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 / 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.

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.

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.

Symptomatic deep vein thrombosis of the lower extemities in Curacao: a clinico-epidemiological investigation - abstract

The incidence, symptoms and complications of deep venous thrombosis (DVT) of the lower extremities in 131 hospitalized patients were determined retrospectively during a five-year period, January 1986 - January 1991. In 81 patients (61 percent) the diagnosis was supported by ascending venography, while in 50 patients (39 percent) the diagnosis was based on clinical findings only. The estimated annual incidence rate for definite DVT was 11.1 per 100,000 person years and increased with age. Swelling (92 percent), pain (89 percent) and tenderness (87 percent) on palpation were the most frequent symptoms, while immobilization (43 percent) and varicose veins (42 percent) were the most frequent risk factors. Five patients (6.2 percent) died in hospital. A total of 17 patients (21 percent) developed pulmonary embolism. As most primary care physicians refer patients with symptoms of DVT to our hospital, we conclude that DVT of the lower extremities has a low incidence in Curacao, has a similar clinical picture as elsewhere and leads to considerable short-term morbidity and mortality due to pulmonary embolism (AU)

Epidemiological and clinical features of systemic lupus erythematosus in the Dutch Caribbean - abstract

To determine incidence, prevalence and outcome of Systemic Lupus Erythematosus (SLE) in a well-defined black Caribbean population, data were gathered from three different sources (hospital records, consultants' private records and death certificates) on all patients with SLE during the 10-year period 1980 - 1989. The average annual incidence of SLE was 4.6/100,000 and showed little variation, while the point-prevalence (at the start of 1990) was 47/100,000. Both rates were highest in females aged 45 - 64 years (incidence 12/100,0000, prevalence 1 in 526). Survival probability at 1, 5 and 10 years after diagnosis was estimated at 92 percent, 60 percent and 45 percent, respectively. The occurrence of lupus nephritis (present in 73 percent of all patients), high disease activity (SLEDAI score V 10 points), and an increasing number of exacerbations were all associated with poor survival. Thus, SLE is a prevalent disease in black Caribbean females with a high freqency of renal involvement, leading to a significantly decreased survival (AU)

The 10-year congenital rubella syndrome incidence in Curacao: 1977-1986 - abstract

In order to assess the magnitude of the congenital rubella syndrome in Curacao, and to provide data for evaluation of the rubella vaccination programme, a retrospective study of its incidence during the period 1977 - 1986 was conducted. This was done by tracing all hospital medical records of newborns with signs and symptoms indicative of congenital rebella syndrome or with a specialist's diagnosis. All cases were confirmed by laboratory tests. A yearly incidence of 0 to 0.4/1,000 live births was observed in non-epidemic years. In 1977 and 1985, very high incidences of 1.77/1,000 and 2.44/1.000 were observed. No seasonally could be observed. No surveillance data on rubella in the study period are available. It is concluded that from 1977 to 1986, rubella infection of pregnant women, and congenital rubella syndrome have occurred regularly, with two epidemic increases in 1977 and 1985 (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)

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)

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)

Occurrence of rheumatic carditis in the native population of Curacao, Netherlands West Indies

Among 3,391 admissions for internal diseases at Curacao, Netherlands West Indies, over a period of five years, there were 61 for acute rheumatic fever. Three cases were complicated by chorea minor. Scarlet fever was not observed. Among 1,307 autopsies on native of Curacao, Aruba and Bonaire there were 20 which disclosed typical gross lesions or sequelae of rheumatic carditis. In 12 of these histologic examination was possible, and in 11 typical Aschoff bodies were found. The supposition is advanced that rheumatic carditis is more frequent in the tropics than is commonly believed but that the true incidence can be determined only by collecting reliable data, based especially on autopsies with histologic examinations. (summary)

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)

Incidence of cervical carcinoma in a high-risk, non-screened area results of a retrospective analysis on the Dutch Caribbean Antilles from 1983 to 1998

Cancer of the uterine cervix is one of the most common malignancies worldwide. The average annual incidence of cervical cancer varies widely per geographical area. Some of the highest rates have been reported in Latin American and Caribbean countries. Previous research into the frequency of cervical carcinoma in Curaçao, the main island of the Dutch Caribbean, has reported predominantly far-advanced stages of the disease. The objectives of this study were to determine: whether there are indications of changes in the incidence of cervical carcinoma, whether these changes are a result of increased clinical attention paid by general practioners (GPs) and gynaecologists, and whether less advanced stages of cervical cancer were found, indicating earlier diagnosis. Data on patients with cervical carcinoma, obtained from records kept in the Department of Pathological Anatomy at the St Elisabeth Hospital in Curaçao were retrospectively analyzed for the period 1983 to 1998. To study the incidence rate over time, cumulative and incidence rates, standardized to the World Standard Population, were calculated and compared to the rates in other Latin American and Caribbean countries. The age-standardized incidence rate for Curaçao was 14.3 per 100 000 women. The cumulative rate up to 74-years-of-age was 1.6. Sub-division into the three groups showed a trend towards a decrease in the incidence and cumulative rates. A comparison of clinical staging International Federation of Obstetrics and Gynaecology (FIGO) showed a trend towards an increase in time of almost 48 to 59 in stage IA (ie less severe cases). A significant increase (p < 0.0001) was found in the numbers of smears performed in the complete period of 1983-1998, compared to a previously examined period of 1972-1982. The incidence of cervical cancer in Curaçao appears to be decreasing, and is lower than in other areas in the region. The number of smears GPs performed over time increased However the incidence is still relatively high compared to western countries and cases are still presenting in relatively advanced stages of the disease. Although the introduction of a screening programme might not influence the actual incidence of cervical cancer dramatically, nonetheless it may contribute to earlier diagnosis of cervical carcinoma

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