Institution care for the elderly in Curacao

This study investigated the need for care among the elderly living in a institution (nursing home or a home for the elderly) in Curacao. Answers were sought for the following questions: (1) what type of care do the elderly living in an institution need (2) is there a difference in needs for care between those living in a nursing home and those living in a home of the elderly? (3) is there an overlap between populations of the two? Interviews were conducted with the head nurses of both types of institutions on the need for care. The instruments used were an 8-item scale on Activities of Daily Living (ADL), a 5-item scale on Household Activities (HHA) and a 4-item scale on Memory and Orientation Disorders (MOD). Additional questions were asked about demographic characteristics, being beridden or incontinent and other physical problems. There were severe limitation for HHA (85 percent), and ADL (57 percent); 43 percent had severe MOD, 55 percent had severe problems with incontinence and 23 percent had one or more additional physical problems. With the exception of MOD, the nursing home population had more severe problems. However, almost half of the elderly in homes had a similarly extensive need for care. Despite differences in the manner in which each institute was financed and the amount of money they received as well as differences in admission criteria and educational level of the personnel, there was a great overlap between the nursing home population and those living in homes for the elderly. It is therefore necessary to (better) integrate these two forms of intramural elderly care.(AU)

Alarmingly high prevalence of obesity in Curaçao: data from an interview survey stratified for socioeconomic status.

OBJECTIVE: The aim of the article is to report the prevalence of obesity, abdominal fatness and waist circumference in different socioeconomic classes in Curaçao. DESIGN: In 1993/1994 a health interview survey (the Curaçao Health Study) was carried out among a random sample (n = 2248, response rate = 85%) of the adult non-institutionalized population of Curaçao. METHODS: We analyzed the association between obesity (BMI > or = 30), abdominal fatness (waist hip ratio (WHR) > or = 0.95 for men, WHR > or = 0.80 for women) waist circumference (WC > or = 100 cm for men, WC > or = 91 cm for women) and socioeconomic status (SES) by age adjusted logistic regressions, for men and women separately. RESULTS: The prevalence of obesity was about 27%: 36% of the women and 19% of the men were obese. An at risk WHR was reported among 62.2% of the women and among 20.4% of the men. A WC above the cut-off point was reported for 44.3% women and 25.3% men. Compared to women of higher SES, the lower SES women have a two to three times higher risk of a BMI, WHR or WC exceeding the cut-off points. Among men, no statistically significant difference between an increased BMI, WHR or WC and SES factors was found. The overlap between the three measures is large, about 56% of the women scored similarly on all three measurements. Among men the overlap is even greater (73%). CONCLUSIONS: The prevalence of obesity in Curaçao is alarming. Low SES women are at the greatest risk of an increased BMI, WHR or WC. The obesity figures can be placed between industrialized societies and less modernized cultures. Action and additional research on the prevention of obesity in Curaçao are deemed necessary. The cut-off points in our study for WC in the non-white population are preliminary and need to be elucidated further.

Socioeconomic inequity in health care: a study of services utilization in Curaçao.

The aim of this study is to examine whether there is socioeconomic equity in health care utilization in Curaçao, Netherlands Antilles. We explore how educational level is related to utilization of GPs, specialists, hospitals; dentists and physiotherapists, taking into account the effects of sex, age and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis: probability (or incidence) of services use versus overall volume of contacts. The data were derived from the Curaçao Health Study, a health interview survey among a random sample (N = 2248) of the non-institutionalized population aged 18 and over. The results indicate that there is socioeconomic inequity in the probability of health care utilization in Curaçao. People with a higher educational level are more likely to consult a specialist, dentist or physiotherapist, and are also more likely to be hospitalized. This is not only the case when the mediating effects of socioeconomic inequalities in health (need) are taken into account, but also before adjustment for health inequalities. In other words: there appears to be both vertical inequity (i.e. greater needs for services are not met by greater use) and horizontal inequity (i.e. similar needs for care are not met by similar levels of services use). The observed inequalities in use of specialists and hospitals contrast with findings from international research. The volume of health services use (i.e. the numbers of consultations) appears to be hardly connected with a person's position in the SES hierarchy; only dental services are used more extensively by higher educated individuals.

Home care for the elderly: needed and received: an analysis of the care needed and care received by the non-institutionalized elderly population in Curacao

Curacao, as well as other Caribbean islands, has a growing number of the elderly. In this study we analyzed the home care needed and received by the elderly. Such data are needed for planning health services. Data from the Curacao Health Study were used for this purpose: a face-to-face interview among a random sample of the population. Of the elderly (aged 65 years and over) 23 percent needed help with one or more activities of daily living (ADL), 6 percent needed help with three or more ADL. Those aged over 75 years especially needed help with these activities. 22 percent of the elderly received informal care, consisting mainly of household tasks, accompaniment or monitoring and emotional support. Daughters were the most important care givers, followed by sons. Elderly with multiple ADL - impairments more often received informal care and also more intensive care (more physical care, e.g. bathing). 24 percent of the study sample indicated that they had no one to take care of them in case of long-term illness. This occurred more often when elderly people live alone (50 percent). The ageing of the population will result in a higher need for informal care. However, social changes such as fewer children per couple, a growing number of elderly living alone and increased participation of women in the labour force, will result in fewer potential caregivers. Ways to stimulate informal care and organize cost-effective formal care should therefore be sought.(AU)

Socioeconomic inequity in access to health care: a study of services utilization in Curacao - abstract

This study examines whether there is socioeconomic equity in health care utilization in Curacao. We explore how education level is related to utilization of various health services, taking into account the effects of sex, age, and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis; probability (or incidence) of services use versus overall volume contacts. The data was derived from the "Curacao health study", a health interview survey among a random sample (n=2248) of the non-institutionalized population 18 years and over. The results indiacte that there is socio-economic inequalities in health (need for care) is taken into account. In other words: greater need for services are not met by greater use (vertical equity) and similar needs for care are not met by similar levels of service use (horizontal inequity). The volume of use (i.e. the number of consultations with a care provider, once a person has entered the health care system) appears to be fairly equitable. The observed inequalities in probability of specialist and health utilization contrast with findings from international research. The outcomes of this study underline the importance of health care reforms in order to attain more equitatble access to health care. (AU)

High prevalence of obesity in Curacao: data from an interview survey stratified for socio-economic status - abstract

The aim of this paper is to report the prevalence of obesity and abdominal fatness in different socioeconomic classes in Curacao. In 1993/1994 a health interview survey (the Curacao Health Study) was carried out among a random sample (n = 2248, response rate = 85 percent) of the adult non-institutionalized population of Curacao. We analyzed the association between body mass index (BMI) and socioeconomic status (SES) as well as the relationship between waist-hip ratio (WHR) and SES by logistic regression models for men and women separately. The overall prevalence of obesity among women peaked at age 46 to 55 years (OR 4.195 percent CI 2.6 - 6.6) and between 56 to 65 (OR 1.7 95 percent CI 1.0 - 3.1) years in men. Women of lower SES are approximately twice as much at risk of being obesed compared to women of higher SES (OR 2.4 95 percent CI 1.7 - 3.4) for the low SES group. The percentage of participants with an at risk WHR (cut off point 0.80 for women and 0.95 for men) is more than three times higher among women than among men (62.2 percent versus 20.4 percent). WHR increased significantly with age among both genders. Compared to women of higher SES, the lower SES women have a three times higher risk of a WHR exceeding th cut off point (OR 3.0 95 percent CI 2.0 - 4.5). The overall prevalence of obesity was much higher than in Spain, Brazil and the Netherlands. The high prevalence of obesity in Curacao justifies action and research on the prevention of obesity in Curacao. (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)

Physical complaints and emotional stress related to routine diagnostic procedures of the fertility investigation.

The aim of this study was to map out the extent of the physical complaints and emotional stress due to diagnostic routines of the infertility work-up. To this end a questionnaire was sent to 96 consecutive couples visiting an infertility clinic of a university hospital. The results indicate that women often have physical complaints as a result of the hysterosalpingography (59%) and the diagnostic laparoscopy (47%) and mostly experience these diagnostic procedures as very stressful. Both the postcoital test and the semen analysis caused a moderate amount of stress. The other diagnostic procedures, including physical examination of both sexes, recording of the basal temperature and taking blood for hormonal determinations, were accompanied by fewer complaints and much less stress. It is concluded that the role of the hysterosalpingography and the diagnostic laparoscopy in the routine infertility work-up needs to be reconsidered in view of the burden they pose to the women involved.

Knowledge, attitudes and behaviour on smoking and alcohol use in Curacao

The objectives of this paper are to describe the findings on knowledge and attitudes concerning substance use (tobacco and alcohol) among the participants of the Curacao Health Study and to relate these results to their behaviour. A random sample of the adult non-institutionalized population of Curacao (n=2248) were asked about their knowledge and attitudes on health lifestyle patterns and preventive behaviour. In this paper we specifically focus on smoking and use of alcohol. Men in Curacao use more alcohol and tobacco than women. The prevalence of self-reported smokers is markedly lower than, for instance, in the Dutch population and that of the U.S. and the difference between the sexes. In Curacao men generally also score lower on knowledge and attitudes regarding the use of tobacco and alcohol than women. Those actually exhibiting unhealthier lifestyles in this respect have lower scores than those having healthier lifestyles. The same relationship holds true for women, though less pronounced. Although knowledge, attitudes and behaviour are clearly associated with one another, the causal relationship between them is not unequivocal. Other factors may also play a role in influencing lifestyle changes. More research is needed to guide the further development and implementation of health promotion and intervention programmes in Curacao (AU)x

The impact of social support on mental health: results from the Curacao health study

The objective of this study was to describe the relationship between perceived social support and mental health in Curacao. A random sample (n=2248) of the non-institutionalized adult population of Curacao was surveyed through face-to-face interviews, containing items on health, social support and background variables. The prevalence of psychological distress was about 20 percent. The prevalence was higher in women, widowed persons, the chronically ill and persons from the low socio-economic classes. Perceived social support was relatively low in young persons, divorced and single persons, the chronically ill and low education groups. There was a strong inverse relationship between perceived social support and psychological distress: persons who feel they have low social support have more psychological distress. This relationship could be found in almost all subgroups, but is especially strong in young women. Prevention and intervention programmes should acknowledge the great impact of social support on mental health. In terms of prevention of psychological distress, people in stressful situations should be helped by reinforcing their social support (e.g. patient should be helped to improve their social support (e.g. halfway houses for (former) psychiatric patients) (AU)

Human sperm movement assessed with the Hamilton-Thorn motility analyzer and in vitro fertilization.

UNLABELLED: The relationship between sperm movement characteristics obtained by computerized analysis and the in vitro fertilization rates of human oocytes was studied. In 144 consecutive in vitro fertilization treatments a sample of prepared semen was analysed by a Hamilton-Thorn Motility Analyzer. In addition a visual estimation of sperm count and motility was made. Significant correlations with the fertilization rate were found for all visual parameters. Of the computerized measurements, the mean velocities of motile spermatozoa and the concentration of motile cells were significantly correlated. The average path velocity correlated best (r = 0.42, P < 0.001). There was no relationship between the percentage of motile sperm showing hyperactivated movement and the fertilization rate. A forward stepwise logistic regression analysis selected the following variables of predictive value for fertilization: average path velocity, male factor infertility as indication for in vitro fertilization, motility and concentration, as measured by the Hamilton-Thorn analyzer. A logistic regression model to predict the cases with low (< 0.2) or high fertilization rates, included the average path velocity as a significant variable and classified the samples with 90% overall accuracy. IN CONCLUSION: movement characteristics of spermatozoa in culture medium, especially the average path velocity are of prognostic value in prediction of human oocyte fertilization rates.

Intra-uterine insemination or timed intercourse after ovarian stimulation for male subfertility? A controlled study.

In this randomized trial we investigated whether intra-uterine insemination (IUI) in couples with male subfertility leads to a higher probability of conception than timed intercourse after ovarian stimulation with human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG). A total of 76 couples started 249 cycles, of which 47 were cancelled to prevent multiple pregnancies or hyperstimulation. After 202 completed treatment cycles, 15 pregnancies occurred, 11 after IUI and four after timed intercourse. The pregnancy rate per completed cycle with IUI was 10.3% (95% confidence interval: 5.5-17.5%) and 4.2% (1.2-10.1%) with timed intercourse. Compared with the estimated spontaneous chance to conceive, IUI after ovarian stimulation appeared to be more effective in the first three cycles. We conclude that in subfertile couples with a male factor, IUI tends to improve the probability of conception as compared to timed intercourse when ovarian stimulation is applied, and we advise such treatment for three cycles.

The validity of the postcoital test for estimating the probability of conceiving.

OBJECTIVE: We determined the prognostic value of the postcoital test in subfertile couples. STUDY DESIGN: A retrospective study relates the result of the postcoital test to the occurrence of a spontaneous pregnancy. In a fertility center of a university hospital, data from the complete fertility workup of 956 couples who were examined because of infertility due to cervical hostility, male subfertility, or unexplained causes were collected. Statistical analysis was done with Cox regression. RESULTS: The postcoital test result 9 to 12 hours after intercourse is strongly associated with future pregnancy during the first year after intake; the association is also present when the relation with other prognostic variables is taken into account. CONCLUSIONS: The postcoital test result is a strong predictor of possible fertility within the following year.

The prediction of the chance to conceive in subfertile couples.

OBJECTIVE: To develop a model that can predict the chance to conceive spontaneously in subfertile couples. DESIGN: In a cohort study, a consecutive series of patients consulting infertility was followed up. We related information from previous history, physical examination, postcoital tests (PCT), semen analyses, and sperm penetration meter tests with the occurrence of a spontaneous pregnancy. SETTING: Fertility center in a university hospital. PATIENTS: Nine hundred ninety-six couples consulting for infertility due to cervical hostility, male subfertility, or unexplained infertility. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): Time between intake and occurrence of the first spontaneous pregnancy. RESULTS: Information from the previous history (duration of infertility, primary or secondary female infertility, age of the woman, fertility problems in male's family), the percentage motile sperm in the first semen analysis, and the result of the first PCT are sufficient to predict the chance to conceive. A pocket chart is presented for easy use of the model. CONCLUSIONS: With a limited amount of diagnostic information, the chance to conceive spontaneously can be predicted.

Effects of varicocele treatment in adolescents: a randomized study.

OBJECTIVE: To study the effects of varicocele treatment on testicular function in adolescents. DESIGN: A prospective controlled study in 88 randomly selected adolescents. SETTING: All participants were referred to the fertility outpatient clinic of our university hospital. PARTICIPANTS: All participants with a varicocele were randomly assigned into two groups. Group 1 (n = 33) was not treated, whereas group 2 (n = 34) was treated. A similar group of healthy volunteers without a varicocele served as a control group (group 3, n = 21). INTERVENTIONS: Testes volumes were measured at intake and during follow-up using an orchiometer. Semen analysis was performed according to standard procedures both at intake and after 1 year of follow-up. Serum hormone levels were determined at intake using a radioimmunoassay. Treatment was performed by means of transcatheter embolization of the left testicular vein. MAIN OUTCOME MEASURES: Testes volumes and semen quality at intake and after 1 year of follow-up were compared within and between the three groups. Hormonal parameters were determined at intake only. RESULTS: Before treatment, the mean left testis volume in groups 1 (n = 26) and 2 (n = 27) (20.0 mL; 95% confidence interval [CI]: 18.2 to 21.8 and 21.6 mL; 95% CI: 19.4 to 23.8, respectively) were significantly smaller than those in the control group (n = 19) (24.5 mL; 95% CI: 22.7 to 26.4). During follow-up, left testis volumes of the treated group were comparable with those in the control group (24.2 mL; 95% CI: 22.2 to 26.1 and 24.8 mL; 95% CI: 23.0 to 26.7 respectively) and significantly (P < 0.001) different from the untreated group (20.3 mL; 95% CI: 18.8 to 21.8). A significant increase in left (P < 0.01) as well as right (P < 0.05) testis volume was observed after treatment. Semen parameters before treatment were not significantly different between the three groups. Sperm concentration increased significantly (P < 0.01) from 47.4 x 10(6)/mL (95% CI: 42.5 to 53.3) to 68.9 x 10(6)/mL (95% CI: 50.6 to 87.2) in the treated group, whereas semen quality in the untreated and control groups did not change. Although both testes volumes and sperm concentration improved in the treated group, these phenomena were not consistently correlated to each other. CONCLUSIONS: Although not apparent in all adolescents, varicocele correction resulted in an increase in left testis volume and sperm concentration. At this moment, it is not clear if early preventive treatment of varicocele in adolescents, in time, will have a positive effect on testicular function.