillean clusters of related strains, but no clustering between ethnic groups. Clusters included sequences of individuals living in Suriname and the Antilles as well as those who have migrated to The Netherlands. Similar clustering patterns were observed in env and gag. Analysis of HIV mobility among ethnic groups showed significantly lower migration between groups than expected under the hypothesis of panmixis, apart from higher HIV migration between Antilleans in The Netherlands and all other groups. Our study shows that HIV transmission mainly occurs within the ethnic group. This suggests that cultural factors could have a larger impact on HIV mobility than geographic distance.

Blood pressure and lifestyle on Saba, Netherlands Antilles.

During the 20th century, infectious disease morbidity and mortality generally waned whereas chronic degenerative diseases posed a growing burden at the global level. The population on Saba, Netherlands Antilles has recently experienced such an epidemiologic transition, and hypertension was reported to be extraordinarily high, although no prevalences have been reported and relationships with lifestyle factors associated with rapid modernization have not been explored. In this study, a medical and demographic questionnaires, as well as body composition and blood pressure measures were collected from 278 Saban men and women aged 18-91 years. When age and sex adjusted, 48% of the population was hypertensive. Age, BMI, and Afro-Caribbean descent were all associated with higher blood pressures. In a second phase, 124 individuals of the 278 were invited to receive a longer questionnaire on individual exposure to modernizing influences such as travel and education. Higher blood pressure was associated with having lived in fewer different places in the past; those who stayed only on Saba or Statia had higher blood pressures than those who had also lived in more modernized areas. However, this was no longer statistically significant after adjustment for age and BMI. Lifestyle incongruity was positively associated with higher blood pressure in that those with more discord between material wealth and income were more likely to be hypertensive, and this remained statistically significant after adjustment for age and adiposity. In summary, hypertension is highly prevalent on Saba and tended to be associated with greater age, adiposity, Afro-Caribbean ancestry, and lifestyle incongruity.

The role of dopamine D3, 5-HT2A and 5-HT2C receptor variants as pharmacogenetic determinants in tardive dyskinesia in African-Caribbean patients under chronic antipsychotic treatment: Curacao extrapyramidal syndromes study IX.

Tardive dyskinesia (TD) is associated with polymorphisms of the dopamine D(3), serotonin 2A and 2C receptors (DRD3, HTR2A and HTR2C, respectively). This study investigated the possible relationship between TD and the polymorphisms Ser9Gly (DRD3), 102T>C (HTR2A), -1438G>A(HTR2A) and Cys23Ser (HTR2C) in African-Caribbean inpatients. One hundred and twenty-six patients under chronic antipsychotic treatment were genotyped. The assessment of TD was carried out with the abnormal involuntary movement scale (AIMS). The relationships between the carriership of the least frequent alleles and the respective orofaciolingual dyskinesia (TDof) (sum of the items 1-4 of the AIMS), limb-truncal dyskinesia (TDlt) (sum of items 5-7 of the AIMS) and TD (sum of items 1-7 of the AIMS) were analyzed with ANCOVA, comparing means with age as a covariate and stratification for carriers and non-carriers of the mutations. In addition, we conducted pre-planned t-tests to compare AIMS values of carriers of the combinations of alleles versus the corresponding non-carriers. In the study population, females with 9Ser carriership exhibited higher AIMS values than non-carriers. Male subjects with 9Ser carriership in combination with 23Ser or -1438A carriership exhibited higher AIMS values. In male patients also, the combination of 23Ser and -1438A carriership increased TD. The study clearly shows that the African-Caribbean population differs from the Caucasian population with regard to the association of TD with the polymorphisms studied and suggests that the association of TD with the studied polymorphisms of the 5-HT(2C) and probably of the 5-HT(2A) receptor are the result of a changed susceptibility of the patients, independent of the action of the antipsychotics on these receptors.

The epidemiology of burns in a medical center in the Caribbean.

A retrospective study on burns patients admitted to the Sint Elisabeth's Hospital on Curacao was conducted during the 11-year period from the years 1992 to 2002. This is the first such study performed in Curacao. Curacao does not have an established burn center, therefore severe burns cases are treated in a general hospital. Only the very severe cases are referred to burn centers abroad. Data were collected on incidence, gender, age, cause, total body surface area (TBSA burned), degree, localization, case fatality, length of hospital stay (LOS), and seasonal variation. A total of 336 burns patients were admitted. This represented an annual admission of 31 patients, and an annual cumulative incidence of 2.3 episodes per thousand persons for burns admissions. The male to female ratio was 1.6:1, and the mean age of admission was 24.3 years. Most burned patients were observed in the age group ranging from 0 to 4 years old (29.2% of all burns cases). The mean TBSA of burn was 13.6%, range 0.5-80%. The most common cause of burn was scald (47.9%) followed by flame (22.3%). The overall mean LOS and case fatality were 15.8 days and 3.3%, respectively. Second and first degree combined, and second-degree only burns were the most frequent. Most frequent localizations burned were the arms, thorax, and legs. Most burns occurred at the end and at the beginning of each year (comparable to winter and spring period in other studies), being the seasons with the most public holidays and other festivities. We conclude that the incidence, age and gender distribution, LOS and TBSA of burns on Curacao were very similar to data from other international studies from the US, Europe and Asia. Scald and fire were the major causes of burns, being preventable injuries. Especially in young children the need for a prevention program is essential. Also, there is a need to inform people from all ages on the danger of fire injuries, especially during public holidays and other festivities when the incidence is the highest.

Infra-inguinal arterial reconstruction for peripheral arterial disease: the Curaçao experience / Reconstrucción arterial infrainguinal en la enfermedad arterial periférica: la experiencia de Curazao

BACKGROUND: The prevalence and treatment of peripheral arterial disease in the Caribbean is not well documented. The aim of this study was to review the results from a small hospital in the Caribbean. METHODS: One-hundred and eight infra-inguinal arterial reconstructions on 90 patients were retrospectively reviewed Patients were classified according to the categories suggested by the Ad Hoc Committee on Reporting Standards of the Joint Councils of the Society for Vascular Surgery. Follow-up ranged from 0 to 103.1 months. The Kaplan-Meier method was used to visualize survival, limb salvage rates and primary and secondary patency rates. Cox regressions were used to identify potential risk factors. RESULTS: The limb salvage rates were 74.5% after one year and 71.4% after five years. Overall primary patency rates were 67.0 % after one year, 63.4% after three years and 50.8 % after five years. Overall secondary patency rates were 86.4% after one year and 75.1% after five years. The primary patency rate for autologous saphenous vein was 82.4% (SE 7.5%) after five years. The primary patency rates for prosthetic grafts were 62.1% (SE 8.5%) after one year; 56.9% (SE 9.2%) at three years and 37.9% (SE 16.7%) after five years. CONCLUSION: Infra-inguinal arterial bypass surgery is feasible in small Caribbean hospitals showing results comparable to major studies.

ANTECEDENTES: La prevalencia y el tratamiento de enfermedad arterial periférica en el Caribe no están bien documentados. El objetivo de este estudio fue examinar los resultados de un pequeño hospital en el Caribe. MÉTODOS: Se examinaron retrospectivamente ciento reconstrucciones arteriales infrainguinales en 90 pacientes. Los pacientes eran clasificados según las categorías sugeridas por el Comité Ad Hoc para el Reporte de Normas de los Consejos Unidos de la Sociedad de Cirugía Vascular. El seguimiento tuvo un rango de 0 a 103.1 meses. Se usó el método Kaplan-Meier con el objeto de ver las tasas de super-vivencia, salvamento de la extremidad, y tasas primarias y secundarias de permeabilidad. Se usaron regresiones de Cox para identificar los factores de riesgo potencial. RESULTADOS: Las tasas de salvamento de miembro fueron 74.5% después de un año y 71.4% después de cinco años. Las tasas generales de permeabilidad primaria fueron 67.0% después de un año, 63.4% después de tres años y 50.8% después de cinco años. Las tasas generales de permeabilidad secundaria fueron 86.4% después de un año y 75.1% después de cinco años. La tasa de permeabilidad primaria para la vena safena autóloga fue 82.4% (SE 7.5%) después de cinco años. Las tasas de permeabilidad primaria para los injertos prostéticos fueron 62.1% (SE 8.5%) después de un año, 56.9% (SE 9.2%) a los tres años y 37.9% (SE 16.7%) después de cinco años. CONCLUSIÓN: La cirugía de bypass arterial infrainguinal es factible en hospitales caribeños pequeños que muestran resultados comparables a los de estudios importantes.

Infra-inguinal arterial reconstruction for peripheral arterial disease: the Curaçao experience.

BACKGROUND: The prevalence and treatment of peripheral arterial disease in the Caribbean is not well documented. The aim of this study was to review the results from a small hospital in the Caribbean. METHODS: One-hundred and eight infra-inguinal arterial reconstructions on 90 patients were retrospectively reviewed Patients were classified according to the categories suggested by the Ad Hoc Committee on Reporting Standards of the Joint Councils of the Society for Vascular Surgery. Follow-up ranged from 0 to 103.1 months. The Kaplan-Meier method was used to visualize survival, limb salvage rates and primary and secondary patency rates. Cox regressions were used to identify potential risk factors. RESULTS: The limb salvage rates were 74.5% after one year and 71.4% after five years. Overall primary patency rates were 67.0 % after one year, 63.4% after three years and 50.8 % after five years. Overall secondary patency rates were 86.4% after one year and 75.1% after five years. The primary patency rate for autologous saphenous vein was 82.4% (SE 7.5%) after five years. The primary patency rates for prosthetic grafts were 62.1% (SE 8.5%) after one year; 56.9% (SE 9.2%) at three years and 37.9% (SE 16.7%) after five years. CONCLUSION: Infra-inguinal arterial bypass surgery is feasible in small Caribbean hospitals showing results comparable to major studies.

The incidence of anorexia nervosa on Curaçao.

OBJECTIVE: Although anorexia nervosa was once thought to occur only in affluent societies, cases have now been documented across the globe. To examine whether anorexia nervosa emerges in societies undergoing socioeconomic transition, the authors studied the incidence of anorexia nervosa on the Caribbean island of Curaçao. METHOD: The authors contacted the full range of community health and service providers on Curaçao, including dietitians, school counselors, and all 82 general practitioners. They also studied inpatient records for 84,420 admissions to Curaçao General Hospital and two private hospitals in 1995-1998. Probable-incident subjects were interviewed. RESULTS: The incidence rates in 1995-1998 per 100,000 person-years for anorexia nervosa on Curaçao were 1.82 (95% confidence interval [CI]=0.74-2.89) for the total population and 17.48 (95% CI=4.13-30.43) for the high-risk group of 15-24-year-old females. No cases were found among the majority black population. For the Curaçao mixed and white population, the incidence rate per 100,000 person-years for anorexia nervosa was 9.08 (95% CI=3.71-14.45). CONCLUSIONS: The overall incidence of anorexia nervosa on Curaçao is much lower than in the affluent societies of the United States and Western Europe. Within Curaçao, sociocultural factors appear to be associated with differential incidence rates of anorexia nervosa. The incidence of anorexia nervosa among the majority black population is nil, while the incidence among the minority mixed and white population on Curaçao is similar to that of the United States and the Netherlands.

PCR detection of lizard malaria parasites: prevalence of Plasmodium infections with low-level parasitemia differs by site and season.

Plasmodium-specific polymerase chain reaction (PCR) primers allowed detection of infections with very low-level parasitemia for 3 species of malaria parasites infecting Anolis lizards at 2 Caribbean sites, Puerto Rico and Saba, Netherlands Antilles. A verification study, using a single-tube nested PCR to eliminate contamination, showed that infections as low as 1 parasite per millions of erythrocytes could be detected by amplifying a 673 bp fragment of the cytochrome b gene. Very low-level parasitemia infections, subpatent under the microscope, were common in A. sabanus on Saba sites, with no significant seasonal difference (31% of infections appearing uninfected by microscopic examination in summer were found infected by PCR, 38% in winter). At the Puerto Rico site, the subpatent infections were also common in A. gundlachi, but were more prevalent in winter (53%) than in summer (17%). A similar high frequency of subpatent infections is known from studies on human and bird malaria, but a previous PCR-based study on a temperate lizard malaria system found few such low-level infections. Differences in the prevalence of subpatent infections by site and season suggest transmission biology may select for distinct life history strategies by the parasite.

Curaçao patients with coronary artery disease have a higher prevalence of the HFE C282Y mutation.

Epidemiological studies indicate a positive relation between iron status and coronary artery disease (CAD) risk The HFE C282Y allele is associated with increased iron status and higher CAD risk. We investigated whether HFE C282Ymight be a CAD risk factor in Curaçao in a case-control study design. The patient group comprised 42 men and 10 women. Fifty-four men and 30 women without history of CAD served as age and gender matched controls. HFE C282Y genotypes were established using sequence-specific priming polymerase chain reaction. None of the investigated subjects were homozygous for HFE C282Y, whereas 5/52 (9.6%) CAD patients and 1/84 controls (1.2%) were heterozygous for HFE C282Y (p = 0.03). The HFE C282Y mutation was 8.8 fold (95% CI 1.001, 77.8; p = 0.049) more prevalent in CAD patients than in controls. The HFE C282Y allele frequency in Curaçao is higher than that of African populations, but comparable with that of Jamaica. We conclude that Curaçao CAD patients have somewhat higher frequency of HFE C282Y heterozygosity than controls, and that the HFE C282Y allele frequency in the Curaçao population is higher than might be expected in persons of African descent. The consequences of HFE C282Y heterozygosity as CAD risk factor are as yet uncertain, since there is no proof that iron lowering reduces CAD risk.