Estimating the risk of dengue transmission from Dutch blood donors travelling to Suriname and the Dutch Caribbean.

BACKGROUND: The risk of dengue transmitted by travellers is known. Methods to estimate the transmission by transfusion (TT) risk from blood donors travelling to risk areas are available, for instance, the European Up-Front Risk Assessment Tool (EUFRAT). This study aimed to validate the estimated risk from travelling donors obtained from EUFRAT. METHODS: Surveillance data on notified dengue cases in Suriname and the Dutch Caribbean islands (Aruba, Curaçao, St. Maarten, Bonaire, St. Eustatius and Saba) in 2001-2011 was used to calculate local incidence rates. Information on travel and donation behaviour of Dutch donors was collected. With the EUFRAT model, the TT risks from Dutch travelling donors were calculated. Model estimates were compared with the number of infections in Dutch travellers found by laboratory tests in the Netherlands. RESULTS: The expected cumulative number of donors becoming infected during travels to Suriname and the Dutch Caribbean from 2001 to 2011 was estimated at 5 (95% CI, 2-11) and 86 (45-179), respectively. The infection risk inferred from the laboratory-based study was 19 (9-61) and 28 (14-92). Given the independence of the data sources, these estimates are remarkably close. The model estimated that 0·02 (0·001-0·06) and 0·40 (0·01-1·4) recipients would have been infected by these travelling donors. CONCLUSIONS: The EUFRAT model provided an estimate close to actual observed number of dengue infections. The dengue TT risk among Dutch travelling donors can be estimated using basic transmission, travel and donation information. The TT risk from Dutch donors travelling to Suriname and the Dutch Caribbean is small.

Gastroenteritis-associated Guillain-Barré syndrome on the Caribbean island Curaçao.

BACKGROUND: The number of patients with Guillain-Barré syndrome (GBS) who have been observed in Curaçao, the Netherlands Antilles, may be increasing. METHODS: Clinical and serologic data were obtained from records of patients admitted between 1987 and 1999 and fulfilling National Institute of Neurological and Communicative Disorders and Stroke criteria for GBS. When possible, serum and stool samples were collected. The results were compared with a large Dutch epidemiologic study. RESULTS: The authors identified 49 patients, an overall crude incidence rate (IR) in Curaçao of 2.53/100,000 inhabitants (95% CI 1.87 to 3.35) (Dutch study 1.18, rate ratio (RR) of 2.14, p < 0.001). The IR in Curaçao increased from 1.62 in 1987 to 1991 to 3.10 in 1992 to 1999, RR 5.22 (95% CI 2.48 to 10.2, p = 0.02). The IR showed a curvilinear shape within a year. In comparison with the Dutch group, patients from Curaçao had a more severe course of the disease, with a mortality rate of 23% (3.4% in the Dutch group, p < 0.001), a higher percentage of preceding gastroenteritis (p < 0.001), and less sensory involvement (p < 0.001). In 8 of 10 serum samples, evidence was found for a recent infection with Campylobacter jejuni. CONCLUSIONS: The authors found a steady increase in incidence of GBS over the years in association with a more pronounced seasonal preponderance and a more severe course. The clinical characteristics suggest a role for C jejuni.

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.

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)

Dengue in Curacao: an analysis of available data from 1993, 1995 and 1996 - abstract

Dengue is endemic in most countries of the Americas. The presentation of the disease can range from an undifferentiated fever to a more life-threatening form, ie., the dengue shock syndrome. Four serotypes of the viruses are distinguished: the most common ones in the American regon are types 2 and 4. It is transmitted primarily through the Aedes aegypti, a vector widely found in the region. Dengue is also a health problem in Curacao, where since 1973 endemicity has been established. The objective of the present study is to describe the dengue situation in Curacao with regards to the prevalence, surveillance system and vector control, as well as the evaluation of these. This was done on laboratory-based surveillance data of the years 1993, 1995 and 1996. Cases were either confirmed by laboratory results or classified as probable cases based on clinical information, using the case definition of the Pan American Health Organization. Results of the surveys on larval indices of the same years are presented. The surveillance data show that there was an outbreak in the first few months of 1993. One death was reported in February. During this outbreak, dengue types 2 and 4 were isolated. In 1995, there were two outbreaks, one in March/April and another one later in the year during the year during the months October/November. At the beginning of 1996 the last cases of the 1995 outbreak were detected, but in the second half of the year no confirmed cases were reported. Both the curent surveillance system and the vector surveys hae provided valuable data. Nevertheless, the prevalence of the disease in 1995 shows that the availability of information is not enough for the prevention of disease if not combined with a defined plan of action. (AU)

Lifestyle in Curaçao. Smoking, alcohol consumption, eating habits and exercise.

The Curaçao Health Study was carried out among a randomized sample (n = 2248, response rate = 85%) of the adult non-institutionalized population in order to assess aspects of lifestyle that may pose health risks. Factors examined were tobacco and alcohol use, eating habits and exercise behaviour. Outcome variables were cross-tabulated by gender, age and socioeconomic status. 17.1% of the participants were smokers and 20.5% were regular drinkers, including 6.3% of the men who consumed alcohol excessively (4 or more glasses of alcohol a day). 75% of the participants did not exercise regularly, 37% did not eat vegetables daily, and half did not eat fruit daily. Other poor eating habits were the addition of extra sugar and salt to prepared food by 33% and 20% of the participants, respectively. On the whole, men had less healthy lifestyles than women, with the exception of exercise behaviour. People of high socioeconomic status (SES) drank less alcohol, and exercised more often than those of low SES. Considering the high prevalence of diabetes mellitus and hypertension in the Caribbean, research on lifestyle factors in other Caribbean countries is required to facilitate the development of regional prevention and intervention programmes.

Lifestyle in Curacao: smoking, alcohol consumption, eating habits and exercise

The Curacao Health Study was carried out among a randomized sample (n = 2248, response rate = 85 percent) of the adult non-institutionalized population in order to assess aspects of lifestyle that may pose health risks. Factors examined were tobacco and alcohol use, eating habits and exercise behaviour. Outcome variables were cross-tabulated by gender, age and socioeconomic status. 17.1 percent of the participants were smokers and 20.5 percent regular drinkers, including 6.3 percent of the men who consumed alcohol excessively (4 or more glasses of alcohol a day). 75 percent of the participants did not excercise regularly, 37 percent did not eat vegetables daily, and half did not eat fruit daily. Other poor eating habits were the addition of extra sugar and salt to prepared food by 33 percent and 20 percent of the participants, respectively. On the whole, men had less healthy lifestyles than women, with the exception of execise behaviour. People of high socioeconomic status (SES) drank less alcohol, and exercised more often than those of low SES. Considering the high prevalence of diabetes mellitus and hypertension in the Caribbean, research of lifestyle factors in other Caribbean countries is required to facilitate the development of regional prevention and intervention programmes. (AU)

Lifestyle in Curacao: smoking, alcohol consumption, eating habits and exercise

The Curacao Health Study was carried out among a randomized sample (n = 2248, response rate = 85 percent) of the adult non-institutionalized population in order to assess aspects of lifestyle that may pose health risks. Factors examined were tobacco and alcohol use, eating habits and exercise behaviour. Outcome variables were cross-tabulated by gender, age and socioeconomic status. 17.1 percent of the participants were smokers and 20.5 percent regular drinkers, including 6.3 percent of the men who consumed alcohol excessively (4 or more glasses of alcohol a day). 75 percent of the participants did not excercise regularly, 37 percent did not eat vegetables daily, and half did not eat fruit daily. Other poor eating habits were the addition of extra sugar and salt to prepared food by 33 percent and 20 percent of the participants, respectively. On the whole, men had less healthy lifestyles than women, with the exception of execise behaviour. People of high socioeconomic status (SES) drank less alcohol, and exercised more often than those of low SES. Considering the high prevalence of diabetes mellitus and hypertension in the Caribbean, research of lifestyle factors in other Caribbean countries is required to facilitate the development of regional prevention and intervention programmes.

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)

Body mass index distribution in the Curacao health study: differences in socio-economic factors - abstract

The objective of this paper was to determine the prevalence of underweight, normal weight and over weight based on the body mass index (BMI) for sex and age groups, as well as for socio-economic factors. This is important since obesity is a risk factor for prevalent diseases (diabetes mellitus, in Curacao. From a random sample of 3000 persons > 18 years of age in Curacao, weight and length were measured in 2248 (75 percent) individuals. Using the U.S. National Center for Health Statistics ((NCHS) cut-off values of BMI for over-weight (male = 27.8; female = 27.3) we found a markedly higher prevalence of overweight in both sexes when comparing the data to international findings, but more so in females. Fifty per cent of women > 25 years of age are overweight, peaking at 62.2 percent in the 45 to 64-year of age gruop. In females socio-economic status (SES) was inversely related to mean BMI, lowest SES groups having the highest mean BMI. Approximately one-third of the male population greater than and equal to 18 years of age were overweight. Further, it was found that length was proportionately related to SES for both sexes (AU)

The Curacao health study: cross-cultural use of a health survey; results from the pilot study - abstract

A health survey offers a unique opportunity to explore the health-related needs of a population by collecting complete, comprehensive and integrated information on health, health-related behaviour and sociodemographic factors. Preparatory to a large-scale health survey on Curacao, a pilot study was carried out. The instruments used include measures of health status, lifestyle, use of conventional and traditional medicine, health-related attitudes and knowledge, as well as personal characteristics and characteristics of social relations. For this pilot study, the questionnaire was translated into Dutch and Papiamento. For the main study, English and Spanish versions will also be available. The questionnaire has been tested in face-to-face interviews with 134 individuals aged 18-90 years, randomly selected from the Registry Office. The willingness of the population to participate in the survey was remarkably high. The interview protocol has been evaluated, and the psychometric properties of the instruments have been determined. The experiences with the interview protocol are generally positive, and the psychometric analyses show that most instruments yield valid and reliable information. The overall conclusion is that, when adapting the survey design to the specific conditions of a multilingual community with a large variation in socio-economic levels, a health survey in Curacao is feasible and that a useful and relevant instrument is available (AU)

Socio-economic health differences in Curacao: results from the pilot of the Curacao health study - abstract

The objective of the current study is to investigate whether the data collected in the pilot of the Curacao Health Study could be used to determine possible socio-economic health differences in Curacao. In order to do this, secondary analyses were performed on data from a sample of 134 persons. In males there appeared to be a difference between higher versus lower educated groups with respect to the total number of chronic complaints and perceived general health. In addition, males without access to a car reported a poorer general health compared to the group that does have access to a car. In females, these differences were not significant. However, females reported on the average more chronic diseases, more short-term complaints, worse physical functioning and a poorer general health compared to males. Because of the small sample size no definite statements on socio-economic health differences in Curacao can be made, although the type of data collected proved not only useful but necessary to conduct further investigation in this matter (AU)